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This is for my mom. She is being treated for her third ...

Sent to Health Experts June 14 04:01 PM

This is for my mom. She is being treated for her third bout with ovarian cancer. However, before it showed up this time, while not on any medications and blood work showing no cancer, she developed severe, unremitting itching that has now been going on for 3 months and is almost completely debilitating. It keeps her from resting or sleeping. Doctors no help. Just this week she is having liver workup done, with ultrasound. So far, everything negative on liver. Her original doctor, who has moved to Columbia, says he's never seen it before like this and doesn't think it's the cancer or Rx. This itching will get her before the cancer and her quality of life is almost nil because of it. Don't know where to turn next. Thank you.

 

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June 14 4:27 PM (25 minutes and 28 seconds later)
         
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Let me start by saying how sorry I am that your mother has had to suffer with this. Most people are unaware just how debilitating itching like this (also called pruritus) can be. I am sure that it has also be very hard for you.

Pruritus is actually a fairly common side-effect of cancer or of its treatment. You mention that your mother's physicians don't think that the ovarian cancer is the cause, and the cause may remain unidentified. This doesn't matter, however, and your mother should not be suffering simply because no one can identify the cause of the intense pruritus (the cause is, quite often, not identified anyways). She should be receiving treatment for it in any case.

Treatments can vary. Lotions and topical ointments can help (she's probably tried this), and oral medications can also be some help. These can include antihistamines (histamine is often involved in the horrible itching sensation), sedatives, tranquilizers, and anti-depressants, among others. There are many options.

Applying a cool cloth can also provide some relief, and some find pressure or rubbing the area (gently) can also provide some relief. Some other things that might help include distraction, music therapy, relaxation, and imagery techniques.

So while the cause of this may remain unidentified in the short (or long) term, that does not mean that your mother should continue to suffer.

Call her physician today (or tomorrow if it's too late today). Tell them her pruritus is out-of-control, has been for months, and that she needs some relief immediately. If they won't help you, get a second (or third) opinion until you find someone who will. There is someone out there who will help her find some relief.

Again, I'm sorry that she has had to suffer for so long, and I sincerely hope that both of you find some relief.

Here is a link with some more information, if you're interested: http://www.cancer.gov/cancertopics/pdq/supportivecare/pruritus/patient

I hope this helps. Please let me know if you have any further questions - I'm more than happy to help. Take care - Dr. Fay

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Jonathan Fay, M.D. -- Doctor (MD) -- 100% Positive Feedback on 534 Health Accepts
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June 14 4:51 PM (24 minutes and 45 seconds later)
         
Reply to Jon Fay's Post: Dr. Fay, thank you, but every single thing you mentioned has been done and is being done. I have even looked at two of her doctors and told them point blank that the itching is what's going to kill her. Nothing that has been tried has worked. The cancer doctor seems to be only able to deal with cancer.
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June 14 4:56 PM (4 minutes and 21 seconds later)
         
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O.K., I understand. So they have tried trials of different medications (antidepressants, etc.), with no relief whatsoever? Or is her oncologist not responsive to your complaints?

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Jonathan Fay, M.D. -- Doctor (MD) -- 100% Positive Feedback on 534 Health Accepts
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June 14 5:37 PM (41 minutes and 38 seconds later)
         
Reply to Jon Fay's Post: Her oncologist is somewhat responsive, I guess. But he just says he doesn't know. He thinks when the tumor shrinks the itching will stop. I don't see how it could be the cancer if the cancer wasn't showing up at the time it started. I know it could have been there just not showing up in blood work. The doctor at Sloan-Kettering, her original oncologist now at Columbia in NY, her dermatologist, my MD, none of them think it's the cancer causing this. She has been given Ambien to help with sleep, but only works for 2-3 hours, if at all. Beginning Ambien CR tonight. Trazadone, Haldol, Xanax are just a few of the meds tried.

Thank you.
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June 14 5:54 PM (16 minutes and 23 seconds later)
         
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June 14 6:07 PM (12 minutes and 57 seconds later)
         
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The Ambien CR should help, at least with the sleep. Since it is continuous release, it will provide a more even support for her sleep. You mention trazadone, haldol, xanax - I'm sure that she has also tried numerous antihistamines.

It sounds like her oncologist, unlike the rest of the physicians that are involved, believes that the pruritus will remit when the cancer burden and tumor mass is reduced. Have they done studies to evaluate other potential causes of pruritus?

Let me know, and I'll get back to you - Dr. Fay

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June 14 6:16 PM (8 minutes and 45 seconds later)
         
Reply to Jon Fay's Post: This week blood work was ordered for liver workup. Today she began 24-hour urine collection for porphyria. Yesterday she had an ultrasound on liver. So far all negative. We were hoping to find bile duct blockage, but they said no, at least based on the tests done so far. Still waiting for results for hepatitis. She has CBC every month, and another blood workup--CM ?? I'm not sure. She's a retired nurse, so she knows about a lot of this.
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June 14 6:21 PM (5 minutes and 44 seconds later)
         
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June 14 6:50 PM (28 minutes and 29 seconds later)
         
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It sounds like they are evaluating many of the potential causes of pruritus related to cancer and its treatment. The liver and kidneys are two relatively obvious potential culprits - hopefully the liver function tests that you are waiting on (or perhaps a hepatitis panel) will provide some insight.

I just wanted to mention a few important things. Pruritus, in anyone, can be related (of course) to exposure to certain triggers. Try changing detergents and soaps to hypoallergenic formulas. No perfumes, as well. Heat almost always makes the itching worse, so cool baths as well.

In addition, just because her bloodwork was clear prior to the re-emergence of this 3rd episode, this does not mean that the pruritus is not related to the cancer. The cancer could have been undetectable by lab results, but still could have been present.

I don't know, this is a tough one. There seems to be a disagreement on what is causing this. I would, at this point, recommend a second and third opinion with other oncologists regarding her pruritus, and moreover, with its treatment. Another oncologist might have a trick, a certain medication or therapy, that hasn't been tried yet. Other than that, the other potential causes of it should continue to be actively ruled out.

I wish I had a better answer for you. Let me know if you have any further questions, or any other thoughts. I hope that you both find some relief. Take care - Dr. Fay

If I have helped, then please click the ACCEPT button and leave positive feedback - Thank you, and take care
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Jonathan Fay, M.D. -- Doctor (MD) -- 100% Positive Feedback on 534 Health Accepts
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