Question: My aunt is diagnosed with T2N0M0 right breast carcinoma. 3cm, ER+, PR+, HER2--. Quadrantectomy done with axillary dissection on XXXXXXX 9th, 2017. TC*4 chemo given with 21 days radiation. Chemo completed on 27th April, 2017. Radiation completed on 26th May, 2017. Currently on Femara started from 27th May, 2017.

She had left neck pain couple of weeks back and consulted an orthopedic for the same. He took the x ray and told it is normal. Since she was complaining neck pain while she try to swallow as well, doctor told us to consult an ENT specialist for an opinion.

Below medications are given:
Altraday - 1 tablet/day for 5 days
Nortryptomer-p - 30 tablets but she took only 7
Pantocid - She took along with Altraday
Myoril 4mg - 2 tablets/day for 5 days.

After taking these tablets she started feeling better and even the pain while swallowing was gone, so we didn't consult the ENT as we wanted to wait and see. Mid of last week after completing the above medications, she told that the similar pain is felt in right neck but it is not as intense as left side and it was manageable. But today she again complaining the severe pain in left neck but pain while swallowing is not there.

Questions:
1. What could be the reason for this neck pain? Any medication you suggest for it.
2. I consulted the oncologist and he had suggested to wait consulting ENT for few more days and he feels it very unlikely because of metastases as she recently finished the treatment and also she was at early stage. What is your opinion on this?

Thanks for the response.

As mentioned in my query, her main problem is the neck pain. Do you think that the neck pain is could be because of the sore throat?

I have attached her throat picture for further reference.

Kindly advise on the possible treatment options.

Yeah. She is not feeling the neck pain while swallowing now.

She feel pain both on movement as well as at rest. While moving she is complaining pinching like pain.

X Ray cervical(back and side view) was taken 2 weeks back and the doctor told that it was normal. Only the X Ray film was given and not the report. Doctor also mentioned that the throat area was showing little darker and suggested to get checked by ENT. Is this of any indication? But as mentioned earlier the neck pain while swallowing is gone now.

Can you please mention the name of the tablet with diclofenac plus thiocholchiside composition?

Kindly let me know your opinion.

I have attached the X-Ray images for your reference. Please go through it.

Regarding medications:

1. She is already taking Almity calcium tablets twice daily as per the advise from the oncologist. She was also give Zyclastin bisphosponate injection around a month back as the spine dexa scan was showing Osteopenia with value -2.

2. I believe that Acepol T or Dolomed MR are the pain killers and please advise on how many days it should be taken twice daily.

3. Kindly advise the brand/tablet name with composition diclofenac plus thiocholchiside which you had advised earlier for muscle relaxation.

Also, please let me know if there is anything we can do to relieve her pain. Thanks for you time in helping us.

Thanks for the response again.

Previously the orthopaedic doctor mentioned about some dark area near the throat in X-Ray and i hope you hav seen it and everything is fine.

I will give her Acepol T tablet for couple of days and see if there is any inprovement and then take her to Orthopeadic again. Hope this is fine.

Diclofenac plus thiocholchiside will not be given to her.e