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What Causes Numbness In Feet After Having Oxaliputin Treatment For Cancer?
Question: My husband has finished 12 rounds of chemo therapy for colon cancer. His drug regiment included oxaliputin a platinum based chemo drug. On the 10 round he started to experience extreme numbness in his feet, extending up to almost his waist and his fingers became so numb that he can't button a shirt, pick up anything and he has lost his balance and fallen several times and he is having trouble controlling his bowels and bladder. Our oncologist says he has never seen this extreme of neuropathy and he feels that it is some underlying condition. With on line research, I found that this is called chemo induced peripheral neuropathy. It also said that a platinum bases chemo takes several month before the ill effects to start to lessen. My question to you is if there is anything that a neurologist can do to make this better or at least tolerable and also if nothing is done will the neuropathy get better on it's own and what time frame can we expect? As you can understand he is very depressed, confused and just wants to know that this isn't something he will have to deal with forever.
Brief Answer:
He may prescribe symptom reducing treatment.
Detailed Answer:
I read your question carefully and I understand your concern. Peripheral neuropathy is a common side effect with oxaliplatin treatment, but your husband unfortunately seems to be a particularly severe case.
There is no specific treatment to reverse the neuropathy. In many patients it does improve once the treatment is interrupted, but in some of them it may take months or even persist in some cases. Because your husband seems to be a particularly severe case, chances are recovery will take a while and some residual damage might persist, but hopefully to a lesser degree than right now.
Regarding what the neurologist can do, well he can confirm the diagnosis by the help also of tests like nerve conduction studies and perhaps lumbar puncture to test for other possible causes. Also some fairly routine tests might be done such as blood count, blood glucose, kidney and liver function, thyroid function, Vitamin B12 levels for other causes of peripheral neuropathy. I suspect you may already have done some of them in your cancer evaluation and chemo follow up, they are routine tests and can be done where you live I believe.
At times peripheral neuropathy might be in the setting of the cancer itself, neuropathy as a paraneoplastic syndrome, but that is usually associated with other types of cancer not colon's.
However I would say the diagnosis is pretty evident, further tests are needed only if one wants to be really thorough. In terms of treatment as I said no specific treatment is available to be suggested by the neurologist, nerve regeneration will depend by the body itself, therapy will try only to reduce the bothersome sensations in his limbs. Several alternatives could be tried, but there is a lack of important studies in this subtype of neuropathy, current recommendations list only duloxetine as a treatment of a proven efficacy. Another alternative is Gabapentin.
So since it appears it is difficult for you to reach a neurologist, if you could be prescribed Duloxetine I would wait for a while to see if he's improving with treatment withdrawal, if yes that would confirm the cause. If he keeps worsening then the trip would be necessary.
I remain at your disposal for further questions.
He may prescribe symptom reducing treatment.
Detailed Answer:
I read your question carefully and I understand your concern. Peripheral neuropathy is a common side effect with oxaliplatin treatment, but your husband unfortunately seems to be a particularly severe case.
There is no specific treatment to reverse the neuropathy. In many patients it does improve once the treatment is interrupted, but in some of them it may take months or even persist in some cases. Because your husband seems to be a particularly severe case, chances are recovery will take a while and some residual damage might persist, but hopefully to a lesser degree than right now.
Regarding what the neurologist can do, well he can confirm the diagnosis by the help also of tests like nerve conduction studies and perhaps lumbar puncture to test for other possible causes. Also some fairly routine tests might be done such as blood count, blood glucose, kidney and liver function, thyroid function, Vitamin B12 levels for other causes of peripheral neuropathy. I suspect you may already have done some of them in your cancer evaluation and chemo follow up, they are routine tests and can be done where you live I believe.
At times peripheral neuropathy might be in the setting of the cancer itself, neuropathy as a paraneoplastic syndrome, but that is usually associated with other types of cancer not colon's.
However I would say the diagnosis is pretty evident, further tests are needed only if one wants to be really thorough. In terms of treatment as I said no specific treatment is available to be suggested by the neurologist, nerve regeneration will depend by the body itself, therapy will try only to reduce the bothersome sensations in his limbs. Several alternatives could be tried, but there is a lack of important studies in this subtype of neuropathy, current recommendations list only duloxetine as a treatment of a proven efficacy. Another alternative is Gabapentin.
So since it appears it is difficult for you to reach a neurologist, if you could be prescribed Duloxetine I would wait for a while to see if he's improving with treatment withdrawal, if yes that would confirm the cause. If he keeps worsening then the trip would be necessary.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My husband is 6 ft. tall and about 212 lbs. He takes 4 600 mg Gabapentin pills a day. He had considered taking one less as he has been experiencing general weakness and that is a side effect listed for this drug. Can he take Duloxetine as well? Or is it one or the other? If just one, which one do you suggest?
He also takes one 20mg furosemide for Lasix for the swelling in his feet and legs. And 100 mg of Lossartan for blood pressure, and a potassium chloride.
He also takes one 20mg furosemide for Lasix for the swelling in his feet and legs. And 100 mg of Lossartan for blood pressure, and a potassium chloride.
Brief Answer:
Huge dose, combination possible
Detailed Answer:
Wow, 4600 mg is a huge dose. Personally I have never gone beyond 1800 mg a day in my patients and on paper the maximal dose is 3600 mg a day, so I definitely would consider lowering the dose. Were the falls present before treatment? Because dizziness and balance issues could be treatment side effects as well.
Yes it can be combined with Duloxetine, they have no direct interactions. However with him taking already so high doses of Gabapentin I would be careful of side effects like somnolence and dizziness. There has been a study combining gabapentin with duloxetine with a better efficacy than each of them alone (for diabetic neuropathy though), so the combination makes sense, but we are talking about partial superiority, not miracle working, so side effects must be watched for as well.
If I were to choose one I would pick Duloxetine because it's the one carrying a recommendation for your particular type of neuropathy, however the number of studies are scarce. As I said both it and Gabapentine are only to alleviate symptoms, do not influence the outcome, so if you've noted no efficacy with Gabapentine it only makes sense to try Duloxetine.
I hope to have been of help.
Huge dose, combination possible
Detailed Answer:
Wow, 4600 mg is a huge dose. Personally I have never gone beyond 1800 mg a day in my patients and on paper the maximal dose is 3600 mg a day, so I definitely would consider lowering the dose. Were the falls present before treatment? Because dizziness and balance issues could be treatment side effects as well.
Yes it can be combined with Duloxetine, they have no direct interactions. However with him taking already so high doses of Gabapentin I would be careful of side effects like somnolence and dizziness. There has been a study combining gabapentin with duloxetine with a better efficacy than each of them alone (for diabetic neuropathy though), so the combination makes sense, but we are talking about partial superiority, not miracle working, so side effects must be watched for as well.
If I were to choose one I would pick Duloxetine because it's the one carrying a recommendation for your particular type of neuropathy, however the number of studies are scarce. As I said both it and Gabapentine are only to alleviate symptoms, do not influence the outcome, so if you've noted no efficacy with Gabapentine it only makes sense to try Duloxetine.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Wow indeed....I was wrong. The dosage for the Gabapentin is 2,400 mg a day. He had taken it down to 1,800 mg a day and felt it was doing just as well. We will go to our GP with your information and see what he says. His oncologist is from a neighboring town and only comes once a month. We haven't been to impressed with him. He told us that cancer treatment was very patient specific and yet when my husbands experience was so out of the norm he never seemed to listen. When the side effects became so severe at 10 treatments my gut feeling was to discontinue the chemo as it was a preventive measure to begin with. His surgeon was pretty sure that he got it all and his lymph nodes were clear. They did a genome test to begin with and the chances were 17% that it would recur in 5 years. Knowing what we do now, we would never of gone forward with the chemo. They need a chart to tell you the chances that chemo can totally ruin your life. Thank you so much for clearing up some of our questions and giving us some options.
Brief Answer:
Thank you
Detailed Answer:
You have a point there, perhaps treatment should have been stopped if symptoms were already so severe, it's a difficult decision at times though.
I hope your husband will feel better soon. Thank you for your appreciative words.
Thank you
Detailed Answer:
You have a point there, perhaps treatment should have been stopped if symptoms were already so severe, it's a difficult decision at times though.
I hope your husband will feel better soon. Thank you for your appreciative words.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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