Question: Hi, Dr. Sundriyal:
I have asked a few questions earlier, please review my previous questions and your answers for detail. I have attached PET-CT report to you for your review. Now a surgeon suggested to perform Right Hip Radical Resection since the cancer in the right femur ball/neck >50% already to avoid pathologic fracture. The procedure is much large than conventional hip replacement, I would like to ask how the procedure would affect the overall disease/outcome or risk to spread again or may be is a good to remove the large cancer? Do you think that chemo or hormone+radiotherapy would work for this bone mets(8.4x5cm in size)? The patient can get back to normal walking after the procedure? What is your experience and advice to share? Looking forward to hearing from you ASAP. Thanks so much.

Hi, Dr. Sundriyal:
Thank you very much for your quick response.
It is a tough time/decision for the patient and family.
What is the better/proper approach that medical literature have been reported for patient like this case, I mean choose/beginning hormone therapy first to shrink cancer OR surgery first, then hormone treatment? Per your oncology experience, what option do you think is best for patient if:
1---For the patient, beginning hormone therapy+radiotherapy ASAP to shrink or kill the femur mets cancer without Hip Radical Resection? If so, (avoid to injury) and how effectiveness and how long usually would take to see the cancer become shrink or killed? The femur joint can be repaired and functional after hormone treatment?
2---Beginning hormone therapy+radiotherapy ASAP to shrink the cancer lesion, then consider to Hip Radical Resection (recovery+physical therapy may take about 3 months as well)
3---Consider operation for Hip Radical Resection first, then beginning hormone therapy+radiotherapy if any

This is a very difficult decision in life time, could you provide/share your experience which option is better for the patient in your opinion, please advice, thanks so much.

Dear Dr. Sundriyal:
Thanks for your help and support. These days we are prepare for the operation (5/19) . We visited our primary doctor and got U/A, EKG and PT/PTT/INR done this morning.
Also working with insurance company try to get approval for hormone therapy drugs. Our oncologist may prescribe Fulvestrant+Femara+palbociclib, but not finalized yet. As you suggested that we requested the surgery and hormone therapy could start at same time. the oncologist said he"would rather wait until we get the results from the hip surgery". We have no choice.
By the way, Zoledronic Acid will be given by IV on 5/18, but blood calcium and ALP are in normal range.
That is the update so far. Sorry to reply you until today.
Thank you very much again for your concern and help.

Hi, Dr. Sundriyal:
Thank you very much for your reminder and suggestion. Cross our fingers!
Will stay in touch.

Hi, Dr. Sundriyal:
Yes, I did ask the oncologist office today to start hormone treatment ASAP, she said it is not sure HR+ or - before the surgery, receptor may change, otherwise, waste time and money (claim from insurance company). So we have to follow the doctor's order. I would request the hormone treatment as soon as the surgery complete.
Thanks so much again.Hi, Dr.Sundriyal:

Yes. Hope everything is going smoothly.

By the way, what dietary advise you may suggest after the surgery and during the treatment course, may be a long term.

One of my friend mentioned that Ayurveda is proven science and believes in DOSHAS from XXXXXXX is effective way to maintain health and cure cancer, do you have any information on that to share? Your thoughts?
Thanks again.

Thanks very much, Dr. Sundriyal:
We visited the surgeon this morning again and have all paper work done for pre-operation.
Will keep you posted.
Thanks again.