pcl1029

Forum Replies Created

Viewing 15 posts - 1,621 through 1,635 (of 1,667 total)
  • Author
    Posts
  • pcl1029
    Member

    Hi,Gavin,
    Thanks for this info. If it holds true in human as now in the lab;this dihydroartemisinin will be 5 times more potent than 5FU.
    By the way, the Chinese herbal medicine name is Qing Hao.
    The plant that this compound derived from is herba Artemisiae Annuae .
    Artemisia capillaris thunb (the young leaves and stems of the plant) is used in herbal formulations to treat gallbladder inflammation,night sweat and tiredness.
    God bless.

    pcl1029
    Member

    Hi,
    As being a father and a patient myself,may I suggest the best and most practical thing you can do for your dad now is to graduate from UCLA in June.He will be there and strong enough to see you graduate. It is the best gift that a father can have when seeing his children up there shaking hands with the chancellor of the university and later taking photos and hugging by his children who has just gone thru a milestone in his/her life and the bright future is ahead of them.
    I will do the research for your here if you allow me to do so;so don’t worry and remember as the bible said in 1Corinthians 10:13 “God is faithful and he will not let you be tested beyond your strength,but with the testing he will also provide the way out so that you may be able to endure it.”
    good luck and be a UCLA graduate to make your father proud.
    God bless.

    in reply to: Father has cholangiocarcinoma and trying to help #50048
    pcl1029
    Member

    Hi,
    May I suggest to wait until the next CAT Scan or MRI result before deciding the next step of treatment or additional options;even though when CA19-9 >600 is indicative of association with non-resectable CC.
    BTW,intrahepatic CC is quite different from extrahepatic CC in terms of the tumor markers value ,treatment plans and prognosis. I suspect your father’s is extrahepatic or ductal in nature.
    I hope the info. helps.
    God bless.

    in reply to: Dad recently diagnosed #50056
    pcl1029
    Member

    Hi,
    I will try to answer if you don’t mind. Suggestions for questions 1-6.

    1. Dr. Bloomston is a very good surgeon;Dr.Saab is very informative and patient
    in answering your questions.Google their names at the top right hand corner of this web site to find out more about them along with the name Dr. Kato ; that is if you want to go the extra mile to check out whether surgery is still possible . I do not have opinion on Dr. Chalikonda.
    2. Gemzar+Xeloda+Avastin is a clinical protocol represented the two most commonly used first-line chemo agents currently used in treating CC along with a molecularly targeted therapy agent(MTTA) Avastin. Side effects are minimal(ie, you may or may not experience diarrhea/constipation,increase blood pressure,hand and foot syndrome and fatigue(usually on the 2nd or 3rd day when you have treatment with Avastin.)and Dr.Saab will give you a 10 pages info. about “Systemic therapy for advanced cholangiocarcinoma” when you sign up for that clinical trial.
    3. I think it is better than the standard Gemzar/Cisplatin for stage IV CC;the reason is that you will have an additional and relatively new drug in helping to fight this CC.Without the MTTA,the objective response rate is about20-40%;with the MTTA, the chance may be increased to about 40-60% in general.
    4.Check out Dr.Kato or Dr.Chapman and hospitals on this web site if you want to seek more opinions about surgical and hospital options.
    5. please read “Complementary and Alternative Medicine(CAM)” under this web site to find the current approach on this subject.
    I hope the info. helps you to make the correct decision.

    God bless.

    pcl1029
    Member

    Hi,
    For ductal CC,the treatment of choices included external beam radiation therapy(EBRT);5FU or gemcitabine systemic chemo therapy.Local ablation for intrabiliary therapies included photodynamic therapy(PDT) and brachytherapy or clinical trials.
    RFA is mainly for intrahepatic CC treatment. therefore RFA may not be the choice for your husband if his liver is not involved.
    Swollen lymph node sometimes is due to infection rather than the CC,so your oncologist may be right on that.
    God bless.

    pcl1029
    Member

    Hi,
    Ca19-9 tumor marker is not a reliable test for detection of CC. esp. for intrahepatic CC. However when the CA19-9 cutoff value was raised to 100,the specificity was found to be higher in patients with peripheral CC.

    My best suggestion to you is :
    Try to ask the doctor to get the PET Scan done as soon as possible if one had not been done within the last couple months.If a CT was done within the last couple months and shown nothing,then ask to do a MRI.
    MRI with contrast is the best chose of scans to detect lesions<1cm .
    Only the scan will give you a definite answer.
    Recurrence is common in CC but there are still many ways to combat this disease ;among them, radiation frequency ablation(RFA ) is one of the option if surgery is not indicated.
    God bless.

    in reply to: My dad recently diagnosed #49949
    pcl1029
    Member

    Hi,
    If I were you, get a second opinion at Mayo Clinic ,MD Anderson or any university hospitals suggested here in this web site. Surgery resection,Radio Frequency Ablation(RAF) and other radiation external therapy like EBRT and internal radiation therapy like brachytherapy , photodynamic therapy,proton beam therapy . Chemotherapy with or without radiation are other options.
    Recurrence is common so make sure your father has enough liver reserve for the surgery or do RAF. There are currently no effective standard treatment protocol for treating cholangiocarcinoma.
    And if you are in Hong kong or other Asian countries like Taiwan or mainland China, it is much easier to find a good Chinese Herbal Practitioner to complement your father’s western style medical practice.Those countries even may have clinical trials for CC.
    God bless.

    in reply to: Complementary and alternative medicine (CAM) #49231
    pcl1029
    Member

    HI, Gavin,
    You are welcome.
    Thanks for your help for all the herbal web sites listings that provided by you.
    Otherwise It will take longer for me to work on the info.
    God bless.

    in reply to: CT vs MRI #17495
    pcl1029
    Member

    Hi, Lainy
    May I ask where is your GIST located ? in the esophagus ;or in the stomach upper(fundus) or lower part near the pyloric opening or locate in the upper GI(small intestine) or lower GI tract(ie,colon)? and is your GIST Thanks for asking this interesting question.
    God bless.

    in reply to: CT vs MRI #17493
    pcl1029
    Member

    Hi, Lainy

    I will do a research first if you don’t mind;but I will be prompt.

    God bless.

    in reply to: Complementary and alternative medicine (CAM) #49229
    pcl1029
    Member

    Hi,
    As always, this for your information only;consult medical professionals first.
    It is dangerous to try to practice alternative medicine base on knowledge alone without using professional guidance.
    I have difficulty to find” Chinese Character” of each Chinese herbal medicine that is listed in English. That is very important to differentiate the actual species of the plants used for the herbal formula. So you need to identify the correct one before even to read about each herbs.
    The following website will provide names of herbals in both Chinese and English;also they will teach you how to pronounce the herbal in Chinese or Japanese or Koren languages.They also provide good drug information in both Chinese and English;such as the indication,dosage and their side effects.
    It is by far one of the best web sites I have found to provide me a better and comprehensive knowledge ;it provide much detail info.on herbal formulas than I expected.
    The most benefit I think about using Chinese herbal medicine is that ,it will complement your treatment and reduce the harsh side effects that chemo produced in the body(fatigue,nausea and vomiting shortness of breath,pain) Because Chinese herbal medicine is based on to treat the WHOLE BODY first and not the symptoms ALONE. (ie : if you feel shortness of breath ,the practitioner will add ingredients to help you on breathing better ;next visit if you feel very fatigue,he/she will add other herbal ingredients to increase your energy to the MAIN herbal formula specific designed for your tumor situation;that is why you need to show the practitioner your tongue;your face and eye ;tell him/her about your bowel movements- how often and loose or constipated;urine color,quantity,your appetite; any sleeping ,depressing and pain problems also should be addressed at time of visit.A good and experienced practitioner will change herbals for each problems you mentioned to the Main CC formula.This is the reason (to treat the whole body) that I believe in using herbs.
    That is why the most IMPORTANT way to use Chinese herbal medicine is to find a good and experienced Chinese Herbal Medicine Practitioner;They are much easier to find now if you live in the big cities in like New York,San Francisco,LA Chicago in the States;Toronto and Vancouver in Canada;London in UK & Sidney in AU.Most of them are not expensive and each visit with herbs provided may be less than 10 US dollars/day;The practitioner may give you a 3-4 days supply of herbs and ask you to come back every week or 1-2week to follow up on the effectiveness of the treatment.
    For patients who gave up the traditional chemo treatment,this may be a reasonable choice in addition to hospice.And if you want to try it out while you are on chemo,I suggest you should try it only on your chemo off weeks if you did not consult your doctors first.
    If you are interested to use Chinese herbal medicine to complement your treatment.Equip yourself with basic knowledge about Chinese herbal medicines that are related to CC first, then go to find a good practitioner to help you in using them;there are only about 15-20 of them that use mainly for CC.
    Some herbs that used for treating CC are Scutellariae baicalensis; Oldenlandia diffusa;Paeonia lactiflora;Scutellria rivularis;Rehmannia glutinosa;Poria
    cocos;Forsythia suspensa;Glycyrrhiza uralensis;Bupleurum chinense;Zizyphus jujuba;Prunus persica;Cordyceps sinesis and others.
    The wed site is:
    http://www.alternativehealing.org
    God bless.

    in reply to: CT vs MRI #17492
    pcl1029
    Member

    Hi,

    Additional info for the CT vs MRI has been added on 4/22/2011.
    I think it was on my reply on “blood transfusion”under intro or discussion on this web site..In addition, ultrasound is better in providing better image for gallbladder.But ultrasound result is more dependent on the operator skills as compare to CT and MRI.
    Apart from that, Ultrasound is an inexpensive FIRST step widely available around the world for people who worry about CC or liver lesions and want to check them out for their own health needs.
    EARLY DETECTION is the key for treating this disease.
    I also updated my message about treatment on itching under the reply for
    ” Help itching….” either on introduction or general discussion section.
    and I just finished update the info. on Complementary and Alternative (CAM).

    Here is the CT vs MRI reply; the update about itching will appear after .
    The CAM update is on this web site under Alternative Treatment section.
    God bless.

    Hi,
    Side effects of blood transfusions are fever and transfusion allergic reactions such as itching ,rash and shortness of breath ,which if occur, will be in the beginning of the transfusion and generally will be managed by premedicated with Tylenol and Benadryl(antihistamine.) before transfusion.
    CEA and CA19-9 are tumor markers ,along with ALK phosphatase, to MONITOR the progress of the chemo treatment. Doctors are looking for a TREND rather than single value ,together with the Cat Scan result to determine the course of treatment. If you have intrahepatic CC the values may NOT be as useful as if you have extrahepatic CC. for the CA19-9.
    If you have advance cancer or cancer metastasized ,CEA is more likely to have higher value;a steady rising CEA value often is the first sign of tumor recurrence.
    If you have CC in your liver(intrahepatic),you will most likely to have a much lower CA19-9 value than if you have the CC in or near the main bile ducts .
    CA19-9 is ordered for checking bile duct blockage and that is why after putting in a new stent the CA19-9 will be lower.

    Cat Scan is for diagnosis purpose.(including initial diagnosis and follow up after resection or chemo treatment for CC. Both MRI and Cat Scan are used to look for structural changes.PET scan is used to look for functional changes of the CC.
    According to one study compared 20 intrahepatic patients images ,the extent of the tumor enhancement was similar with both MRI and CT methods,however the relationship of the tumor to the vessels and surrounding organs was more easily evaluated on CT scan as opposed to MRI.For perihilar tumors CT also has limited sensitivity for extra regional nodal disease(ie metastases to the periaortic,pericaval or celiac artery lymph nodes.)—from uptodate .com
    PET Scan allows visualization of CC because of the high glucose uptake of the bile duct epithelium(the lining )– the “Hot spots” will light up on the PET scan.
    A PET scan therefore can help to tell if the bile duct obstruction is caused by a cancer or not.PET scan can also be useful in determining the cancer may have return after treatment.
    Some hospitals equipe with machine that is able to perform both A PET and CT scan at the same time(PET/CT scan) ;this allows the radiologist to compare areas of higher radioactivity on the PET with the appearance of the that area on the Cat scan. But according to the radiologist I talk to , A (PET/CT scan ) is not the SAME as if you take them SEPARATELY. Remember CT is for structural and PET is for functional visualization. That is why sometimes doctors order a PET scan on this 3 month checkup and on the next checkup, he/she orders a CAT Scan with contrast instead.

    Additional info. from uptodate.com as of 4/22/2011.
    MRI and CAT SCAN (CT) have similar resolution for liver lesions.
    CT has been considered to be superior to MRI for evaluating extrahepatic organs and calcifications. MRI is more specific than CT for differentiating cavernous hemangiomas,diffuse hepatic steatosis and focal fatty infiltration.Also MRI should be reserved for the evaluation of lesions less than 2 cm,or lesions located adjacent to the heart or to major intrahepatic vessels.If you are allergic to the IV iodinated contrast agent used for CT,then MRI is the alternative because the contrast agent used is different than CT.
    I hope the above info. helps.

    Last edited by PCL1029 (Yesterday 23:43:06)

    Online
    Hi,
    As always,consult doctors for advice first;this is strictly for informational purpose only.
    Of course,the most important thing is to treat the underlying problem first which is the buildup of the bile acids due to bile ducts obstruction.(ie; stents)

    For mild cholestatic pruritus ,nonspecific measures such as warm baths,emollients and antihistamines should be considered as the first-line therapy.
    OTC emollients such as Benadryl cream,hydrocortisone 1% cream,Calamine lotion,Aveeno,lanacane and sarna cream will provide some relief.
    Rx emollients such as hydrocortisone 2.5% ,fluocinolone, triamcinolone, halcinonide , betamethasone and clobetasol (from low to high potency in order) are available thru prescription for short term use.
    Systemic antipruritic medications such as Benadryl 25mg-50mg can be used at night. and cyproheptadine (Periactin by Merck) three to four times daily may be useful when sedation is to be avoid.
    Benadryl is over the counter and cyproheptadine may required a prescription in the States.
    Cholestyramine (Questran),Colesevelam(Welchol) and colestipol(Colesid) are called bile acid sequestering agents which are prescribed for lipid lowering purpose. ( needs prescriptions in the States).
    In patients with biliary obstruction, these agents reduce the serum bile acid level by binding to the bile acids in the intestine,decrease bile acids reabsorption ,reduce excess bile acids deposited in the dermal tissue with resultant decrease in pruritus (itching).The one that used more frequently is cholestyramine 4gm 1-2 times daily to a maximum of 24gm(6doses) per day.
    Side effects of the bile acid sequestering agents included nausea,bloating and cramping;increase liver enzymes . Colesevelam(Welchol)-3tablet twice daily- is better tolerated and less likely to cause GI side effects.

    Newer topical agent like naloxone lotion is in phase II clinical trial for treatment of pruritus accompanying cutaneous t-cell lymphoma by Elorac,Inc. It may be of value to CC patients as well.
    God bless.
    Additional info: from uptodate.com
    Better efficacy of taking bile acid sequestering agents may be increased by taking a dose before and after BREAKFAST in patient with an intact gallbladder to enhance the excretion of the agent that cause itching.
    Also rifampicin 150mg-300mg twice a day or oral naltrexone,setraline 75-100mg(Zoloft) daily can be tried if other measures fail.
    Other medications like phenobarbital,colchicine and methotrexate as well as paroxetine(Paxil) are also being mentioned.
    IF you are using opiate narcotics to control pain such as Fentanyl,Oxycodin,codeine,Demerol,propoxyphine(Darvocet),ultram,morphine,methadone,hydromorphone(Dilaudid),hydrocodone(Norco,Vicodin and Percocet etc) ,you should not take naltrexone as well as the the lotion I mentioned above. Because it is an opiate antagonist, and it will counteract the opiates to control your pain.All of them required prescriptions in the States.

    As always,this is strictly for information purposes only.so consult your doctors first.

    Last edited by PCL1029 (Yesterday 20:44:42)

    in reply to: Help, the itching is awful! #49724
    pcl1029
    Member

    Hi,
    As always,consult doctors for advice first;this is strictly for informational purpose only.
    Of course,the most important thing is to treat the underlying problem first which is the buildup of the bile acids due to bile ducts obstruction.(ie; stents)

    For mild cholestatic pruritus ,nonspecific measures such as warm baths,emollients and antihistamines should be considered as the first-line therapy.
    OTC emollients such as Benadryl cream,hydrocortisone 1% cream,Calamine lotion,Aveeno,lanacane and sarna cream will provide some relief.
    Rx emollients such as hydrocortisone 2.5% ,fluocinolone, triamcinolone, halcinonide , betamethasone and clobetasol (from low to high potency in order) are available thru prescription for short term use.
    Systemic antipruritic medications such as Benadryl 25mg-50mg can be used at night. and cyproheptadine (Periactin by Merck) three to four times daily may be useful when sedation is to be avoid.
    Benadryl is over the counter and cyproheptadine may required a prescription in the States.
    Cholestyramine (Questran),Colesevelam(Welchol) and colestipol(Colesid) are called bile acid sequestering agents which are prescribed for lipid lowering purpose. ( needs prescriptions in the States).
    In patients with biliary obstruction, these agents reduce the serum bile acid level by binding to the bile acids in the intestine,decrease bile acids reabsorption ,reduce excess bile acids deposited in the dermal tissue with resultant decrease in pruritus (itching).The one that used more frequently is cholestyramine 4gm 1-2 times daily to a maximum of 24gm(6doses) per day.
    Side effects of the bile acid sequestering agents included nausea,bloating and cramping;increase liver enzymes . Colesevelam(Welchol)-3tablet twice daily- is better tolerated and less likely to cause GI side effects.

    Newer topical agent like naloxone lotion is in phase II clinical trial for treatment of pruritus accompanying cutaneous t-cell lymphoma by Elorac,Inc. It may be of value to CC patients as well.
    God bless.
    Additional info: from uptodate.com
    Better efficacy of taking bile acid sequestering agents may be increased by taking a dose before and after BREAKFAST in patient with an intact gallbladder to enhance the excretion of the agent that cause itching.
    Also rifampicin 150mg-300mg twice a day or oral naltrexone,setraline daily
    can be tried if other measures fail. but if you are using opiate narcotics to control pain, do not take naltrexone because it is an opiate antagonist,and all of them required prescriptions in the States.
    As always,this is strictly for information purposes only.so consult your doctors first.

    in reply to: ammonia levels #49637
    pcl1029
    Member

    Hi,
    As always,consult your doctor for advice first;the following is for informational purpose only.

    The normal dose for lactulose in treating hepatic encephalopathy is 30-45ml three to four times daily by mouth; if necessary ,hourly doses of the same may be given until a laxative effect is induced;once a laxative effect has been established,dosage should be reduced to produce 2-3 loose stools daily.
    Rectal dosage mostly reserved for coma patient- dilute 300ml of lactulose in 700ml water administered via rectal enema and retained for 30-60min;may repeat every 6 hours as needed;oral therapy should replace rectal as soon as possible.
    God bless.

    in reply to: GEMOX treatment #49602
    pcl1029
    Member

    Hi,
    In hospitals in US, generally they will pre-medicate you with ondansetron and/or dexamethasone intravenously ( IVPB )over 30 min to decrease the side effects like nausea/vomiting of the GEMOX treatment. They will start gemcitabine- a 30 min IV infusion.(on day 1),followed by oxaliplatin-a 2hour IV infusion.(on day 2),every 2 weeks.
    If you are on GEMOX-3 protocol,then you will receive Gemzar on days 1,8,15 and the other on day 1 and 15,repeated every 28 days.

    If you are interested,the objective response rate(that is complete response + partial response) to GEMOX protocol are 36%,22% (Ann Oncol.2004);26%(Br J Cancer.2006);41% (Oncology 2007) and 15%(Br.J cancer.2008).

    Major side effects listed from the above studies are grade3-4 thrombocytopenia (9-23%);anemia(10%);peripheral neuropathy(7-19%);nausea/vomiting are common.
    I hope the info. helps.

Viewing 15 posts - 1,621 through 1,635 (of 1,667 total)