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911DOC
911DOC, Board Certified Dr.
Category: Medical
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Experience:  Emergency Medicine Physician
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Why would steroids given just prior to a Chemo treatment

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Why would steroids given just prior to a Chemo treatment make the patient fell better for 24 hours ?
A Cat scan done on 8/7/13 showed that the tumor margins have shrunk. All the patient's Chemo numbers ,after her third treatment .are goog,however , the patient has been VERY SICK ever since her eight hour surgery done by Dr. Azodi on 6/4 at the Smilow Cancer Center at Yale.
She contracted C-Diff soon after the operation. A stool test for C-Diff on 8/ 1/13 was negative but she continues to be Very Ill.
The key question is : after all of the above ,what could be the cause for her to continue to be very sick as of today. This has been the case now for over sixty days. Neither her Oncologist nor her Gastroentologist can determine the cause of the sickness.
They have her on a three day test of taking a small amount of prescription steroids. Again,since she start the prescription yesterday afternoon ,she is feeling relatively well.
Any advise for next steps or diagnosis ?
for over sixty days.
911DOC :

I do not think this question can be adequately answered online

911DOC :

this is a complex case

911DOC :

and I do not even know what kind of cancer is being treated

911DOC :

that being said

911DOC :

giving steroids is probably an attempt by her treating physicians to address the possibility

911DOC :

of either an auto-immune component so her disease, such as underlying rheumatoid arthritis or lupus

911DOC :

or a paraneoplastic syndrome

911DOC :

something that happens with certain forms of cancer where the cancer itself secretes hormones that wreak havoc in the body

911DOC :

also

911DOC :

steroids can shrink, rather quickly, swelling and inflammation surrounding a tumor

911DOC :

especially if the tumor is in the brain

911DOC :

for your information

911DOC :

the other possibility is that she is relatively adrenally insufficient due to the stress of the cancer and the chemo

911DOC :

It sounds like the C diff is no longer a problem, and this is good

911DOC :

I believe that her response to steroids is likely due to one of the above mentioned possibilities

911DOC :

and I am glad she is feeling better

911DOC :

I do not see you in the chat so will change this to a Q and A format.

If your question has been adequately answered please consider leaving positive feedback. If you have further questions simply type them in the box below and click reply. Have a great evening, and, should you need my assistance in the future please begin your question with 'for 911doc'.

Best

911DOC :

I mean have a great day ;)

911DOC :

best

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