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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18445
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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This is going to be a long one, but I am honestly desperate

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This is going to be a long one, but I am honestly desperate and do not know where to turn to. My mother had breast cancer on her right breast 17 years ago; she received radioactive treatment near the chest area. Last May 2012 she was diagnosed with cancer on her right breast again and breast removal with silicone implant placement was the solution implemented by the doctors. About two months later, she started feeling a lot of pressure from the implant, and her right arm started going numb with mild pain. The implant was taken out after three months due to bad healing and constant pressure and meanwhile her numbness and pain started getting worse. After many doctor visits and no answers to her rare arm condition, we visited Mayo clinic in Jacksonville where a brachial plexus specialist diagnosed her, and recommended surgery with electrical signals to see what was going on in that area. The surgery took place on August 2013, and the doctor described the results as morphological problems with some of the nerves, and some connections from the brain to the brachial plexus were not responding. He stated that it could have been due to the radiation treatment she received 17 years ago that put her in this state. She is currently in physical therapy, massage treatment, medication and even tried acupuncture. Her condition seems to be worsening by the months; she has no motion of the right arm and is in chronic pain almost every day, from pain from medium, to mostly high and severe. I do not know if to try another doctor, what treatments are available, or how to cure it. I researched to find something but this disease seems pretty rare in occurrence. I am desperate and in need of some answers. If you could please help me, I would greatly appreciate it, thank you.
I'm sorry that your mother has been having so many problems.
It will help if you could provide some further information:
When you say that she had surgery with electrical signals, do you mean that this was a diagnostic test measuring electrical signals or a surgery in which there was implantation of a device to place electrical signals?
If the former, do you have a copy of the report?
What medicines and doses have been tried?

Customer: replied 3 years ago.

am sorry for the vagueness from my part in the electrical signals portion. I meant it was a surgery to test what nerves were functional and which nerves were malfunctioned by sending stimulating electrical signals to the nerves, and as far as medicines she is taking Tramadol 50mg, Gabapentin 300mg, Cyclobenzaprine 10mg, and Oxycodon for severe pain, I have the report with me with the procedure.

I also note that when she is in her severe pain cases, most of the medications stated above to not decrease her pain.

How many times per day is she taking each medicine, particularly the gabapentin?
Has she been tried on any other medicines previously?

Customer: replied 3 years ago.

Gabapentin 3 times a day, Tramadol once a night, Cyclobenzaprine also only once a night. as stated, oxycodon is only for very severe pain, so that one can be once a week to once every three days depending. Cyclobenzaprine is the only new medication she is taking, the rest have been the same for some time now.

Thank you for the additional information.

The medical term for this problem is a radiation-induced brachial plexopathy. This is not seen as often as was once seen with better radiation protocols, but can still happen, as your mother has experienced.

Unfortunately, there are no cures for the condition. Some people who develop plexopathy relatively soon after the radiation will improve spontaneously over time, but the likelihood of spontaneous improvement when the plexopathy occurs 17 years after radiation is much lower.

Although there is no cure, there are several medicines that can be used to try to control the symptoms. The gabapentin, an anti-seizure medicine, is one of the commonly used medicines, which works by suppressing the firing in the nerves carrying the pain message, but it may require a higher dose. The 300 mg three times per day is OK if it is effective, but the dose can be increased up to 1800-3600 mg per day, in divided doses, if the current dose is not sufficient.

There are other medicines that can be used to try to control symptoms, including another anti-seizure medicine, pregabalin, and certain antidepressants, such as amitriptyline, nortriptyline, and duloxetine, which also work by suppressing the firing of the nerves.

In someone with severe, intractable pain, it may also be an option to perform a chemical sympathectomy, a procedure in which the nerves are damaged using a chemical irritant.

The brachial plexus specialist would usually be able to assist her with these options, but if it is difficult to be seen regularly at the Mayo clinic, another consideration would be to see a Pain Management specialist.

If you have any further questions, please let me know.

Customer: replied 3 years ago.

What exactly is a chemical sympathectomy, does it destroy the nerves?

A chemical sympathectomy is the injection of a chemical, such as phenol, that is intended to damage the nerves, and particularly the nerves that carry pain. This is specifically done to a particular group of nerves, the sympathetic nerves. The goal is not to damage all the nerves to that portion of the body, or it would cause numbness and paralysis, but to preferentially affect the nerves carrying the pain message.

Customer: replied 3 years ago.

would the sympathectomy reduce her chances of recovering movement in her arm?

Typically, it would not affect the chances of recovering movement in her arms.

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