Hello doctor, Hope you are fine and doing well. My mother has been diagnosed grade 4 breast cancer last month. She had abscess drainage last month on left breast. So now she is taking Femara 2.5 every day and took Zometa 4.0 mg recently as per doctor's advise. So the next day she felt sick like fever, the next day she was felling weakness and then lost consciousness temporarily for 30 seconds. Then we took her to the emergency. They did some tests which they found the sugar level was 331, PO2 level was 18.4, PCO2 was 26.8, and now she is fine and under treatment. So doctor, I selected you as our second opinion and I will keep following up with you concerning her treatment. I am attaching all the reports and doctor's advise which we received here. Please check the reports and doctor's note and advise in detail.
Hello. I have gone through all the reports (attachment removed to protect patient identity). It looks like she is having a metastatic inflammatory breast cancer with lung and bony metastasis. My recommendations: She needs to control her diabetes with diet, exercise and medication. Consult a diabetic clinic or endocrinologist. Replace zometa to Denosumab if possible, as her kidney may be suffering from diabetic nephropathy. Denosumab is more effective and comparatively safe for kidneys After denosumab she needs calcium and vitamin D supplements. Breast abscess once drained can recur, so doctor should examine it at every visit. Also in case of fever. One possibility may be reaccumulation of abscess. As She had an episode of temporary loss of consciousness. It can be related to sudden drop of Calcium after Zometa or can be related to some brain pathology, if she will develop same symptoms one more time, she should do an MRI brain with contrast. She has a multilevel disc disease with thecal compression, need a neurosurgical review urgently. Regarding treatment of Breast Cancer. She should continue with Letrozole, but alone it is not enough. So need to add Palbocicib or go for Letrozole plus Fulvestrant. Continue for 2 to 3 months followed by CT scan workup, etc., for reassessment before further decesion.