Expert: Claes-Gustaf Nordquist, M.D. - 2/22/2011

Question
QUESTION: My husband has had cancer almost three years.  It is considered either a grade II or III.  It began to grow a few months after diagnosis - had 30 days of radiation.  Did fairly well but slept a lot.  Brain shunt failure caused revision of the shunt April 2010.  Husband wanted knee replaced and had surgery on Dec. 3rd, 2010.  Many, many complications - overload of fluids, anemia, anemia of chronic disease, cellulitis.  After 21 days came home.  Three days later taken to emergency with altered mental status accompanied by extreme frequency of urination.  Sodium level upon admission 116.  Admitted to hospital and adjustment to sodium level started/determined he had SIADH.  Obvious cause - brain tumor.  (Hospital MRI showed 1 1/2 times growth.  But, oncologist MRI 2 weeks later slight growth was seen.  Not as was reported earlier from a very poor MRI.)   Sent home on Demeclocycline and water restriction.  Although doctors at the hospital assumed the tumor caused the SIADH, oncologist was not sure it was the cause.  

He has slept around 22 hours a day for over one year at least 5 of 7 days a week.  Nothing has helped to give him energy.  He is seeing a nephrologist very soon hoping to get a determination of the cause of the SIADH plus some direction for me in regard to the management of the SIADH.

In the meantime he continues to be extremely fatigued, sleeps around 22 hours/day and is not eating a lot.  What specialty can help me manage the SIADH if it will be a permanent feature and what specialist might help with the sleeping problem if it is directly a result of the location of the tumor?

ANSWER: His sleeping pattern may very well be caused by his tumor. For any medical help with that - if at all possible which is very uncertain and doubtful - you should consult a neurologist. I'm as uncertain as his own oncologist with regards to his electrolyte (sodium) problem. It may be due to kidney problems though I can not completely exclude his tumor due to its location. A kidney doctor should be consulted as seems to be the case.



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---------- FOLLOW-UP ----------

QUESTION: Your thoughts on chemo pill, temador for someone so frail.  Also, am I correct that further radiation would not be advisable because of the location?  Including cyberknife and other similiar radiation?

I'm wondering if you might guess as to whether, if the tumor grows, he might experience hydrocephalus again.   I wish he could just simply go to sleep without all the effects of hydrocephalus, sodium drop, etc.

I hope your crystal ball would at least give me your best experienced guess.

Thanks so much!

Gay Perry

ANSWER: Unfortunately I do not have a crystal ball. That would make this work MUCH easier!  Hydrocephalus is always a possibility his doctors will have to be prepared for and look for! I suppose that he has already received a "full dose" of radiation. In that case more - at least conventional - radiation therapy is out of the question since there is an upper limit to how much you can give. It may however be possible to give him unconventional radiation therapy like GammaKnife, CyberKnife or proton beams. But that you have to discuss with his doctors. And it may be impossible. I do not think he would be given such medication unless his doctors think he can manage. Thanks!


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---------- FOLLOW-UP ----------

QUESTION: Actually, just an update and repeated thanks for your replies.  I had already made an appointment with a nephrologist and we went today.  He is willing to see if the SIADH will not be permanent and will direct me with the myriad of management questions that will be coming up.  He has told me to d/c both the demecloycycline and an SSRI.  Continue the fluid restriction for a month and we will see if the sodium level manages to remain stable.  (I recognized few see SIADH continue after a patient comes home and failed to find most that I had dealt with to lack the deep knowledge that I needed to provide my husband with the best possible quality of life!  Thanks, again.

Answer
You are most welcome! Happy to be of help! Sorry that I can not help you with his kidneys. Too far from my area of expertise!





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