[NPInfo] that PMR pt

Fri Nov 2 21:39:21 PDT 2007

Paula--
You wrote "he had prostate ca several years ago and surgey. what is weird i
that he had spine films and chest films-NEGATIVE except his compression
fracture last spring". 

I'm simply trying to point out to you that the compression fx MAY NOT have
been a NEGATIVE finding as you stated-- it could in fact have been a VERY
POSITIVE finding and, with this man's prostate cancer history, someone (his
care provider at the time) should have gotten suspicious and picked up on it
when they read the x-ray report. Sounds like someone (his care provider at
the time) dropped the ball. In patients with breast, lung, or prostate
cancer (as well as thyroid and kidney), a fracture MAY indicate a metastatic
process going on and one should not just dismiss it as a NEGATIVE finding
(as you have mentioned several times) without a full work-up. In this poor
man's case, the compression fx may have been an extremely significant
finding-- nothing NEGATIVE about it at all-- but apparently, according to
your report, no one was putting 2+2 together and now everyone is acting so
surprised at the results. It probably should have been one of the first
things someone thought of at the time of the x-ray. 
Dena Galler

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Paula Sumner
Sent: Friday, November 02, 2007 8:49 PM
To: NP Info
Subject: RE: [NPInfo] that PMR pt

dena, what do you want from me, a mea culpa? i only just met the man.
  paula

Dena <galdena at sbcglobal.net> wrote:
  The spine films didn't pick WHAT up????? I thought you said the films last
spring showed a compression fx? Again, what do you think the cause of the
compression fx could be? Could it have been a fx due to cancer? Men do not
get compression fx for the same reason women do because they don't have the
same risks of osteoporosis. DID he have osteoporosis??? Had his prostate
cancer been treated with hormone therapy in the past? 

A fx could be early signs of mets Ca. You certainly wouldn't see a big ole
tumor on x-ray at the beginning... you would simply see a fx. Bony mets are
most commonly due to breast, lung, and prostate cancer-- and the spine,
pelvis, and ribs are the first bones to be affected. Unfortunately, it is
not uncommon for prostate cancer to be diagnosed in the late stages while
working up C/O of back pain and/or spine fx in men-- the prostate cancer had
already metastasized to the bone. So, a compression fx in a man with a
history of prostate cancer should definitely have been worked up at the time
of the finding.

http://bonetumor.org/tumors/pages/page66.html
http://www.liebertonline.com/doi/abs/10.1089/jpm.2006.0185

Dena Galler

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Paula Sumner
Sent: Friday, November 02, 2007 5:37 PM
To: NP Info
Subject: RE: [NPInfo] that PMR pt

as stated, apparently his spine films at the time did not pick it up. we
admitted him to the hosppital so he could be evaluated.
paula

Diana Galler wrote:
The key here, Paula, might have been the compression fx. It could have
been mets at that point causing it. With a previous hx of prostate cancer
and a compression fx, a work-up should have been done at that time.
Dena Galler

Paula Sumner wrote: he had prostate ca several years ago and surgey. what is
weird i that he had spine films and chest films-negative except his
compression fracture last spring. He was failing in his apt so we put him in
asst living-had a lot of muscle pain, was incontinent since prostate
surgery, was bowel focused and needed help stooling. The pred nisone we
started last week pretty much eliminated his pain, but his legs were weaker
r>l, dev foot drop. that is when we admitted him. CXR shows a cavitation in
a lung, ct scan shows his manubrium almost eat up (never c/o pain there), a
mass in the kidney and maybe liver, and in his spine!
paula

"Rogers, Barbara" wrote:
Paula
Do you know what the primary cancer is?

Barb

-----Original Message-----
From: npinfo-bounces at nurse.net
To: npinfo at nurse.net
Sent: Wed Oct 31 17:47:42 2007
Subject: [NPInfo] that PMR pt

That pt I asked for info on PMR about (and got the only list reply: send to
rheumatology) -he dev foot drop so he was admitted to the hospital--has
mets! what a shock. we came to like this guy, and care about him-it is just
stunning news.
Paula

Paula J. Sumner RN, MSN, HTP, CHt
Healing Touch, Hypnotherapy, Emotional Freedom Technique, Reiki-2
3500 Westgate Dr., Suite 504-G
Durham, NC 27707
919-490-4656

http://paulajsumner.byregion.net Referral ID#10102918

http://www.justanswer.com/home.asp?r=HolisticNurse&bn=2

http://www.letstalkcounseling.com/sites/paulasumner
__________________________________________________
Do You Yahoo!?
Tired of spam? Yahoo! Mail has the best spam protection around
http://mail.yahoo.com 
_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************
_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

Paula J. Sumner RN, MSN, HTP, CHt
Healing Touch, Hypnotherapy, Emotional Freedom Technique, Reiki-2
3500 Westgate Dr., Suite 504-G
Durham, NC 27707
919-490-4656

http://paulajsumner.byregion.net Referral ID#10102918

http://www.justanswer.com/home.asp?r=HolisticNurse&bn=2

http://www.letstalkcounseling.com/sites/paulasumner
__________________________________________________
Do You Yahoo!?
Tired of spam? Yahoo! Mail has the best spam protection around
http://mail.yahoo.com 
_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

Carla R. Anderson, FNP-C
Healing Presence Family Practice, PC
carla_rayne at yahoo.com
503 819 9726
_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

Paula J. Sumner RN, MSN, HTP, CHt
Healing Touch, Hypnotherapy, Emotional Freedom Technique, Reiki-2
3500 Westgate Dr., Suite 504-G
Durham, NC 27707
919-490-4656

http://paulajsumner.byregion.net Referral ID#10102918

http://www.justanswer.com/home.asp?r=HolisticNurse&bn=2

http://www.letstalkcounseling.com/sites/paulasumner
__________________________________________________
Do You Yahoo!?
Tired of spam? Yahoo! Mail has the best spam protection around
http://mail.yahoo.com 
_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

Paula J. Sumner RN, MSN, HTP, CHt
Healing Touch, Hypnotherapy, Emotional Freedom Technique, Reiki-2
3500 Westgate Dr., Suite 504-G
Durham, NC 27707 
919-490-4656

http://paulajsumner.byregion.net Referral ID#10102918

http://www.justanswer.com/home.asp?r=HolisticNurse&bn=2

http://www.letstalkcounseling.com/sites/paulasumner
__________________________________________________
Do You Yahoo!?
Tired of spam? Yahoo! Mail has the best spam protection around 
http://mail.yahoo.com 
_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

Paula J. Sumner RN, MSN, HTP, CHt
Healing Touch, Hypnotherapy, Emotional Freedom Technique, Reiki-2
3500 Westgate Dr., Suite 504-G
Durham, NC 27707 
919-490-4656

http://paulajsumner.byregion.net  Referral ID#10102918

http://www.justanswer.com/home.asp?r=HolisticNurse&bn=2

http://www.letstalkcounseling.com/sites/paulasumner
 __________________________________________________
Do You Yahoo!?
Tired of spam?  Yahoo! Mail has the best spam protection around 
http://mail.yahoo.com 
_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************