Naked Science Forum
Life Sciences => Physiology & Medicine => Topic started by: OldMan on 16/03/2005 01:57:46
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Ok some of you are already aware of the situation with my dad's health so I'll skip all that and get to the latest.
Basically he almost seems to be suffering from dementia or something along those lines but also has lucid moments, or so I've been told, I kind of had trouble picking which was which the other day.
Someone said maybe it was all the painkillers etc he's on just messing with his memory. I'm probably more inclined to believe that the cancer may have moved to his brain or there is a tumour near by putting pressure on his brain.
I guess what I'm asking is could it be due to the pain killers at all? I know some can effect epileptics (sp?) with their memory but he isn't epileptic.
Answer doesn't make much difference in the long run, I just want to know.
Tim
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Dear Tim
sorry to hear about this, just one more thing to add to your catalogue of concerns.
There are a number of reasons why someone with an advanced malignancy might become confused, and you have correctly identified 2 likely causes.
Top of the list is drugs. Painkillers are designed to block pain signalling in nerves and therefore often have side effects upon other parts of the nervous system. These are often imperceptible at low doses, but as tolerance builds up, or the pain worsens, and larger doses are needed, side effects are more likely to manifest themselves. Opioids (morphine-like drugs) are common causes of confusion. Some of the patients I have treated in the past have complained that these drugs can cause 'muddled thinking' and hallucinations. They are very sedating, so you can understand why someone taking them appears to have lost the plot because they are continually nodding off and life can become quite fragmented with little continuity.
Other possibilities are that the cancer is fiddling around with the body's biochemistry. Tumours can release various factors, including hormones, which can alter salt balance, push up calcium levels, affect hydration status and the function of other organs, and trigger the production of too many blood cells and the levels of stress hormones. These are referred to as paraneoplastic effects - in other words they are systemic manifestations not directly caused by the physical presence of the tumour. Certain paraneoplastic effects include the immune system attacking nerve fibres, which can occur in the peripheral and central nervous system. This normally causes problems with co-ordination, rather than just arousal, so I think a biochemical cause might be more likely.
The other point you raise is metastasis - spread - of the cancer to other parts of the body, including the brain. This is more common with some tumours than others - lung and breast cancers often spread to the brain - but occurs about 8-10% of the time with renal cell carcinoma. The signs of a cerebral metastasis are initially a focal neurological deficit; in other words, the part of the brain to which the tumour has spread stops working properly, so the patient finds it difficult to do tasks involving that part of the brain. Very often the presence of the tumour also triggers fits (seizures), and causes the pressure inside the head to rise, which can cause unconsciousness.
In your Dad's case, from what you've said, I'd condemn the drugs first, then consider other causes of his altered conscious state.
Best wishes
Chris
"I never forget a face, but in your case I'll make an exception"
- Groucho Marx
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Thanks Chris, much appreciated.
I guess one thing I forgot to mention is he developed a speach and swallowing problem sometime ago. They did a scan when if first started and were unable to identify the cause, I haven't heard any updates since, but he has recently had radio on his neck and upper back indicating it seems to be gradually working its way up the spine.
Thanks again.
Tim
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Dear Tim
right, well that would fit the bill for focal neurological deficit as I discussed above, although I suspect that what you are seeing is a combination of all of the effects I mentioned.
Chris
"I never forget a face, but in your case I'll make an exception"
- Groucho Marx