Back pain with Radiation? Osteoporosis?

[ocstacy]

Hi all,

My mom has 8 more days of Xeloda and Radiation and she gets to take a 6 week break prior to surgery. My mom is mentioning back pain and she has Osteoporosis. Does anyone have bone pain or back pain from the radiation? She does take Ibprofen for pain, but she has mentioned it more this week. Is is true on the last week of radiation, they try to zap it stronger and more intense? Her Oncologist mentioned that during her break, that she will become more weak a week after. What was your experience like? Please share.

Thank you

[MissMolly]

Ocstacy:
Your mother's low back pain is likely more related to the effects of radiation to adjacent connective and soft tissues than pain of specific bone origin.

Radiation for rectal cancer often has latent effects on connective and soft tissues in the pelvic floor and hip joints. Both are cited as areas prone to collateral damage from radiation treatment.

The hip joint capsule and connected tendons and ligaments become thickened and less pliable. Soft tissue (aka insulating padding between organs and structures) shortens and contracts. Connective tissue, especially the thin wispy fascia that covers organs and serves as a protective covering, can tether or attach to the abdominal and pelvic wall as well as to other organs or a segment of intestine - internal elements of the body become "stuck" or glued to one another. "Frozen abdomen" is a term that used to describe the hostile environment that can develop as a result of radiation treatments.

With radiation, connective/soft tissue and the hip joint capsule become inelastic and less agreeable to free movement. This places communicating stress in the lumbar and lower thoracic vertebrae.

The hips and pelvic floor are especially susceptible to collateral damage. It may first appear as general stiffness in daily activities, such as putting in a pair of shoes or picking up the newspaper at the entryway of front door. Hip external rotation and abduction (movement away from body mid-line) is an early casualty and one of the first movement patterns to be restricted (ex. Inability to cross one leg over the other).

The sacro-iliac joint is commonly limited in movement. Sacro-iliac restriction is often neglected by physicians in performing a quick assessment of low back pain. Low back pain more often than not includes an SI joint that lacks normal glide.

You may want to look at some basic slow-sustained stretches or easy yoga postures for your mother.

A basic lunge position is effective in stretching the piraformis muscle (often implicated in low back pain as the sciatic nerve runs beneath the piraformis muscle and the gluteus Maximus and gluteus mediums).

Stretching for hip external rotation and abduction (ex. Sitting cross legged on the floor or sitting in a chair crossing one leg over the other with the knee pointed outward to the side).

Assuming a semi-squatted position is another effective pose.

There are a wealth of books with simple yoga poses that might be helpfu. Look for titles such as "Gentle Yoga" or "Reatorative Yoga." Giamia is a respected publisher of yoga books and DVDs.

If your mother is up to going to a warm therapy swimming pool at a local YMCA or community center with an arthritis water program that may be a comforting option. This may not be appropriate if her bowel and anal continence is a concern of a possible fecal accident.

It is important to keep the lower body moving during pelvic radiation to keep deep connective tissues subtle, gliding, and moving.
Karen

[Soccermom2boys]

Is is true on the last week of radiation, they try to zap it stronger and more intense? Her Oncologist mentioned that during her break, that she will become more weak a week after. What was your experience like? Please share.

Thank you

Yes, I didn't realize that myself until I was getting close to my last treatments, but generally it seems you do five weeks of five days of radiation to the pelvic area and then the last three days of the 28 days is aimed solely at the tumor(s).

I recall rebounding fairly well within a week of finishing, but this is not to say internally I don't have collateral damage from my radiation treatments. It really does vary widely how we all weather the storm, hopefully she will be fine, tired of course and sore, but able to rebound within a week or two of them ending. She will want to then prepare her body physically for round two, the surgery.

[Aqx99]

To this day I have a fair amount of tailbone pain from the radiation. It was at its worst right at the end of treatment and in the weeks after. It was so bad that my nurse navigator noticed me squirming in my seat at support group and asked me if I was in pain. I told her I was trying to deal with it, but she insisted I tell my oncologist. When I went in to my appointment, I found that she had already told her about my pain. She prescribed me hydrocodone to use as needed. The pain has decreased as time has passed, but I still get some pain from sitting too long. My ostomy nurse suggested using a memory foam cushion when I sit. It has made a world of difference.

[ocstacy]

She will want to then prepare her body physically for round two, the surgery.

Yes, thank you. She doesn't want surgery, and going through depression. I feel like the 5th week is the hardest. She is so emotional, I am trying so hard to be strong for her. It is so hard going through this with her at times. Today is the worst. She said she wanted to die, she didn't care anymore.

[ocstacy]

Nurse suggested using a memory foam cushion when I sit. It has made a world of difference.

Yes, we had one made by a Kinesiologist. She used it often. We are starting the BRAT diet again this week.

[ocstacy]

If your mother is up to going to a warm therapy swimming pool at a local YMCA or community center with an arthritis water program that may be a comforting option. This may not be appropriate if her bowel and anal continence is a concern of a possible fecal accident.

It is important to keep the lower body moving during pelvic radiation to keep deep connective tissues subtle, gliding, and moving.
Karen

Thank you Karen. My mom is very stubborn. She is a stubborn Sagittarius that never listens, obviously that is why she found her cancer later than earlier. She ignored the Dr's suggestion to get one 3 years ago and I just found out about that last week. Anyhow, my mom will not take a bath or go into a swimming pool.. she is very comfortable just being in her own skin. I think the sitz bath would help her. Thank you for the suggestions about the yoga moves. With her Osteoporosis, I am so hesitant about her trying new things. I am afraid of fractures.

[MissMolly]

Ocstacy:
The worst thing for a person with osteoporosis to do is to adopt a sedentary life style.

Bone tissue needs weight-bearing and resistive stress to be healthy. Bone that is not regularly stressed is bone that decalcifies and has an over-abundance of osteoclasts (cells that remodel and remove bone) and fewer osteoblasts (cells that rebuild and strengthen bone).

Believe me, I understand osteoporosis at a personal level. I have been on corticosteroids for 25 years and have severe osteoporosis owing to the detrimental effects of glucocorticosteroids.

Inactivity and being sedentary (sitting at the computer, lying in bed) are ingredients that will advance and accelerate bone loss.

I do yoga every day. Yoga is generally recommended for people with osteopenia and osteoporosis. Stretching elongates tendons, providing a resistive and bone building stress to weakened bone.

But I agree that starting with yoga may not be the optimal choice for you mother if she is not otherwise used to moving her body in a regular form of exercise.

Start small. Get your mother a quality pair of walking shoes and encourage your mother to walk outdoors. The weight bearing effects of walking are known to be beneficial in increasing bone density. No need to go to a gym. Simply put on a pair of athletic shoes, lace up, and head out the door.

Another easy way to build bone strength and maintain flexibility is through simple Thera-band exercises. Thera-band is rubber tubes or rubber bands that can be used in a variety of positional variations to strengthen key muscle groups. It comes in different colors corresponding to different degrees of tension. You can even Google, "Thera-band exercises for osteoporosis therapy" to get ideas and pictorial guidelines of different upper and lower body exercises. Keep it simple and basic. Start with the lowest tension bands (yellow colored).

Wall push-ups are a basic exercise for strengthening the back and easing osteoporosis effects to the spine. Stand about 14 inches away from a wall. Place both palms on the wall. Lean the body into the wall, bending the elbows. Push away from the wall, straightening the arms and elbows. Yiola. That is a wall push up.

With osteoporosis of the spine and hips you want to avoid extreme and sudden flexion/forward bending combined with rotation of the body axis. People are apt to suffer a compression fracture from mundane daily tasks such as picking up a paper clip from the floor, bending/flexing at the waist and twisting the torso.

It is essential to continue to move the body when someone has osteoporosis. The process of bone remodeling (the worker-bee cells of bone are called osteoblasts and osteoclasts) depends on weight bearing and resistive stress.

My osteoporosis is so severe that it is graded as 4 standard deviations below the mean on the Dexa scan results. It cannot get any worse than this. I am up and walking and doing yoga and their band exercises as a means to keep me upright and functional. I do these activities to lower and minimize the risk of fracture. I do these activities to avoid a fracture.

Keep it simple and easy for your mother. Become her walking and Thera-band partner and buddy. Go for a walk together, do a few Thera-band stretches together - a mother-daughter buddy system.

Consider asking for a physical therapy referral and 2-3 visits to provide your mother with an individual assessment and individualized home program.

Maintaining what ever level of activity I can keeps my emotional spirits lighter and brighter as I struggle with health challenges. Your mother may also find a lifting of her spirit with walking, being outdoors, and moving her body.
Karen

[ocstacy]

Maintaining what ever level of activity I can keeps my emotional spirits lighter and brighter as I struggle with health challenges. Your mother may also find a lifting of her spirit with walking, being outdoors, and moving her body.

Yes, I agree. Thank you............. I see that you were on hospice, did you graduate? My uncle graduated hospice,he will be 89 this Fall. He has no family and since we have moved in with him, he is in much better health. I will pray for you and hope that things will get better for you. My mom is not looking forward to her surgery or temp bag

[NHMike]

Ocstacy:
Your mother's low back pain is likely more related to the effects of radiation to adjacent connective and soft tissues than pain of specific bone origin.

Radiation for rectal cancer often has latent effects on connective and soft tissues in the pelvic floor and hip joints. Both are cited as areas prone to collateral damage from radiation treatment.

The hip joint capsule and connected tendons and ligaments become thickened and less pliable. Soft tissue (aka insulating padding between organs and structures) shortens and contracts. Connective tissue, especially the thin wispy fascia that covers organs and serves as a protective covering, can tether or attach to the abdominal and pelvic wall as well as to other organs or a segment of intestine - internal elements of the body become "stuck" or glued to one another. "Frozen abdomen" is a term that used to describe the hostile environment that can develop as a result of radiation treatments.

With radiation, connective/soft tissue and the hip joint capsule become inelastic and less agreeable to free movement. This places communicating stress in the lumbar and lower thoracic vertebrae.

The hips and pelvic floor are especially susceptible to collateral damage. It may first appear as general stiffness in daily activities, such as putting in a pair of shoes or picking up the newspaper at the entryway of front door. Hip external rotation and abduction (movement away from body mid-line) is an early casualty and one of the first movement patterns to be restricted (ex. Inability to cross one leg over the other).

The sacro-iliac joint is commonly limited in movement. Sacro-iliac restriction is often neglected by physicians in performing a quick assessment of low back pain. Low back pain more often than not includes an SI joint that lacks normal glide.

You may want to look at some basic slow-sustained stretches or easy yoga postures for your mother.

A basic lunge position is effective in stretching the piraformis muscle (often implicated in low back pain as the sciatic nerve runs beneath the piraformis muscle and the gluteus Maximus and gluteus mediums).

Stretching for hip external rotation and abduction (ex. Sitting cross legged on the floor or sitting in a chair crossing one leg over the other with the knee pointed outward to the side).

Assuming a semi-squatted position is another effective pose.

There are a wealth of books with simple yoga poses that might be helpfu. Look for titles such as "Gentle Yoga" or "Reatorative Yoga." Giamia is a respected publisher of yoga books and DVDs.

If your mother is up to going to a warm therapy swimming pool at a local YMCA or community center with an arthritis water program that may be a comforting option. This may not be appropriate if her bowel and anal continence is a concern of a possible fecal accident.

It is important to keep the lower body moving during pelvic radiation to keep deep connective tissues subtle, gliding, and moving.
Karen

Thanks for your very detailed post. I didn't realize that they change things the last three days but I'll keep it in mind. I'll also work on stretching for this stuff (I have a standard stretching routine before running but sometimes do an extended version and I have lots of Yoga resources).

[skb]

During my chemoradiation, I experienced no bone pain / skeletal pain but I started having it about a month after the radiation ended (see dose below).

The sacrum developed a lesion and also the L5 bone on the back. I was worried if it indicated bone metastasis but they seem to be just side effects of the radiation. The radiology report from Mayo attributes these injuries as probable side effects of radiation.

I have started walking daily for 30 min. Seems to help.

- sreekanth

----------------------------
Dx 3/21/17- T3N0M0- distal rectal cancer, 5cm tumor, adenocarcinoma, 2.5 cm from anal verge, slight internal sphincter involvement
4/18/17 to 5/22/17: Simultaneous chemo and radiation - oral pills- Xeloda 1800mg twice a day for 25 days, 200 Cgy radiation per day totaling 50Gy for 25 days
6/28/2017: biopsy from where tumor used to be reveals no invasive adenocarcinoma
8/09/17: MRI study at Mayo reveals no primary tumor left
8/11/17: deemed complete responder, placed in wait and watch
8/17/17: starting mop-up chemo with Folfox and oxaliplatin (IV infusion)