The Colon Club

Dear O Stoma Mia,

I have been reading about ’possible biopsi and ablation/surgery’.
Suddenly I remembered the feeling that I wished I had known about Cimetidine when DH had his surgeries (did not know/understand until after DH’s surgeries in 2016).

From http://coloncancersupport.colonclub.com ... ry#p447809
Maia: ”Those going for surgery (or even for biopsies) might benefit, if your doctors do not object, by taking cimetidine some days (or a week) before and after surgery (specially before). There are several articles, over the years, that state that cimetidine may help to prevent seeding and, therefore, recurrence.
Cimetidine is Tagamet, the anti-acid, over-the-counter. It is a histamine H₂ receptor antagonist that inhibits stomach acid production but happens to have this effect also.”
(She has references to studies)
—-
In that same thread you OSM post about interactions...
http://coloncancersupport.colonclub.com ... 81#p384289

I used your link posted there now and checked DH’s prescribed meds.

Metformine BGR 850mg
”cimetidine will increase the level or effect of metformin by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.”

Urorec 8mg
(Silodosin)
”cimetidine will increase the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.”

Coveram 10mg
(Perindopril arginine/Amlodipine)
Sadly I can not find info about perindopril)
”cimetidine will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.”

So... thinking out loud.. should I order Cimetidine? and try to contact/ask our Onc before the appointment? (worried she will say no). If the PET is not good I presume the biopsi/ablation will take place soon after our appointment with the Onc so I guess then it will be too late to start Cimetidine

If you O Stoma Mia or anyone else would like to comment on this - I will be very grateful.

LPL wrote:Dear O Stoma Mia, ...
So... thinking out loud.. should I order Cimetidine? and try to contact/ask our Onc before the appointment? (worried she will say no). If the PET is not good I presume the biopsi/ablation will take place soon after our appointment with the Onc so I guess then it will be too late to start Cimetidine

If you O Stoma Mia or anyone else would like to comment on this - I will be very grateful.

I have read your post above andI bookmarked it. Unfortunately, I have not done any literature-review updates on Cimetidine since 2015, and I myself have never used it in this context.

I think it would be better if you looked for feedback from members who have actually used it in the peri-operative context and who may have more recent information than I currently have.

There is one member here with "Ongoing - Tagamet" in their Signature who logged in here less than a month ago, so I know that there are some experienced Cimetidine / Tagamet users still around and monitoring this forum.

On a different but related issue, if the PET scan turns out to be bad, my own first reaction would not be to prepare for an ablation but would be to first look for a second PET-scan opinion -- in other words, an additional radiology reading of the same PET-scan CD-rom, but by a different radiologist from a different radiology center. In addition, I would look for an additional oncology opinion, -- i.e., a second oncology opinion, but from a specialist in lung oncology (i.e., a pulmonary diseases expert). This is what I did when I had a surprise lung nodule appear on my scan a few years ago.

Ablations (RFAs) are not the only way of getting rid of suspicious lung nodules. There are several other ways to be considered and to be evaluated at the same time. It is not at all clear to me that ablation would be the best type of procedure to use. I would want to have more information given to me about all of the possible procedures to use, and the risks and benefits of each.

Praying for good results for you.

O Stoma Mia wrote:
On a different but related issue, if the PET scan turns out to be bad, my own first reaction would not be to prepare for an ablation but would be to first look for a second PET-scan opinion -- in other words, an additional radiology reading of the same PET-scan CD-rom, but by a different radiologist from a different radiology center. In addition, I would look for an additional oncology opinion, -- i.e., a second oncology opinion, but from a specialist in lung oncology (i.e., a pulmonary diseases expert). This is what I did when I had a surprise lung nodule appear on my scan a few years ago.

Ablations (RFAs) are not the only way of getting rid of suspicious lung nodules. There are several other ways to be considered and to be evaluated at the same time. It is not at all clear to me that ablation would be the best type of procedure to use. I would want to have more information given to me about all of the possible procedures to use, and the risks and benefits of each.

That sounds as a good plan! Thank you O stoma Mia.

hopeful1 - Thank you for prayers.

I hope he gets good scans!

Best wishes for a good meeting with the doctor on Monday!

DE Thank you !

OSM, It feels so good to get well wishes from people who understand.. and wow! remembering to post when I need it the most <3
I will get back and report what we will find out.

So.. I have not translated the PET result yet but I think our Dr appointment went well. We did not get any definitives, she is going to consult (more) with expert (professor) colleges. She does not believe the lung nodule(s) are malignant. Says: probably inflammation.. we will check again in 3(?) month.
However, there were high SUV in DH’s colon, different places. I see that the report are mentioning (due to) Metformin?? (We followed the preparations and DH took his metformin the morning before the PET).
Our Onc now talked about Metformin also. And I have seen research (see below). She now want hubby to have a new colonoscopy.
That is where we are now.
It could have been worse...

From (2010) https://www.ajronline.org/doi/10.2214/AJR.10.4663
”..,Metformin is a well-established first-line antihyperglycemic drug used in the treatment of patients with type 2 diabetes mellitus (DM) [6–8]. Recently, emerging evidence that metformin influences FDG uptake in the intestine has been reported [9, 10]. Gontier et al. [9] reported that the intestinal FDG uptake induced by metformin is typically intense and diffuse, so it can mask an actual malignant lesion and can lead to false-negative results. For reducing this unwanted intestinal FDG uptake, Ozulker et al. [11] investigated the effect of stopping medication. The increased FDG uptake in the intestines during metformin treatment was significantly decreased after stopping medication for 3 days. Considering the relatively short plasma half-life of metformin after oral administration (range, 4.0–8.7 hours) [12], we investigated the feasibility of medication discontinuation for 2 days on reducing the increased intestinal FDG uptake induced by metformin. In addition, we also investigated changes in blood glucose level after the discontinuation of medication for 2 days with intrasubject (study 1) and intersubject (study 2) analysis.”
”CONCLUSION. The discontinuation of metformin for 2 days is feasible for reducing the high intestinal FDG uptake induced by metformin.”

Glad your appt went well!

LPL wrote:So.. I have not translated the PET result yet but I think our Dr appointment went well. We did not get any definitives, she is going to consult (more) with expert (professor) colleges. She does not believe the lung nodule(s) are malignant. Says: probably inflammation.. we will check again in 3(?) month.
However, there were high SUV in DH’s colon, different places. I see that the report are mentioning (due to) Metformin?? (We followed the preparations and DH took his metformin the morning before the PET).
Our Onc now talked about Metformin also. And I have seen research (see below). She now want hubby to have a new colonoscopy.
That is where we are now.
It could have been worse...

From (2010) https://www.ajronline.org/doi/10.2214/AJR.10.4663
”..,Metformin is a well-established first-line antihyperglycemic drug used in the treatment of patients with type 2 diabetes mellitus (DM) [6–8]. Recently, emerging evidence that metformin influences FDG uptake in the intestine has been reported [9, 10]. Gontier et al. [9] reported that the intestinal FDG uptake induced by metformin is typically intense and diffuse, so it can mask an actual malignant lesion and can lead to false-negative results. For reducing this unwanted intestinal FDG uptake, Ozulker et al. [11] investigated the effect of stopping medication. The increased FDG uptake in the intestines during metformin treatment was significantly decreased after stopping medication for 3 days. Considering the relatively short plasma half-life of metformin after oral administration (range, 4.0–8.7 hours) [12], we investigated the feasibility of medication discontinuation for 2 days on reducing the increased intestinal FDG uptake induced by metformin. In addition, we also investigated changes in blood glucose level after the discontinuation of medication for 2 days with intrasubject (study 1) and intersubject (study 2) analysis.”
”CONCLUSION. The discontinuation of metformin for 2 days is feasible for reducing the high intestinal FDG uptake induced by metformin.”

Hi
I understood that nodules wasnt seen. That is great and others were could be ımflamation. Dont be stress. I think pet result is not bad. But every little think is important so they will observe. But i think chemos side effect . Good luck. My husband MR will be given tomorrow. Nervous too. But we try to live with this.


Ebru

Educator, thank you for your comment.
I have also been thinking maybe these nodels due to chemo? Who knows.. Good luck with your MRI tomorrow!

LPL-
Thank you for providing the update on PET scan results. It's reassuring to see that they didn't find any obvious metastatic nodules. Now they will do a new colonoscopy and a followup scan, but this is probably just standard procedure to double-check that everything is OK.

You have been doing quite a lot of research on this lately. I hope your DH appreciates all of the hard work that you have been doing.

LPL wrote:Educator, thank you for your comment.
I have also been thinking maybe these nodels due to chemo? Who knows.. Good luck with your MRI tomorrow!

Thanks Im waiting

Just checking in to see how it's going. The waiting sucks, doesn't it!?!?

mpbser wrote:Just checking in to see how it's going. The waiting sucks, doesn't it!?!?

Yes, and today doctor said pet and mr results good . Chemo achieved. And I am relax now to another scan. Lots of mets gone . But go on chemo . This is little boring . But he is smiling this enough for me