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Cancer in Podiatry
- Thread starter lillytwig
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Absolutely, and you will get Cancer patients in your practice - it isn't uncommon - you'll have to be very aware of the pathology manifesting in their system under the chemo and their medications as this will certainly influence your decision to put them on prescriptions and treating their foot and ankle conditions.
D
Dr_Feelgood
There are also begin and malignant tumors that can be present in the lower extremity. Some of them can be very aggressive and should be referred to an oncologist. I personally would refer any patient that has signs of malignancy. It does not mean you will be be involved in the treatment; it just means you are getting a specialized opinion (and you have the patient's interest in mind).
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there are also effects of the chemo on the LE.
swelling of the legs and feet and neuropathy of the feet that lasts longer then the duration of the chemo sometimes indefinitely.
I have seen ulcerations of the feet due to chemo neuropathy after breast cancer.
swelling of the legs and feet and neuropathy of the feet that lasts longer then the duration of the chemo sometimes indefinitely.
I have seen ulcerations of the feet due to chemo neuropathy after breast cancer.
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We just signed someone up today for excision of a cancerous skin lesion. I've also seen quite a few bone tumors.
W
whiskers
In so many ways.
Phramacologic:
Some chemotherapeutic drugs may be metabolized by one of the many cytochrome p450 subfamilies thus affecting the systemic and therapeutic levels of both drugs.
Cancers may disrupt normal absorption, distribution, metabolism and excretion of chemotherapeutic agents depending on the drug and the particulars of the cancer.
For example, if the patient has liver or kidney dysfunction related to his or her cancer and/or the treatment, certain medications may not be able to be cleared as efficiently from the body and dose monitoring may be necessary. Again, knowing how the drug is metabolized and excreted may be beneficial in determining the appropriate clinical selection of therapy.
Similarly, removal of organs and tissues b/c of malignant growth may impede absorption, distribution, metabolism and excretion of chemotherapeutic agents.
There are many considerations that could be discussed regarding the phramacological aspects of treating pts.
Physicologically:
The neoproliferative state of the malignancy may exact excessive nutrient requirements that the patient can't fufil due to cancer cachexia, or sheer tumor load and the subsequent nutritional demand leading to a shift in the metabolic state of the pt with the patient becoming acidotic due to the shift to reliance on fatty acids for energy. (which may impact some therapies and even the types of organisms that can grow in the blood as in a septicemia or may shift the pka of particular functional groups on the drug and change affinity for the binding site) This may also relate to the pharmacologic transport of these metabolites and reduce the available bilirubin for chemotherapeutic modalities to be effectively stored and transported. For example, if a drug has a high affinity for protein binding to be transported in the blood, it may require different dosing in order to compensated for the decreased available protein available for binding.
Again, this doesn't even scratch the surface of how important our basic sciences are.
This discussion could get into everything from psychosocial aspects ( does a cancer pt want a particular therapy if they only have X amount of months to live) to immunological (cytokines and immune fxn), metastatic spread, hemodynamics etc, etc..... But I have 30000 other things I should be doing right now.
I think that any disease could potentially have implications on our podiatric practice of medicine and we all need to be well aware of that.
The foot and ankle are very well attached to the rest of the body;
in more ways than one.
D
Dr_Feelgood
I've seen some X-rays where this is not true. We had an amazing case Dr. Smith showed us. An overweight patient was doing PT and attempted to stand up. Just then an inversion sprain that ends w/ a open fracture and the foot is just hanging there. The patient ended up needing an amputation.
W
whiskers
You've given me every reason not to over exert myself! I better just take it easy, I value my feet!
I may just have to begin slithering on my belly...
Snakes and loathsome sea-beasts don't need podiatrists. everyone else had better get one.
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3 Best ways to tell if you're too fat:
3: You have to rock the lazyboy first to get enough momentum to stand up.
2: Either way you turn, you're not making in through that door.
1: When you stand up, your foot snaps off.
3: You have to rock the lazyboy first to get enough momentum to stand up.
2: Either way you turn, you're not making in through that door.
1: When you stand up, your foot snaps off.
D
Dr_Feelgood
D
Dr_Feelgood
This is classic and true. You know what gets to me; we are expected to tell people to stop smoking but not to tell them they are fat as heck. Research has shown that obesity and inactivity are the two biggest factors that lead to morbidity and mortality.
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This is classic and true. You know what gets to me; we are expected to tell people to stop smoking but not to tell them they are fat as heck. Research has shown that obesity and inactivity are the two biggest factors that lead to morbidity and mortality.
whatever man - i used to shadow a DO who would yell at obese kids and their parents for their poor eating habits...not to mention that he wouldn't give samples to any patient who smoked - since by his logic if the patient can afford a pack of cigarettes to waste his life, then surely he can afford medication...
by far the coolest doc i ever shadowed
D
Dr_Feelgood
I like him already but I'm sure most people said he has a "god complex" b/c he doesn't sugar coat the news.
I'm going to do the smoking thing too. I like that idea and I will tell the people too.
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surprisingly, people (patients) loved him because he was very genuine in his work. He's an ass and doesn't sugar coat anything but he calls them as he sees them - so I respect that.
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A very underappreciated trait in medicine nowadays.
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A recent article in Podiatry Today (podiatrytoday.com) nicely covered Marjolin's ulcer, which is a form of SCC that commonly occurs in the lower extremity. You should read it. Aside from Squamous cell tumors, there are often basal cell tumors and neuro-vascular tumors (see Morton's Neuroma). As far as podiatry goes in treating these issues, excision is done, but chemotherapy is left to the oncologists.
There are a number of case reports here: Cancer metastasis in the foot in which the first symptom of a cancer elsewhere was a metastasis to the foot.