Andrew Putnam

Caring.com Expert

About

Andrew Putnam, M.D. is the director of the Palliative Care Program at Lombardi Comprehensive Cancer Center and Georgetown University.

Recently Published on Caring.com

  1. Friday December 09, 2011

    1. What is a dangerous # for a man's PSA to be, before becoming prostate cancer?

      Answer - The dangerous number for a PSA before you worry about prostate cancer varies depending on the man's age. The number usually considered normal for a PSA is 4. It is important to understand that as a man ages, his prostate enlarges. A larger prostate will cause a higher PSA. So for a younger person, say below 60 years old, the PSA should be well below 4...

  2. Friday October 14, 2011

    1. What can symptoms can we expect during my mother-in-law's hormone therapy for breast cancer?

      Answer - It is challenging to predict future symptoms in many cancers including breast cancer. The symptoms depend on where the cancer spreads to and how rapidly it grows in different places; shortness of breath if in the lungs, swelling in the abdomen and legs if in the liver etc.

    2. Where can I find financial assistance for my cancer treatments?

      Answer - When looking for financial assistance with cancer treatment, the clinician who can likely be the most help is a social worker. In addition to many other skills, A good social worker knows the ins and outs of methods of payment as well as different agencies and groups.

    3. Is my wife's trouble eating related to her hormone therapy?

      Answer - It is very challenging to encourage eating with anyone with advanced cancer. While it may be the hormone therapy, it is also possible that it is the advanced stage of the illness itself. With advanced cancer, it is normal for a patient to lose interest in food for many reasons...

    4. What cancer treatment option would be best for my father with severe dementia?

      Answer - This certainly is a very difficult decision with no obvious "right answer". I have not seen this specific situation but there are a couple of general considerations when thinking about cancer treatment in a patient with severe dementia.

  3. Wednesday October 12, 2011

    1. How do doctors know when a person with cancer is about to die?

      Answer - Doctors do not know for sure when someone will die. We have no crystal balls. From our experiences, we can have some idea and so the "weeks to months" which gives a general idea without being specific. There are many patients who will say that "my doctor said I had (some amount of time) to live and I am long past that...

  4. Thursday August 11, 2011

    1. Is there a set amout of chemotherapy a lung cancer can receive?

      Answer - You ask several questions having to do with chemotherapy in lung cancer patients. From your description it sounds like your mother's cancer is metastatic. If so I am very sad to write that yes, the outlook for your mother is as bleak as it seems...

  5. Thursday July 28, 2011

    1. Is it safe for children to be around chemotherapy and radiation patients?

      Answer - This is a question of radiation and chemotherapy safety. Radiation only affects people exposed to the source of radiation. So when your father is treated with radiation, it affects him but he is NOT radioactive. Other people around him are safe, children included. The same is true with chemotherapy...

  6. Friday June 10, 2011

    1. How can I help dad with the neuropathy in his feet?

      Answer - I am so sorry to hear that your father is having such a hard time. Neuropathy in feet (and sometimes hands) can be very painful. The medications that can help with this pain can be Amitriptyline or Nortriptyline (there are others in the same class of tricyclic antidepressents), Neurontin (gabapentin...

    2. How do we decide if mom should get treatment for her cancer?

      Answer - 18 years after colon cancer, this could also be a new cancer. In any case, it is important to talk to an oncologist to get full information. The decision of whether to treat a cancer is a case of balancing the benefits and burdens. It is reasonable at age 87, especially if your mother is confused...

  7. Wednesday May 18, 2011

    1. Was I right not letting my doctor perform another CAT scan on me?

      Answer - In the situation you describe, I believe that the importance of an accurate picture of possible change outweighs the risk of the CT Scan. Yes the radiation exposure of a Ct Scan is much greater than that of an x-ray but the risks are still very small. Knowing as early as possible if there is growth in the mass is crucial...

  8. Tuesday May 17, 2011

    1. Are blood tests always taken before a chemotherapy session?

      Answer - It is usual to have blood tests before chemotherapy but not always on the same day. Different chemotherapies have different risks and so different tests need to be done at different times. It is very unlikely that the chemotherapy given on that day contributed to your father's stroke. The effects of the chemotherapy usually take some time to kick in...

  9. Thursday April 28, 2011

    1. Can drinking too much alcohol lead to a relapse of Dad's stomach cancer?

      Answer - There are two parts to the answer about drinking alcohol with stomach cancer. The direct answer is that alcohol is not thought to be a risk factor for stomach cancer and so will not cause the return of his cancer. On the other hand, there are many other effects of alcohol on the body and these can have...

  10. Wednesday April 06, 2011

    1. What are lymph nodes, and what does it mean that they're finding cancer there?

      Answer - Lymph nodes are areas in the body, where lymph fluid flows and there often the body fights disease. The fluid carries the disease but also brings white blood cells and antibodies and other disease fighters to the lymph node where the fight often takes place. The fact that your mother's cancer has moved to her lymph nodes is a bad sign...

    2. Does coughing and phlegm mean my mother's lung cancer has returned?

      Answer - It is important to remember that while coughing and lung cancer are related, a cough can be caused by other possibilities. A cancer patient can catch a viral or bacterial infection (both of which can also cause headaches) as easily, or even more easily, than a person without cancer. People with cancer can develop ordinary illnesses as well...

    3. How long does it take for the side effects from chemotherapy to begin?

      Answer - The onset of chemotherapy side effects depends on the chemotherapy and the individual. Sometimes side effects start within a day or 2 of starting chemotherapy and at other times they can start several days later. Being fine at the start is a good sign but it does not mean that the side effects will not start later...

  11. Thursday February 24, 2011

    1. What is the window of opportunity for breast cancer surgery?

      Answer - The window of opportunity for breast cancer surgery is different in different people depending on the stage of disease. The question for any surgery is will the benefits outweigh the burdens. To do a major surgery, the surgeon will generally want the tumor to be small enough that s/he can get it all...

    2. Could a low red blood cell count mean cancer?

      Answer - There are many reasons for a person to have low iron and low numbers of red blood cells. In a woman, it could be blood loss from regular periods (menses) that leads to the low iron. Diet and not eating enough iron can also be a reason among others. Cancer can be a reason for low red blood cell production...

  12. Friday January 28, 2011

    1. Is it true that there is no pain associated with breast cancer?

      Answer - The amount of pain with breast cancer depends on where the cancer is. Often if at an early stage only in the breast, there may be no pain or other symptoms. Regular mammograms are needed to find those early cancers before they grow bigger...

    2. Can itching in the genitals indicate possible cancer?

      Answer - While itching all over the body can be a sign of cancer, it would be very unusual for itching specifically in the vaginal and anal areas to be a sign of cancer. The itching could be caused by the dryness that comes post menopause, which can lead to horrible itching and discomfort...

  13. Monday December 20, 2010

    1. If the cancer is nearly gone, is it still stage 4?

      Answer - The stage of a cancer is a term that is given at diagnosis and does not change even if the cancer improves. The stage does not get downgraded even if the cancer disappears with treatment. So yes your mother is still considered Stage 4 lung cancer. Median survival is about 12 to 16 months but some people live several years and others die in a shorter time...

  14. Friday December 17, 2010

    1. How long can Mom last with a feeding tube and esophageal draining tube due to gastric adenocarcinoma?

      Answer - Life expectancy after gastrectomy for gastric cancer is very hard to predict as it depends on how much cancer is left and where and also how fast what is left grows. With the feeding tube she has a source of nutrition and so could last quite some time...

  15. Friday November 05, 2010

    1. My mother is told she has less than a year due to her cancer, but she's still not sick. When does that happen?

      Answer - With stage 4 lung cancer, very few patients will live one year or more and so doctors give that warning. As for when will someone with stage 4 lung cancer show signs of illness, that is hard to answer. Many people look fine for a while and then start to get short of breath...

  16. Friday October 29, 2010

    1. What is the life expectacy with stage 4 prostate and liver cancer?

      Answer - Life expectancy with stage 4 prostate cancer varies greatly because stage 4 means distant metastases and they are often in the bone. These can be very painful but usually do not immediately affect length of life. You wrote that your husband had mets in the liver which is probably more serious...

  17. Friday October 08, 2010

    1. Why is my father's oncologist making him choose between chemotherapy or hospice?

      Answer - I do not know why your father's oncologist is saying that now he must choose between chemotherapy and hospice. There may be a reason, such as the lymphoma might be growing and it is important to treat it now. If that is so, your oncologist ought to be able to explain it...