instruction: hello doctor hope you are fine and doing well my mother has been diagnosed grade breast cancer last month she had abscess drainage last month on left breast so now she is taking femara 5 every day and took zometa 0 my recently as per doctor advise so the next day she felt sick like fever the next day she was felling weakness and then lost consciousness temporarily for 30 seconds then we took her to the emergency they did some tests which they found the sugar level was 31 pop level was 18 pco2 was 26 and now she is fine and under treatment so doctor I selected you as our second opinion and I will keep following up with you concerning her treatment I am attaching all the reports and doctor advise which we received here please check the reports and doctor note and advise in detail
output: hello I have gone through all the reports it looks like she is having a metastatic inflammatory breast cancer with lung and bony metastasis my recommendations she needs to control her diabetes with diet exercise and medication consult a diabetic clinic or endocrinologist replace zometa to denosumab if possible as her kidney may be suffering from diabetic nephropathy denosumab is more effective and comparatively safe for kidneys after denosumab she needs calcium and vitamin supplements breast abscess once drained can recur so doctor should examine it at every visit also in case of fever one possibility may be reaccumulation of abscess as she had an episode of temporary loss of consciousness it can be related to sudden drop of calcium after zometa or can be related to some brain pathology if she will develop same symptoms one more time she should do an mri brain with contrast she has a multilevel disc disease with thecar compression need a neurosurgical review urgently regarding treatment of breast cancer she should continue with letrozole but alone it is not enough so need to add palbocicib or go for letrozole plus fulvestrant continue for to months followed by it scan workup etc for reassessment before further decesion