Ellis–just checking on you!
Question:
> I saw the highly regarded thoracic surgeon May 1. He recommends a > thoracotomy to remove right lower lobe, which would reduce > lung capacity 25%; rather than just remove the much smaller > superior segment. [apparently segmectomy is difficult compared to > lobectomy].
If segmentomy is "difficult" but not "impossible," then there must be surgeons somewhere on this planet who are skilled at doing it. You should discuss that possibility with your HMO. — Steven D. Litvintchouk
Response:
- Hide quoted text — Show quoted text -> > Hi–wondering how you are and if you received any > > results from your tests? maureen > Results of ‘lung needle biopsy’. > The good news is no cancer was found in this biopsy, or > the previous bronchoscopy biopsy. > The bad news is no pathogens were identified to treat. > The pulmo doc now says there is still a 10-20% chance of > cancer, and has referred me to a thoracic surgeon to > discuss implications of removing right lower lobe. > [4 x 6 cm infiltrate--the CT scan suggests either > pneumonitis or cancer] > Will see the surgeon May 1. [this would result in a > reduction in total lung capacity of around 20% I'm told] > I still feel pretty good, under the circumstances; > a little allergic cough; and occasional hemoptysis. > Walking a couple of miles/day. > If my condition stays stable, I plan to go for a 2nd opinion > from the local Medical School, even if I have to pay for it. > There are some possibilities, like fungus [Valley fever], > chronic mycoplasma pneumonia, anaerobic bacteria, etc. > I got a very comprehensive 2nd opinion Thurs, from the > asst head of the Chest Clinic at the local medical school. > He and the assisting Fellow looked at all my x-rays/CT scan, > pathology reports, bronchoscopy, and medical reports. > He basically concurs with my pulmo doc that at a minimum > I need a VAT thorascopy [3-holes] to get a good tissue sample for > biopsy, to check for cancer; and to remove the superior segment of > the right lower lobe, which is blocked and could cause > pneumonia. A pathologist would be standing by to do frozen > slides. If cancer was detected the operation would be > enlarged to remove right lower lobe and some lymph nodes. > Will see the thoracic surgeon May 1 for more details. > The 2nd opinion doctor recommended surgery in next 4-6 weeks. > I’m now set up for a followup visit with my regular pulmo > doc on May 7; and measurement of my PFT at the medical school > on May 22 with followup visit there May 23. The surgery > would be performed at the medical school/hospital.
The last x-ray suggested a neoplasm, which could be benign or malignant. I saw the highly regarded thoracic surgeon May 1. He recommends a thoracotomy to remove right lower lobe, which would reduce lung capacity 25%; rather than just remove the much smaller superior segment. [apparently segmectomy is difficult compared to lobectomy]. Needless to say I’m concerned about losing this much lung, especially with asthma and a below average size chest. [never smoked] Am now set up to get PFTs [pulmonary function tests] measured at my clinic on May 3. Get a PET scan at the VA Hospital on May 6. [not sure if my HMO will pay for this, it's a $2,000 test; takes 4 hr] This is very confusing, when different doctors recommend different things. Perhaps the PFTs and PET scan will shed some lite. I may want to consult another thoracic surgeon, but they are a rare breed. [I'm in N. Calif] Ellis
Response:
> I discovered there is a law in Calif that requires HMOs to refer out > for a 2nd opinion, at the expense of the HMO. AB12 [assembly bill > 12]. The HMO has a list of doctors to whom the referral can be made.
If your primary doctor recommends an expensive surgery, it’s in the HMO’s interest to refer you for a second opinion, whether there’s a law or not. This is OT, but a few years ago an orthopedist recommended a knee surgery where I’d have to have a tendon transferred from my arm to my leg, and I’d have to be in a straight-leg cast for 6 weeks. Needless to say, this didn’t sound too appealing. I went for a second opinion at an office where I was struck by the threadbareness of the carpet and the upholstery in the waiting room. The second orthopedist referred me to a physical therapist. The PT gave me exercises to do, and my knee is now stable, if not entirely recovered. — (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ There are important differences between Milosevic and Sharon. For example, Sharon has better hair.
Response:
I’ve been looking for a post from you! Hoping for the best–please keep us posted! Maureen – Hide quoted text — Show quoted text -> > Hi–wondering how you are and if you received any > > results from your tests? maureen > Results of ‘lung needle biopsy’. > The good news is no cancer was found in this biopsy, or > the previous bronchoscopy biopsy. > The bad news is no pathogens were identified to treat. > The pulmo doc now says there is still a 10-20% chance of > cancer, and has referred me to a thoracic surgeon to > discuss implications of removing right lower lobe. > [4 x 6 cm infiltrate--the CT scan suggests either > pneumonitis or cancer] > Will see the surgeon May 1. [this would result in a > reduction in total lung capacity of around 20% I'm told] > I still feel pretty good, under the circumstances; > a little allergic cough; and occasional hemoptysis. > Walking a couple of miles/day. > If my condition stays stable, I plan to go for a 2nd opinion > from the local Medical School, even if I have to pay for it. > There are some possibilities, like fungus [Valley fever], > chronic mycoplasma pneumonia, anaerobic bacteria, etc. > I got a very comprehensive 2nd opinion Thurs, from the > asst head of the Chest Clinic at the local medical school. > He and the assisting Fellow looked at all my x-rays/CT scan, > pathology reports, bronchoscopy, and medical reports. > He basically concurs with my pulmo doc that at a minimum > I need a VAT thorascopy [3-holes] to get a good tissue sample for > biopsy, to check for cancer; and to remove the superior segment of > the right lower lobe, which is blocked and could cause > pneumonia. A pathologist would be standing by to do frozen > slides. If cancer was detected the operation would be > enlarged to remove right lower lobe and some lymph nodes. > Will see the thoracic surgeon May 1 for more details. > The 2nd opinion doctor recommended surgery in next 4-6 weeks. > I’m now set up for a followup visit with my regular pulmo > doc on May 7; and measurement of my PFT at the medical school > on May 22 with followup visit there May 23. The surgery > would be performed at the medical school/hospital. > I discovered there is a law in Calif that requires HMOs > to refer out for a 2nd opinion, at the expense of the HMO. > AB12 [assembly bill 12]. The HMO has a list of doctors > to whom the referral can be made. > Ellis
Response:
- Hide quoted text — Show quoted text -> Hi–wondering how you are and if you received any > results from your tests? maureen > Results of ‘lung needle biopsy’. > The good news is no cancer was found in this biopsy, or > the previous bronchoscopy biopsy. > The bad news is no pathogens were identified to treat. > The pulmo doc now says there is still a 10-20% chance of > cancer, and has referred me to a thoracic surgeon to > discuss implications of removing right lower lobe. > [4 x 6 cm infiltrate--the CT scan suggests either > pneumonitis or cancer] > Will see the surgeon May 1. [this would result in a > reduction in total lung capacity of around 20% I'm told] > I still feel pretty good, under the circumstances; > a little allergic cough; and occasional hemoptysis. > Walking a couple of miles/day. > If my condition stays stable, I plan to go for a 2nd opinion > from the local Medical School, even if I have to pay for it. > There are some possibilities, like fungus [Valley fever], > chronic mycoplasma pneumonia, anaerobic bacteria, etc.
I got a very comprehensive 2nd opinion Thurs, from the asst head of the Chest Clinic at the local medical school. He and the assisting Fellow looked at all my x-rays/CT scan, pathology reports, bronchoscopy, and medical reports. He basically concurs with my pulmo doc that at a minimum I need a VAT thorascopy [3-holes] to get a good tissue sample for biopsy, to check for cancer; and to remove the superior segment of the right lower lobe, which is blocked and could cause pneumonia. A pathologist would be standing by to do frozen slides. If cancer was detected the operation would be enlarged to remove right lower lobe and some lymph nodes. Will see the thoracic surgeon May 1 for more details. The 2nd opinion doctor recommended surgery in next 4-6 weeks. I’m now set up for a followup visit with my regular pulmo doc on May 7; and measurement of my PFT at the medical school on May 22 with followup visit there May 23. The surgery would be performed at the medical school/hospital. I discovered there is a law in Calif that requires HMOs to refer out for a 2nd opinion, at the expense of the HMO. AB12 [assembly bill 12]. The HMO has a list of doctors to whom the referral can be made. Ellis
Response:
Hi–wondering how you are and if you received any results from your tests? maureen
Response:
> Hi–wondering how you are and if you received any > results from your tests? maureen
I sometimes wonder which is worse: getting a diagnosis of a very serious illness, or getting no diagnosis. ("Well, Steven, the tests were inconclusive, so we still don’t know what is wrong with you….") — Steven D. Litvintchouk
Response:
> Hi–wondering how you are and if you received any > results from your tests? maureen
Results of ‘lung needle biopsy’. The good news is no cancer was found in this biopsy, or the previous bronchoscopy biopsy. The bad news is no pathogens were identified to treat. The pulmo doc now says there is still a 10-20% chance of cancer, and has referred me to a thoracic surgeon to discuss implications of removing right lower lobe. [4 x 6 cm infiltrate--the CT scan suggests either pneumonitis or cancer] Will see the surgeon May 1. [this would result in a reduction in total lung capacity of around 20% I'm told] I still feel pretty good, under the circumstances; a little allergic cough; and occasional hemoptysis. Walking a couple of miles/day. If my condition stays stable, I plan to go for a 2nd opinion from the local Medical School, even if I have to pay for it. There are some possibilities, like fungus [Valley fever], chronic mycoplasma pneumonia, anaerobic bacteria, etc. However the basic saying in pulmonology is ‘When in doubt, take it out’ E.
Response:
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