I am not sure why PET scan was not done. If medicare does not cover it, is it possible for you to pay for it? Though PET scan would show extensive disease the stage does not change. It is stage 4 disease now and the management is only palliation. Since the pathology had been reported as poorly differentiated carcinoma most probably the primary would have been from one of the prior cancers she had. Stage and treatment does not change for both type of cancers since the disease is already spread throughout the body and treatment would be just symptom control and possible try for relief.
EF is 35 % which means her heart is not quite good to tolerate any kind of chemotherapy. She also had electrolyte imbalance in addition to few serious infections and multiple fractures.
Please understand and accept that this condition is serious and she is terminally ill (which may be my inference based on the clinical conditions you have given me - I MAY STILL BE WRONG - YOUR DOCTOR IS THE BEST PERSON TO JUDGE THE TREATMENT. Any amount of investigation is not going to help her at present as she may not be fit for any form of treatment.
Please discuss with your doctor about a peaceful end of life care procedures in case if your doctor had not discussed with you earlier.
Hope I could clear your doubts. I will be available to answer any of your queries online --> https://www.icliniq.com/ask-a-doctor-online/medical-oncologist
Thank you doctor.
\nYes, they drained the pleural effusion. I believe 1200c's of dark blood tinged fluid. Positive for malignant cells but pathology only revealed poorly differentiated carcinoma. They punctured her lung in process and she has a partial pneumothorax. Initially breathing was vastly improved but in last few days has become quite difficult.
\nShe is in a great deal of pain but managed by hospice care to the extent possible. My real frustration is not knowing her primary site and suspecting that the doctors are being vague to cover for their incompetence. Shouldn't the bone scan have revealed something?
\nI asked for a PET scan last week on the day she was admitted - Wednesday and he said that Medicare would not pay for an inpatient to get a PET scan. She just went to her primary two weeks ago and she sent her home on lasix and an increased dose of amitriptyline 50mg for her depression. This was done with no blood work and a history of low sodium, chloride and albumin.
\nShe entered hospital with hyponatremia, severe weakness and dementia. That is when they decided to drain the fluid. She also had two enlarged lymph nodes for the past 4 months in her chest area behind her heart. Echo revealed 35% - cannot remember which side.
\nThey never tested her for lupus, HIV, sarcoidosis. Is it also possible that she has pulmonary fibrosis? What are other causes for lower lobe bilateral scarring? I accept that she is dying but I have issues with her being all of a sudden stage IV with no primary, and poorly differentiated carcinoma and no answers from imaging to date.
\nHer liver enzymes have been fine. Her white count has never gone up with prior infections. Only a slight left shift when she had the pseudomembranous colitis with the cdiff. She has been mildly anemic for years. Receives vitamin B12 shots regularly. Her illnesses always come on when she is doing well and starts getting out more.
\nShe lives in warm, very humid climate. Her furnace was disintegrated with broken metal burning in the pilot light and soot or particulate matter all over it. I moved her out in June after she fell coming back to bed and broke her tibia and fibia straight through with separation right above the ankle.
","datePublished":"2014-10-15T11:32:47","author":{"@type":"Person","name":"Anonymous User 01HACE0CQQXYFDQV9T79PP1Q57"}}}]}The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Medical oncology
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