Metastatic CA

[VentdependenT]

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Consult for Craniotomy tomorrow:

59y/o with hx breast Ca present to ER for "presyncopal episode" with fall and arm pain + vision changes 2 Day ago. Found to have pathologic fx of Right arm. Off to MRI/CT scan. Discover Lung metastases and large mass involving kidney with infiltration of renal vein and IVC. Head scan shows large tumor with mass effect.

Pt poorly controlled DM (hba1c of 15) with moderate HTN.

Denies CP/SOB. Sedentary lifestyle. Only recent neurologic changes.

Scheduled for MRI with anesthesia for tomorrow then off for a craniotomy immediately after.

Is there a reason to do this case? Yes or no? I say yes for quality of life, but sheesh what a bummer eh?

 

[Noyac]

Everyone knows how I feel about futile care. this however, may not be one of those cases. Do the crani and take the kidney out at the same time.

 

[supahfresh]

I agree. Its palliative, but its the right thing to do as long as the patient wants it done.

 

[toughlife]

Consult for Craniotomy tomorrow:

59y/o with hx breast Ca present to ER for "presyncopal episode" with fall and arm pain + vision changes 2 Day ago. Found to have pathologic fx of Right arm. Off to MRI/CT scan. Discover Lung metastases and large mass involving kidney with infiltration of renal vein and IVC. Head scan shows large tumor with mass effect.

Pt poorly controlled DM (hba1c of 15) with moderate HTN.

Denies CP/SOB. Sedentary lifestyle. Only recent neurologic changes.

Scheduled for MRI with anesthesia for tomorrow then off for a craniotomy immediately after.

Is there a reason to do this case? Yes or no? I say yes for quality of life, but sheesh what a bummer eh?

I would not wish that on anyone.

 

[VentdependenT]

Urology boys aren't on board yet, but I'll give em a heads up. Let ya know how it goes.

 

[Planktonmd]

Urology boys aren't on board yet, but I'll give em a heads up. Let ya know how it goes.

This craniotomy is intended to improve neurological symptoms and maybe a better quality of life for whtever time this poor patient still has.
She is not going to be cured and her best outcome would be a year or two of acceptable quality of life, that's not too bad though, it could be worth it.

 

[Mman]

Pt poorly controlled DM (hba1c of 15) with moderate HTN.

I'm not sure if "poorly controlled" is the wording I'd use to describe her DM. An A1C of 15 is somewhere in the range of an average plasma glucose of 450-500 over the last 3 months. I'm not sure that is controlled to any degree.😱

 

[Fastrach]

Surgery or not, she's a goner within the next month, I guarantee. Even if she makes it thru the crani, with those comorbidities she'll very likely end up on the final common pathway: tubed in unit postop, won't be able to wean, will pick up either a nasty infection or DVT/PE along the way, likely have a demand MI in the process, get her beans banged & end up on dialysis, then at the very best will end up trached, pegged, and maybe get sent off to an LTAC or SNF to pick up some pseudomonas or mrsa if she somehow survives all this. That's if she doesn't have a complication from the crani that brings her back to the OR a few more times in the process.

Seriously, I'd opt to save her that fate and consult Palliative Care for hospice. I MIGHT buy into a "palliative" VP shunt vs. ventriculostomy if she's got bulging vents.... but if I were the patient, I'd ask for the Fentanyl patch and fishin' pole. Just my 2 cents.

 

[VolatileAgent]

Surgery or not, she's a goner within the next month, I guarantee. Even if she makes it thru the crani, with those comorbidities she'll very likely end up on the final common pathway: tubed in unit postop, won't be able to wean, will pick up either a nasty infection or DVT/PE along the way, likely have a demand MI in the process, get her beans banged & end up on dialysis, then at the very best will end up trached, pegged, and maybe get sent off to an LTAC or SNF to pick up some pseudomonas or mrsa if she somehow survives all this. That's if she doesn't have a complication from the crani that brings her back to the OR a few more times in the process.

Seriously, I'd opt to save her that fate and consult Palliative Care for hospice. I MIGHT buy into a "palliative" VP shunt vs. ventriculostomy if she's got bulging vents.... but if I were the patient, I'd ask for the Fentanyl patch and fishin' pole. Just my 2 cents.

dude, you need to post more. seriously.