Need You Guys Help-Please Pray for My Patient

[island doc]

---

Members don't see this ad.

I need you guys help. Please pray for my patient. God knows who the patient is. (No pun intended.)

I have been working with a middle aged patient this week. Presented with epigastric pain, nausea and vomiting, weight loss. Abdominal US this week revealed multiple solid masses in the liver. Confirmed on CT today. Suspicious for neoplasm. CT abdomen otherwise negative. The first thing on my plate for Monday morning is to arrange for liver biopsy. I don't have a good feeling about this.

There are times medicine is not fun, I fear this will be one of them. 🙁

The last malignant tumor I discovered was a medulloblastoma in a 17 year old high school senior who was wanting to join the Army. (No chance of that now.) Classic triad: Headache, Nausea/Vomiting and Ataxia. He actually did very well considering his diagnosis. Complete surgical resection by a pediatric neurosurgeon colleague of mine, followed by chemo and radiation at St. Jude's. He was left with a posterior fossa syndrome though, but no mets.

Prior to that was having to tell the parents of a beautiful 11 year old girl that my efforts to resuscitate her after she had drowned had failed and that she was dead. That was the beginning of the end for me in emergency medicine.

 

[aatrek]

I wish you and your pt all the best of luck and health.

I am wondering, however, what field are you in.

I can tell you, coming from a surgical onocology perspective, liver bx for dx of solid masses in the liver are very rarly helpful. There are very limited senioros that the bx does any help and it comes with a significant risk (mortatily of .5-15% depending on presence of cirhosis) and also with risk of onocologic spread.

I realize that liver mass bx are done frequently in medicine, however, I can tell you that onocologic lit. supports dx via tumor markers and rad studies.

sorry... if I am intruding. I realize that you did not post this for medical adcive, however I find myself being consulted after a non-helpful bx has been done all the time.

good luck
A.

 

[island doc]

I wish you and your pt all the best of luck and health.

I am wondering, however, what field are you in.

I can tell you, coming from a surgical onocology perspective, liver bx for dx of solid masses in the liver are very rarly helpful. There are very limited senioros that the bx does any help and it comes with a significant risk (mortatily of .5-15% depending on presence of cirhosis) and also with risk of onocologic spread.

I realize that liver mass bx are done frequently in medicine, however, I can tell you that onocologic lit. supports dx via tumor markers and rad studies.

sorry... if I am intruding. I realize that you did not post this for medical adcive, however I find myself being consulted after a non-helpful bx has been done all the time.

good luck
A.

You are by no means intruding. Actually, PET/CT had crossed my mind, but after talking with the radiologist (who recommended biopsy), I decided to go that route, but plan on talking with a general/oncologic surgeon about this on Monday. I do plan on CEA, CA-125, etc, and may yet still go the PET route.

P.S. Radiologist: "My heart sank when I saw this."

 

[island doc]

Latest Update. Patient now hospitalized with 99% certainty (pending path results) of esophageal adenoCA with liver mets. No need for liver biopsy.

 

[primadonna22274]

I'm so sorry islanddoc. This stuff is hard.
My first year in practice I found 3 serious breast cancers in a 4-month period, all by palpation. I felt like the angel of death.
This is the stuff that can keep us human or make us callous. Give it to God and know that you have done the best you can.
Lisa PA-C

 

[r90t]

You may have caught his disease at a point where he can still have some quality of life with treatment thanks to medical intervention. I have the ENT/GI service right now in an underserved area of the country and all of my pts are T3-4N0-2cM0-1. I rarely see T1-2 dz. Aggressive induction chemotherapy combined with chemo/radiation offers quality time, but it is likely palliative care. You have bought him time to get his affairs in order, something that is a huge benefit, for both himself and his family. Having suffered a sudden loss in my immediate family recently, I would have cherished the extra time that you have given this patient and family.