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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 42812
Experience:  Experienced Oncology Physician trained in New York City. I'm ready to help.
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May I talk to Dr

Customer Question

Hello, May I talk to Dr David
Submitted: 1 year ago.
Category: Oncology
Expert:  Dr. David replied 1 year ago.
Hello, this is Dr. David. I have read your question and I'm ready to help.
what is your question?
Customer: replied 1 year ago.
Hello, Dr David,Attached is the chemotherapy protocol
Expert:  Dr. David replied 1 year ago.
thanks for the chemotherapy protocol.
Customer: replied 1 year ago.
doctor comment with table
Customer: replied 1 year ago.
I forgot to tell I am John
Expert:  Dr. David replied 1 year ago.
what do you want me to do about this chemotherapy error?
Customer: replied 1 year ago.
Is it convenience I talk to you in this open area?
Expert:  Dr. David replied 1 year ago.
sure.
Customer: replied 1 year ago.
Ok fine. Then I can open to talk
Expert:  Dr. David replied 1 year ago.
you need to not be calling me at work.
Customer: replied 1 year ago.
this is my mistake so I drop off immediately and I will not do it next time. I think this is the personal phone.
Customer: replied 1 year ago.
I am apologize for this fault
Customer: replied 1 year ago.
Hope you accept my apologise
Expert:  Dr. David replied 1 year ago.
why do you want to keep calling me?
I have helped you with your already and given my opinion for you to give to the lawyers.
Customer: replied 1 year ago.
I understand what do you mean on the damage of spinal cord. I have MRI on the spine, head and throat. Everything is fine.
Apart from numbness, I the pain did not leave from me specially on the hip area so I cannot go to sleep. The shrinkage of the neck always cause me dizziness, headache and fall down immediately
Expert:  Dr. David replied 1 year ago.
you need an MRI scan of the brain and brain stem with IV contrast
the shrinkage of the neck is from weight loss and fibrosis and scar tissue in the neck.
you need an MRI scan of the hip as well
that could be arthritis or bursitis in your hip
Customer: replied 1 year ago.
But the OT doctor said there is no problem.
I called you because I would like to know the update on the analysis on the chemotherapy error you agreed to me I have TT the money to the bank.
Expert:  Dr. David replied 1 year ago.
I agree with the chemotherapy error
they should have kept you at the lower dose reduction of 80
but if you didn't have any absolute neutrophil nadirs during radiation and chemotherapy, that would have been fine.
Customer: replied 1 year ago.
Last time you asked me why I asked you because I said I trust you
Expert:  Dr. David replied 1 year ago.
I am not a chemotherapy doctor.
Customer: replied 1 year ago.
well, I am the patient not the expert. The lawyer will not listen to me but your analysis is good.so I trust you.
In order to strength my case. Last time we are talking if I can get a help with a simple cover letter telling that
Customer: replied 1 year ago.
On the balance of probability, the frequent syncope and pain has been directly caused by the excessive chemotherapy and exacerbated by the looseness of the mask resulting in greater radiotherapy doses, and causing reduced blood flow through in the major arteries of the neck.Recalculation of chemotherapy doses and radiotherapy dose plans would reduce the risk of the side effects experienced. The symptoms are far greater than expected, and those explained to me before treatment. I receive excess chemotherapy over what was required this would have contributed significantly - by sensitising the radiation - to all the side effects especially the neurological toxicity."is enough.
Expert:  Dr. David replied 1 year ago.
have you had doppler studies of your neck showing reduced blood flow through your neck?
Customer: replied 1 year ago.
A simple cover letter ( no need to be complicated ) for supporting is enough so I can attach the report you sent me before for the board reference and draw for attention. This is the local style
Customer: replied 1 year ago.
I had done the doppler studies . everything is OK. wait a minute for I scan the report
Expert:  Dr. David replied 1 year ago.
if the doppler is ok, then there is no reduced flow through the carotid arteries.
Customer: replied 1 year ago.
but I sometime fall down suddenly without prediction . It seems no blood to brain.
Customer: replied 1 year ago.
You said it is normal.
But Soft Touch on some point of the neck will cause serious dizziness and headache for a few days. This is what you said the fibrosis on the neck and shoulder
Customer: replied 1 year ago.
But it is over expected
Expert:  Dr. David replied 1 year ago.
there is blood to the brain.
the carotid arteries are working.
you need to see a neurologist and get more testing
you might need nerve conduction studies
you most likely have fibrosis and scar tissue in your neck.
Customer: replied 1 year ago.
I agreed the fibrosis on my neck. It is already happened after radiotherapy . The whole neck like the stone very hard according to past medical record. The nerve conduction also show serve degree of numbness this year. The neurologist said he cannot do anything to me.
Expert:  Dr. David replied 1 year ago.
after radiation therapy, I have said before that your doctors should have told you to do neck stretching and flexing exercises to help decrease neck fibrosis and scar tissue.
it doesn't sound like they did this for you.
that is also substandard care.
Customer: replied 1 year ago.
100% no advise. I cannot go sleep after 2 weeks of radiotherapy. The neck like a stone. Whole body in painful and numbness after to now. I also cannot breathe and like suffocation so I breath with hot water steam .
If I know it, I will do more physiotherapy. The answer is everything is normal . You can see my neck
Expert:  Dr. David replied 1 year ago.
you have shown me pictures of your neck.
are you saying I am not giving you advice or your doctors are not giving you advice.
you should be doing more neck stretching and physical therapy after your radiation therapy completed.
Customer: replied 1 year ago.
You teach me a lot so I still ask your advise. There is no advise from my local government doctors.
Expert:  Dr. David replied 1 year ago.
you should be continuing your neck stretching and physical therapy.
Customer: replied 1 year ago.
I must need to do it , otherwise, my neck will stiffen .Is it normal as the attached photos as the neck shrink (the loss of tissue bulk in the neck) and possible damage to nerves to the muscles of the neck (evidently the spinal accessory nerve) . There is also cramps in the neck
Customer: replied 1 year ago.
May I know why I breath with hot stream because of suffocation during and after radiotherapy a few months . Is it because of nasal adhesion and shrinkage of neck.?
If you asked me, I will tell who take the responsibility.of my current situation I will tell the person is the radiation therapist technician who monitor my facial mask fitting .
Expert:  Dr. David replied 1 year ago.
the neck can shrink after you have had neck radiation and weight loss all over your body.
if you can shrug your shoulders, then your spinal accessory nerve is working
you have not had neck surgery. neck surgery would be worse.
yes, your mask should not have been loose during your radiation therapy.
Customer: replied 1 year ago.
May I know when will I have the simple supporting letter from you we talked before ( June) telling thatOn the balance of probability, the frequent syncope and pain has been directly caused by the excessive chemotherapy and exacerbated by the looseness of the mask resulting in greater radiotherapy doses, and causing reduced blood flow through in the major arteries of the neck.Recalculation of chemotherapy doses and radiotherapy dose plans would reduce the risk of the side effects experienced. The symptoms are far greater than expected, and those explained to me before treatment. I receive excess chemotherapy over what was required this would have contributed significantly - by sensitising the radiation - to all the side effects especially the neurological toxicity."Thks David. This is the last chance so I can attached your previous report for the board attention.
Customer: replied 1 year ago.
1-2 pages I think it is enough. This is our style.
Expert:  Dr. David replied 1 year ago.
there is no evidence of greater radiation dose. that can not be proven.
there is no reduced blood flow through the major arteries.
Customer: replied 1 year ago.
How about the significant weight loss - and then
" chemotherapy can exacerbate the consequences of poorly delivered radiation" ?
Expert:  Dr. David replied 1 year ago.
significant weight loss can cause your thin neck.
Customer: replied 1 year ago.
May be I am not telling clearly. I am not talking on the thin neck..
I was informed the radiotherapy and chemotherapy is related to each other specially on the significant weight loss so I can attach the previous report.altogether. Based on my radiotherapy report situation. May i know if you can write simple cover letter on this topic .
Customer: replied 1 year ago.
as you said you can do it for me before.
Expert:  Dr. David replied 1 year ago.
weight loss is complex issue.
you need more evaluation to know why you have lost weight.
if you are eating enough calories?
what is your thyroid hormone levels?
are you having difficulty swallowing?
have you had a swallow study evaluation?
you could have stricture of your proximal esophagus. this can cause it to be difficult to swallow
have you had an upper endoscopy scope to look down into your esophagus to look for narrowing of your esohpagus. this can be caused by radiation therapy
Customer: replied 1 year ago.
I know the above reasons may cause weight loss. I have difficulty in swallowing but I did not arrange for any upper endoscopy scope to look down ....... But t seems they will say the condition is normal if I do the upper endoscopy now..Also, after radiotherapy, the showed position close to left abdomen is painful and then to scrotum for a few years. But USG showed no problem but I felt the scrotum always in wet condition and rub with the inner thigh. What is the root cause ?
Expert:  Dr. David replied 1 year ago.
radiation would not cause problems in your left abdomen area.
if you have difficulty in swallowing, your ENT doctors need to order a barium swallow study and you have to have an upper endoscopy to look at your esophagus to look for stenosis or narrowing of the upper esophagus which can be caused by radiation
Customer: replied 1 year ago.
I understood and I know. This is my another problem.
Customer: replied 1 year ago.
Thank you Dr David
Expert:  Dr. David replied 1 year ago.

you are welcome

please leave positive rating above the chat box so I can get credit for helping you today

Thanks for using JustAnswers.com

Customer: replied 1 year ago.
Dear Dr David,Regarding of the TT for the chemo analysis report, pls, let it be since you are not the chemotherapy doctor. In fact, you have helped me a lot.
Expert:  Dr. David replied 1 year ago.

ok.

Customer: replied 1 year ago.
Thank you Dr David.Furthermore, I talked you there is a typing error on the date on the radiotherapy report.The report is good but still in pending because of the date.
2.5 months delay from the date of radiation planning should be 2.5 months delay from the date of mask making.I was advised it is best if the date is correct in the report but I still do not receive . You asked me to make a change. May I have your authorization to put the electronic signature from the old copy to the revised report
Expert:  Dr. David replied 1 year ago.

yes, you can make those changes.

Customer: replied 1 year ago.
it is very important to have your approval. if it is the possible for you signed the latest copy and then send to me?
Expert:  Dr. David replied 1 year ago.

sure.

Customer: replied 1 year ago.
Thank you David. You are my benefactor.
You print the attachment and then send to meOr I print the revised copy and then I send to you. After you signed it, you can put it back to the returned envelope with address and then send back to me.
Expert:  Dr. David replied 1 year ago.

you print the revised copy and send it to me.

Customer: replied 1 year ago.
Ok.
I print the revised copy and then I send to you.
After you signed it, you can put it back to the returned envelope with address and then send back to me.I can go to have sleep now
Customer: replied 1 year ago.
The attachment just for reference. I submit the electronic signature copy first and then I will mail the copy for your signature in parallel.
Expert:  Dr. David replied 1 year ago.

fine.

Customer: replied 1 year ago.
You know you are highly recommend by all the radiation clinical oncologist. I am wondering if you can come to HK three years ago. Everything will be fixed but I still have the wish on this case.
The road is tough but I cannot give up and keep to walk.
Expert:  Dr. David replied 1 year ago.

I can't come to HK, but keep up the fight.

Customer: replied 1 year ago.
Thank you Dr David. Not only for me, it is the system error. A lot of patients is suffering under this abuse violation of the international system without making any changes.Regarding of the ENT issue, the hospital reply they worked in HK for a long time . They are Chinese and have experience. Positive family history, palpation for lymph nodes, imaging and blood tests do not count much if biopsy was performed.What is the situation in US?
Expert:  Dr. David replied 1 year ago.

not as much NP cancer here in USA.

Customer: replied 1 year ago.
I see. If the comment is fair as you are independent and do not know me
Customer: replied 1 year ago.
My father was died in nasopharyngeal carcinoma when he was aged 4X and I was aged 4
Expert:  Dr. David replied 1 year ago.

I see.

that is the family history.

Customer: replied 1 year ago.
Good night Dr David. I can have good sleep tonight.
Expert:  Dr. David replied 1 year ago.

good night.

Customer: replied 1 year ago.
Apart from the 7 mm gap I found on 4 Nov 2008.
May I know if the plan status is : unapproval is normal procedure on 4 Nov since I have the radiotheraphy date on 14-11-2008
Expert:  Dr. David replied 1 year ago.

a 7mm gap is normal from the lateral fields and low ant fields to protect the spinal cord from overlapping radiation.

the radiation plan was approved on nov 4, 2008 before you started on nov 14. I don't understand your unapproval issue

Customer: replied 1 year ago.
Why the doctor put a stop on medical note? The unapproved was marked in the medical notes attached.
Expert:  Dr. David replied 1 year ago.

that is the dosimetrist and computer automatically printing that out looking for the doctors approval before the start of radiation

the radiation oncology doctor has to approve the radiation plan before the start of radiation.

Customer: replied 1 year ago.
I understand. Because the medical note marking STOP and Rt care . It is normal, right?
Expert:  Dr. David replied 1 year ago.

RT care usually refers to skin care to help calm down radiation skin effects.

Customer: replied 1 year ago.
I see. This is very helpful.
Expert:  Dr. David replied 1 year ago.

you are welcome

Expert:  Dr. David replied 1 year ago.

please leave positive feedback so I can get credit for helping you.