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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Oncology
Satisfied Customers: 10553
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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Second opinion] - Surgeon wants to biopsy by going in side

Customer Question

Second opinion] - Surgeon wants to biopsy by going in side ribs up to upper left lung and I am not against it because I want to know what is going on. IPF and Lung cancer run in my family big time. My question is would this be a smart decision at this time? I feel I am over the crisis but still have stats that drop when I lay down or when active for a bit.I have had numerous CT scans in the past few years that describe my lungs as having pulmonary scarring, air trapping, mosaic lung pattern, poor inspiratory effort. Two nodules 7mm in right middle lobe and 5mm right lower lobe have been unchanged for years. Recently I was in one hospital for low oxygen, sob and have always had a chronic non-productive cough. Discharged and back at a bigger hospital 3 days later even worse. They even warned me I may need to be on a vent. I have muscle soreness and weakness x3 years and muscle spasming in abdomen and back that is worse some days than others that started 4 months ago. I have constant pain in upper lungs and constant pain around lower lungs that feels like being hugged too tight. I am on home oxygen to be used during sleep and when active or reclining. The trending test showed I went down to 86% at the 3-minute mark. I have edema that is treated with 2mg of bumex 2x a day but I still retain a lot of fluid. When admitted I weight 297 at 5’6” and after discharge was down to 271. On a July 2016 CTA I also had a 15 mm right hilar node.
CTA that was done on 9-7-16 at first hospital admission
There are bilateral upper lobe predominantly patchy ground glass opacities including peribronchial groundglass nodules. A few of these grown glass nodules are also present in the right middle lobe. minimal dependent atelectasis in noted at lung bases. mild interlobular septal thickening with upper lobe predominance. Enlarged pretrachael, subcarinal and bilateral hilar lymph nodes measuring 1.7cm in short axis. mild interlobular septal thickening with upper lobe predominance. Likely mild pulmonary edema. infection unlikely.Next admission 09/13/2016 PROCEDURE: CT CHEST NON CONTRAST - HRCT PROTOCOL
COMPARISON: Recent chest CTA 9/7/2016.
Lungs: There are scattered patchy ground-glass opacities, seemingly
randomly-distributed throughout both upper lobes, and to lesser
extent, the lingula and right middle lobe, with a discrete 8 mm
irregular ground-glass nodule in the anterior aspect of the right
middle lobe (6:100). These occur largely at sites of more dense,
confluent patchy consolidations on the recent CTA, with normal
intervening pulmonary parenchyma.Of note, there is no only minimal paraseptal emphysema at the lung
apices, with no evidence of underlying interstitial lung disease.
There is no significant air-trapping on the expiratory-phase
acquisition, with only minimal bibasalar dependent atelectasis.Airway: The proximal airways are patent.Pleura: No pleural effusion, thickening or calcification.Lymph nodes: There are a few small lymph nodes in the pretracheal and
-carinal stations, smaller than on the recent study, and not meeting
CT size criteria for pathologic enlargement. There is no
intrathoracic, axillary, supraclavicular or lower cervical
lymphadenopathy.Thoracic aorta and great vessels: The thoracic aorta is normal in
course and caliber with minimal atherosclerotic calcification.Pulmonary arteries: Unremarkable.Heart and pericardium: The heart is normal in size without
pericardial effusion. There is no detectable coronary artery
calcification.Lower neck/mediastinum: Unremarkable.Thoracic spine and chest wall: There is anterior wedging of the
T8-T10 vertebrae with resultant kyphosis, not significant change
since the recent study, with no acute-appearing vertebral
compression. Also noted are degenerative disc and endplate disease
throughout the thoracic spine, with apparent congenital T1-T2 "block
vertebra."Visualized upper abdomen: Unremarkable, allowing for the
non-enhanced acquisition.
_______________________________IMPRESSION:1. Patchy ground-glass opacities scattered throughout both upper
and, to a lesser extent, middle lobes, at sites of consolidations on
the recent outside CTA, therefore, likely post-inflammatory; the
intervening pulmonary parenchyma is unremarkable.2. No finding to suggest underlying interstitial lung disease, with
only minimal biapical paraseptal emphysema.3. No intrathoracic lymphadenopathy, with only small anterior
mediastinal nodes, smaller than on the previous study and therefore,
likely "reactive."Do you feel a biopsy is warranted?Will testing the upper lobe scarring explain all the new nodules and why all those enlarged lymph nodes?
Submitted: 17 days ago.
Category: Oncology
Customer: replied 17 days ago.
Dr. David has answered that I should have a biopsy in the past, so I pushed to seek a surgeons opinion. The surgeon will be taking from an area in my upper left lung. Is it likely the ground glass opacity as described will give reason for the enlarged nodules all in the center of my chest as well as the multiple new irregular ground glass nodules as well? He is not taking a sample of either of those...
Expert:  Dr. Rick, MD replied 16 days ago.

Hi. Dr Rick here. I completed an Internal medicine internship in NYC and have two decades of clinical experience. How can I assist you today?

Expert:  Dr. Rick, MD replied 16 days ago.

Question and answer is just one of the services I offer. I can also provide you with premium services, such as live telephone or skype consultation, at a small additional cost. Let me know if you are interested.

Do you have any other medical problems or take any medications?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.

Customer: replied 16 days ago.
This is the list directly from my patient portal
• Iron deficiency
• Retinal venous tortuosity
• Hypoxia
• Shortness of breath
• Abnormal chest CT
• Lung nodule
• Balance disorder
• Obesity
• Restless legs syndrome
• Oligomenorrhea
• Intrinsic asthma with acute exacerbation
• Cervicalgia
• Chest pain
• Lower back pain
• Floppy eyelid syndrome
• Transient diplopia
• Sciatica, left
• Muscle spasm
• Morbid obesity
• Snoring
• COPD (chronic obstructive pulmonary disease)
• Onychomycosis of toenail
• Dry eye syndrome of both lacrimal glands
• Metabolic syndrome
• Generalized anxiety disorder
• Post-traumatic stress disorder
• Impaired fasting glucose
• Esophageal reflux
• Hearing loss
• Asthmatic bronchitis
Customer: replied 16 days ago.
I just had a sleep study that showed mild sleep apnea 11 times a minute. Also, even with cpap machine they couldn't get my oxygen above mid 80's when asleep, which is where it dropped to as soon as I fell asleep with a low of 70.
Customer: replied 16 days ago.
sorry but I checked with my other patient portal and to add there is
balance disorder
Coronary artery arteriosclerosis

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