22 July 2013

Good news, Bad news, and Options

Monday dawned and it was a beautiful morning. The traffic on the way North was less than many times we have made the trip. We made good time, found a parking space (actually, there is valet parking at the U of U Med Center so that was easy), and went to the Pulmonology Clinic. After the initial paperwork and check-in, we went over to Radiology for a chest x-ray. Then back we went to the Clinic to wait for our turn with the Fellow Doctor. The nurse that called Ford's name and did the weight, bp, temp, and all was a little older, a bit feisty, and all-in-all very pleasant. Once our doctor came in and began talking, it seemed like the feeling of anticipation of the pending good news mounted. He asked several "pulmonary" questions. Then turned to the computer screen. As he looked through the records and listened as Ford related to him the events of the phone call from the previous day, he gave a "hmm" and then paused and frowned. He hemmed and hawed and mumbled something about "that shouldn't have been done." Then he turned to us and said, "Well, there is good news and bad news. We will go with the good news first. The serology reports did show that, yes. there were a positive results on two cultures, the Microplasma and the Chlamydia. However, the positives showing are antibodies which mean that it possibly could be something current. Yet it also could be showing something from as far as 30 years back. It just shows that Ford HAS had these, not that he NOW has these."

Oh.

"And, the comparison of the chest x-rays taken today with those from a week or two earlier actually show no improvement."

Well, that was definitely not what we had been expecting.

The doctor then did say that normally it does take 6 to 8 weeks for a chest x-ray to show any improvement or difference after treatment. And, that it probably was premature to do a follow-up x-ray so soon after Ford's release.

Okay...

The doctor then talked briefly about options including perhaps doing a round of steroids to see if the lungs would clear. For Ford, steroids is not an option he wants to do. He dealt with Prednisone with the Chemotherapy and refers to it as "the superman drug" because he felt like he could do anything while he was one it and didn't sleep during the time he was taking it. The doctor then said that he wanted to consult with his Attending Doctor and that he would be back, most likely with her.

We waited and briefly talked about the results we had just received.

The Fellow Doctor returned with the Attending Doctor who reviewed with Ford what results were showing. She then talked about pinning down exactly what the cause(s) of the reoccurring pneumonia might be. She talked about repeating the bronchoscopy, this time taking a tissue sample. Here is when the Fellow Doctor spoke up and said that they made a poor choice not taking the tissue sample when they had performed the previous bronchoscopy (with a different Attending).

The Attending Doctor said that a bronchoscopy has a 70% yield meaning 70% chance of showing exactly what the cause is. She explained the procedure and what would be done to gather the tissue and the locations from which they would take tissue. http://en.wikipedia.org/wiki/Bronchoscopy

The second procedure she talked about was a CT guided biopsy done with a core needle and is spot directed. She then said that since it was so specific, it wouldn't be a good choice in Ford's case.

The third procedure is a Video-assisted thoracic surgery or VATS. This procedure has 100% yield and would definitely give results of what the cause is. http://www.health.harvard.edu/diagnostic-tests/video-assisted-thoracic-surgery.htm

She also talked briefly about an Open-lung biopsy.

She told us that she would be doing the bronchoscopy if we chose to do that procedure. If Ford were to choose the VATS, then a very capable thoracic surgeon would be performing the procedure, and that surgeon happened to be her husband.

This is the direction that we could tell they preferred to take, to get some definite answers sooner rather than later. She said that the risks are minimal... of course, there are always risks with a general anesthesia. The most common risk is bleeding. And Ford's blood clotting factor (Factor IV Leiden) could actually be a plus, unless he throws a clot. The other risk explained is an air leak, caused if the lining of the lung should get nicked which then results with a collapsed lung. No problem, they would simply insert a tube to re-inflate the lung and the recovery time in the hospital would be longer.

The other thing that the Attending did, was she could not believe that Ford had passed a walking oxygen test before leaving the hospital. She wanted one done in the office which included some stairs. The Fellow assured her that he had passed the walking test before, however, she still insisted she couldn't believe he had.

We asked for some time to talk over the options we had been given, so the Attending left the room. The nurse who had helped before came in to get Ford for his walking test. It gave me some time to try to process the information.

When Ford returned, the Fellow came back into the room smiling and said that he had really made a definite statement with his walk. That not only did he walk, but the nurse had taken him up to the 4th floor (the clinic is on the first level), and that his oxygen levels were great. Then he told us that he would he needed to go on  his rounds but wanted to know what we decided to do before he left.

Ford and I talked for a few minutes and then decided that we would choose a different option all together. Ford wanted to go home and spend two week recovering without any meds or tests. He would see if he would be allowed to work from home and minimize any outside contact and give his lungs a chance to heal on their own.

The Fellow seemed surprised and let us know that in the case that any symptoms should reoccur, we were to bring him back to the U of U Emergency Department. At that time, the VATS would then be the only option. And that Ford would most likely be admitted to the Huntsman Hospital.

Ford acknowledged the risk he was taking, we made a follow-up appointment and came home. We both felt good about giving his lungs a chance to recover on his own.

Next stop... BYU.

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