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After Cancer Finding, Patient Shouldn’t Need To Wait for Information

Dear Dr. Roach: My 81-year-old mother-in-law had a biopsy done on a lump in her breast on a Friday. The following Tuesday, the doctor’s office called to tell her it is cancer, but she cannot get an appointment with the doctor until three weeks later. No other information was provided. When she called the office to get some more information, a nurse just said, “The doctor will talk with you at your scheduled appointment.” In the meantime, my mother-in-law and our entire family are just a bit stressed trying to deal with the cancer diagnosis and what it might possibly mean. I’m guessing/hoping that it must not be too serious or the doctor would not be making her wait so long. I’m just wondering if this is normal to give a patient this kind of news and then make her wait so long to get more information. Sounds kind of cruel to me. I would appreciate your thoughts. — G.G.

Answer: I am horrified at this treatment. The diagnosis of cancer is always a difficult one to hear; it is life-changing, and there are many questions that need to be answered. Regardless of how “serious” the doctor thinks it might be, waiting three weeks to get any information is just wrong. I know firsthand just how busy doctors can get, but you have to make time to have this conversation with the patient and her family.

Dear Dr Roach: I am a 71-year-old male recently diagnosed with idiopathic pulmonary fibrosis. Three breathing tests and two lung CT scans have shown mild restrictive lung capacity and that the fibrosis is not progressing at this time. Also, fortunately, I am not experiencing any breathing problems.

My lung specialist suggested taking 600 mg of acetylcysteine three times daily. He also suggests periodic CTA exams and breathing tests. It is my understanding that at this time, the condition is not treatable. Could you provide your opinion on the value of these suggestions? — R.D.

Answer: Idiopathic pulmonary fibrosis is a progressive inflammation of the lungs of unknown cause. Different people will progress at different rates, and the fact that yours is not progressing, as shown by the lung CT scans and breathing tests (pulmonary function tests, or PFTs), is very good news. I do agree with your pulmonologist and recommend keeping up with these tests to monitor your condition.

Your understanding that IPF is not curable at this time is correct; however, it is treatable, and your pulmonologist (lung specialist) is treating it. The N-acetylcysteine you are taking has been shown to reduce the rate of progression. Another drug, pirfenidone, has had some benefit in trials, as has Viagra and medicines like it.

Not smoking is always important for everybody with any kind of lung disease, and as the condition progresses, many people will need oxygen. Pulmonary rehabilitation improves symptoms of shortness of breath and increases walking distance.

The Pulmonary Fibrosis Foundation has much information about this condition at www.pulmonaryfibrosis.org, as does www.ipftoday.com.

Dear Dr. Roach: My husband had shingles about five years ago; when we went in for our flu shot, we were both encouraged to also get the shingles vaccine. Doesn’t he have immunity from actually having had it? We are both 60 years old. — J.R.

Answer: Even if you have a history of shingles, you should still get the shingles vaccine, since it is still possible to get shingles again after having it once.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.