Mom and the Pulmonary Nodule of Terror

In My Humble Opinion
1

Yesterday my son was complaining of nausea (and has been nauseous for a few days), so he asked to stay home from school and I asked my mom if she’d mind running him to our doctor’s office just to be on the safe side.

While they were at the doctor’s office, the front desk was kind enough to tell my mother the following,

“Oh! There was something on your last chest x-ray so we’re scheduling you for a CT scan. Someone from the CT place should contact you later today.”

Mind you, my mother’s last physical was a month ago. I’m not sure how long it takes to see a “something” on a chest x-ray, but a month seems a bit absurd. My mom calls me practically in tears, she has no idea what the “something” might be because I’m fairly certain that the front desk at our Dr’s office is trying to win an award for being vague and unhelpful.

My mom finally called the office later in the day and asked them to tell her what it was that the doctor saw. They told her that they have identified a 1.2cm pulmonary nodule in the upper lobe of her left lung. I immediately hit Google because I am a masochist and decided that it was likely somewhere between scar tissue from a previous bad bout with pneumonia (2-3 mos ago) or OMGCANCER. Mom went straight for the cancer diagnosis, of course. I tried to tell her not to jump to the worst conclusion, but I know that I would do the same in her place.

She’s a 53 yr old non-smoker who worked at an electric motor shop for several years and is scared to death that she’s got cancer from the nickle-plating spray they used on motors back in the day.

The CT place called and scheduled her for a week out. I cannot imagine my already tightly wound and worrier of a mother sitting on her thumbs for a week while a nodule she’s apparently had for at least a month hangs out in her lung. Fortunately, a friend at work knows someone at a local hospital’s CT dept and we pulled some strings and got her scheduled for today.

Unfortunately the combination of health care bureaucracy and dr’s office ineptitude have resulted in some trouble getting pre-authorization for the CT scan. The dr’s office has advised my mom that, “You can’t just get the scan anywhere, we already set up an appt for you with XYZ.”

The health insurance company has advised that the dr’s office is dumb and you CAN get the CT anywhere that takes United, but they need the doctor’s office to contact them/the hospital for some information.

Right now we’re all waiting for word back from the care coordinator at the hospital who is working to, well, coordinate between the Dr’s office, the CT dept and the insurance. Eeeee.

I’m posting here to essentially vent a bit, but also to hopefully gain some insight from others who have experienced a wonky chest x-ray, CT scans, etc. What amount of time are we looking at for CT results? Does anyone have any experience with VATS (Video-Assisted Thoracic Surgery), needle biopsy of the lung, etc?

In other news, if anyone has recommendations for primary care physicians in the Phoenix area who take United and/or Aetna, please let me know. I’m pretty much thoroughly disgusted the staff at ours.

2

Sooo… no one here has had any abnormal lung x-rays, huh?

Does this mean that I can safely depend on SDMB membership to protect my lungs from spots, nodules and other blips of doom going forward? :slight_smile:

3

Don’t know what to tell ya, other than that sucks, and I guess it’s probably nothing?

4

Ooo! Ooo! Me! I had an abnormal chest x-ray about 5 years ago. Sarcoidosis. Cleared up spontaneously.

5

Hope it turns out okay. Yes, there is always the chance that a lung nodule can be cancer, but there are also plenty of benign explanations for a lung nodule, if there even is an actual nodule. I’ve had patients who had “something” show up on a chest x-ray but it turned out to be nothing at all on the CT scan…just some kind of image artifact. Radiologists are usually very cautious and have a low threshold for saying that something requires further imaging to be sure it’s not anything bad.

6

I had a suspicious spot on my right lung at my CT-scan two weeks ago. I get scanned every half year after my colon cancer.
The spot had grown from 4 to 6 mm in diameter in the last year.
I was send to a PET/CT scan which should show rapidly growing cells and the spot didn’t light up on the scan. The doctor said it probably was a scar from pneumonia.

I can understand your mother. It was a bad week before I got the result of the second scanning.

7

Thank you all for your responses. Color me shocked that Sarcoidosis can clear up spontaneously! The insurance is still having a hard time getting ahold of our doctor for the “peer to peer review” step of the process. Oy.

Those of you who have had abnormal chest x-rays, did it take a month for your doctor’s office to advise you needed a follow up CT scan?

I’m trying to decide if maybe I was a little rash to try to switch doctor’s based on that response time. Maybe it does take longer to get x-ray results than I think it does.

8

While I have no experience with lung scans, my mother’s recent experiences, combined with my aunt’s experiences, and some others . . .

Well, let’s just say this–the waiting a month suggests to me that it’s odd (and therefore worth checking out) but not expected to be serious, or she’d already have had some sort of follow-up.

Reading most tests seems to take not very much time, communicating with patients for reasonably normal results (as opposed to OMG! take the patient to the hospital for an emergency procedure) seems to take forever.

9

Moving to IMHO, where solicitations for medical commentary generally go. From MPSIMS.

Seriously, hope it turns out to be benign and you all negotiate the red tape successfully.

10

My pulmonologist said he’s seen many cases that were confined to the lungs clear up spontaneously, and of those that cleared up spontaneously, he’s never seen a single xone recur. Mine was also asymptomatic and was only caught because I had a chest x-ray to check on a suspected broken rib.

It took my doctor about 3 days to call me and tell me to come in for a conversation. But they are part of a highly networked and automated system of offices connected to a major local hospital, so that might have something to do with the rapid turnaround on test results.

11

Nothing medically useful to say, just that I’m pulling for you and mom. And yeah. Another doctor’s office sounds wise!

12

I had kidney stones, and they x-rayed me in the E.R. Turns out they give old x-rays to med students to study or something. I get a call like 3 months later saying there’s an abnormal spot on your lungs. Can you come in and have it x-rayed? I had to wait 10-14 days to find out. In the meantime I thought I had cancer, pneumonia, something omgggg I’m going to die. I called everyday for results, bugging them. Finally, they say oh it’s nothing. It was an just a bad x-ray, bad film, or they read it wrong. Stupid hospital for putting me in panic mode.

13

  1. She should have no problem getting her scan done anywhere that takes her insurance, with the caveat that if her plan requires referrals, she would need to get the doctor to write one. She should ask if there’s some medical reason the scan needs to be done at place X (e.g. needs it done with some specialized equipment)… or, perhaps, does the doctor have a financial interest in place X???

  2. The delay of a month after the chest X-ray is INEXCUSABLE. When, if ever, were they going to tell her about this??? A casual offhand remark when she was there for another family member is NOT appropriate.

  3. and yeah - she needs to leave that practice. Bureaucratic mistakes are one thing, but this is sheer incompetence.

14

So was your son okay?

Did you ask the doctor’s office why it took a month for them to notify her? Is it possible they called and left a message on her phone that she didn’t see or hear? I’m notoriously bad about checking my home voicemail since I got my cellphone…I’ve missed lots of calls that way.

15

Don’t panic until there’s reason to panic. A lot of small, solitary pulmonary nodules are benign. Given that your mom was never a smoker, the nodule’s more likely to be a granuloma or a hamatroma than a cancer.

Oh, and folks - learn from malkavia’s mom’s situation. NEVER assume that your doctor’s office will call you if there’s a problem, so no news is good news. If you have a test done and you haven’t received the results (good or bad) from that test in a week or so, CALL YOUR DOCTOR AND ASK FOR THEM! It shouldn’t happen, but things sometimes do get misfiled or fall through the cracks, and you don’t want to be hurt (or worse, die) because some clerk put a piece of paper in the wrong pile.

16

Agreed. I changed doctors once because the office staff never called with test results, you had to call and pester them, they continually lost parts of my file (and more than once misplaced the entire file). The final straw was their change in policy - you now had to make an appointment to get any test results (including your annual cholesterol check) and pay your copay.

17

Most solitary pulmonary nodules are benign, though since a substantial number are malignant they are worked up through imaging tests that are more precise than chest x-ray (i.e. CT, MRI, PET CT) and often biopsied. There’s a website that lets you plug in information about the patient and imaging characteristics to come up with an estimate of how likely a lesion is to be malignant (how accurate this is I can’t say).

On my end of things as a pathologist, if a needle biopsy (cytology test) is done under imaging I often can make a preliminary diagnosis within a few minutes. This is easiest if the cells are obviously malignant; if the lesion is a granuloma due to infection, sarcoidosis etc. it’s harder to tell on cytology smears. Actual biopsy tissue needs overnight processing (whether from a VATS procedure or core biopsy) so most results are out the next day. It’s important to make sure that whoever performs the biopsy has a lot of experience doing them, for reasons of patient comfort/safety/accuracy of obtaining diagnostic material.

As someone who tends to assume the worst for himself or family members when it comes to worrisome signs/symptoms/lab or imaging tests*, I have an idea what the OP’s mother is going through, and hope she gets a speedy benign diagnosis.

By the way, this is getting way ahead of things, but if there’s a lung biopsy done and the results are hard to interpret, the Phoenix area has a world-class pathology group (at Mayo Clinic of Scottsdale). They’re good people to consult if there are questions about the diagnosis.

*my record is laden with false alarms.

18

Seriously. Once I waited, and waited, and waited for some CT results on my ankle, and already knew what the problem was (no cancer, just bone spurs and scar tissue - they just wanted to get an idea of how bad to decide on treatment). The problem was that some doofus at the hospital never sent the results to my doctor, and they wouldn’t release them directly to me because they said my doctor needed to explain them to me (which is ludicrous). It took a while to get it all straightened out.

19

Yeah, my aunt was excrutiatingly slowly diagnosed with gallstones. The unforgivable part of the delay was the part where her test results were sent to an eye doctor with the same last name as the doctor with a more relevant specialty. And no one fussed–not the doctor who didn’t get the results, not the doctor who got irrelevant test results on someone who wasn’t even his patient.