Re: Cancer and Kaiser, What facility is best

From: J (meander00_at_privacy.net)
Date: 07/13/04 

Date: Mon, 12 Jul 2004 20:15:55 -0400

Pinstripe wrote:

> Mom is 84. Her symptoms are some weakness but it varies from day to
> day. She has pain in her lower back in the mornings but it goes away
> after an hour or so. (she has arthritis in her lower spine) She has
> lower bowel bloating and pain and has for months. We thought this was
> related to her recent Pancreatitis (she has a very large gall stone
> Kaiser has failed to remove) but apperantly not. She does have
> diverticulitis which could explain the pain. This week she is getting
> a barium enima and xray to further check this out. She has not lost
> weight. She did vomit when she had the Pancreatitis but not since
> then. She has been seen by her doctor for a breast exam last week and
> was ok. She has a mamogram this week. Lymph nodes are all fine. What
> it comes down to in terms of symptons they are the lower bowel pain
> and bloating (painful at times but not disabilitating) and some
> weakness. To me the lower bowel pain seems much less then it was when
> she had full blown Pancreatitis. She does have some coughing and
> chocking. She's had this since she was in her early 40's after the
> birth of my sister. She has never smoked. She does not drink.
>
> She is not bed ridden and still runs her home and is primary care
> giver to my father who has advanced Alzheimer's disease. Her blood
> tests show no enemia, no cancer markers, nothing elevated except her
> Amylase (175U/L). She had Pancreatitis a few months back, and this has
> not dropped but her Lipase is back to normal levels. On her upper and
> lower CAT scans there are no masses, only very small spots in her
> lungs that are not calsified. These spots are too small to biopsy.
>
> The cancer diagnosis is based only on the small lung spots and no
> biopsy or test result. This is the reason I am so concerned she get a
> 2nd diagnosis. At Kaiser if the specialist says noting can be done you
> are returned to your primary doctor and that's where it is left. Nore
> more tests, no treatment, nothing. I think you can understand my
> frustration.

Hello Howard, thank you for the additional information.
I am not a doctor and I was hoping for some input from some of the doctors here first.
Since nobody's showed up yet, I'll stick my neck out and say the following.

Amylase is derived primarily from the pancreas and salivary glands; it is also present in
the ovaries, small and large intestine, and skeletal muscle.
http://medicine.ucsf.edu/housestaff/Chiefs_cover_sheets/pancreatitis.pdf

Absent further cancer findings from the tests you've mentioned, there's really nothing to
"treat" but for perhaps gallbladder removal which may be the cause of the pancreatitis.
(see below for more).

Since her lung cancer is not symptomatic, it doesn't make sense to treat with chemo which
may have side effects.

I would also have her salivary glands and tonsils looked at by an ENT ( your reference to
choking and coughing) . It could just be a nervous habit, a hiatal hernia (GERD) which
might show up on an upper GI barium, a polyp somewhere in the back of her throat,
stricture in her airway from inflammation or fat deposit acquired during pregnancy).
What an ENT does is go down the throat and nose with a device with a camera to look. They
also palpate certain areas in the mouth and below the tongue to feel for abnormalities.
There may also be one good imaging test to look for abnormalities in the head and neck
area.
Possibly have her thyroid palpated and her thyroid levels checked. Her primary care
physician should be able to do those. Those along with the tests you've mentioned is the
most I would ask for if it was my parent or grandparent. There comes a time where
searching just doesn't give enough return for the inconvenience, potential discomfort,
costs and sometimes risks in older patients.

Surgery for a large gallstone?..Well, I was 22 and very fit at the time. It's my
understanding that for large gall stones, they have to do open surgery, which is a big
abdominal cut. The day of surgery isn't bad (other than not being allowed to eat) and
risks of anesthetics unless it can be done with less strong sedation. Day 2 and 3 for me
were awful. Partly because the bed was elevated to suit the short nurses and when they
wanted me up and out of bed, the abdominal pain was excruciating having to stretch way
done to the floor, or bend over to lean on them for support to get out of bed. Once I
told them off and told them to only send me a tall strong male nurse, the problem was
over and I was able to get up and around myself fairly soon. (just an FYI to watch out
for)

I had an IV and a drain (perhaps because it was infected). By Day 3, I was hungry but
they wouldn't feed me. By day 4, I was ravenous and they brought me 2 slices of toast at
which time, I asked them where the rest of the meal was <smile>. They released me day 5
and after a week of taking it easy at home (I was weak), I was able to go back to some
normal activities, but I think the whole healing time is about one month to 6 weeks.
(stitches and being careful bendng).
I'm not sure how long they keep such a patient in hospital these days, but the longer an
elderly person is in bed and/or in hospital, the more chance of catching various
infections (viral or other) and dying of pneumonia.

So the question of an 84 year old, who is already weak, can this person withstand such a
surgery? The other is by doing open surgery, they also can have a look around at other
anatomy nearby. It's also possible to have gallbladder or bile duct cancer (which is
near the gallbladder).

My 3 grandparents lived well into their 90's and as far as I know had no surgeries in
their elder years. I wouldn't want to encourage you (re gallbladder surgery) and have
something go wrong. I'm just giving you some ideas to weigh carefully.

Let's see what the others say. Steph usually has a one-liner for such situations
Thank you reading and whatever happens, please keep in touch and let us know.
J