In search of … answers

Today was (another) CT scan day — for the high res scans I mentioned earlier. This time they did inspiratory (“Take a deep breath and hold it”) and expiratory (“Take a breath, exhale completely, and hold”) scans. For one of those, I forget which, I was lying on my stomach instead of my back. So now they have all sorts of scans to examine and compare. Oh, and they got a sinus scan too, since the pulmonologist thinks sinus drainage might be a factor. If so, I’m in trouble, because that’s just a year round fact of life for me. Lots of low grade allergies, and there’s always some allergen floating around even if it’s only the dog, the cat, or my outstanding collection of house dust.

It’s my understanding that the pulmonologist will study all this and call me to discuss it on the 21st. She was already booked solid with appointments that day, but I’m content with a phone call. Don’t need to spend an hour driving down there just for a discussion that could be conducted on the phone. I want to see the scans, of course, but I’ll be down there again sooner or later and can see them then.

I’m just hoping she studies everything carefully, has an “aha!” moment, and prescribes something that will quickly, magically banish this cough. Sooner rather than later, please.

The fly in the ointment that I haven’t mentioned before: She’s a fellow. Still studying, with her fellowship having come after her residency. Not exactly a greenhorn, but not a grizzled old pulmonologist who’s been diagnosing tricky lung problems for thirty or forty years. She does consult with another doctor, older I assume. I’m trying to be open-minded about the medical education system and her abilities and knowledge in particular. She might be brilliant. But I can’t help wishing I was seeing the head of the department or an associate professor or someone more experienced than a fellow. I could have seen one of the established doctors if I’d waited till February for an appointment, but I didn’t want to cough that long.

So now I wait. And cough. Some more..


Note: If you’re into medicalese, here’s an abstract I found that sort of explains what’s going on. Remember, the pulmonologist saw a mosaic attenuation pattern on my first CT:

Areas of variable lung attenuation forming a “mosaic pattern” are occasionally seen on computed tomography (CT) or high-resolution CT (HRCT) images of the lungs. This CT mosaic pattern of lung attenuation is a nonspecific finding that can reflect the presence of vascular disease, airway abnormalities, or ground-glass interstitial or air-space infiltrates. However, it is often possible to distinguish among these categories. In small airways disease and pulmonary vascular disease, the pulmonary vessels within the lucent regions of lung are small relative to the vessels in the more opaque lung. In infiltrative diseases, the vessels are more uniform in size throughout the different regions of lung attenuation. The distinction of small airways disease from primary vascular disease requires the use of paired inspiratory/expiratory CT scans. The terms “mosaic perfusion” or “mosaic oligemia” have also been used to describe this heterogeneous pattern of lung attenuation. We believe that the term “mosaic pattern of lung attenuation” is preferable when describing areas of variable lung attenuation because the term “mosaic perfusion” implies pulmonary vascular pathology.


3 thoughts on “In search of … answers

  1. disperser Wednesday, December 09, 2015 / 4:29 pm MDT

    Two ways of looking at it . . . yes, experience counts, but once in a practice, most doctors have difficulties keeping up with all the new advancements, innovations, and procedures. A fresh set of eyes is sometimes good, especially if the problem is outside the norm. From what you have mentioned, you’ve not had anyone giving you a good explanation for the cough. Perhaps a young brain, unencumbered by preconceived ideas borne from experience is exactly what you need.

    . . . of course, if she turns out to be crap, never mind.

    • PiedType Wednesday, December 09, 2015 / 4:49 pm MDT

      LOL. Well, she seemed pretty smart. And I’ve got both her eyes/brain and her supervisor’s looking at the problem. I’ve been given a lot of possible explanations, by several different doctors in different specialties, but no one has said for sure that X is the problem and therefore Y is the treatment. If the chemo was the problem, and/or the radiation, and both of those are now finished, maybe the simple passage of time will be the ultimate cure. But I’d really like to know for sure. And know that the abnormalities now showing on the scans are gone.

      • PiedType Saturday, December 12, 2015 / 12:07 pm MDT

        My sister has subsequently explained that only the very brightest, top residents get offered fellowships and that means this young doctor is one of the best. And as I explained in a subsequent post, she has definitely impressed me.

"You don’t have to say everything to say something." ~Beth Moore

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