Case Examples From My Practice
Case 1: Finding a solution the patient could accept
A 51-year old woman was recently diagnosed with Stage 2 breast cancer. Because the tumor was
relatively large and her breast was relatively small, she was advised by two separate oncologists to have a mastectomy. The
patient was greatly distressed as she did not want a mastectomy but also did not want the poor cosmetic outcome of lumpectomy.
After reviewing her breast MRI scan and pathology reports, I told her about a procedure called skin-sparing, nipple-sparing
mastectomy with immediate reconstruction. She was very enthusiastic about the procedure since it would clearly have a better
cosmetic outcome. She wondered aloud why none of her oncologists told her of this option. I sent her to UCLA Medical Center-they
are experts in the procedure and could give her plenty of information regarding its high benefits and low risks. When her
insurance company would not cover the UCLA surgical team, I helped her negotiate the insurance maze. The UCLA team ended
up doing the surgery and her insurance covered the expenses.
Case 2: Implementing The Latest Research
A 55 year-old lecturer/author was found to have squamous cell cancer of the back of the tongue
with metastases to the neck and lung. His oncologist (a well-known doctor in a large city) recommended a treatment with the
standard chemotherapy regimen that had a 30% - 40% rate of partial or complete remission. The patient wanted to know if more
effective treatments were available.
This man contacted me around the time of the American Society of Clinical Oncologists' annual conference. While I was there,
I specifically researched this case. It turned out that the percentage of partial and complete remissions in this kind of
cancer could be doubled (to 88%) if a newer medication type, an EGFR (epidermal growth factor receptor) inhibitor, was added
to the chemotherapy. The oncologist, when presented this information, was very uncomfortable with the newness of the protocol
and convinced the patient to proceed with the standard chemotherapy. Within six weeks, the patient landed in the intensive
care unit, near death because the cancer had progressed dramatically. The oncologist then told the patient that there was
nothing more to offer, that he should just accept that he had only a few weeks to live. I was able to find another oncologist
who was comfortable with adding anti-EGFR medications to the treatment plan. Soon thereafter, the patient went into a partial
remission. As of the time of this writing, the patient continues in partial remission more than 11 months after his diagnosis
of metastatic squamous cell cancer. During this time, he has actively continued his writing career.
Case 3: A Misdiagnosis
A 51-year-old woman had metastatic lung cancer. She was very unhappy with her oncologist who rushed
appointments, didn't return phone calls and generally appeared uncaring. She was certain that her oncologist had given up
on her.
The preliminary pathology report diagnosed the cancer as a non-small cell lung cancer. I obtained a copy of the final pathology
report. The final report revealed the cancer to be of the small cell type, a completely different tumor from the non-small
cell variety. That meant the oncologist was giving her the wrong chemotherapy for her type of tumor. With my help, they
found another oncologist who was much more meticulous in his attention to the case. The chemotherapy was changed to a more
appropriate combination. All test results were subsequently sent to me for review. Our discussions of those results helped
the patient understand her disease process and her treatment choices more fully. Despite the initial mistreatment, she outlived
her prognosis by almost a year of quality life.
Case 4: A Missed Diagnosis
A 45-year-old woman suffered from moderately severe chronic shoulder pain. After surgery, she
accidentally tripped over her dog and fell on her shoulder. After that time, her shoulder pain worsened. Her surgeon could
find nothing wrong and was at a loss as to how to help. She consulted a second surgeon who then performed two more shoulder
surgeries. Her shoulder pain continued to worsen, requiring daily treatment with strong opioid (narcotic) medication.
I contacted the country's leading authority on shoulder injuries and arranged for an appointment. She traveled to Texas where
the shoulder expert found that a shoulder tendon had been pulled away from the bone (avulsed) when she fell after her first
surgery. The original orthopedist missed it. The second orthopedist not only missed it, but also compounded the problem
by performing two further, inappropriate surgeries. The needed corrective surgery was done and resulted in a much better
quality of life.
 |
