I’m not contagious

Back in March of this year, I got told “you have cancer.” Those are words I hate hearing and unfortunately have heard them before. However, this time I didn’t know that basically I was a hot mess on the inside. Regardless though, I am a strong female with broad shoulders who will look cancer in the eye and let it know I don’t fight like a girl! I will kick it’s ass one more time.

I wanted to share with the world everything so far that they have found out. (PLEASE NOTE THE FOLLOW ARE TAKEN DIRECTLY FROM MY PATIENT RECORDS..so I do apologize ahead of time if the language is very “doctor”)

7/20/15

Interval History Narrative

42 WF being followed for:

1. 6 mo hx worsening low back pain associated with R sciatica, mild right leg weakness and numbness, and 1 month hx of urinary > bowel incontinance.

2. Axial skeletal bone mets, and L adenaxal area 4.7 cm complex cystic mass on 3-25-15 by BRMC AP CT

3, June 2015 R frontal/orbit headache with nausea

4. July 2015 medial breast pain and tenderness

5. 2008 follicular thyroid cancer post total thyroidectomy and 131I in Brandon

6. 2002 Uterine cancer post TAH (but ovaries retained) in Sarasota

7. FH + for uterine cancer in mother, maternal GM, and maternal great GM

8. Active smoker 9. PCN, sulfa and doxycycline allergies

Impression and Plan Impression

1. 6 mo hx worsening low back pain associated with R sciatica, mild right leg weakness and numbness, and 1 month hx of urinary > bowel incontinance. Need to rule out cancer related cord compression and/or radiculopathy

2. Axial skeletal bone mets, and L adenexal area 4.7 cm complex cystic mass on 3-25-15 by BRMC AP CT

3, June 2015 R frontal/orbit headache with nausea – r/o brain mets

4. July 2015 medial breast pain and tenderness

5. 2008 follicular thyroid cancer post total thyroidectomy and 131I in Brandon

6. 2002 Uterine cancer post TAH (but ovaries retained) in Sarasota

7. FH + for uterine cancer in mother, maternal GM, and maternal great GM

8. Active smoker 9. PCN, sulfa and doxycycline allergies

Plans

1. My concerns for above problems, esp. cord compression, shared with pt and husband. Qs answered. She is also very concered when I mentioned the possible causes. The agree to plans below

2. Given the potential urgencies, DRC will evaluate and possibly admit the pt to MCC tonight. I spoke to PA Kevin Eaton, and the DRC apprised.

3. Bloodwork sent from MIP earlier this afternoon: – routine – CEA, CA19-9, CA27-29, CA-125, calcitonin, SPEP, SIF, SLCs

4. Recommend urgent – TLS spine MRI, brain MRI – decadron

5. Other work up as inpatient/outpatient – bone scan – TVag US – mamogram or breast MRI (pt has implants) – TAP CT to compare with 3-25-15 AP CT – consider gyn consult – bone biopsy of other bx based on updated scans

6. Told the pt course is not predictible in terms of followup. In case a likely primary tumor source of the presumed bone mets is found she will be steered to that tumor program. In case she remains a CUP dx, I have set up an EP visit with routine labs in about 10 days at MIP

Diagnosis:

Bone metastases, Chronic back pain greater than 3 months duration, Headache,

7/28/2015

Interval History Narrative

42 WF being followed for:

1. Since Jan. 2015 – 6 mo hx worsening low back pain associated with R sciatica, mild right leg weakness and numbness, and 1 month hx of urinary > bowel incontinance. Outside 3-25-15 by BRMC AP CT – Axial skeletal bone mets MCC workup: 7-20-15 MCC TLS MRI – no cord compression; small metastatic type lesions; L2-S1 DJD MGUS workup neg. CEA, CA125, CA27-29, CA19-9 all normal 7-27-15 bone scan neg. except for DJD 7-27-15 TAP CT stable bone lesions – ? mets; otherwise neg. – L breast 2.1 x 0.9 cm nodule – 3 mm RML lung noduleL ovarian 3.5 cystic mass,

2. 2015 3-25-15 by BRMC AP CT – L adenexal area 4.7 cm complex cystic mass MCC workup: 7-27-15 TV US – L ovary

3, June 2015 R frontal/orbit headache with nausea

4. July 2015 medial breast pain and tenderness

5. 2008 follicular thyroid cancer post total thyroidectomy and 131I in Brandon

6. 2002 Uterine cancer post TAH (but ovaries retained) in Sarasota

7. FH + for uterine cancer in mother, maternal GM, and maternal great GM

8. Active smoker

9. PCN, sulfa and doxycycline allergies Whe pt first seen pt sent to DRC because of concern of cord compression. But 7-20-15 TLS spine MRI neg. Pt given tramadol in ER, but no help to backpain. Still has low back pain 6-7 on 10 scale. Further outpt workup done including 7-27-15 bone scan neg. except for DJD 7-27-15 TAP CT stable bone lesions – ? mets; otherwise neg. 7-27-15 TV US – L ovary likely has 2 symple cysts

Radiology

07/27/2015

12:45 CT TAP w/Cont (Thorax, Abd,Pelvis):

1. Multiple subcentimeter sclerotic foci are visualized within the spine and pelvis. These are unchanged compared to the priorexamination from 3/25/2015. These did not show activity on bone scan which may be due to their small size. These could still represent osseous metastasis, but are indeterminate.

2. Nonspecific asymmetric nodular density in the left breast, correlate with mammography.

3. Nonspecific 3 mm right middle lobe pulmonary nodule.

07/27/2015

10:53 NM Bone Scan-Whole Body:

1. Osteoarthritic changes of the skeletal system.

07/27/2015

09:16 US Transvaginal:

1. Two anechoic structures in the left ovary without vascularity likely represent simple cysts.

2. The right ovary is not definitely visualized on this exam. Correlate with previous surgical history

07/20/2015

22:06 MRI Thoracic Spine w/wo Contrast:

1. CT scan abdomen demonstrated several tiny sclerotic lesions in the lumbar spine and posterior ilium most of which are not well visualized on MRI but most likely represent tiny sclerotic metastases

07/28/2015

11:30 MRI Breast Bilateral w or w/o Contrast: Finding

1: Oval mass measuring 2.1 cm in the LEFT breast at 3 o’clock 1 cm FN requires additional evaluation. Targeted ultrasound is recommended. (BI-RADS 0)

2: Multiple enhancing foci in BOTH breasts are probably benign

7/28/2015

Thorax

There is a nonspecific 3 mm right middle lobe pulmonary nodule (series 3 image 49). Patchy areas of groundglass opacity are nonspecific and may be related to edema or atelectasis. Tiny calcified right lower lobe pulmonary nodule likely represents granuloma. No focal lobar consolidation.

There is asymmetric soft tissue density in the breasts with a 2.1 x 0.9 cm area of nodularity in the left breast.

Abdomen and pelvis :

Subcentimeter area of hypodensity in the right hepatic lobe (series 2 image 174) is too small to characterize

The kidneys enhance symmetrically. There is mild prominence of the right ureter without calyceal blunting or obstructive lesion. There is a subcentimeter hypodense lesion in the interpolar right kidney. A similar subcentimeter lesion seen in the interpolar left kidney.

Multiple small sclerotic lesions are visualized within the sacrum, iliac bones and vertebral bodies.

7/27/2015

Degenerative changes of the shoulders, knees, feet, elbows

7/20/2015

The sclerotic lesion noted on CT scan the right aspect L3 vertebral body does correlate with a small enhancing lesion seen on sagittal image 6 series

The tiny sclerotic lesions are otherwise not visualized on MRI but most likely represent tiny sclerotic metastatic lesions.

There is a bony metastatic lesion involving left posterior ilium.

In the lumbar spine, there are bulging discs L3-4 and L4-5 and small broad-based disc protrusion L4-5

08/05/2015

Mass at 3:00 2cmfn in the left breast on mammogram correlates with the MRI finding

BASICALLY I AM A FREAKING HOT MESS! 

To recap, there is a mass in my breast, my kidney, my lung, and mets on my the scallop part of my pelvic bone and my spine. Add in my TBI, collapsed nasal passage and sinus issues.

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