My Mom (F, 72, long-term smoker, otherwise remarkably healthy and fit at dx) with NSCLC Stage 1B (I think) 2/07. Went for lobectomy in 4/08 to remove 2 'small' tumors. Sugical error lead to removal of entire left lung. Lymphs clear. Continues follow up with surgeon and PCP every 3 mos. (Blood work, xray). Never had a post op CT. Has never needed oxygen.
Did well until 4/08. Began chronic cough in April (one year post op). Initial suspicion was 'seasonal allergy' related. Chough persisted despite allergy treatment. She and PCP progressed to tx for post nasal drip, gerd, etc. Condition worsened. Used Prednisone, Symbicort, antbiotic, prilosec, coedine syrup. Condition worsened. Hospitalized 7/14-7/20. At admission: fever 99.5, chest xray fine; CT showed a "couple tiny white spots and shadowy thing around aorta", lying flat exacerbates cough (nearly impossible - she sleeps in a recliner); severe fatigue and weakness; rib soreness, shortness of breath upon simple exertion. Tx: IV Levaquin; neb. xopenex; singulair, prednisone 10mg QD; musinex; prilosec; percoset by PCP and Pulmonoligist. Condition improved to 'moderate' after 6 days (less cough, more exercise tolerance (approx 1/4 mi slow walking), less fatigue, sleep with sleep medication). . Released on 7/20. Condition not improved since; cough (clear mucus) returning. General condition: fatigue, weak, periodica low-grade fever/chills, generally lousy - not as bad as when admitted but a bit worse since discharge. PET scan scheduled for next week.
Does it sound like the cancer perhaps has returned?
Is a chronic cough common after lung removal? (Worse upon lying down, talking, bending forward, quick movements)
Could we be overlooking something we ought to be investigating?
She was in awfully good shape in April and is in awfully bad shape now. I've been positive and patient but I'm gettin' kind of freaked out now. Any words of wisdom would be greatly appreciated!
The cough is difficult to ascribe only to a cancer recurrence for smokers and for those who have undergone surgery. The only clear way of diagnosing the recurrence is to see it on the imaging, and hence, the PET would be able to give the best evidence for or against it.
It seems that she has also received the full battery of drugs, including suppressants and antibiotics.
It may be a good idea to keep a diary as to time and place where the attacks are more frequent. While initially an allergic basis was considered, she may benefit from fresh air. IF the attacks tend to associated with a lot of phlegm, mucus, has she tried to use any inhalers with ipratropium (this drug tends to dry up mucus)? Is the pulmonologist considering chronic obstructive lung disease?
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