Oncology (General Cancer)/Lung and colon cancer


Hello Dr. HIgby, first let me thank you for taking the time to read this.  I apologize because of its length but I want to give you the full explanation.  This is regarding my Dad.
About 3 months ago he started having some sever abdominal pain.  We took him to the Veteran's Hospital and they did a CT scan of the abdomen.  They decided it was an appendicitis.  They also noted some small spots on his liver and the lower parts of his lungs.  They removed his appendix and part of the bowel because the appendix had partially ruptured and infected the bowel.  After the surgery he had some complications including bleeding and low blood pressure.  So the bleeding stopped but then he got really bad abdominal pain again and they admitted him again.  They did another CT scan and noted that the bowel in a different spot was swollen.  They gave him a course of iv and oral antibiotics and after about 4 days discharged him.  One doctor at the VA said that they are not sure if the swollen bowel is related to the appendicitis and infection so he wants to do a colonoscopy which they will be doing in June.  They also last week did a chest CT scan and noted 3 small spots (5x10mm is the largest) on his lungs and some on Hypodensities on his liver and one on his right kidney (but this could not be fully viewed).  Now I am unfamiliar with the term hypodensity. They are going to be repeating the CT scan every 3 months to see if the spots on the lungs grow.
Now to my questions.
My dad is having a lot of fatigue.  He was having this prior to the surgery.  I am concerned that this can be related to the spots on his lungs because he has had a bad cough for the past 6 months to a year.  Plus he is still having some abdominal pain.  Not severe.  He is also getting some memory loss.  It is hard to get a hold of a doctor at the VA so I was wondering if all this is something to be concerned with.  He had a colonoscopy 3 years ago and they said it was clear.  My Dad is 67 years old.  It was the nurse that notified us of the results of the CT scan via a phone call.  I was able to get the CT scan report from the MyHealtheVet website which you can access the VA records.  I do all the ordering of my Dad's medications and such.  (I am on file as being able to speak for my Dad because he can not hear on the phone and does not understand about getting on the internet).  
Is there anything I can do for my Dad to help him get through this.   Plus how long does it take before if they know it is something really bad.  I think the part that concerns me the most is the fatigue.  My dad was a logger for 40 some years and was always the rock in the family.  Again thank you for your time

A chronic cough and fatigue are bad signs, but I'm not sure they are related to the relatively small abnormalities that are seen on CT scan.  I agree that if the spots are very small a safe bet is to check again in three months.  Hypodensity simply means that there are spots in the liver which aren't as dense as the surrounding tissue.  They could be cysts or tumors or congenital abnormalities.  
If he were my patient I would start by making sure he did not have tuberculosis or a fungal disease of the lungs.  If that was ruled out by skin tests and/or blood tests, I would consider first a ct scan with a PET scan (if the PET shows uptake where the spots are, that would be a good reason to do a biopsy right then).  If the PET is negative, I'd consider a bronchoscopy.  To me it sounds like he has a chronic lung infection and the spots are simply distractions.  He needs to find a doctor who will get to the bottom of this.  As for his memory loss that may be related to what is going on or could be a separate issue.  People at his age could have early Alzheimer's disease, which is unfortunately increasingly common.  Keep me posted on what is going on.  

Oncology (General Cancer)

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Donald Higby, M.D.


I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.


I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

American Society of Clinical Oncology

New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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