Re: would you order an MRI ....The correct answer

[Guest guest]

Two Red Flag:

1)

Something about it seemed different to you. Go with your

gut always. You have experience; you have felt thousands of lipomas

before.

2)

It suddenly appeared 3 cm size in 1 month. I have had

people say they have had sudden growths of lipomas but usually weight loss

precipitated the discovery. So that was a red flag too.

However, you probably should have posted the question of the

best imaging for a new onset soft tissue mass rather than best imaging

technique for a lipoma.

Great catch for you. Sorry for the patient though.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Dr.

Nwaizuzu

Sent: Sunday, December 12, 2010 4:29 PM

To:

Subject: would you order an MRI ....The correct

answer

Thank you all for your response. believe me, I am not the

kinda doctor that sends every lipoma case to MRI. infact I have never sent one

for radiologival studies before and I have seen more than a thousand cases

in this lifetime. To be perfectly honest with you guys November 22nd 2010 was

the first time I MRI-d such lesion.

There was something about that mass that worried me. I

looked at this tumor for more than an hour that very day.. and even now looking

back at it. i cant place a finger on what it was that disturbed me. Even

after the diagnosis was established I have examined and re examined it without

knowing why I had sent the guy for an MRI.

One thing I am sure was that if he didnt have an insurance i

probably wouldnt have gone the MRI route but as God will have it he had

Bluecross blueshield, and they didnt gve me a hard time with pre auth process.

I cant thank God enough that I listened to that thiny inner voice that

urged me to MRI the lesion.

When i got the call from the radiologist the following

morning my heart almost stopped. he said its 90% likely its soft tissue sarcoma

histiocytoma... I sent the patient to a oncology surgeon who confirmed the

diagnosis after a biopsy and histology. I know absolutely nothing about this

neoplasm. so i googled it. and on the first page I saw that a family physician

was burnt by this diagnoisis sometime in 1993..see the link below.

http://www.nwsarcoma.org/sarcoma-stories/patient-profiles/328-linda-h

I am still in shock. and may not recover again from this

experience. I am sure my views of lipoma-like tumors has changed for ever. morale

of the story;In medicine always trust your instincts

thanks

Nwaizuzu MD

From: " Kennedy, Jim "

To: " "

< >

Sent: Sat, December 11, 2010 4:09:19 PM

Subject: RE: would you order an MRI

Cheapest treatment is excision. I would do it if he is worried.

________________________________________

From:

[ ]

On Behalf Of Dr. Nwaizuzu [familydocta@...]

Sent: Saturday, December 11, 2010 2:58 AM

To:

Subject: Re: would you order an MRI

the patient noticed the mass a month ago

has remained the same size since he first noticed it

no lymphadenopathy

He has been healthy . no other symptoms.

the consistency is pretty much that of a lipoma.

________________________________

To:

Sent: Fri, December 10, 2010 7:04:10 PM

Subject: Re: would you order an MRI

How long has he had it? Is it growing? does he have others? How are his nodes?

How is his constitution? If had x long time, unchanged and feels benign, Could

have it removed for cosmetics or so clothes can fit.

If new, increasing size, FNA and remove

Not sure if US is going to help your decision making. MRI could define it

better but $$$

On Fri, Dec 10, 2010 at 3:16 PM, Kathy Saradarian, MD >

wrote:

An ultrasound first and if not sure than a CT. What do you mean by

“looks” like a lipoma?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com<http://www.qualityfamilypractice.com/>

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: <mailto: >

[mailto: <mailto: >]

On Behalf Of Dr. Nwaizuzu

Sent: Friday, December 10, 2010 4:40 PM

To: <mailto: >

Subject: would you oRder an MRI

Would you oder an MRI for a mass on the deltoid muscle measuring 3 inches in

diameter that looks like a lipoma?. The man is 47 year old with no significant

past medical history

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Office:

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This email transmission may contain protected and privileged, highly

confidential medical, Personal and Health Information (PHI) and/or legal

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[Guest guest]

You'll recover and g o on  to take good care of more people Good job This job is really really hard.Jean

 

Thank you all for your response. believe me, I am not the kinda doctor that sends every lipoma case to MRI. infact I have never sent one for radiologival studies before and I have seen more than a thousand cases in this lifetime. To be perfectly honest with you guys November 22nd 2010 was the first time I MRI-d such lesion.

There was something about that mass that worried me. I looked at this tumor for more than an hour that very day.. and even now looking back at it. i cant place a finger on what it was that disturbed me.  Even after the diagnosis was established I have examined and re examined it without knowing why I had sent the guy for an MRI.

One thing I am sure was that if he didnt have an insurance i probably wouldnt have gone the MRI route but as God will have it he had Bluecross blueshield, and they didnt gve me a hard time with pre auth process. I cant thank God enough that I listened to that thiny inner voice that urged me to MRI the lesion.

 When i got the call from the radiologist the following morning my heart almost stopped. he said its 90% likely its soft tissue sarcoma histiocytoma... I sent the patient to a oncology surgeon who confirmed the diagnosis after a biopsy and histology. I know absolutely nothing about this neoplasm. so i googled it. and on the first page I saw that a family physician was burnt by this diagnoisis sometime in 1993..see the link below.

http://www.nwsarcoma.org/sarcoma-stories/patient-profiles/328-linda-h

I am still in shock. and may not recover again from this experience. I am sure my views of lipoma-like tumors has changed for ever. morale of the story;In medicine always trust your instincts

thanks

Nwaizuzu MD

To: " " < >

Sent: Sat, December 11, 2010 4:09:19 PMSubject: RE: would you order an MRICheapest treatment is excision. I would do it if he is worried.

________________________________________From: [ ] On Behalf Of Dr. Nwaizuzu [familydocta@...]

Sent: Saturday, December 11, 2010 2:58 AMTo: Subject: Re: would you order an MRI

the patient noticed the mass a month agohas remained the same size since he first noticed itno lymphadenopathyHe has been healthy . no other symptoms.the consistency is pretty much that of a lipoma.

________________________________To:

Sent: Fri, December 10, 2010 7:04:10 PMSubject: Re:

would you order an MRIHow long has he had it? Is it growing? does he have others? How are his nodes? How is his constitution? If had x long time, unchanged and feels benign, Could have it removed for cosmetics or so clothes can fit.

If new, increasing size, FNA and removeNot sure if US is going to help your decision making. MRI could define it better but $$$On Fri, Dec 10, 2010 at 3:16 PM, Kathy Saradarian, MD > wrote:

An ultrasound first and if not sure than a CT.  What do you mean by “looks” like a lipoma?Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.com<http://www.qualityfamilypractice.com/>

Solo 4/03, Practicing since 9/90Practice Partner 5/03Low staffingFrom: <mailto: > [mailto: <mailto: >] On Behalf Of Dr. Nwaizuzu

Sent: Friday, December 10, 2010 4:40 PMTo: <mailto: >

Subject: would you oRder an MRIWould you oder an MRI for a mass on the deltoid muscle measuring 3 inches in diameter that looks like a lipoma?. The man is 47 year old with no significant past medical history

CyberDefender has scanned this email for potential threats.Version 2.0 / Build 4.03.29.01Get free PC security at http://www.cyberdefender.com/

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Go in the directions of your dreams and live the life you've imagined.This email transmission may contain protected

and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above.If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.

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[Guest guest]

My husband (he's an ER doctor) and I constantly remind each other to " go with

your gut. " One of my best teachers in residency always said " It's cancer until

you prove it's not. " These 'rules' have helped me so many times.

> >

> > An ultrasound first and if not sure than a CT. What do you mean by " looks "

> > like a lipoma?

> >

> >

> > Kathy Saradarian, MD

> > Branchville, NJ

> > www.qualityfamilypractice.com<http://www.qualityfamilypractice.com/>

> > Solo 4/03, Practicing since 9/90

> > Practice Partner 5/03

> > Low staffing

> >

> >

> > From: <mailto:

> > > [mailto:

> > <mailto:

> > >] On Behalf Of Dr. Nwaizuzu

> > Sent: Friday, December 10, 2010 4:40 PM

> > To: <mailto:

> > >

> > Subject: would you oRder an MRI

> >

> >

> >

> >

> > Would you oder an MRI for a mass on the deltoid muscle measuring 3 inches

> > in diameter that looks like a lipoma?. The man is 47 year old with no

> > significant past medical history

> >

> >

> >

> > CyberDefender has scanned this email for potential threats.

> > Version 2.0 / Build 4.03.29.01

> > Get free PC security at http://www.cyberdefender.com/

> >

> >

> >

> > --

> > M.D.

> > www.elainemd.com<http://www.elainemd.com/>

> > Office:

> > Go in the directions of your dreams and live the life you've imagined.

> > This email transmission may contain protected and privileged, highly

> > confidential medical, Personal and Health Information (PHI) and/or legal

> > information. The information is intended only for the use of the individual

> > or entity named above.

> >

> >

> >

> > If you are not the intended recipient of this material, you may not use,

> > publish, discuss, disseminate or otherwise distribute it. If you are not the

> > intended recipient, or if you have received this transmission in error,

> > please notify the sender immediately and confidentially destroy the

> > information that email in error.

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> >

[Guest guest]

I had a patient(years ago) who was sent to a surgeon from a nursing home before I saw the patient or was aware of the consultation or  issue so  when I saw her the next time, I was shocked at the size. The nurse tried to reassure me that the surgeon had evaluated it and nothing needed to be done.  The surgeon did not order MRI or FNA so I immediately sent for Bx in pathology.  Same outcome--sarcoma--she died.  Not great teamwork---

C

 

My husband (he's an ER doctor) and I constantly remind each other to " go with your gut. " One of my best teachers in residency always said " It's cancer until you prove it's not. " These 'rules' have helped me so many times.

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[Guest guest]

,

My mother in law was telling me about a month ago about a friend of hers who had just died from what was thought to be a lipoma (also turned out to be a sarcoma)....I have since remembered all the people I've reassured about lipomas over the years and wondered....

For whatever reason, you did a good job that day.  I often think only those of us in this profession can understand how tough our job is:  not-under calling, not over-calling (which is probably easier),  but hitting it just right.  That's why it is critical that we support each other.  I am thankful everyday for the community of support I do have.

 

Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com