Two Cities, Three Pulmonalogists -------------------- No capital "A" Answers (1)

Yesterday, Shelley and I went to Dr. Glen Peterson at Alta Bates Hospital in Berkeley. I briefed him on my history and the trouble of the last six months.

He looked at LAB test results and radiology reports. Then, he looked at and compared the two CT Scans as we watched and he gave us a lot of information about what we were seeing. He did the same with my August x-ray, comparing it with one done in 2005. Fred smiles for the camera in an x-ray almost as well as in the CT. so we can do the next follow-ups with x-rays. There's a lot less radiation in an x-ray so I'm happy about this.

Fred seems to have grown, but not greatly. He thinks Fred is atelectasis, which simply means that part of the lungs are not inflated and begs the question of what is causing this collapse.

I asked him if Fred could be caused by a cancer tumor pushing into one of the major bronchial tubes, obstructing the easy flow of air. He said it was possible but not very likely, that other scenarios offer more probable explanations. He said we couldn't rule out cancer but it's a minor eventuality.

Then he gave us a visual image. Think of an accordion, he said, which is compressed and collapsed with very little air inside. This is your lungs when you breathe out. Imagine that something sticky, like partly-dried mucous, is inside the folds of the accordion when it is folded together. Then, you breathe in. Part of the accordion opens but other segments of it are stuck together with mucous. Maybe some of these folded sections open a bit, others don't open at all. The air does not get into those areas and when the scanner takes a picture of it, that area shows up as a feathery white cloud. This is Fred.

He did a very thorough physical exam and gave me prescriptions for a mucous thinner, guaifenesin, the ingredient in cough syrup that helps you cough up mucous. If there is no change when I see him again in 4-6 weeks, he'll likely try another, more-targeted bronchoscopy to get more samples and perhaps some better visual information.

I'm not sure whether he talked about a long needle into the right middle lobe of my lung in the context of doing a biopsy or as a way to re-inflate the lung. But he said we wouldn't take that option lightly because the entire lung could collapse. If that happened, I'd have to be hospitalized and/or it could lead to a serious infection.

He spent an hour with me and only became time-anxious toward the end. He was smart and very present in the room, asked me good questions and treated us respectfully.

(To be Continued)