Ask the Doc: Dr. Whaley talks about Mediastinocopy and anemia with MGUS Voice Of Rural America

Ques­tion 1: Patient had stage 4 head and neck can­cer and has worked con­tin­u­ous­ly dur­ing chemother­a­py and radi­a­tion. A new node was detect­ed under the breast bone and he was referred to a chest sur­geon to cut his throat to look under­neath the breast bone to take out the node and oth­er near­by nodes. There are a num­ber of nodes in the neck, and he has respond­ed to the ther­a­py for the node in the neck. We are infer­ring that the node is a new node and that all the nodes in his neck and head have been respon­sive in ther­a­py. We were not told if he has had COVID or had the shot along with Rheuma­toid arthri­tis. The pro­ce­dure need­ed is Medi­astinoscopy, which will go under the breast­bone, will give a high­er accu­ra­cy because you get more nodes. The inci­sion is small and the scope goes right behind the breast­bone which allows you to get to the low­er nodes. Medi­astinoscopy is an old pro­ce­dure and used to be the pro­ce­dure of choice before PET and CT scans. 

Ques­tion 2: Patient has had MGUS for 12 years with­out pro­gres­sion. He was in the hos­pi­tal with diver­ti­c­uli­tis for 8 days. Three weeks lat­er the patient had severe ane­mia and renal fail­ure which were new com­pared to the labs 3 months before. IV flu­ids in the hos­pi­tal were giv­en for the antibi­otics but also for the low blood pres­sure. His blood count has not improved but the blood count is slow to come back to nor­mal lev­els. There are oth­er things that cause ane­mia like med­ica­tion. Numer­ous things can hap­pen to make ane­mia hap­pen. As long as the hemo­glo­bin stays above 10 he is going to get bet­ter. With­in the next 6 week the patient should get bet­ter and what hap­pened to him is com­mon with what hap­pened in the hos­pi­tal. So the MGUS through this whole case was not of any sig­nif­i­cance. Fol­low up with the pri­ma­ry doc­tor to monitor. 

There are peo­ple with COVID out there and it is high­ly con­ta­gious. But it is not untreat­able. Biden has been immu­nized for COVID and it hasn’t worked. 

What hap­pens in Aus­tralia will gen­er­al­ly hap­pen in the US the fol­low­ing sea­son. Peo­ple that have a high chance and dan­ger from influen­za should get the flu shot despite the fears of the COVID vac­cine. Before the COVID vac­cine there was an increase in vac­cines and now because of the push to get the vac­cine there will be more peo­ple that will be more vac­cine resistant. 

There was a Polio case in NY, the first of its kind in 10 years. COVID is the third cause of death for peo­ple over 70 because they had so many under­ly­ing illnesses.