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Ask Dr. Gott 12/22

To operate or not to operate?

DEAR DR. GOTT: I am a 66-year-old white male, in good health. That is, no heart problems or other major ailments.
    After a fall, I had a CT scan to see whether any bones were broke or cracked. Thankfully not, but a large tissue mass was found in on the right side of my chest, I am told about the size of a grapefruit.
    CT scans were done 30 days later and 90 days later. No change in the mass, but my doctor sent the information to a colleague who interviewed me and told me even though they were 99.9 percent sure it was benign, I should have it taken out.
    I went to an oncologist who specializes in tumors for a second opinion and was told, in his opinion, I did not need the surgery. He felt the mass may have been there all my life.
    Two days later, his nurse called and advised me that after consulting with doctor No. 1, he now feels I need the surgery. I am told it is major surgery, and I would be in the hospital about a week.
    Now I am trying to decide which way to go. I am having no symptoms or pain, but I am concerned that doctor No. 2 did not call me personally and tell me why he changed his mind. He just had a nurse call me. Where should I go from here?
    DEAR READER: Although I respect the opinions of diagnostic radiologists, how a lesion looks on scanning can be misleading. You definitely need to have a procedure that will result in the extraction of tissue for analysis - in a word, a biopsy. This is far less invasive than an operation to remove the chest mass in its entirety and should indicate whether the lesion is benign. To be candid, I cannot conceive of such a mass being present for decades, although the doctors surely have to consider a congenital anomaly or a vascular problem.
    If the biopsy is unsuccessful or nondiagnostic, you should consider surgery for the mass.
    I don’t know why the oncologist failed to report to you directly in a timely fashion. Perhaps he owes you the courtesy of a sit-down session to discuss his opinion and his reasons for later altering his recommendation. It seems to me that you need as much information as possible in order to make a reasonable decision about how to proceed. Judging from your letter, such information has not been forthcoming. Enlist your doctor’s support in resolving these issues.
    To give you related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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