Before each appointment, the patient went to the lab so that Quan could monitor the inflammatory markers. As the pain lessened, the numbers improved. But the patient was now in terrible pain. His inflammatory markers should have been high as well — but they weren’t. And that was odd. Which prompted Quan to wonder: Was this really PMR? When a disease doesn’t behave the way you expect it to, you have to at least consider the possibility that maybe it’s not the right diagnosis. But if it wasn’t PMR, what was it?
New, Scarier Possibilities
Right at the top of Quan’s list was malignancy. There are some rare disorders that look very much like PMR that have been associated with cancers. Was the patient up to date on his colonoscopies? He was. He smoked when he was younger — had he had the screening chest CT that is recommended for those who’d smoked? No. Quan sent him to get an X-ray. He also ordered additional blood tests to look for other possible causes of this kind of pain and other types of cancer.
The chest X-ray wasn’t normal. A CT scan revealed a crop of nodules, barely the size of apple seeds, in the upper lobe of the right lung and a sprinkle in the base as well. The radiologist thought this was probably pneumonia but said that it could also be cancer. He recommended repeating the study in three months.
Time can be an important diagnostic test, providing key information about a disease. But it can be brutal for those who are doing the waiting. Between the fear of cancer and the pain in his shoulders and hips, the man started to wonder if his life was still worth living.
Things Seem Bleaker
The second CT scan confirmed the couple’s worst fears. There were more nodules, many more. The radiologist still thought it could be an infection, but cancer was also a real possibility. They couldn’t get in to see a lung specialist for weeks but couldn’t bear to wait any longer. Quan called a surgeon he knew, and the doctor agreed to see the man the same day. After reviewing the imaging and examining the patient, the surgeon told the couple that the only way to know for certain what was in the lung was to remove the tissue and examine it. He scheduled the man for surgery the following week.
After the operation, a new doctor, a specialist in infectious diseases, brought the results. I have good news and bad news, he told them. The good news — it’s definitely not cancer. The bad news is that we still don’t know what it is. For the patient, whatever it turned out to be, it couldn’t be as bad as cancer.