Don't wait to get answers on lung issue
Q. I'm 73 years old and have been told by two doctors (after having two lung X-rays one month apart) that I have a small spot on my lung. The last doctor said it is probably scar tissue. I have never smoked, or had pneumonia or any other disease or illness that might have caused this. The doctors attribute it to age. The latest advice was to wait six months and have another X-ray to see if the spot has enlarged. Can you shed any light on this? Do you think it's advisable to wait six months, or should I go to a pulmonary doctor?
A. I advise you not to wait. If I were in your shoes, I would opt to discover what the spot is now, not later. You need proof that the "small spot" is benign and not early lung cancer. Get a referral to a pulmonary specialist, who may order a CT scan or MRI, possibly followed by a biopsy of the lesion. Depending on the outcome of the tests, the specialist can then advise whether treatment is necessary, and, if so, provide you with appropriate options.
While I may be overreacting, I would hate to miss diagnosing an early lung malignancy. Let me know how this turns out.
Q. In our paper recently, you answered a letter from a reader who wanted to know if Evista was better than another drug. You replied that you were less enthusiastic about the medication and mentioned that it "should remain on the shelf" until the complications were fully understood. You mentioned that Evista can cause premature heart disease in some women.
I currently take Evista with 1,200 milligrams of calcium. I am a healthy 53-year-old menopausal woman. Is there another drug that I should be taking in lieu of Evista? My doctor has recommended another drug (Boniva, I think). I'm not thrilled with the idea of that drug, either.
A. All drugs have side effects, even nonprescription ones. As I have mentioned before, whether a patient takes a medication or chooses not to do so, the person needs to know about the risk/benefit factors.
Biphosphonates, such as Fosamax and Boniva, do carry the rare risk of osteonecrosis of the jaw. This risk is increased in people with cancer and poor dental hygiene. The increased risk of premature heart disease is a far more worrisome side effect for women who take Evista.
If you have moderate to severe osteopenia (bone weakness) or any stage osteoporosis, the choice of medication is up to you and your physician. There will still be the possibility of side effects regardless of the treatment you choose. If you have mild osteopenia, you may be able to prevent it from worsening by increasing your daily intake of calcium and vitamin D. Speak to your gynecologist or primary-care physician about your options.
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