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Doctor insights on: No Action Required Watchful Waiting

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Is radiation treatment necessary or required for dcis?

Is radiation treatment necessary or required for dcis?

Sometimes.: The primary treatment for dcis is surgical: either a lumpectomy or a mastectomy. Following a lumpectomy, radiation therapy is often recommended, depending on the type of dcis, the size, and the age of the patient. ...Read more

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Watchful Waiting (Definition)

Watchful waiting, also known as expectant management, involves weighing the risks of treating an injury or illness against not treating it. Doctors will also consider the severity of symptoms the patient is having when deciding whether to "watch and ...Read more


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A-fib, stroke prophylaxis: arixtra works diff from warfarin, no approval by fda & no studies establishing its effectiveness. How can it be acceptable?

A-fib, stroke prophylaxis: arixtra works diff from warfarin, no approval by fda & no studies establishing its effectiveness. How can it be acceptable?

Agree with you: Arixta is effective in for venous blood clots. It works faster than warfarin but has to be injected, so it is given temporarily. Sometimes it is selected bec of a Heparin allergy. For atrial fibrillation, there are 3 new pills (pradaxa, xarelto, eliquis) that can be used instead of warfarin. They are very attractive because they dont require monthly blood test monitoring. ...Read more

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Is exam needed in a miscarriage&everything came out? But need papers for work&HR proving there was but no longer a pregnancy. No insurance/$ for exam

Is exam needed in a miscarriage&everything came out? But need papers for work&HR proving there was but no longer a pregnancy. No insurance/$ for exam

Need exam: You will need an exam to insure all the products of conception are gone. This is to insure no retained placenta or fetal remnants Then you will get the necessary paperwork signed. ...Read more

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Cardiac n sugar patient, under treatment for BPH, PSA upto 3 yrs ago was normal. Now PSA-100. Whether biopsy is advisable n future course of action.

Cardiac n sugar patient, under treatment for BPH, PSA upto 3 yrs ago was normal. Now PSA-100. Whether biopsy is advisable n future course of action.

Likely Prostate canc: Once PSA level is over 20 ng, it is almost certain to be due to prostate Cancer. Biopsy is done to confirm(100) that you have Prostate cancer so that you can be placed on some sort of medical or surgical treatment. You need to consult a Urologist for further guidance. ...Read more

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Need expert advice. After radical prostatectomy is there chance for psa rise?

Need expert advice. After radical prostatectomy is there chance for psa rise?

Yes, ...: Some one third after radical prostatectomy(rp) may have "rising psa" over time, which suggests three potential conditions: local recurrence; microscopic spread to nearby tissues, notably regional lns; spread to far sites, such as spine, pelvis, ribs, and lungs. Remember: the report of no metastasis from bone scan and ct before rp does not guarantee no spread in 100% because these tests can not .. ...Read more

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When is surgery necessary or required for treatment of diverticulitis?

When is surgery necessary or required for treatment of diverticulitis?

When complicated: Most diverticulitis is successfully treated with antibiotics. Indications for surgery include free perforation with sepsis, an abscess that can't be treated with percutaneous drainage, fistulas to other organs, strictures or obstruction, and occasionally numerous recurrent episodes of diverticulitis. ...Read more

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Is there a medical reason for delaying the stitching of a wound from outpatient surgery (basil/squamous cell removal) 1 day? Additionally, is it customary to report the stitching procedure as a different procedure for medical insurance charging?

Is there a medical reason for delaying the stitching of a wound from outpatient surgery (basil/squamous cell removal) 1 day? Additionally, is it customary to report the stitching procedure as a different procedure for medical insurance charging?

Your : Your doctor may be delaying closure of the wound to allow the pathologist to interpret the pathology specimen and make sure there are no signs that there are cancer cells that need to be removed (i.e., look for positive margins). There are separate medical procedure codes for the skin cancer excision and wound repair so it is customary to see two procedure charges in these types of situations. ...Read more

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For the recurrence of endocarditis, any possible treatment other than heart surgery or taking anti-biotics for life time? Success examples?

For the recurrence of endocarditis, any possible treatment other than heart surgery or taking anti-biotics for life time?  Success examples?

Endocarditis: If endocarditis recurs, especially after valve replacement surgery, it is very difficult to eradicate. This is because the antibiotics are unlikely to ever fully contact the artificial valve. The reason why antibiotics are prescribed for life, is that as soon as they are stopped, the infection of the valve is likely to blossom again. Surgery is the treatment of choice for infected artificial valve. ...Read more

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For the recurrence of endocarditis, any possible treatment other than heart surgery or taking anti-biotics for life time? Success examples?

For the recurrence of endocarditis, any possible treatment other than heart surgery or taking anti-biotics for life time? Success examples?

Endocarditis: Bacterial endocarditis can destroy heart valves and may even spread to the heart muscle with abscess formation thus it can be lethal. The treatment is prolonged antibiotics to eradicate the bacteria and possible valve replacement if the valve is sufficiently destroyed to pose a risk to life. ...Read more

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I've just finished treatment for lymphoma. Which included 8 avbd chemos and 12 radiotherapy sessions. I'm just waiting for scan in a couple of weeks. ?

I've just finished treatment for lymphoma. Which included 8 avbd chemos and 12 radiotherapy sessions. I'm just waiting for scan in a couple of weeks. ?

Good luck: I d not really understand your question, but perhaps you are wondering about how to approach uncertainty. You have probably been told your odds of cure. If you have a lymphoma that is sometimes or usually cured, plan for a normal life while cherishing each day -- too few people do this. If your time will be short, enrich it by finding what is meaningful for you. Be well informed and good luck. ...Read more

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Thymic extra nodal marginal zone lymphoma diagnosis on thymectomy. How aggressive is this? Do I need to act fast? Waiting for bmb to see if it spread, 1 wk.

Not aggressive: Extranodal marginal zone lymphoma is not aggressive - we all it indolent lymphoma. It is fine to wait until you have all your testing done to see if you need any other treatment. Best wishes. ...Read more

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My doctor is doing watchful waiting for leukemia. Is this normal?

My doctor is doing watchful waiting for leukemia. Is this normal?

Possible: It depends on what kind of leukemia the patient has.. Certain leukemias like chronic lymphocytic leukemia (cll) can be watched for several years without requiring any treatment. ...Read more

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Neutrophils 30, WBC 30 plus colostomy booked for next week. Is surgery still safe or likely postponed?

Neutrophils 30, WBC 30 plus colostomy booked for next week. Is surgery still safe or likely postponed?

Abnormal WBC: Why you had thecolostomy ?. At any event 30, 000 WBC is very abnormal. You do notr said about other symptoms because with that count or you have a serious infection or hematologic problem, leukemia or other problem. Investigate before going for surgery. ...Read more

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Continuing reflux with ppi use and Barrett's short segment possible after scope. Waiting on biopsy results. Is nissen recommended?

Continuing reflux with ppi use and Barrett's short segment possible after scope. Waiting on biopsy results. Is nissen recommended?

Depends on a lot: of things, such as severity of Barrett's, severity of reflux, and motility of esophagus. Your gi specialist and surgeon can give you proper advice. ...Read more

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If I am thinking of doing a non directed donor kidney donation, is there an advantage to doing it now or waiting 1/2 yrs? At the rate of stem cells and dialysis will it no longer be neccisary in 2 yrs

If I am thinking of doing a non directed donor kidney donation, is there an advantage to doing it now or waiting 1/2 yrs? At the rate of stem cells and dialysis will it no longer be neccisary in 2 yrs

A noble decision: You are very sweet to consider donating a kidney. As you know organs can save lives and no matter when, it will benefit someone. Make sure you are in good health yourself and that none of your family members have kidney disease. When you have only one kidney left also avoid extreme sports and sports that involve blunt trauma/falls. To decide when and where is all up to you. ...Read more

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No prostate,PSA increasing 1/14: .13,9/14: .3,11/24/14: .6 Bone scan done results 12/8, what are the next steps if scan is positive for mastesisis(sp?

No prostate,PSA increasing 1/14:
 .13,9/14: .3,11/24/14: .6 Bone scan done results 12/8, what are the next steps if scan is positive for mastesisis(sp?

Prostate Carcinoma: A rising PSA is concerning for metastatic disease and yes a bone scan is in order. Painful bone metastases can commonly be treated successfully with external beam radiation therapy. Zoledronic acid (Zometa) is a bisphosphonate that can delay the onset of complications associated with prostate cancer bone metastases and relieve pain. Speak with your oncologist. ...Read more

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Is it usually safe to let a perianal haematoma run its (painful) course without surgical intervention ? Topical anticoagulant ??

Is it usually safe to let a perianal haematoma  run its (painful) course without surgical intervention ? Topical anticoagulant ??

Yes: this clotted hemorrhoid (that's what it sounds like) or perianal hematoma will slowly resolve. Suggest you try Sitz Baths with hot water (not "burning" but as hot as you can tolerate it) may help the pain and "speed" the resolution of the clot (resorption)! Hope this helps and BTW topical anticoagulants are useless in this condition! Hope this helps Dr Z ...Read more