Ask the Doc: Dr. Whaley talks about Mediastinocopy and anemia with MGUS

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.