To Your Good Health: Patient wishes to pick and choose what issues to follow up on
DEAR DR. ROACH: I am a 63-year-old female in very good health. Admittedly, I smoked for 22 pack-years, but that is pretty far in the past. I have had two CT lung scans as a result of a pneumonia diagnosis last fall. The second, a follow-up six months after the first one last December, found a ground-glass attenuation nodule about 1 cm diameter in my upper right lung.
I have also been found to have emphysema and/or COPD, although I suffer no discomfort or symptoms from those.
My significant other has urged me not to have a follow-up appointment with a specialist (pulmonologist), and in fact I canceled an appointment I had with one last February. I have a new appointment, but I only want to talk about the CT scan results having to do with the nodule, with my main concern being heavy doses of radiation (I am scheduled for another CT scan next May).
The pulmonology office requires that I have spirometry testing before I see the specialist, but doesn’t this only address the COPD and emphysema issues? If I am found to have diminished lung capacity, I don’t want to be prescribed albuterol or other inhalers to address this, since I have no symptoms of which I am aware. I live a very active and athletic life.
My diet is completely plant-based whole foods and has been for seven years. How would you approach this issue if you were my general care physician? -- R.C.
ANSWER: A ground-glass opacity nodule is called that because of its appearance on X-ray or CT scan. They are a specific area of abnormality in the lung, and may represent an area of inflammation, but also may represent early stages in the progression to lung cancer. Because of this, these findings are followed by yearly CT scanning for at least three years. Studies have shown that 12 percent to 26 percent of GGN increase in size: This is a significant risk factor for lung cancer, as is a size greater than 1.5 cm. One study showed that 95 percent of GGN removed for an increase in size of 0.2 cm or greater than 1.5 cm were cancerous. Because of this, I agree with the repeat CT scanning: I feel the small risk of radiation is greatly outweighed by the ability to identify a potential lung cancer before it has a chance to spread.
As far as getting spirometry goes, that is indeed to evaluate the emphysema (emphysema is one of the major types of chronic obstructive pulmonary disease). Knowing how severe the disease is has value; however, the fact that you have no symptoms suggests mild disease. I understand you are annoyed that the specialist demands a test that is not relevant to the reason you are referred: If I were your primary care doctor, I’d have a chat with the specialist to see if it were truly necessary.
A plant-based diet reduces risk of developing lung cancer.
DR. ROACH WRITES: A recent column on keeping insulin cool during a trip to a hot climate without power generated several letters alerting me to an evaporative cooling case, specifically for insulin and other medication, that uses only water to maintain a safe temperature. I was unaware of this device, which is generally well-reviewed.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.