Swapon Kumar

Dear Mr. Tom, Thanks a lot for your kind reply. I will insist to take appointment in medical oncologist Within one month if possible. But I want to give another information that now i am in Kuwait as a Captain in Bangladesh army as a pharmacist . So need some approval from the authority as well as health insurance concern on that regards.In last appointment with my pulmnologist may be MD or FCCP in Respiratory medicine insist to take an recommendation to do PET scan ( FDG -uptake ) Initial staging he marks on the serial. But he told to done that one in next February or like that . I am a middle class family person and only earning person of the family with old father and mother with newly married one. So take everything on consideration. Is it best to do PET Scan within one month or then take appointment with medical oncologist or done that one after appointment with him her , which one logical ? I find a way or some light at the end of the tube experienced friend like you . I get real assurance from you my friend .Expect your reply on that regards.

Dear Tom, I am very much glad that you give response on that regards. I take an appointment with a pulmnologist. After observing the ct report he recommend to perform another ct after 6 month. But after googling i found every where recommend further workup approach. Is it wise to wait another 6 or three month because i experience some symptoms like pain below sternum and throat mucus.But after consulting pulmnologist , he told it is so small to biopsy or other procedure. and My Age and smoking history not support to do that. I need to take referral from pulmnologist to take appointment to medical oncologist. What can i do on that situation ?

My Disease History Name : Swapon Kumar Age : 29 Years Marital Status : Married I Share my health conditions. At Mar 2015 , I experienced some burning and localized type chest pain in left chest area .After taking several investigation like Ecocaridography and Nuclear stress test it was confirm that it was not from Heart .Doctor told me to GERD ,musculoskeletal or something like that .Also perform upper gastro endoscopy in May which came back normal. But in Jun 2016 I found my left Supra Clavicle region slightly higher than right .After that one doctor recommend me to perform MRI. Findings of MRI Shows no Lymph node .Only 3 mm thickness in transverse process muscle body in Brachial Plexus region Higher than Right area. After that because of chest pain I take another opinion who recommend me to perform CT and after performing that with 5mm thickness pre and post contrast IV findings are multinodular densities shows in both lung field at October 13,2016.One Subcentrimetric Sizable nodule in left lower lobe at Lateral Basal Segment .(Not mentioned Size ) In November 2016 I have some cough with blood sputum in morning . So Perform Skin tuberculin test which come back +8 mm and Two Consecutive acid first Bacillii (AFB ) Test show negative result .Then perform another IV contrast CT with 2.5 mm MPR Images Result Shows : (21 st November 2016 CT Date ) : CT-1 (Findings ) Right Lung : -small round 3.6 mm nodule seen in the peripheral part ,anterior segment of the right upper lobe with smooth well defined margin with surrounding lung parenchyma. -4 small irregular shaped nodules ranging from 3-4 mm seen in posterior basal segment ,located adjacent to each other surrounding lung parenchyma . Left Lung : -solitary, round 9.4mm sub pleural nodule is seen at the lateral basal segment of the left lower lobe ,well defined margin surrounding lung parenchyma. (12th February 2017 CT Date ) : CT-2 (Findings ) No appreciable interval changes as compared to the previous study, the previously seen nodules shows no change in size nor in number or location. After another six month follow up I take appointment in another ct. In the mean time I experience several symptoms like Bad headache, serious Back pain , some swelling in LUQ area but Performing ultrasound ,no organomegaly or abnormal pathology seen. (24th July 2017 CT Date ) : CT-3 (Findings ) Scan through the chest shows a well defined nodule in the anterior segment of the right upper lobe.No intralesional calcification or cavitation noted. It measures about 6mm.Another pleural based nodule noted in the left lower lobe along the postero lateral chest wall. It contain foci of calcification and measures about 9mm in size. Bilateral lung nodule,one in the right upper lobe and another one in the left lower lobe as described.Further workup advised. In comparison with the last CT dated 12/02/17,the size of the right upper lobe nodule shows increase in size. However, the nodules noted in the right lower lobe as mentioned in the previous report are not visualized in the current study. Blood Profile Count History : All other parameter of total biochemistry remain normal except uric acid shows high maximum time. I also perform RF Factor which came back normal. My lymphocyte count maximum time in near the top and some times higher than range .But RBC ,WBC ,Haemoglobulin within normal range . Dated Differential Range Absolute Range ×1000 03-01-17 34.07% 20 %-50 % 2.4×1000 2.0-4.0 10-01-17 45.2 % 20.5 %-51.1 % 3.5×1000 1.20-3.40 22-01-17 42.7% 19.4%-44.9 % 2.56×1000 1.30-3.5 05-02-17 33.66% 20 %-50 % 2.5×1000 2.0-4.0 23-04-17 46.8 % 20 %-50 % 2.8×1000 2.0-4.0 07-05-17 44.6 % 20 %-50 % 3.23×1000 2.0-4.0 21-06-17 30.6 % 20 %-50 % 2.0 ×1000 2.0-4.0 22-07-17 52.4 % 20 %-50 % 3.43×1000 1.0-4.0 (Low Neu) 30-07-17 46.3% 20 %-50 % 3.2×1000 2.0-4.0 This is my disease history. But I am now very much concerned regarding experiencing some during pressing at toilet .some pain in right upper rib cage sternum area when bent and a point near right breast pain and swelling a little.. And also increase Size of Right upper lung nodule. What should be the next point now this stage what should I do from my view point ????