My dad, who will be 91 next summer, recently moved in with me and my husband. (My mom died of a stroke in 2005, and since then, he had been living alone.) We live on a cattle ranch in west Texas, 50 miles from the nearest thing that could be called a city.
Background: Papa had surgery for lung cancer (non-small cell) in 1998. The cardio-thorasic surgeon removed the top lobe of Papa's right lung. Papa never saw a cancer doctor, and he did not have radiation or chemo or any other treatment, since the cancer had not spread into any lymph nodes.
Papa was also diagnosed with emphysema in 1998, and that has been progressing slowly. He is on oxygen most of every day, and a recent test shows he has about 50% of normal lung capacity. However, he is still reasonably active for his age, working a bit in the garden, etc., although he tires easily.
Current situation: He had a suspicious annual xray in January 2007, so we got his xrays from last year (in his old hometown) for comparison. The comparison looked bad, so the primary care doctor ordered a CT scan, which he had a couple of weeks ago. It showed a 9 mm star-shaped mass that looked very suspiciously like a malignancy, plus another 1.5 cm mass that was questionable.
Problems: I think we don't have any idea what his options are until we have a firm diagnosis with type of cancer, etc. Papa says he doesn't see any reason to try to extend his life, since he is over 90 already, but neither of us know what treatments might help make him more comfortable as the disease progresses.
Now I am having trouble locating a pulmo doctor who will consult with us about whether he can have needle biopsy, given his compromised lungs. Our primary care doctor says the pulmo doctors do the biopsies, and that is who we should see next. (I am confused by this, because a radiologist did his 1998 CT-guided biopsy.)
Apparently we live in an underserved area. There are only 3 pulmo doctors in the nearest city, which is 50 miles from us. One of these doctors just got called into active duty military service. Another wants to review Papa's test results before deciding if he wants him as a patient (Is this common?)and I am working to get the results to him.
I called Papa's pulmo doctor from 1998, who is still in the old hometown (150 miles or so from us). The receptionist said no, don't sent any test results, we aren't allowed to give out the fax number, the nurse will call you in a day or two after reviewing your case (how can she review it, since they didn't ask for anything except my brief phone description?). After hearing nothing for several days, I called again today and was told both the doc and the nurses are on vacation this week, and we are sorry no one called but we can't do anything until they come back, and besides, we are fully booked for 6 weeks anyway.
If I don't hear back soon, maybe I should give up and try for an appointment at a cancer center in a larger city? Dallas is about 4 hours away, and we have relatives in that area...
Is it typical to get the runaround for a while when trying to get a specialist? I never had trouble getting doctors when I lived in Austin. Is the problem the rural area, or that my dad is on Medicare, which pays very low rates?
Does anyone have experience with treatment and diagnosis for such an elderly patient, with emphysema also?
Thanks for any advice or suggestions etc.
Moogy