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Question for Dr. Joe - fluid around heart

Remembering Dave

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Dr. Joe, in case you didn't see our posts under General, Dave went into the hospital last week with a mild case of bronchitis but ended up having surgery to drain excessive fluid in his pericardial sac - over a quart.

They did pathology on the fluid but we haven't heard anything on it yet. The word is, it could be caused by (1) the bronchitis; (2) reaction to chemo and/or radiation); (3) cancer in the pericardial sac; or (4) we'll never know.

How likely do you think it is that there's cancer in there? The cardiologist kept coming in to check on Dave and speaking like that's definitely what it is. the surgeon and oncologist say it's hard to tell, could be anything, but cancer cells can't be eliminated as a possibility and is likely.

Of course I am worried sick about it. The oncologist keeps mentioning that since Dave's SCLC came back in his sinus cavity it is most likely somewhere else as well, although all his scans - PET Scan back in July, two or three CT scans of head and chest since then - don't show a thing. The PET scan was totally clear except for the sinus tumor.

Just wanted to get your gut feel or experience on the subject.

Guess I'm looking for a little cyber-hand holding!


Karen C.

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First of all, when doctors see someone with cancer, they automaticaly assume that all problems are related to the cancer. I'm not surprised about your cardiologists response, I always find the knee jerk "its gotta be the cancer" frustrating. While it of course could be related to the cancer, infection and radiation can definitely cause pericardial effusions. If the fluid they drained does not have cancer cells, that doesn't definitively rule cancer out but makes it less likely. But you certainly have reasons other than cancer to cause this.

If it is cancer, the fluid will recur and they will likely need to do a pericardial window (I'm assuming they just did a pericardiocentesis this time?). When that is done, they should send the pericardial sac to the pathologist. If it is being caused by cancer, they will see it. If no cancer then it was caused by something else. If the fluid doesn't return, then it was not cancer.

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oh, gosh, Joe, you are so on cue about that darn cardiologist! He seemed like such a nice man and did some really neat things, like LISTENED to Dave's blood pressure and by listening he could tell if there was or wasn't fluid in there, but he was just so, well, darn smug about the fluid being caused by the cancer! and he was in and out so quick, I found myself wanting to shout "but wait, come back, why do you think it's gotta be cancer?"!!!

wow, thanks for THAT perspective.

they did do the window, I guess I wasn't clear. the surgeon stuck the tube in the sac and it stuck out of dave's chest and drained into a pump thing for a couple of days. then when the tube was removed, it was supposed to leave the hole (the window) so any additional fluid would just drip out into his abdominal cavity. it all sounded good to me but I was wondering how they would ever know if any more excessive fluid accmulated if it had a way out. I almost felt like that attitude was that it didn't matter since it was all cancer anyway.

ok, about the radiation - Dave's chest radiation was well over a year ago. on all of his ct scans since then, I think, SOME fluid around the heart has appeared but not enough, until now, for anyone to be worried. could it be slowly building up since that chest radiation? could a combination of things make a difference, like it got started by the chest radiation, and then his various infections, additional chemo, etc., sort of "egged" it on?

I know I'm bombarding you with questions, but am feeling a tad desperate here . . .

thanks, you are a lifesaver!

Karen C.

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Hi Karen, I may be able to help a little with your questions.

First, you're right that they will not know now if the fluid is reaccumulating. The up side of course, is that the potentially life-threatening consequences of fluid buildup in the pericardial sac can be averted. I'd advise phoning the doc's office to ask about the pathology results until you get an answer about what caused it.

Second, the fluid could have been building up for a while. It takes a certain amount of fluid to cause symptoms, or to cause the "rubbing" sound the cardioogist was hearing. Normally, there is a small amount of fluid in the pericardial sac anyway; the amount has to increase to cause any symptoms.

I sympathize with your feeling that everyone assumed it was cancerous. As long as you and Dave do not assume that, you have a leg up on the disease.

Keep fighting the good fight. Best wishes to you both, Teresa

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