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What questions should we ask? Thanks!


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My fil is in the hosp right now w/ cellulitis and coughing up blood. (You will see his history at my signature)

My husband will be there on Weds to be w/ mil & fil and wants to be ready to ask some questions.

From what I read on these message boards, I think he won't get avastin because he has had some "squamous" type cells.

What are the next line of drugs?

What about something called "perfusion" where they put chemo right into the tumor area?

He had a red cell transfusion about 1 1/2 weeks ago, and his red cells are back down to almost nothing. I want my hubby to ask about the lc being in his bone marrow. Is anyone familiar w/ this? I'm suggesting this because of the 5cm bone tumor near the hip.

He is also being treated for cellulitis around the subcutaneous tumor. All kinds of complications can come from this...

Alrighty then. You all seem so knowledgeable. Thank you for your information.

love and prayers,


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All I can think of is the two

types of cellulitis, carcinoma erysipeloides

and erysipelas, both respond to penicillin,

but are not treated the same way.

One needs surgical debridement to heal.

You did well with bc, hoping fil gets

some good suggestion for treatment.



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Read about steroid treatment not sure of exactly what type Of cellulitis? Steroids might be the trick can't hurt to ask for Cellulitis

First Issue;


Nonexcisional treatment of lipomas, which is now common, includes steroid injections and liposuction.

Steroid injections result in local fat atrophy, thus shrinking (or, rarely, eliminating) the lipoma. Injections are best performed on lipomas less than 1 inch in diameter. A one-to-one mixture of 1 percent lidocaine (Xylocaine) and triamcinolone acetonide (Kenalog), in a dosage of 10 mg per mL, is injected into the center of the lesion; this procedure may be repeated several times at monthly intervals.8 The volume of steroid depends on the size of the lipoma, with an average of 1 to 3 mL of total volume administered. The number of injections depends on the response, which is expected to occur within three to four weeks. Complications, which are rare, are the result of the medication or the procedure, and can be prevented by injecting the smallest total amount possible and by positioning the needle so that it is in the center of the lipoma.

Liposuction can be used to remove small or large lipomatous growths, particularly those in locations where large scars should be avoided. Complete elimination of the growth is difficult to achieve with liposuction.8,18 Office procedures using a 16-gauge needle and a large syringe may be safer than large-cannula liposuction. Diluted lidocaine usually provides adequate anesthesia for office liposuction.


Surgical excision of lipomas often results in a cure. Before the surgery, it is often helpful to draw an outline of the lipoma and a planned skin excision with a marker on the skin surface (Figure 2). The outline of the tumor often helps to delineate margins, which can be obscured after administration of the anesthetic. Excision of some skin helps to eliminate redundancy at closure.

The skin is then cleansed with povidone iodine (Betadine) or chlorhexidine (Betasept) solution, making sure to avoid wiping away the skin markings. The area is draped with sterile towels. Local anesthesia is administered with 1 or 2 percent lidocaine with epinephrine, usually as a field block. Infiltrating the anesthetic in the subcutaneous area surrounding the operative field creates a field block.


Differential Diagnosis of Lipoma


Epidermoid cyst

Subcutaneous tumors

Nodular fasciitis


Metastatic disease

Erythema nodosum

Nodular subcutaneous fat necrosis

Weber-Christian panniculitis

Vasculitic nodules

Rheumatic nodules


Infections (e.g., onchocerciasis, loiasis)



Complications of Lipoma Excision


Surgical infection/cellulitis/fasciitis


Hematoma formation

Injury to nearby nerves with permanent paresthesia/anesthesia

Injury to nearby vessels/vascular compromise

Permanent deformity secondary to removal of a large lesion

Excessive scarring with cosmetic deformity or contracture

Muscle injury/irritation

Fat embolus




Small lipomas can be removed by enucleation. A 3-mm to 4-mm incision is made over the lipoma. A curette is placed inside the wound and used to free the lipoma from the surrounding tissue. Once freed, the tumor is enucleated through the incision using the curette. Sutures generally are not needed, and a pressure dressing is applied to prevent hematoma formation.


Larger lipomas are best removed through incisions made in the skin overlying the lipoma. The incisions are configured like a fusiform excision following the skin tension lines and are smaller than the underlying tumor. The central island of skin to be excised is grasped with a hemostat, or Allis clamp, which is used to provide traction for the removal of the tumor (Figure 3). Dissection is then performed beneath the subcutaneous fat to the tumor. Any tissue cutting is performed under direct visualization using a no. 15 scalpel or scissors around the lipoma. Care must be taken to avoid nerves or blood vessels that may lie just beneath the tumor.

Once a portion of lipoma has been dissected from the surrounding tissue, hemostats or clamps can be attached to the tumor to provide traction for removal of the remainder of the growth. Once it is freed, the lipoma is delivered as a whole (Figure 4). The surrounding tissue in the hole can be palpated to ensure complete removal of the tumor. Table 2 lists possible complications of excision.

FIGURE 3. The skin inside the incision grasped with a hemostat to provide traction. The lipoma is dissected from the surrounding tissue using scissors or a scalpel.

FIGURE 4. Once freed, the lipoma is delivered as a whole, and hemostasis is achieved.

FIGURE 5. Interrupted 3-0 or 4-0 Vicryl sutures are used to partially close the dead space.

Adequate hemostasis is achieved following the removal of the lipoma using hemostats or suture ligation. The dead space is closed beneath the skin using buried, interrupted 3-0 or 4-0 Vicryl sutures (Figure 5). Occasionally drains may have to be placed to prevent fluid accumulation, but this should be avoided if possible. The skin is then closed with interrupted 4-0 or 5-0 nylon sutures. A pressure dressing is placed to reduce the incidence of hematoma formation. The patient is given routine wound care instructions, and the wound is checked in two to seven days. The sutures are removed after seven to 21 days, depending on the body location. Specimens should be submitted for histologic analysis.

Second; Ask about Aranesp to boost red Blood cell production or Neulasta for White Blood Cell Production

Third; Lung Cancer treatment. Onc will know but when you find out what rtreatment plan is used let us know and we can share side effects info with you. With Chemo there should be steroids and anti-nausea meds administered by IV with chemo.

Get an organizer small portable for dad for apptmnts and Meds. List all taken for any reason. Questions for onc.Also test results. 95% of people suffer memory loss when naked in Doctors office. ( That was a Little Humor Laught track here) will say a prayer and let us know when you get more info.

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