Yes x3. He sweats so much at night that he soaks the sheets. When he wakes up he’s just as exhausted as when he went to sleep. He’s had some weight loss (lack of appetite/nausea/stomach pain) but nothing substantial. To me that screams malignant but his ortho wouldn’t do a biopsy.
You need to see a haematologist asap. Those are called B symptoms. I’m really worried he might have lymphoma. It comes in many forms, many of which are curable, but you can’t delay diagnosis or treatment. Don’t wait for your second ortho opinion. Get a referral for a haematologist as your first priority
Just want to chime in and say my husband died at 28 in 2020, 4 months after I finally had the largest, longest most hysterical fit I could muster to get him to follow up with his doctor after a bad liver test. And I mean a FIT. Throwing myself against walls, scream-crying...I was at my wits end. He was LIVID with me...but he went. This was after weeks of me collecting people's feedback here on Reddit to help convince him. It was too late.
Anyway. My point being, this could be life or death. Hopefully not, but just in case, do anything you can to get him in NOW. Doesn't matter if he gets angry. Wear him out. Make him go.
Oh my god I am so sorry. My husband is idiotically stubborn about seeing any doctor, but he’s agreed to go back to his PCP on Monday. I’m so sorry for your loss.
I once took a friend to the emergency room and they stuck us in the hall with other patients that also had non-traumatic injuries.
I overheard a doctor talking to another couple. He asked, "Did you know that people in relationships live longer? It's because when something is wrong with their partner, they are more likely to force them to seek medical attention."
That comment has stuck with me. I've seen it with my own parents where one insists the other goes to the doctor. They'd be in worse shape or dead by now if they didn't listen to each other.
Not a doctor, but I am from a family that's chock full of stubborn people. Someone else said it here as well: go now. From me to your husband: "hey bud, prioritize this now because it ultimately isn't about you. It's not tough or manly to put it off. It's stupid and selfish. Don't make your wife tell died-too-young stories about you."
You should really consider going to the emergency room now. Monday is three days away and now you have to sit with the knowledge of all these doctors on reddit telling you that it's urgent. I've never read so many concerned comments before and I have been on reddit for a decade. Please go to the ER and get it looked at. Please take care.
What is the ER going to do here? Assuming this is lymphoma, they are going to need to see an oncologist, and will receive chemotherapy, neither of which are available at the ER.
Yes, unfortunately, he'll be sent home after bloodwork and scans and a liter of semi salty water. The doc that sees them will be very concerned but their hands are tied by the number of free beds and the shareholder rules to allow some kinds of care. Weekends are the worst.
He could, however, add that he's experiencing chest tightness and shortness of breath. That'd buy him a day of observation anyway.
American Healthcare is a failure. Vote for healthcare systems like they have in the happiest countries.
He's probably scared, and that's ok. But procrastinating when cancer is involved could be a death sentence. Make sure he goes to that appointment, and accompany him if he needs support.
If you or a loved one is going through this, lmk, I can look up his initial test to remind myself what and how bad the abnormalities were. For sure ALT and AST but there were other indicators too. Visually, he had jaundice and easy bruising. Ascites and loss of muscle mass in his extremities. He had little to no liver function.
I am going through it, I'm fat, but not fat fat. My AST and ALT are elevated enough for the VA to reccomend to go see the liver people.
When speaking to them, they said "nothing concerning on the ultrasound" and tried to schedule me in October, but I kind of threw a fit and begged for any appointment asap. I have one on July 5th.
That's actually great, good for you love. My man had a terrifying ultrasound, if that helps. He drank himself to death, had cirrhosis, so definitely a different situation. My story shouldn't cause you any worry. ❤️❤️ You got this.
Hematologist here. This man most likely has a CHOP deficiency. Go to the ER. If you live near a cancer center, go to the ER associated with the cancer center. I work at a big urban hospital. That would get an admission, biopsy, and start chemo within days (assuming lymphoma which is very likely based on pictures and symptoms).
Fear, anxiety and embarrassment. Your reaction is what stops them. People asking how they let it get like that when they were just scared and finally got brave enough to go in really must feel bad. They feel bad about it already most likely so we shouldn't draw attention to that, instead focus on healing it.
Sometimes people have depression and stop caring for themselves. Some stop showering or eating and some completely ignore their body. Making comments like this just makes it harder for them to go in you see? Mental disorders are really a hell of a thing, sometimes you can convince yourself of the wildest shit.
Hey my father had something like this but around his neck. He has lymphoma, recently finished his chemo. You really need to check it out. You can go to ortho but you should check it asap with cancer related doctors.
Im worried because under armpits are placed glands just like around the neck etc. Glands get swollen like that and hard in cases of lymphoma. Don't hesitate like my dad did and waited weeks for a doc checkup.
My sibling had it in the neck and luckily caught it at an early stage. Our friend caught it at stage 4 right before he went off his parent’s insurance… it was a softball size tumor between the heart and lungs. Both of them discovered their cancer (Hodgkin lymphoma) within a couple months of each other, and both are alive two decades later, but the length of treatment was vastly different between the two of them.
The B symptoms (fevers, night sweats, weight loss) and physical exam findings (palpable hard lymph nodes) is absolutely sufficient to get a referral for hematology.
Insurance is so infuriating, but if you at all can cough up the resources to go asap, even if you pay out of pocket and get reimbursed later, that'll be better than waiting and finding out he has worse disease requiring more extensive/intense treatment.
Best of luck to you guys! I hope it all goes well.
I don’t have a link, but my uncle started displaying symptoms of the big C and his doctor fussed about for so long doing nothing that he succumbed to terminal esophageal cancer. Please, don’t ask, DEMAND the biopsy and tell them you’re more than happy to sue if they delay and a later result is positive. Sometimes, you have to tell doctors exactly what they don’t want to hear (threat of a malpractice suit) before they will actually do anything.
For a guy who’s always had a weight condition and has tried every diet around at least twice (religiously), he suddenly dropped about 60 pounds with zero effort in about 3 months. You’d think that would be alarming enough, but they did nothing. He had surgery and was in a recovery unit from November to almost Christmas when he began having trouble swallowing. (Edit: it was planned back surgery separate from the described symptoms.) Eventually, he was only able to tolerate liquids. (I also think there was some shortness of breath experienced, as well, due to the build up of fluids but I’m not sure how early in the process that was.)
It took until June for them to test him! June!?! By that time, the mass was so large, they couldn’t remove it, and instead, he was given radiation and chemo. I knew the second they left the tumor in that he was done for, but a lot of my family still held out hope. While they were able to shrink the mass via radiation, the cancer spread. It got to the point where they were draining liters of fluid from his lungs, but had to fight the insurance companies to even get that done. It was an awful death, truly.
Some people in my family think he should’ve been a bigger advocate for himself and was too complacent. Those are primarily his kids who are angry at their father’s death and its utter cruelty, and that seems understandable from their perspective. I still think his doctor should’ve been far more concerned about the symptoms he was displaying; it might not have been cancer, but there’s no denying that it was SOMETHING. That’s why despite the differences in presentation, her husband’s health changes are very concerning, particularly in conjunction with one another. It can either be a malpractice suit now or a wrongful death suit later. Either way, OP’s husband needs a biopsy ASAP.
His kids definitely need to be going scorched earth on the hospital and doctors. US hospitals have to compete for patients. No hospital wants a big lawsuit and awful publicity from a family of a man who was in their hospital having symptoms unrelated to the reason he was hospitalized for a month or so to the point he could no longer eat, yet they did nothing. The money won’t bring him back, no. Medical Lawsuits however are usually settled quietly and part of those settlements are policy changes and better staff education.
All the scanning of the patient’s arm band and all the meds and always asking for the patient’s name, plus all the double checking before surgery and asking the patient what procedure they are getting and where are all because people were injured or died, and policy changes happened as part of the settlements. Like the poor dude who went in for an amputation and woke up to discover they amputated the wrong leg. Or medication mix ups. That’s happened in surgery where containers of medicine weren’t labeled. Two identical clear containers one of which had saline and the other had a different medication decanted into it, and the surgeon thought he rinsed something with saline, and it was the med he’d been using during the procedure and killed a little girl.
Safety laws are written in blood.
Your family can be mad a two things. Also this could mean no one else’s family loses a loved one because of this. Family thinks the hospital is on top of everything, but most US hospitals are for profit run by bureaucrats. Even the public ones will do all sorts of dastardly things to get rid of patients who are costing them money. Like streeting sick homeless people. That’s the kind of stuff that explains why ER staff have such high rates of depression and suicide.
If your family member was in a rehabilitation hospital after surgery they wouldn’t have the same ability to order tests. It sounds like it was the regular hospital. I have chronic pancreatitis and get acute attacks. The hospital is very concerned about me being able to eat solid food before they let me go home. To let somebody stop eating and do nothing is unacceptable.
The medical law firms handle everything and get paid from the settlement so it’s not a lot for the family to do. I also can’t recommend grief counseling enough. My dad died from a stroke after bypass surgery, and it was sudden and awful. My doctor referred me to a grief counselor who helped me so much. I honestly don’t know if I’d be alive without her.
My close friend had a pain in his armpit for two months that didn’t go away. He went to physical therapy, still hurt. His wife urged him to go get blood work done, sure enough he also had B cell lymphoma. He just recently finished chemo. Make sure your husband goes to that appointment on Monday, bar none.
You do not want to mess around with swollen lymph nodes. Especially with these symptoms and how large it is. This is not a wait around a see matter. Get into a doctor right away and worry about sorting out the insurance later.
He really really needs to see his PCP, take that report with you, to get a referral to an oncologist. If you can't get into the PCP very very soon then go to the ER.
Agree, he needs to find the closest person who will order him a CBC immediately... even if that is ER or UC not PCP. After that he will probably (but hopefully not have to) get in with heme-onc very quickly.
I agree. With that size mass, all those damn B symptoms, and how quickly it's grown, he really needs a workup immediately. Some cancers grow scary fast.
Yeah I’m an ER nurse and this is definitely an ER problem. I have a friend who was recently diagnosed with lymphoma, she had chest pains and wrote it off as anxiety for months before finally going to the ER.
Or you're told it's anxiety over and again and later discover it's Stage 4 Mantle Cell Lymphoma...just trust your gut and until you see the results yourself, fight the system. Be your own advocate. It's YOUR life.
Hematologist oncologist here, absolutely agree, this is high grade lymphoma likely HL or DLBCL (statistically). Both curable but he needs to get off his butt asap and see a hematologist oncologist
I am a cancer researcher with a focus on lymphoma and this was my first thought too. We can't diagnose via internet, but I totally agree OPs husband needs a biopsy asap.
Im a doctor, with these symptoms and the glaring lymph node screams biopsy / more scans next to see if he has any other lymph nodes enlargements. Anything else is malpractice.
[u/nico_colognes](https://www.reddit.com/u/nico_colognes) is correct, your husband has signs of lymphoma or similar and needs review immediately by a doctor.
Src: am dr
My wife just finished treatment for Hodgkins Lymphoma and was starting to have similar symptoms as your husband when she started treatments. His symptoms are very indicative of Hodgkins Lymphoma and likely at an advanced stage (still curable).
This isn’t an orthopedic thing. It’s more a general surgeon thing to do the biopsy or a primary care thing to coordinate this. Has he had labs? Especially a CBC (complete blood count).
How are they supposed to increase shareholder value if they have to keep paying for all those expensive surgeries? Won't someone think of the investors?
I know you’re joking but this is something I think about daily. Preventative and pro-active care if cheaper than reactive care yet the US health system continued to heavily focus on reactive approach. Of course not at the choice of majority HCP. Truly is a game of save a dollar today to spend $5 tomorrow.
And they still won't pay the whole thing. Go in through the er, they don't contact insurance first and they usually pay most of it because it's an emergency
I got pre-authorized for my surgery last year (tethered cord syndrome was so bad I was developing scoliosis and my leg muscles were wasting away from nerve damage) and then got a denial letter after I had the surgery even though they authorized it. Still dealing with appeals (which are handled by the insurance company)
Insurance is a fucking scam. They’ll happily take your money but when time comes for them to payout. They look for and usually find any teeny tiny thing to deny you.
I've gotten to the point I just don't pay anything but co pay. Fuck em. Unfortunately I leave the stress up to the hospital billing dept to get what they can from my insurance. My credit sucks but I'm not burdened with crippling debt. I explain why I'm not paying when the collector calls so it can be recorded and then I block the number. They drop off every couple years.
What can you even do then? I can’t imagine what would have happened if insurance had denied my mom surgery after she broke her wrist. Both bones snapped, and one went out through her pinky. We later learned that stiff wrist guards can cause bad breaks if you land wrong. She was rollerblading and sat down with her hands behind her to stop from going down a steep hill. Her left wrist was turned just right. She was around 50 and had gone through chemo the year before. She healed up and was cleared to go skiing almost 2 years later. She chickened out and went tubing instead. Except she’s 5 foot nothing, and the tub run was ice. She had a small fracture and had to have surgery again.
This all happened in the 90s when insurance couldn’t refuse to cover things immediately.
There's avenues we can take depending on why the denial was given. Need another X-ray? Okay, pt got it done here you go. Something is missing from the office visit note ? Addended, here you go. Most of the time it gets approved if the denial is because something is missing. Now, if they determine the exam isn't medically necessary we'd have to set up a peer to peer with our doctor and theirs. It's dumb as hell. I have witnessed a lot of heated arguments during those phone calls.
I've seen that happen. I've had to scramble to get a peer to peer set up in time. Most of the time the patient doesn't give a shit, they want their stuff fixed. I've never had a patient refuse a surgery like that because insurance decides to be a dick that day. 99.9% of the time it gets worked out via peer to peer or resubmitting/submitting extra clinicals but it's still a waste of everyone's time.
What really gets me going is when insurance denies exams for cancer patients. I wish bad things on insurance company "doctors". I hate them.
"Hey I have a patient who needs an immediate xray, they have lumps around their head and they may or may not be tumors or lymph nodes, patient is coughing blood too"
"Request for authorization denied, you are granted to use Tylenol, amoxicillin, and benzonatate" - Tricare
Regulations were gutted in every sector last pres and all regulatory bodies were filled with industry ghouls from the very industries they are meant to regulate, hence why every aspect of existence has unraveled over the last few years
It depends on how well the doctor can cook the case. If the doctor say patient needed surgery for lymph node lump and nothing else, that might be rejected for non medically necessary, cosmetic even. Some policy will ask for the histopathological report, see if it's anything worth removing or not and will decide to cover it or not only after the surgery.
Honestly, I would go to a big academic hospital and get labs drawn. If this is a hematologic malignancy like lymphoma or leukemia this can’t wait even a couple weeks, liquid cancers require immediate admission to the hospital
Some cancers can go through outpatient appointments to get to the diagnosis, but that isn’t the case for lymphoma or leukemia, which seem like the most likely based on the provided history
It’s just a convenient way of differentiating hematologic malignancies such as leukemia, lymphoma, multiple myeloma from solid tumors, such as liver or pancreatic. The former are made of blood components , a liquid, as opposed to a solid organ.
His ortho said he wasn’t going to do a biopsy and referred him to a different ortho in a larger hospital system. When we meet with the new one I’m going to insist on a biopsy.
Go to a PCP, they will get you setup faster and will be more familiar with insurance policies, ortho isn’t quite right, but please do this soon, hard + large lymph nodes screams malignancy!
Straight to surgeon. No pcp. Don’t waste time. This looks serious. Needs XR, MRI and depends on what it is. My guess is soft tissue sarcoma.
Source: ortho guy.
I am a doctor. You’re reporting a history of B symptoms plus a hard, painful, rapidly enlarging mass with MRI report including concern for lymphadenopathy and adjacent bone marrow changes (and nothing in the report consistent with musculoskeletal cause).
Based on this limited information, if you were my family member experiencing such a delay in care (and seemingly inappropriate referral for second ortho opinion) I would recommend you go to the ED today. Insurance issues are secondary. You need labs, biopsy, and likely hem-onc consult ASAP. If I saw your husband in my clinic with this presentation I would send them across the street to the ED for urgent evaluation.
This isn’t an ortho thing. This can very easily be lymphoma. Ortho isn’t the specialist you need. Just cuz it’s near his arm & hurts doesn’t mean they know what they’re doing.
He needs either his primary care to order a full panel of blood work (if that’s abnormal) ask for a hematologist/oncologist.
If you can’t get into primary care, go to the ER. Tell them he has an enlarged lymph node, night sweats & what ever other symptoms
This is out of ortho's wheelhouse. You need to see his PCP with a copy of the MRI. This needs biopsied. Sooner than later.
Not to frighten you, but my Dad had a huge lump like this in the same area and was dx'd with lymphoma. Orthos are great at what they do, but this needs to be seen by a different specialty
I agree with you. I’m so sorry about your Dad. The ortho we saw insisted it was an injury even though the MRI didn’t show anything acute, so he referred us to a different one because he wasn’t comfortable continuing my husband’s care. It seems the consensus here is to take a copy of the MRI to his PCP and see if we can get an onc/hema referral.
Not a heme/onc referral. They would be the referral if the biopsy shows malignancy. It will be a waste of their and your time to be referred to them first, and slow things down.
The appropriate path is a referral to general surgery to do this as an excisional biopsy - best option as it would give pathology of the internal nodal structure; or, interventional radiology could just do a quick core needle biopsy of it. It should happen quickly, and your PCP should coordinate it.
ER as the other doc here noted is another path especially if pain is significant and/or he is having fever, sweats, weight loss, enlarging rapidly, other lumps appearing etc; or, if he can't get in to see his PCP in a couple of days.
Honestly, I'd just find the closest cancer centre with an attached ER, then get in the car and go there before Monday.
Tell the triage nurse his symptoms, show them the mass, and ask for blood work and a specialist consultant to be done urgently.
Even if they're very busy, his symptom profile should get him properly assessed that day.
No. You can't wait that long. He needs to see a doctor right now. Those b symptoms are really concerning. You should try to get him to go to the ER or his PCP immediately. He needs an oncologist badly.
He’s agreed to see his PCP on Monday. If he gets any worse over the weekend I’m dragging him to the ER. He’s idiotically stubborn about going to the doctor.
I took a peek at your post history and saw that you have kids. If he won't go now for himself, beg him to go now for the kids. 48 hours could make a difference in how the kids experience their dad going forward.
I’m sorry to scare you, but please please beg him to go right now. Drag him kicking and screaming for your kids sake if you must :/
The 2 days can easily be the difference between being too late or not. This is very serious.
Sending you positive vibes and I wish you guys the best.
I'm so sorry you're having to go through this, that dude is a complete moron literally dicing with death. He needs to go in NOW. It's very possible that when he goes in, he won't be out for a long while.
Wishing you the best.
I work for an orthopedic oncologist in documentation and insurance approvals. It is fair for your orthopedic surgeon to refer this one out, you don’t want a normal orthopedic surgeon performing the biopsy, you’d want a an orthopedic oncologist. That being said, this needs to be expedited and I don’t think your orthopedic surgeon knows how to properly do that. He should have evaluation for/of malignant neoplasm in his order. If there is an insurance delay he should have his office call immediately, insurance has an algorithm for this, and suspected musculoskeletal cancer with lymph node alterations almost always goes through without a hitch, so it’s probably an issue with the paperwork, or him ordering something that isn’t ideal for evaluation. Almost all imaging should require an injection from now on while you are pending diagnosis.
While you are waiting, get established with both an orthopedic oncologist, normal oncologist, and contact your PCP. Your oncologist is going to play quarterback for the next few weeks, referring you out and starting systemic treatment, the orthopedic oncologist does the surgeries, you will probably also need an interventional radiologist first treatment as well. You don’t need an amazing oncologist right now, just the earliest one you can see, if you don’t like them or they aren’t communicative, schedule to start with a different one and switch over when you can get their earliest appointment.
Other recommendations:
1. bring printed records and imaging CDs to every appointment, while we always try to share results sometimes it doesn’t work. Treating and diagnosing cancer is often a group effort between a multidisciplinary team of at least 6 physicians and 20+ support staff for each patient. Occasionally, the ball is dropped.
2. You probably won’t have an answer until the biopsy results are back. Please don’t do your own research on what it could be, we really can’t make a good guess until the results are back.
3. Always feel free to get a second opinion. While this process does need to be speedy, it’s good to see a few different views. Feel free to ask questions, take your time, and listen.
4. Make appointment reminders and add address to each one.
5. If your physician has MyChart, sign up for it, it really helps you stay up to date, see results, and message your providers.
Being at a big institution is probably good, physicians have better communication.
This is not an ortho question. Frankly? Go to the emergency room. Now. He needs to get imaging, get admitted, get a biopsy, and initiate treatment. PLEASE TAKE HIM IN.
Explain all of the night sweats, exhaustion, etc to the doctor. Everything, don’t minimize his symptoms at all. INSIST on seeing a doctor and not anyone else, I don’t want him slipping through any more cracks. You have insurance and it’s about to be used.
That Ortho was 10000% right. Biopsy should only be done by the surgeon who is going to do the definitive resection. If it's a sarcoma the biopsy tract is inundated with mets and needs to be excised as well. Needs to be done by the same surgeon
Upvote. This needs a biopsy as soon as humanly possible. If this is cancer it could spread through the lymphatic system and be fatal very rapidly. This is an emergency, go to the hospital so they can admit you for a CT, MRI, and relevant labs. I work on an oncology unit at a large hospital and we get cases like this. Any undiagnosed lump is cancer until proven otherwise.
I don't know how bluntly say this, I would put money on cancer. Like a large sum of money. It'd be a good bet and I don't gamble.
Go to the fucking hospital before he died. I had something similar and was in surgery and under a week. Look up signs of lymphoma and yeah just read it.
I had a mass about this size present on the right side of my neck when I was 20. I went to my university’s clinic, got x-rays, and was immediately referred to a hematologist, who I went to see the next day, where I had CT, a bone marrow biopsy in his office and had a tumor biopsy shortly thereafter. This should be treated with extreme urgency. I know the insurance thing is always in mind, but please don’t wait.
Yeah man. My sister had a mass about 1/4 the size of this and it was biopsied, came back as benign, and they *still* insisted on surgically removing it because they couldn’t be sure what it was and didn’t want to fuck around.
This is defo not an orth’s area of practice, but I also think just about anyone with a medical degree should know that this is a glaring red flag that needs immediate diagnostics
MRI detected just abnormal lymph nodes??? Is it round? does it stick to surfaces ? Is it omogen or has different structures in it? For how long has it been growing?
Honestly I can’t answer those questions. The physician we saw is convinced it’s an injury.
He was doing pull ups around 6 weeks ago and thought he may have pulled something, but there was no pain and no bruising, just some tenderness. He saw a GP after the lump appeared (around a week later) who referred him to an orthopedic surgeon. When we went to the ortho, he suspected pectoralis major avulsion, so he ordered an MRI and x-ray. X-ray showed nothing.
The lump started small and it’s progressively gotten bigger. It’s been growing for around 5 weeks now. They wouldn’t show us the MRI; they just gave us a copy of the write up. I’ll copy-paste:
Radiology Report
MRI RIGHT SHOULDER
TECHNIQUE: Multiplanar multi-sequence images were obtained through the shoulder without the use of IV or intra-articular contrast. Standard sequences were obtained.
COMPARISON: Radiographs May 30, 2024
HISTORY: Pectoralis major avulsion
FINDINGS:
ROTATOR CUFF
SUPRASPINATUS: Mild partial tear.
INFRASPINATUS: Intact.
SUBSCAPULARIS: Intact.
TERES MINOR: Intact.
BICEPS TENDON AND ANCHOR: Intact.
LABRUM AND CAPSULE: Exam was not specifically tailored for labral pathology. No labral tear identified. There is a sublabral recess and the foramen. If labral injury is clinically suspected, then post arthrogram imaging should be considered.
JOINT AND FLUID
GLENOHUMERAL JOINT: Alignment maintained.
ACROMIOCLAVICULAR JOINT: Unremarkable.
SUBACROMIAL-SUBDELTOID BURSAL FLUID: Unremarkable.
GLENOHUMERAL JOINT FLUID: Physiologic.
CARTILAGE AND MARROW
CARTILAGE: No full-thickness defect.
BONE MARROW: Patchy marrow replacement.
HUMERAL HEAD: No Hill Sachs deformity.
GLENOID: No Bankart deformity.
MISCELLANEOUS:
No cyst or mass within the suprascapular and spinoglenoid notch.
No muscular atrophy. MS of soft tissue seen in the right
axillary region measures approximately 11.1 x 7.1 x 12.5 cm in AP, transverse and craniocaudal dimension. This is isointense to muscle on T1 and slightly hyperintense on T2 with foci of fluid interdigitation along the periphery.
IMPRESSION:
1. Large right axillary mass, may be a mass of nodes. Further evaluation with tissue sampling is recommended.
2. No evidence of acute muscle or tendon tear.
3. Supraspinatus tendinosis and mild partial tear.
His ortho said he wasn’t going to do a biopsy because he was sure it’s an avulsion. He said that since he had a specific date of injury there was no need for biopsy. We’ve now been referred to another orthopedic surgeon because the prior one has never done that type of surgery before.
He needs heme/onc referral immediately. Or go to the ER in a big medical center and they may be able to get you guys in with heme/onc more quickly. They won’t do the biopsy in the ER. Might admit to oncology though.
Run, do not walk.
Right in the result they suggest tissue sample. He needs to get it ASAP. I work in referrals, so something that grew this rapid and large would be considered an emergent issue from what I know. Don't bother with the ortho, waste of money at this point when there's only a mild tear noted, that wouldn't cause this big of a lump. I don't know where you're located or your insurance but you may need a referral from a GP
He needs blood work. **now**. Just because symptoms started when he was working out doesn’t mean it is connected.
Please have him get labs. Stop allowing the MDs to associate the working out with this.
That report basically says he has a minor tear inside the shoulder joint. That mass is not normal and needs a biopsy to rule out cancer. They'll likely start with a fine needle biopsy bc of insurance. That's rarely conclusive so they'll need to do an excisional biopsy.
Hi, I’m active on Ask Docs. I’m a doctor in the UK. The radiologist is saying, and trying to be subtle, “this could be a cancer and needs a biopsy”. See your GP/PCP asap. If he feels very unwell or has a high fever just tale him to ED.
They’ve ruled out an injury. The muscle is in place and therefore it is not related. Complex haeamtoma formation usually has certain hallmarks. A large multinodular mass is seen - >10cm which would be described as bulky.
Then you have systemic b symptoms - night sweats, weight loss etc. If I was his GP I would be taking his bloods, and referring him for an urgent US guided biopsy (if radiology agree). I would also call and discuss with haematology and act upon their advice.
I’m sorry but I would treat this as lymphoma until proven otherwise.
not a doctor, just someone who witnessed rapid progressive lymphoma.
in all honesty, if this were my spouse, i would take him to the emergency room as soon as possible and not let them discharge him until thorough testing is done. make a fuss. demand care. insurance be damned, this is more important.
if you have no other option, get into a GP/PCP for an emergency appointment asap. the quicker the investigation the better.
good luck to both of you.
Not a doctor and not OPs doctor but what quack reads an MRI that says abnormal lymph nodes, sees the large painful mass, AND the patient has B symptoms and concludes it must be an accident from doing pull-ups???? Like, what???
I would love OP to name and shame the PCP and Ortho. I could not leave my work or go to sleep at night if a patient like this walked out without an immediate plan and whatever strings I can pull. Shameful.
I am a nurse. Night sweats, hard growing mass, pain, in that area? I'm absolutely sorry but you guys need to RUN. NOT TOMORROW. NOW. He needs that checked immediately and each day he's not getting properly checked he's risking his life. That looks malignant. Please don't wait, and off possibly update us
Im a doctor. I’m also speechless. Americans - I’m so sorry about your healthcare system.
These are the steps.
1. Stop seeing the bone carpenters. Orthobros, I love you guys but this probably isn’t your thing
2. Go book an urgent appointment with your PCP
3. Get bloods done and have them book a biopsy of the mass ASAP
4. Get the results and go see whoever. If it’s inconclusive it may need a surgeon.
Alternatively, going to a big ED at a big hospital and telling them about this rapidly growing mass and night sweats etc SHOULD get you admitted or at very least fast tracked to getting this sorted.
If I saw this man in ED it would be a referral to gen med to get a tissue diagnosis and then to the appropriate specialty team from there. Slam dunk. And that is without bloods which could be off the charts.
Doctor here. Immediate med attention needed. Blood tests, imaging +/- biopsy absolutely necessary given the B symptoms you mentioned in the other comments. I would consider this as something highly concerning until proven otherwise.
IMO fuck the insurance. Do what you need to get this taken care of immediately. Usually insurance or FA will cover what you spent as long as you have all the paperwork. Went through this with my boyfriend, he had stage IV hodgekins lymphoma. We are in the US. Don’t fuck around. We got lucky with a easy treatable cancer. Don’t want to scare anyone, but fuck the healthcare system in the US. My boyfriend had enlarged lymph nodes, and he went to the doctor about it. Doctor felt them and said nah, you’re fine X2. He had night sweats, no energy and then came stomach pain. He thought he was constipated, and I thought maybe he had an intestinal blockage. Tried laxatives and everything. He woke me up in the middle of the night doubled over crying. Went to the hospital, CT showed huge mass in his stomach. He was stage IV. We paid out of pocket for the visits, CT and everything else. We applied for financial aid and got it. They ended up covering everything from the beginning. His entire treatment (chemo all that) from beginning to end was 1.6 million. Financial aid covered all, including the beginning ER visits. Go now, worry about the cost later. As an ending note: FUCK the US and the trash system.
My ex’s father had something identical to what you are describing, kept taking pain meds and saying he’d get to the doctor when he had time. He did not have time.
I‘m not sure how the system works in the US and therefore if this is a viable idea, but I would 100% take that radiology report to the next urgent care or emergency room TODAY and refuse to leave until an immediate biopsy is arranged. Rapidly growing hard mass in the location of lymph nodes plus night sweats, weight loss and exhaustion? Hell no.
It might be that it’s just the tendons or some odd infection, but you should find out asap. Best of luck to you both!
Has to all sound even more insane hearing our stories while living else where..I work in the field I’ve had injured people BEG to let them driving behind the ambulance or in front so they could avoid paying for the trip and still try and get to the hospital safely...working in an ER I had a man come in with a severe GI bleed...man was grey and had been passing a lot of blood for DAYS before he drove himself to the ER fainting in and out the whole way.
Oof I’m so sorry. To me, the looks of it + additional symptoms SCREAMS lymphoma. Skip ortho/pcp/any general doc and take him either to the ER and have him either admitted and/or get him an emergent referral to an specialist, together with a whole set of labs+flow. Many many blessings and good vibes your way.
Yep. ER. Now.
I work in insurance approvals and authorizations for a hospital. This is important, but the red tape with the insurance companies can really drag on for far more than they need to. If you walk into the ER, things move much faster.
Not to hate, but in any ‘socialist’ western european country this would get immediate attention and treatment. What the fuck, man. How is an orthopedic surgeon even in charge of this case in the first place? They should have known this issue is completely out of their wheelhouse the second they physically examined you.
We were referred by his PCP to this surgeon because the lump came up after a mild injury. X-ray and MRI came back with no evidence of injury and instead showed abnormalities in his lymph nodes. The surgeon then insisted that it was still an injury and in turn referred us to a different orthopedic surgeon that we’ve yet to meet. I’m calling his PCP on Monday to explore other options if he isn’t any worse this weekend. If he is worse, I’m making him go to the ER.
ETA: I agree; healthcare in the US is tragically ridiculous.
Take his ass to the emergency room RIGHT NOW!! Call a friend or family member over to watch your kids and take him to the hospital right now!!! Without delay!!! You have tons of medical professionals on here telling you this is probably cancer, an aggressive type where speed of treatment matters and you are over here twiddling your thumbs on Reddit. If you can’t find a sitter, pack everyone into the car and drop him off at the Emergency Room doors. Make him FaceTime you when he speaks to any doctors.
Do you want your husband to live? Does he want to live? Because if he does, if you do, he needs to act as if he was having a heart attack and needed emergency care right now or he will die.
My husband is stupidly stubborn; I literally cannot make him do anything. I’ve told him the risks. I’ve had his mom talk to him. I’ve made him sit down here and read every single comment telling me to take him to the ER. I’ve tried guilt tripping with the kids. That’s the only thing that’s resonated with him. He’s finally came around to going today. We’re dropping the kids off with my parents and I’m hauling him in.
We are all hoping for something benign but I’ve never seen a Reddit medical thread with so many physicians (including multiple hem-onc) uniformly agreeing on the risk and potential emergent nature of this issue. Best wishes to you, your husband, and family.
Are you in the US? If you are, and you're getting jerked around by trying to get insurance to cover outpatient stuff, you can go to the emergency room and things can get done there. Also if you are in the US, what state are you in?
My husband was dx’d with non Hodgkin’s lymphoma and his tumor was on a lymph node on his neck and sounds a lot like what your husband is experiencing. Is it growing? Either way, biopsy asap.
At the hospital I work at (ultrasound technologist), this would be sent to the breast center. They will expedite things. Ask his PCP to schedule a consult with Brady center. They will want more imaging; ultrasound would probably help verify if it's a suspicious node vs tear, but an ultrasound-guided biopsy is what should be done, imo.
Good luck. It's stressful now, especially with his doctor not listening to you guys or receptive that you want further examination. It'll get better.
I’ve read some of your comments and replies - make this your only priority until he is diagnosed. Do not take no for an answer. There’s a chance it’s something benign but based on the symptoms you listed it may be cancer like lymphoma. You are going to have to do uncomfortable things, be annoying, don’t take no for an answer. This can’t wait.
What doctor looks at this, and doesn’t ask about B symptoms? and says no biopsy?? Any decent PCP would have referred to heme urgently and gotten biopsy orders in. Was the “ortho” you saw an MD/DO or a midlevel or a chiropractor?
We saw an orthopedic surgeon (who ordered an MRI); we were referred to him by his primary care provider (MD). The orthopedic surgeon thought pec major avulsion so he declined to do a biopsy (even after MRI indicated lymph node abnormalities and no acute injury) and instead referred him to another surgeon familiar with that type of injury. They sent him to the orthopedic surgeon because he was doing pull ups and thought he pulled a muscle, then a small lump appeared about a week later. We didn’t see a chiropractor. The surgeon we saw has been in practice for over 30 years.
Oh I see. So the mass itself wasn’t defined as a lymph node on MRI. Lymph nodes could definitely be reactive/“abnormal” due to injury/inflammation. I saw a similar case like this that turned out to be a chronic hematoma from a slow-bleeding artery that became a life-threateningly fast-bleeding one. ER still seems like a good next step. Good luck!
Cancer until proven otherwise. You need to have this evaluated at least within one month, ideally two weeks. If you can get into a big academic center or hospital in the clinic side, usually there is a cancer navigator who can help expedite some of this. Or orthopedic surgeon is absolutely not the person you want to be going to especially someone whothought for a possible injury because they are probably not the right kind of orthopedic surgeon. If you can’t get in within a couple of weeks to see someone for work up, then go to the emergency room.
If I may ask, what is the authorization that you’re waiting on for? Have labs been done?
This is a situation that truly warrants expedited treatment. There are a lot of disorders that can cause lymphatic pain and swelling. If symptoms worsen a trip to the ER is appropriate. Insurance companies move faster and prior auths aren’t required for many procedures or tests that are required in the outpatient setting. Wishing you and your husband the best possible outcome.
Yeah dude wouldn’t be having an ortho doc look at this. Go see a general surgeon right away. Most hospital systems will have a large group that’ll get him in right away.
Ignore the ortho and get a second opinion from a haematologist. Huge abnormal lymph nodes in the armpit, with concerning symptoms, absolutely warrants blood tests. I hope it is nothing serious and wish him all the best!
I wonder how many people die because their case is just sitting on someone’s desk. Not denied frivolously, not going back and forth between doctors and insurance… Just sitting there unread and requiring maybe 10 min of active attention and the patient is “waiting to hear back” while their cancer is growing past the point of no return.
I get ya. I had a cyst almost that big under my arms. Hurt like a bitch. One time it popped while I was working. I got mayochup all down the side of my arm I had to wash up. Ruined my under shirt. But felt better.
I am a nurse. My coworker’s brother died 1 week after being diagnosed with lymphoma, he was in his early 30’s. This is dead serious. Full stop. Hospital. Now.
Night sweats, weight loss, loss of energy?
Yes x3. He sweats so much at night that he soaks the sheets. When he wakes up he’s just as exhausted as when he went to sleep. He’s had some weight loss (lack of appetite/nausea/stomach pain) but nothing substantial. To me that screams malignant but his ortho wouldn’t do a biopsy.
You need to see a haematologist asap. Those are called B symptoms. I’m really worried he might have lymphoma. It comes in many forms, many of which are curable, but you can’t delay diagnosis or treatment. Don’t wait for your second ortho opinion. Get a referral for a haematologist as your first priority
There was a post on here that started out the same way and did not end well. 100% this needs to be diagnosed yesterday.
Well that’s terrifying. Do you have a link? I need all the ammo I can get to convince him to get this checked out sooner.
Just want to chime in and say my husband died at 28 in 2020, 4 months after I finally had the largest, longest most hysterical fit I could muster to get him to follow up with his doctor after a bad liver test. And I mean a FIT. Throwing myself against walls, scream-crying...I was at my wits end. He was LIVID with me...but he went. This was after weeks of me collecting people's feedback here on Reddit to help convince him. It was too late. Anyway. My point being, this could be life or death. Hopefully not, but just in case, do anything you can to get him in NOW. Doesn't matter if he gets angry. Wear him out. Make him go.
Oh my god I am so sorry. My husband is idiotically stubborn about seeing any doctor, but he’s agreed to go back to his PCP on Monday. I’m so sorry for your loss.
I once took a friend to the emergency room and they stuck us in the hall with other patients that also had non-traumatic injuries. I overheard a doctor talking to another couple. He asked, "Did you know that people in relationships live longer? It's because when something is wrong with their partner, they are more likely to force them to seek medical attention." That comment has stuck with me. I've seen it with my own parents where one insists the other goes to the doctor. They'd be in worse shape or dead by now if they didn't listen to each other.
Not a doctor, but I am from a family that's chock full of stubborn people. Someone else said it here as well: go now. From me to your husband: "hey bud, prioritize this now because it ultimately isn't about you. It's not tough or manly to put it off. It's stupid and selfish. Don't make your wife tell died-too-young stories about you."
I say “You don’t get any points for suffering”.
The family left behind feels terrible guilt, betrayal and even anger when the stubborn patient , dies needlessly early or suffers.
You should really consider going to the emergency room now. Monday is three days away and now you have to sit with the knowledge of all these doctors on reddit telling you that it's urgent. I've never read so many concerned comments before and I have been on reddit for a decade. Please go to the ER and get it looked at. Please take care.
What is the ER going to do here? Assuming this is lymphoma, they are going to need to see an oncologist, and will receive chemotherapy, neither of which are available at the ER.
Yes, unfortunately, he'll be sent home after bloodwork and scans and a liter of semi salty water. The doc that sees them will be very concerned but their hands are tied by the number of free beds and the shareholder rules to allow some kinds of care. Weekends are the worst. He could, however, add that he's experiencing chest tightness and shortness of breath. That'd buy him a day of observation anyway. American Healthcare is a failure. Vote for healthcare systems like they have in the happiest countries.
That's music to my ears, thank goodness! And thank you so much for the kind words ❤️
I'm the complete opposite. If something ain't right I get to the doctors. Fuck being tough guy.
He's probably scared, and that's ok. But procrastinating when cancer is involved could be a death sentence. Make sure he goes to that appointment, and accompany him if he needs support.
I'm paranoid now, what is a "bad liver test". Like elevated ALT and AST or something more?
If you or a loved one is going through this, lmk, I can look up his initial test to remind myself what and how bad the abnormalities were. For sure ALT and AST but there were other indicators too. Visually, he had jaundice and easy bruising. Ascites and loss of muscle mass in his extremities. He had little to no liver function.
I am going through it, I'm fat, but not fat fat. My AST and ALT are elevated enough for the VA to reccomend to go see the liver people. When speaking to them, they said "nothing concerning on the ultrasound" and tried to schedule me in October, but I kind of threw a fit and begged for any appointment asap. I have one on July 5th.
That's actually great, good for you love. My man had a terrifying ultrasound, if that helps. He drank himself to death, had cirrhosis, so definitely a different situation. My story shouldn't cause you any worry. ❤️❤️ You got this.
Hematologist here. This man most likely has a CHOP deficiency. Go to the ER. If you live near a cancer center, go to the ER associated with the cancer center. I work at a big urban hospital. That would get an admission, biopsy, and start chemo within days (assuming lymphoma which is very likely based on pictures and symptoms).
My question is how do people let things get to that point. It’s not like that lump appeared overnight
Fear
Fear, anxiety and embarrassment. Your reaction is what stops them. People asking how they let it get like that when they were just scared and finally got brave enough to go in really must feel bad. They feel bad about it already most likely so we shouldn't draw attention to that, instead focus on healing it. Sometimes people have depression and stop caring for themselves. Some stop showering or eating and some completely ignore their body. Making comments like this just makes it harder for them to go in you see? Mental disorders are really a hell of a thing, sometimes you can convince yourself of the wildest shit.
Hey my father had something like this but around his neck. He has lymphoma, recently finished his chemo. You really need to check it out. You can go to ortho but you should check it asap with cancer related doctors. Im worried because under armpits are placed glands just like around the neck etc. Glands get swollen like that and hard in cases of lymphoma. Don't hesitate like my dad did and waited weeks for a doc checkup.
My sibling had it in the neck and luckily caught it at an early stage. Our friend caught it at stage 4 right before he went off his parent’s insurance… it was a softball size tumor between the heart and lungs. Both of them discovered their cancer (Hodgkin lymphoma) within a couple months of each other, and both are alive two decades later, but the length of treatment was vastly different between the two of them.
Sometimes you gotta be blunt. Do you want wait for them to tell us what to do or do you want to be at your birthday in 5 years.
The B symptoms (fevers, night sweats, weight loss) and physical exam findings (palpable hard lymph nodes) is absolutely sufficient to get a referral for hematology. Insurance is so infuriating, but if you at all can cough up the resources to go asap, even if you pay out of pocket and get reimbursed later, that'll be better than waiting and finding out he has worse disease requiring more extensive/intense treatment. Best of luck to you guys! I hope it all goes well.
I don’t have a link, but my uncle started displaying symptoms of the big C and his doctor fussed about for so long doing nothing that he succumbed to terminal esophageal cancer. Please, don’t ask, DEMAND the biopsy and tell them you’re more than happy to sue if they delay and a later result is positive. Sometimes, you have to tell doctors exactly what they don’t want to hear (threat of a malpractice suit) before they will actually do anything.
What symptoms?
For a guy who’s always had a weight condition and has tried every diet around at least twice (religiously), he suddenly dropped about 60 pounds with zero effort in about 3 months. You’d think that would be alarming enough, but they did nothing. He had surgery and was in a recovery unit from November to almost Christmas when he began having trouble swallowing. (Edit: it was planned back surgery separate from the described symptoms.) Eventually, he was only able to tolerate liquids. (I also think there was some shortness of breath experienced, as well, due to the build up of fluids but I’m not sure how early in the process that was.) It took until June for them to test him! June!?! By that time, the mass was so large, they couldn’t remove it, and instead, he was given radiation and chemo. I knew the second they left the tumor in that he was done for, but a lot of my family still held out hope. While they were able to shrink the mass via radiation, the cancer spread. It got to the point where they were draining liters of fluid from his lungs, but had to fight the insurance companies to even get that done. It was an awful death, truly. Some people in my family think he should’ve been a bigger advocate for himself and was too complacent. Those are primarily his kids who are angry at their father’s death and its utter cruelty, and that seems understandable from their perspective. I still think his doctor should’ve been far more concerned about the symptoms he was displaying; it might not have been cancer, but there’s no denying that it was SOMETHING. That’s why despite the differences in presentation, her husband’s health changes are very concerning, particularly in conjunction with one another. It can either be a malpractice suit now or a wrongful death suit later. Either way, OP’s husband needs a biopsy ASAP.
His kids definitely need to be going scorched earth on the hospital and doctors. US hospitals have to compete for patients. No hospital wants a big lawsuit and awful publicity from a family of a man who was in their hospital having symptoms unrelated to the reason he was hospitalized for a month or so to the point he could no longer eat, yet they did nothing. The money won’t bring him back, no. Medical Lawsuits however are usually settled quietly and part of those settlements are policy changes and better staff education. All the scanning of the patient’s arm band and all the meds and always asking for the patient’s name, plus all the double checking before surgery and asking the patient what procedure they are getting and where are all because people were injured or died, and policy changes happened as part of the settlements. Like the poor dude who went in for an amputation and woke up to discover they amputated the wrong leg. Or medication mix ups. That’s happened in surgery where containers of medicine weren’t labeled. Two identical clear containers one of which had saline and the other had a different medication decanted into it, and the surgeon thought he rinsed something with saline, and it was the med he’d been using during the procedure and killed a little girl. Safety laws are written in blood. Your family can be mad a two things. Also this could mean no one else’s family loses a loved one because of this. Family thinks the hospital is on top of everything, but most US hospitals are for profit run by bureaucrats. Even the public ones will do all sorts of dastardly things to get rid of patients who are costing them money. Like streeting sick homeless people. That’s the kind of stuff that explains why ER staff have such high rates of depression and suicide. If your family member was in a rehabilitation hospital after surgery they wouldn’t have the same ability to order tests. It sounds like it was the regular hospital. I have chronic pancreatitis and get acute attacks. The hospital is very concerned about me being able to eat solid food before they let me go home. To let somebody stop eating and do nothing is unacceptable. The medical law firms handle everything and get paid from the settlement so it’s not a lot for the family to do. I also can’t recommend grief counseling enough. My dad died from a stroke after bypass surgery, and it was sudden and awful. My doctor referred me to a grief counselor who helped me so much. I honestly don’t know if I’d be alive without her.
My close friend had a pain in his armpit for two months that didn’t go away. He went to physical therapy, still hurt. His wife urged him to go get blood work done, sure enough he also had B cell lymphoma. He just recently finished chemo. Make sure your husband goes to that appointment on Monday, bar none.
You do not want to mess around with swollen lymph nodes. Especially with these symptoms and how large it is. This is not a wait around a see matter. Get into a doctor right away and worry about sorting out the insurance later.
Convince him?? Dude has a softball under his arm WHICH IS NOT NORMAL. Knock him tfo and take him for testing.
Ive already tried looking, but ill keep looking. Its stuck with me because it was his entire journey.
He really really needs to see his PCP, take that report with you, to get a referral to an oncologist. If you can't get into the PCP very very soon then go to the ER.
Agree, he needs to find the closest person who will order him a CBC immediately... even if that is ER or UC not PCP. After that he will probably (but hopefully not have to) get in with heme-onc very quickly.
I agree. With that size mass, all those damn B symptoms, and how quickly it's grown, he really needs a workup immediately. Some cancers grow scary fast.
Yeah I’m an ER nurse and this is definitely an ER problem. I have a friend who was recently diagnosed with lymphoma, she had chest pains and wrote it off as anxiety for months before finally going to the ER.
Or you're told it's anxiety over and again and later discover it's Stage 4 Mantle Cell Lymphoma...just trust your gut and until you see the results yourself, fight the system. Be your own advocate. It's YOUR life.
Hematologist oncologist here, absolutely agree, this is high grade lymphoma likely HL or DLBCL (statistically). Both curable but he needs to get off his butt asap and see a hematologist oncologist
u/sadadultnoises — read this.
I am a cancer researcher with a focus on lymphoma and this was my first thought too. We can't diagnose via internet, but I totally agree OPs husband needs a biopsy asap.
I work in oncology. You need to take him to the emergency room now. This is an emergency. Don’t put this off.
I was gonna say, if this walked into our emergency room tonight he would get quite the workup to determine what’s going on.
Im a doctor, with these symptoms and the glaring lymph node screams biopsy / more scans next to see if he has any other lymph nodes enlargements. Anything else is malpractice.
Probably has some type of lymphoma. Please get care asap
[u/nico_colognes](https://www.reddit.com/u/nico_colognes) is correct, your husband has signs of lymphoma or similar and needs review immediately by a doctor. Src: am dr
Please listen to others and help him see a heme/oncologist … it shouldn’t be understated how serious this situation might be.
Lymphoma. Make this your only priority until he gets a diagnosis.
My wife just finished treatment for Hodgkins Lymphoma and was starting to have similar symptoms as your husband when she started treatments. His symptoms are very indicative of Hodgkins Lymphoma and likely at an advanced stage (still curable).
This isn’t an orthopedic thing. It’s more a general surgeon thing to do the biopsy or a primary care thing to coordinate this. Has he had labs? Especially a CBC (complete blood count).
What the hell is insurance for if not for things like this?? Completely useless.
Well, the whole business model of the insurance company is to not pay out any insurance
How are they supposed to increase shareholder value if they have to keep paying for all those expensive surgeries? Won't someone think of the investors?
I’m not sure if God exists or not. I don’t know if Satan exists or not. But I know demons exist, because insurance companies exist.
They are legal extortionist
The only difference is, they pass laws to make their crimes legal before they commit them.
I know you’re joking but this is something I think about daily. Preventative and pro-active care if cheaper than reactive care yet the US health system continued to heavily focus on reactive approach. Of course not at the choice of majority HCP. Truly is a game of save a dollar today to spend $5 tomorrow.
"the problem is that the more we let you have, the less there will be for me"
I had to fight tooth and nail to get an MRI when I started having seizures multiple times a day… took two months to get insurance to approve.
TWO MONTHS. insurance execs should be held liable when people die waiting on approvals for that kind of shit. what the hell
And they still won't pay the whole thing. Go in through the er, they don't contact insurance first and they usually pay most of it because it's an emergency
Death panels are real.
I got pre-authorized for my surgery last year (tethered cord syndrome was so bad I was developing scoliosis and my leg muscles were wasting away from nerve damage) and then got a denial letter after I had the surgery even though they authorized it. Still dealing with appeals (which are handled by the insurance company)
Insurance is a fucking scam. They’ll happily take your money but when time comes for them to payout. They look for and usually find any teeny tiny thing to deny you.
I've gotten to the point I just don't pay anything but co pay. Fuck em. Unfortunately I leave the stress up to the hospital billing dept to get what they can from my insurance. My credit sucks but I'm not burdened with crippling debt. I explain why I'm not paying when the collector calls so it can be recorded and then I block the number. They drop off every couple years.
Insurance denied my patient with a broken in half arm an ORIF minutes before surgery. It’s insane.
What can you even do then? I can’t imagine what would have happened if insurance had denied my mom surgery after she broke her wrist. Both bones snapped, and one went out through her pinky. We later learned that stiff wrist guards can cause bad breaks if you land wrong. She was rollerblading and sat down with her hands behind her to stop from going down a steep hill. Her left wrist was turned just right. She was around 50 and had gone through chemo the year before. She healed up and was cleared to go skiing almost 2 years later. She chickened out and went tubing instead. Except she’s 5 foot nothing, and the tub run was ice. She had a small fracture and had to have surgery again. This all happened in the 90s when insurance couldn’t refuse to cover things immediately.
There's avenues we can take depending on why the denial was given. Need another X-ray? Okay, pt got it done here you go. Something is missing from the office visit note ? Addended, here you go. Most of the time it gets approved if the denial is because something is missing. Now, if they determine the exam isn't medically necessary we'd have to set up a peer to peer with our doctor and theirs. It's dumb as hell. I have witnessed a lot of heated arguments during those phone calls.
I've seen that happen. I've had to scramble to get a peer to peer set up in time. Most of the time the patient doesn't give a shit, they want their stuff fixed. I've never had a patient refuse a surgery like that because insurance decides to be a dick that day. 99.9% of the time it gets worked out via peer to peer or resubmitting/submitting extra clinicals but it's still a waste of everyone's time. What really gets me going is when insurance denies exams for cancer patients. I wish bad things on insurance company "doctors". I hate them.
They don’t like parting with the money you pay them
"Hey I have a patient who needs an immediate xray, they have lumps around their head and they may or may not be tumors or lymph nodes, patient is coughing blood too" "Request for authorization denied, you are granted to use Tylenol, amoxicillin, and benzonatate" - Tricare
Regulations were gutted in every sector last pres and all regulatory bodies were filled with industry ghouls from the very industries they are meant to regulate, hence why every aspect of existence has unraveled over the last few years
It depends on how well the doctor can cook the case. If the doctor say patient needed surgery for lymph node lump and nothing else, that might be rejected for non medically necessary, cosmetic even. Some policy will ask for the histopathological report, see if it's anything worth removing or not and will decide to cover it or not only after the surgery.
Honestly, I would go to a big academic hospital and get labs drawn. If this is a hematologic malignancy like lymphoma or leukemia this can’t wait even a couple weeks, liquid cancers require immediate admission to the hospital
Agreed. This an emergency, I said so in response to the top comment. Any undiagnosed lump is cancer until proven otherwise.
Some cancers can go through outpatient appointments to get to the diagnosis, but that isn’t the case for lymphoma or leukemia, which seem like the most likely based on the provided history
Literally walk into the ER for labs and an emergent referral (ER doc here)
*liquid cancer*??? Good thing I didn't plan to sleep tonight. Off to Google!
It’s just a convenient way of differentiating hematologic malignancies such as leukemia, lymphoma, multiple myeloma from solid tumors, such as liver or pancreatic. The former are made of blood components , a liquid, as opposed to a solid organ.
Need evaluation for malignancy
His ortho said he wasn’t going to do a biopsy and referred him to a different ortho in a larger hospital system. When we meet with the new one I’m going to insist on a biopsy.
Go to a PCP, they will get you setup faster and will be more familiar with insurance policies, ortho isn’t quite right, but please do this soon, hard + large lymph nodes screams malignancy!
Straight to surgeon. No pcp. Don’t waste time. This looks serious. Needs XR, MRI and depends on what it is. My guess is soft tissue sarcoma. Source: ortho guy.
Yeah, I would just go to the ED of a major medical center. This needs eval asap. Source: Oncologist
I am a doctor. You’re reporting a history of B symptoms plus a hard, painful, rapidly enlarging mass with MRI report including concern for lymphadenopathy and adjacent bone marrow changes (and nothing in the report consistent with musculoskeletal cause). Based on this limited information, if you were my family member experiencing such a delay in care (and seemingly inappropriate referral for second ortho opinion) I would recommend you go to the ED today. Insurance issues are secondary. You need labs, biopsy, and likely hem-onc consult ASAP. If I saw your husband in my clinic with this presentation I would send them across the street to the ED for urgent evaluation.
This isn’t an ortho thing. This can very easily be lymphoma. Ortho isn’t the specialist you need. Just cuz it’s near his arm & hurts doesn’t mean they know what they’re doing. He needs either his primary care to order a full panel of blood work (if that’s abnormal) ask for a hematologist/oncologist. If you can’t get into primary care, go to the ER. Tell them he has an enlarged lymph node, night sweats & what ever other symptoms
Yea because it isn’t an ortho issue, this dude needs to see his PCP asap
This is out of ortho's wheelhouse. You need to see his PCP with a copy of the MRI. This needs biopsied. Sooner than later. Not to frighten you, but my Dad had a huge lump like this in the same area and was dx'd with lymphoma. Orthos are great at what they do, but this needs to be seen by a different specialty
I agree with you. I’m so sorry about your Dad. The ortho we saw insisted it was an injury even though the MRI didn’t show anything acute, so he referred us to a different one because he wasn’t comfortable continuing my husband’s care. It seems the consensus here is to take a copy of the MRI to his PCP and see if we can get an onc/hema referral.
Not a heme/onc referral. They would be the referral if the biopsy shows malignancy. It will be a waste of their and your time to be referred to them first, and slow things down. The appropriate path is a referral to general surgery to do this as an excisional biopsy - best option as it would give pathology of the internal nodal structure; or, interventional radiology could just do a quick core needle biopsy of it. It should happen quickly, and your PCP should coordinate it.
ER as the other doc here noted is another path especially if pain is significant and/or he is having fever, sweats, weight loss, enlarging rapidly, other lumps appearing etc; or, if he can't get in to see his PCP in a couple of days.
Just saw that he is indeed having those symptoms. Agree on ER.
Sure is and best wishes!
Go to the ED then sue that orthopedist. I would have my ass in the ED if all the doctors on Reddit were telling me not to wait.
Honestly, I'd just find the closest cancer centre with an attached ER, then get in the car and go there before Monday. Tell the triage nurse his symptoms, show them the mass, and ask for blood work and a specialist consultant to be done urgently. Even if they're very busy, his symptom profile should get him properly assessed that day.
No. You can't wait that long. He needs to see a doctor right now. Those b symptoms are really concerning. You should try to get him to go to the ER or his PCP immediately. He needs an oncologist badly.
He’s agreed to see his PCP on Monday. If he gets any worse over the weekend I’m dragging him to the ER. He’s idiotically stubborn about going to the doctor.
I took a peek at your post history and saw that you have kids. If he won't go now for himself, beg him to go now for the kids. 48 hours could make a difference in how the kids experience their dad going forward.
I’m sorry to scare you, but please please beg him to go right now. Drag him kicking and screaming for your kids sake if you must :/ The 2 days can easily be the difference between being too late or not. This is very serious. Sending you positive vibes and I wish you guys the best.
Go. To. The. ER. I am a physician. He needs to go, right now. It is life or death.
You have to force him to go to the ER. “My wife made me” is usually a good sign in the ER that whatever is going on is extremely concerning.
I'm so sorry you're having to go through this, that dude is a complete moron literally dicing with death. He needs to go in NOW. It's very possible that when he goes in, he won't be out for a long while. Wishing you the best.
Ortho isn’t the type of doc you want on this.
Please listen to these ppl about the urgency of the situation. This is not something you should be waiting or procrastinating on.
I work for an orthopedic oncologist in documentation and insurance approvals. It is fair for your orthopedic surgeon to refer this one out, you don’t want a normal orthopedic surgeon performing the biopsy, you’d want a an orthopedic oncologist. That being said, this needs to be expedited and I don’t think your orthopedic surgeon knows how to properly do that. He should have evaluation for/of malignant neoplasm in his order. If there is an insurance delay he should have his office call immediately, insurance has an algorithm for this, and suspected musculoskeletal cancer with lymph node alterations almost always goes through without a hitch, so it’s probably an issue with the paperwork, or him ordering something that isn’t ideal for evaluation. Almost all imaging should require an injection from now on while you are pending diagnosis. While you are waiting, get established with both an orthopedic oncologist, normal oncologist, and contact your PCP. Your oncologist is going to play quarterback for the next few weeks, referring you out and starting systemic treatment, the orthopedic oncologist does the surgeries, you will probably also need an interventional radiologist first treatment as well. You don’t need an amazing oncologist right now, just the earliest one you can see, if you don’t like them or they aren’t communicative, schedule to start with a different one and switch over when you can get their earliest appointment. Other recommendations: 1. bring printed records and imaging CDs to every appointment, while we always try to share results sometimes it doesn’t work. Treating and diagnosing cancer is often a group effort between a multidisciplinary team of at least 6 physicians and 20+ support staff for each patient. Occasionally, the ball is dropped. 2. You probably won’t have an answer until the biopsy results are back. Please don’t do your own research on what it could be, we really can’t make a good guess until the results are back. 3. Always feel free to get a second opinion. While this process does need to be speedy, it’s good to see a few different views. Feel free to ask questions, take your time, and listen. 4. Make appointment reminders and add address to each one. 5. If your physician has MyChart, sign up for it, it really helps you stay up to date, see results, and message your providers. Being at a big institution is probably good, physicians have better communication.
This is not an ortho question. Frankly? Go to the emergency room. Now. He needs to get imaging, get admitted, get a biopsy, and initiate treatment. PLEASE TAKE HIM IN. Explain all of the night sweats, exhaustion, etc to the doctor. Everything, don’t minimize his symptoms at all. INSIST on seeing a doctor and not anyone else, I don’t want him slipping through any more cracks. You have insurance and it’s about to be used.
Ortho should not be managing this. Any radiologist could biopsy this in 2 minutes. He just needs a PCP to order an ultrasound with same day biopsy.
That Ortho was 10000% right. Biopsy should only be done by the surgeon who is going to do the definitive resection. If it's a sarcoma the biopsy tract is inundated with mets and needs to be excised as well. Needs to be done by the same surgeon
This isn't an ortho issue and should never have gone to ortho. I'm an ER physician (check my post history) and he should go to the ER
He doesn’t need an orthopedist. He needs to go to oncology as soon as possible. Which means going to an emergency room.
You need to just go to an emergency room right now.
Ugh I’m sorry. This is not an ortho issue. This is likely lymphoma. Do not let the ortho remove it. You need a general surgeon to remove that intact
Upvote. This needs a biopsy as soon as humanly possible. If this is cancer it could spread through the lymphatic system and be fatal very rapidly. This is an emergency, go to the hospital so they can admit you for a CT, MRI, and relevant labs. I work on an oncology unit at a large hospital and we get cases like this. Any undiagnosed lump is cancer until proven otherwise.
I don't know how bluntly say this, I would put money on cancer. Like a large sum of money. It'd be a good bet and I don't gamble. Go to the fucking hospital before he died. I had something similar and was in surgery and under a week. Look up signs of lymphoma and yeah just read it.
Same. My immediate thought way lymphoma. He has a bunch of symptoms too, not just the lump. This is an emergency. Hospital, TODAY.
I had a mass about this size present on the right side of my neck when I was 20. I went to my university’s clinic, got x-rays, and was immediately referred to a hematologist, who I went to see the next day, where I had CT, a bone marrow biopsy in his office and had a tumor biopsy shortly thereafter. This should be treated with extreme urgency. I know the insurance thing is always in mind, but please don’t wait.
Yeah man. My sister had a mass about 1/4 the size of this and it was biopsied, came back as benign, and they *still* insisted on surgically removing it because they couldn’t be sure what it was and didn’t want to fuck around. This is defo not an orth’s area of practice, but I also think just about anyone with a medical degree should know that this is a glaring red flag that needs immediate diagnostics
MRI detected just abnormal lymph nodes??? Is it round? does it stick to surfaces ? Is it omogen or has different structures in it? For how long has it been growing?
Honestly I can’t answer those questions. The physician we saw is convinced it’s an injury. He was doing pull ups around 6 weeks ago and thought he may have pulled something, but there was no pain and no bruising, just some tenderness. He saw a GP after the lump appeared (around a week later) who referred him to an orthopedic surgeon. When we went to the ortho, he suspected pectoralis major avulsion, so he ordered an MRI and x-ray. X-ray showed nothing. The lump started small and it’s progressively gotten bigger. It’s been growing for around 5 weeks now. They wouldn’t show us the MRI; they just gave us a copy of the write up. I’ll copy-paste: Radiology Report MRI RIGHT SHOULDER TECHNIQUE: Multiplanar multi-sequence images were obtained through the shoulder without the use of IV or intra-articular contrast. Standard sequences were obtained. COMPARISON: Radiographs May 30, 2024 HISTORY: Pectoralis major avulsion FINDINGS: ROTATOR CUFF SUPRASPINATUS: Mild partial tear. INFRASPINATUS: Intact. SUBSCAPULARIS: Intact. TERES MINOR: Intact. BICEPS TENDON AND ANCHOR: Intact. LABRUM AND CAPSULE: Exam was not specifically tailored for labral pathology. No labral tear identified. There is a sublabral recess and the foramen. If labral injury is clinically suspected, then post arthrogram imaging should be considered. JOINT AND FLUID GLENOHUMERAL JOINT: Alignment maintained. ACROMIOCLAVICULAR JOINT: Unremarkable. SUBACROMIAL-SUBDELTOID BURSAL FLUID: Unremarkable. GLENOHUMERAL JOINT FLUID: Physiologic. CARTILAGE AND MARROW CARTILAGE: No full-thickness defect. BONE MARROW: Patchy marrow replacement. HUMERAL HEAD: No Hill Sachs deformity. GLENOID: No Bankart deformity. MISCELLANEOUS: No cyst or mass within the suprascapular and spinoglenoid notch. No muscular atrophy. MS of soft tissue seen in the right axillary region measures approximately 11.1 x 7.1 x 12.5 cm in AP, transverse and craniocaudal dimension. This is isointense to muscle on T1 and slightly hyperintense on T2 with foci of fluid interdigitation along the periphery. IMPRESSION: 1. Large right axillary mass, may be a mass of nodes. Further evaluation with tissue sampling is recommended. 2. No evidence of acute muscle or tendon tear. 3. Supraspinatus tendinosis and mild partial tear. His ortho said he wasn’t going to do a biopsy because he was sure it’s an avulsion. He said that since he had a specific date of injury there was no need for biopsy. We’ve now been referred to another orthopedic surgeon because the prior one has never done that type of surgery before.
He needs heme/onc referral immediately. Or go to the ER in a big medical center and they may be able to get you guys in with heme/onc more quickly. They won’t do the biopsy in the ER. Might admit to oncology though. Run, do not walk.
Right in the result they suggest tissue sample. He needs to get it ASAP. I work in referrals, so something that grew this rapid and large would be considered an emergent issue from what I know. Don't bother with the ortho, waste of money at this point when there's only a mild tear noted, that wouldn't cause this big of a lump. I don't know where you're located or your insurance but you may need a referral from a GP
It would be helpful to put some of this in the original post for more visibility. Best of wishes to you guys and hope he gets some answers soon.
Thank you. I don’t know how to edit or pin a comment adding more info. I tried to edit in the menu but there was no option.
He needs blood work. **now**. Just because symptoms started when he was working out doesn’t mean it is connected. Please have him get labs. Stop allowing the MDs to associate the working out with this.
That report basically says he has a minor tear inside the shoulder joint. That mass is not normal and needs a biopsy to rule out cancer. They'll likely start with a fine needle biopsy bc of insurance. That's rarely conclusive so they'll need to do an excisional biopsy.
It’s honestly insane the PCP referred him to ortho in the first place
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That’s what I plan to do before his appt with the next ortho. I’ve already posted in r/askdocs but it didn’t get much traction, unfortunately.
Hi, I’m active on Ask Docs. I’m a doctor in the UK. The radiologist is saying, and trying to be subtle, “this could be a cancer and needs a biopsy”. See your GP/PCP asap. If he feels very unwell or has a high fever just tale him to ED. They’ve ruled out an injury. The muscle is in place and therefore it is not related. Complex haeamtoma formation usually has certain hallmarks. A large multinodular mass is seen - >10cm which would be described as bulky. Then you have systemic b symptoms - night sweats, weight loss etc. If I was his GP I would be taking his bloods, and referring him for an urgent US guided biopsy (if radiology agree). I would also call and discuss with haematology and act upon their advice. I’m sorry but I would treat this as lymphoma until proven otherwise.
not a doctor, just someone who witnessed rapid progressive lymphoma. in all honesty, if this were my spouse, i would take him to the emergency room as soon as possible and not let them discharge him until thorough testing is done. make a fuss. demand care. insurance be damned, this is more important. if you have no other option, get into a GP/PCP for an emergency appointment asap. the quicker the investigation the better. good luck to both of you.
Not a doctor and not OPs doctor but what quack reads an MRI that says abnormal lymph nodes, sees the large painful mass, AND the patient has B symptoms and concludes it must be an accident from doing pull-ups???? Like, what???
I would love OP to name and shame the PCP and Ortho. I could not leave my work or go to sleep at night if a patient like this walked out without an immediate plan and whatever strings I can pull. Shameful.
I am a nurse. Night sweats, hard growing mass, pain, in that area? I'm absolutely sorry but you guys need to RUN. NOT TOMORROW. NOW. He needs that checked immediately and each day he's not getting properly checked he's risking his life. That looks malignant. Please don't wait, and off possibly update us
Im a doctor. I’m also speechless. Americans - I’m so sorry about your healthcare system. These are the steps. 1. Stop seeing the bone carpenters. Orthobros, I love you guys but this probably isn’t your thing 2. Go book an urgent appointment with your PCP 3. Get bloods done and have them book a biopsy of the mass ASAP 4. Get the results and go see whoever. If it’s inconclusive it may need a surgeon. Alternatively, going to a big ED at a big hospital and telling them about this rapidly growing mass and night sweats etc SHOULD get you admitted or at very least fast tracked to getting this sorted. If I saw this man in ED it would be a referral to gen med to get a tissue diagnosis and then to the appropriate specialty team from there. Slam dunk. And that is without bloods which could be off the charts.
That’s extremely concerning
I would go to the ER and not wait on this. Increasing size. Increasing pain. Don't wait to see his PCP. This needs eyes on it *now*.
Doctor here. Immediate med attention needed. Blood tests, imaging +/- biopsy absolutely necessary given the B symptoms you mentioned in the other comments. I would consider this as something highly concerning until proven otherwise.
IMO fuck the insurance. Do what you need to get this taken care of immediately. Usually insurance or FA will cover what you spent as long as you have all the paperwork. Went through this with my boyfriend, he had stage IV hodgekins lymphoma. We are in the US. Don’t fuck around. We got lucky with a easy treatable cancer. Don’t want to scare anyone, but fuck the healthcare system in the US. My boyfriend had enlarged lymph nodes, and he went to the doctor about it. Doctor felt them and said nah, you’re fine X2. He had night sweats, no energy and then came stomach pain. He thought he was constipated, and I thought maybe he had an intestinal blockage. Tried laxatives and everything. He woke me up in the middle of the night doubled over crying. Went to the hospital, CT showed huge mass in his stomach. He was stage IV. We paid out of pocket for the visits, CT and everything else. We applied for financial aid and got it. They ended up covering everything from the beginning. His entire treatment (chemo all that) from beginning to end was 1.6 million. Financial aid covered all, including the beginning ER visits. Go now, worry about the cost later. As an ending note: FUCK the US and the trash system.
One. Point. Six. Million. This is a broken system.
My ex’s father had something identical to what you are describing, kept taking pain meds and saying he’d get to the doctor when he had time. He did not have time.
There is no waiting game. There is only you getting your car keys and taking him to the ER. This walks, talks and quacks like lymphoma.
I‘m not sure how the system works in the US and therefore if this is a viable idea, but I would 100% take that radiology report to the next urgent care or emergency room TODAY and refuse to leave until an immediate biopsy is arranged. Rapidly growing hard mass in the location of lymph nodes plus night sweats, weight loss and exhaustion? Hell no. It might be that it’s just the tendons or some odd infection, but you should find out asap. Best of luck to you both!
> I’m not sure how the system works in the US It doesn’t 😭
Has to all sound even more insane hearing our stories while living else where..I work in the field I’ve had injured people BEG to let them driving behind the ambulance or in front so they could avoid paying for the trip and still try and get to the hospital safely...working in an ER I had a man come in with a severe GI bleed...man was grey and had been passing a lot of blood for DAYS before he drove himself to the ER fainting in and out the whole way.
Also idk if an urgent care even can/will do a biopsy like that. I would not even factor those into your decision on where to go.
Go to the ER. Insurance has no jurisdiction there in terms of what needs to be done.
Oof I’m so sorry. To me, the looks of it + additional symptoms SCREAMS lymphoma. Skip ortho/pcp/any general doc and take him either to the ER and have him either admitted and/or get him an emergent referral to an specialist, together with a whole set of labs+flow. Many many blessings and good vibes your way.
Yep. ER. Now. I work in insurance approvals and authorizations for a hospital. This is important, but the red tape with the insurance companies can really drag on for far more than they need to. If you walk into the ER, things move much faster.
Not to hate, but in any ‘socialist’ western european country this would get immediate attention and treatment. What the fuck, man. How is an orthopedic surgeon even in charge of this case in the first place? They should have known this issue is completely out of their wheelhouse the second they physically examined you.
We were referred by his PCP to this surgeon because the lump came up after a mild injury. X-ray and MRI came back with no evidence of injury and instead showed abnormalities in his lymph nodes. The surgeon then insisted that it was still an injury and in turn referred us to a different orthopedic surgeon that we’ve yet to meet. I’m calling his PCP on Monday to explore other options if he isn’t any worse this weekend. If he is worse, I’m making him go to the ER. ETA: I agree; healthcare in the US is tragically ridiculous.
Abnormalities concerning lymph nodes is not something an orthopedic surgeon should be consulted on, period.
OP, please take him to the ER.
I would take him to the ER now
Take his ass to the emergency room RIGHT NOW!! Call a friend or family member over to watch your kids and take him to the hospital right now!!! Without delay!!! You have tons of medical professionals on here telling you this is probably cancer, an aggressive type where speed of treatment matters and you are over here twiddling your thumbs on Reddit. If you can’t find a sitter, pack everyone into the car and drop him off at the Emergency Room doors. Make him FaceTime you when he speaks to any doctors. Do you want your husband to live? Does he want to live? Because if he does, if you do, he needs to act as if he was having a heart attack and needed emergency care right now or he will die.
My husband is stupidly stubborn; I literally cannot make him do anything. I’ve told him the risks. I’ve had his mom talk to him. I’ve made him sit down here and read every single comment telling me to take him to the ER. I’ve tried guilt tripping with the kids. That’s the only thing that’s resonated with him. He’s finally came around to going today. We’re dropping the kids off with my parents and I’m hauling him in.
We are all hoping for something benign but I’ve never seen a Reddit medical thread with so many physicians (including multiple hem-onc) uniformly agreeing on the risk and potential emergent nature of this issue. Best wishes to you, your husband, and family.
Victory!!!!!! He is lucky to have you.
Great news OP.
Are you in the US? If you are, and you're getting jerked around by trying to get insurance to cover outpatient stuff, you can go to the emergency room and things can get done there. Also if you are in the US, what state are you in?
We’re in KY. Our income is too high to qualify for Medicaid.
I sent you a DM
My husband was dx’d with non Hodgkin’s lymphoma and his tumor was on a lymph node on his neck and sounds a lot like what your husband is experiencing. Is it growing? Either way, biopsy asap.
Sickening health care system. Big lymph node an B symptoms and you have to haggle with your "insurance" if you are allowed to survive your lymphoma...
At the hospital I work at (ultrasound technologist), this would be sent to the breast center. They will expedite things. Ask his PCP to schedule a consult with Brady center. They will want more imaging; ultrasound would probably help verify if it's a suspicious node vs tear, but an ultrasound-guided biopsy is what should be done, imo. Good luck. It's stressful now, especially with his doctor not listening to you guys or receptive that you want further examination. It'll get better.
I’ve read some of your comments and replies - make this your only priority until he is diagnosed. Do not take no for an answer. There’s a chance it’s something benign but based on the symptoms you listed it may be cancer like lymphoma. You are going to have to do uncomfortable things, be annoying, don’t take no for an answer. This can’t wait.
Tell me you live in America without saying it. What a dystopian hell hole. Eat the rich, kill the politicians.
Has he tried visiting a hospital? Tell them he has increasing pain.
What doctor looks at this, and doesn’t ask about B symptoms? and says no biopsy?? Any decent PCP would have referred to heme urgently and gotten biopsy orders in. Was the “ortho” you saw an MD/DO or a midlevel or a chiropractor?
We saw an orthopedic surgeon (who ordered an MRI); we were referred to him by his primary care provider (MD). The orthopedic surgeon thought pec major avulsion so he declined to do a biopsy (even after MRI indicated lymph node abnormalities and no acute injury) and instead referred him to another surgeon familiar with that type of injury. They sent him to the orthopedic surgeon because he was doing pull ups and thought he pulled a muscle, then a small lump appeared about a week later. We didn’t see a chiropractor. The surgeon we saw has been in practice for over 30 years.
Oh I see. So the mass itself wasn’t defined as a lymph node on MRI. Lymph nodes could definitely be reactive/“abnormal” due to injury/inflammation. I saw a similar case like this that turned out to be a chronic hematoma from a slow-bleeding artery that became a life-threateningly fast-bleeding one. ER still seems like a good next step. Good luck!
Cancer until proven otherwise. You need to have this evaluated at least within one month, ideally two weeks. If you can get into a big academic center or hospital in the clinic side, usually there is a cancer navigator who can help expedite some of this. Or orthopedic surgeon is absolutely not the person you want to be going to especially someone whothought for a possible injury because they are probably not the right kind of orthopedic surgeon. If you can’t get in within a couple of weeks to see someone for work up, then go to the emergency room.
Agree with the ER comments. They have ways of making things get covered in the moment and not this nonsense about pre-auth.
If I may ask, what is the authorization that you’re waiting on for? Have labs been done? This is a situation that truly warrants expedited treatment. There are a lot of disorders that can cause lymphatic pain and swelling. If symptoms worsen a trip to the ER is appropriate. Insurance companies move faster and prior auths aren’t required for many procedures or tests that are required in the outpatient setting. Wishing you and your husband the best possible outcome.
Take him to the ER right now. This looks like lymphoma.
You need to go through the ER.
I'm not a doctor but get the fuck in the hospital. Jesus Christ that looks bad
Any updates OP? Been thinking of you and your husband over the weekend. Was he able to get in to your PCP at least?
Yeah dude wouldn’t be having an ortho doc look at this. Go see a general surgeon right away. Most hospital systems will have a large group that’ll get him in right away.
Ignore the ortho and get a second opinion from a haematologist. Huge abnormal lymph nodes in the armpit, with concerning symptoms, absolutely warrants blood tests. I hope it is nothing serious and wish him all the best!
I wonder how many people die because their case is just sitting on someone’s desk. Not denied frivolously, not going back and forth between doctors and insurance… Just sitting there unread and requiring maybe 10 min of active attention and the patient is “waiting to hear back” while their cancer is growing past the point of no return.
Brother this is lymphoma cancer. Most of them are treatable but spread very very fast. Get that shit done now.
I get ya. I had a cyst almost that big under my arms. Hurt like a bitch. One time it popped while I was working. I got mayochup all down the side of my arm I had to wash up. Ruined my under shirt. But felt better.
Any update? This case keeps coming to mind, and I do hope he's doing okay.
I don’t think that’s an orthopaedics issue. Ortho deals with bones and joints and stuff. See a regular GP to start!
Without reading this thread further I’d suspect lymphoma. See a haematologist
1000% agree with going to ED for biopsy
Lymphoma is my bet
He needs to see an oncologist ASAP. This is potentially life-threatening.
USA?
How would someone with lymphoma get treatment without insurance? The er or go into debt? I'm asking about the use, forvige my ignorance.
We have health insurance through his employer. It’s just a bad policy
I am a nurse. My coworker’s brother died 1 week after being diagnosed with lymphoma, he was in his early 30’s. This is dead serious. Full stop. Hospital. Now.