PCP: Four weeks later

During my last week at Dr. P's office, we had a patient, RP, who presented with a testicular mass about 1-2 cm in diameter that had felt like a rock. Dr. P had suggested that I come back in 4 weeks to follow up on him, so I did (I was curious to know what the final diagnosis was). When I returned to Dr. P's office, Meme said that RP had just come in two days ago to discuss his diagnosis with Dr. P, and she let me see his chart. In addition to the testicular mass, RP had also presented with night sweats and early satiety, so the GI doctor endoscoped him and found a bleeding cancerous mass in the fundus of his stomach. The testicular mass was found to be diffuse B-cell lymphoma, so now we had to ask, was the stomach mass a lymphoma, or a separate gastric adenocarcinoma? A biopsy showed that it was the same lymphoma as the testicular mass. A PET scan (which arrived minutes after I showed up) revealed three lymph nodes in his abdomen were positive for tumor cells, but there was no metastases to the brain. So RP's diagnosis, while not great, was still better than if he'd had two separate cancers in his body. Dr. P still had one more patient to see when I stopped by, but he took the time to go over RP's chart with me and explain what they were going to do next. RP's CBC, to my surprise, was unremarkable except for anemia attributed to his gastric bleed, but Dr. P said some lymphomas are normocytic like that. *sigh* RP had that testicular mass for at least one year. If only he'd gotten it checked out sooner...

Still, it was good to see Dr. P and his staff again, and I also got to meet Dave, his new PA that he talked about so much before he even came to work here. Dave is a licensed nutritionist as well as a PA and worked with a GI doctor for many years, so primary care is actually new to him. But he likes it, and he already fits in with everyone at the clinic. =)