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Is it safe to wait -- bone pain and weight loss
Mar 2, 2001

Dear Dr.Dezube. On 10/10/2000 I had an MRI of my hips due to hip/bone pain of 2 months standing that has not responded well to Physical Therapy and was needing increasing amounts of OxyContin ( up to 30 mgs bid) and OXYIR 5mgs just to cover the pain. The MRI showed "diffuse marrow infiltration in the pelvic area with scattered 2-8 mm foci which are decreased in signal on T1 weight images and increased on the T2 signal. Involvement of the femurs and spine as well but to a lesser degree". The radiologist opinion was, TB, Histo and less likely widely Metatastic disease. Bone Marrow biopsy was negative. All blood work and cultures are negative for fungal disease, normal CBC and metabolic panel, and the attending ID Dr. (not my usual Dr.) thinks it's either nothing or a low grade malignancy (sp). I've lost 27.5 pounds gradually (down to 138 from 167, 5' 11") since 12/97 and feel 'hot' all the time especially early in the a.m. and the pain in the hips and p.n of the feet are my only symptoms other than low energy. Now they want to wait another 2 months do another MRI, see if there is any change and do another biopsy in an area where they are more likely to extract a nodule itself to biopsy. This is driving me crazy and as loathe as I am do have another biopsy I would rather do it now and get it over with than wait till the end of January. Should I push for the biopsy now or be a "good boy" and wait and go nuts? Stats: cd4 700 vl <40 //cd4 nadir 380 vl 72000 viramune/abc/d4t Sorry to be so long winded, and thanks for you time!

Response from Dr. Dezube

Given that you have quite severe pain in the setting of a very abnormal MRI and weight loss, I would recommend NOT to wait. It is NOT unusual to have one or even two negative biopsies before you get a diagnosis. Many diseases involve the bone marrow in a spotty fashion (this means that a biopsy can easily miss the diagnosis). Since your CD4 count is quite high (CD4=700), opportunistic infections are quite unlikely. However, it is important to make sure you don't have Hodgkin's disease, lymphoma, or another cancer; these cancers can occur at any CD4 counts. It may pay to have the next biopsy by an orthopedist or similar specialist who can biopsy a specific area of bone, which is abnormal on the MRI. Good luck and please keep me posted.


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