The pain was inescapable. No position or angle could bring relief from the constant piercing ache that ran from Lorraine Foley's shoulder down to her fingers. "I would wrap my shoulder tightly, bind my arm to my torso," Ms. Foley, 78, remembers. "I kept it raised, kept it lowered. Nothing brought relief."
She visited a specialist who diagnosed her with a pinched nerve and prescribed physical therapy. "I went to physical therapy for over a year-with no improvement. My arm and hand ached more than ever." By this time, she started noticing other odd things going on with her body-her voice was getting hoarse, her eyelid was drooping and her eyeball seemed to be sinking deeper into its socket. It was high time for a second opinion.
"Emil Baccash, M.D., is my primary care physician. Why I didn't go to him at first, I don't know, but thank goodness I finally did!" says Ms. Foley.
Dr. Baccash, who specializes in geriatric medicine and is an attending physician in NYM's Department of Internal Medicine, saw right through the pinched nerve theory and sent her for an MRI (magnetic resonance imaging) scan. "With no improvement over the course of a year's physical therapy, her 50 plus years of heavy smoking, and her many other symptoms, it was clear that something significant was going on and whatever it was had been overlooked for too long."
The MRI revealed what 100 years of physical therapy could not have helped: Ms. Foley had lung cancer, and a rare one at that. "A Pancoast tumor occurs in less than three percent of lung cancers," says Hani Ashamalla, M.D., chairman of radiation oncology at NYM. "And as was the case with Ms. Foley, it often goes undetected because its symptoms are inconsistent with typical lung cancer symptoms, like shortness of breath and coughing."
A Pancoast tumor is located on the top of the left or right lung and affects adjacent areas, such as cervical vertebrae, ribs, blood vessels and a network of nerves called the brachial plexus, which runs through the neck, armpit, and arm. Because the tumor puts pressure on these nerves, symptoms often appear neurological in nature, and are often diagnosed as such.
The cancer diagnosis also explained the seemingly unrelated symptoms, including the drooping eyelid and sinking eye: the tumor was compressing nerves leading to the eye and the face, resulting in a condition called Horner's syndrome, whose defining symptoms are a drooping eyelid, sinking of the eyeball into the face, constricted pupil, and decreased sweating on the affected side of the face.
"At NYM, we are uniquely equipped to treat Ms. Foley," says Dr. Ashamalla. "Our Comprehensive Lung Cancer Center (CLCC) is staffed with a core group of physicians- radiation and medical oncologists, thoracic surgeons, pulmonologists, interventional pulmonologists, interventional radiologists-that meet on a bi-weekly basis to review all new cases and discuss all of the possible treatment options. This results in an efficient, well-coordinated plan of care, tailored to each patient." Additionally, the CLCC consolidates
all services related to lung cancer screening, diagnosis and treatment, allowing patients to get all their consultations, tests, procedures, treatments, support and follow-up at one institution.
Because Ms. Foley's tumor involved two cervical vertebrae and a network of blood vessels, surgical removal of the cancer was deemed too risky. Thus, a protocol of chemotherapy
treatments and weekly radiation therapy was prescribed.
"Our radiation oncology program is truly state of the art," says Dr. Ashamalla, "which allowed us to treat Ms. Foley with the most advanced technology available for her type of cancer. Lung cancers can be tricky to target because the breathing motion means that the tumor is in an almost constant state of movement. However, using a combination of respiratory gating therapy, which accommodates for breathing movement, and intensity modulated radiation therapy (IMRT), which emits beams three-dimensionally, we were able to deliver the radiation with incredible precision."
Ms. Foley received her chemotherapy at NYM's Ambulatory Infusion Center, a dedicated outpatient center that, in addition to chemotherapy, offers infusions for blood disorders, rheumatoid arthritis, Crohn's disease, anemias and osteoporosis.
After seven weeks of treatment, a CT (computed tomography) scan revealed that the tumor had shrunk and Ms. Foley noted a complete disappearance of the pain that had been plaguing her for more than a year. Her six-month follow up revealed that the cancer was gone.
"We started with an inoperable malignant tumor, and ended with an excellent outcome," says her hematologist/oncologist David Dosik, M.D. "We were able to provide Ms. Foley with an accessible, coordinated treatment plan, and it paid off."
"I continue to go for my check ups and continue to be cancer free, thanks to my team. I feel so fortunate," says Ms. Foley. "I was born at New York Methodist and have lived in Park Slope all of my life. Thanks to NYM, my life was saved in Brooklyn as well!"
Read this story, other inspiring patient stories and more in the Annual Report to the Community 2012-2013.
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