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What Does The Chest X Ray Report Suggest?
Question: Patient is my mom who is a 64 year old female . She did a chest xray today which came as follows:
Parenchyma of the lungs: No acute focal pulmonary infiltrate.
9 mm nodular density projects over the right mid lung field.
Recommended: Non contrast chest CT scan is recommended nonemergently for further characterisation.
She has no coughing, no other breathing problem. We took her to ER for chest congestion. ER doctor was telling me that usually not to worry of that 9 mm size and do another xray in 6 months.
Obviously we are worried. How can we treat this. Please advice. Thanks
Mr XXXXXXX
Parenchyma of the lungs: No acute focal pulmonary infiltrate.
9 mm nodular density projects over the right mid lung field.
Recommended: Non contrast chest CT scan is recommended nonemergently for further characterisation.
She has no coughing, no other breathing problem. We took her to ER for chest congestion. ER doctor was telling me that usually not to worry of that 9 mm size and do another xray in 6 months.
Obviously we are worried. How can we treat this. Please advice. Thanks
Mr XXXXXXX
Brief Answer:
Get done CT thorax with Contrast.
Detailed Answer:
Hello dear, thanks for your question HCM.
I can understand your situation and problem.
You need to get done CT thorax first.
I will recommend to get it done with Contrast. Because in pulmonary nodule we need to see following things to differentiate between malignant and benign nature of nodule.
1. Exact size
2. Exact shape
3. Margins
4. Nodule is calcified or necrotic or dense.
5. Surrounded lung parenchyma involved or not.
6. Mediating lymphomas involved or not.
All these will be seen only in CT thorax with Contrast.
So better to get done CT with Contrast.
Possibility of benign nodule is high but better to rule out malignant nodule by CT thorax with Contrast.
Treatment comes in next stage, we need to first diagnose the nature of nodule whether it is benign or malignant.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Get done CT thorax with Contrast.
Detailed Answer:
Hello dear, thanks for your question HCM.
I can understand your situation and problem.
You need to get done CT thorax first.
I will recommend to get it done with Contrast. Because in pulmonary nodule we need to see following things to differentiate between malignant and benign nature of nodule.
1. Exact size
2. Exact shape
3. Margins
4. Nodule is calcified or necrotic or dense.
5. Surrounded lung parenchyma involved or not.
6. Mediating lymphomas involved or not.
All these will be seen only in CT thorax with Contrast.
So better to get done CT with Contrast.
Possibility of benign nodule is high but better to rule out malignant nodule by CT thorax with Contrast.
Treatment comes in next stage, we need to first diagnose the nature of nodule whether it is benign or malignant.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Sir. My other concern is the CT scan as i was talking the general doctors that CT scan are very dangerous. Lets say as it is only 9 mm , and it is a nodule not a mass which is 30 mm and greater, some of them suggesting that to do another xray after 6 months as my mom has no symtoms of coughing or blood etc.
My only fear is Sir, are CT scans ok as it sometimes increases chances of cancer in future with excessive radiation and my mom,s health is very fragile in nature.
I totally respect your decision but please advice on the radiotion effect of CT scan. Lets say her nodule is benign but will it dvelop into cancer with so much radiation?
Thanks much Sir,
Mr XXXXXXX
New York
USA
I also wanted to know if the nodule is benign , how is it treated, should the doctor take it out to avoid further growth or should it be left on observation? and for how many months?
Thanks again XXXXXXX
My only fear is Sir, are CT scans ok as it sometimes increases chances of cancer in future with excessive radiation and my mom,s health is very fragile in nature.
I totally respect your decision but please advice on the radiotion effect of CT scan. Lets say her nodule is benign but will it dvelop into cancer with so much radiation?
Thanks much Sir,
Mr XXXXXXX
New York
USA
I also wanted to know if the nodule is benign , how is it treated, should the doctor take it out to avoid further growth or should it be left on observation? and for how many months?
Thanks again XXXXXXX
Brief Answer:
No need to worry for radiation damage.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
I can understand your concern and problem.
Don't worry about radiation exposure in CT scan.
Yes, you are right about radiation and it's damage.
But CT thorax does not give massive exposure.
Single CT thorax is practically not causing any radiation damage.
So forget about CT induced radiation damage.
And yes, you can definitely wait and watch for six months and get done repeat chest x ray.
But as a pulmonologist, I prefer early screening of lung nodule and early detection of lung cancer.
Because early detection and treatment (surgical removal) of malignant nodule is having excellent prognosis and good quality of life.
All lung cancer, initially develops as nodule only.
And later on it grows and turns into mass.
So 9 mm nodule can be malignant nodule, though the possibility of malignant nodule in her case is very very less.
I prefer to stay on safer, preventive side.
So my recommendation for her is CT thorax with Contrast to rule out early cancer.
And if radiation exposure is the only factor which troubles you, then no need to worry for this as single CT scan can not cause radiation damage.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
No need to worry for radiation damage.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
I can understand your concern and problem.
Don't worry about radiation exposure in CT scan.
Yes, you are right about radiation and it's damage.
But CT thorax does not give massive exposure.
Single CT thorax is practically not causing any radiation damage.
So forget about CT induced radiation damage.
And yes, you can definitely wait and watch for six months and get done repeat chest x ray.
But as a pulmonologist, I prefer early screening of lung nodule and early detection of lung cancer.
Because early detection and treatment (surgical removal) of malignant nodule is having excellent prognosis and good quality of life.
All lung cancer, initially develops as nodule only.
And later on it grows and turns into mass.
So 9 mm nodule can be malignant nodule, though the possibility of malignant nodule in her case is very very less.
I prefer to stay on safer, preventive side.
So my recommendation for her is CT thorax with Contrast to rule out early cancer.
And if radiation exposure is the only factor which troubles you, then no need to worry for this as single CT scan can not cause radiation damage.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Above answer was peer-reviewed by :
Dr. Raju A.T
Sir thanx so much for explainning things so nicely. I got a pulmonologist apointment after 2 weeks from now. My concern is will it take 2 weeks wait period be too long. How fast these nodules grow in size?
Also Sir, if these nodule is non cancerous, should we still operate it and take it out? or let it grow and continue to xray and watch.
If it is non cancerous, will any medication work on it without surgery?
Thanks
Mr XXXXXXX
Also Sir, if these nodule is non cancerous, should we still operate it and take it out? or let it grow and continue to xray and watch.
If it is non cancerous, will any medication work on it without surgery?
Thanks
Mr XXXXXXX
Brief Answer:
If it is benign then nothing to do, just wait and watch.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
2weeks time is not too long, so don't worry. Get done CT thorax with Contrast after 2 weeks.
2 weeks times will not matter much.
If we think this nodule to be cancerous, the usual doubling time is 2-3 months.
And in benign nodule, surgery is not indicated.
Causes of benign lung nodule are
1. Calcified lymphnode
2. Benign cyst
3. Granuloma (tuberculosis) etc.
All these will be differentiated on CT characteristics.
So treatment of it will be decided on CT appearance. First 2 don't need any treatment except wait and watch.
But anti tb treatment should be started if it is granulomatous nodule.
Please let me know
1. Did she have any Pulmonary infections like tuberculosis or pneumonia in the past?
Please reply me, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
If it is benign then nothing to do, just wait and watch.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
2weeks time is not too long, so don't worry. Get done CT thorax with Contrast after 2 weeks.
2 weeks times will not matter much.
If we think this nodule to be cancerous, the usual doubling time is 2-3 months.
And in benign nodule, surgery is not indicated.
Causes of benign lung nodule are
1. Calcified lymphnode
2. Benign cyst
3. Granuloma (tuberculosis) etc.
All these will be differentiated on CT characteristics.
So treatment of it will be decided on CT appearance. First 2 don't need any treatment except wait and watch.
But anti tb treatment should be started if it is granulomatous nodule.
Please let me know
1. Did she have any Pulmonary infections like tuberculosis or pneumonia in the past?
Please reply me, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again Sir. My next question is the Pulmologist i made apoinment is very busy and hoping he is great doctor. But his office told me that he do not do surgeries. But he refers to other doctor if surgery is needed.
So now the question is , so pulmologist do not do surgeries if they have to remove the nodule? or should i look for a different doctor?
I totally respect all doctors and he is also an MD,but again when it comes to family , you want a good doctor from emotional point of view.
Thanks XXXXXXX
So now the question is , so pulmologist do not do surgeries if they have to remove the nodule? or should i look for a different doctor?
I totally respect all doctors and he is also an MD,but again when it comes to family , you want a good doctor from emotional point of view.
Thanks XXXXXXX
Brief Answer:
Pulmonologist don't do lung removal surgeries.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Pulmonologist don't do lung removal surgeries.
It is done by Cardio Thoracic Surgeons.
Pulmonologist will diagnose her nodule whether it is benign or malignant.
If it turns out to be malignant then he will refer to Cardio Thoracic Surgeon for lung resection.
This is standard practice, so don't worry about it.
And when it comes to patients, we doctors don't do things with emotions. We go buy the guidelines and try our level best to achieve good, positive results.
I want to know few more things about her.
1. Did she have any previous lung infection like tuberculosis or pneumonia?.
2. Did she have any previous chest x ray to compare?
Please reply answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Pulmonologist don't do lung removal surgeries.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Pulmonologist don't do lung removal surgeries.
It is done by Cardio Thoracic Surgeons.
Pulmonologist will diagnose her nodule whether it is benign or malignant.
If it turns out to be malignant then he will refer to Cardio Thoracic Surgeon for lung resection.
This is standard practice, so don't worry about it.
And when it comes to patients, we doctors don't do things with emotions. We go buy the guidelines and try our level best to achieve good, positive results.
I want to know few more things about her.
1. Did she have any previous lung infection like tuberculosis or pneumonia?.
2. Did she have any previous chest x ray to compare?
Please reply answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir basically her primary care doctor told us to take her to ER because her presurre was very fluctuation it was like 160 or 185 over 85 or 90. He tried different medications...it did not work. She is very nervous kind and hypertension type and worries too much. Lately she cannot sleep well too even with ambian 10mg(not sure if you know the XXXXXXX terms of medications)
So at ER they did her normal routine test like EKG and chest xray, they found bundle block ekg which they are saying not a serious condition and the 9mm nodule they are saying as incidental and non emergency non contrast CT
She never had pnemonia in past or any coughing at all...never smoked or drink,,,,typical XXXXXXX house wife and this is the first time she had chest xray.
Thanks XXXXXXX
i also want to know lately she cannot sleep as she is also very anxious, Doctors gave her 2 ambian sleeping medications daily night of 10mg but still she is getting less sleep. Any advice?
Thanks XXXXXXX
So at ER they did her normal routine test like EKG and chest xray, they found bundle block ekg which they are saying not a serious condition and the 9mm nodule they are saying as incidental and non emergency non contrast CT
She never had pnemonia in past or any coughing at all...never smoked or drink,,,,typical XXXXXXX house wife and this is the first time she had chest xray.
Thanks XXXXXXX
i also want to know lately she cannot sleep as she is also very anxious, Doctors gave her 2 ambian sleeping medications daily night of 10mg but still she is getting less sleep. Any advice?
Thanks XXXXXXX
Brief Answer:
Did her cardiac size was enlarged in chest x ray?
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Now you are opening up things.
Did her cardiac size was enlarged in chest x ray?
Have she undergone 2d echo?
Is it really stress which keeps her awake in night or is it cough or chest pain at night?
And bundle branch block in recently detected hypertensive patient should be taken care thoroughly.
In my opinion you should consult cardiologist and discuss her case.
And no need to worry for 9mm nodule as it will mostly come benign only.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Did her cardiac size was enlarged in chest x ray?
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Now you are opening up things.
Did her cardiac size was enlarged in chest x ray?
Have she undergone 2d echo?
Is it really stress which keeps her awake in night or is it cough or chest pain at night?
And bundle branch block in recently detected hypertensive patient should be taken care thoroughly.
In my opinion you should consult cardiologist and discuss her case.
And no need to worry for 9mm nodule as it will mostly come benign only.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again Sir. As you can see am also like nervous like my mom and asking too many questions.
Her chest is not enlarged in the chest xray.
She is not waking up due to cough and has no chest pain . Her blood report in ER shows no signs of heart attack. but i guess she was too much worried about her high blood pressure.
Just to kindly let you know she is also suffering from severe knee osteo arthiritis of both knees .
Her cardiologist did some preliminary test and results are ok and they now want to do stress test until her bp comes down.
Sir, also, i found a clinic in New York who specializes in treatment of lung nodule step by step, but the doctors of this clinic is a Thoracic surgeon. Sir i am just wondering should I take her to this clinic directly or should I first go to the pulmonologist and once he refers and then only follow up with thoraic doctors.
Thanks again
Mr XXXXXXX
Her chest is not enlarged in the chest xray.
She is not waking up due to cough and has no chest pain . Her blood report in ER shows no signs of heart attack. but i guess she was too much worried about her high blood pressure.
Just to kindly let you know she is also suffering from severe knee osteo arthiritis of both knees .
Her cardiologist did some preliminary test and results are ok and they now want to do stress test until her bp comes down.
Sir, also, i found a clinic in New York who specializes in treatment of lung nodule step by step, but the doctors of this clinic is a Thoracic surgeon. Sir i am just wondering should I take her to this clinic directly or should I first go to the pulmonologist and once he refers and then only follow up with thoraic doctors.
Thanks again
Mr XXXXXXX
Brief Answer:
Better to first consult pulmonologist.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Since she had cardiologist 's consultation and he didn't find anything serious, no need to worry for cardiac cause.
She only needs blood pressure control.
And for Pulmonary nodule, possibility of benign nodule is more in her case.
So better to first consult pulmonologist and decide the nature of nodule.
And if it is suspicious of malignant one then only consult Thoracic Surgeon.
Benign nodule does not need surgical treatment.
So better to consult pulmonologist first.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Better to first consult pulmonologist.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Since she had cardiologist 's consultation and he didn't find anything serious, no need to worry for cardiac cause.
She only needs blood pressure control.
And for Pulmonary nodule, possibility of benign nodule is more in her case.
So better to first consult pulmonologist and decide the nature of nodule.
And if it is suspicious of malignant one then only consult Thoracic Surgeon.
Benign nodule does not need surgical treatment.
So better to consult pulmonologist first.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir, thanks so much...i already became a fan of yours.
Next a very silly question about my dad. He is 80 years old and had no lung problem except for old age coughing sometimes. His recent chest xray was fine too.
Only thing that makes me nervous is he takes those dry nasal brown powder or snuff powder that is legally sold in XXXXXXX and also nowdays available in USA in XXXXXXX stores.
He takes it thru nose since he is 40 yrs old. His excuse is it clears his nose conjestion. My concern is can these snuff powders cause lung cancer?
Mr XXXXXXX
Next a very silly question about my dad. He is 80 years old and had no lung problem except for old age coughing sometimes. His recent chest xray was fine too.
Only thing that makes me nervous is he takes those dry nasal brown powder or snuff powder that is legally sold in XXXXXXX and also nowdays available in USA in XXXXXXX stores.
He takes it thru nose since he is 40 yrs old. His excuse is it clears his nose conjestion. My concern is can these snuff powders cause lung cancer?
Mr XXXXXXX
Brief Answer:
This can cause nasal and pharyngeal cancer.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Snuffed things can cause lung cancer but it is more commonly cause nasal and pharyngeal cancer.
So better to ask him to quit as soon as possible.
Incidence of cancer is also depends on
1. Type of substance.
2. Amount of it.
So please reply me above things, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your father.
Thanks.
This can cause nasal and pharyngeal cancer.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Snuffed things can cause lung cancer but it is more commonly cause nasal and pharyngeal cancer.
So better to ask him to quit as soon as possible.
Incidence of cancer is also depends on
1. Type of substance.
2. Amount of it.
So please reply me above things, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your father.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Sir...i will try to download the picture and send the nasal thing he takes.
Also Sir, does smoking really causes cancer?...i seen many non smokers gets cancer, or second hand smokers BUT some chain smokers dont get cancer at all.
Also, if a husband smokes outside, after how long he should come back home to give company to his wife and child?
Mr XXXXXXX
Also Sir, does smoking really causes cancer?...i seen many non smokers gets cancer, or second hand smokers BUT some chain smokers dont get cancer at all.
Also, if a husband smokes outside, after how long he should come back home to give company to his wife and child?
Mr XXXXXXX
Brief Answer:
Smoking is the biggest risk factor for cancer.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
I will definitely wait for your reply.
Tobacco smoking is the biggest risk factor for many cancers including lung cancer.
But it is not the only causative agent.
Pollution, chemicals, old scars, genetic, hereditary and old age are other risk factors for lung cancer.
So not all smokers develop lung cancer, and all lung cancer patients are not smoker.
Lung cancer can develop in non smoker if above risk factors are present.
So non smokers can develop lung cancer.
And for them "passive smoking" is another risk factor.
And smoke inhalation is causing cancer. So person who is smoking is harmful only till he exhales smoke. After completing his cigarette, he is harmless to others.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your father and mother.
Thanks.
Smoking is the biggest risk factor for cancer.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
I will definitely wait for your reply.
Tobacco smoking is the biggest risk factor for many cancers including lung cancer.
But it is not the only causative agent.
Pollution, chemicals, old scars, genetic, hereditary and old age are other risk factors for lung cancer.
So not all smokers develop lung cancer, and all lung cancer patients are not smoker.
Lung cancer can develop in non smoker if above risk factors are present.
So non smokers can develop lung cancer.
And for them "passive smoking" is another risk factor.
And smoke inhalation is causing cancer. So person who is smoking is harmful only till he exhales smoke. After completing his cigarette, he is harmless to others.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your father and mother.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again....one quick question does my father's snuff powder taking at home causing any danger like passive smoking to others?
or its only risking his nose?
XXXXXXX
or its only risking his nose?
XXXXXXX
Brief Answer:
It is harmful to himself only.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Snuff powder is injurious to your father only. No need to worry for others.
I will be happy to help you further.
Wishing good health to your father and mother.
Thanks
It is harmful to himself only.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Snuff powder is injurious to your father only. No need to worry for others.
I will be happy to help you further.
Wishing good health to your father and mother.
Thanks
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again Sir,,,You becoming a family friend...so back to my MOM again,
So after coming back from ER i took her to routine cardiac checkup and discuss about bp fluctuations etc.
This cardiac doctor is good but he does have a tendency to check everything with all patients which is good anywayz.
So because my mom has bundle block ekg for years now,and her bp is not controlled, he said to do a Nuclear Stress Test which will give an idea if there is any blockage and then if necessary he will do angioplast etc.
Now, i do my internet search and etc and got conflicting answers.
One cardiologist told me that regular stress test should be done first as i asked him about my nervousness of radiation used in nuclear stress test. i asked another cardiac office, they said radiotion in nuclear test is minimal.
So am confused. As you know am scared of CT scan etc and now you think its safe to do a Nuclear stress test?
I wud rather prefer to do angioplast right away anywayz and see if there is any blockage.
So why unnessarily do stress test to get insurance money? haha
The ER heart doctors told me that bundle block ekg is a ok condition and leave it like that.
And then after 2 weeks we will do the CT scan of lungs. You see what i mean. Too many advises and too many radiation brother.
Please advice what you think. You are simply great to explain things
Thanks much
Mr XXXXXXX
New York, USA
So after coming back from ER i took her to routine cardiac checkup and discuss about bp fluctuations etc.
This cardiac doctor is good but he does have a tendency to check everything with all patients which is good anywayz.
So because my mom has bundle block ekg for years now,and her bp is not controlled, he said to do a Nuclear Stress Test which will give an idea if there is any blockage and then if necessary he will do angioplast etc.
Now, i do my internet search and etc and got conflicting answers.
One cardiologist told me that regular stress test should be done first as i asked him about my nervousness of radiation used in nuclear stress test. i asked another cardiac office, they said radiotion in nuclear test is minimal.
So am confused. As you know am scared of CT scan etc and now you think its safe to do a Nuclear stress test?
I wud rather prefer to do angioplast right away anywayz and see if there is any blockage.
So why unnessarily do stress test to get insurance money? haha
The ER heart doctors told me that bundle block ekg is a ok condition and leave it like that.
And then after 2 weeks we will do the CT scan of lungs. You see what i mean. Too many advises and too many radiation brother.
Please advice what you think. You are simply great to explain things
Thanks much
Mr XXXXXXX
New York, USA
Brief Answer:
Get done routine stress test.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
And thanks a lot for considering me your family friend.
This means a lot for me.
In my opinion, you should get done routine stress test for her.
It is simple OPD based test. And if something is wrong in it then go for Angiography and angioplasty if required.
No need to directly go for angioplasty.
Since she is having bundle branch block since years, I don't think she will have anything serious in stress test.
But it is better to be at safer side, so get done simple stress test.
And yes, you can go for CT thorax after 2 weeks.
And don't worry much about radiation exposure.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Get done routine stress test.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
And thanks a lot for considering me your family friend.
This means a lot for me.
In my opinion, you should get done routine stress test for her.
It is simple OPD based test. And if something is wrong in it then go for Angiography and angioplasty if required.
No need to directly go for angioplasty.
Since she is having bundle branch block since years, I don't think she will have anything serious in stress test.
But it is better to be at safer side, so get done simple stress test.
And yes, you can go for CT thorax after 2 weeks.
And don't worry much about radiation exposure.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother.
Thanks.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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