Lump and Ache

New patients are naturally wary of the doctor. They don’t know what they are going to get in the consult. It may not be a pleasant experience for both parties. Who knows, in a worst case scenario, the doctor may not hesitate to pass a death sentence on the hapless patient.

This patient who gate crashed [came without prior information] into my clinic had severe anxiety writ large on his face. I asked him to sit and try and relax. He sat on the front of the chair and I could see the hands tremble. He was perspiring. I waited for him to begin.
After a minute or so he said, ‘I have a tumor on the lower part of my back and it is hurting me’
Normally patients don’t say tumor, they say swelling or lump. If someone says tumor I am certain he has already seen another doctor and has borrowed the terminology. We doctors as a tribe don’t know how [or don’t want to] to put our diagnosis in simple lingo. We have to say myocardial Infarction instead of heart attack, Cholecystitis instead of infected gallbladder. Sometimes when we don’t know how to describe an illness appropriately enough with a high sounding name, like when one has vertigo due to vestibular disease then we call it BPPV which stands for benign paroxysmal positional vertigo which in real terms mean a benign form of vertigo which comes in paroxysms related to position of the head!

So this tumor word had me worried because it connotes a growth of some type and could be serious especially when it is also causing back ache. After getting the history that the swelling was noticed several years ago and the pain from the last two months, I asked him to undress and lie down on the couch.

This is what I found. He had a small mobile lump and he had a stiff lower back. The lump belongs to group of fibro fatty innocent tumors called fibromas/ lipomas. The rigid back needed to be investigated. I told him so and assured him that he two are unrelated. He said he has already been extensively investigated which included an MRI scan. He proceeded to take out as sheaf of papers from his sling bag. The MRI showed slightly indented cord but not serious enough to have caused his back ache. His other reports were normal.

What this young man needed was posture correction at work and a set of exercises to stretch his low back. His lump needed no intervention. I told him so.

‘Doctor, are you sure’? He asked.
‘As sure as one can be, going by the evidence’, I said. Then he took out another set of papers in which a surgeon had advised admission for removal of the tumor and surgery for the disc prolapsed!

I sat in silence for a while not knowing what to do or say. I told him, ’you have come to me for an opinion and advice, according to me you need no surgery, try out these exercises and get back to me after six weeks, we will review you back problem. The lipoma needs no removal, not now and not in foreseeable future’.

That was two months ago. He came to see me few days ago. His back ache was very much better and his much feared lump didnot seem to bother him.