Dr. Anton Titov: “My mother had a ‘fibrotic scar’ in her lung for several years. In 2014 this ‘scar’ grew and was re-classified as a lung tumor. This was a sudden and sad new interpretation of diagnostic tests.

I consulted a renowned thoracic surgeon at a top hospital in Boston.

I received this gloomy summary:

“Just to be clear, the multiple abnormalities in the lung largely removes it from the realm of surgery. There is no hurry with the biopsy because we don’t have very good options.  I don’t mean to be pessimistic, but her best option is very slow growing tumor.”

I had no reason to challenge this experienced surgeon’s verdict. I had interacted with this senior academic thoracic surgeon during my residency.

He is a very competent expert, deeply respected by peers.

So all we could do was… nothing.

“But we found the right expert. He had the knowledge that other surgeons in the same speciality, with the same academic status, working in the same hospital, did not have. Finding a perfect expert made a crucial difference in the clinical decisions and the results of treatment of my mother.”

The method of searching for and interacting with experts who precisely match the profile of a patient’s medical challenge forms the core of Diagnostic Detectives Network approach.

Patient education is paramount for achieving the best treatment results. Video conversations with leading medical experts help patients to become well-informed participants in shared decision-making process with their physicians.

I reviewed dozens of medical research articles on the presumed tumor type.

I reached out to many physicians whose contacts I had accumulated since I started working at Harvard’s teaching hospitals in 1994.

I discussed the situation with researchers who I knew from the days of working on my PhD in Molecular and Cell Biology in a Nobel Prize-winning laboratory at The Rockefeller University in New York.

Deep medical literature review and discussion with my contact network led me to two experts who made this exact type of lung tumor a major focus of their research and clinical work.

One of these experts, interestingly, also worked in Boston. In fact, not only he worked in the same hospital system, he was almost next door to the first thoracic surgeon who I consulted about my mother.

After reviewing the case, this other surgeon immediately put my mother on his operating schedule.

He proceeded fast with the pre-operative diagnostic tests.

In a few days, he reverted to us with a completely different assessment of my mother’s situation:

“All of the mediastinal and hilar lymph nodes are negative. I think we can proceed to right upper lobectomy on the original date of surgery. The plan would be to remove any extension into the right lower lobe. The other groundglass lesions will be left alone. The remaining lesions will likely pose little risk to her life.”

That was a completely different assessment and treatment strategy for my mother.

While I had no reason to doubt the “we can do nothing” verdict of the first expert, my mother and I certainly preferred action to inaction. Optimism often prevails!

Thus, it took a week of the literature search and discussions with my professional contact network to identify and reach out to this other surgeon who specialized precisely in the treatment of the type of lung tumor my mother had.

In two weeks my mother underwent a minimally invasive operation (VATS) to remove her lung tumor.

She was discharged from a hospital to home 6 days later.

I then had this follow-up message from the surgeon:

“Completely resected. It extended in the right lower lobe but we had an adequate margin. All [lymph] nodes were negative. All margins were negative. There is no need for chemotherapy or radiation, just surveillance imaging Q6 months for 2 years and yearly thereafter.”

This was many years ago. My mother still leads an independent life, walks for miles, and continues to have a close and joyous relationship with her granddaughter.

A true revelation for me was not the fact that there I was, plugged into a Harvard medical system for 20 years, getting a pessimistic “nothing to do” verdict from one major surgeon.

It was also not the fact that I got a completely different assessment and action plan from another expert who was working next door to the first one, in the same hospital system.

A true revelation for me was the specific reason why the second surgeon preferred to resect the primary tumor.

He explained:

“If we do not resect and let the tumor keep growing, however slowly it does grow, the risk of internal transformation of this type of tumor into a more aggressive “classic” lung cancer would become nearly certain. Whereas for other small lesions this risk is very small. So we have to remove the primary tumor.”

This explanation was confirmed by another medical oncologist who studied the behavior of this type of lung tumors.

All that convinced us of a need to act quickly and accept risks of surgical operation and general anesthesia.

It is important to emphasize that both surgeons were profoundly knowledgeable in their field. Both surgeons were highly experienced.

It was not a question of one doctor being “better” than the other.

For me, the difference between them was the intensity of their professional focus on this specific type of lung tumor.

It was the difference in awareness of the changing landscape of treatment for this particular type of tumor.

In other words, the difference between the “do nothing” strategy, proposed by one surgeon, and “resect now” strategy, proposed by another surgeon, can be summed up in two words: “precision medicine“. No one knows everything.

When you encounter any medical challenge, you have to find a specialist who precisely fits the exact issue at hand.

A true expert is the precise key that can open the lock of a patient’s medical issue, and do so without damaging everything around it.

That’s how one gets the best possible results of any therapy.”

Dr. Anton Titov has extensive international clinical and research experience. He was a Neurological Surgery Resident at Brigham and Women’s Hospital and Children’s Hospital Boston (major teaching hospitals of Harvard Medical School), a Research Fellow in Neurology at Children’s Hospital Boston, and a Research Fellow in Medicine at Beth Israel Deaconess Medical Center in Boston (also a major teaching hospital of Harvard Medical School). He also had medical experience in the UK, including Freeman Hospital in Newcastle upon Tyne, University Hospital of South Manchester, and Royal Shrewsbury Hospital.

Dr. Titov received an MBA from Harvard Business School and a PhD in Molecular and Cell Biology from The Rockefeller University (laboratory of Dr. Günter Blobel, who was awarded Nobel Prize in Medicine in 1999). He was a Special International Student at Harvard Medical School, where he rotated at Massachusetts General Hospital’s Cancer Center, Lown Cardiovascular Group, and Neurosurgery department of Brigham and Women’s Hospital. He holds an MD from St. Petersburg Medical Academy. He also studied mathematics at St. Petersburg State University.

Dr. Titov also held positions in the life sciences and investment management industry: Healthcare Advisor to TVM Capital; Managing Director at Onexim Group, a Vice-President at Delta Private Equity Partners, and an Associate at Investment Banking division of Goldman Sachs International (London).