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DEAR DR. ROACH: A dear friend of ours was diagnosed with lung cancer and subsequently had a stroke. Since then, he was told that he had disseminated intravascular coagulation (DIC) and that there wasn’t any treatment for it. The doctors don’t want to do surgery for the cancer because they’re afraid that he might have another stroke, so he’s been left without options. They told him that he could spend his time going from doctor to doctor or go home and be with his family for whatever time he has left.
Does all this sound reasonable to you? Any light you can shed on this would be greatly appreciated. -- M.F.
ANSWER: I wish I could shed some light on it, but the story has me puzzled. DIC is a very serious condition where the body’s clotting system spirals out of control, with blood clots forming and placing the person at risk for strokes. Pulmonary emboli (blood clots that travel into the lungs) and other clots can also occur.
However, the clotting is so extensive that the body runs out of platelets and clotting factors. So, the person is also at risk for severe bleeding, including bleeding at the site of the lung tumor, but also bleeding at other locations in the body. DIC is a rare complication of lung cancer, and its prognosis is very poor, with half of people succumbing within two weeks of developing DIC.
With such a condition, sending a person home doesn’t seem to be the appropriate therapy. It’s certainly an option for people who want to spend their last days at home; however, there are available treatments. The most important first step is to treat the cancer, if possible.
Some lung cancers are amenable to surgery; others can be treated with radiation or chemotherapy. Without knowing how extensive your friend’s tumor is, I can’t give an opinion on which treatment is reasonable. There are treatments for DIC that involve stopping the clotting cascade, as well as replenishing the body’s clotting factors and platelets.
It does sound to me that your friend hasn’t been treated well. “Go home to die,” which sounds like the message your friend is getting, should never be the only option.
DEAR DR. ROACH: A recent column asked about treating seasonal allergies with Flonase versus Allegra. I have annoying perennial vasomotor rhinitis, which I’ve managed with NasalCrom (nasal cromolyn sodium) for years. I wonder why you didn’t mention it in your article. Is there some long-term complication with it that I am unaware of? — J.S.
ANSWER: There’s seldom enough room in a column to discuss all the possible treatments for a medical condition. In the case of nasal cromolyn sodium, it’s about as effective as oral antihistamines, but most people require a dose every 4-6 hours. It’s less effective than steroids for most people, but nasal steroids don’t work for everyone and can have side effects, such as nosebleeds.
If it works, however, it’s a great choice since it’s exceptionally safe. It’s hardly absorbed into the body, and serious side effects -- whether short- or long-term — are very rare. If I had enough space, I’d discuss other treatments such as allergy immunotherapy; nasal ipratropium bromide (Atrovent); oral leukotriene inhibitors such as montelukast (Singulair); saline nasal sprays or washes; and even biologic therapies such as omalizumab (Xolair). But all I can do is mention that these may also be appropriate therapies for some people to try.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
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