Male, 82, 50 year smoker. upper left lobectomy 2001, wedge resection R lung 2006, Stereotactic radiation of PET-identified nodules, L lung Mar2011,R lung Jul2012, R upper and middle lobes Jul2013. Recent PET identified probable metastasis left side 5th rib, shoulder, hip. Planned chemo now delayed by dyspnea which progressed from bothersome to extreme (O2 @ 3 or 4 L/m 24/7) following ineffectual pulmonary vein ablation 11Nov, Pace Maker installation 15Nov. Dyspnea blamed on (1) pneumonia, treated with misc antibiotics, no effect; (2) radiation pneumonitis, treated with prednisone, no effect. Pulmonologist says return in 2 months. Is it time for a 2nd opinion? pulmonologist s opinion