NATURE OR NURTURED

    This question is often brought up , is it nature or nurtured. When we have a disease that can not be explained we talk about is it related to nature - genes etc or due to environment -nurtured. And it is very difficult  to answer it . In medicine the studies are done in twins to see if the GENES determine the outcome or how they were brought up . This is seen in studies for depression or bipolar or also for even homosexuality. That brings me to today's story. 

    I saw this patient may be 4 years ago and he had shortness of breath. He was admitted to a hospital  and was seen by cardiologist and lung specialist and hospital doctor and was told that heart was OK and he has emphysema. He decided to come to me  and so I did the work up and told him that he seems to have aortic valve problem and I admitted  and then  had aortic valve surgery. He also had HIV  and he had discontinued the medications  and so we had to start the HIV medicines . He did not come to my office much and he was followed by cardiologist. I did not know what was happening as he did  not come and he had major problem as heart. 

    I did see him every time he was in hospital. The cardiologist told me that he was noncompliant with meds . He was admitted and had shortness of breath and every time when I saw him I felt that he had cardiac problem and when we did echocardiograms, his pumping action was down to 20-25%The meds were adjusted and then he was OK for a while and then he would have same problem . The cardiologist felt that he would improve with the newer medicines . In span of 4 months he has been admitted 3 times  and he has not seen me in office for his COPD in last 2 years. So now for last 6-8 months he has not improved  and now for last 3 months they have told him that he will need a defibrillator. Patient has not made up his mind as to have it done or not. 

   So I  saw the problem with aortic valve  and we acted upon it and he had surgery and he did get better . Now he is worsening and the question is -is it related to his noncompliance or is it that in spite of surgery and medications he had bad genes  and he was going to get worse . 

  ISIT NATURE OR NURTURED