WHY ? WE DON'T KNOW

   In medicine and in general our life we see things that can be explained on the basis of our knowledge or logic or science. I have often said that the GOD has kept us guising. The man thinks that we KNOW and then the God or an incidence tells us that we DON'T KNOW everything. Many years ago my professor of Preventive and Social medicine had a heart attack and I went to see him in hospital. In those days we did not have stents  and all the modern things that we have to treat the heart attack. He made a statement to me . 'I don't smoke , I don't eat meat and I eat lots of fish and I don't drink alcohol, I exercise  and my cholesterol is normal. I do or have high blood pressure or diabetes - I still have heart attack !'Since then we have much more understanding of atherosclerosis and heart attack and the risk factors but the basic statement is still true. We have no clue as to why some get sick and some don't. That brings me to the story for today. 

   I saw this male patient of about 70 years of age . He had been smoker and had COPD. He did not have much shortness of breath and he had routine chest X- ray and that was abnormal. So he came to me and then I did the work up. He had bronchoscopy and PET scan and breathing test and biopsy  and he had lung cancer . Based on the tests that we had done he had cancer that could be resected  and there was no evidence of spread of the cancer to any organs or the lymph nodes . So I sent him to thoracic surgery. and he also thought that he needed surgery So he had surgery and the cancer was out. The margins were clean and no blood vessels were invaded  and no lymph nodes showed any spread of the cancer . He was seen by cancer specialist and was told that he does not need any chemotherapy as there was spread . 

    More than a year went by and he was followed by VA cancer specialist and he was doing ok . He came to me  and he was doing fine . Then last time when he came to me he had laryngitis. He had lost his voice and so I was concerned  and I wanted to do CT scan and he told me that his cancer doctor had done the scan and that was fine and I did see the report and he had nothing on the CT scan to suggest any recurrence. So I sent him to ENT to check on throat- vocal cords . He had paralysis of left vocal cord! So ENT doctor did new CT SCAN - 1 month from the last one and he did it with contrast  and that showed that he had recurrence at the site of resection. Just to explain medical anatomy - the nerve that supplies to left vocal cord comes down and goes in chest and winds around left central part where there are nodes and blood vessels  and then goes back in neck and goes to vocal cord. So when there is cancer in middle of left central part this nerve can get caught and the vocal cord can get paralysed . So he had that and I did do biopsy  and he has recurrence. 

    So all the odds were in favor of so called CURE and then he had CT scan  and that did not show tumor and then in one month new CT scan did show the cancer !So do we really know or we are just medical statisticians ?