Sunday, July 29, 2012


   We often see patients that do not change in spite of  overwhelming proof about good life style and good , healthy habits . But as a physician we continue to tell patients about these things . I often wonder when insurance companies talk about 'prevention ' . This is because most of the things that are recommended are 'early doagnosis' rather than 'prevention ' . The only thing that is true  prevention is healthy eating , exercise, ,do not smoke or drink too much alcohol or do drugs .So this story is of one my patients , that occurred sometimes ago.
   I saw Eddie in the office for the complaint of shortness of the breath.He was 58 years old and was smoker . He smoked 2 packs per a day . He was also obese with weight of 280lbs .He had high blood pressure and diabetes . He also drank 3 to 4 drinks a day. I had my work cut out . I did breathing test and that did confirmed the diagnosis of COPD , the lung disease due to smoking . Due to obesity it had gone down further. I told him to quit smoking and do daily walk and some exercise. I also told him to cut down on his alcohol intake , this would reduce his calorie intake . We put him on some medicines for the COPD , and ordered sleep study . With weight and history of snoring I was sure that he would have sleep apnea. He also had some swelling of the feet , which could be due to his obesity , . However I wanted to make sure that there was no problem with his heart . He had seen cardiologist in the past and the work up was OK.
     He came for the follow up and had not stopped smoking or drinking . Had lost no weight . But he was taking medicines and was feeling little better . The sleep study did confirm the sleep apnea . He was prescribed the CPAP mask to treat it . He did not like it and so was not using it . I educated him on the need for the treatment of sleep apnea and the issues that would get worse if he did not use it . On the next follow up there was no change in his behavior . He was still smoking and drinking and had not lost any weight . He had started using CPAP at least for part of the night . I did not have much to add . His heart test was OK and he was happy about that .
    This continued for next 6 or 8 months . He continued to come with same complaints with no change in his habits . I tried to adjust medicines and educate him .
    He did not come for next 6 months . He had missed his 2 visits and so when he came for the follow up I was surprised . I hardly could recognise him . He was well groomed and had lost 60 lbs of weight . He had stopped smoking and given up drinking . He was going for the daily walks and was using CPAP . He was accompanied by a lady . He told me that he had applied for the disability and if not approved , he was going to quit the job and get married to the lady , who was accompanying him .. I was pleasantly surprised . I asked him as to how did it happen . His answer was , he was  'reborn '.christen . I did see him once again in next 2 months . His disability was approved and he was moving out of town to a small town near  coast and had bought a small boat .
     So I thought this was the happy ending of a good story, till I got a call . I had a call from a hospital near by . He had moved to a place about 60 miles from my office and had a new doctor . He was admitted to  the hospital after a fall .The story was that he was doing fine and had gone for fishing with his wife . He had a boating accident and fell down and had an injury to cervical spinal cord and was paralysed bellow neck. He was on respirator and was not going to get off. I spoke to the doctor in that hospital about his medical problems and tests etc. They were not going to be of much value in the treatment or prognosis.

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