Wednesday, August 15, 2012


     I have been board certified in Internal medicine , pulmonary Medicine and also in Sleep Medicine . I have taken no. of examinations . When I was in training , I was told to always check nurse's notes . There were no. of other things that I have learned to look at  , when assessing the patient . Most of the doctors are not used to doing this . But I find it quite helpful  in diagnosing the problem . The story that I am going to tell occurred may be 28 years ago .
     I had stated practice  and I had new patient . She was 72 years old female, who had moved to our area few months ago . She had moved to live with her daughter. She was 'getting old ' had problem living alone . She was seen by and followed by no. of doctors from where she came from . She had history of high blood pressure and Had smoked for may be 10 or 15 years. She was not eating well and appeared depressed . So she was seen by a psychiatrist in her own place . Now that she had moved here , she was seeing all new doctors . She saw new , local psychiatrist and he asked her to see me . When I asked her as to what was her main complaint, she said my breasts are tender . I was not to sure as to what exactly she meant . But when I asked her again she said the same thing . Her psychiatrist note that she had brought, also said the same thing as reason for the referral . When I talked to the daughter , she said that the mother had that complaint and was worked up quite extensively . with X-ray , cardiac work up and even endoscopies , without any reason being found for her complains.. The daughter had brought in all the old work up . She had no . of tests done and all of them were normal . The x-ray , bronchoscopy , EGD, to look inside the stomach , cardiac ultrasound and stress  tests all were OK . I went through her doctor's note . There was nothing glaring in the notes . The only thing that I noticed that was striking was that SHE HAD POST 60 LBS. One would have missed it as she was still overweight . She was still over 200 lbs.
      I knew something was wrong . She may have lost weight due to being depressed and not eating , but according to the daughter she was eating well , at least for last 3 months , since she had moved here and had still lost the weight . I decided to do the work up . She had band like pain , starting from spine and going around the chest and coming to the front and she would feel her breasts being tender. . I decided to do the CT scan of the spine . It showed a tumor on the back side and penetrating in to her spine and causing irritation of the nerve , that caused the radiating pain . We did the biopsy and it was cancer . I had consulted the radiation doctor and she was treated with the radiation .
      If I had not noticed the weight loss , that was not obvious , unless one looks at each visit weight , I would have sent her back to the psychiatrist and would have missed the cancer .

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