Saturday, January 12, 2013


   If I would say to any person , that medicine is nothing but  statistic, they would laugh at me . Well may be not laugh , but would disagree with the statement. But if one looks at the way the medicine is 'practiced ' , he will have to agree that medicine is based on statistic and is practiced most of the time , if not one hundred % of the time with statistic in mind.Take for example of  acute bronchitis or case of pneumonia The treatment that I would give, will be based on statistical data as to which antibiotic will work 'best' with given circumstances . If the patient has COPD or is alcoholic or has HIV , we will select different antibiotic .Same is true of most of the other diseases , even the chronic conditions as high blood pressure or diabetes or rheumatoid arthritic etc. We have studies that have shown that certain drugs work best with certain conditions. We even have data as to which a better drug for Asian or African American patient.But sometimes we have to 'think 'differenly '. If this was not the case then we might as well ask "computer " to prescribe the treatment .The story that I am going to tell is one such case .
      It was 4-45 pm , I was in my office and was about done with the patients and the 'charts ' ,messages and the paper work. I got a call from the ER. One of my colleges was admitting a patient to ICU , with clot in the lungs . His blood pressure was little low and so he was going to be in ICU. I went to see the patient . He was 78 years old male with history of high blood pressure . He had artrhitis of the hips and had surgery done recently . The surgery went well and he was transferred to a rehab unit.. In cases of hip and knee surgery , there a high risk f developing a 'clott' in the leg veins and it can  'travel' to lung . This complication is called pulmonary embolism and can be fatal.So to prevent it we put patients on small dose of blood thinner .He was discharged on one such blood thinner . Two days after the discharge , he was not doing well and the nurse had noticed a swelling of the lags . In the begging it was thought to be due to recent surgery and limited activity . But then he became short of breath and so was sent to ER.In the emergency room he had a CT scan done and it showed pulmonary embolism .His blood pressure was low and he also had a clot in the legs . When I saw him some additional blood tests done . When we put patients on blood thinner , called Warferin --coumadine, we monitor a blood test called INR. He was not on this drug , but his INR was prolonged as if he was on it . The therapeutic level at which the clots do not occur , (statistically), is between 2.5 and 3 or so . His level was more than 3 and he still had clots , both in legs and in the lungs I was surprised. I did some more tests . I had my tentative diagnosis.I started treating him with medicines and fluid and oxygen . (I am avoiding the derails of medical part ). The test reports came back and my hunch was correct .
     He had developed  allergy to the blood thinner that he was getting and so he was 'clotting ' inside blood vessels . This random clotting caused the problem . It consumed the 'factors '(chemicals ) needed for the clotting and so he was bleeding too or oozing blood . The good news is hat patient improved and went home . The treatment that we gave him was a different blood thinner to help resolve the clots .
  Statistically patient should not develop clots with adequate amount of blood thinner , but he did and the treatment with other blood thinner was the treated though sadistically one does not need blood thinning agent if INR is therapeutic . The case occurred when we were not very 'familier ' with this condition called HIT , which is very well known now,  but one has to think about it , which I did and did get the reward. i.e.patient survived !!!!

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