Saturday, November 2, 2013


      I used to watch , and I still do watch sometimes the cartoon of Tom and Jerry . Each time one tries to cheat other or try to defeat other . But the things seem to be working much better for Jerry and go against Tom . Sometimes I feel the same way when I am treating patients . I try to find out 'best ' treatment for one condition and when it is successful I pat myself on my back . But then something else pops up . Then I try to do something for that condition and then third thing pops up.
     The story that I am going to tell you is one such story . This has no sad or great ending, but it 're enforces ' my belief in reincarnation .This is a 59 years old male patient that I saw few years ago . He had diagnosis of asthma . He had never smoked and was mildly obese . He had  problem with his aortic valve and surgical repair for the same .For whatever reason he was difficult to control . I tested him for allergies , and they came negative . I tested for Immune globulin , to see if he was lacking the immune proteins , that would continue to have inflammation and would make the asthma worse . The were normal . I tested for for an enzyme , lack of which can cause emphysema . It was OK too . After seeing him for 6 or 9 months I was not sure what else could be done . i had done CT scan and it had shown no major finding in lungs , but had hiatal hernia .He was hospitalized few times and may a times his symptoms started quite suddenly. There was no respiratory infection, which is common cause for asthma attack . It occurred that his asthma was due to the Hiatal Hernia . Due to hiatal hernia there is a weakness of the sphincter between the stomach and esophagus. This was causing the asthma worsening , according to me . I told the patient  my thought process and told him that we should consider fixing the hernia . This meant a surgery .He agreed . The surgery was done and his attacks of asthma improved . I cur down on his asthma medicines and now he was on only inhalers . We had stopped steroids. and other medicines and he was fine . I was very happy .
        All most a year had passed . He had seen me in office couple of times and was not admitted for long time . Then I got a call from the ER . He had chest pain , shortness of the breath and his blood pressure dropped . The wife had called 911 and paramedics took him to ER In the ER they found out that his left lung had collapsed . There were blisters or called blebs and one of them rupture and like a car tire his lung collapsed .The ER physician put in chest tube and it expanded his lung . He wanted to admit him . But the patient and his wife did not want to be admitted to that hospital as I don't go there . He was transferred to the hospital , that I go . He was fine . The chest tube was still leaking  air , telling me that the 'hole ' in the lung had not healed .When I reviewed the chart , I realized that when he collapsed the lung , his blood pressure had dropped . This was dangerous sign . I got the CT scan from the other hospital .It showed that he had number of blebs . So he could get similar episodes as these blebs could rupture. I discussed with the patient and his wife . I wanted to have him a surgery to fix the problem . I called the thoracic surgeon .He agreed and patient underwent surgery .The surgeon did a procedure where a talc is blown in . The talc causes inflammation and it acts as 'glue'.  In next few days he was discharged . I had known but forgotten to mention that he had similar episode 20 years ago on the right side and had surgery for it .
       He was admitted again in 4 months for atrial fibrillation , irregular heart beats and was tested and then put on blood thinner . His asthma was quite stable during all this time .He was doing OK for 6 months . And then I got a call from ER again. He had left sided chest pain and so as per my instructions he came to ER . The CT scan showed that he had collapsed the lung . DUE to the surgery that we did , there was no major collapse , but there was some air collection on medial side . He was OK and he was not short of breath , his Oxygen level was normal .I was not sure what else to do . I called the surgeon and he did a mini surgery and put in 2 chest tubes to suck out the air that had leaked . He did well and went home . I am afraid that he may get another episode. The only good part is that (hopefully) with his surgery , his lung can not collapse to cause major problems .
     But I am amassed that this nonsmoker  had aortic valve replaced , had bad asthma , that we control with hernia surgery , then he gets collapse of the lung , not once , not twice , but 3 times . (if you consider the one that occurred on the right side several years ago .)

No comments:

Post a Comment