Saturday, June 7, 2014


   I have now seen models of computerized medicine or the decision made by the computer . Our brain does work as computer, but at times we do have instincts.And they do work better than the well thought out computer program.Many years ago I was reading a book called 'MIND Control' written by Jose Silva.It stated that we have intuition as children, but as we grow older, we are told to think 'logically' and as we develop logical thinking , we loose intuition.The computers work logically .There is no intuition in the computer decision making.It is all logic. Off course the logical thinking is programmed by the human beings.
   In medicine ,when we make decisions ,many a times it is not completely based on logical thinking, but it is based on 'feeling'. The patients that I am going to tell is one such story.
   I have been seeing this 68 years old female.She was a smoker and in 2010 I diagnosed her as having a lung cancer . She also had a history of a lung cancer in 2004. In 2004 she had a surgery and had part of her left lung removed. In 2010, after the new cancer was detected ,I referred her to a surgeon.She had a new surgery and at that time the surgeon did what is called a wedge resection . This is to save lung,by limiting the amount of the lung that can be removed, as much as possible.There is a risk that the resection margins may show cancer cells under microscopic examination ,which necessitates additional treatment and recurrence rate is higher.But as patient looses less lung , the shortness of breath is less.So this lady had 2 lung surgeries . I was following her with follow up CT scan.She had continued to smoke , had shortness of breath on exertion, and had significant cough. Few months ago the CT scan showed the increase in size of a nodule by 2 mm in span of 1 year.So I did a bronchoscopy and a PET scan. The PET scan is a biological scan . In this scan we check the glucose uptake in the spot, comparing it to the normal tissue.As cancer cells and infections have higher metabolic rate,the glucose uptake is much higher than normal lung tissue.The PET scan uptake was there but at much lower level than seen normally with cancers. So I decided to do follow up on the CT scan. The CT scan was done in 4 months.The nodule had grown by 5 mm and repeat PET scan now showed the uptake to be very high, highly likely to be cancer. I did check the breathing test and it showed adequate lung reserve. She had continued to smoke and had significant cough and was short of breath. But the nodule was still small and so in short ,she was surgical candidate. I was quite skeptical as to her ability to tolerate the 3rd lung surgery. But I had no choice but to refer her to a surgeon. Patient was not very old , had adequate lung capacity and was willing to have the surgery. So I sent her to a surgeon. I also sent her to a radiation doctor for the opinion,as if the surgery can not be done, then we could treat her cancer with radiation treatment.
     The surgeon saw her and so did the radiation doctor . Both felt that the best option was to give radiation and not the surgery. So my " FEELING "was correct ,or at least all 3 of us felt same.So if this was a computer decision, then she would have had surgery and may not have done well .    

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