Sunday, August 24, 2014


    In medicine and for that matter in other fields , there are accidental discoveries . The old example was that of discovery of penicillin.Some other drugs have been discovered by shear chance . Some chemotherapeutic agents belong to this category( cisplatinum). Then there are accidental uses of the drugs. A medicine that was used for allergy,was noted to cause increase in appetite and cause weight gain.So it is used not for the allergy, but to improve appetite and weight gain (Periactine).This is true for non medical inventions too. Sticky note is one such invention.But what I wanted to tell today is not that kind of accidental discoveries , but some other kind ,where no one knew or expected , a disease , and it was diagnosed by accident. I had written a story of a pregnant lady, who came to hospital and became unconscious and none of the doctors suspected pregnancy with it's bad effect called eclamcia.It was by accident that some one ordered the pregnancy test and the pregnancy was diagnosed and once the c-section was done patient got 'cured'.So the story that I am going to tell is similar to that.
      I saw this 90 years old patient in my office . He had diarrhea and had lost 20lbs weight. So the primary care physician did CT scan of the belly and it showed some abnormality in the lungs. Since the bottom of the lungs are not 'flat', but are curved, when they try to go to the top part of the belly, (liver) they will have some pictures of the lungs . So he had a CT scan of the lungs . The CT scan of the lungs showed a nodule in the lungs. So with the weight loss , i decided to do a bronchoscopy. My concerned was not to diagnosis lung cancer though it was a possibility, my concern was to atypical infection called MAC. So he came to do this procedure as out patient. He was put in a procedure room ,after the nurses did the history and some examination . They did notice the low heart rate. But they were waiting for me . When I entered the room ,I noticed that his heart rate was ,30 .His blood pressure was 1410/70 and his oxygen saturation was 97%. He was comfortable and had no complaints.When I looked at the monitor , I realised that he had a heart block ,i.e. only every other beat was conducted.So even though he had no symptoms related to this low heart rate, he needed a pacemaker. Needless to say that I canceled the procedure and called the cardiologist . I admitted the patient to ICU and started him on intravenous drip of a drug that did improve his heart rate, He had  pacemaker inserted and is did fine .
        So if he was not on monitor and if I had not scheduled his procedure, then his heart block may have remained undetected, at least for some time .

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