Thursday, August 14, 2014


    There are times when I often wonder what else could do or is there anything that I can do to change the outcome.Someone had said that if you do certain things repeatedly , it becomes habit, and when you do it more often it becomes second nature. I think  I can say that about smoking. I also talk about the circle of mind. Let us say I have never tasted a Pizza and you bring in a pizza and ask me to try it. When I see the pizza , I would have no reaction or desires I have never seen pizza. But then you tell me try it as ' it's great.'So I try it and I like it or dislike it . So eating pizza leaves an impression.So next time when I am hungry or passing by pizza place , I would recollect that the pizza was good or bad and that would cause to buy it . Eating it will leave impression and then that will create desire to eat it again and so on and so forth.This is circle of mind .Action causes impression and impression leads to desire and desire leads to action.This is worst with smoking and that is my today's story.
       I saw this young 40 years old patient, with abnormal chest X-ray.She had lung mass. As usual I did the biopsy and the breathing test . She had a cancer and the lung capacity which was OK . She was a smoker and had the reduction in the lung capacity, but it was acceptable for the taking out the cancer. We had thought that she will need a lobe to be taken out ( approximately 2/3 rd of the lung , may be 2 lobes . But when the surgeon went in , the tumour was quite close to the center and he had to take out entire right lung .This was her only chance to may be give her a chance of cure.She did well and no major problem .She was given radiation treatment to prevent the recurrence. I followed her for long time after the discharge .She had quit smoking for may be 4 months or so. Then she started the smoking again . She had reduced lung capacity as she had lost the lung and she did not start with the normal lung capacity.She also had the cancer , but it did not matter , She was smoking. I must have followed her for few years and then she was lost for follow up .
    Then I got a call from a general surgeon , asking me to see a patient that I had seen before . She had routine mammogram and it had shown abnormality and so a biopsy was done . It showed a cancer . So she needed surgery . He wanted to me to 'clear' her for surgery as she had lost one lung and was a  current smoker. I saw her .She was still smoking . There was no evidence of recurrent lung cancer . Her lung capacity was lower . But I cleared her for surgery.It was breast cancer . She had no problem post surgery. She was started on oral  chemo. She continued to smoke . I must have talked to her several times and it made no effect. She continued to smoke .
    Three years passed . She had problem with acute bronchitis and was short of breath. So needed to be admitted. The routine chest X-ray done showed a abnormality in the remaining lung. She had CT scan and it confirmed that she had a lung mass. With her history of 2 different cancers the possibility of new lung cancer was high , and the possibility of spread of breast cancer was there.I did do the bronchoscopy and got nowhere. She was too short and I did not see ant tumor to the biopsy and deep biopsy were out of question with her shortness of the breath. I spoke to radiologist to see if he could do needle biopsy . He did not want to take a chance as she had only one lung and if it would collapse after the biopsy , she would probably could not tolerate and may die . So I spoke to the oncologist and we decided to do radiation as he 'felt' that possibility of lung cancer was higher than breast cancer. She continued to smoke and died in less than a year.

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