Tuesday, September 23, 2014


     Sometimes we do things for long reason and get the 'right'answer.One does not want to go a wedding or to a party,but then he meets his dream girl. But in medicine , it rarely happens . I feel that we do too many tests, Some of them with normal results and are (at least my mind waste of money). This is more common in hospitals as no one wants to miss any thing and the physicians that are seeing patients , are not the ones that know patients and are not going to do out patient  follow up.So the tests get ordered.But the story that I am going to tell is one little unusual one.
   I had known this lady who was smoker. She had some COPD. I had taken care of her husband. He had COPD too . After taking care of him for few years, he died . Then she started coming to me more regularly.She was a smoker . She was hospitalised for pneumonia. We did a CT scan and it showed some scars and emphysema.She was doing better.But her platelet count  was low . So we did a further work up. At time I came to know that she also was drinking alcohol. So I did a liver test and it showed that she did have a liver disease related to alcohol . After extensive discussions , she agreed to stop smoking and drinking. It should be noted here that she had a colon cancer resected year and half ago. I continued to do follow up . She improved significantly .Her lungs got better. She hardly needed any inhalers. Her platelet counts improved and her liver function was normal.We continued to do follow upon her periodically.I do chest X-ray every year.
      She was also followed by an oncologist.So one day I get a call from him that he did a blood test and it was elevated suggesting of recurrence of colon cancer . So he did CT scan of belly and chest . The Ct scan of the belly was OK but the CT scan of the lungs showed that her lungs had abnormal density in right and left upper lobes . She had scars in left upper lobe , and it did look little worse. But the right upper lobe was new . I did PET scan and it showed the activity in right upper lobe . The left one where there was a scar was mildly active in that area, which could be scar or cancer. I did breathing test and a bronchoscopy.It was of no use.,did not help. So I asked radiologist to do the biopsy of right upper lobe . It showed LUNG CANCER and not colon cancer . (in my mind the possibility of colon cancer was almost zero ) I sent her to a chest surgeon . My thought was to take the cancer out. But the surgeon was concerned about the left side . He wanted the biopsy of Left side . So I agreed and the biopsy was done and it showed LUNG CANCER. So she had a lung cancer which had spread to other lung .I am not sure as to which side the cancer started.
     So the blood test that was done to do the follow up of the colon cancer was correct test to find out recurrent colon cancer, though the chance of recurrence was very very low. But there was truly no reason to do the CT scan of the lungs . So the test that was ordered which showed the cancer was not the right test , but it gave us the diagnosis of the lung cancer .

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