Saturday, January 24, 2015


      I have written about the destiny and if we are able to change it. I had said that the problem with the question related to destiny , is that one that we don't know what exactly is the destiny.Then we don't know if we have enough time and thirdly if our efforts are enough or not . So one may think 'something' as a destiny and try to change it . In reality the change that he or she thinks they are trying for , may be the real destiny .If if fact the destiny is different that what we think , our efforts may be inadequate or we may not have enough time to change it . But for a second consider that we DO KNOW the destiny and we don't even try to change and the time is limited . Today I am going to tell a story of a patient where I felt the situation is as I described before.
      I was consulted on this young patient who was about 35 years old and had smoked for her entire adult life . She was admitted with shortness of the breath.She had lot of cough and was wheezing. She also had fever.
She also had history of high blood pressure and had developed kidney failure and then when they stopped working , she needed to be put on dialysis . She had refused to stop smoking and was not following restriction of  fluid /water intake .I started her on steroids and other breathing medicines . Asked her to not smoke and follow the water restriction. She did not follow any of my advise and continued to smoke and continued to eat and take as much of water as wanted. Her neck veins were very prominent and I had thought that it was due to excess fluid in the body as she did not have urine out put.But it continued even after dialysis . So I did Echo cardiogram. It showed that the pressure in the lung circulation(pulmonary pressure) was 75. Normally this pressure is 25. I explained this to patient .I also told her that this is serious and it will need further work up and treatment. The medicines that we use costs almost $100,000 per year. So we are needed to do definite test . This is a test where we put a catheter in the right side of the heart and the measure the actual pressure.It took another 2-3 days to convince her to get this done . When this one was done the actual pressure was more than 100. This is considered very high and needs CONTINUOUS INTRAVENOUS DRIP of a medication. This would need a special access line .She flatly refused. So I had no choice but to try pills, which are special pharmacy drugs and can be obtained after forms are completed .But it would take 3 weeks and may be more since she had not signed the forms. She wanted not to take the medicines for the COPD , wanted to stop the steroids and not take the inhalers.So I had to stop them.She continued to smoke.
       I have told her that this is serious condition and she could die with or without the treatment. I also told her that the smoking will make this worse. I also told her that pressure will go up and this can kill her. So I (think) I know the Destiny.But it is not 100%. I do know how we can try to change the destiny. But I also know that the efforts are LESS and I am not sure if we have ENOUGH TIME.

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