Friday, January 30, 2015


       The medicine has evolved. In the past when the diagnosis of AIDS was made, it was a death sentence.Now a days we can treat and can control the disease that many patients with HIV can live long life . We can diagnose fetal genetics analysis to know more about defects without waiting till end of the pregnancy and avoid the threat of abortion .(which can occur when we did take out amniotic fluid to analyses for fetal defects, there is a risk of abortion.). Now a days we can do this very early (may be as early as 14 weeks.)with mother's blood.But sometimes we are left to the mercy of 'fate' or God.I thought about this when I was taking care of a patient .
      I saw this 74 years old patient , who had a chest pain and then went to see his family doctor. There was no fever and he did not have much cough. He had chest X-ray,that showed he had pneumonia and so he was admitted.I saw him and looked at his chest X-ray. It showed the pneumonia and showed some fluid around the lung. He had no elevation of white cell count as is normally seen in pneumonia or any infection. The fluid did not appear to be large .He was nonsmoker and so I decided to watch it with follow up chest X-ray in next day or so , with antibiotic treatment. I ordered the CT scan in next day or so and I was surprised . The CT scan showed large fluid. I could not believe the difference between the chest X-ray and CT scan . I decided to take out the fluid the same day even though it was weekend .I drained 1200 ml of fluid ,which was bloody . I had the discussion with him and his wife as I was quite concerned about cancer.
       As expected the fluid did come back positive for cancer. This meant that the fluid needed to be treated as with cancer it is likely to come back again. We normally put in a catheter , which can drain the fluid as needed .Or We can do instillation of the talc powder.I called a chest surgeon and a cancer specialist. The cancer specialist, oncologist, wanted 'more' tissue so that we can know 'MORE ACCURATE' tissue diagnosis. Now a days we are doing tumor markers and this has changed our way of thinking and it does give us better understanding of the type of cancer and also the choice of treatment. So I asked the surgeon to do additional biopsies to get more tissues and he did it . The patient and his wife were explained in detail our plan . So the new biopsies were done . It took additional 5 days to get the final diagnosis . The pathologist told me that the cancer was there , and the cells have changed so much that IN SPITE of all the new stains and the marker , they could not tell me for sure that it started in lungs or not , though 'MOST LIKELY" it was lung cancer. So once again in spite of our modern day medicine we were left with the decision to our old way of thinking!!

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