Wednesday, July 22, 2015


      In medicine there are things that are conventional in certain situation ., but are not conventional under other circumstances. Some of the examples that I can give would be use of certain medicines that are not recommended or not used for certain diseases.are used under special circumstances. Albuterol, which is bronchodialater and used to treat asthma or COPD, is used to treat high potassium under certain situation.I came acrose one patient sometimes ago that may fall under same category.
      I saw this patient who came with a diagnosis of pneumonia. He was a66years old patient , who had quit smoking few years ago . He started with cough and it continued . He took over the counter cough medicines , but it did not get better. He then had an episode of coughing up of blood . He had also lost 5-8 lbs of weight . He went to a' walk in clinic' and they did chest X-ray. The chest X-ray showed 3 masses. They told him that the chest X-ray was not normal and they would treat him for pneumonia . But he needed to see a lung specialist . So he came to me . He had brought with him the X-ray. I saw it and knew that he most likely had Lung Cancer and not only he had cancer , but it was inoperable. I explained him my suspicion and the work up . I told him that we needed to answer 3 questions , 1Is it  Cancer, 2 Has it spread  and 3 What can we do for it. I did tell him that since there were 3 separate masses most likely it was inoperable. We did the work up . I ordered a CT scan and a PET scan and breathing test and a bronchoscopy.
     The bronchoscopy showed that there was a tumor blocking the right main bronchus , going to right upper lobe . I did the biopsy and it did confirm that it was lung cancer . I saw him in the office and discussed with him and his wife .The type of cancer that he had could be treated with chemotherapy as the best option of the choice. But the tumor was quite bulky and he had it in right upper lobe and right  middle lobe and left upper lobe. But there was also the tumor blocking the main bronchus partially . So in addition to sending him to a oncologist , I also sent him to a radiation doctor.
    He saw both doctors , but the radiation doctor wanted to treat this with chemotherapy and did not want the radiation . He did not call me . So the patient was scheduled to get a port put in . When he showed in the hospital to, get the port, his heart rate was 150 and the blood pressure was low . So instead of getting a port put in , he was admitted to ICU . I saw him , so did a cardiologist and the oncologist. He was started on medicines for the increased heart rate. In next 48 hrs he got many different medicines to control heart rate. Nothing worked . He continued the same rate and rhythm and the blood pressure was low . I could not give him any medicines as it would increase the heart rate. We had done a new CT scan as I was worried about fluid around the heart due to cancer. The fluid around the heart could cause blood pressure to drop.There was no fluid , but the tumors were there and the enlarged lymph nodes were pressing on the pulmonary artery .So I called the radiation doctor and asked them to reevaluate. He agreed and and started the radiation treatment . I also called the oncologist and asked them to give the chemo right away , and they did . Within 2 days of the 2 radiation treatments and one cycle of the chemotherapy , the heart rhythm became normal and the rate was normal too . He stayed in the hospital foe next 5 days and was discharged home . He was off oxygen and most of the medicines .
     I COULD BE 100% WRONG , but I believe that the radiation treatment and the chemotherapy effectively reduced the volume of the tumor enough to reduce the pressure on the heart and then in turn reduce the heart rate. So the radiation treatment ,which is normally not first line of treatment for his cancer, was used and it worked.The only other possibility is that the GOD intervened. (may be giving me the thought of trying to push for the radiation and chemotherapy !!)

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