Sunday, October 25, 2015

Grace of God -2

         So in the last Blog I described the case where I saw someone that was not at the best level of health and mentally . Again I do not want to take anything from the family as I know everyone of us would like our loved ones to live for ever . Very few of us are 'ready' to let go , and that too when they are very very old and unconscious. So I understand the behavior of the relatives. But what I don't understand is WHY the disparity .So let me tell the other story.
        I saw this 42 years old female for chronic cough . She was anon smoker and had some cough going for long time , may be 2-3 months . She had never smoked . Had no other medical history , other than she had melanoma resected out few years ago . Her physical examination was normal . Her lungs sounded clear and there was no other abnormal findings . The chance of asthma and allergies is very high in patients who are nonsmoker and have chronic cough as main complaint. So I told her the differential diagnosis . I ordered the blood test for allergies , a chest X-ray and breathing test . I gave her sample of inhaler and a short course of steroids . She called me in 2 weeks . She had cancelled the follow up , the breathing test and had not done the blood test . She was feeling great and her cough had gone away . So she had concluded that it was due to allergies and she thought that she would rather go to allergist and do testing , rather than doing blood test for me .My office gives me the charts of all patients that miss the appointment or cancel the work up , like CT scans or breathing tests etc . So We called her and told her to do at least chest X-ray that I had ordered. She did the X-ray . The radiologist called me with the report . It showed LARGE mass in the lung . So I called her and got her to do CT scan. The CT scan showed the same findings . I saw her day after the CT scan was done . She came to me with her husband . I told them that in all probability it Wes Cancer . We need to answer 3 questions , Is it Cancer , Has it spread , and What can we do about it . So I ordered a PET scan , which is accurate in about 85 to may be 88% of the time in picking up the cancer. The Pet scan and the breathing test was scheduled for next day and the Biopsy was day after . The PET scan showed that the mass was highly active and there were lymph nodes and there were 2 skin nodules . All these findings made her inoperative .
      I am not going to talk about the diagnosis or the treatment . What I was bothered with this experience is that this 43 years old female who had done all the right things in life and had her all faculties in tact and significant life left , has inoperable cancer .
                                       HOW DO YOU EXPLAIN  THAT?

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