Saturday, October 24, 2015


     I see many patients in my practice that have gotten the short end of the stick . And then there are patients that happen to be 'lucky'. I have often wondered as to why certain things happen to some patients. That leads to the so called bad luck or the theory of reincarnation and the laws of Karma . But even though I know the theory and believe in the reincarnation and laws of karma , it does not stop me from getting surprised and wonder about the God's plan . I thought about it when I saw recently some patients.
     First one was a84years old male who was admitted with possible pneumonia . He had significant dementia and was sleeping most of the time . He did answer some questions , but did not know where he was . He did follow some commands . or instructions I knew that he had pulmonary fibrosis and may have some other medical problems. His mantle status and advanced dementia and the age would make him more prone to aspiration , food and the liquids going wrong way and in lungs at times . So I ordered a CT scan and swallow study. The swallow study did confirm my suspicion that he was aspirating. So the speech therapist ordered some instructions . The CT scan did confirm that he had fibrosis . But it also showed a mass in liver . The radiologist wrote in the report that he was concerned about the primary cancer of the liver. I spoke to the family several times and try to get him to be DNR .He was unable to walk . He was sleeping most of the time and did not know where he was and he also had pulmonary fibrosis which caused him to need oxygen all the time . There were some restrictions or modifications on his food as well due to aspiration. But the family did not want to make him DNR and wanted all the work up . So I ordered the PET scan which picks up cancers may be 85 to 88% of the times . The PET scan was positive . So the radiologist felt that he had cancer of the Liver . Another round of talk was done with the family . They wanted biopsy to confirm it . So we had to do the biopsy . Interestingly enough he had history of heart problem and heart attack and stents . So he was on blood thinner . So we had to hold the blood thinner for 5 days before the biopsy could be done . The biopsy was attempted , and it turned out that HE DID NOT HAVE CANCER , BUT HE HAD AN ABSCESS -collection of pus . He was on antibiotics for pneumonia , so we readjusted the antibiotics .
       So here is my question . This patient who was older , had heart disease , had dementia , had aspiration , and had pulmonary fibrosis and could not walk , and he did not have cancer . So with the treatment of infection he was going to be OK if there was anything to be OK with him . And then the next one that I will tell in my next Blog will point out the problem that I sometimes have with the diseases . What is the purpose of beating all the odds of cancer in this patient ? What does God thinks and why does this happen in patients that we mortals can't seem to see the benefit and then when we wish someone not to have fatal disease , they have it . You will get it when I write my next blog soon . 

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