Wednesday, December 23, 2015


       We are often happy , proud and boast when we are right or feel YOU did help someone . But at times this sis not so , In medicine it happens more often than in other professions . Sometimes we suspect cancer and we work to find or may prove that we are right. But when we get the diagnosis we are not happy as the diagnosis is not the best diagnosis. and the prognosis is not good. I had similar experience recently . The key in this story is different than I started this blog .

      So I saw this female who was about 70 years old who had chronic cough . She was seen by other doctors outside the country and had some investigations . She had no shortness of the breath and when I told her to cough all that she would cough would be spitting saliva . Her lungs sounded cleat and her X -ray was OK and the oxygen saturation was normal . I ordered the allergy blood tests and then did the breathing tests. It showed no obstruction or suggestion of asthma . I did try her on medicines for asthma and for allergies . She may be got little better but continued to have cough . Again it was only saliva and not real sputum . She was lost for follow up as she went out of town . I saw her again after a gap of few months . She had seen a cardiologist  as she was short of breath too . He did a echo cardiogram and then scheduled the stress test . So when she saw me she told me that she was quite Short of breath . I did make her walk as I do it in every patient when they complained of shortness of the breath . She could walk barely 30 feet. Her oxygen did drop little bit and she was not wheezing . But I could hear a loud murmur that I did not recollect hearing it . So I did a ct scan to rule out scars and send a note to the cardiologist . I wanted to tell them that her shortness of breath was real and was worse . I could not figure out as to why . But  a blood test was ordered . I got a text from the cardiologist that the stress  test was OK . Then came the diagnosis . Her hemoglobin was less than half the normal . So she was admitted for the work up and the blood transfusion . The further work up showed that she had acute leukemia . She was started on chemotherapy .
    So when I saw her for the first time , which was a year ago , my impression was that she did not have major issues , but I still did the work up . The last time when I saw her , I was quite concerned that SHE HAD something . though I could not figure out as to the cause of her shortness of the breath . But I knew that she had something . Unfortunately it turned out to be acute leukemia -not the best diagnosis and the prognosis .  

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