Sunday, March 20, 2016


    Many years ago I had heard comments about statistics. I am sure you can add to the list . Some of them are interesting. One was ,' there are lies and then there are lies , and then there is statistics!'. The other one was, 'if you put one hand in boiling hot water and other in ice cold water, then statistically you are at comfort'. So sometimes when we in medicine talk about chance , or probability or possibility , we truly are talking about what happens to majority . But by no means this is 100% but we in medicine  get our opinion further confirmed as majority of the patients behave as we knew from the statistical data. I  have been always puzzled as to why in a study all the patients don't behave same way . The sugar is sweet and everyone who tastes it will say the same thing . Then why a particular cancer in particular stage behaves differently in different patient ?These thoughts came to my mind when I saw this 74yeras old patient recently.
      He is a 75 years old male whom I saw several years ago . He was maybe 60 years old at that time and had come to me for an abnormal cheat x-ray. So I did a CT scan and then a biopsy. The CT scan showed that he had a mass in the right lower lobe and there were number of lymph nodes in the chest that were enlarged. This indicated spread of cancer to these nodes and made him inoperable . The biopsy confirmed the lung cancer . So he was treated with radiation and chemotherapy. Per my 'thinking' -which was based on the statistical data of this type of cancer in inoperable stage,- was that  he was not going to last mare than 2 or 3 years. I had told him that and he had known it to from other sources including oncologist. Certainly we all read the same books and know the same data. But he did not die . So I continued to follow him and he did OK .Few years passed by and it was more than 10 years that he not only did not die , but had no evidence of the cancer. Then it happened. His CT scan was abnormal. So I did a bronchoscopy. He had new cancer . So he was started on new chemotherapy. We could not do more radiation . So I followed him up and he continued to do well . May be it was 2 more years and he coughed up blood. So I did a bronchoscopy . His chemo was stopped as he had no evidence of cancer . My bronchoscopy showed that he had recurrence of the right sided cancer and there was a different cancer on left upper lobe . The interesting part was that in spite of me seeing the cancer - a new one - on left side , the CT scan did not show any cancer, not did PET scan showed the cancer. ( another statistical data which was not right ). So he was given different chemo . This time he got quite sick. He could not eat and developed weakness in the legs and had number of other issues . He also had pneumonia and swelling of the legs . He was so weak that he could not even stand up . So I told him and to his wife that there was no sense in continuing the chemo and made him 'no code' . He was discharged to extended care facility. He needed help and the wife could not have taken care of him at home . I did not think he was going to last more than few weeks . So I forgot about him . He showed up in my office about 7 or 8 months down the road . He was walking , and eating well and was doing OK.So I did another CT scan and as it was abnormal did another bronchoscopy. He had recurrence of the cancer on left , but none on right. I had stopped counting as to how many times he was cured or told that he was cured and had new cancer or recurrence of the cancer . Statisticaly this is impossible . He has defied  all the odds. 

Thursday, March 10, 2016


      When one goes to a physician , they expect that the physician will be one step ahead of the treatment or the diagnosis. And most of the time it works . But at times it is a frustrating and the story that I am going to tell is one such . As a physician we like to help , anticipate and treat or prevent the problem that may arise. So it is quite frustrating when we come across the surprise . So this is such a case that in spite of every one we did not anticipate the outcome .
      I saw this 45 years old male that had chronic cough . As usual I did the allergy testing and the breathing test . The allergy test did show some allergies and the breathing test showed that he had mild asthma. So I put him therapy for the asthma and he did improve . In next few months he was seen by me for one or two times and then was lost for follow up . He had some personal issues and so was out of town and was doing well and so postponed the follow up . He came back to me as he again had some cough . His lungs sounded clear , and so I sent him to an allergist. Then he had further allergy testing . When he went back to him he was told about the allergy shots . At that time he was having shortness of the breath . So he was given steroid shot . He continued to feel shot of breath , so he decided to go to ER. There was nothing positive in the ER on examination or chest X-ray . But I decided to do CT scan .The CT scan showed that he had clots in the lungs and he also had pneumonia . So the pneumonia was not seen on plain X-ray and he had no fever. He was admitted and was started on blood thinner . He was anemic and so I did the work up and I also did the work to find out as to why he would get clots. I also called a blood and a cancer specialist . We treated the pneumonia and then he was discharged. He was followed up by me and the oncologist . He was readmitted in less than 10 days as he had fever . in spite of the antibiotics . So he was treated for the pneumonia and was seen by infection specialist . I ordered the scan of sinuses as I was not convinced that the fever was due to pneumonia. He did have bad sinusitis , so I called the ENT consultants . They saw him and did not do anything different. They told him to see them in the office. He was doing better and was discharged. I saw him and he was still weak and was seen by all the consultants as out patients. I did follow up CT scan and it showed that the pneumonia was better . He was feeling better and had no fever and was back to job .
        So when I saw him in the office I was happy that finally he was doing better and we had done well with him , anticipating the clot in first place , then the sinus infection and then the follow up on Ct scan etc He looked OK and told me that he had much improved energy . The I saw him and noticed a lump in the neck . It was lymph node enlargement. He had shown it to his PCP and he told him to watch  it . I was not going to do that. I ordered an antibiotic and CT scan of neck . I told him to see ENT doctor  ASAP .The next thing that happened was that he was admitted and  had a biopsy of the enlarged lymph node and HE HAD LYMPHOMA.