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.

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