Saturday, June 25, 2016


   I have often talked about the lung diseases as I am a lung specialist . But as I often say the various organs in the body are related to each other like the various residents in a town . What one does affects every one other at one or other time . The obvious ones are the lungs and the heart. But recently - may be in last few years I have realized that the the Gastrointestinal system does affect the lungs mare than one way . Some of the elements may be related to patients living longer. Sometimes ago I saw this Indian patient . He walked in my office and had no appointment . He was working in a motel . When my office secretary asked him as to why he was in my office , he told her that the owner of the motel told him to come to me and I will take care of him . I started seeing him.
   He had a condition called scleroderma and he had no health insurance . So it was somewhat difficult to take care of him. But we managed . He had scar tissues in the lungs and also had circulation problem in the fingers and toes . He had chronic cough due to the scars in the lungs and was also short of breath . I did do CT scan at a discounted price from a radiology center and did complete pulmonary functions free. and treated him with meds . He had developed a ulcer on his ankle and had some ulceration on fingers . So I treated it with home remedies . I gave him Papaya cream and honey and asked him to soak both feet in hot water as long as he can to improve the circulation . All these things worked and the ulcers healed . After about 2 years of the follow ups , he got health Insurance and then he moved out of town , but continued to do the follow up with me .
    He was quite bad and I decided to refer him for transplant evaluation . I had done the check up on his heart as the scleroderma can cause the pulmonary pressure to go up . The heart check up was ok . The transplant evaluation as far as lungs were concerned , went well and they did think that he would be good candidate in ; near future'. But on further evaluation it was noted that he had problem with his esophagus. This is actually quite common .I had not done any work up on swallowing as he had no insurance and he had no GI symptoms. So  it came as a surprise and a disappointment . HE HAD ESOPHAGEAL MOTILITY problem .
     Normally the esophagus moves as contraction rings so the the food is squeezed down .  HE had no contractions . This can cause the food and the water to stay in the esophagus for prolongrd peroids of time and that can then regurgitate and go in lungs and can cause aspiration. This can further damage the already damaged lungs . This an absolute contraindication for the surgery and he was rejected fo transplant.
    Since then I have seen similer problem in some of the older patients without the scleroderma .Most of them presented as chronic cough, or recurrent pneumonia,  

No comments:

Post a Comment