Saturday, July 30, 2016


     I have been in medical practice for many years and sometimes I feel that nothing can surprise me . But many a times I come across patients that have a diagnosis that is not uncommon , but it surprises me or may be it touches the heart. Some one coming for pain in the belly and then finding out wide spread cancer, is one of them . I often wonder as to how come there were no other warning symptoms. So today I am going to tell a story of one such patient.
     I was asked to see this patient who had pneumonia. This older patient had history of bladder cancer and has seen by urologist several times . He had some surgeries and treatment with BCG. (I have never known as to how this BCG came out as the treatment for the bladder cancer . The BCG is TB vaccine . It was used in the past for the protection of TB and now we know that it does not do the job so we don't use it . But how could one might have thought to use the BCG - a TB vaccine to treat bladder cancer?) He came to the hospital with painful urination and difficulty with urination. So he had some urinary retention. But the routine chest X-ray showed some infiltrates or congestion in the lung. So he was started on treatment for the pneumonia and I was asked to see him . He had never smoked and had not much of respiratory related complaints. He had some cough and no fever and had some minimal shortness of breath. I did do the CT scan as there was fluid around the lung and he did not have typical history of the pneumonia . The CT scan showed same -pneumonia and the fluid . So I decided to take out the fluid . So with the ultrasound guidance I took out 1200ml fluid . I was quite concerned about this being due to cancer rather than due to pneumonia.
    He felt great after I took out fluid . (It is amazing to see how one can have that much fluid and have no major shortness of the breath). In between he was seen by the urologist and had some surgery to help the bladder issues and they told him that he will have to have urinary catheter left in for few weeks. So he was not very happy. I got the fluid report and there were NO CANCER cells. So he and his wife were happy and I was happy but surprised .So I called a chest surgeon to do additional biopsy from inside . He wanted to go home .So he wanted to wait  But there were other issues going on . So I did another chest X-ray. I knew what I was going to get . The fluid had recurred in less than 3 days! So now he agreed to do the additional biopsy that the surgeon had suggested .
     The biopsy is done by inserting a small scope through a small incision in the chest. It is called THORACOSCOPY. The biopsy showed the cancer , IT WAS A LUNG CANCER . He and his wife were not happy , neither was I . But I was happy that I had ordered the biopsy.
     He stayed in the hospital for another few days to get a port put in and then to start chemotherapy as out patient . We left a chest catheter in to drain the fluid periodically at home .
     I felt quite bad as he and his wife were quite depressed . He came with urinary problem and left with the diagnosis of inoperable lung cancer and 2 CATHETERS, which he was quite unhappy about! He asked me HOW CAN THIS HAPPEN?

No comments:

Post a Comment