Sunday, August 14, 2016


     I love to read and I do get enough material to read. I like to keep in touch with new development in medicine . But in doing so I sometimes come across certain thins that come out of research that amazes me . It reminds me of one of the episodes of Seinfeld. In the episodes he says that some people want to find out cure for cancer or may be AIDS, while others find out seedless grapes !Some of the stories that I read belong to such class as seedless grapes . So let start on some of the medical things that I have seen or heard in last few months.
    The FDA approved a drug few months ago for ---are you ready - for 'DOUBLE CHIN' .So this drug called 'KYBELLA'. So this drug which is given as injection to reduce the fat in double chin . As I read it , there was a mention that number of injection may be needed . The question popped in my mind how many would you need to reduce xxxx, never mind .
    The next one was seen by me as a study. Since I saw it I have told it to many of my patients and they all laughed and I was trying to find out for the reason for the results that the researcher got. These researcher did survey and followed patients with diabetes and other heath issues . The patients were asked if they thought that their 'spouses' were nagging . They were also asked to score the happiness in their married life . I am not sure how the nagging 'scores' were done , but the conclusion was very interesting . When the men the study felt that their wives were more nagging and  had negative opinion about the marriage, their diabetic control was better than in men who thought that their wives were not nagging and the married life was good . But exactly opposite was true  in women . So if the women thought that their husbands were more nagging and their married was not happy , their diabetic control was poor !
    I had some questions . How do you score nagging and how do you grade marriage . And may be the nagging wives will be more upset about keeping scores and saying that the marriage was not happy.! The reason for the result may that the wives's nagging may be causing the husbands to eat better and may be forced to exercise and that may help diabetes . On the other hand the wives when nagged and had less satisfaction in their marriages , ATE to relieve the tension and reduce frustration and so the diabetic control was poor .
     So now that I talked about the food and eating and overeating, let go to my next invention. So  do you realize that 86 % of African American women are overweight or obese ? This is also a major issue in Hispanic and whites . So recently FDA approved a device to help this. It is clear that we can not control our food intake . So this GENIUS came out with device . A tube is inserted in the stomach and it can be attached to suction . So you can eat anything and as much as you want . Then attach the stomach to suction and it will 'suck' it out before it is absorbed and adds inches and pounds to you.
    I have few more but may be in next blog.

Saturday, August 6, 2016


   I love stories that have mystery , I also love movies where one can not predict the end .But the problem with these stories is that once we know the end , we can not read it again . There is no fun in reading such story , when we know what is going to happen . The same is true of the movies. In medicine when some one says patient is interesting , it is because we did not know the diagnosis. But sometimes finding the diagnosis is not the end of story. And we don't know what to do .Today I am talking about a mix of these 2 problems .
     I was asked to see a patient for abnormal chest CT scan . I saw this 48 years old patient who came for not feeling good and having black stools. He was a homeless person. He was a smoker 2 packs a day and 18 cans of Beer a day alcoholic . In spite of all this he came because he was not feeling good. The work up was done . It included CT scan of the chest .It showed couple of nodules . So I was called in to see patient . He looked cachectic and so I asked him as to if he had lost weight .Again it would be easy to understand if a homeless person had lost weight. But some one who can smoke 2packs per day and drink 18 cans of beer should not loos weight due to lack of food. He had lost 40lbs of weight. Weight loss is an indicator of cancer in many cases , at least in many patients . So I asked him if he was not eating well. He told me that he could not swallow. The food sticks in throat  was his answer. So I ordered the swallow study and CT scan of the neck. The swallow study showed no problem with the food pipe or esophagus. Son at least he did not have cancer of the esophagus. But the CT scan of the neck was abnormal.
     We called the throat doctor-ENT specialist .I had also decided to look inside the lung -bronchoscopy. He had lung nodules and so I also ordered the PET scan . In PET scan tagged glucose is injected and whole body is scanned to see the uptake of the glucose . The glucose is picked up by every cell in the body and the 'pick up' is higher in cancer cells and inflammation . So it helps the diagnosis of cancer.When I did the bronchoscopy, I saw A MASS INVOLVING THE RIGHT VOCAL CORD AND extending above it . I did not do biopsy as I felt it was too risky to do it with mild sedation. The PET scan did not show any 'pick up' in lung nodules but did show the pick up in throat mass. So I called the ENT surgeon .
    With the vocal cord cancer , radiation treatment can be done . But due to Location of the cancer ,patients usually can not swallow well with radiation, so they need FEEDING TUBE . He would have also needed food like Ensure or BOOST to feed through the feeding tube . He would also need daily transportation to get radiation. So now we are faced as to how to manage this in a homeless man . To add to our trouble the surgeon could not do the biopsy for next 10 days. So if we discharge him we don't know if if he would show up for the follow up and the biopsy.
    So this takes me to my original point . NOW we KNOW the diagnosis , but WHAT NEXT?