Saturday, February 25, 2017


    I have been in practice for many years,and sometimes it makes you humble. You realize that you can not diagnose everything and you certainly can not cure every thing . There is always a factor of luck. And more I  see more I realize that WE are not the DOER , but we are just an instrument of the nature or the GOD or the luck. HE or SHE allow us to feel that we are in control and then in a flash , we feel we have lost the control. I have that feeling many a time and recently on couple of times it hit hard. That brings me to the case today.
     I saw this patient as my last new patient in the office. She came with a note from her surgeon stating SOB-shortness of the breath. I had no other records. So I tried to get some history from her. I also checked hospital computer where she was hospitalizes.She was young lady and had breast cancer diagnosed year ago. She had mastectomy on both sides and also then had both ovaries removed as the cancer was very aggressive. She received radiation treatment and then chemotherapy. She was hospitalized with shortness of the breath and then was found to have fluid around lung and heart. So had surgery and  had a catheter inserted to drain fluid around the lung and the fluid from the heart was drained .
      She was followed by many doctors including a lung specialist. Now she was in my office.I did not know that she was seeing another lung specialist.She was short of breath on any activity and her heart rate was more than 130. I also thought that she may have fluid on the other side also. So I told her that she needs to be in the hospital to find out what could be done,if any , and to first find out what was the cause of the increased  heart rate. She  had seen  heart specialist and he gave her some pills to take for reducing the heart rate. But the problem was that her blood pressure was low and this medicine could make it worse. So I wanted to get her in hospital and find out what can be treated
      So I admitted her and ordered the tests and some treatment. I did a CT scan and it showed that she had blood clot in the lung -which could explain the shortness of the breath and increased heart rate. She also had more fluid on the left , which could explain shortness of breath and increased heart rate. The CT scan also showed that the fluid on the right ,where there was a catheter inserted to drain it 2-3 times , had become locculated-had formed pockets , which means the catheter could not drain it. He blood count-the hemoglobin was half the normal. So all these could explain the problem and were treatable. But couple of things bothers me. Why was it that the oncologist or the cardiologist or the lung specialist did not bother to do the tests.May be because the underlying problem was not treatable- the wide spread breast cancer and I was sure that this bandage approach would only prolong the unavoidable end.
                            BUT THERE WAS GLIMMER OF HOPE !!

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