Saturday, March 18, 2017


   When it rains, it pours, is a common phrase used especially in relation to money or expense. So when we have one unexpected expanse , we end up having to face some other expenses. But I have also seen this when some bad news is seen . It is also said that bad news comes in threes. I have seen this in some of my patients . That brings e to my today's patient.
   I saw this patient more than a year ago.She was a smoker and her mother was my patient , who had advanced COPD. The mother was on oxygen. She had COPD and she was treated and told to quit smoking and she did . She was out of town and was sick and had some X-ray and CT scan done . But some how I did not see her for almost a year. She came back because she had cols and was treated by her PCP and was not getting better . She did not have fever , and did not look to be in any distress. But she was feeling short of breath and had cough with not much expectoration. She did have some wheezes , but not bad and her oxygen saturation was OK . Her mother was admitted to hospital with a viral infection , called RSV- Respiratory Syncitial Virus. This is not uncommon virus and the mother is quite old and has advanced COPD , and so I was not surprised that she needed to be hospitalized. So I thought that she may have the same virus. Her chest X-ray was OK . So I treated her with steroids and some other medicines and ordered chest CT scan .
    She came to see me shortly after the CT scan as the CT scan was abnormal . Actually she came day after the CT scan .The CT scan showed mass in the lung. She was still not feeling good  and the CT scan showed that the mass had pressed on her middle lobe bronchus and the middle lobe was collapsed. So I decided to admit her to give some antibiotics , for possible obstructive pneumonia .
   She was admitted and then I did the further work up. So she had CT Scan of the belly and the MRI of the brain and the PET scan. She also had the bronchoscopy. Her CT scan of the belly showed that there was cancer in her Liver and the Adrenals . The MRI of the Brain showed that she had multiple metastases in the Brain and the PET scan confirmed all the spread and showed that the cancer was also in the BONES . She was obstructed in the right lower lobe and the right middle lobe.
    So essentially she had lung cancer which had spread to liver , adrenal, bones and the brain!
   She will need chemotherapy and radiation treatment , but this what I called , when it rains , it pours! 

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