Saturday, April 1, 2017


   I have written about the inadequacy of the medicine in past . But when one is in practice of medicine for many years, he or she thinks that everything is routine. But then a patient shows up with what looks like routine case , and then when the final diagnosis is there , one meets with surprise. It has happened to me in the past and sometimes a new patient or an incidence reminds me of the inadequacy of the medicine. The story that I am going to tell is one such story.

       I had seen this 74 years old male patient for at least 5 years.He came to me for a cough and then I did the work up . He was not a smoker and had never smoked . He had some allergies and the cough was kind of chronic and intermittent. He had no other major medical history. He had no TB or diabetes or skin cancer or asthma . The only thing that was different he had was that he had cancer of the kidney few years ago and had one kidney taken out. I did the routine work up . I see chronic cough patients every day. So I did the allergy blood tests and the breathing test and tried him on some allergy and asthma medicines. He did better . But to history of the cancer , he was concerned and so I did or his PCP did CT scan of the chest . It showed a small nodule. So I decided to do the follow up. He had follow up CT scans periodically . First one in 4 months and then every 6 month intervals as there was no difference in the nodule.
    The last time I did the CT scan, the report showed that the nodule was same , but he had some plural-covering of the lung-thickening. It was not all around the lung but only in certain places and that to only at 2 or 3 places . The thickness was barely few mm.I did not know what to make out of this findings. I decided to do the PET scan and the bronchoscopy. He also had started to have some chest pain on the same side as the plural , while the nodule was on other side.
   The bronchoscopy was negative and did not add anything to the diagnosis. But the PET scan showed that the entire pleura was hot or lighted up. This means that something was going on in the pleura. So I sent him to a chest surgeon to do the biopsy of the pleura . He underwent the chest surgery and it showed MESOTHELIOMA!.I had suspected the cancer due to the findings on the PET scan , but never thought he could have mesothelioma. One he had no history of working with asbestos , which is almost exclusive cause of the mesothelioma and secondly he had the cheat pain only for short duration and did not need much pain medicines . But not every case is standard case. As we say sometimes , patients don't read books when they have complaints and have particular disease. .
        So this is what I call Inadequacy of medicine.

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