Sunday, April 9, 2017


   Long time ago , I was complaining about the car repair bill to a car .mechanic The cost of the part was not that high, but the cost of the labor was very high. So the answer that I got was not that unexpected.He knew that i was a Physician and that was translated in to to two conclusion, one that I did not have much knowledge of cars and secondly I had money. So he told me that the human body is old machine and there is no change in it for many many years , contrary to that  the automobile engine has changes significantly in last few years and it continues to evolve and change and so it is much more difficult and time consuming to diagnose a problem , so the labor cost is much higher than what I get to see a patient on follow up. I did tell him that if I make a mistake (or some family member or a lawyer conclude for his or her own monitory benefit that I made a mistake,)the patient could be harmed or can die. That is not so with the car . But I had no way of getting my car fixed without him, so I did not argue. This brings me to the story that I am going to tell today.

    I saw this patient 78 years old female for pain in the belly . It actually was flank pain rather than belly pain. The reason I was called in was due to her chronic cough and the possibility of scars in the lung , so called Pulmonary fibrosis. The husband was bed side all the time . So I saw her , She had never smoked and she had some cough . I checked her oxygen saturation and it was normal. On her physical examination, she had some crackers ,which are indicative of scars in the lungs. The CT scan of the belly had shown no new findings , but she had some tumor in the belly ,unchanged from 2014. No one knew the etiology of the small abnormality next to liver , which is on the right side and her pain was on left flank. She did have vertebral fracture and some artritis in the spine.
   So I ordered the CT scan of the chest to check on the fibrosis.I did not do any investigation on he flank pain as Gastroenterologist was consulted. The Gastroenterologist  decided to do endoscopy, which I did not think was going to add anything and it did not. But I was talking to the husband and he was getting frustrated as 'she was here twice and no one can find the cause of the pain.' And he was right . She was in the hospital twice and as out patient had complained to PCP for last one month. So I told him that I think the pain is due to the lumbar spine problem and not due to the gatrointesinal problem . I ordered MRI of the spine and it did confirm my suspicion . She had severe arthritis and fracture of the first lumbar vertebra ,so the pain was due to the fracture. We talked about the arthritis where she would need to see spine MD and the fracture where we could try a procedure where they inject cement in the vertebra and that gives pain relief in majority of the patients. She and the husband agreed .

      So the procedure was done by neurosurgeon.She did well. I saw her about 4 or 5 hours after the procedure and she was OK , But like any other procedure she was out on the oxygen . The procedures are done with light sedation or anesthesia. She had no chest pain or flank pain or shortness of the breath. I told the nurse that we need to wean down the oxygen as we wanted to get her home in the morning. The fibrosis was confirmed and I would have to do the further work up as out patient.
   I get a call from the nurse that she was fine , but her oxygen was low . So I ordered blood oxygen check and it came back alarmingly low .Again she had no complaints. I was not sure as to what may be the reason , but I was worried about a blood clot in the lung due to lack of physical activity . So I ordered a CT scan of the chest . But I was not sure if I could give her blood thinner as she had invasive spine procedure. So I called the neurosurgeon . ( I had 4 different phone calls before I got the right doctor).He had no problem using the blood thinner, but he did not think this was related to the procedure . We had problem with the IV access and so I had to change my order on the CT scan . But then we got good IV and we did the CT scan. I got a call from the radiologist that she did have clots but they were NOT BLOOD CLOTS but it was the CEMENT clots .

     During the entire span of about 6 or 7 hours , I had about 12 calla and spoke to 5 different doctors trying to get the things done .
     Yes the human body -the machine is old , but problems are NEW and by the way there is no extra labor cost that I can bill !

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