Sunday, July 23, 2017


    In medicine and in life I often find that what could be considered as the TRUTH changes . medicine as such is as much science as art. So like in life or religion the search for the truth comes down to personal persistence .So one has to try hard and go withe the heart . That brings me to some patient;s story.

      I saw this patient , about 78 years old male who had lost 40 lbs of weight over period of 4 months . He had quit smoking 10 years ago and he had no cough or chest pain or shortness of the breath.The primary care physician sent him to Gastroenterology.   The specialist did the colonoscopy and the endoscopy The colonoscopy showed some polyps and they were benign. So he had no diagnosis as to why he was loosing weight. He had no fever , and no other  complaints.His cheat X-ray was reported as normal .
     And then one day he had  a bout of the cough and he noticed blood . His blood in the sputum continued for one day and so he called the primary care physician. He sent him to emergency room. In the ER they did CT SCAN of the chest. The CT scan showed that he had a mass in the middle part of the right lung and there was collapse of the right upper lobe . So I spoke to the patient and the family.
      He had normal chest X-ray. There was no evidence of cancer on the chest X- ray even though by looking back at the CT scan ,which had shown the mass or the cancer , I could not see the cancer , that was inoperable.
      I did the bronchoscopy and he has mass in the upper lobe -that was not seen on the CT scan , and it was causing the blockage of the right upper lobe and that had caused the collapse of the upper lobe.
    So I he had cancer of the lung and it had spread to the lymph nodes and had caused the collapse of the upper lobe , but NOTHING WAS SEEN ON PLAIN CHEST X-RAY!!

     I will tell story of the other patient where persistence on my part gave the diagnosis. 

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