Monday, January 1, 2018


     When we say that it is a coincidence,it means we did not expect it or the chance of the thing happening was too low and so when that happens , we call it a coincidence .It is not uncommon to have the family members to go to same family doctor as that is what the family doctor is or was suppose to be , -treat the family . But to see same specialist for the similar condition is less likely. But again the high blood pressure or the diabetes are so common and do depend sometimes on common environmental factors , such as diet , exercise or life style, that the husband and the wife can get similar condition and then go to same specialist . In my specialty COPD could be one such condition as it is related to smoking and many couples do or did smoke together . So that is not a coincidence . But today I am going to tell you about a patient that is rather unusual and so it is a coincidence.

       Many years ago I saw this fire fighter , who was about 50 years old . He had retired earlier and had some cough . He was short of breath and had no chest pain or weight loss . In fact he was obese. He had no fever and had no other problems . We did the routine work up and it turned out that he had some scars in the lungs . We did the further work up  and did the breathing test and also did some blood work up . He had reduced lung capacity and also had reduced ability to transfer the oxygen , which is  seen in patients with scar tissues or fibrosis. He was young and so we decided to do the open lung biopsy.His blood tests were not very specific for any particular condition like lupus or rheumatoid arthritis.The open biopsy was done and it confirmed the diagnosis of the fibrosis . But we had done the biopsy to find out the reason for the fibrosis and so the biopsy was difficult one to get the diagnosis . So it was sent out to Mayo Clinic . The report came as 'fibrosis and the inflammation most likely due to connective tissue disorder , may be scleroderma'.The blood tests were not very specific for the connective tissue disorders. So I did call a specialist for the same , rheumatologist.
      He decided to start him on some drugs . The patient did not like the doctor , but did do follow up with him . But unfortunately he had pancreatic inflammation related to the drug that was used . He decided that he did not want to see anybody else , but me . I did try to send him to other university centers , but he refused. So I had no choice to give him steroids . This did help him to some extent , but he gained some weight and then had sleep apnea .  He continued to get worse over period of next 5 or more years and needed oxygen 24/7. He was young patient and so I wanted to send him for transplant evaluation , but he told me hr was too old and he feels that the transplants are for young adults and he did not want to take them away from some kid who would benefit from this better than he.To make the long story short , he dies about 6 or 7 years after I started seeing him .

      Fast forward to 2016. I saw this lady in my office for the chronic cough and her last name was same as this patient . The name is German  and I had difficult time pronouncing it . So I remembered it quite well . I had seen her when he was sick , but most of the follow up he had come alone as they had mentally challenged son. So when I saw her I knew that she must be his wife , even though there was a gap of 4 years or so . So I did work up on her and she had fibrosis . She also had scleroderma and she had classical finding of the scleroderma .She had circulation issues , she had very bad esophagues and had some aspiration and many other things that are seen in scleroderma. I sent her to a different rheumatologist and she is very happy with her , She has not progressed as far as her fibrosis is concerned and she is stable.

           So this is what I call coincidence. The husband and the wife , who are not genetically related had similar or same diagnosis, which is other than diet or smoking related and has nothing to do environment.  

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