Friday, February 2, 2018


     In medicine we have patients that do not behave as we expect --may be they have not read the medical text books! But after being in practice for long time ,I have realized that whenever there is 'interesting case ' , it is bad for the patient . In past I have seen patients that I thought had cancer and they did not have it -good for the patient and then when sometimes I thought it could not be cancer , it turned out to be cancer-bad for the patient. The case that I am about to tell is one where there is no diagnosis -at least for now .
     I saw this patient in office for some cough and shortness of the  breath . As usual we do some tests and he did have some asthma . The pulmonary function test confirmed it . The chest x- ray was OK and so I put him on medicines for the asthma and he did well . He came back for follow up and he was again having problem . So I saw him . He had some more cough and some sputum and had no fever. His lungs did not sound bad . But he was having problems and so i added some medicines and also gave  short course of the steroids . He called me to tell me that it had helped .

      He came back earlier. The steroids helped , but when he completed the course , he started having problem . He had no fever and not much cough . But he was short of breath and has some cough . The oxygen was little low . The lungs did not have any wheezing. I was concerned. I wanted to get him in hospital . He was reluctant and wanted to try steroids again . I  told him that I  wanted to do CT scan of the chest to make sure that he did not have the blood clots . He agreed . I ordered the CT scan stat. I got a call at 4 pm that he had larger fluid around the left lung and had some mass in pancreas. I called him and told him to come to ER ASAP. We admitted and then started work up . He had PET scan scheduled and I did tap the chest and took out 1200 ml fluid . He had biopsy of the pancreas and the blood tests done for the pancreatic cancer . The blood test came back normal and the fluid that I had drained out , did not show any cancer cells . The biopsy also did not show cancer .

   So now we have no diagnosis . He had larger fluid collection and we don't know the diagnosis . He had pancreatic mass and in spite of the biopsy we don't have the diagnosis . The next step would be to do 'open biopsy' either of pancreas or if the fluid collects , biopsy from inside lungs . The mystery of the medicine continues.   

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