Saturday, April 14, 2018


     I am against the price control in many situations . Th feeling that  'whatever market bears 'is the price was my opinion . But more I look at life , I think some regulations are required to avoid exploitation. I had a dog many years ago . One day when I returned home from going to beach on Friday and Saturday, he could not walk . I had to do something . So I called a veterinary doctor that I knew . He has seen me and come to my house and I have gone to his place may be once a that time . He agreed to see my dog . He did X-ray and did give him a steroid shot ( which I thought was only thing that was needed ) , He also did Give me some shampoo and some steroids pills . My bill was $467. I was shocked as I knew the cost of the medicines and the cost of X- ray . I did not say anything nor did I ever took my dog to him again. He did tell me that people are willing to spend lot of money on their pets than on their kids . When in next year or so my dog needed back surgery , I had another shock . This time I was told as to how much each test would cost .Again my shock was that the doctor charged me for disposing of the needle too ! Having a pet is by 'choice and so may be if one does not want to spend money, he should not have pet . But that brings me to my today's story.

       I saw this 63 years old male . He had some cough and had bad bronchitis . He was in hospital and I saw him and treated him and as 'usual' he had CT scan in ER. It showed a nodule as small as 9 mm or so . He had quit smoking more than 20 years ago , so for the practical purpose he was non smoker -after 14 years of quitting smoking, the incidence of lung cancer is same in  ex smoker as in nonsmoker . Taking in to account the age and the size of the nodule I decided to do the follow up n the CT scan . The new CT scan showed increase in the nodule -almost double. So I did a PET SCAN .
    The PET scan did show uptake in the nodule suggesting that it was likely to be cancer . I did do a bronch and then saw in office . The bronchoscopy did not show any lesion and the cytology -pap smear of the lung was negative . But the size of the nodule was so small that I had not expected it to be positive . So now I talked to him and the wife . He had good lung capacity and he would have tolerated the resection of the nodule .So my first choice was to send him to a surgeon and then have do the surgery. Now a days robotic surgery is done , which has very small incision and the recovery is very quick. The other choice was to do needle biopsy and then if positive consider either resection by surgeon or do Steriotactic Radiation. This relatively new technique. This is used for nodules -- cancerous nodules that are less than 2.5 cm or inch . The radiation is given in higher than usual dose and it is more precise and only 5 treatments ts or sessions are needed . Some times this can be done in patients who are very high risk for open biopsy or resection due to poor lung capacity or age or other conditions like heart problem etc . The good news is that this treatment is almost as effective as resection . Some times we can do this without having  definite diagnosis of cancer . 

    I spoke to him and his wife and wanted to send him to surgeon . So I was shocked when he told me he would prefer either doing nothing and watching it --which I was against or seeing radiation doctor.. I was talking to him and he told me that 'Doc I have spent $46000 for getting new teeth and I want to use them !'So this 83 years old patine had to spent that much money more than an average cost of new car - to get new teeth.



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