Saturday, December 22, 2018


    I have known that EVERYONE understand the money, from small child to old adult. When I tell patients about why they are short of breath, I tell them to think about the income . I tell them that if the income is reduce then they will be short of money. ( may be other than millionaires ). If the income reduced to less than half, then they will be very short of money to a point that they will have to cut down on many usual activities like eating out in fancy restaurants or going to a movies etc. So if the lung capacity is reduced they will be short of breath . I have not had any one ask me to explain after this talk . But we often complain about cost of many things -we say that health care is expensive or we are spending too much for defence budget. I do agree . This month when we were looking at the policies for individual health care policy , there is only one insurance company in State of Florida which does offer . The cost for $3759 deductible policy was $1700 per month , That is is even with no health problem . So that is outrageous . May be because we are paying for 'others' as they may have pre-existing condition . So we do not think too deep as to the cause of the high health care cost or cost of medicines . The same is true for defence. Majority of the cost for defence is personal and not weapons . This hit home as we just signed for new health insurance for year 2019 , but also I came across a patient .

      So I saw this patient few months ago . She is 68 years old and has had many problems like seizures after a brain surgery and had asthma and diabetes . I saw her as she came with pneumonia. She had pneumonia in right upper lobe . The pneumonia occurs in most cases when we inhale or aspirate bacteria  and it is common in lower lobes . The TB is more common in upper lobes . She was comfortable and did not have fever and had minimal sputum . We did CT scan and that showed that she had a mass in the right center and that was pressing on blood vessels and the bronchus in that area ,So I did a bronchoscopy and she had a tumour  and that was blocking the right upper lobe bronchus and so she had pneumonia , The biopsy showed that it was a CARCINOID . The carcinoid is a tumour that some call it BENIGN tumour that can SPREAD or some call it MALIGNANT tumour that grows very slowly -even sometimes it takes years . I called radiation doctor and cancer doctor . I wanted radiation treatment as this lady also had liver problem and some other issues and I was not very keen on chemotherapy. The oncologist wanted additional biopsy  and so we did it  and it did not change the diagnosis . ( The carcinoid could look like small cell cancer of the lung  and the treatment would have been different if it was small cell cancer).So she was discharged and started on chemo .
      She was readmitted with elevated blood sugar and number of other problems after chemotherapy . She was in ICU and then did well and was transferred out of ICU. She was weak and so physical therapy was started . She was doing good except for the need for the PT . So we asked her to be transferred to rehab unit for 2-3 weeks, Every thing was approved , but she continued to be in hospital . I was not sure as to the hold up . Her lungs were clear and she was not on oxygen and she had no shortness of breath and all the intravenous medicines were stopped and her kidney function , blood count and blood pressure were OK. So I was not sure . I contacted the case management  and the answer I git was what made me write this one . The rehab unit gets paid certain amount which includes the cost of the drugs /medicines. She was getting chemotherapy - one daily  and one every so often . The cost of only one of the drugs that was given daily was -are you ready - $17000!The rehab unit was not going to get any money to do the rehab and her stay if they paid the chemotherapy cost . So they refused to accept her . So SHE IS KEPT IN HOSPITAL FOR 5 DAYS  and the cost of the health care continues to rise .
    (I suggested to hold the chemo for 2 weeks if the oncologist and the patient will agree as i do not think it will alter the outcome in this patient with carcinoid that I am sure has been there for last few months if not years )

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