Sunday, January 27, 2019


     As a child we used to read a book called ISAP NEETY , Isap was a slave and he could talk to or communicate with animals . There used to be a another book called PNACHTANTRA . In that book also there were short stories and the animals could talk . Every story in these books had some moral to be concluded and that was stated at the end of the story . In one of the story there was lady who had a mongoose. That was her pet . She also had a infant child.She had to go out of the house to get some water from the well.The child was sleeping and so she decided to go out in back yard to fetch some water. It took her some time to come back.When she came back she saw the mongoose at the door of the room with blood on it's face . She concluded that the mongoose attacked the child when she was out. She threw the water pot at the mongoose which almost killed the mongoose. She ran in the room where the child was sleeping sound and there was  a dead snake next  to the child . So when she was out , snake came in the room and the mongoose saw the snake  and attacked the snake  and killed it . So the mongoose killed the snake  and not the child . But the lady jumped to conclusion. This is not uncommon for all of us . We JUMP to conclusion without having checked all the information. That brings me to story for today .
       I saw this hospital as second opinion He was 74 years old male who was primarily followed by VA.He was a smoker and inspite of diagnosis of COPD , he had continued to smoke.He also had coronary artery disease and had 5 stents. He also had circulation problem and had shortness of breath on walking 50 feet or less. His breathing test had shown severe compromise and the flow rate was 22%only. He was in hospital  and had CT scan done . The CT scan showed a nodule. The lung specialist that was called saw the patient and wanted to do Bronchoscopy . The patient was short of breath and the nodule was too small to have adequate sampling with regular bronchoscopy. So there is a relatively new technique called navigational bronchoscopy .The computer with help of CT scan 'guides' - navigates- to get to the small nodules that are not seen with the scope. In my experience , this needs anesthesia  and is not greatly successful in getting sample or diagnosis unless one is expert in doing it . The patient refused the procedure and so I was called in to see him . HE was obese patient  and had smoked and was fairly well aware of his medical problems. His fear of the procedure was that with anesthesia, he may end up on respirator and then will have difficult time to get off it .And in my opinion he was right.In addition to that he had 3 CT scans at VA and  he knew the results  and he thought that he had nodule in the past . Not only he was aware of the CT scan findings , but he had 'access' to the reports . I told him to pull up the reports in the computer and he was right . HE DID HAVE NODULE REPORTED - SAME AS WAS IN THE CT SCAN THAT WAS REPORTED IN NEW CT SCAN! So with his advanced lung disease, the nodule being there before I suggested to do follow up on the CT scan in 3 months and then consider PET scan . He was not a candidate for open biopsy  and the newer Radiation technique for smaller nodules is only 5 sessions and it has great cure rate. So if indeed he has cancer one could confirm the likelihood of it being cancer -nor 100% and no tissue type known - by PET scan and treat it .
     Just because there was a nodule does not mean cancer especially if he had it for a while . I agree that this still could be cancer but the diagnostic test should not cause more problems . So jumping to do a test was premature  and just like that lady was hasty in concluding that the mongoose hurt her child. 

No comments:

Post a Comment