Saturday, May 4, 2019


     In medical practice sometimes I wonder as why I end up seeing some patients . I do not seem to have much contribution to their specific care and still sometimes I am asked to see them and then it seems that they want to come to ma for follow up. The only way I can explain this is by law of Karma. Something sometimes that we had in past that brings them to me . I will tell you about one such patient .
      I saw this 76 years old male in my office . Due to language barrier he was accompanied by 3 other family members. Sometimes in medical office where the exam rooms are small, this is overwhelming . It also takes longer time to get to the real story. But here the family was well versed  with his medical problems and had the reports with them too. They were genuinely concerned. He was admitted with bleeding from the stomach , which turned out to be due to ulcer and then the work up was done . He was a smoker and heavy alcohol uses  and had liver disease due to excessive alcohol intake . The routine chest X- ray showed that he had spot on the lung and so a biopsy was done  and it showed lung cancer . Due to some blood abnormality , further work up was done  and diagnosis of prostate cancer which had spread to bones was done . So to summarize, he had alcoholic lever disease  and lung cancer and prostate cancer . He had seen oncologist and chest surgeon. So I was not sure as my role . But as I always do I saw the patient and told them on the need for the breathing test to make sure that he had adequate lung capacity to cut out part of the lung containing the cancer as that seemed to be the plan . But when I examined the patient, he had an enlarged lymph node in neck.So I told them that the biopsy of that node was very important as if it had cancer cells, there was no reason to do the resection. If the cancer has spread then the surgery would be futile.We scheduled him for breathing test and then the follow up .
       I did not see him for may be 6 weeks or so  and then one day they came back.He had missed the appointment for the breathing test. I had received no reports or any communications from the primary care doctor or oncologist or the surgeon. But the family had the reports . I was not sure as to what was the reason for their follow up. So he had surgery and the diagnosis of the cancer was confirmed .One lymph node was positive for cancer and it was close to food pipe or esophagus.The lymph node was there and they did not do biopsy but he was sent to ENT throat doctor  and had diagnosis of cancer of the lung. So now he had 3 cancers and liver disease and lung disease due to smoking and the lung cancer had spread to lymph node . So the chance of recurrence was high . They had planned radiation lung and tongue  and then chemotherapy. The family and the patient has several questions for ME . This is in spite of seeing the oncologist and radiation doctor and multiple other doctors .
    I was not sure why they came to me ,but I explained them the radiation side effects to swallowing and also the side effects of the chemo . They were not aware of some of the side effects, So I TOLD THEM TO TALK TO THE ONCOLOGIST AND RADIATION DOCTORS  AND told them he may have difficulty with swallowing and may need feeding tube.

No comments:

Post a Comment