Saturday, June 1, 2019


      The question that I raised or we have heard in past as a joke.But sometimes in practical life we see the similarity. There is also saying that 'it was so simple that anybody could have done it but no one did it as everybody thought that some one will do it" I am not sure if that is due to procrastination.May be it is due to being lazy. What ever may be the cause, we see this quite often. Look at doing year end taxes. Ever year we see TV station showing the crowd at post office t 11th hour of April 15th. So why do people wait? But I am going to tell a story where I am not sure what is the cause of the passing the bug - may be ignorance , may be something else.
       I have seen this patient for a while . He had shortness of breath and some cough .So we did work up and found out that he also had sleep apnea and also he had low oxygen . He was also diabetic  and he also had some cardiac problems  and he had pacemaker put in..So he was followed by cardiologist. I did start him on a new medication for the fibrosis or scar tissue in lungs  and also on oxygen. He needed treatment with pressurized mask for sleep apnea ,but he did not like it. So one day he was in my office for the follow up. He was doing OK and I was not going to change any medicines . We did talk about retrying the the mask for sleep apnea.I was about to done and when I did look up at him, he was going to fall - he passed out . I put him on floor  and had my secretary call 911.He had pulse  and also oxygen was OK. The paramedic came in and his blood sugar was little low  and he woke up and was taken to ER.I was not called in and when I checked it he was doing OK  and was seen by cardiologist and he was discharged in 2 days . He was doing good .
     He came for the follow up in 3 months  and he was OK .I wanted to do new CT scan to check on his fibrosis. So I had my office schedule it . He was sitting in the chair and my secretary was talking to him and he rolled his eyes  and passed out . She called me  and we called 911 and i forced coke as much as he could take as he was diabetic  and I thought that he may have low blood sugar. He was taken to ER  and was admitted like last time  and I was not called . He was again seen by cardiologist and then discharged in 4 days. No CT scan was done. So I did CT scan and his fibrosis was stable .
    He had elevated PSA  and was told to have prostate cancer and was sent to Radiation doctor to treat the cancer. While in the office he again passed out and was admitted to hospital.I WAS CALLED THIS TIME - I am not sure why as his lung condition was stable. Again he was seen by cardiologist  and was told that he will need something called LOOP RECORDER ,to see if he had some irregularity of heart. I reviewed the old record.He had 2 echo cardiogram during previous hospitalization. IT HAD SHOWN THAT HE HAD defect in septum which separate the upper chambers of the heart. That had caused for the blood to go from left side where the pressure is higher to right side where the pressure is low . This leads to elevated pressure on right side  and less blood going to body . This can lead to the episodes of black out spells. I talked to him and called his regular cardiologist  and asked him if he could do the further work up and the treatment as the one that was seeing him was going to do the monitoring, which would not add or diagnose the problem, He agreed .    The patient was sent to a third cardiologist - pediatric cardiologist - as such defects are common in children and they are better at  diagnosing. So this third cardiologist did part of the cardiac catheterizing and called a 4th cardiologist to do additional procedure to make sure that he did not have blockage in coronary arteries . The diagnosis that was made in last 2 ultrasound of heart was confirmed . The hole in the chambers was there  and the blood flow was going from left to right side -normally there should none  and no mixing should happen-was confirmed.So now he was sent to 5th cardiologist to see what could be done . I was not sent any report. I was talking to patient to get update  and knew about the procedures that were done . I do treat elevated pressure on right side circuit of the heart to lung  and none of these cardiologist can 'FIX' the hole  and he will need heart surgeon to fix it.
     So it took 5 cardiologist to diagnose the problem!

1 comment:

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