Sunday, July 14, 2019


      I am a firm believer in GOD and also in medicines . Sometimes these 2 things seem to have cross roads. I do believe in chance  and also in probability. If I see someone with stage 4 lung cancer , there is high chance that the survival is limited .But I also know that there are patients who will beat all the odds-in both direction.This is the bell shape curve. Majority of the patient fall in the middle and some will die much sooner  and some will survive more than expected . But that does not mean medicine is wrong. We also see Faith being invoked when the disease is bad and these are the same people that may not have done prayer outside church or may not have helped someone in need. But what I wanted to say that just because one has firm faith does not mean one can neglect medical advice or medical odds.This brings me to today's story.
      I  had seen this 70 plus years old patient in office for cough. She was nonsmoker  and also did not drink alcohol. She had no major medical issues that just high blood pressure and that was well controlled .She had cough and she also had some shortness of breath.I did the work up and the breathing test did show some obstruction and so she did have some element of asthma. I also noticed that the oxygen transfer factor - called diffusion capacity as oxygen is transferred across the lungs in to blood, was reduced . Her chest X- ray had shown some 'chronic changes' . With her cough and shortness of breath and also the lower diffusion capacity, I decided to do high resolution CT scan of the chest .I was concerned that she may have scars or fibrosis in lungs . The CT scan did show fibrosis . I explained it to her that she has both asthma  and fibrosis. I also told her that the fibrosis could get worse  and she will be more short of breath. There were new medicines out  and if she has some worsening in next 3-6 months we could consider the medicines . The medicines were expensive though covered by insurance . The cost would be $30000 per year. But insurance covered the cost. She was followed by me for about 9-10 months  and she was stable . Then she stopped coming . Clinically she was stable. The cough was there but the shortness of breath was better and when I mentioned on medicines , she refused them and told me that the GOD will HEAL. Certainly she was not worse  and she was not interested in medicines or the oxygen use which she needed at night .
       I did not see her for long tome  and may be a year down the road she was hospitalizes .She was short of breath and had very small blood clot in lungs . She needed oxygen and then she was started on blood thinners . I told her that she has not done follow up. The fibrosis appear to be same. She was sent home  and then she came to my office for determining the need for portable oxygen . Her oxygen was very low  and I called her primary doctor  and told him that she needed oxygen ASAP. and I was sending her to hospital ER.I needed STAT CT scan to make sure there was no worsening of the clot . The out side radiology facilities sometimes can not accommodate such emergency and I was worried that if she needed more treatment , she will have to be in hospital. With HMO insurance I have to get everything approved from PCP. She had scars  and the clot was smaller and she was sent home. I was under the impression that she was started on oxygen . She was not . She came to my office next week  and was doing much better The oxygen was better and she was not as short of breath as she was when I had seen her a week ago. She did not have oxygen and she felt she will not need as the GOD will heal, Same thing that she had told me when I had mentioned newer medicines for fibrosis. I scheduled for a walk test where we walk patient for 6 minutes  and monitor oxygen and  decide if they need oxygen and how much. She needed oxygen  and I again talked to her on getting or considering the new medicines for fibrosis. When we talk about use of oxygen , her statement was same -I am fine  and the Lord will heal me.
       Certainly over course of last 2 years or so she has had some ups  and down  and certainly the GOD can heal. But one has to take responsibility and also have to DO efforts to get better . One can not expect high blood pressure or diabetes or pneumonia to be cured without taking medicines  and just praying. Prayers have a role  and it more in some cases  and less in others . But as human beings GOD wants us to do efforts on our part and then he will do HIS part .

Sunday, July 7, 2019


     We all have gone through life sometimes feeling that we could change certain things . When we were younger and did not get that A grade we thought we could have done something something and could have changed the grade - may be done more study or behaved better or something else . When we lost a tennis match , we felt we could have handled a serve better or done more practice. At that particular moment, we field the desperation and feel that our life is changed for ever with that one change or decision. But then when we look back at it after several years , these incidences have not made any major impact on our future life . I see the same thing sometimes in my patients . That brings me to today's story.
     I saw this patient in my office by chance.It was Friday and  I had a text from one my friends, who is a cardiologist that there was a patient who was short of breath and if I could see him soon. I normally do  not see patients in the afternoon on Friday .But I told him that I could make an exception and see him on same day- the Friday.So I told my office to call the patient and saw him at 2 pm. I am in the office on Friday but do not have scheduled patients, He came in . He was a 76 years old male who had acute bronchitis  and he was coughing and has wheezes. He was also short of breath.He came with his wife . He has been smoker in past and had quit may be 1-2 years ago and has had shortness of breath before . But after quitting smoking he had improved  and he did not need any medicines  and he had not been on any inhalers . He did not have any pulmonary function test in past or had any chest X- ray in recent past. I examined him and he had had significant bronchospasm and he was short of breath. He also had very low oxygen saturation on examination. So he needed a chest X- ray , a breathing test , oxygen  and antibiotics  and steroids . He also was going to need medications to be given by nebuliser to help the wheezes. I thought that it would be better if he is in the hospital. He was quite stubborn and did  not want to be admitted.So I called in prescriptions  and also told him to do chest X- ray ASAP as I would have changed my plan if he had pneumonia. I told him to call me or go to ER if he felt more short of breath. I also called a company to provide oxygen at home .
       The radiologist called me with the report that his chest X- ray showed a mass . I  had to call him with the news  as that meant that he may have cancer . I called him and told him of the findings  and told him that we will do CT scan soon .
    He had a CT scan and that did show a  mass.He had improved  and he was had been on steroids  and also nebulizer treatments  and also other inhalers and he was not short of breath. We did breathing test and I wanted to do bronchoscopy. He was not sure  and postponed the tests couple of times . The CT scan did show the mass and so I did PET scan and that also showed that the mass did pick up suggesting 90% chance of cancer .His breathing test showed that he had significant reduction in pulmonary reserve. I had extensive discussion done with him on several occasions,The options of therapy for the lung cancer is surgery or chemo or radiation. Due to poor breathing capacity he was not a candidate for the surgery. But he did not want me to do the biopsy and and wanted to see surgeon. So I sent him to one . The surgeon told him that he could not have surgery as the surgery and the resection of the part of the lung would leave him with need for respirator. . He decided to see another surgeon for the opinion . The opinion was again the same. Every time he had done something he would walk in my office  and wanted to talk to me  and I did for short time. I also told him to see radiation doctor . The mass was not very large and short course of radiation would have achieved the 'cure' in many patients . But he was bent on having surgery.
     One of the surgeon did biopsy of lymph node - I am not sure what that would achieve  and that was negative for the cancer.,He did have needle biopsy  and then when cancer was confirmed he did have radiation .He has continued to come to me  and he has clear lungs  and he has not been using any inhalers and nebulizers . He feels fine  and after almost a year of the treatment , he has no evidence of cancer .

  So it was very important for him to have surgery and he wasted time , money and also had some surgery that did not change much  and it did not change anything in his life -at least for 1 year so far. 

Friday, July 5, 2019


     I have started a YOU TUBE CHANNEL  to talk about various things . I will be adding one short video at least every week .
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Check it out under JUST-A-TALK .
I will continue to do the blog too .