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. 

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