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 .

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