I have often used this term and many other use it too. The vicious circle could be in any form. When one likes a particular food - say ice cream, we eat it and we like it and we love it . So there is an impression after eating ice cream and then when we are hungry or even when I am nor hungry, but see ice cream, we want to eat it and that leads to action and that again leads to impression and hat again leads to action.This is vicious circle . But the one that I am talking about today is different one and we do see it sometimes in medical life. We have seen patients that get in trouble with certain actions and then get in trouble and then get better and get better and they do the same action and then the circle continues.
This brings me to today's patient. I have known this patient for many years . She has been smoker and she was a nurse . She had diagnosis of COPD and she continued to smoke . She also had arthritis and she was on pain medications. She had stopped working and she was in hospital few times I saw her few times and she was treated and discharged . She was not regular in doing office follow up, but she was in hospital in between and so I continued to do the follow up. She continued to smoke.
One time she was admitted and she had pneumonia and she had significant cough and bronchospasm and she was not getting better and she could not cough up the secretions well. So I did the bronchoscopy . I saw something in the bronchial tubes and thought that she may have aspirated part of her bridge form partial dentures. But trying to take out was difficult as she had problem with oxygen saturation and also she had significant bronchospasm. I called a surgeon and he did do bronchoscopy with anesthesia, so the respiration could be supported and he found out that she had beckon pieces on lung. She got better and I did swallow study and she ha some problem and she had some arthritis in neck and that may have caused the problem . The speech therapist told her to see ENT doctor and then she was discharged .Next few years she continued to smoke and was readmitted several times and was treated . I had a suspicion that she was having problems due to her continuation of smoking and also respiratory infection and may be aspiration. I did few swallow studies and she had some abnormality and the speech therapist and they felt that she had abnormality and not bad to do much . My feeling was that she may do OK and then when she would aspirate that would cause chemical bronchitis.That would cause problem with COPD and with recurrent problem she had more secretions and then needed more medications . This caused more damage .But she would not follow up in office and would not do nay precautions for aspiration .
Then she was admitted again and she did better and was to be discharged and she did not have a place to go and so she was waiting in hospital. And then she had worsening of COPD. and so I was called and i knew what had happened She had aspirated !! I did the treatment and also the CT scan and that did confirm that she had aspirated and developed pneumonia when she was in hospital and the new swallow study did show aspiration. She was told by speech therapist to do certain precautions - not to drink liquids . She did not follow them . I used to see soda in her room and soft drink cans and she was drinking them . NO PRECAUTIONS . She improved and went to rehab . But I am quite sure that she will be back in hospital as she continues to smoke and has aspiration and does not follow precautions. This is the vicious circle that I was talking about .
This brings me to today's patient. I have known this patient for many years . She has been smoker and she was a nurse . She had diagnosis of COPD and she continued to smoke . She also had arthritis and she was on pain medications. She had stopped working and she was in hospital few times I saw her few times and she was treated and discharged . She was not regular in doing office follow up, but she was in hospital in between and so I continued to do the follow up. She continued to smoke.
One time she was admitted and she had pneumonia and she had significant cough and bronchospasm and she was not getting better and she could not cough up the secretions well. So I did the bronchoscopy . I saw something in the bronchial tubes and thought that she may have aspirated part of her bridge form partial dentures. But trying to take out was difficult as she had problem with oxygen saturation and also she had significant bronchospasm. I called a surgeon and he did do bronchoscopy with anesthesia, so the respiration could be supported and he found out that she had beckon pieces on lung. She got better and I did swallow study and she ha some problem and she had some arthritis in neck and that may have caused the problem . The speech therapist told her to see ENT doctor and then she was discharged .Next few years she continued to smoke and was readmitted several times and was treated . I had a suspicion that she was having problems due to her continuation of smoking and also respiratory infection and may be aspiration. I did few swallow studies and she had some abnormality and the speech therapist and they felt that she had abnormality and not bad to do much . My feeling was that she may do OK and then when she would aspirate that would cause chemical bronchitis.That would cause problem with COPD and with recurrent problem she had more secretions and then needed more medications . This caused more damage .But she would not follow up in office and would not do nay precautions for aspiration .
Then she was admitted again and she did better and was to be discharged and she did not have a place to go and so she was waiting in hospital. And then she had worsening of COPD. and so I was called and i knew what had happened She had aspirated !! I did the treatment and also the CT scan and that did confirm that she had aspirated and developed pneumonia when she was in hospital and the new swallow study did show aspiration. She was told by speech therapist to do certain precautions - not to drink liquids . She did not follow them . I used to see soda in her room and soft drink cans and she was drinking them . NO PRECAUTIONS . She improved and went to rehab . But I am quite sure that she will be back in hospital as she continues to smoke and has aspiration and does not follow precautions. This is the vicious circle that I was talking about .
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