There is a saying that stitch in time saves none. If one does things in time then one does not have to worry about getting things worse. The saying is is related to clothes but it also applies to our every action and every decision that we make or action that we do . It may be diabetes and eating sugars or blood pressure and salt intake. . If we do not do action in time and the diabetes or blood pressure gets worse and has complications , then acting in right way will not help us as much as if we would have taken precautions early. I have seen this in many patients and that brings me to today.s patient.
I saw this patient who was 78 years old and had some dementia . He came with family and i could not figure out why he came to me . He had some abnormality , He was in hospital and he had pain the belly. He had CT scan of the belly done and that showed some abnormality in lung and so had CT scan of the chest done and that showed a very tiny nodule. He had seen primary care doctor and he sent him to me . He had also seen Gastroenterology and he was planning to do endoscopies . I had no reports and I got them and I was surprised He had very tiny nodule in lung but had a mass in pancreas and also in liver . The patient of the family did not know about it and they were surprised . I explained it to them that he seems to have cancer that seems to have spread to liver and may be lung . The endoscopies will not help but he needs diagnosis of cancer by biopsy and then we can decide as to the treatment . The Lung nodule was too small and there was no way anybody could do biopsy of the nodule. So I decided to do the PET scan to know the extent of the cancer and scheduled him to have biopsy of the Liver
He had the biopsy and that did confirm the diagnosis of cancer He had pancreatic cancer and the biopsy did show that liver spread was confirmed . I saw them in office and told them the diagnosis and the treatment options of chemo . I also told them on chemotherapy and the side effects and the 'prognosis' . I told them that the pancreatic cancer with spread to liver is not good news They decided to go ahead with chemo. I had told them to consider future choices and also the poor prognosis and DNR or Do Not Resuscitate status . Thew were not sure.
He was admitted in hospital and he had received chemo and the blood counts were low . He had some pain and that was due to enlarging Liver metastasis.He was given pain medications and that caused more confusion and I again talked to the familyb. I told them that in spite of treatment he was not doing well and the cancer had increased and they need to see the oncologist and see they could consider radiation which has less side effects and may be do no treatment ts .We also talked about the DNR .
He was discharge and then was readmitted and it happened . I had expected it. He had cardiac arrest and they did CPR and he had to be put on respirator and also had rib fractures and collapse of lung and had to have tube put in chest to re expand the lung. We had the discussion and they agrees after 3 days to make him partial DNR . Now the decision had to made to withdraw the machine - respirator . That was much more traumatic to his wife and sons . But once someone is on respirator , we can not withdraw without doing the forms for withdrawal of LIFE SUPPORTS .
THIS IS I CALL STITCH IN TIME . If they had made the decision in advanced for DNR, we would ot have gone through he suffering for patient - the tubes , rib fractures, chest tube and also the family to make the withdrawal decision . .
I saw this patient who was 78 years old and had some dementia . He came with family and i could not figure out why he came to me . He had some abnormality , He was in hospital and he had pain the belly. He had CT scan of the belly done and that showed some abnormality in lung and so had CT scan of the chest done and that showed a very tiny nodule. He had seen primary care doctor and he sent him to me . He had also seen Gastroenterology and he was planning to do endoscopies . I had no reports and I got them and I was surprised He had very tiny nodule in lung but had a mass in pancreas and also in liver . The patient of the family did not know about it and they were surprised . I explained it to them that he seems to have cancer that seems to have spread to liver and may be lung . The endoscopies will not help but he needs diagnosis of cancer by biopsy and then we can decide as to the treatment . The Lung nodule was too small and there was no way anybody could do biopsy of the nodule. So I decided to do the PET scan to know the extent of the cancer and scheduled him to have biopsy of the Liver
He had the biopsy and that did confirm the diagnosis of cancer He had pancreatic cancer and the biopsy did show that liver spread was confirmed . I saw them in office and told them the diagnosis and the treatment options of chemo . I also told them on chemotherapy and the side effects and the 'prognosis' . I told them that the pancreatic cancer with spread to liver is not good news They decided to go ahead with chemo. I had told them to consider future choices and also the poor prognosis and DNR or Do Not Resuscitate status . Thew were not sure.
He was admitted in hospital and he had received chemo and the blood counts were low . He had some pain and that was due to enlarging Liver metastasis.He was given pain medications and that caused more confusion and I again talked to the familyb. I told them that in spite of treatment he was not doing well and the cancer had increased and they need to see the oncologist and see they could consider radiation which has less side effects and may be do no treatment ts .We also talked about the DNR .
He was discharge and then was readmitted and it happened . I had expected it. He had cardiac arrest and they did CPR and he had to be put on respirator and also had rib fractures and collapse of lung and had to have tube put in chest to re expand the lung. We had the discussion and they agrees after 3 days to make him partial DNR . Now the decision had to made to withdraw the machine - respirator . That was much more traumatic to his wife and sons . But once someone is on respirator , we can not withdraw without doing the forms for withdrawal of LIFE SUPPORTS .
THIS IS I CALL STITCH IN TIME . If they had made the decision in advanced for DNR, we would ot have gone through he suffering for patient - the tubes , rib fractures, chest tube and also the family to make the withdrawal decision . .
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