Sunday, July 12, 2020


    I often see patients with abnormal CT scan or chest x- ray. I had written an article  titled Darwin,Mouse and Me . The article was related to the Theory of evolution proposed and accepted by scientific community  and how it is supported by genetics that we know today and was not known or thought about when Darwin proposed it . But I had some objections about as to WHY did evolution happened . So I stated certain genes  and mutation that happens in them which explained some of the diseases. But this mutation does not support the theory of Survival of Fittest  and Procreation as the causes given by Darwin . The mutation that causes the host to die soon like breast cancer gene BRCA1 and BRCA2 .So why would this mutation occur? I had suggested Law Of Karma as the possible explanation. The editor of the magazine that did published it had a question as to could be due to certain toxins that we get exposed to it. So the toxins do play the role in development of cancer  and now a days we are inundated with commercial by many layers on Talc exposure , Round up exposure , Zantac  and many other things that may have contributed to development of cancer. But why only some get it and not all develop cancer ?But that is not the point of the discussion. But this brings me to today's story.
    I saw this 72 years old male patient who had smoked 2 PPD for many years.He had some cough and some shortness of breath. He had chest X- ray done by PCP  and it was abnormal  and so he had CT scan and that showed a mass. So he was sent to me.He has been smoking  and also drinking 5-6 drinks a day He had clear lungs  and I told him the possibility of the cancer and the work up. We talked about the PET SCAN  and the biopsy and that included either bronchoscopy or needle biopsy or even open biopsy.He was not very agreeable. He was not very happy  and did not want too many tests.His concern was radiation exposure that according to him can cause cancer. I told him that radiation for chest x- ray is very low  and even CT scan has more radiation exposure but it is much less than the dose used to treat cancer. After discussion he agreed for PET SCAN  and that was positive and that did suggest high possibility of cancer. He was smoker and had a PET positive mass and so the chance of cancer was high. He did not want any more tests  and so after the discussion we decided to do new scan in 3-4 months He did not want it that soon  and so we agreed to do it in 5 months . He had new CT scan in 5 months  and to my surprised the mass had not grown but was slightly smaller.So he did not want to do anything . I told him that he still has possibility of cancer and biopsy was indicated to confirm or rule it out .He did not want it. He was more concerned about the radiation and that causing the cancer. He had not cut down on smoking or drinking alcohol. He was firm about not doing more CT scan. So we decided to do follow up in office in 6 months.
     He came back and he was feeling fine . I asked him on smoking and he had not reduced from 2 PPD  and no change in alcohol intake . He told me that he has smoked for more than 50 years  and it was very difficult . I asked him that is 50 years of smoking was not enough? After the talk he agreed to do the CT scan  and the CT scan was done  and to my surprise the CT scan showed significant reduction in the mass. He was happy . He did not come for follow up  and then after a year he came for the follow up .He was still smoking and drinking and had not worsened  and did not want CT scan  and still worried abut the radiation causing cancer and not worried about smoking causing cancer or drinking alcohol and it's side effects on body .
   He did not have cancer - at least as off today .

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