Saturday, April 17, 2021


     Since last March 2020, we have been indebted with information on COVID 19  and we still are learning. Last year when I was checking out there were atleast 15 different medications that were tried or given or had some 'promise' and as off today we have very few. Most of the medicines have been proved to be not very successful. But at many places people are still being treated with some of these medicines. Vitamin C and vitamin D are some of them. So some one asked me a question ,Can a fully vaccinated person transmit the virus? And I came across the answer  and may be a proof of the information. 

    I saw this male patient . I had seen him 3 years ago and he was a smoker and had COPD - smoking related lung disease. He had work up and when I did CT scan I found out that he had a kidney mass . I did further work up and send him to  urologist. He had surgery and it was kidney cancer. He did OK and came to see me once and then did not do follow up.After 3 years he came to me as he had abnormal CT scan of the chest. He had COVId infection  in a month  and then he was fine  and on march 1st he had his first shot of the vaccine. He had no major problem but he had chest x- ray as he has had some cough later on . The chest X- ray showed some abnormality and so he had CT scan of the chest . The CT scan showed  a mass or pneumonia. There were 2 spots and so he was sent to me . He has been smoker and had COPD. We decided to do the work up . He had CT scan and at the same time he had second test done for COVID 19.  and that was positive. He had no problems and he wanted to go back to work.So he did another COVID test  and that was negative. This was done in 6 or 7 days after the positive test . He also had his second dose of vaccine  and did very well and had no reaction to it . So this tells me that one could get infection even after having vccine . But patient may have no symptoms  and the course seems to be limited as he was negative in less than 7 days . 

   Then I came across the data from CDC  and also some srtcle from British Medical Journal.They had 5800 cases among 77 millions vaccinated  and some were admitted  and some died.But  that should not surprise anyone . The vaccine is not 100% successful like any other vaccine . I also saw another study  on antibody titre in patients who had solid organ transplants and who were on immunosupressants. Only 17 % patients had antibody titer. So I am sure when antibody titers will be done in patients who had vaccine and got infected, we may get the answer . May be the antibody titers may not be high or adequate in atleast the patients who needed to be hospitalised . But we don't know that yet..

Sunday, April 4, 2021


    I had a call from a physician asking me to see him as he wanted to do CT scan of the chest due to so called new recommendation on doing low dose radiation CT scan to diagnose cancer of lung . Several years ago we started doing CT scan of chest in current smokers and Ex smokers for 14 years to diagnose cancer of lung early . There was new article  and some added changes but overall it is about the same . But since it appeared  in Newspaper, he wanted to get it done . He had quit smoking 30 years ago and he would not fall in to the recommended patients that would qualify for the CT scan.But that brings me to the story for today. 

    I had seen this patient for last 3-4 years .She is 74 years old female who had smoked for many years and had quit several years - 18 years ago. She had bad emphysema and needed oxygen  and had not much of wheezing. She had shortness of breath and I had done CT scans  and she had some small nodule . We followed the CT scan for 3 years and there was no change in tiny nodules and the radiologist felt that it was benign.The last scan was 8 or 9 months ago and  I had plan to do yearly scan.She saw me  and had pain in belly and so I told her to see Gastroenterologist and also to talk to primary care physician. I told her to take antacid and also ordered a chest X- ray . The chest X- ray was reported as normal. She continued to have pain and the gastroenterologist could not see her for 4 weeks or more  and so when she still had pain ,she went to walk in clinic and they did CT SCAN of chest and also belly. The Ct scan of belly showed masses in liver  and the lungs had nodules that we had seen  and also had some lymph node enlargement . She was admitted  and then we did further work up . We did the PET SCAN  and that showed that the liver spots were hot and the lung nodules were warm not very hot . There was some uptake in lymph nodes in chest but again not very high . So we did the liver biopsy. The biopsy showed lung cancer that has spread to liver.

      I had done chest X- ray done less that 3 weeks before the CT scan  and that had shown nothing to suggest cancer. The PET scan also did not show very high activity in nodules  and also the size was increased,but not very much from the CT scan that was done 9 months ago. So where did the cancer arise  and why we did not see large tumor in lungs  and why the liver mass was 3 or 4 times the size of the nodule in lung where the cancer started  and lastly why was the chest X- ray unable to give even hint of anything happening. 

    And that is why my question - How often (doing a CT scan) is enough . The recommendations are to do once a year  and that would not  and did not catch the cancer early!