Sunday, May 16, 2021


    We have seen COVID infection for more than 1 year and I have seen may share of the disease. I do not have vast experience ,but I have seen different presentation and severity  and it is not actual 'changing ' face but it is just the variation in presentation. All the statistics does down the drain when you see theses kind of variation. So the so called 'risk factors' are valid for majority of patients but one can not hold them as 'Gospel truth'.In 2020 earlier part of the disease I saw a 91 years old African American women who had not left her home  and had significant hear problem ,hypertension and had possible heart failure  and may be pneumonia admitted . She was to be discharge to a extended care facility  and so at the time of discharge we did COVID test and to my surprise and horror it came positive.She did not have fever, she had no oxygen issues  and she did not have much cough or upper respiratory symptoms and she also was never exposed to crowd. So how did she acquire it or why she was asymptomatic  and lastly in spite of all the risk factors,she had no problem with 'recovery'? (she was never sick so not sure there was any need for recovery) That brings to me the patient story for today. 

    I saw this 74 years old male patient several years ago. He came to me for cough. He had seen primary care physician and also then allergist and he has had work up. He had allergies and was treated  and then he came to me as the cough continued . I did the work up and he had pulmonary fibrosis - scars tissues in lungs and so he had cough . I told him that we will do work up to find any etiology for the scar tissues and that was done and we did not fond any. So we decided to do follow up and in case the fibrosis gets worse we will star the treatment . I followed him for more than 2 years and the CT SCAN and the breathing tests were OK and did not show any deterioration. He stopped coming  and then after a gap of many months to a year he came to see me and he had some shortness of breath in addition to cough. The cough was also worse. So I did the same tests and nor=ted that on breathing test he was worse . So we started him on treatment with relatively new drug . He was doing OK but continued to have cough and even though I had told him that the cough will continue and not much could be done for it other than giving cough medicines , he was frustrated . He was teaching i one of the centers and the cough was bothersome . So he had called me many times  and I did add some different cough medicines  and at times tried steroids too. So one day he called me and he was having coughing spells and also had chest pressure . He was a older patient and had lung problem and so when he had chest pressure I told him to go to ER. I was concerned about things like heart or clot in lungs . He went to ER  and had CT scan done and that showed no clot. As routine goes he had COVID test done and that was positive. He had no fever and no upper respiratory symptoms. His oxygen saturation was fine  and he looked OK To my surprise, when I saw him in ER he had mask which was not covering nose  and was in hallway. We admitted him for observation only because he was OLD  and had LUNG DISEASE - the so called risk factors . I discharged him after 2 and half days when he had no new complaints . 

   So here is a older patient with high blood pressure , lung problem-all the risk factors for bad outcome   and was teaching  and had COVID and had no problem due to it. That is why we are not like automobile machine- same model and make but different response.

No comments:

Post a Comment