Saturday, May 7, 2022

MIND OVER MATTER

     In past I have stated that 'The eyes does not see what Mind does not sees' have seen several examples of this statement when I take care of patient. It may be memory problems which are not picked up by patients or their families to the doctors or nurses not seeing what is in front of them as their mind did not think. I had mentioned of patients that was sleeping  and the family sitting around  and thinking that she is doing 'fine' and the nurse also thinking gthe same and also the doctor who saw her .Then when I ordered the blood oxygen - carbon dioxide to know that she was in serious trouble due to elevated CO2 which acts as sedative. I THOUGHT OF ELEVEATED COO2 in this patient with poor lung capacity and so I COULD SEE it . But somehow others did not THINK OF it and so they did not SEE it. The story that I want to tell you is similar .

     I saw this young man who had seen other doctors  and had come to see me as second opinion. He has been having shortness of breath for almost one year and he complained about it to his PCP. He was non smoker and he did not seem to have any cough or wheezes . He had no chest pain and this had creeped up over period of time . So the PCP sent him to a cardiologist . The cardiologist with his blinders did the cardiac work up. He did the tests to rule out cardiac issues as the cause of shortness of breath, He had Echocardiogram  and stress test. He was seen  and then after the tests he was not called with reports  and as expected he thought that the tests were OK. He had follow up 3 months after the first visit with the cardiologist. When he saw the cardiologist, the cardiologist went over the tests  and realized that his pulmonary artery pressure was elevated. Let me explain this medical thing. The blood from which the oxygen has been taken out  and retuned through veins to right side of the heart . The Right side of the heart called Right Ventricle pumps it to the lungs where it gets the oxygen and then it goes to Left Side of the heart . The Left side chamber called Left Ventricle pumps to body . So we have 2 circuits -one right side of heart to Lungs and other Left side pumping to body . The blood pressure that we measure  is the pressure that left ventricle generates when it pumps to body but the Right side pressures  cannot be checked without doin g Echocardiogram. The normal blood pressure is 120 to 140  and the normal Right side pressure is 25. So his pressure on right side was 60 . This is called PULMONARY HYPERTENSION. 

      I am not talking about the diagnosis of pulmonary hypertension and the work and the treatment, but I wanted to point out that the cardiologist who saw him first time and did the work up had also read the echocardiogram which had shown elevated pulmonary pressure . But the elevated pressure was SEEN and the REPORT was dictated by the same cardiologist . So why was that not noted at the time of report generation ? The answer is YOUR EYES DON'T SEE WHAT YOUR MIND DOES NOT THINK !!


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