Saturday, May 28, 2022

TO TREAT OR NOT TO TREAT

   In medicine we have many of us who are nonflexible. I f i check blood pressure on a patient and the recording is 150 / 95 , there is no question in my mind or for that matter in any physicians' mind as to treat or not treat. The high blood pressure must be treated ,we will treat it.If the blood sugar is high we treat it though it may depend upon age of the patient - but if the sugar is high, then we will treat it. Ig we see 80 years old person and fasting blood sugar is may be 110 we may not treat it but if the patient is 30 years old we will treat it . So there is some variation in treating diabetes . The same holds true in case of elevated lipids - cholesterol - though most of the cardiologist have lost the flexibility and treat even 90 years old with same medications  and that may be due to combinations of factors like insurance company asking us to do check marks  and then pharmaceutical company pushing for the drugs  and so on. But most of us weigh the benefit V  risk. The story that I am telling story  today is one such patient. 

    I saw this 84 years old patient. She had chronic cough and the PCP had treated with meds and antibiotics and cough meds and steroids, She had a chest X- ray done  and that was showing some chronic changes . She came to see me with her daughter. The cough was going on for more than a year. I did a CT scan and the breathing treatment. The CT scan showed damaged bronchi and mucous plugging  and and some other abnormality . I decided to do Bronchoscopy  and also some sputum culture for acid fast bacteria. The bronchoscopy showed that she had damaged bronchi and mucous  and the cultures came back showing bacteria called MAC. (If you want to know on MAC please see my YouTube  channel  under JUST A TALK on MAC or check out NTM )This is bacteria which  grows in damaged lungs  and also causes more damage. And patients have chronic cough sometimes blood in it and low grade fever  and night sweats and weight loss etc. Her sputum cultures also showed MAC . So under ideal conditions she NEEDS treatment . The problem is that the treatment consists of at least 3 drugs for 18 months . One of the drug can affect Liver and other one has potential for eye. So we monitor liver and eyes . So I discussed with her and her daughter on the treatment  and the medications and follow up and the monitoring etc. After the discussion they decided that they did not want the treatment . I agrees with them with one condition. WE HAVE TO MONITER HER with CT scan  and  clinically. There is a possibility of worsening if untreated . 

     So we have a disease  and we decided not to treat taking in to account her age her symptoms and understanding of the disease  and risk of worsening. And I have some older patients that WE have decided to watch  and they have done well without the treatment .  

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