ART, SCIENCE AND MAC

     I have often felt that there is an ART in medical science. But most of the time doctors feel that medicine is science and not art and many a times in controversial cases we are held accountable as we did not treat as science. But there is individuality  and there must be variation n work up and treatment of the same disease in different situations. If I see a mass in a very old person, who has dementia and is wheel chair bound, i will have different choice of work up and treatment than when I have another patient who is 40 years old and has all his faculties intact and is physically also fit . This applies to almost every disease. The control of diabetes is much more strict when we are treating younger person than we are looking at 80 years old person . The damage that can happen with low blood sugar is bad and the chance of missing it in elderly person is high and so we allow the blood sugars higher than what would be acceptable for younger patient. This brings me to todays story .

   I saw this lady who was a nurse  and she was in her mid fifties . She had never smoked and she has some cough for long time. She saw a lung specialist and he did the usual work up and then did follow up. She had CT SCAN and breathing tests and some inhalers tried on her . She had no shortness of breath and she has no chest pain and she looked OK. She did not have any weight loss and no low grade fever. But she had abnormal CT scan of chest done. So she had bronchoscopy  and that grew a bacteria called MAC. This is also called mycobacterium Avium or MAC for short  and also falls under NTG -NONTUBERCULOUS MYCOBACTERIA. She was sent to Infectious Disease specialist  and he sent her to me for whatever reason. She being a nurse was somewhat aware of the treatment options and the side effects etc and wanted my opinion. The treatment for MAC which is a chronic condition and it needs treatment which is prolonged . The current treatment is that with 3 drugs for 18 months . The medicines are given either daily or 3 days a week depending upon the disease severity . The medicines are continued for 12 months AFTER the sputum shows no bacterial growth after the treatment is started . One of the medicines has sometimes effect on Liver and so we need to watch blood test for liver damage . Other one can cause problem with vision - optic nerve and so we need to check the vision periodically  and so we need close watch . If the sputum continues to shoe the bacteria ( it's mycobacterium and not the bacteria )then we have to start 4the drug. Some may have problem with stomach.

    So, she wanted to know my opinion if she could avoid it . Here is art  and science mixed . Ideally if she has 2 samples positive for MAC then she needs treatment - this is science . But if we can watch her clinically and with CT scan and also with sputum culture then that will help . I have no test that can tell me if a particular patient will get worse or not. So it becomes purely an art . The science is -TREAT and the art is treat or not treat and just WATCH . There is risk in either approach - she can have side effects with medications or she may get worse without the treatments. 

        Now you know what I mean by ART and SCIENCE mixed in medical practice. .