PERSISTENCE PAYS

   In medicine sometimes persistence pays. We see things and with previous experience we think we know the diagnosis  and then the tests are carried out and the diagnosis is not obtained . So sometimes the persistence pays. In past it has also happened that we think that there is cancer or some other diagnosis  and then the tests show something different. But one has to go by what we think  and continue the work up. This brings me to the story for today. 

  I had seen this patient in office for the shortness of breath. She had been smoker in past  and had quit many years ago and she was getting short of breath and so the primary care doctor sent her to me .I knew that she must have COPD the disease that happens when people smoke and over period of time it must have gotten worse. So I did the work up . She had o chest X- ray in long time . I did the chest X- ray and breathing test and AAT a genetic test to see if she had lack of certain enzyme that can cause emphysema in smokers. The chest X-ray came showing some abnormality and so I did CT scan. The CT csna showed 2 masses  and she had it quite close to center of left lung. I did PET scan and in Pet scan  glucose is used and that is picked up by every cell in the  body and the concentration of the  glucose pick up is measured. .Higher the pick up more likely to be due to cancer. So the PET scan is 80% accurate in picking the diagnosis of cancer. So there are cancer where the metabolic activity of the cells is not much higher than normal cells and so the pick up is not that high. This is seen in very slow growing cancers. And there are infections that will be positive on PET scan . So it is not 100% . Her Pet scan was positive and so I was sure that she had cancer of the lungs . I did bronchoscopy and I did see narrowing of the bronchus and I was sure that the biopsy will be positive for cancer, but it did not. So, I did ask radiologist to  do needle biopsy. . That also did not show cancer. I had told family that most likely based on our tests , she had cancer. But we did not get the tissue diagnosis. 

    I sent her to a chest surgeon   to consider open biopsy . I thought that was the only 100% test to get the diagnosis of cancer. I was sure that she had cancer. The surgeon called me Her lung function was not that great  and so he wanted to redo needle biopsy with larger needle - so called CORE Biopsy.She had the core biopsy  and that showed the CANCER!

    So the persistence paid.