DIFFERENT STROKES FOR DIFFERENT FOLKS

    We have saying that there are different strokes for different folks What I may like or enjoy others may not like or enjoy. But in medicine the computer generated treatment will not be different for 2 patients but will be different based on patient's and their family's choice. I have realized this long time ago and so the medicine is as much a Science as it is Art .That brings me to the story for today. 

  I had seen 2 different patients in my office . One was a 93 years old female who had abnormal CT scan of the chest . She had a nodule . The spot on the lung is called nodule when the size is less that 2 or 2.5 cm - roughly less than an inch. It was may be half an inch in size . She was otherwise doing OK and we decided to do minimal work up. With that size it was difficult to do biopsy if not impossible and  she has no symptoms from it . I did do the PET scan. It showed that there was some activity but not very high . So we decided to do follow up CT scan . She continued to have no complaints . We did do the new ct scan and then another one . At the end of 8 months or so the nodule had grown by may be 3-5 mm  and so after discussion I did new PET SCAN .The PET SCAN this time showed more activity that before . So I had discussion. It most likely was slow growing cancer . The size increase though minor and the increase in PET scan uptake was suggesting that it was slow growing and so we had discussion. I suggested BOT TO DO BIOPSY or surgery ,but do radiation treatment . For a small nodule we can do what is called stereotactic radiation ,which is 5 sessions of radiation and the success rate is vert high for such a cancer . We will not know what type of a cancer it is and so no chemotherapy or immunotherapy will be offered. She did not want chemo or surgery and so the decision was easy. She did very well. 

   I also saw another patient. He was 90 years old and had some dementia . He had some cough and he had CT scan done by his PCP  and that was abnormal and so he came to me .I looked at him and then found out that he had prostate cancer in past and he had several CT scans in past We could find out 2 old Ct scan  and the nodule had grown over period of one year. By chance the new Ct scan report had not bothered to check old scans and so I had to pull them out . I spoke to patient and family. I suggested doing a PET scan and then consider work up if it had increased uptake. They were reluctant for any work up. I was not sure why did they come to me if they did not want any work up. After I had more explanation the daughter agreed for PET scan ,but she was still not sure if they would go ahead with radiation -short course like I did in other patient . So the similar age patents , similar growth in nodule ,but thought process was different .