I have always said in medicine, that do not ask the for thr direction to the place that you do not want to go. In medicine many a times we tend to do 'routine' tests and then when the reports come back have difficulty in explaining the report . When I was doing internship , I had done a test on a patient and that came back abnormal. When asked the cardiologist on the case as to why the test was abnormal. His answer was ' I would not have done the test and then I don't have to explain the results.". I have tried to follow yhat principle in my medical life.
I saw this new patient. He was 55 years old and he has some eye problems and so he went to see doctor. He had cataract surgery and he was told that he may have a disease called sarcoidosis. He was sent to me I saw him and he had no lung or breathing complaints and he was nonsmoker .His examination was unremarkable. He had done a blood test which is specific for sarcoidosis .It is called ACE level - Angiotensin Converting Enzyme level. The only condition in which this is elevated is sarcoid. The Fan=mily Physician had done that and it was elevated . He had CT scan of the chest done and that showed some abnormality in lungs and as I expected it also showed that he had some lymph nodes enlarged . This was consistent with diagnosis of sarcoid. So based on eye examination and elevated ACE level and now the CT scan findings -- all pointed to sarcoidosis .But we needed the biopsy . The findings on CT scan had minimal abnormality in lungs and the nodes were enlarged . So I decided to have the nodes biopsied . So I sent him to another physician who did a procedure calle EBUS . In this procedure the biopsies or aspiration of lymph nodes is done with a needle
The procedure was done and samples were sent . The biopsy did come back showing sarcoid as the diagnosis. But the sample was also sent for what is called flow cytometry. In this test cells are analyzed and that showed some abnormality . I am not sure if we had explanation for this . I am not sure if the cells seen were due to sarcoid and inflammation or was there different cause . So I had to send him for additional tests and send him to cancer specialist to rule out lymph node cancer . Again that adds to the tests and in all probability he has sarcoid and not a cancer . But since we did the test and that showed some abnormality, we have to do additional tests.
