CHANGING FACE OF MEDICINE

     I have written in past about medicine has changed in last 10 years or so what we never thought was possible has been done routinely. But I also remember when Obamacare came in there was a talk od so called Death squad '. How do you handle he aging population . Do we older members of our society same as younger members or treat them same? I have always maintain that every case should be treated based on INDIVIDUAL and as a GROUP . and I feel the same. But problem is becoming more frequent. That brings me to the talk for today. 

  I have seen at least 3-4 patients who were older than 89 years of age . The  good part was hat though they were old they all were in fairly good health  and had some issues but not depilating. But they were old. The second part was that 2 of 3 were also menially clear and one had fair amount of memory loss. The common factor was that all 3 had a pulmonary nodule that was PET positive . So I saw 2 of them who had a nodule  and that had grown in time . I had seen them and decided to do follow up CT scan and the nodule grew and so we did do PET scan and then showed that the nodule had uptake suggesting that it was cancerous . The growth and the positive PET SCAN was almost 100% suggesting that it was cancer. Now a days we have techniques like Navigational bronchoscopy ,which gives us diagnostic yield much higher than what we could have gotten in past with simple bronchoscopy. We also have better technique of needle biopsy. But we decided not do it as they were not interested in getting chemotherapy. So there was no need for tissue type - what kind of cancer it is as chemotherapy is based on type of cancer. We did radiation therapy - a short one 5 sessions in all 3  and that is suppose to give cure in many - may be 80% in these small cancers . 

    Then I saw this 4th patient, who has weak heart and had fluid around the lung and then when I treated it with diuretics the fluid is gone but now he has a nodule which is growing. So he is 95 years old who has heart problem and has increasing nodule - how do you handle it -stay tuned .