MINE FIELDS IN MEDICINE

      I have heard this statement that when  Taliban terrorist left certain areas they left the place with mines  and they were unpredictable and can explode anyplace that we did not expect. I have felt the same thing in medicine. This is so true in case of cancer . I don't like when a patient diagnosed with cancer and have gotten treatment with chemotherapy, come for the follow up in my office and tell me that the oncologist told them that the cancer is gone. I know better that making such a statement and so does the oncologist. But patients like that and then when the cancer comes back, then we have hard time explaining the recurrence. And I call this as the mine field where we have no way of knowing all the mines -the metastasis -which are there, but not obvious. That brings me to story for today. 

 I had seen this young woman who had been diagnosed with breast cancer and she has had surgery and then radiation and then chemo. She had some abnormality in lungs and that also was breast cancer. She also had some bone spread. She was short of breath and so she had chest x- ray and she had fluid built up around her lungs and so she came to me. We did drain more than a litter and it showed cancer cells and so we did follow up chest x- ray in 3-4 weeks and the fluid had come back. So we did a catheter to drain fluid periodically at home. She did well and she had some chemotherapy changed and she was ok . The fluid drainage continued to be less and less. 

     More than  months passed by and i get a call from ER . She was in ER for shortness of breath. I spoke to the ER physician and told him to do the CT scan as she had 'white out' on right side - suggesting either the fluid or collapse of the lung. Sometimes the catheter may get clogged or may not be in 'right ' place. The CT scan showed that her right lung had collapsed . I  did bronchoscopy to see if her  right lung bronchus was blocked from 'inside' or it was due to pressure from 'outside' . If she had blockage from inside then I could put in radiation catheter and that would treat / burn the tumor and then that will help 'open' the obstruction. She did not have any tumor inside the bronchus, so she had pressure from outside . So we called radiation oncologist and she was started on radiation. 

    So she had breast cancer - that had spread to lungs - then had pleural fluid  and now mass that was pressing on the bronchus - just like new mines were discovered every so often. Then I had a call from Mayo clinic where she had gone for second opinion. The oncologist called me and told me that she had done MRI of the liver and SHE HAD MULTIPLE METASTASIS TO LIVER. Just like another mine exploding in her face .