I have done my medical education many years ago and since then the medicine has grown and we have been able to keep with new developments . But now a days we have added the burden of computer educated generation where patients have seen . checked on computer and think they know the answers
We still have many patients that trust their doctors , but still we have sometimes problem and we have to explain things . It is difficult to wife off the slate which is not clean to start with and write new things . Sometimes it is not fault with patients but with people surrounding That brings me to the story for today. I saw this 80 plus years old patient in office for shortness of breath . HE was smoker and had diagnosis of laryngeal cancer and that was treated and he was better and was in remission . He had COPD and he has shortness of breath and so he came to me . I asked him questions and I found out that he was admitted to hospital and he had CT scan and that had shown nodule , the so called spot on the lung, He did not have any new Ct scan after the discharge 4 months ago. So I ordered the new CT scan and that showed that the nodule had grown . That means that it was likely to be cancer . Since he had laryngeal cancer , there was possibility of new lung cancer or metastasis. So I ordered the PET scan . The PET scan picks up cancer may be 85% of the time . The PET scan showed activity in the lung nodule and also some activity in food pipe esophagus . We had done breathing test and he had severe compromised lung function. He was older and had bad lungs and enlarging nodule . So I asked interventional lung specialist to see him and do navigational bronchoscopy and biopsy . Ehen the biopsy was done it came back positive for cancer. She called me and the family and she wanted them to see cancer doctor - oncologist and Gastroenetrologist. I called the family as I wanted to discuss the further work up and treatment plan . I was told by family that they know it is cancer and what was I going to do . I insisted on bringing them in .
I had discussion with them and i was glad that they came . They were confused between oncologist and Gstro. I told them that he did not have great lung capacity and he was not a candidate for lot of invasive tests . But we needed to know if this spot - that had biopsy positive for cancer was ARISING IN LUNG or had started in esophagus and SPREAD TO LUNG . The distinction was very important as if there was no cancer of esophagus , then we could do short treatment of the lung cancer called stereotactic radiation and that will not cause much problem with h9 compromised lungs and has some cure rate . In contrast to that if he has had esophageal cancer, then treatment of the lung nodule will be not useful and then either chemo or localized radiation to esophagus will be needed and that may cause difficulty in swallowing and need feeding tube - may be. These kind of things was not there when thy had checked on Google.
I cleared him for doing endoscopy and when they left they were happy that they came. . .
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