NOTHING IS KOSHER

    In medicine we have often talked on rare bird or certain things that we feel comfortable about certain findings .But the medicine is statistic and as one knows that not 100%. So I say there is nothing is Kosher. I have often stated that with statistic ,one can put one hand in boiling water and other in ice cold water and YO ARE AT COMFORT !! But in medicine we have certain things that are common and when we are proved wrong or we have deviation from 'usual; we don't like  as we did not expect it. That brings me to the story for today.

  I saw the patient about 70 years old male who has been 2 pack a day smoker. He had a CT scan done by PCP and that showed a nodule about 13 mm - just half an inch in size . So he was sent to us . I did start the work up .I explained the patient that, I am concerned about high chance of cancer and needs to answer 3 questions ,i.e. Is it cancer , Has it spread and What can be done as treatment. I ordered a PET scan and breathing test and did bronchoscopy. Some how he did not do pet scan for 6 weeks and rest of the work up was done. He came to see me again . The bronchoscopy did not show much and so when we had done washing and brushing - what I call as pap smear of the deeper parts of the lung came back as normal. But the PET scan was not normal and to my surprise, the nodule which was 13 mm was now 21 -23 mm and had increased uptake, indicating that it was likely to be cancer. But more than that the growth in such a short time indicated rapidly growing or aggressive cancer .I also was not very happy that many of the lymph odes which were not reported as enlarged , were enlarged and had uptake, indicating spread of the cancer. 

  I explained it to him and decided to send for additional biopsies and also have chest surgeon look at him in case the nodes are not positive then he can resect it out.