VITAL SIGNS

     In medicine we  have something called vital signs . These include pulse rate ,blood pressure ,temperature and respiratory rate. These are recorded in every patient - in out patient settings and also in ER and in patients setting  or hospitalized patients . The reason these are called Vital Signs , as they tell us about any  disease that needs immediate  treatment. If the Blood Pressure is high or low , it needs treatment and same with temperature - fever or hypothermia  and so on. In an average day in office - clinic , we do not have major issues with anything that needs emergency treatment related to Vital Sings abnormality. Certainly if Blood Pressure is very high we treat it and of someone has fever we treat it . This brings me to the story of this patient for today.

    I had seen this patient few times . He had abnormal CT scan of the chest and after doing the work up , we had done bronchoscopy , PET scan and breathing test and determined that he needed surgery and he had under gone surgery to take out part of the lung that had the growth. It was not a cancer . But we had done follow up CT scan as he was ex-smoker .This time he came to me and had a CT scan that was good , no abnormality was seen. But when I checked his pulse and oxygen saturation , the pulse was 33pwe min. This is very low heart rate - pulse rate . The Blood Pressure was normal , He had no shortness of breath or chest pain . He was not feeling dizzy He felt 'fine'. I checked hos pulse and heart rate to make sure that it was low. I tried to call his cardiologist and could not get anyone to call me . So I called his primary care and told him to see him ASAP. I was concerned that he would need to be admitted or may need pacemaker. 

   The patient and his wife were not very happy as 'he is fine '. I insisted that he goes to his primary doctor NOW . I also called him and he agreed to see him. He was seen and had HEART BLOCK , which means his electric circuit in heart was broken. He was sent to ER and he needed pacemaker . He was ot very happy and initially refused to have pacemaker ,but I called his wife and then he agreed  to have pacemaker. 

      The Vital signs are recorder thousands of time in office and this is one of those rare examples where they proved to be VITAL  and save life .  

WRONG TEST BUT RIGHT ANSWER

        I have seen in medicine, a test is done and then something that we did not anticipate comes out and then we don't know what to do. I remember ,when I was doing internship, I had done a cardiac test and that came back abnormal and I asked my attending cardiologist as to how to explain the result, he answered 'I would not have done the test and so I don't have to give explanation. But this time it was different. That brings me to my story for the patient.

    I have known this patient for few years . He had sleep apnea and he has been on CPAP and had done well. He had some weight loss but nothing major. He also had some other issues but they were stable. He had no major medical problems and so many a times out talks used to be things other than medical problems. He needed new primary doctor and I had suggested a name and he went to him and was very happy. He had seen me and I had told him to get routine chest x- ray as I like chest x- ray once a year . He had quit smoking may be 25years ago. He had some asthma and I had treated him for bronchitis in past and so I had told him to do x- ray.

    He called me one day . He had my cell phone number. So he texted me that he had seen Primary care physician and he was complaining of right sided chest pain. He was seen by PCP and they ordered a CT scan of chest pain. The CT scan showed LEFT UPPER LUNG MASS .So the pain was on the right side and the CT scan showed mass on left and that does nit explain the pain . But the liver ,which is in belly and on right side showed masses. Now that would explain the pain on RIGHT SIDE. So the patient was sent to cancer doctor - oncologist. The oncologist is the physician who treats CANCER with chemotherapy. But there must be CONFIRMED DIAGNOSIS OF CANCER to treat with chemotherapy. Without a tissue diagnosis , this doctor cannot do any treatment. The oncologist ordered PET SCAN and wanted radiologist to do biopsy . The patient  called me as the oncologist wanted MRI of the Liver. He was frustrated a little bit and so he called me 

   I got hold of the PET SCAN pictures and took it personally to interventional radiologist. He agreed to do the biopsy ,and did not feel that MRI of liver was needed. The biopsy was done and it showed NOT A LUNG CANCER, but showed COLON cancer , which had spread to liver and lungs . 

     So, the pain that he had MAY HAVE BEEN due to liver metastasis, or could be something else But a CT scan of CHEST was ordered and that showed  Lung masses on RIGHT ,. The discovery of lung masses and liver metastasis was accidental.