CAN YOU PREDICT DEATH ?

      This is very interesting question. I am not talking about someone sick in ICU and is on respirator and falling blood pressure. I am talking about can we predict death in a regular walking -talking patient ,who has no cancer. But recently I came across a form that I had to complete where the first question was 'Is patient likely to die in one year?' This is recent and it was a patient who was to undergo minimally invasive cardiac surgery. As a lung specialist, I often get forms to ;CLEAR' the patients for various procedures or surgeries - endoscopies to cataract surgery to colon resection and so on. The risk of any surgery is increased when the patients have lung problems and the lung capacity is compromised. This brings me to the story for today.

     I have known this patient for many years . He was  70 years old patient, who had chronic cough . I had done the work up and that included breathing test and Chest x-ray . We even did the CT scan of chest . He had mild to moderate asthma or obstruction on his breathing test. The x- ray was ok and so I gave him inhalers to treat the asthma. He used it and came back and told me he does not know when to use as he did not find any change in cough. So he would  not use it. I also did swallow study to see if he was aspirating-food or liquid going wrong way -instead of going in food pipe , esophagus ,it would go in wind pipe or trachea. This would then trigger the cough reflex. He did have aspiration. But then again he did not feel he had any problem with swallowing. So he did not do anything . I continued to follow him for more than 5 years  and he did well with no hospital admission or major pneumonia. 

   Then he saw a cardiologist and they diagnosed him with a heart valve problem and they wanted to do minimally invasive heart surgery to fix it. I cleared him for the surgery and he did well. He came back to see me. He was doing good and had uneventful recovery from the heart surgery. He however had urinary retention and he was diagnosed with enlarged prostate and needed surgery to fix that. Just as a rule risk of lung problems is increased when the surgery is close to lungs Say for example amputation of a toe is much less risky that having lung surgery with compromised lungs. Now he needed prostate surgery. I cleared him for the surgery. He did well and then was to be discharged. And then HE ASPIRATED . The aspiration caused major pneumonia and his oxygen dropped . He developed respiratory failure and then was struggling. He and family made decision not to put him on respirator and so then hospice was called and he died . 

    So the patient that survied heart surgery dies after prostate surgery -CAN TOY PREDICT DEATH?  

IT IS SIMPLE FLU -IS IT ?

       We all have heard of Flu and how it is a viral infection and there is vaccine for that. The vaccine are good and prevent diseases. But in case of Flu it is 'hit or miss'. There are seasons when flu vaccine are not that effective and some others where it's effective,  In my last several years of practice I have seen Flu where people get better in 4-7 days and then there are some where the fatigue and cough and malaise continues for weeks.  But then there are some where the diagnosis is done in 1-2 days and then we use antiviral medicines and people get better. And then there are EXCEPTIONS to rule. Which brinhs me to the story for today. 

      I had seen this elderly male who was 82 years old and had a nodule on his chest x- ray. He came to me and had work up done . He had had hypertension and had chest pain and that was worked up and he had CAD coronary artery. He had work up and then had blockage and then had stents. During the work up he was found to have this new spot on the lung and so he came to me 

     We did the work up and then he had breathing test and also PET scan. He had descent lung capacity and the PET scan did show increased uptake suggesting the spot to be cancer. I had options of surgery - radiation treatment. He wanted to have it removed. I sent him to a chest surgeon and he agreed and the patient had the surgery. It was cancer and everything was good and he did not need any additional treatment like radiation or chemotherapy. 

    Over period of next few weeks he developed fluid around his lung and had some cough. He thought it was a set back and was worried - could it be cancer? I treated him with steroids and the fluid went down to minimal. He continued to do well. And then he had flu.

     He went to ER and was treated with antiviral medicines and he did not feel better . He saw primary care and was given steroids and antibiotics . He continued to have sough and could not eat well and lost weight. He was congested and had no energy . He could not do much waking and exercise . He used to go to gym before this Flu infection. He did not have fever and his oxygen saturation was normal . He came to me and he looked 'bad.' As mentioned no fever and no shortness of breath . But he looked mineable. I decided to hospitalize him . The standard rules don't apply as he had no fever - no shortness of breath and no pneumonia . The does not meet the criteria for hospitalization. But when you look at patient , the story was different. HE was old patient who had heart problem and had lost part of the lung with cancer and he was not recovering from this SIMPLE FLU quickly and he needed better care that can be done in hospital . I ADMITTED HIM !

   SIMPLE FLU CAN BE BAD IN CERTAIN HOSTS - PATIENTS.