Sometimes in medicine we have situations where we have to say 'there is good news and there is bad news.' We see that often with many medical conditions like coronary artery disease. Now a days more and more patients are getting CT coronaries and then we detect a blockage on the CT scan. We then have to do heart cath. where we can see the blockage and then we can fix it . Sometimes a stent is needed and sometimes bypass surgery is needed . So the Bad news is that patient has coronary artery disease and the Good news is we can fix it - say with stents. This type of things happen more often with diagnosis of cancer - bad news -there is cancer -good news is we can operate and cure it. This brings me to the story for today. It is similar but little different.
I had seen this patient for sometimes . Her husband was mu patient and he had significant lung condition and also had sleep apnea and cardiac issues . She started seeing me for abnormal CT scan chest .She had seen lung specialist many years ago and had done follow up on the CT scan and that was stable . But then she stopped going and had no CT scan done for 2-3 years. When I saw her she was stable and had no major pulmonary complaints. We did the new Ct scan and the abnormality was stable .Most likely she had scar . But since scar can become cancerous , I continued to do follow up and do new scan in 6 months.2 years must have passed by and then when we did the new scan , there was an increase in the size of the abnormality and the radiologist stated obstruction of the bronchus. So I was concerned and I did do PET SCAN . In PET scan glucose which is tagged with radioactive isotope is given and the scan is done . The glucose tends to be picked up more avidly by cancer cells and so based on the pick up, we can decide if one has high chance of cancer or low chance. The PET scan was done and it showed high pick up. This increased the chance of developing cancer in the scar. I did do bronchoscopy , but that came back with no diagnosis. So I decided to send her to thoracic surgeon.
He looked at the patient and the scans and felt that it was most likely benign and felt that the surgery would be " messy". I felt that with given PET scan findings of increased uptake and the growth that was seen on the serial scans , we needed to take it out as the chance of cancer was high . She was nont sure . But then we talked with family and her and she agreed .
She had the surgery. The surgeon tried to do it with mini incision- VAT or robotic and that did not work as she had lots of adhesions. So he had to do it with larger incision. The pathology showed that there was NO CANCER. After the surgery she went home , but in that post op period, she had irregular heart beats - though they resolved without treatment, they would or could be life threatening. So she was seen by cardiologist who specialist in electric circuit in heart . She did not want additional procedure and so was sent home with new heart medicines.
She went to see her regular cardiologist after discharge. As is so common now a days , she was seen by nurse practitioner and no new tests - work up and no new medicines. She came to see me . I had not seen her in hospital, but I reviewed her medicine list and realized that she was on new cardiac medicines. So I asked her she told me as much as she could . I went on to hospital site and realized that she had very dangerous cardiac irregularity. SO I HAD TO CALL THE CARDIOLOGIST HIMSELF AND TOLD HIM TO SEE HER SOON AND DO WHATEVER WORK UP IS NEEDED.
So now the GOOD-BAD AND GTHE UGLY. The good part was that she did not have cancer. The bad part was that we had to do surgery to diagnose . The bad part was that she needed open big incision surgery . The good part was that in spite of that her recovery was smooth and quick. The bad part was that she had cardiac issues after surgery. The good part was that was treated and she did well . AND THE UGLY PART WAS INSPITE OF SEEING CARDIOLOGIST AFTER DISCHARGE - THE ARNP AND THE CARDIOLOGIST DID NOT KNOW THE SERIOUS NATURE OF HER HEART PROBLEM AS MODERN MEDICINE IS PAYING MORE ATTENTION TO HOW E WRITE NOTES AND NOT AS TO HOW WE CARE FOR THE PATIENTS.
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