Monday, May 17, 2010

Lump and Ache

New patients are naturally wary of the doctor. They don’t know what they are going to get in the consult. It may not be a pleasant experience for both parties. Who knows, in a worst case scenario, the doctor may not hesitate to pass a death sentence on the hapless patient.

This patient who gate crashed [came without prior information] into my clinic had severe anxiety writ large on his face. I asked him to sit and try and relax. He sat on the front of the chair and I could see the hands tremble. He was perspiring. I waited for him to begin.
After a minute or so he said, ‘I have a tumor on the lower part of my back and it is hurting me’
Normally patients don’t say tumor, they say swelling or lump. If someone says tumor I am certain he has already seen another doctor and has borrowed the terminology. We doctors as a tribe don’t know how [or don’t want to] to put our diagnosis in simple lingo. We have to say myocardial Infarction instead of heart attack, Cholecystitis instead of infected gallbladder. Sometimes when we don’t know how to describe an illness appropriately enough with a high sounding name, like when one has vertigo due to vestibular disease then we call it BPPV which stands for benign paroxysmal positional vertigo which in real terms mean a benign form of vertigo which comes in paroxysms related to position of the head!

So this tumor word had me worried because it connotes a growth of some type and could be serious especially when it is also causing back ache. After getting the history that the swelling was noticed several years ago and the pain from the last two months, I asked him to undress and lie down on the couch.

This is what I found. He had a small mobile lump and he had a stiff lower back. The lump belongs to group of fibro fatty innocent tumors called fibromas/ lipomas. The rigid back needed to be investigated. I told him so and assured him that he two are unrelated. He said he has already been extensively investigated which included an MRI scan. He proceeded to take out as sheaf of papers from his sling bag. The MRI showed slightly indented cord but not serious enough to have caused his back ache. His other reports were normal.

What this young man needed was posture correction at work and a set of exercises to stretch his low back. His lump needed no intervention. I told him so.

‘Doctor, are you sure’? He asked.
‘As sure as one can be, going by the evidence’, I said. Then he took out another set of papers in which a surgeon had advised admission for removal of the tumor and surgery for the disc prolapsed!

I sat in silence for a while not knowing what to do or say. I told him, ’you have come to me for an opinion and advice, according to me you need no surgery, try out these exercises and get back to me after six weeks, we will review you back problem. The lipoma needs no removal, not now and not in foreseeable future’.

That was two months ago. He came to see me few days ago. His back ache was very much better and his much feared lump didnot seem to bother him.

Thursday, May 13, 2010

Fat cats don't hunt

I am one of those who never liked the 20/20 version of cricket. It is more like a slam bang jamboree rather than real cricket. Indian version of this is called IPL and it was over about two weeks ago. Just after this the team went to West Indies for the world cup of the same format. It came as no surprise to me that the much hyped team India got a through drubbing. This was mainly due to what commentator Ian Bishop aptly described as spineless batting.

On docile Indian pitches even the fastest bowler is rendered innocuous and our heroes are used to this and away it is a different story. The ball comes at you at an uncomfortable height and you should be quick on your feet and eye to either ward off or hit the ball. Our players did neither and preferred to get out! They were such a jaded and faded lot after the hectic IPL that even a child could see that they were an unfit lot. Adding insult to injury there seemed to be no pride representing the national side. This is entirely due to the fact that there is so much more money in domestic IPL than world cricket and our team full of fat cats were not hungry for a win. As the legendry Imran Khan commented that there may come a time when players may prefer to stay away from representing their country and prefer to play for their club!

Now coming to the sordid affairs of the IPL. When money, glamour, business and politics become bedfellows, it is foolish to expect honesty and straight forward deals. The high flying commissioner of the league, Mr Lilith Mody was found wanting on many counts and was summarily booted out, few tears were shed by the viewing public. Few were indeed shed for another IPL casualty, the articulate blabber mouth, Sashi Taroor.