Dr. Qaadri

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What my patient's chest X-ray didn't show - Another way to get COPD

By Dr. Shafiq Qaadri, MD

    On occasion, patients who come from overseas present with remarkable conditions, often the legacy of modest medical facilities. A patient of mine brought in her mother, who had just arrived from Hunan province in China. The frail lady spoke minimal English, so I relied on her daughter for translation. As I was taking the history, she told me the mother had not had any surgery.

    I was conducting what I thought would be a routine physical exam. As I listened to her chest, I was startled to discover there was absolutely no air entry on the entire left side—no breath sounds whatsoever! First I thought the bell of my stethoscope was not turned properly. But adjusting it didn't work. Then I observed an ever-so-faint surgical scar, some 2O cm long, under the left axilla.

    I brought this to the daughter's attention and there was a quick flurry in Mandarin. Then the daughter said, "Oh, sorry, she did have an operation."

    "When?" I asked.

    "Fifty years ago."

    "What was the operation?"

    More exchange in their own language. "They took her lung out."

    "What do you mean, 'They took her lung out'? Why?"

    More Mandarin. "Well, doctor, that was the treatment for TB then," the daughter told me. "They didn't have pills. So they took the lung out."

    Now, I understood that in China the needs of the collective override the concerns of any individual, but I thought this was rather aggressive. "And she doesn't feel short of breath, or tired all the time? She doesn't have any problem?" I asked in disbelief.

    "No, she's fine," the daughter replied.

    After so much time, the lady had adjusted to her handicap. This was all the more remarkable, as her chest X-ray (pictured above) was one of the most memorable I have ever seen. The entire left lung was absent, with collapse of the left chest, and the usually midline trachea was completely coiled toward the collapsed left side.

    She had changed her breathing style—being somewhat minimalist—with only slight chest excursions. Yet she was completely asymptomatic. She denied any shortness of breath—a remarkable display of tolerance and steely reserve.

    Decades ago in China, the local authorities had to decide on a public health measure that would be efficient and easily implemented for TB. Without medications, they came up with the strategy of simply removing whole lungs. The patient and I affectionately refer to her treatment as the Chairman Mao technique, and I'm pleased to report that she's doing well.

Dr. Shafiq Qaadri is a Toronto family physician and Continuing Medical Education lecturer. www.doctorQ.ca

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