Shukhendu’s story: one of precision and timing ‘The pain in my chest was like a brush with death itself. I couldn’t move; my heart almost cracked with the effort as I tried to park my motorbike that evening,’ the dread in Shukhendu’s expression was clearly apparent as he recalled the days which lead to his dangerous predicament. Shukhendu’s chest pain was also accompanied by spells of breathlessness, cough and fever. Since the pain was right sided doctors in Sylhet primarily thought that Shukhendu probably had a bad case of pneumonia which will subside with antibiotics and pain medication. But the Chest X Ray revealed everyone’s worst fears. A huge tumor had slowly crept between the soft tissues of his chest, pushing his heart and great vessels backwards. This tugging effect of the tumor led to nerve entrapment causing excruciating chest pain; the likes of which could not be relieved by high potency analgesics. After his referral to Dhaka for better care, Shukhendu recalls the days of dejection and hopelessness which followed; the glimpse of a slow and painful death sent shockwaves of agony and exasperation through his family and friends. In Apollo Hospital, more tests and evaluation revealed a benign growth which could be surgically excised. The subsequent development of events has led the Stethoscope team to interview Dr. Md. Zulfiqur Haider, Consultant Cardiovascular and Thoracic Surgery, Apollo Hospital. Stethoscope: Sir, would you please inform us of the salient features of Shukhendu’s case? Dr. Z. H.: When Shukhendu arrived at Apollo’s OPD on the 24th of May, he underwent a full cardiac evaluation because of his chest pain, as it is well known that any atypical chest pain may result from cardiac problems. What baffled us all was that in spite of the severity of the pain his heart was functioning normally! We decided to examine the tumor in his chest which could only be done by taking a biopsy (a medical test on cells taken from body) under guidance of a CT-Scan machine. The biopsy revealed that the tumor was benign, that meant Shukhendu would not need any expensive chemotherapy or radiotherapy regimens to downstage the mass before it could be operable. Stethoscope: Why was it necessary to treat the condition surgically instead of leaving him on pain medication, since Shukhendu’s condition did not pose any eminent danger? Dr. Z. H.: It is true that pain was the worst complain on Shukhendu’s part and that alone does not require surgery but this benign growth would eventually compress his heart and great vessels to a stage where it would not be compatible for life. By then the tumor will have grown too large and too deep for effective surgical removal. Stethoscope: The tumor being benign must have been a huge relief. What was your next step in helping Shukhendu? Dr. Z. H.: On the 27th of May, we operated on Shukendu. It’s because of the gigantic size of the tumor we were compelled to make a giant incision which passed from the right side of his chest to the left, an incision known as clamshell incision. Once inside his chest cavity we were able to view the tumor which was adherent to his lungs, partially obscuring his heart and intertwined between major vessels. The dissection was very difficult and almost took 5 hours to eliminate all remnants of this viscous tumor. Our team of anesthesiologists worked very hard to maintain Shukhendu’s ventilation status as his lung function could easily have been compromised while we were dissecting it to remove unhealthy tissue. Once the operation was complete it was now up to our colleagues in the ICU to help our patient recover from the trauma of such an enormous procedure. Stethoscope: Were there any complications during his recovery period? Dr. Z. H.: There were absolutely no complications during the post-operative period. His blood work and all other physical parameters were fine and we were able to release him on the 2nd of June. Stethoscope: What is the follow up plan for Shukhendu? Dr. Z. H.: The tumor which we identified is a mature cystic teratoma. Such masses are not known to show malignant proliferation. From our end at the surgical department we will review his condition to see if there are any problems at the incision site. The oncology department at Apollo Hospital will check to see at regular intervals if the tumor grows back again from any remnant we might have failed to excise. Humbled and grateful by this renewed call to life, Shukhendu openly boasts of the efficiency with which the sons of our soil dealt with his tumor. No doctor can play God, but when competence works hand in hand with vigilance and discipline the divine spark can defy all odds. To read the article please click: theindependentbd/index.php?option=com_content&view=article&id=219159:shukhendus-story-one-of-precision-and-timing&catid=176:stethoscope&Itemid=214
Posted on: Tue, 17 Jun 2014 03:45:30 +0000
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