Monday, November 12, 2012

A stubborn blood pressure that refuses to rise !

This was in the winters of December 2008. Mr A, a close family friend of mine had come from Silicone valley (USA) to take care of his father who had been diagnosed and operated for kidney cancer (Renal cell carcinoma) at AIIMS, New Delhi in September 2008.

On that morning, Mr A called me up and frantically said “Pankaj bhaiya, the blood pressure of papa has fallen and is refusing to rise. Its 74/40 since late last night. We called a physician and he has given a lot of medicines and injections. Even after giving 4 bottles of intravenous fluids, the pressure is still the same. He was absolutely alright yesterday evening- eating, drinking, talking and joking. What should we do?”.

I  was surprised and confused at the same time. I had seen him recovering absolutely well after the operation in September and had resumed his normal routine from mid October. I had also telephonically conversed with him two days back and he was quite jovial (optimistic as he always was) and reassuringly fit. So what could have happened so suddenly? Was he in shock (extreme fall in blood pressure most commonly due to bleeding or infection)? But there were no obvious signs of any bleeding or infection.  I also discussed with the physicians treating him but they were clueless as well.

Clueless, thinking in all possible directions. It was a déjà vu situation; a situation I find myself quite often in. May be I welcome, am always happy and available to analyze difficult and complex medical conditions or may be I am too nosy (poking my nose everywhere); whatever it was, my mind was running amok and scanning all the possible causes of hypotension (low blood pressure ) I could think off.

Suddenly, like a flash of light, it struck. Could it be adrenals (glands responsible for production of steroid hormones in the body which play a vital role in maintaining blood pressure); Adrenal failure because of the metastasis (spread) from the operated kidney cancer tumour. Since the patient was not in the condition for a CT scan, I requested Mr A to suggest his physicians to give an injection of steroid (Inj Hydrocortisone) immediately and evaluate the response. Even if the adrenals were normal, one injection of steroid was perfectly safe.

One hour later, I got a call from Mr A. The response was more than dramatic. The patient was sitting and talking with his pressures restored. Mr A was extremely happy and thankful; but I was sad and sorry. My heart had sunk.  I couldn’t muster courage to tell him at that moment of momentary joy that the cancer has come back with a vengeance   and has almost reached the last stage.

I said “thank you, take care” with a heavy voice which he could hardly hear and closed the call.

 

 

1 comment: