Thursday, June 7, 2012

Part 2 Is there a doctor on the plane?

It has too busy with travel and treatment and lectures and the Stanley Cup Finals (GO KINGS GO) to blog. I should be able to catch up more with lots of good news about me and ibrutinib from rainy Orlando real soon

But first when I last left you, I was walking to the back of the plane to see who needed medical attention.

To see if I could help?

To see if was putting myself at risk/

What I found in the last  row was a man in his early 50s acutely short of breath with an oxygen mask on, very afraid for his life.

Less than a minute after arrived, t was being asked should we divert  the plane to Las Vegas. (What power. I should have said that Hawaii was a better choice).

I took a brief medical history. Turns out my patient suffered from chronic inflammatory demyelinating polyneuropathy (CIDP). I had had one patient with that rare disorder years ago. It is a bit like MS in that the sufferers develop an auto-immunity against their own myelin sheaths so the nerves, especially the motor nerves getting weaker and weaker. If CIDP involves the respiratory muscles, life threatening shortness of breath is a rare but real possibility. Pneumonia can also occurs with a decrease cough reflex.

He denied chest pain. No calf swelling or tenderness. No cough or fever. No new new meds or foods. No history of asthma or severe allergic reactions. No other major medical issues.

I used the emergency stethoscope that the steward provided. I could hear no air moving in and out. A very very bad sign. Then I listen to the heart. Again I heard nothing. But my patient had a normal pulse.  And he was not turning blue or had any altered mentation. In fact there was none of the classic signs of respiratory distress- nasal flaring, using accessory muscles, tracheal tugging. Maybe the CIDP was obscuring them? I retrieved my own stethoscope from my seat. Still nothing. Then I listen to my own heart. Nothing. The problem of course was the volume of the ambient noise, not that my patient had no air entry into the lungs and that his heart had ceased beating. I didn't asked if they could turn the engines off for a few minutes so I could listen in the quiet, but the thought did cross my mind for a moment.

He had an infusion of IVIG the day before and was worried about the effect of flying so soon afterward. Now I have great personal familiarity with flying right after IVIG. I have done it dozens of time without a blink or blip. I plan my long foreign trips around my IVIG and try to get it just before I leave for  exotic lands. He was very reassured by this.
We chatted more. He was able to talk without gasping or halting. He was felling better, less air hungry. We walked up to first class. His gait was weak and his hands shaky. CPID has devastated his muscles.

No need to divert the plane.

We talked about his family, my leukemia, his treatment. The oxygen mask came off. He was smiling, relaxed, feeling OK again. I gave him my contact information.

His panic attack was over. I still had the paramedics meet the plane and take over his care. After all I had yet to really auscultate his lungs. I could have missed a pulmonary embolism or a cardiac issue or....

That afternoon back home at last, I got a call from a dear friend, a fellow family doctor with CLL living in Canada just admitted to the neuro-ICU with chronic inflammatory demyelinating polyneuropathy. Was it related to the weird immune system us CLLers share? Was it totally unrelated? Seeing as no-one knows the cause of CIDP, it is anyone'e guess.

What are the odds? Two cases of an exceedingly rare disorder on the same day. 

Synchroncity? Where is Dr. Jung when I need him?

I had done my doctorly thing. It ended well. I could talk to my Canadian friend with some fresh knowledge of CIDP from the research I did after I landed.

The steward asked for my frequent flier number as I was leaving the plane. Maybe I will even get some miles out of just doing what I do.

One last puzzle piece. When I got down to baggage claim, another doctor who was on our flight walked up to me too thank me for jumping in. He was being treated for cancer and didn't want to take the risk of offering to help due to his lowered immunity. 

Don't be judgmental.

We all make decisions. If the patient that I had found at the back of the plane had not had a panic attack on top of a rare neuromuscular disorder, but was suffering from a much more common condition such as severe asthmatic bronchitis, putting anyone such as me or the more reluctant doctor at grave danger and with little to offer in the way of help, his decision would have been the correct one, not mine.

It is good to be lucky.

I promise more lucky news soon from my ibrutinib trial at OSU.

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Anonymous Anonymous said...

Wow synchronicity indeed, I do love how the universe works. I'm wondering if the other Dr may have come forward had you not. Here's hoping you get a free upgrade to first on your next long haul flight good samaritan that you are. Very excited about all the ibrutinib developments, can't wait to hear how you're going. Best wishes, Deborah

June 8, 2012 at 4:33 AM  
Anonymous Marilyn Yocum said...

Exciting story, Brian.
I enjoy the little side thoughts you throw in....not asking to turn the engines off, where is Dr Jung when you need him and don't be judgmental. The last one especially.

Most of all, your own experiences with IViG being a reassurance to him. What ministered more, your training as a doctor or your experience as a patient?

And all the while someone else is watching, another doctor, wrestling with his degree own involvement. Don't be judgmental is right.

Really enjoy your blog. 4 years now.

June 8, 2012 at 4:55 AM  
Anonymous Anonymous said...

So glad to hear the rest of the story. And so very thnakful that you were able to help without putting yourself in jeporady. Now, what about your Kings. They went down the tubes on Wed. night......Maybe my Ducks will still be the only SO CA team with a Cup! Ok, I will say it....GO KINGS!

June 8, 2012 at 7:25 AM  
Anonymous Michael Friedman said...

Brian, I get your emails because I, too, am a CLLer (recently relapsed after 8 years of remission -- I am participating in a GS1101 study). This post has to be one that has most grabbed my attention. What an amazing chain of events and you describe it all so elegantly.

I deeply appreciate that you admonished us not to judge the other doctor on the flight. And what are the chances that there would be two doctors on board, both with cancer and compromised immune systems?

Lovely post, thank you.

June 8, 2012 at 1:28 PM  
Anonymous Anonymous said...

I agree, lovely post - glad you didn't ask them to turn the engines off! My inventory is been reading here for 3 years, kinda on behalf of my sister. I have told her about you, Brian. Alison.

June 9, 2012 at 5:24 AM  
Blogger pkenn said...

I was on the fringes of a similar incident at the Music Center. My opera companion is a doctor. As we were walking out at intermission the usher was directing people toward a different door. There was a man who had passed out just outside the seating area in a hallway. When my friend indicated that he was a doctor another man there said he was a doctor and everything was under control. We walked out around and I knew we were going back in. Ken was very concerned that the man had possibly had a heart attack and that no one was calling paramedics. He pushed the issue with the head usher, who had arrived by then, and was told the staff nurse was on her way. I could see he clearly thought that wasn't enough and pulled out my cell phone and asked if I should dial 911, at which point the usher did. It turned out that the other doctor was an eye doctor - with a big ego. We were able o find out the next day that the man was all right, but no one could tell us anything else - HIPPA - probably shouldn't have told us that. I'm glad everything turned out all right for your patient.

June 10, 2012 at 12:25 AM  
Anonymous Anonymous said...

That story just proves again what an awesome man/Dr. you are! God has us in specific places for specific reasons. Maybe that other Dr. wouldn't have been able to talk to that man like you did.

Great job Dr. Koffman!!


June 10, 2012 at 11:16 AM  
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