Jun 27, 2014


BACKGROUND. These are the relevant events.
1. From age 18 to 25, 1962-1969, I smoked heavily, then stopped and never smoked again.
2. Around 2004 I discovered through a CAT scan that I have emphysema (mild in right, medium in left).
3. Around June 1, 2014, I had spring allergy symptoms: sniffling, sneezing, a little coughing. (Adopting my subset of the McDougall Program diet got rid of earlier terrible spring-time allergies: http://anti-itisdiet.blogspot.com/2010/07/what-do-i-eat.html)
4. A sore throat developed. The coughing worsened. At one point, I coughed very deeply and felt a stabbing pain in my left lung, low.
5. A few days later, I began coughing up a little blood (clotted), as well as a lot of mucus.
6. On last Saturday, I coughed up about two cups of blood. A kind neighbor took me to the local hospital, where I received blood tests (yes, I am thin; no, I am not anemic) and chest x-rays. I coughed up some more blood. The ER doctor prescribed an antibiotic (Augmentin, which wrecked my gut and I needed to discontinue after only two days)

The most likely explanation of events is that the coughing ruptured an artery in my lung most weakened by emphysema, the blood accumulated in the lung, and over several days the body coughed it up—all a perfectly natural sequence of events.

RESOLUTION. The coughing of blood stopped (classic bell curve) within two days. Now, almost a week after the hospital event, I am very slowly recovering. Everyday I can walk a little further. I can work a little longer. I need less cough syrup to suppress the cough. The cough interfered with eating; my BMI dropped to 15.6, in spite of adding fat sources: walnuts, avocados, and olives.

My primary care physician recommended another antibiotic, doxycycline, and I am taking it for 10 days—without intestinal distress.

A CASE OF OVERDIAGNOSIS. My PCP told me that the radiologist at the hospital suspected that I have lung cancer. His "reasoning" was this: He couldn't see all parts of my lungs because I have a lot of scar tissue from 17 pneumothoraces in the last 52 years. The radiologist recommended a thorough investigation (in the radiology department) to either find the lung cancer or decide there is zero chance that I have lung cancer. Among other things he recommended a CAT scan (45 times more radiation than a normal chest x-ray!).

I refused any more investigation.

The radiologist's argument amounts to this: There is a dark space under my bed. Monsters can lurk in dark spaces. Therefore there probably is a monster there.

AGREEMENT. My PCP and I have agreed once again that "less is often better than more." We also agreed that my approach to medical care is the "Shelton Way" not the "Bellevue Way." I live in a small timber town, Shelton, but it is the county seat. It has a county hospital that networks with formerly independent, specialized clinics. My clinic is now part of that network.  I am unsure, but I assume that my doctor's reference to "Bellevue" apparently points to an advanced research hospital. I am unsure whether he was referring to Bellevue, Washington or to the Bellevue Hospital in New York.

The Shelton Way means: Not expecting answers to every medical questions; accepting ambiguity; being guided by symptoms not by what "might be there." The Bellevue Way means leaving no questions unanswered; resolving all ambiguity by conducting all possible tests, no matter how expensive; and worrying about what might be wrong, even if no symptoms or other evidence point in that direction.

I have told my doctor that if I cannot locally receive the medical care I supposedly need, then I will do without that medical care. I refuse to chase the latest testing and treatment. I am ready to die if locally available medical care is insufficient.

CONCLUSION. This episode has been very unpleasant, but I have learned and I have increased my respect for my PCP.

Burgess Laughlin
Author of The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith, described here: http://www.reasonversusmysticism.com/