I practised at a medical college as an Assistant Professor and recently started private practice at a hospital in Navi Mumbai. I didn’t have too many patients and left the office to grab a quick cup of tea! As I passed the lift lobby (I always use the stairs), I saw a man reaching forward to press the button for the lift. I could not see the man’s face, but the hand was enough to make the diagnosis! I tapped his shoulders and told him – “You almost certainly have a tumour in your brain, and you need to see me. My name is Dr Tejal Lathia, and I consult in OPD no 4.”
Now this man had come to the hospital with his pregnant wife, and after hearing what I said he did what any sane person in his place would have done, he took the lift down and disappeared, far from this mad doctor.
As I said earlier, I had no patients (you know why now !!) so I actually went down to the reception to look for him. I was ready to offer my services for free if need be.
I twiddled my thumbs for an hour after that. The staff were very puzzled why I refused to leave the office as I had no patients (I do have patients nowadays, so please don’t misunderstand!).
An hour later, he came back with his pregnant wife. I asked him if he had noticed any change in his facial features, any increase in the size of his hands and feet, any increase in sweating.
You see, this man had Acromegaly, it literally means large hands and feet. It is a condition caused by the production of excess growth hormone in the brain by a tiny gland called the pituitary. This growth hormone makes everything grow – bones, muscles, tissues, quite simply your nose, tongue, hands, feet, heart! It is missed for many years because the changes are very gradual.
I finally managed to convince him to get a simple blood test to confirm his body’s excess growth hormone.
To cut a long story short, he underwent surgery and radiotherapy. He also had another baby boy after his treatment and is fit and fine. He does need to take some medications but is otherwise healthy.
A young 33-year-old woman came to me with a history of recent treatment for a blocked heart vessel. Now, this is very unusual. Women are lucky that they have the estrogen hormone, it protects them from heart diseases (unlike men) right up to their menopause, approximately till they are 50. So, I was concerned and asked her about her periods. She said that they were irregular. She had been told that she had PCOS. Now, PCOS can put a woman at high risk of heart disease but not usually this early (30’s). She almost certainly had to be low on estrogen hormone.
I looked at her closely. She had a certain set to her ears, slightly different teeth and facial features. Medicine is not only a science but an art as well. I questioned her again. She said she had a cyst removed from her ovary. Now the alarm bells were clanging ominously. Finally, she put all her cards or in this case, her files on the table.
She had a rare disease where the ovaries don’t work right from early on, and their facial features give away the diagnosis. The fact that she also had a thyroid problem further strengthened my case. The diagnosis is important because if we give her estrogen tablets, it would protect her heart and prevent another heart problem.
Of course, the patient found it hilarious that I suspected her diagnosis by looking at her ears. She had never heard anything so bizarre!
Endocrinology is as fascinating as it is rewarding. Every single day brings a different challenge. Keeping your eyes and ears open greatly increase your chances of a correct diagnosis. Patients who trust you and follow instructions make their own lives healthier! And a simple acknowledgement for our efforts makes our lives worthwhile.