Annoying episode of the TV show 'A Gifted Man'
I just wanted to mention/discuss something which annoyed me recently.
I was watching an episode of a show I have enjoyed lately, namely she CBS show "A Gifted Man". The main character is a brilliant neurosurgeon at the top of his field, whose life undergoes a dramatic change when he begins to have 'visitations' from his dead ex-wife. As it turns out, he and his ex-wife actually both worked as family physicians in a remote part of Alaska years before, trying to help people. (Although he later left family practice and became a neurosurgeon.)
All right. In one of the latest episodes a man is coughing up blood, and it appears he does have a history of drug use. The fellow is actually a friend of the main character's. As far as symptoms go, he also has lost a lot of weight as well as lost his appetite in general, and has begun craving salt. Both our main character (i.e. the neurosurgeon) and another character (i.e. a general practitioner/family physician) have a 'eureka' moment when they hear about the weight loss, loss of appetite, and salt craving, and conclude the patient must have Addisons's disease (i.e. lack of or badly functioning adrenal grands). The (female) family physician who is working with our neurosurgeon states however that the only thing that "doesn't fit" with Addison's is the coughing up of blood (i.e. hemoptysis, in medical terminology). Upon which our main character states that one needs to be a neurosurgeon to figure this out (which is one thing I strongly disagree with)...
He explains that the patient must have lung cancer, which must have metastacized to the brain (more specifically, right in the area of the pituitary gland). This has, he concludes, affected the function of the pituitary gland in the brain, which gland actually secretes a hormone called ACTH which stimulates the adrenal gland. Therefore, no/low pituitary function = no/low adrenal function and Addison's disease.
My slightly annoyed comment is as follows.
There are a number of ways one could get Addison's disease (it can actually happen as a result of direct damage to the adrenal glands or as a result of damage to the pituitary gland as mentioned in the show). The scenario in the show certainly is one answer, but IT ISN'T THE ONLY POSSIBLE EXPLANATION FOR HIS SYMPTOMS!! The bleeding from the lungs/bronchi could be completely unrelated to the Addison's disease (they are correct that his other symptoms are rather characteristic of this condition however).
Later, it is also stated that the patient is lucky because, while he does have lung cancer, his cancer is: (i) localized and (ii) of the 'small cell' type of lung cancer which they state responds well the chemotherapy.
Um, here's some information for you folks. The small cell type of lung cancer is actually the most aggresive and the most deadly form of lung cancer and despite its high response to chemotherapy it also tends to REOCCUR in the majority of patients. Also, in actual fact the patient's tumor is NOT localized if he has already has a metastasis. That implies that there may well be other cancerous cells elsewhere in the body which aren't yet obvious. So having lung cancer in general is bad, and having the type of lung cancer be of the 'small cell' type is particularly bad.
To CBS: Don't you have medical consultants working for you for a show like this??? PLEASE.... Use them!! Argh!
Also, I will admit that this is a bit of a technical topic, but it did annoy me.
/end rant :-D
References
1. On Addison's disease: http://www.mayoclinic.com/health/addisons-disease/DS00361/DSECTION=causes
2. Causes/reasons for coughing up blood (i.e. when the blood comes from the lungs/bronchi): http://www.mayoclinic.com/health/coughing-up-blood/MY01064/DSECTION=causes
3. Patient information on lung cancer treatment: http://www.uptodate.com/contents/patient-information-small-cell-lung-cancer-treatment
I was watching an episode of a show I have enjoyed lately, namely she CBS show "A Gifted Man". The main character is a brilliant neurosurgeon at the top of his field, whose life undergoes a dramatic change when he begins to have 'visitations' from his dead ex-wife. As it turns out, he and his ex-wife actually both worked as family physicians in a remote part of Alaska years before, trying to help people. (Although he later left family practice and became a neurosurgeon.)
All right. In one of the latest episodes a man is coughing up blood, and it appears he does have a history of drug use. The fellow is actually a friend of the main character's. As far as symptoms go, he also has lost a lot of weight as well as lost his appetite in general, and has begun craving salt. Both our main character (i.e. the neurosurgeon) and another character (i.e. a general practitioner/family physician) have a 'eureka' moment when they hear about the weight loss, loss of appetite, and salt craving, and conclude the patient must have Addisons's disease (i.e. lack of or badly functioning adrenal grands). The (female) family physician who is working with our neurosurgeon states however that the only thing that "doesn't fit" with Addison's is the coughing up of blood (i.e. hemoptysis, in medical terminology). Upon which our main character states that one needs to be a neurosurgeon to figure this out (which is one thing I strongly disagree with)...
He explains that the patient must have lung cancer, which must have metastacized to the brain (more specifically, right in the area of the pituitary gland). This has, he concludes, affected the function of the pituitary gland in the brain, which gland actually secretes a hormone called ACTH which stimulates the adrenal gland. Therefore, no/low pituitary function = no/low adrenal function and Addison's disease.
My slightly annoyed comment is as follows.
There are a number of ways one could get Addison's disease (it can actually happen as a result of direct damage to the adrenal glands or as a result of damage to the pituitary gland as mentioned in the show). The scenario in the show certainly is one answer, but IT ISN'T THE ONLY POSSIBLE EXPLANATION FOR HIS SYMPTOMS!! The bleeding from the lungs/bronchi could be completely unrelated to the Addison's disease (they are correct that his other symptoms are rather characteristic of this condition however).
Later, it is also stated that the patient is lucky because, while he does have lung cancer, his cancer is: (i) localized and (ii) of the 'small cell' type of lung cancer which they state responds well the chemotherapy.
Um, here's some information for you folks. The small cell type of lung cancer is actually the most aggresive and the most deadly form of lung cancer and despite its high response to chemotherapy it also tends to REOCCUR in the majority of patients. Also, in actual fact the patient's tumor is NOT localized if he has already has a metastasis. That implies that there may well be other cancerous cells elsewhere in the body which aren't yet obvious. So having lung cancer in general is bad, and having the type of lung cancer be of the 'small cell' type is particularly bad.
To CBS: Don't you have medical consultants working for you for a show like this??? PLEASE.... Use them!! Argh!
Also, I will admit that this is a bit of a technical topic, but it did annoy me.
/end rant :-D
References
1. On Addison's disease: http://www.mayoclinic.com/health/addisons-disease/DS00361/DSECTION=causes
2. Causes/reasons for coughing up blood (i.e. when the blood comes from the lungs/bronchi): http://www.mayoclinic.com/health/coughing-up-blood/MY01064/DSECTION=causes
3. Patient information on lung cancer treatment: http://www.uptodate.com/contents/patient-information-small-cell-lung-cancer-treatment