Case Studies

A few of the interesting cases that Dr. Dushyant Patel has diagnosed and treated, in office or in hospitals, are mentioned here reflecting his clinical expertise and acumen as well as his excellent medical knowledge and diligence in the care he renders:

  • One of his patients had a routine Physical exam and Dr. Patel detected a barely palpable prostate nodule with some firmness on one lobe. Patient's PSA level was within normal range but was elevated by 1 point compared to his previous level of PSA. He referred the patient to an urologist who did not feel the prostate nodule much on the exam but prostate ultra sound did confirm the presence of the prostate nodule and the biopsy showed moderately aggressive adenocarcinoma. The urologist complemented Dr. Patel stating, "Dr. Patel, you saved this patient's life", especially as the lesion, which turned out to be aggressive cancer, was barely detectable on the exam and could have been easily missed. The patient requested another urological opinion (asking if he could be referred to an urologist who treated his friend) for which Dr. Patel assisted him and he was operated by the second urologist and patient was doing fine the last time he was seen.

  • An elderly patient came to Dr. Patel from another primary care physician, after he was referred by his wife and son to our office, with a history of Diabetes, High Blood Pressure, High Cholesterol and joint pains for over one year. While patient had osteoarthritis, Dr. Patel evaluated him and diagnosed him to have Gout as well. After he was treated for gout his joint pains resolved indicating that he had significant component of pain from gout.

  • One of Dr. Patel's patient requested if he could see his daughter in her late teens. She had been seen by two primary care physicians according to the father for abdominal pain with negative abdominal ultrasound. Dr. Patel ordered a pelvic ultrasound (which had not been done by previous physicians) because patient had left lower abdominal pain and diagnosed that this patient had an ovarian tumor that was congenital in nature. Patient was referred to a gynecologist who resected the ovarian tumor after which the pain resolved.

  • Dr. Patel saw two patients a few years ago with hypertension. Both were in their 30s and one patient had uncontrolled hypertension because she was not taking her medications due to side effects. When she complied with the new medication regimen prescribed by Dr. Patel, her BP was in the acceptable ranges without any side effects. Both patients were seen by other physicians in the past. Dr. Patel detected both patients to have renal lesions indicative of kidney tumor on their initial work up. Urologists resected the tumor on both cases and they were found to be malignant kidney tumors. Both patients did well post operatively on further follow up while under the care of Dr. Patel.

  • Dr. Patel saw a young female patient after she moved from another city where she had been seeing another physician. While obese, she complained of mild persistent "gas" (flatulence) and complained that she could not lose weight to the Pediatrician in the office who was her son's physician and referred the mother to Dr. Patel. Her (abdominal) examination was unremarkable. Dr. Patel decided to order additional tests on her (UGI & abdomen US). He suspected as well as diagnosed her to have intra abdominal tumor/malignancy that turned out to be an aggressive pancreatic cancer with metastases. The surgeon who was consulted was trained at the Stanford University complemented Dr. Patel, stating, "Dr. Patel, no other doctor would have worked the patient up", because her symptoms were not typical of a malignancy and she had no weight loss or abdominal pain. (The Gastroenterologist on the case initially thought that her intra-abdominal mass on her ultrasound was either from Tuberculosis or Crohn's disease.)

  • A few years ago Dr. Patel had seen two young patients with atypical and unexplainable symptoms and upon work up, they were found to have vitamin deficiencies. Their symptoms improved after the treatment.

  • Dr. Patel was called in by an Obstetrician to see a patient who had severe abdominal pain and who was in the midst of delivering her baby. Dr. Patel promptly saw the patient and found her to have an acute abdominal condition requiring immediate surgery. She was found to have acute Meckel's diverticulitis and recuperated well after the surgery and delivering her healthy baby.

  • Dr. Patel saw a patient in her 90s upon the request of the emergency room physician, who indicated to him that the patient was a "No Code" and family did not want any pacemaker on her, relaying that patient had recurrent syncopal attacks due to sick sinus syndrome and heart block. Cardiologists had evaluated her three times before Dr. Patel was called in. Patient's spouse as well as her son accompanied her in the E.D. While Dr. Patel respected the family's desire not to do any aggressive or resuscitative measures, he explained to the son that she could benefit from a pacemaker as she was at risk for falls that could potentially lead her to sustain head trauma that could cause brain hemorrhage/ hematoma or hip fracture or other complications and this could be prevented by patient having a cardiac pacemaker. Her son understood the reasoning of the benefit of the pace maker and that it was appropriate to do so in this situation. Patient did fine after the pacemaker was implanted.

  • Dr. Patel was called in to attend a patient with acute upper gastrointestinal bleeding with a hemoglobin that dropped to a range of 3 (one of the lowest levels he has seen in his practice). Patient refused blood transfusions, because he was a Jehovah's Witness. The patient understood he could die without the transfusion, especially as the gastroenterologist was unable to stop the bleeding from his ulcer after procedures on two attempts. Patient agreed to a special protocol using thrombotic agents as a last resort and was monitored by hematologist/surgeons and Dr. Patel. Dr. Patel was able to work with the patient as well his church leaders who were present and supportive of patient in the ICU. With this protocol his bleeding stopped. He was told about the risk associated with thrombotic agents including the possibility of myocardial infarction/stroke. He was stabilized and discharged in a satisfactory condition. It was emphasized to him to not take any NSAID medication which had been the cause of his bleeding from the ulcer, this time as well as in the past. He was advised to try and seek other treatment for his lower back pain.

  • ER physician requested Dr. Patel to see a patient in his 20s for recurrent seizures for which he had been seen by a neurologist the day before and he also had several visits to different ERs with supposedly an unremarkable brain CT scan and drug screening. The ER physician told Dr. Patel that patient's alcohol and drug screen were unremarkable. Patient also denied the history of alcohol and drug use in presence of his parents. Dr. Patel suspected it to be otherwise and after extensive conversation with the patient and the family, the diagnosis was pinpointed to be drug/alcohol withdrawal (during which time the drug screenings were unremarkable). Patient was referred to a specialist for further management. Neurologist who had seen the patient the day before came in and asked Dr. Patel how he got the history of drug use. (Neurologist was unable to get that history from the patient and he did not know the cause of patient's seizures).

  • Dr. Patel was called at midnight by an emergency room (ER) doctor as he did not know the cause of coma in the patient in the ER. ER doctor was waiting for patient's lab tests and when asked, he stated to Dr. Patel that he did not have the urine analysis. He promptly went to see the patient and diagnosed patient to have Diabetic Ketoacidosis (DKA) causing his coma. He discontinued IV Dextrose being given by the ER physician as he noted patient's blood sugar to be over 1700. Dr. Patel skillfully managed patient's new onset of DKA in the ICU until patient was able to go home to his daughter/son-in-law. Patient did not have any insurance and Dr. Patel treated this patient at no charge in spite of attending him for a few weeks.

  • Dr. Patel requested an urologist to see a young patient with a new onset of hematuria (blood in urine); his previous abdominal and urine exams were normal. After extensive tests including renal angiogram and biopsy, the results did not yield the diagnosis of cancer that was suspected. After his hematuria stopped, he was discharged with an outpatient follow up. He complained of a new onset of mild shoulder pain upon follow up visit. His shoulder X-rays were ordered and were read by the radiologist as normal but then, there was an addendum with a mention of "possible mild radiolucent area in the humerus." The patient was advised to see an orthopedic surgeon promptly for humerus bone biopsy to exclude the possibility of kidney cancer metastasis. Patient went to an orthopedic surgeon that was known to his wife. His biopsy revealed that he had renal cancer that had metastasized to the humerus. He was referred to an oncologist for further care and follow up with the urologist.

  • An elderly patient came to Dr. Patel's practice after she had previous history of bladder cancer that was resected by an urologist and had the ureterostomy. Dr. Patel diagnosed her to have a small polyp in the rectal area on a routine sigmoidoscopic exam that turned out to be rectal cancer which was resected by a colorectal surgeon. She had radiation therapy as well. A few years later, her tests for stool occult blood were positive. She was given a note to take to the gastroenterologist for repeat colonoscopy. Upon the next follow up with Dr. Patel, she was asked if she had undergone the repeat colonoscopy exam. Patient stated that she forgot to give the note to her gastroenterologist and hence, she was reminded to return to her gastroenterologist to complete the colonoscopy. She was found to have a large pre-malignant tumor in the cecum. She had partial colon resection by the same colorectal surgeon and did well for many years.

  • One of Dr. Patel's patients told him that he was going to another state for about eight months and he was requested to see Dr. Patel upon his return. A few months later, the patient was noted at the office window by Dr. Patel. On conversing with the patient, Dr. Patel found out that he was seeing an ENT doctor for a new onset of pain behind his ear. He had a folder of his X-Rays ordered by his ENT doctor. Dr. Patel requested the patient that he should be seen and accommodated him during the office lunch time. Dr. Patel ordered blood tests that revealed that the patient had a new onset of anemia. Upon additional work up, Dr. Patel detected that the patient had stomach cancer. This patient had normal stomach X-rays (UGI) one year before he went out of California and he had no abdominal pain, anemia, weight loss or occult gastro- intestinal bleeding in the past.

  • Dr. Patel admitted a patient after she was brought in to the ER from a nursing home with acute respiratory failure due to severe emphysema requiring ventilator support. She had a vague complaint of chronic abdominal pain but there was no acute abdominal illness. Later on in the afternoon, the gastroenterologist contacted Dr. Patel wondering if he knew that the patient was taken to the O.R. The patient had been taken for an exploratory laparotomy by the surgeon on the case without Dr. Patel's knowledge. Dr. Patel called the O.R. and pulled the patient out of the O.R. (without undergoing any surgery). He explained to the surgeon that her abdominal pain was not from any acute surgical problem and that there was no indication to do any exploratory laparotomy while the patient was on a ventilator. Patient subsequently did well and was able to wean off the ventilator. Later on, she moved out of California to be with her family. Dr. Patel always places importance on the welfare of his patients and especially so in this case, as the patient's family was not around.

  • A young patient complained of a cough for about a year and had history of high blood pressure medication given to him by a previous internist. Dr. Patel changed his high blood pressure medication as he suspected that it was the cause of his cough. The patient's cough resolved after changing to another BP medication.

  • Dr. Patel diagnosed an enlarged thyroid on patient's first visit. Patient was not aware of it. The patient stated that she had been seen by another internist and an ENT specialist prior to seeing Dr. Patel. Dr. Patel ran additional tests and patient's thyroid biopsy showed a tumor that turned out to be noncancerous.

  • Dr. Patel was called in by an ER physician to manage a patient with acute respiratory failure who was on a ventilator as he had Acute Respiratory Distress Syndrome (ARDS)/non-cardiogenic Pulmonary Edema which has poor prognosis. After considering all the possibilities Dr. Patel ordered appropriate tests including Legionella pneumonia work up and started the patient on triple antibiotics plus IV Erythromycin. The consultant Pulmonologist put an order to discontinue IV Erythromycin the next day without Dr. Patel's knowledge, which was promptly caught by Dr. Patel during his rounds. He specified to the ICU nurse and Pulmonologist to resume IV Erythromycin and to not stop it unless he approved, as results of the tests he ordered were pending. Patient actually did have Legionella pneumonia causing ARDS and IV Erythromycin saved his life. He was able to get off the ventilator quickly and was discharged in a few days.

  • During his training days, Dr. Patel was making rounds with his team and he saw another team discussing a patient, whose X-Rays were up on the view box. They were discussing that the patient had shock (without any sepsis, bleeding or acute heart attack). After a quick glimpse at patient's X-Rays, Dr. Patel stated that the patient probably had cardiac tamponade from the colon eventration in to the thoracic area as he noted intestines in the chest cavity. That was exactly what it turned out to be and the attending physician stated at that time that it was so rare that he might never see a case like that again. Dr. Patel has always had a keen diagnostic skill from his training days.

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