Contact Us
Mental Health
Financial advice
Youth Matters
Techno Corner

M. P. Ravindra Nathan
By M. P. Ravindra Nathan, MD, FACP, FACC Director, Hernando Heart Clinic, Brooksville, FL Editor-in-Chief, AAPI Journal

It is always difficult to break bad news to the patients or their relatives because nobody is a winner in these situations. Yet, it needs to be done somehow. I have observed several patients deal with adversity over the past many years and I know each reacts differently. The following two cases come to mind.

Mrs. Sara R, a 72-year-old persistent cigarette smoker, in spite of strong advice from physicians, came one day with a cough. She had suffered from Atrial Fibrillation, a rhythm disorder of the heart, which was well controlled with medications. Although her husband used to come regularly at four-month intervals, the wife was often a no-show saying that “she is fine and doesn’t see the necessity for frequent follow-ups.”

During this visit, she said she has this nagging cold and a persistent cough. She hasn't lost any weight. My initial impression was that she may have a touch of bronchitis but insisted on a chest X-ray and prescribed an antibiotic. The following day, the radiologist called me and said, "You know what, Sarah has a tumor in the right lung."

I immediately asked Sara and her husband John to come to the office and also pick up a copy of the chest X-ray from the hospital along the way. Being a straight shooter as I am, I put up the X-ray on the view box and said without mincing words:

"Sara and John, I have to tell you something very important. Sara has a spot in the right upper lung, which we need to look into.”

"It is cancer, isn't it, Dr. Nathan, I know it is," Sara said, as though she had a premonition. She looked sad but stoic.

"I don't know that yet, but it could be a tumor. Not all tumors are cancerous though. I am sending you to a pulmonary specialist who will do a CT chest and bronchoscopy with biopsy. Then only we will know the true nature of this lesion." "What are my chances is there a cure for this condition?"

Since we always have to give hope, no matter how bad the odds are, I said carefully: "It all depends on how operable the lesion is, meaning if the CT doesn't show spread. Let us not jump into any conclusion. This could turn out to be a benign lesion." Although, I knew that was less likely.

As it turned out, Sarah did have an unresectable squamous cell cancer of the right lung, which did not respond well to radiotherapy, and chemotherapy and she died after 18 months. I used to see John afterward for another couple of years till he moved out of the area. But I think both of them appeared to be satisfied with my handling of the case.

The case of Jim S. was different. A 58-year-old, self-assured business executive, Jim was literally dragged to my office by his wife for a cardiac check up. It appeared that he had multiple risk factors for coronary heart disease and his exercise stress test with nuclear imaging turned out to be abnormal. So, I recommended a heart catheterization test. Visibly upset and in great denial, words tumbled out of his mouth.

“Get out of here, I don’t have any heart disease. I am not taking that test.”

“No, Jim, you have to do what the doctor says, it is your life,” his loving wife coaxed him.

“It was your idea in the first place,” he said angrily pointing a finger at his wife. “All I had was a little heart burn.”

“You can get a second opinion if you would like,” I was trying to giving them an exit strategy, if they didn’t want to make a decision.

“No, that won’t be necessary,” the wife said softly but with a touch of firmness in her voice. “Go ahead and schedule it and I will see that Jim shows up.”

As it turned out Jim had multi-vessel coronary disease and needed bypass surgery. He was back at his desk working away after six weeks and was happy and certainly more respectful during his next office visit.

Over the years, I have had many instances to tell patients that either they have severe heart disease needing bypass surgery, angioplasty, etc. or cancers of various kind with grim outlook. A lot of patients have a ‘sinking feeling’ when suddenly confronted with adversity. And yet I consider openness is the best way to start any discussions and it probably helps healing faster. Heart disease doesn’t evoke much fear these days since most are easily treatable. But cancer still strikes terror in the minds of people, so one has to be careful and soft when breaking the bad news. The last thing you want to do is to frighten a patient so that they will shun any form of treatment and withdraw from all doctors.

If the patient is ill in the hospital and may not be able to handle the shock of the news, I first inform the close relatives know the true nature of the condition and take their advice before informing the patient. However, in real life we have to face many difficult and unpleasant issues and keeping the hopes high against reason is not a good idea either.

Sensitive and caring interactions between patients and their treating physicians and nurses – is what communication is all about. Consider each patient as an individual.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

Payal Patel

As the colder fall and winter months approach, the whole array of colds and allergies come into practice as a pediatrician. In this article, I would like to share some valuable information with most of the parents who have to deal with these common childhood illnesses.


A cold is caused by one of the 200 different types of cold viruses. Healthy infants and toddlers can get an average of 7-8 colds per year. Remember, this is just an average, so if your child gets 5-6 colds or on the extreme 10-12 colds per year, it is still considered normal. A cold usually lasts about 5-10 days. Usually, it starts with a runny nose which is clear in color but can progress to a yellow-green color before the cold is over. It may also produce fever as a symptom which usually subsides in 3-4 days.


Most parents bring their child on the second or third day of the cold symptoms. In my experience as a pediatrician and as a mother, I have noticed that the cold symptoms are worst on the third to the fifth day and then gradually decrease thereafter. If these symptoms were to continue or worsen past 4-5 days then I tell the parents to return to the office. In these cases, a bacterial infection can be a possibility since the mucous that sits in the nose and throat can harbor bacterial growth.

One of the most common misconception that I encounter in my practice is parents wanting antibiotics for the common cold. I take my time to explain why antibiotics only work for a bacterial infection, and are not useful since a cold is caused by a virus. The only cure is time since the virus will slowly go away. TREATMENT

I recommend symptomatic relief with over the counter cough and cold medicines only as needed. If the child has a fever, I recommend Tylenol and Motrin. Otherwise, I encourage supportive measure like saline suctioning for babies or nose blowing for older children. Getting rid of the nasal discharge is a way of eliminating the virus from our body. Another helpful measure is a humidifier since this delivers moist air and will ease the child’s breathing.

Parents worry when their child is not eating much during a cold. I stress the importance of providing plenty of fluids, which include water, juice, pedialyte, and even milk, as a means to help the immune system. PREVENTION

Hand Washing- Since colds are spread by direct contact with a cold virus through touching someone’s hands, and also things such as toys, door knobs, etc. Remember, if your child goes to school, daycare, or even playgroups they are constantly exposed to many different viruses. Obviously, they are more prone to infections, but this exposure will also build their immune system. Also if the child has siblings that go to school or live in large family settings, they are at increased risk of exposure to infections.


If your child has yellow-green nasal discharge for greater then 10 days with no improvement.

If the child complained of earache, sinus pressure and pain, any vomiting or severe sore throat

If fever lasts more than 3 days or is higher than 102 degrees

If eyes are red and have yellow discharge

If there is breathing difficulty with uncontrollable coughing, increase in breathing rate, or use of chest muscles excessively

If child is clearly not drinking enough and looks dehydrated-decrease in urine, no tears when cries.


On the other hand, allergies are your body’s reaction to some type of an allergen. Most commonly noted is seasonal allergies to pollen, grass, or ragweed usually during the spring and fall months. The symptomatic way to differentiate it from a cold are clear nasal discharge, sneezing, sniffling. The child can also have itchy, watery, red eyes. Allergies are not associated with a fever, and usually occur around the same time of the year. The treatment is an antihistamine medication like Benadryl, or other medications such as Children’s Claritin or Dimetapp Non Drowsy for allergies, sometimes along with prescription nasal sprays. Stronger medications for severe allergies are available through prescription.

Dr Payal Patel can be reached at

Contact Information
The Editor:
Send mail to with questions or comments about this web site. Copyright © 2004 Khaas Baat.

Anything that appears in Khaas Baat cannot be reproduced, whether wholly or in part, without permission. Opinions expressed by Khaas Baat contributors are their own and do not reflect the publisher's opinion.

Khaas Baat reserves the right to edit and/or reject any advertising. Khaas Baat is not responsible for errors in advertising or for the validity of any claims made by its advertisers. Khaas Baat is published by Khaas Baat Communications.