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BLOG: The story of a Hiroshima bomb survivor — Part 1
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Paul Satoh, MBA, PhD, had been a patient of mine since 2007; he is now 81 years old. He is not only a patient but also a friend.
Paul is an active adjunct professor of chemical engineering at Michigan State University. He retired a few years ago from his most recent full-time job as the vice president for basic and explanatory research at Neogen Corporation in Lansing, Michigan.
Paul and I decided to write his story and share it with the world. In fact, not only one story, but many stories. We would like to tell the story of his life journey from Hiroshima, Japan to Lansing, Michigan.
Paul is a very smart thinker, an avid researcher, a high intelligent scientist, a marvelously creative inventor, and an exceptional educator — all with a great sense of humor. Still, Paul never quits learning. He recently graduated from Michigan State University with a master’s degree in business administration.
When Paul was initially referred to the Michigan State University endocrinology clinic in early 2007, the reason for consultation was for management of his type 2 diabetes.
Paul politely asked if he could inquire about my medical qualifications before I began the consultation, I agreed and gave him a run-down of my medical school and postgraduate medical training history.
During my clinical evaluation of Paul on this consultation visit, I found that there was an asymmetry in air entry between the two sides of his chest. Clinicians realize that this physical exam finding suggests some problem in the lungs or respiratory passages. Paul is a very meticulous observer and asked why I was listening more and more to his back.
Paul asked impatiently, “What does this have to do with my diabetes?”
“The air entry is unequal in your chest,” I explained.
Paul asked what that meant and I explained that there may be a problem in his lungs. I asked if he had any respiratory distress or history of asthma or prior lung infections. Paul responded that he had never been told there was a problem with his lungs.
At that point into the consultation, I became concerned that this situation might have made Paul somewhat skeptical or leery of my clinical competence.
Paul then began to gradually change the tone of his conversation; he stated that he was not aware of any problems with his lungs and that he had prior imaging studies and did not recall any doctor suspecting or telling him of a lung or respiratory problem.
Paul then asked, “what do we do next?” I said I would order a chest x-ray and he went for the x-ray the same day. The report came back and I was so surprised I went down to the radiology department to review the images myself. There was a significant deviation of the trachea that would explain the asymmetry in air entry. Further, a faint shadow of a large soft tissue was noted deep on one side of the neck, causing the tracheal deviation.
I called Paul the same day and notified him of the findings. He was, likewise, surprised. I asked him to come the next day so I could repeat the neck exam. On repeated exam I was not able to feel the mass with certainty. A subsequent neck imaging confirmed a subtle thyroid mass located deep into the neck and behind the bony structures, explaining why the mass eluded physical exam. Paul underwent surgery and ultimately the mass turned out to be a poorly differentiated follicular thyroid cancer, with rare features that were difficult to interpret by local pathologists. We sent the surgical slides to one of the most renowned thyroid pathologists in the country for a second opinion, who confirmed the rare type of thyroid cancer. Following thyroidectomy and radioactive iodine ablation, Paul has been in remission since then.
In retrospect, following surgery, Paul noticed that he could now sleep better at night, realizing his air passages had been somehow previously comprised from the pressure of the thyroid cancer that deviated his trachea.
Paul wished to publish his comments about the diagnosis and management of his incidentally discovered thyroid cancer: “I was impressed with the careful diagnostic skills of Dr. Aldasouqi which led to the discovery of the large mass of follicular carcinoma of thyroid. I believe those skills were instilled during the days of his medical training, where he must have been trained to develop an intuition by the meticulous listening to the breath sounds. Perhaps, evidence-based medicine based on large numbers of data utilizing artificial intelligence should not ignore the importance of well-instilled skills which enable the physician to meticulously evaluate differential sounds, texture or color quality during evaluation of their patients.”
Naturally, the next question at that time was “what risk factors did Paul have for thyroid cancer?”
Typically, when we evaluate a case of thyroid cancer, or a suspected case, we focus on two plausible risk factors: family history of thyroid cancer and personal history of radiation exposure to the head/neck region.
Some thyroid cancers run in families, such as medullary thyroid cancer, but are very rare. The most common cancers, papillary and follicular thyroid cancers, do run in families but less strongly than the former.
Radiation exposure is an intriguing piece in this context — contemporary physicians will be surprised that in the older days (perhaps in the 1940s and 1950s) many conditions were treated by external radiation. Enlarged tonsils, adenoids and acne are examples. It was not unusual for general doctors to have therapeutic x-ray machines in their clinics. So, now we encounter occasional patients with history of radiation exposure to the head and neck.
Interestingly, radiation exposure has occurred in certain geographic locations with the Chernobyl and Fukushima nuclear accidents being the most popular occurrences. Populations exposed to radiation from these accidents were found to have a very high risk of thyroid cancer. What about exposure to atomic bombs?
So far, there are only two such incidents: the Hiroshima and Nagasaki atomic bombs.
In the case of Paul, he has no relevant family history of thyroid cancer. Regarding radiation exposure in childhood, Paul was 8 years old when the atomic bomb was dropped on Hiroshima. It seems that this remote risk factor has chased Paul all the way from Hiroshima to Lansing. The expert pathologist described Paul’s cancer as having features similar to those noted in thyroid cancer in patients who were exposed to the radiation from Chernobyl, commenting that such features are characteristic of massive radiation exposure.
The story of Paul’s survival from the Hiroshima atomic bomb is to be continued.