World Hepatitis day – Test.Treat.Hepatitis

Today is world Hepatitis Day . The theme is Test.Treat.Hepatitis.

325 million people are affected with Hepatitis B and C which is root cause for liver cancer leading to 1.3 million deaths every year. Hepatitis B can be prevented and C is treatable.

As with my blogs, I want to share a true story and this time the story is about myself.

I have been operating patients with Liver cancer and Hepatitis B for the past 3 decades. Like many others, I was under the false notion that I was immunized for Hepatitis B. Hepatitis B immunization is done on Day 1, Day 30 and after 6 months. I vaguely remembered that I was immunized on Day 1 and Day 30 but was not sure on the 6 months booster which unfortunately is the case with many of us.

One of my doctor colleagues was looking for a job in another Institution and fortunately that Institution insisted on Hepatitis B and C testing. To his utter shock and disbelief he was tested positive for Hepatitis C, which must have been contracted from a patient. Fortunately there are drugs for treating Hepatitis C and also new drugs that reduces the treatment to just 3 months. He was cured completely from Hepatitis C and could join the job.

Then I thought, why not get tested for Hepatitis B & C and to my utter disbelief found that I had NO antibodies for Hepatitis B. In other words, I was at high risk for contracting the disease. This was because of inadequate immunization. So I was operating patient with Hepatitis B taking due precautions but I could have contracted Hepatitis B and C. There is effective immunization for Hepatitis B. I immediately took immunization again and now have adequate antibody titre.

This certainly is relevant and I urge my medical colleagues and friends to get tested for B and C. We do not know when get exposed. Hepatitis is a silent disease which goes on for a long time and can lead to cirrhosis or fibrosis of liver and then later  liver cancer.. This can be easily prevented.

In the US, the CDC has given directive that those born in the 50s and 60s are not immunized for Hepatitis B, as the vaccines were not part of the universal immunization programme as per today’s guidelines.  This is also  true for us.

Yes, we have risk of getting exposed. Hepatitis B spreads with body fluids, could be in hospitals, dentists, tattooing or unsafe use of injections. All this can be prevented. India has only constituted committees ( WHO infographic). This is the time for action and not just forming committees. Apart from the guidelines, WHO makes it amply clear that we can eliminate Hepatitis by 2030 . My own example is more than enough for anyone to be tested immediately.

If you do not remember that you are immunized, you can get immunized for Hepatitis B. This is partly true of those families who have patients diagnosed with Hepatitis B. Hepatitis C has no vaccine at this point of time but has good treatment.

Elimination of hepatitis reduces risk of liver cancer and cirrhosis. Saves lives.

Here’s an appeal by Dr. Tredos Adhanom Chebreyesus, Director General of WHO that calls for immediate action.

“World Hepatitis Day is an opportunity to highlight one of the world’s most pressing public health issues. Globally, viral Hepatits B and C affect 325 million but only 1in 10 of those people have been tested and only one in 5 have received appropriate treatment. Viral Hepatitis slowly and silently degrades a person’s health leading to liver cancer and cirrhosis which results in 1.3 million deaths every year. The good news is that we have new medicines that can cure Hepatitis C in 3 months or less. WHO’s new recommendations call for treating everybody with Hepatitis C aged 12 years or older with these new drugs. That’s about 70 million people. While testing and treatment are key to eliminating Hepatitis, we also need strong focus on prevention. We have a clear vision for elimination and we have the tools to do but we must accelerate our goal of eliminating Hepatitis by 2030.”

 

Does Age matter?

I had written earlier on surgery for a 79 year old gentleman. Now a true story about an 85 year remarkable old  lady.

When I was coming to my clinic I saw an elderly lady in a wheel chair.

I thought to myself, whatever it is, I just have to counsel her that she would not be suitable for any major surgery and send her back home for some supportive care.

Her son is a Paediatrician in the US. He came in and I started saying, “How old is your mother? She is 85 and too old to undergo any surgery”.

Then he stopped me and said, “I also know that, but I just want you to talk to her once before making up your mind”.

I said, “Oh! Certainly, let me just talk to her”. So she came in and I said, “You see Maaji, you are 85 and surgery at your age would be problematic because of complications”. She had a colon cancer with obstruction.

She said, “I am Mrs. Dikshit,( she insisted that I use her real name). There are 15 doctors in our family. So I know what I am talking. Do you know that I never went to a hospital so far? I do not have any heart problem or any other issue and this is the first time I am getting surgery done. YOU ARE GOING TO OPERATE ON ME. I know that I will survive”.

I was amazed that this lady who is so certain about her outcome. I said, “ but…” and she cut me short and said, “ NO ‘BUT’, YOU ARE GOING TO OPERATE ON ME, IT IS FINAL, IT IS MY DECISION”.

I said, “Okay, things may go wrong”.

She said, “So what if things go wrong. I am 85 as you know and lived my life well. Even otherwise I am not going to have much of a chance, so I’d rather take a chance with your surgery”.

Reluctantly I said, “Okay, let me try”.

My team was looking at me as if to say ‘Don’t do this, you will operate and we are going to have a problem’. We carefully evaluated her and every single test was normal. There was no way we could refuse surgery and taking high risk consent we went ahead with surgery. Believe it or not, on the 8th post-op day she literally walked home. When she came for suture removal she was walking and insisted that she will not come on a wheel chair.

I was so happy that I hugged her and said, “You are really remarkable, bless us that we would be like you at your age, so positive and so full of life”.

with mrs dikshit

More and more senior citizens are getting operated. As we know, longevity is increasing and we see more and more elderly patients. We are extending our boundaries of surgery with better assessment and anesthesia. Earlier I used to feel 65 is the limit, then 70, then 75 and now it is nearly becoming 85 which is really pushing the boundaries.

But more than anything else, I think it is not just the chronological age but physiological age as to the other co-morbid conditions, how active was their life and whether they had multiple other problems. I think all these factors have to be taken into consideration while planning surgery for elderly. The mental attitude is important There are many articles on surgery in elderly. Elderly patients have same outcomes for cancer if they don’t have postoperative complications says Dr Preston “ Geriatric surgery is about the disease and not the age”.

The most fascinating story is of Dr. Michael deBakey, the pioneer heart surgeon of Baylor college, Houston who was the father figure of cardiac surgery. In December 2006, at the age of 97, he had chest pain and was diagnosed with Dissecting aneurysm of Aorta. He had treated 10000 such patients. But as with many patients of his age, he was in denial and then refused surgery. After a month the chest pain was unbearable and he nearly collapsed. His partner for 40 years Dr. Noon said, ”Either surgery or death, what will you choose”. His wife then intervened and consented for surgery. Anaesthetists were not willing to put such an elderly and important person to sleep for a complex cardiac surgery and were literally forced. The surgery went on for 7 hours and with exceptional care of HIS OWN team, Dr Debakey was discharged from the hospital. He himself could not believe that he survived the surgery. The whole story is interesting NY Times article

It will be great if all of us can age without co-morbid conditions. Yes, at some point of time there will be some illness but at least if you are fit by that time you are more likely to come out fine.

The engine has to be kept running in good condition and then you can cover long distances.

Life is beautiful but the ‘second chance’ should be a remarkable journey

 

Here is a true inspirational story.

Last week I operated on Nimi for the 3rd time. She insisted that I use her name as she is not worried or scared.   She had undergone 8 surgeries since 2009 in different places including MD Anderson centre earlier. Yes, her morale should have been down and she should have been depressed and dejected. On the contrary she is full of life and keeps joking about her “unwelcome friend’. She has recovered well and rearing to get on with her life in full speed. God bless.

I had a chat with her after a major surgery nearly 4 years ago when we removed a huge mass.

She recovered well from the surgery and said “Doc, you have given me a second chance”.

I said, “It is not me but God who has given you a second chance but this ‘second chance’ should be used to lead a wonderful life”.  That statement seems to have stuck with her because she not only got back with vigour to her career but also enjoyed many trips abroad living life to the fullest.

There are many such remarkable men and women who not only beat cancer but also enjoy their lives without brooding continuously.

Thre is no doubt that positive attitude helps tremendously to cope with cancer and as a matter of fact any adversity. Be it chemotherapy or radiotherapy, its all about the will power. Fortunately we have a great family support system.

But more than any thing “ when you defeat fear, you defeat cancer’.

When I see such people I really feel that none of us have any cause to complain about the bad roads, monsoons and all the so called problems we face in our daily life. The biggest lesson from these patients is ‘Big C can not only be conquered but can be defeated with resounding success’.

The ‘second chance’ should be looked upon as a blessing to lead a remarkable life.