A selfie that can save you

Mr. Brahma Rao, a bank executive noticed a small ulceration on the border of his tongue. He was not a smoker and never chewed tobacco. He thought perhaps she has injured his tongue by teeth bite and continued with normal activities. After nearly 4 months he suddenly noticed severe pain in his right ear which alarmed him and the ulcer also had increased in size. He was worried and contacted me. As he was abroad and visiting his family and was due to return, I asked him to send me the pic of the border of the tongue like ‘a selfie of the tongue’ which he did.

tongue-pic

It clearly showed a small 1 cm. ulcer and the edges were elevated. It is a very important symptom and sign as lesions on the tongue having what is called ‘referred pain ‘ of the ear is because of nerve infiltration. I diagnosed him as early tongue cancer and he underwent treatment. Fortunately there was no spread at all and he recovered very well.

 

It is an important pointer for all. The tongue is so visible and can be easily seen and felt. Any kind of nodule or ulcer or nodule that is persistent for more than a month is not to be taken lightly. Tongue cancer is painless and has referred pain to the ear. In vitamin deficiency or an aphthous ulcer is more painful, superficial and small.

It is easy to document by a pic and sent to a doctor.

Ultimately you are responsible for your own health and sooner the diagnosis, the safer you will be.

Advertisements

Beware of sudden deterioration of ‘diabetes’ and loss of weight

 

Recently a colleague of mine frantically phoned up saying that someone who is very close to him has to be seen by me. The patient was a mild diabetic and recently his sugars shot up. He was then taken to a diabetologist who started him on  insulin dose. Then he started losing weight and in the next 4 months he lost 4 kgs. The diabetologist opined “It is because of control of diabetes and it is good that he is losing weight”. However after his sugars came to near normal he continued to lose weight and he lost 4 kgs over the next 3 months by which time there was a sense of urgency.

It was then that he underwent CT Scan and was found to have pancreatic cancer which was inoperable. My colleague was devastated, that inspite of availability of medical expertise diagnosis was delayed.

This is not unusual. It is very important to remember that sudden deterioration of diabetic status suggests either ‘infection’ or ‘tumour’. It is very important at this stage to get a scan done so as to rule out the presence of tumour. Early diagnosis is most important for management of pancreatic cancer as surgery remains the only most useful treatment.

Once again I have to re-iterate that weight loss is not to be taken lightly and any significant weight loss has to be investigated thoroughly including a scan.

Can anyone ‘sense’ cancer?

Can anyone feel that they may have a serious illness and it could be cancer?

You may think ‘Its not possible’, but yes cancer can be ‘sensed’

I ask all the patients, whether they felt ‘not normal’ and that there is a serious illness lurking around. Most of them say  ‘yes’. There is a feeling that something is wrong. the body is becoming weaker and the energy is going down. Or loss of weight and stamina.Many times visit to doctor is postponed or get treated with some usual medications.

Its a combination of nonspecific symptoms, but one does feel ” definitely unwell” .

I am reading the book” when breath becomes air” by a young neurosurgeon Paul Kalanithi, who is diagnosed with advanced lung cancer. He also realises that there is some serious illness, may be ‘cancer’. Its a moving story of an aspiring surgeon who works hard and is about to realize his dreams, when cancer strikes him. He writes his own story , perhaps mirroring the stories of many patients he had seen.

I recall a professor of surgery, a well known teacher, who one day suddenly declared that he had pancreatic cancer. His family and friends were surprised as he looked healthy.

‘Why  do you think so?’

‘For years I have taught students that migratory phlebitis  (red streaks on legs ) is a sign of pancreatic cancer and I have show them in my patients’.

“Now I have the same sign”.

He was investigated in disbelief, but the diagnosis was confirmed.

The first response however is denial, even more amongst doctors. No it cannot be. Then as time goes, the inevitable symptoms like pain set in and  the diagnostic tests are done.

I see many like him. So many experience that loss of energy as though slowly the life is getting squeezed. Its is best to  get investigated at the suspicion and not wait for full blown symptoms. Time indeed is the most critical as stage of diagnosis is the only major predictor of prognosis. Earlier the better.

You may be a busy corporate executive or your children have board exams. Something is always happening, but your health is a super priority. Nothing else matters.

The same thing happens to Paul in the novel. Loss of weight is due to ‘overwork’. Acidity is ascribed to ‘too many coffees and  stress’. Not eating well as ‘no time’.

I recently saw a CEO with symptoms and its only after six months that he went for investigations. Work deadlines,travel, annual reports , social life – so many ‘important’ things- more important than our health. we have so many proverbs but hardly ever care.

Health is wealth ( proverbial sense) , but it only ‘depreciates’ and not ‘appreciate’ like real ‘wealth’ in the bank.

Well the bank balances can evaporate with a single illness.

I see this also in elderly. ‘why bother my son or daughter when they are so busy with their jobs’. That’s not correct. Most families care for their parents and would be devastated if they find an advanced cancer . Many just ask the question” Can my mother or father be cured?”. No matter how old, even 80s, but they want the parents to be with them a bit longer.

Thats normal and human, just push the line a bit. A little more time , just a little !

So when you sense ‘something is wrong’, don’t brush it away.

An early check up can save your precious life.

 

 

 

 

Is cancer incidence increasing?

I met Roopa the other day and she asked me, “Doc, every friend or relative seems to be having cancer. Why? Is cancer incidence increasing?”

I am asked this question very frequently and I keep giving same answers to explain ( not convincingly ) the increasing numbers. With increasing longevity of life there is likely to be more cancer & non-communicable diseases. Life styles have changed and may contribute.

I recently went to the Indian Cancer Society Meeting on the Cancer Registry Project.   The Mumbai Cancer Registry records only residents of Mumbai and not migrant population and has plotted the incidence over the last three decades. Great work and a tough one too!

Breast and Lung cancers are increasing. There is  increase also in rectal and colon cancer.There is a continuous and constant increase in liver and gall bladder cancer in Mumbai. It is likely due to migrant population from north settling in Mumbai. Cervical cancer is decreasing as the hygiene is improving and parity is decreasing. In short we are transforming into a western pattern of incidence.

The worrying feature, however,  is the increase in mortality due to cancer. Stage to stage, more patients succumb in India than in other countries.

We have not made a significant dent overall in treatment. Its not that we don’t have facilities or expertise. We just continue to see patients in advanced stages.

I chaired a panel of experts.. The panel felt that prevention and early detection are the key. What is required is better diagnostic facilities for early detection

  • Creating awareness among people
  • Lifestyle modifications
  • Physician awareness and referal

These are not really difficult and if we concentrate on this perhaps we can start showing decrease as it is already happening in some of the countries in the West, in gastric, lung and cervical cancer.

More thoughts on these later.

 

 

 

‘Be aware’ of anaemia or Low hemoglobin

 

Jai is a regular donor to our Foundation. He is one of those who donates every year without asking. This time he came with a cheque earlier than ;usual and I asked him, “you normally would put in a cheque in March.” He said, “No, this is from my wife. Whenever she wins a kitty party she donates the whole amount to CACF. This is a remarkable way of using kitty money rather than on clothes or fancy things.

I asked Jai who is a businessman the sequence of events that led his coming for surgery. He is already 3 years post-surgery and doing well. Obviously he could detect the disease early and this is his story….

“I am part of the walking club and every morning I go walking for 60 min on Carter road but slowly I started becoming slightly breathless. My friends used to jokingly say that I am getting old and unable to keep up with them. I really could not keep pace with them. I started becoming breathless whilst walking up a flight of stairs too. Initially I thought its because of my heart but my ECG, everything was normal. I went to my general physician who ordered usual tests and to my utter surprise haemoglobin was just 8 gms against normal of 12 gms. So obviously I was feeling breathless because not enough oxygen was being carried by low haemoglobin. This started a series of investigations and fortunately my general physician got a scan done which showed mass in the colon and subsequently endoscopy confirmed Colon cancer and I came for surgery.”

This is a very important story and also brings out a valuable point on being aware of some of the signs and symptoms and taking necessary action on them.

Anaemia or low haemoglobin is one of the classical presentations of gastro-intestinal cancer and it should not be taken as lack of iron or nutrition or due to any other cause. Many times anaemia can be manifested by just tiredness, weakness and breathlessness. Once anaemia is detected it NECESSARY to have a sonography or scan done which can pick up any lesion. It is also good to test the stool for occult blood. If occult blood is positive in any of the 3 samples, colonoscopy or endoscopy are warranted. In this way we are can pick up GI cancers very early.

The best part about GI cancers is that when detected early they just need surgery and good surgery will ensure a long time survival. Most of them, nearly 90%, survive for 5-10 years. Even chemotherpy can be avoided.

So just be aware of these symptoms. The symptoms should not alarm you but should alert you for investigations.

Take care of your health.

Wear blinkers and run the race

Just imagine a horse running a race… the blinkers are put on

The literary meaning of blinkers is “a pair of small leather screens attached to a horse’s bridle to prevent it seeing sideways and behind and being startled”.

The analogy cannot be better.

The moment someone is diagnosed with cancer, unsolicited advice pours in from all corners. Right from sugar free diet to herbals, nature cure, toxic effects of chemotherapy and stories of how their relatives had pain etc. There are very few encouraging voices. Sympathy can overpower you and you don’t need it.

I always advise the patients, ‘just imagine that you are running the most important race of your life’. Don’t lose hope. Don’t allow people to discourage you. In fact ask people to mind their business. You have to attend to the most important business – your health and your life. NO free advice please. If anyone still wants to offer advice send them to me , I will handle them.

Put on the blinkers, don’t look look sideways or behind and don’t be startled by all the noise. Just look at the finish line and run wth all your might

YOU HAVE TO RUN AND WIN !

 

 

 

Good ‘Old’ generation!

 

Yesterday was a very interesting day. I saw 4 patients who are over 70. When I started my surgical career, more than 3 decades ago, we had a fairly unwritten rule that above 50 years be careful and after 60 avoid risky surgery. Some of the major surgeries which we performed on the younger patients were not offered to the elderly patients as there was a fear that there would be some complications and they would not be able to stand the complications.

In the west it has been proven recently that even older patients have the same kind of resistance and power to heal  and tt does not really depend on the age.

‘Physiological age’  is more important than the ‘Chronological age’

Mr. Mehrotra came into my room with a spring in his step. The first thing I asked was “Are you really 79”? He said, “Of course I am 79 and I even have great grandsons.”

I generally do not base my assessment on the biochemical values or numbers.

So I asked him “What do you do in a day and what time do you get up in the morning?” He said, “I am up by 5 in the morning”.

“Oh, and then ? “.

“I go for a walk for about an hour”,

I asked, “how much distance” and he said, “about 5 km.”

(I said to myself “I don’t do that”)

He said, “then I come back and may be have some juice and fruit, a bit of yoga and then I have my breakfast”.

I said, “Fantastic routine, what else do you do, can you go up a flight of steps?” He said, “of course I can because when I go for a swim in the evening, I do go up and down the steps.”

So I said,”oh oh, that means you swim also?”

He said, “of course I swim or go to the gym.”

Well this man is certainly great, at 79 he is fit and is definitely not overweight. I look at the people who came with him, his nephew (who well certainly looked pretty uneasy with the whole conversation) because it was clear that he never walked, forget about gymming and swimming and he was easily 10 kg overweight.   I had to do a major liver surgery for him so I said, “there is a risk in surgery”, he said, “so what, I am ready for it.” I think it is not only the physical fitness but also the mental attitude of the older generation which is remarkable.

Second gentleman was again 75, the same story except that he does not gym and does all the things which normally should have been done by someone who is much younger than him.

I had no hesitation in clearing both the patients for both liver and pancreatic surgeries respectively. Yes, there are some risks involved but it depends on how you take care of your body.

Then came a 75 year old whom I had operated upon for rectal cancer. He said, “doctorsaab, can I go for my walks?” I said, “of course, you can.” He said, “what about the treadmill?”

( Oh, I also have a treadmill but I do not seem to be using it much).

“Yeah, why treadmill, why not just go for a nice walk in the lawns or outside?”

He said, “yes, that I do everyday, I used to do for an hour but now it is 1/2 an hour, but in the monsoon season, if it is raining, I still want to do my exercise and that is why I am asking if I can go on the treadmill”

I said, “of course you can do it but just be careful”.

So, in short, when I look at the older generation it is so enlightening. They are right in front of us- they take care of their health. Their physical fitness is far far better than the younger generation. In fact, I feel that the ‘father’ coming from a small town will do far better than the ‘son’ who is a busy executive in the city. In small towns and villages the people have to walk, there are no fancy cars. They have fresh vegetables, fresh produce, plenty of clean air and certainly they are far healthier than their city bred sons who are either stressed out, stuck in the traffic, no exercise and plenty of excuses not to do so.

Are we going to see a kind of reversal of the longevity which we have achieved over the years and have younger people having lifestyle related diseases in their prime. May be yes, unless we take quick corrective steps. There is no great science involved in this. Just see your father. Ultimately it is the genes which determine your own health and see your father and follow his habits and that itself is going to make you a healthier person.

Old is gold is a saying which is worth remembering every time. It is so true!