The tale of two ‘cities’ and two sisters

I was at the airport waiting for my flight. A lady came to me and said, “Do you remember me??”

I am petrified of  this question as my memory for names is dreadful and I live in constant fear of someone asking me this question.

I mumbled, “ Your face looks familiar. When did you meet me?”

She said “ I am Mrs. Thakur. You operated on my sister’s husband from Delhi who had pancreatic cancer. I want to tell you that you had said that if you operate and resect the tumour,he might live for 4 years and he lived ONLY for 3 ½ years.”

“Oh” I said, “ It is closer to 4 years but yes all the patients need not have the same  survival and that is the reason we give a range.”

“Listen to this”, she said,  ” My husband was diagnosed with pancreatic cancer around the same time in Mumbai. We came to you and you said it is not resectable”. and when I asked ” How is the survival?”, you said “ Unresectable pancreatic cancer has approximately 12 months of survival”. He had chemotherapy and he is alive for 3 years.

“Well” I said, “Science cannot explain everything. It is fortunate that he responded”, but she was adamant that there has to be a reason for it.

“ I want to know if is he Cured and how long is he going to live”, she demanded.  Very difficult questions indeed.

I was actually travelling back from attending a meeting on Neuroendocrine Tumours and a very similar case was presented at the Conference where a patient diagnosed with ‘pancreatic cancer’ with spread to the liver remained well, not 1-2 years but 12 years, with minimum amount of treatment. These are peculiar tumors with slow growth called Neuroendocrine Tumours.

I had to defend medical science. “May be he had a tumour which had better biologic behavior.”

She said “We went to all Centres (Mayo Clinic, Sloan Kettering Centre) and everyone said he will live only for a year.”

I felt a bit relieved that others agreed with my opinion.

I said “ Well, this is a statistical fact that the ‘median survival’ is only really median and there are always more or less aggressive tumours. Moreover if the diagnosis obtained by a technique called cytology, a relatively less aggressive tumour can look aggressive as each area of tumour is different in growth fraction. This is only a scientific explanation I can give but on the other hand, what really matters is that he is fine, the tumour has responded and he has a good quality of life and is travelling around, so why do you want to know about the future, which none of us can really see or predict.”

She was not completely satisfied but I could see that she was thinking about small blessings.

Predictions can go awfully wrong. Medicine is grey at best and NOT black and white as we would want.

On the same day,  I see patients operated 15years ago and doing fine and just 15 months ago with recurrence.

Each patient and each tumour are different !!

I think the best way to handle cancer is to count the blessings and live each day and not worry about what would happen in the days to come”. Its tough but acceptance is the key.

This is not true just of cancer but perhaps with other ailments and even without any ailment.

 We cannot look into the future and fortunately so!

Cause of Cancer – ‘Random unfortunate event’ or ‘ Bad luck’

Parikh is a chartered account and accidentally found a mass. On MRI a ‘tumour’ was found and then the panic set in.

How did I get this? Why ME ???  Whats’s cause? I never smoke or drink and am a vegetarian too !!

Most of the patients invariably ask the question “How did I get Cancer?”

I normally tell them that the cause is really unknown except in those associated with lifestyles like smoking.

It’s a ‘random unfortunate event’.

The fact is that the human cells, a trillion of them, keep dividing and a complex DNA is faithfully replicated. Well this is a super precise process, but even a ‘cell’ can make errors and some of the genes or rather the codon in the ‘genes’ can be ‘bad’. The cell also has remarkable ability of having a system of ‘miss match repair genes’ which will either fix the problems or eliminate bad genes. However some of the changes can occur in critical parts of the DNA , near the oncogenes, which actually trigger uncontrolled growth and replication of cells that is ‘Cancer’.

It is interesting to read Bert Vogelstein’s’s article in the media. Porf. Vogelstein is famous scientist from John Hopkins’ University and was the first to identify that specific genetic changes lead to progressive development of colon cancer. But you may be surprised that the whole process may even take 10 years.

Now they have come out with important information that about 22 such genetic mutations cause 2/3rd of the cancers. Even in 2/3rd where there is genetic mutation, Environment and lifestyles are likely to enhance the ‘bad luck mutation’. The other 1/3rd of cancers are directly related to lifestyle factors like smoking.

What do we then do about the ‘bad luck or the bolt from the blue’ genetic mutation. Very few of them are hereditary and can be detected in families that have clusters of cancers like colon or breast cancer but many of them are again ‘random unfortunate events’. The really cost effective way is early detection.

I had in my earlier blog talked about the 7 warning signals and I once again reiterate that these should be your guide for the New Year!

Take care of your precious health

Enjoy a healthy life !

A mile, NOT an apple a day keeps the doctor away

Earlier I mentioned about the beneficial effects of exercise not only during treatment but also to prevent illness. 

I was actually curious to know the origin of the phrase ‘An apple a day keeps the doctor away’.  It turns out that it is actually a Welsh proverb, originally came in print in February 1866 edition of ‘Notes and Queries’ Magazine, a Pembrokeshire proverb- “Eat an apple on going to bed and you will keep a doctor earning his bread”. That’s scary that a doctor CANNOT earn his bread. What are people upto. Thank God some one has the wisdom to modify the proverb.!! Let me tell you that apples are not a favourite fruit in my own family. Of course they do not want to keep the doctor away and nor do they want to keep him earning his bread.  They just don’t like apples and that actually is fine with me.

 On a bit of reading, I did find that apples are healthy.  They do contain Vitamin C, Pectin which adds to the fibre, zero cholesterol and also boron and quercitin, a beneficial flavonoid.  Certainly an apple a day is not the best way to keep the disease and doctor away. 

A stunningly simple fact !!.  

Exercise is something that we are all advised and it’s also something we don’t like, including ME. But it’s the simplest way to keep away two big Cats – Cardiac and Cancer from coming anywhere near you.  Physical activity of, say, walking a mile a day, clearly reduces Cancer and Cardiac risk as shown in multiple studies. 

Exercise helps in controlling weight, improves bones, muscles and joints, reduces blood pressure by 10 mm and also risk of diabetes, apart from being a great stress-buster and certainly reduces the risk of heart disease.

What about cancer?  We know that cancer can be caused by different mechanisms, but can exercise really reduce the cancer risk?

The answer to that is YES.   NCI (National Cancer Institute) statement on physical activity and cancer risk gives exhaustive information on various cancers. In brief, colon cancers have been very well studied and the risk can be reduced by nearly 30% by reducing the BMI and having atleast 30 minutes of moderate to vigorous physical activity per day.  Does it mean that all those who exercise will never get cancer?  The answer is NO but certainly, it is the easiest way to reduce the risk and certainly is the best way.

 The same is true for breast cancer.   Existing evidence shows that the risk of breast cancer is substantially lowered on exercise and limiting weight gain.  There are multiple mechanisms involved like estrogenic storage in fat, immune responses etc.

It is very simple, that if you exercise you will reduce colonic cancer, breast cancer and endometrial cancer which is cancer of the uterus, all very common diseases. Not only that, it also, as I said earlier, increases the survivorship by a better compliance with treatment.

The most difficult step is to start exercising regularly and I am guilty of the same.   You keep looking for excuses to skip the daily routine of physical activity.  It just needs 20 minutes, a brisk walk, a treadmill or stationary bike.  I know that we do not have green spaces and parks to walk around but you certainly could have a little space for a treadmill or stationary bike. 

 ‘If you can manage 30 minutes every day for 5 days a week’, you are a winner.  Let me tell you the positive benefits are so many, on your joints, on your overall personality that when I do my treadmill for 30 minutes, I have the energy to go through my surgeries the whole day and that I think is the single most benefit, whatever are the other benefits are the additional benefits for me. 

Come on guys,  wake up and walk up.  Walking up, infact, is the simplest way to exercise.  I thought I will talk to you later on simple programme of ‘STEP UP’, which is so remarkably simple that anyone can follow it.  I will highlight on this and the positive benefits of this in my next write-up. Meanwhile, definitely go through National Cancer Institute information if you want detailed information on the physical activity and cancer risk. 

So walk a mile and of course you can also have an apple and certainly keep the doctor away from you.  Don’t wait for tomorrow, START TODAY.