‘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.

Why do good people have a bad outcome in Cancer?

I do not know Atul Chitnis.  I have not even heard of him earlier, till Sharat told me about his accomplishments in helping start-ups by open source software.


I read about a remarkable highly motivated and energetic person wanting to help others.   What really struck me on reading about him is that unfortunately he succumbed to colorectal cancer.  I read an update on his health in January 2013 and I started wondering on 2 issues:

  1. How can someone who is educated, well informed, well connected be

diagnosed  with Stage IV Cancer.

  1. The same issues which plague many of our patients like Chemotherapy toxicity and  expense, have affected Mr. Chitnis.

It is indeed a tragedy that good people like Atul Chitnis had a late diagnosis, a bad outcome and succumbed to the disease.

Let me put it in a proper perspective ‘How do you diagnose or how do you suspect colon cancer’?  I always ask  my patients are there any symptoms and how long did they have symptoms?  They invariably have at least 6-8 months of symptoms – like feeling lethargic and weight loss,which are really warning signals.  Then there can be dark stools, sometimes blood in stools and the bowel does not behave as it should.  The alteration of bowel habits would alert one to do a simple test for occult blood in stools.  If occult blood is present in the stools for 3 consecutive days, then colonoscopy is necessary and perhaps CT Scan too. Colonoscopy is quite simple and takes half a day. Its not painful at all. Here’s how its done.

Should all normal people undergo a colonoscopy, like in the West after the age of 50. (American cancer society guidelines attached). As a health policy on population based screening it would be an enormous load and not cost effective. Those who are conscious and want a clean chit every year can do so. But certainly those who have symptoms like the GI upsets that do not respond in a couple of weeks and have anaemia(low hemoglobin) for unexplained reasons should be on alert. Its difficult to lose weight. I know it to well.  Unexplained weight loss is an important pointer as the tumor starts drawing energy from whatever nutrition is consumed.  So let me say that the message is: ‘Please be on the look out for these early warning signals and seek medical advice early’.  Then perhaps we will be able to save more good people in our society.

Here is simple message for  your treating  doctor. Don’t’ assume that bleeding is due to ‘Piles”, a rectal examination and sigmoidocopy are a must for those who have symptoms. A visit in time will save many years of life.

My sympathies to Mr. Chitnis’ close and extended family and I do hope that the good work he started continues.

American Cancer Society guidelines for early detection of Colorectal cancer:

Beginning at age 50, both men and women should follow one of these testing schedules:

Tests that find polyps and cancer

  • Flexible sigmoidoscopy every 5 years  or
  • Colonoscopy every 10 years, or CT scan with contrast

Tests that primarily find cancer

  • Yearly fecal occult blood test (gFOBT)