The Lord is my shepherd, I shall not be in want. He makes me lie down in green pastures, he leads me beside quiet waters, he restores my soul. He guides me in paths of righteousness for his name's sake.
Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff they comfort me. You prepare a table before me in the presence of my enemies. You anoint my head with oil; my cup overflows.
Surely goodness and love will follow me all the days of my life, and I will dwell in the house of the Lord forever. Psalm 23, from The Bible.
Tuesday, June 17, 2008
Tuesday, March 4, 2008
Quick Self-Screen List for 10 common Cancers
It is good to have a handy sheet to check ourselves out for alarm triggers for cancer that might go off in our system! Here is a short list for a quick self-screen. This list is by no means exhaustive, though I will try to cover as much as I can; I will also keep adding any that are left out in the initial post!
Some general tips:
Cancer is basically an abnormal growth of cells in some part of the body that starts to prey on the body, depleting it of nutrition, energy and finally life. Most cancers are fast growing. Many non-cancerous conditions (like non-healing ulcers, lumps, etc) can transform into cancerous growth over a period of time.
Cancers have loss of weight and loss of appetite in common. Any sudden spurt in growth of an old lump or an old ulcer should also be treated with suspicion.
Some charachteristics specific to location are:
1. Any growth inside the skull will have a set of common pressure symptoms as well as symptoms more specific to its site within the cranium and its type. The common symptoms that can be expected are: Nagging headache that is not amenable to treatment, sudden disturbances in hearing, sight or balance, vomiting, change in behaviour.
2. Cancers of the skin can be either growths or ulcers. Among growth, the old mole transforming in color, shape and size should be regarded as highly suspicious. Long-standing ulcers that fail to heal are also notorious for cancerous transformation.
3. Cancers of the tongue can be caused by sharp tooth, smoking, tobacco chewing, alcohol. Other factors that can contribute are infections by herpes simplex virus, human papilloma virus, family history, immunodeficiency and dietary deficiencies.
These cancers can show up as an ulcer or growth.
4. Cancers of the cheek are common in India because of that age old habit of chewing paan and betel nuts and then securing it in the 'cheek pouch'! Smoking, alcohol, HSV and HPV viral infections may also contribute but paan takes the cake. This often tends to occur in areas where the inside of the cheek gets whitened (leucoplakia). Some conditions called 'pre-malignant' conditions (sub-mucosal fibrosis and lichen planus) can also become cancerous.
5. Cancer of the thyroid: Any swelling in the thyroid gland which is lumpy whether it is one single swelling or multiple swellings, should be removed for diagnosis. A smooth diffuse swelling alone is goitre anything else is suspicious.
The lump can be tested by inserting a needle and aspirating some cells. This test will only be valid if it shows cancerous cells. If the result is negative, the lump MUST be removed for diagnosis for the simple reason that the needle may have missed cancerous cells by even a few millimetres.
Of the 5 types of cancer that can occur in the thyroid gland, the Papillary and Follicular forms are the commonest. Of these, the only way to differentiate between a Follicular lump that is cancerous and a Follicular lump that is not cancerous is to remove the lump with its capsule intact and see if this capsule or covering has been breached anywhere by cancerous cells.
6. Breast cancer: Any lump in the breast must be checked out by a doctor and investigated especially if it is found to be hard, fast-growing and appears to be 'fixed' with limited or no mobility. Women with a family history need to be extra careful. Routine yearly check ups by a doctor, with mammograms for those above 40 years of age and a monthly self-screen are of help in early diagnosis should a problem arise.
This has been discussed in detail as a separate topic. You could refer to it.
7. Lung cancer: Cancer found in the lung could either arise from the lung itself or could have spread there from a cancer found elsewhere in the body, commonly from the kidneys, prostate, breast, bone, gastro-intestinal tract, cervix and ovary. Here we will only discuss cancers that arise from the lung itself.
Among the causative factors for lung cancer, none stands taller than cigarette smoking. This has adverse effects not only on the smoker but also on all others exposed to his/her smoke.
Lung cancer can also be caused by exposure to asbestos, arsenic, chromium, iron oxide, petroleum products and oils, coal tar, products of coal combustion and radiation. This is generally an occupational risk for those involved with these dust or fumes in their work place.
Lung cancer can silently lurk in the body for 8 to 15 years from the time the first malignant cells appear, depending on the type, before it becomes obvious by symptoms. Often cough can be present as the only symptom. Chest pain and discomfort when present can be perceived as "fullness" and "pressure" in the chest. If the tumor has invaded the lung capsule (called the pleura) or the ribs, it can cause sharp pain everytime the lung is moved, the most common movement being breathing. A tumor blocking a large airway can make the lung tissue below it collapse or get infected. There can also be fluid between the layers of the lung capsule which is often blood stained (any blood-stained pleural fluid should make us up the antennae!). A variety of other symptoms occur with the location of the tumor.
Cancer from the lungs usually spreads to the bone, liver and brain.
A variety of investigations are available to confirm the diagnosis of the primary lung tumor. These begin with the humble chest x-ray and go on to include CT scan (MRI can be used for staging as it gives better images of the soft tissues in the mediastinum which is the central compartment of the chest), Fibreoptic bronchoscopy and Transthoracic fine-needle aspiration biopsy under radiographic guidance. A complete set of baseline biochemistry analysis must be done as well as tests to look for spread in the commonly expected areas.
The treatment is long and hard involving surgery when possible and indicated, chemotherapy and radiotherapy. The most sensible thing to do is to avoid the risk factors as much as possible! Those with occupational hazards should go for regular checks like yearly chest x-rays and 4 monthly sputum cytology (unfortunately their success rates remain minimal) and take whatever preventive steps they can to cut down on the hazardous exposure.
Smokers, just throw that burning stick away before it burns you up! Imagine what a lot you will save in terms of life-years, treatment costs and cigarette costs!
If you are a smoker or live with a smoker, here are somethings you absolutely must know!!
1. "Low-tar-low-nicotine Filter cigarrates" may not really reduce the risks as people often tend to inhale more deeply to compensate the dilution.
2. "Side-stream" smoke - inhaled passively by those around the smoker, contains more poisons than "main-stream" smoke - inhaled actively by the smoker. The person inhaling Passive Smoke can end up inhaling upto 3 times more than what the smoker himself/herself inhales as the cause for side-stream smoke (burning of cigarette inbetween puffs) releases more toxins.
3. Children exposed to passive smoke show increased chest infections and lesser growth. Long term effects on children are not yet fully known.
4. It takes 5 to 9 years of abstinence from smoking for the risk of lung cancer to begin to decrease in an ex-smoker. It takes 14 years of abstinence for the risk level to come down to the level of the normal population.
8. Stomach cancer: This is another major cause of deaths due to cancer, world wide. Certain pockets in the world like Japan and a few places in China have an extremely high incidence compared to the rest of the world (70 per 100,000 in Japan as against 15 and 10 per 100,000 in the UK and US respectively). This is attributed mainly to their diet. Yet for this reason, they have the best results of treatment as they have a well-set and elaborate screening program to detect and cure early disease and advanced treatment options for more progressed disease.
Diet that can make one predisposed to stomach cancer is the kind that is salted, smoked and pickled for preservation. The advent of the Refridgerator has cut down on the need of such food, helping to bring down the incidence of stomach cancer. The famous Japanese sushi is the leading contender in Japan.
For some reason, people with Type A blood group are more prone as are men than women.
Cancer of the stomach can be either 'intestinal' or 'diffuse' the diffuse being more dificult to treat. It can also be divided as cancer in the upper part of the stomach or the lower part. The lower part is more common in the common man! The upper part is more common in the affluent and is associated to obesity (just being very fat).
We will look more into cancer of the lower part of the stomach. This is often associated with infection by the bacteria Helicobacter pylorii, an organism that usually causes gastritis and other changes in the mucosal lining of the stomach. For this reason, H pylorii is sought to be eradicated by treatment when it is found in patients with gastric symptoms.
Stomach cancer is eminently curable if it is caught very early, before it has spread to the nearby lymphnodes. The problem is, nobody usually suspects it at this stage as it hardly causes any problems except what we commonly call "dyspepsia" which can be called 'discomfort'. To avoid not detecting an early cancer, as a rule, it is good to first undergo a gastroscopy for any one who gets "dyspepsia" first after 40 years of age (i.e. even before starting treatment - treatment can hide the changes and we may miss H pylorii if they were there). It is also good for anyone else whose dyspeptic symptoms have not subsided with treatment to undergo a gastroscopy. Its eeeeeeeeeech! but it might just save your life!! When a gastroscopy is done, if suspicious spots are found, they are biopsied and the tissue also tested for H pylorii.
The cancer can also bleed silently which may be passed out un-noticed but can show up as unexplained anemia instead. This is one more way it can give away itself. So unexplained anemia should be adequately investigated (hemoglobin levels, a stool blood test and gastroscopy will be some of the investigations called for). Larger bleeds can present as black tarry stools (like after eating spinach or iron tablets).
There is also unexplained tiredness and weightloss like it can be in any form of cancer.
Stomach cancer has many causes, though H pylorii is the flag bearer in most cases (we are not considering special regions like Japan here). Closely following on its heals is cigarratte smoking and some industrial dust, excessive intake of alcohol (though that might do a person in due to other causes earlier), excessive salt intake, deficiency of antioxidants, exposure to N-nitroso compounds and some other conditions like 'Pernicious anemia', 'gastric polyps' and previous surgery for gastric ulcer.
Advanced stomach cancer will cause difficulty to take and keep the food down and a feeling of fullness. Sometimes thrombosis of the deep veins can also occur.
Stomach cancer is treated by surgery when it can be performed and by chemotherapy either with surgery of chemotherapy alone, if it has unfortunately passed the operating stage.
Well, this article is out here so that none of you who reads it or your family or friends ever need to worry about that. Keep the prevention aspects going, binge on red and yellow fruits and veggies like tomatoes, carrots and sweet potatoes that can have protective effects and always be alert for early tell-tale signs!
9. Liver cancer: A routine ultrasound of the abdomen that shows up a lesion (an abnormal growth) in the can be scary! These can be caused by simple tumors that are non-cancerous as well as cancerous growths. Lets see how to differentiate these.
The most common benign or non-cancerous growths in the liver is the haemangioma which is quite plainly speaking, a lump of small blood vessals that have grown abnormally. This can be distinguished by delayed contrast CT scanning from other kind of liver tumors. These haemangiomas may be single or multiple. A biopsy through the skin is NOT advised as the tumor can bleed heavily into the abdomen which is very dangerous. They hardly ever show cancerous change, so can be well left alone after the diagnosis.
The Hepatic Adenoma is another non-cancerous growth found in the liver. This one has potential to become cancerous and so surgical removal of the tumor is the treatment of choice. It has been found to be related to sex hormones including intake of oral contraceptives. In such instances, the tumor size decreased on stopping the hormonal medication.
Focal Nodular Hyperplasia is found more in middle-aged women with no underlying liver disease. This is the only benign or non-cancerous liver tumor that contains a type of cell called 'kupffer cells' which are also found in normal liver. We do not yet know what causes this tumor.
Cancerous tumor found in the liver can be either due to spread to the liver from a cancer in some other part of the body - we call this metastatic tumor; or cancer arising from the liver itself - we call this primary liver cancer. We will deal with both separately.
Cancer that has spread from a primary cancer in another part of the body - These are the more common ones. They usually come from cancers of the gastrointestinal tract, breast or lung. These can be surgically removed if it is possible and will need further treatment like chemotherapy depending on where it has originated from.
Primary cancer of the liver or Hepatocellular Carcinoma - This is a very dangerous cancer which rarely lets its victim survive beyond 6 months. Upto 80% of those with this cancer have cirrhosis associated to it. Livers with cirrhosis are usually fibrotic and shrunken. The most common causes of cirrhosis are viral infections like Hepatitis B and Hepatitis C infections, excessive alcohol consumption and a rare condition called haemochromatosis.
Other causes of Hepatocellular cancer are a fungus called 'aflatoxin' (commonly found in spoilt groundnuts - next time, dump those spoit groundnuts in the kitchen rubbish bin and not your tummy rubbish bin!) and androgenic steroids; a weak association has been found with oral contraceptive pills. This tumor is more common in men than women.
This tumor can spread to the lymph nodes, lung and bones.
The only possible treatment is resection of the tumor and liver transplantation if the tumor is small enough and transplantation is an available option.
Cholangiocarcinoma is cancer that arises out of the bile ducts (network of tubes which transport bile - the green stuff produced by the liver and used for digestion by the stomach). This can arise from tubes that are within or outside the liver. They are often diagnosed late and also have a scope of less than 6 months survival.
These are not associated with cirrhosis or hepatitis B. In the Far East, they are associated to infestation with some species like Clonorchis sinensis or Opisthorchis viverini.
10. Cervical and Uterine cancer: Any bleeding from the vagina that is not related to a period must alert you! By this we mean, any bleeding that occurs unexpectedly between 2 periods, bleeding after sexual intercourse or bleeding after a vaginal examination. Even bleeding after menopause (more likely for uterine cancer) and a heavier normal period will be well worth getting checked out.
Any unexplained persistent vaginal discharge, pelvic pain or pain during intercourse should also raise alarm.
Who is prone to cervical cancer?
The Human Papilloma Virus or the HPV virus infection puts a woman in a high risk category. This virus is transmitted by sexual contact and is more likely in women with multiple partners or women who have a relationship with a man who has multiple partners. This virus may or may not also cause genital warts. There is now a vaccine available against this virus.
Cervical cancer is more commom over the 40 year age group and in those who have had more children.
Cigarrate smoking also increases the risk of cervical cancer. So does long-term (more than 5 years) use of birth control pills.
Any condition that decreases the immunity of a person increases risk, like having a HIV infection.
Daughters of mothers who had been given Diethystilbesterol during pregnancy were found to develop cervical cancer. This drug is now contra-indicated in pregnancy.
Screening: The Pap Test or Pap Smear is a good way to screen, though it may not be perfect always (sometimes disease can be missed).
Pap Test is a simple out-patient procedure that does not require any anesthesia. Some cells from the cervix are taken on a swab through the vagina, put on a special slide and sent for testing. During testing, the pathologist will look out for pre-cancerous of cancer cells.
A Pap Test is advised to be taken no later that 3 years after the first sexual intercourse or the age of 21. For 48 hours before a Pap Test, do not have sexual intercourse, do not use vaginal douche or any form of vaginal medication.
Some general tips:
Cancer is basically an abnormal growth of cells in some part of the body that starts to prey on the body, depleting it of nutrition, energy and finally life. Most cancers are fast growing. Many non-cancerous conditions (like non-healing ulcers, lumps, etc) can transform into cancerous growth over a period of time.
Cancers have loss of weight and loss of appetite in common. Any sudden spurt in growth of an old lump or an old ulcer should also be treated with suspicion.
Some charachteristics specific to location are:
1. Any growth inside the skull will have a set of common pressure symptoms as well as symptoms more specific to its site within the cranium and its type. The common symptoms that can be expected are: Nagging headache that is not amenable to treatment, sudden disturbances in hearing, sight or balance, vomiting, change in behaviour.
2. Cancers of the skin can be either growths or ulcers. Among growth, the old mole transforming in color, shape and size should be regarded as highly suspicious. Long-standing ulcers that fail to heal are also notorious for cancerous transformation.
3. Cancers of the tongue can be caused by sharp tooth, smoking, tobacco chewing, alcohol. Other factors that can contribute are infections by herpes simplex virus, human papilloma virus, family history, immunodeficiency and dietary deficiencies.
These cancers can show up as an ulcer or growth.
4. Cancers of the cheek are common in India because of that age old habit of chewing paan and betel nuts and then securing it in the 'cheek pouch'! Smoking, alcohol, HSV and HPV viral infections may also contribute but paan takes the cake. This often tends to occur in areas where the inside of the cheek gets whitened (leucoplakia). Some conditions called 'pre-malignant' conditions (sub-mucosal fibrosis and lichen planus) can also become cancerous.
5. Cancer of the thyroid: Any swelling in the thyroid gland which is lumpy whether it is one single swelling or multiple swellings, should be removed for diagnosis. A smooth diffuse swelling alone is goitre anything else is suspicious.
The lump can be tested by inserting a needle and aspirating some cells. This test will only be valid if it shows cancerous cells. If the result is negative, the lump MUST be removed for diagnosis for the simple reason that the needle may have missed cancerous cells by even a few millimetres.
Of the 5 types of cancer that can occur in the thyroid gland, the Papillary and Follicular forms are the commonest. Of these, the only way to differentiate between a Follicular lump that is cancerous and a Follicular lump that is not cancerous is to remove the lump with its capsule intact and see if this capsule or covering has been breached anywhere by cancerous cells.
6. Breast cancer: Any lump in the breast must be checked out by a doctor and investigated especially if it is found to be hard, fast-growing and appears to be 'fixed' with limited or no mobility. Women with a family history need to be extra careful. Routine yearly check ups by a doctor, with mammograms for those above 40 years of age and a monthly self-screen are of help in early diagnosis should a problem arise.
This has been discussed in detail as a separate topic. You could refer to it.
7. Lung cancer: Cancer found in the lung could either arise from the lung itself or could have spread there from a cancer found elsewhere in the body, commonly from the kidneys, prostate, breast, bone, gastro-intestinal tract, cervix and ovary. Here we will only discuss cancers that arise from the lung itself.
Among the causative factors for lung cancer, none stands taller than cigarette smoking. This has adverse effects not only on the smoker but also on all others exposed to his/her smoke.
Lung cancer can also be caused by exposure to asbestos, arsenic, chromium, iron oxide, petroleum products and oils, coal tar, products of coal combustion and radiation. This is generally an occupational risk for those involved with these dust or fumes in their work place.
Lung cancer can silently lurk in the body for 8 to 15 years from the time the first malignant cells appear, depending on the type, before it becomes obvious by symptoms. Often cough can be present as the only symptom. Chest pain and discomfort when present can be perceived as "fullness" and "pressure" in the chest. If the tumor has invaded the lung capsule (called the pleura) or the ribs, it can cause sharp pain everytime the lung is moved, the most common movement being breathing. A tumor blocking a large airway can make the lung tissue below it collapse or get infected. There can also be fluid between the layers of the lung capsule which is often blood stained (any blood-stained pleural fluid should make us up the antennae!). A variety of other symptoms occur with the location of the tumor.
Cancer from the lungs usually spreads to the bone, liver and brain.
A variety of investigations are available to confirm the diagnosis of the primary lung tumor. These begin with the humble chest x-ray and go on to include CT scan (MRI can be used for staging as it gives better images of the soft tissues in the mediastinum which is the central compartment of the chest), Fibreoptic bronchoscopy and Transthoracic fine-needle aspiration biopsy under radiographic guidance. A complete set of baseline biochemistry analysis must be done as well as tests to look for spread in the commonly expected areas.
The treatment is long and hard involving surgery when possible and indicated, chemotherapy and radiotherapy. The most sensible thing to do is to avoid the risk factors as much as possible! Those with occupational hazards should go for regular checks like yearly chest x-rays and 4 monthly sputum cytology (unfortunately their success rates remain minimal) and take whatever preventive steps they can to cut down on the hazardous exposure.
Smokers, just throw that burning stick away before it burns you up! Imagine what a lot you will save in terms of life-years, treatment costs and cigarette costs!
If you are a smoker or live with a smoker, here are somethings you absolutely must know!!
1. "Low-tar-low-nicotine Filter cigarrates" may not really reduce the risks as people often tend to inhale more deeply to compensate the dilution.
2. "Side-stream" smoke - inhaled passively by those around the smoker, contains more poisons than "main-stream" smoke - inhaled actively by the smoker. The person inhaling Passive Smoke can end up inhaling upto 3 times more than what the smoker himself/herself inhales as the cause for side-stream smoke (burning of cigarette inbetween puffs) releases more toxins.
3. Children exposed to passive smoke show increased chest infections and lesser growth. Long term effects on children are not yet fully known.
4. It takes 5 to 9 years of abstinence from smoking for the risk of lung cancer to begin to decrease in an ex-smoker. It takes 14 years of abstinence for the risk level to come down to the level of the normal population.
8. Stomach cancer: This is another major cause of deaths due to cancer, world wide. Certain pockets in the world like Japan and a few places in China have an extremely high incidence compared to the rest of the world (70 per 100,000 in Japan as against 15 and 10 per 100,000 in the UK and US respectively). This is attributed mainly to their diet. Yet for this reason, they have the best results of treatment as they have a well-set and elaborate screening program to detect and cure early disease and advanced treatment options for more progressed disease.
Diet that can make one predisposed to stomach cancer is the kind that is salted, smoked and pickled for preservation. The advent of the Refridgerator has cut down on the need of such food, helping to bring down the incidence of stomach cancer. The famous Japanese sushi is the leading contender in Japan.
For some reason, people with Type A blood group are more prone as are men than women.
Cancer of the stomach can be either 'intestinal' or 'diffuse' the diffuse being more dificult to treat. It can also be divided as cancer in the upper part of the stomach or the lower part. The lower part is more common in the common man! The upper part is more common in the affluent and is associated to obesity (just being very fat).
We will look more into cancer of the lower part of the stomach. This is often associated with infection by the bacteria Helicobacter pylorii, an organism that usually causes gastritis and other changes in the mucosal lining of the stomach. For this reason, H pylorii is sought to be eradicated by treatment when it is found in patients with gastric symptoms.
Stomach cancer is eminently curable if it is caught very early, before it has spread to the nearby lymphnodes. The problem is, nobody usually suspects it at this stage as it hardly causes any problems except what we commonly call "dyspepsia" which can be called 'discomfort'. To avoid not detecting an early cancer, as a rule, it is good to first undergo a gastroscopy for any one who gets "dyspepsia" first after 40 years of age (i.e. even before starting treatment - treatment can hide the changes and we may miss H pylorii if they were there). It is also good for anyone else whose dyspeptic symptoms have not subsided with treatment to undergo a gastroscopy. Its eeeeeeeeeech! but it might just save your life!! When a gastroscopy is done, if suspicious spots are found, they are biopsied and the tissue also tested for H pylorii.
The cancer can also bleed silently which may be passed out un-noticed but can show up as unexplained anemia instead. This is one more way it can give away itself. So unexplained anemia should be adequately investigated (hemoglobin levels, a stool blood test and gastroscopy will be some of the investigations called for). Larger bleeds can present as black tarry stools (like after eating spinach or iron tablets).
There is also unexplained tiredness and weightloss like it can be in any form of cancer.
Stomach cancer has many causes, though H pylorii is the flag bearer in most cases (we are not considering special regions like Japan here). Closely following on its heals is cigarratte smoking and some industrial dust, excessive intake of alcohol (though that might do a person in due to other causes earlier), excessive salt intake, deficiency of antioxidants, exposure to N-nitroso compounds and some other conditions like 'Pernicious anemia', 'gastric polyps' and previous surgery for gastric ulcer.
Advanced stomach cancer will cause difficulty to take and keep the food down and a feeling of fullness. Sometimes thrombosis of the deep veins can also occur.
Stomach cancer is treated by surgery when it can be performed and by chemotherapy either with surgery of chemotherapy alone, if it has unfortunately passed the operating stage.
Well, this article is out here so that none of you who reads it or your family or friends ever need to worry about that. Keep the prevention aspects going, binge on red and yellow fruits and veggies like tomatoes, carrots and sweet potatoes that can have protective effects and always be alert for early tell-tale signs!
9. Liver cancer: A routine ultrasound of the abdomen that shows up a lesion (an abnormal growth) in the can be scary! These can be caused by simple tumors that are non-cancerous as well as cancerous growths. Lets see how to differentiate these.
The most common benign or non-cancerous growths in the liver is the haemangioma which is quite plainly speaking, a lump of small blood vessals that have grown abnormally. This can be distinguished by delayed contrast CT scanning from other kind of liver tumors. These haemangiomas may be single or multiple. A biopsy through the skin is NOT advised as the tumor can bleed heavily into the abdomen which is very dangerous. They hardly ever show cancerous change, so can be well left alone after the diagnosis.
The Hepatic Adenoma is another non-cancerous growth found in the liver. This one has potential to become cancerous and so surgical removal of the tumor is the treatment of choice. It has been found to be related to sex hormones including intake of oral contraceptives. In such instances, the tumor size decreased on stopping the hormonal medication.
Focal Nodular Hyperplasia is found more in middle-aged women with no underlying liver disease. This is the only benign or non-cancerous liver tumor that contains a type of cell called 'kupffer cells' which are also found in normal liver. We do not yet know what causes this tumor.
Cancerous tumor found in the liver can be either due to spread to the liver from a cancer in some other part of the body - we call this metastatic tumor; or cancer arising from the liver itself - we call this primary liver cancer. We will deal with both separately.
Cancer that has spread from a primary cancer in another part of the body - These are the more common ones. They usually come from cancers of the gastrointestinal tract, breast or lung. These can be surgically removed if it is possible and will need further treatment like chemotherapy depending on where it has originated from.
Primary cancer of the liver or Hepatocellular Carcinoma - This is a very dangerous cancer which rarely lets its victim survive beyond 6 months. Upto 80% of those with this cancer have cirrhosis associated to it. Livers with cirrhosis are usually fibrotic and shrunken. The most common causes of cirrhosis are viral infections like Hepatitis B and Hepatitis C infections, excessive alcohol consumption and a rare condition called haemochromatosis.
Other causes of Hepatocellular cancer are a fungus called 'aflatoxin' (commonly found in spoilt groundnuts - next time, dump those spoit groundnuts in the kitchen rubbish bin and not your tummy rubbish bin!) and androgenic steroids; a weak association has been found with oral contraceptive pills. This tumor is more common in men than women.
This tumor can spread to the lymph nodes, lung and bones.
The only possible treatment is resection of the tumor and liver transplantation if the tumor is small enough and transplantation is an available option.
Cholangiocarcinoma is cancer that arises out of the bile ducts (network of tubes which transport bile - the green stuff produced by the liver and used for digestion by the stomach). This can arise from tubes that are within or outside the liver. They are often diagnosed late and also have a scope of less than 6 months survival.
These are not associated with cirrhosis or hepatitis B. In the Far East, they are associated to infestation with some species like Clonorchis sinensis or Opisthorchis viverini.
10. Cervical and Uterine cancer: Any bleeding from the vagina that is not related to a period must alert you! By this we mean, any bleeding that occurs unexpectedly between 2 periods, bleeding after sexual intercourse or bleeding after a vaginal examination. Even bleeding after menopause (more likely for uterine cancer) and a heavier normal period will be well worth getting checked out.
Any unexplained persistent vaginal discharge, pelvic pain or pain during intercourse should also raise alarm.
Who is prone to cervical cancer?
The Human Papilloma Virus or the HPV virus infection puts a woman in a high risk category. This virus is transmitted by sexual contact and is more likely in women with multiple partners or women who have a relationship with a man who has multiple partners. This virus may or may not also cause genital warts. There is now a vaccine available against this virus.
Cervical cancer is more commom over the 40 year age group and in those who have had more children.
Cigarrate smoking also increases the risk of cervical cancer. So does long-term (more than 5 years) use of birth control pills.
Any condition that decreases the immunity of a person increases risk, like having a HIV infection.
Daughters of mothers who had been given Diethystilbesterol during pregnancy were found to develop cervical cancer. This drug is now contra-indicated in pregnancy.
Screening: The Pap Test or Pap Smear is a good way to screen, though it may not be perfect always (sometimes disease can be missed).
Pap Test is a simple out-patient procedure that does not require any anesthesia. Some cells from the cervix are taken on a swab through the vagina, put on a special slide and sent for testing. During testing, the pathologist will look out for pre-cancerous of cancer cells.
A Pap Test is advised to be taken no later that 3 years after the first sexual intercourse or the age of 21. For 48 hours before a Pap Test, do not have sexual intercourse, do not use vaginal douche or any form of vaginal medication.
Monday, February 25, 2008
Is this a Breast Lump? Can it be Cancer?
Breast lumps are innocuous things that have a hidden potential to land one in a whole lot of trouble. Breast cancer as such is a condition that can be detected and diagnosed early if we are aware of it. I firmly believe anyone who need not go through it should not. All we need is a high degree of alertness and awareness to follow up on suspicions.
How do we know there is a problem?
The commonest way an early cancer can present is in the form of an innocent lump in the breast. This is easy enough to detect by oneself by regular self-examination. Do not examine daily, then you cannot make out any new change. It would be mre sensible to examine once a month instead. Self examination is ideally performed 3 to 5 days after your period as the breast is least painful or lumpy then.
One of the better ways to examine is: Lie down on the bed. To examine the right breast, tuck your right arm under your head and with the flat of the fingers of your left hand, press down in small circular motions on the right breast and check for any lumps. In a standing or sitting position, check the armpit for lumps (some breast tissue extends into the armpit). To examine the left breast, lie down, tuck in the left arm under your head and examine the left breast with the flat of the fingers of your right hand. Again, do not forget to feel the armpit as well. Stand in front of a mirror and examine both breasts with your arms by your side and also with your arms held up straight. Look for changes in shape, contour, texture of skin- any dimpling or indentations that resemble an orange peel and changes in the nipple.
Self examination is very useful indicator, but it cannot substitute being examined by a doctor or a routine mammogram. So you must not depend on this alone.
Who is at risk?
It is rare to find cancer of the breast in women below 20 years. Those above 20 years must routinely self-examine. Women in whose family other women have had breast cancer are at a greater risk. They must have routine examinations by a doctor and routine mammograms.
As far as diet is concerned, high intake of alcohol is linked to an increased incidence of breast cancer. Body weight? Women who are obese have a greater incidence.
Here is something interesting: Breast cancer is more common in women who have not had children. Breast feeding and child-birth at an earlier age have a protective effect. Hormone Replacement Therapy's role in breast cancer is controversial. Usually those on HRT get more benefit from it which will outweigh any risk.
Men are not exempted: Less than 0.5% of those with breast cancer are men.
If you do have a breast lump, who do you go to?
Breast lumps are dealt by surgeons, not gynecologists. So go to a surgeon.
If you are below 40, an ultrasonogram will be of more use than a mammogram. Above 40 years, a mammogram will give better results.
If the lump is confirmed, get a biopsy done. Do not delay. Every day you save will make a difference.
Biopsy:
This is the clincher. There are two types of biopsy:
1. Fine Needle Aspiration Cytology (FNAC)- In this, the surgeon will put in a needle in different parts of the lump and withdraw some aspirate. Cells from this aspirate will be tested for cancerous or as we call it, 'malignant' changes. THIS CAN ONLY BE DEPENDED ON FOR A POSITIVE RESULT. A negative FNAC does not rule out cancer. Its simple logic. If cancer cells are present in an area the needle missed, obviously the result will be negative! But if there is cancer and the cells are picked up by the needle, then we know there is a problem and can plan further.
2. Excision biopsy: Small lumps can ususally be taken out as a day procedure under local anesthesia. Taken with adequate clearance (which is, a margin of normal tissue around the lump) in case this shows cancer cells, further surgery may not even be needed.
All patients who are discovered to have cancer cells must undergo the full list of investigations to check if the cells have spread anywhere else in the body (this sneaky disease starts to spread early at the microscopic level). Further treatment such as chemotherapy and radio therapy are planned depending on the results of such investigations.
I suppose this is about all I need to write here. Do remember, like the old addage says, 'Prevention is better than cure'. Early catch can also be as good as cure. So don't delay on the biopsy if you have a lump. Don't hesitate to get a second opinion.
Two conditions that cause a lot of confusion with breast cancer are 'fibroadenoma' of the breast which is single or multiple small lumps that are mobile and smooth and 'fibroadenosis' in which the whole breast is painful and lumpy. Fibroadenoma can be biopsied to rule out cancer. Fibroadenosis can be ruled out by a doctor's examination though an ultrasonogram or a mammogram may sometimes be necessary.
How do we know there is a problem?
The commonest way an early cancer can present is in the form of an innocent lump in the breast. This is easy enough to detect by oneself by regular self-examination. Do not examine daily, then you cannot make out any new change. It would be mre sensible to examine once a month instead. Self examination is ideally performed 3 to 5 days after your period as the breast is least painful or lumpy then.
One of the better ways to examine is: Lie down on the bed. To examine the right breast, tuck your right arm under your head and with the flat of the fingers of your left hand, press down in small circular motions on the right breast and check for any lumps. In a standing or sitting position, check the armpit for lumps (some breast tissue extends into the armpit). To examine the left breast, lie down, tuck in the left arm under your head and examine the left breast with the flat of the fingers of your right hand. Again, do not forget to feel the armpit as well. Stand in front of a mirror and examine both breasts with your arms by your side and also with your arms held up straight. Look for changes in shape, contour, texture of skin- any dimpling or indentations that resemble an orange peel and changes in the nipple.
Self examination is very useful indicator, but it cannot substitute being examined by a doctor or a routine mammogram. So you must not depend on this alone.
Who is at risk?
It is rare to find cancer of the breast in women below 20 years. Those above 20 years must routinely self-examine. Women in whose family other women have had breast cancer are at a greater risk. They must have routine examinations by a doctor and routine mammograms.
As far as diet is concerned, high intake of alcohol is linked to an increased incidence of breast cancer. Body weight? Women who are obese have a greater incidence.
Here is something interesting: Breast cancer is more common in women who have not had children. Breast feeding and child-birth at an earlier age have a protective effect. Hormone Replacement Therapy's role in breast cancer is controversial. Usually those on HRT get more benefit from it which will outweigh any risk.
Men are not exempted: Less than 0.5% of those with breast cancer are men.
If you do have a breast lump, who do you go to?
Breast lumps are dealt by surgeons, not gynecologists. So go to a surgeon.
If you are below 40, an ultrasonogram will be of more use than a mammogram. Above 40 years, a mammogram will give better results.
If the lump is confirmed, get a biopsy done. Do not delay. Every day you save will make a difference.
Biopsy:
This is the clincher. There are two types of biopsy:
1. Fine Needle Aspiration Cytology (FNAC)- In this, the surgeon will put in a needle in different parts of the lump and withdraw some aspirate. Cells from this aspirate will be tested for cancerous or as we call it, 'malignant' changes. THIS CAN ONLY BE DEPENDED ON FOR A POSITIVE RESULT. A negative FNAC does not rule out cancer. Its simple logic. If cancer cells are present in an area the needle missed, obviously the result will be negative! But if there is cancer and the cells are picked up by the needle, then we know there is a problem and can plan further.
2. Excision biopsy: Small lumps can ususally be taken out as a day procedure under local anesthesia. Taken with adequate clearance (which is, a margin of normal tissue around the lump) in case this shows cancer cells, further surgery may not even be needed.
All patients who are discovered to have cancer cells must undergo the full list of investigations to check if the cells have spread anywhere else in the body (this sneaky disease starts to spread early at the microscopic level). Further treatment such as chemotherapy and radio therapy are planned depending on the results of such investigations.
I suppose this is about all I need to write here. Do remember, like the old addage says, 'Prevention is better than cure'. Early catch can also be as good as cure. So don't delay on the biopsy if you have a lump. Don't hesitate to get a second opinion.
Two conditions that cause a lot of confusion with breast cancer are 'fibroadenoma' of the breast which is single or multiple small lumps that are mobile and smooth and 'fibroadenosis' in which the whole breast is painful and lumpy. Fibroadenoma can be biopsied to rule out cancer. Fibroadenosis can be ruled out by a doctor's examination though an ultrasonogram or a mammogram may sometimes be necessary.
Monday, February 4, 2008
Blood Pressure? Who, me?
I sure hope its not you! Even if it is, be armed with knowledge and attack it right back!
Blood Pressure is more of a 'trait' than disease. It risies with age and is closely related to Stroke and Cardiovascular disease among a host of other things (it can also affect the eye and the kidney).
Blood Pressure is measured as two readings and expressed in a form that looks like a fraction (but it is NOT a fraction!). For eg. 150/90mm of Hg. This simply means that when the heart is pumping out the maximum blood pressure reached in the blood vessels is 150mm of Hg - we call this the Systolic Blood Pressure; when the heart is relaxed and getting filled with venous blood, the blood pressure that continues to hold up the blood vessels is 90mm of Hg - we call this the Diastolic Blood Pressure.
There are many definitions for ideal blood pressure, but an average reading of 120/80mm of Hg is taken as normal. Between Systolic and Diastolic blood pressures, Systolic is more fluctuant (varies more easily with stress, emotions, position, time of day, etc). So a Diastolic blood pressure reading will give a better guide to control, though controlling the systolic blood pressure is no less important.
A Diastolic blood pressure of 90mm of Hg or lesser is known to increase health benefits.
The WHO classifies 130-139mm of Hg Systolic pressure and 85-89mm of Hg Diastolic pressure as 'high' normal blood pressure.
Blood Pressure tends to run in families but there are many external factors that influence it, which fall well within our control. Some of these factors are diet, smoking, blood cholesterol, alcohol intake and stress. Other factors like age, gender (men are more prone than women but no, it is not proved that women are a cause!), diabetes, ethnic origin are beyond our control.
Diet, smoking, alcohol intake are eminently under our powers to modify and control as is blood cholesterol though to a lesser extent.
A diet rich in salt makes you more prone to developing high blood pressure, especially if someone in your family (I mean a blood relative like parent, brother, sister, uncle, aunt, grand-parent or cousin) is already known to have blood pressure. So keep your hands off the yummy Indian pickle, the dry fish, dry-chillies and other things that come enticingly soaked and dried in curd! Some studies have shown a diet high in potassium can have a protective effect. So grab that banana, and any other fresh fruit you can lay your hands on!
Smoking is slow poison. Like all poisons, best avoided. This requires an entire discussion by itself, coz this is the commonest thing we pay for to buy disease!! All I can say now is stopping smoking can begin to clear out some of the bad effects (depending on how long and how much the smoking has been for. Most effects are reversible in a span of 10 years, though all are not) and going on drugs without stopping will give much less benefit.
Alcohol is a double-take. Too much and it does you in (liver, heart, brain all the way to heaven) but take it in small amounts (what is small amounts?) and it can actually help lower blood pressure! If you do wish to try it out, make sure you are able to stop with small amounts!
Blood Cholesterol is something you can modify though you may not be able to control. This also unfortunately runs in families. There are two types of blood cholesterol: The good HDL (this acts like a big scavenger that removes the smaller bad ones from the blood vessels) and the bad Triglycerides and LDL. The ratio between these types is more important than the actual Total Cholesterol.
Good cholesterol or HDL is abundant in olive oil, certain types of fish and nuts. Upto 4 or 5 helpings of fresh fruits and salads a day also contributes to keep the cholesterol ratio good.
Bad cholesterol starts getting deposited in blood vessels from the age of 2. So start early on a good diet. Ghee, butter are delicious but brim over with bad cholesterol. So keep off them.
Exercise also has many beneficial effects. If you have the time and motivation, go ahead!
How do you know if you have Blood Pressure?
The best way is to have regular health checks. Other than that, here are some symptoms you could watch out for:
Any nagging headache, chest pain (due to prolonged undiagnosed bloodpressure against which the heart struggles to pump out), breathlessnes (since heart finds it difficult to pump against so much resistance, some backlog might soak the lungs), palpitations, bleeding from the nose. Disturbance in vision, fits and transient loss in consciousness can indicate to an impending stroke!
Sometimes, blood pressure can also be secondary to other disease like disease of the kidney, some hormonal problems, disease in blood vessels, pregnancy and certain drugs.
Did you know there is a defined form of blood pressure called 'White-coat' hypertension? It is blood pressure increase in people only in clinical visits!!
If you do have blood pressure, do all the things we have discussed to avoid it and get treated! Whatever anyone might say, once you get blood pressure, it is sadly your friend for life. It is under control on medication, then it is under control because of the medication, so don't try to stop it on your own. Even if it does come under control on diet and exercise, check it out at regular intervals so that it will not quietly sneak up on you without your knowing it!
Blood Pressure is more of a 'trait' than disease. It risies with age and is closely related to Stroke and Cardiovascular disease among a host of other things (it can also affect the eye and the kidney).
Blood Pressure is measured as two readings and expressed in a form that looks like a fraction (but it is NOT a fraction!). For eg. 150/90mm of Hg. This simply means that when the heart is pumping out the maximum blood pressure reached in the blood vessels is 150mm of Hg - we call this the Systolic Blood Pressure; when the heart is relaxed and getting filled with venous blood, the blood pressure that continues to hold up the blood vessels is 90mm of Hg - we call this the Diastolic Blood Pressure.
There are many definitions for ideal blood pressure, but an average reading of 120/80mm of Hg is taken as normal. Between Systolic and Diastolic blood pressures, Systolic is more fluctuant (varies more easily with stress, emotions, position, time of day, etc). So a Diastolic blood pressure reading will give a better guide to control, though controlling the systolic blood pressure is no less important.
A Diastolic blood pressure of 90mm of Hg or lesser is known to increase health benefits.
The WHO classifies 130-139mm of Hg Systolic pressure and 85-89mm of Hg Diastolic pressure as 'high' normal blood pressure.
Blood Pressure tends to run in families but there are many external factors that influence it, which fall well within our control. Some of these factors are diet, smoking, blood cholesterol, alcohol intake and stress. Other factors like age, gender (men are more prone than women but no, it is not proved that women are a cause!), diabetes, ethnic origin are beyond our control.
Diet, smoking, alcohol intake are eminently under our powers to modify and control as is blood cholesterol though to a lesser extent.
A diet rich in salt makes you more prone to developing high blood pressure, especially if someone in your family (I mean a blood relative like parent, brother, sister, uncle, aunt, grand-parent or cousin) is already known to have blood pressure. So keep your hands off the yummy Indian pickle, the dry fish, dry-chillies and other things that come enticingly soaked and dried in curd! Some studies have shown a diet high in potassium can have a protective effect. So grab that banana, and any other fresh fruit you can lay your hands on!
Smoking is slow poison. Like all poisons, best avoided. This requires an entire discussion by itself, coz this is the commonest thing we pay for to buy disease!! All I can say now is stopping smoking can begin to clear out some of the bad effects (depending on how long and how much the smoking has been for. Most effects are reversible in a span of 10 years, though all are not) and going on drugs without stopping will give much less benefit.
Alcohol is a double-take. Too much and it does you in (liver, heart, brain all the way to heaven) but take it in small amounts (what is small amounts?) and it can actually help lower blood pressure! If you do wish to try it out, make sure you are able to stop with small amounts!
Blood Cholesterol is something you can modify though you may not be able to control. This also unfortunately runs in families. There are two types of blood cholesterol: The good HDL (this acts like a big scavenger that removes the smaller bad ones from the blood vessels) and the bad Triglycerides and LDL. The ratio between these types is more important than the actual Total Cholesterol.
Good cholesterol or HDL is abundant in olive oil, certain types of fish and nuts. Upto 4 or 5 helpings of fresh fruits and salads a day also contributes to keep the cholesterol ratio good.
Bad cholesterol starts getting deposited in blood vessels from the age of 2. So start early on a good diet. Ghee, butter are delicious but brim over with bad cholesterol. So keep off them.
Exercise also has many beneficial effects. If you have the time and motivation, go ahead!
How do you know if you have Blood Pressure?
The best way is to have regular health checks. Other than that, here are some symptoms you could watch out for:
Any nagging headache, chest pain (due to prolonged undiagnosed bloodpressure against which the heart struggles to pump out), breathlessnes (since heart finds it difficult to pump against so much resistance, some backlog might soak the lungs), palpitations, bleeding from the nose. Disturbance in vision, fits and transient loss in consciousness can indicate to an impending stroke!
Sometimes, blood pressure can also be secondary to other disease like disease of the kidney, some hormonal problems, disease in blood vessels, pregnancy and certain drugs.
Did you know there is a defined form of blood pressure called 'White-coat' hypertension? It is blood pressure increase in people only in clinical visits!!
If you do have blood pressure, do all the things we have discussed to avoid it and get treated! Whatever anyone might say, once you get blood pressure, it is sadly your friend for life. It is under control on medication, then it is under control because of the medication, so don't try to stop it on your own. Even if it does come under control on diet and exercise, check it out at regular intervals so that it will not quietly sneak up on you without your knowing it!
Quirky Snippets!
Well here is some food for thought:
1. Who was the very first Anesthetist?
Ans: God
2. Who was the very first Surgeon?
Ans: God
Reference? Bible, Genesis Chapter 2: 21,22
I find this very interesting.
"So the Lord caused the man to fall into a deep sleep;" - Exactly what anesthetists do: Put patients into 'deep sleep' before painful surgery.
"and while he was sleeping, he took one of the man's ribs and closed up the place with flesh" - Exactly what surgeons do: After the patient is in 'deep sleep', open, tinker around doing what they have to, then 'close the place with flesh'.
Here comes the best part still: After 'taking one of the man's ribs', what did he do? "Then the Lord God made a woman from the rib he had taken out of the man"!
Guess what the rib is known to contain? Stem Cells!!
So did God use Stem Cells from Adam, do a bit of genetic modification, replace the 'Y' chromosome with 'X' and let it grow? Adam does say Eve is 'bone of my bones and flesh of my flesh'.
To me, Science is the attempt to unravel the mysteries hidden in Creation. This is one mystery everybody is trying to crack!
A final one to munch on: "God formed the man from the dust of the ground and breathed into his nostrils the breath of life": What is 'dust' of the earth? Silica, Carbon- two of the most stable elements in nature. Contained in fossils and diamonds among other things!
1. Who was the very first Anesthetist?
Ans: God
2. Who was the very first Surgeon?
Ans: God
Reference? Bible, Genesis Chapter 2: 21,22
I find this very interesting.
"So the Lord caused the man to fall into a deep sleep;" - Exactly what anesthetists do: Put patients into 'deep sleep' before painful surgery.
"and while he was sleeping, he took one of the man's ribs and closed up the place with flesh" - Exactly what surgeons do: After the patient is in 'deep sleep', open, tinker around doing what they have to, then 'close the place with flesh'.
Here comes the best part still: After 'taking one of the man's ribs', what did he do? "Then the Lord God made a woman from the rib he had taken out of the man"!
Guess what the rib is known to contain? Stem Cells!!
So did God use Stem Cells from Adam, do a bit of genetic modification, replace the 'Y' chromosome with 'X' and let it grow? Adam does say Eve is 'bone of my bones and flesh of my flesh'.
To me, Science is the attempt to unravel the mysteries hidden in Creation. This is one mystery everybody is trying to crack!
A final one to munch on: "God formed the man from the dust of the ground and breathed into his nostrils the breath of life": What is 'dust' of the earth? Silica, Carbon- two of the most stable elements in nature. Contained in fossils and diamonds among other things!
Wednesday, January 16, 2008
Eeek! Is this a heart attack?
Whew! Thats one question anyone would like to know!
'Heart attack' as most people perceive it ranges from various degrees of chest pain, accompanied or unaccompanied by sweating, nausea, a 'fear of death' which could put a person in immediate peril.
Like all horrible things, 'heart attack' also usually comes with fore-warning (diabetics may not have this advantage as their nerves may not recognize the pain). The fore-warning is in the form of 'chest pain' which initially comes on and off, is provoked by physical exertion usually after meals or in cold and also by anger or other excitement. This will usually settle with rest. The pain may not always be in the left side of the chest contrary to popular belief. It can be below the sternal bone (so it is often mistaken for the common gastritis), can radiate to the left arm or even the left lower jaw! It is frequently a crushing kind of pain. Some deviant varieties can present with pain on lying down, pain in the night (caused by vivid dreams in sleep), pain that occurs without provocation (even at rest) and a special type that can occur in women with positive stress test but no findings in an angiogram.
If the pain is not investigated and treated, the effects can be disastrous as we all know. The pain may progress and not be relieved even at rest or may suddenly throw up an excruciating painful episode with sweating, nausea or vomiting and a terrifying fear.
This indicates the 'warning pain' or 'angina' has progressed to a full-blown heart attack! A heart attack needs immediate treatment. The sooner the patient is in a hospital, the better.
We must remember that diabetics often do not have the luxury of a fore-warning pain like this. They tend to not feel the pain, as their nerves have become insensitive; so they are in danger of 'Silent MI' which can be fatal.
If someone gets angina, what do you do next?
Rest. Once the heart slows down with rest, there is more time for the coronary arteries to fill with precious oxygenated blood to deliver to the oxygen-deprived heart muscle. Besides, as the heart slows, its work becomes lesser, making it's need for oxygen also lesser. So it can survive on lower levels for some time.
Get to a doctor as soon as you can and find the cause of the pain, the extent of the disease and the options for treatment.
These are done as simple OP procedures in the form of a physical check up by a doctor (including recording your blood pressure, pulse rate and rhythm, looking for swelling in your feet, etc), complete blood profile for cholesterol, blood sugars, haemogram, an ECG, an ECHO cardiogram, followed by a Treadmill stress test (remember to do the stress test only after confirming your heart can stand it by earlier ECG and ECHO). If these show an indication for angiography, then an angiography is done.
During an angiography, if blocks are found, some are relieved by inserting stents during the angiography itself (this depends on the number of blocks, the extent of block and the site of the block). Others may require surgery.
There are many options now available, so we can be of good cheer! People are even trying stem cell implants to revive portions of the heart that have got 'infarcted' or sort-of 'died' in an earlier heart-attack, in heart-attack survivors!
Prevention though, is always the best though not all factors that cause a heart attack are preventable. We can try to modify what we can to decrease the risk we face:
1. If you are a smoker, QUIT SMOKING! That's like tying a noose around a suffocating man's head! Medicines can't help you beyond an extent if you don't! Besides, after you do stop, it takes 12 to 23 months for the risk level to begin to fall and a much longer time for the risk to fall to baseline levels of non-smokers!
2. Eat sensibly. Don't overdose on fatty stuff especially those fried food and fast food. Happily go overboard on salads and fish (Salmon, Sardines, Mackeral, Albacore tuna, Herring, Sword fish and Lake trout are recomended with an intake of at least two portions per week totalling of 120gms).
3. Try to get some exercise (other than walking around the house).
4. Get yearly health check especially if you have a family member who has had a similar problem (even if you are only 35 or even if you are a woman).
5. Cholesterol gets deposited in the arteries as yearly as 2 years on! So keep the kids also off unhealthy diet (once in a while a stop at the pizza joint or burger stall should be ok!).
If you have any questions, feel free to ask! We have a cardiac team on our panel!
'Heart attack' as most people perceive it ranges from various degrees of chest pain, accompanied or unaccompanied by sweating, nausea, a 'fear of death' which could put a person in immediate peril.
Like all horrible things, 'heart attack' also usually comes with fore-warning (diabetics may not have this advantage as their nerves may not recognize the pain). The fore-warning is in the form of 'chest pain' which initially comes on and off, is provoked by physical exertion usually after meals or in cold and also by anger or other excitement. This will usually settle with rest. The pain may not always be in the left side of the chest contrary to popular belief. It can be below the sternal bone (so it is often mistaken for the common gastritis), can radiate to the left arm or even the left lower jaw! It is frequently a crushing kind of pain. Some deviant varieties can present with pain on lying down, pain in the night (caused by vivid dreams in sleep), pain that occurs without provocation (even at rest) and a special type that can occur in women with positive stress test but no findings in an angiogram.
If the pain is not investigated and treated, the effects can be disastrous as we all know. The pain may progress and not be relieved even at rest or may suddenly throw up an excruciating painful episode with sweating, nausea or vomiting and a terrifying fear.
This indicates the 'warning pain' or 'angina' has progressed to a full-blown heart attack! A heart attack needs immediate treatment. The sooner the patient is in a hospital, the better.
We must remember that diabetics often do not have the luxury of a fore-warning pain like this. They tend to not feel the pain, as their nerves have become insensitive; so they are in danger of 'Silent MI' which can be fatal.
If someone gets angina, what do you do next?
Rest. Once the heart slows down with rest, there is more time for the coronary arteries to fill with precious oxygenated blood to deliver to the oxygen-deprived heart muscle. Besides, as the heart slows, its work becomes lesser, making it's need for oxygen also lesser. So it can survive on lower levels for some time.
Get to a doctor as soon as you can and find the cause of the pain, the extent of the disease and the options for treatment.
These are done as simple OP procedures in the form of a physical check up by a doctor (including recording your blood pressure, pulse rate and rhythm, looking for swelling in your feet, etc), complete blood profile for cholesterol, blood sugars, haemogram, an ECG, an ECHO cardiogram, followed by a Treadmill stress test (remember to do the stress test only after confirming your heart can stand it by earlier ECG and ECHO). If these show an indication for angiography, then an angiography is done.
During an angiography, if blocks are found, some are relieved by inserting stents during the angiography itself (this depends on the number of blocks, the extent of block and the site of the block). Others may require surgery.
There are many options now available, so we can be of good cheer! People are even trying stem cell implants to revive portions of the heart that have got 'infarcted' or sort-of 'died' in an earlier heart-attack, in heart-attack survivors!
Prevention though, is always the best though not all factors that cause a heart attack are preventable. We can try to modify what we can to decrease the risk we face:
1. If you are a smoker, QUIT SMOKING! That's like tying a noose around a suffocating man's head! Medicines can't help you beyond an extent if you don't! Besides, after you do stop, it takes 12 to 23 months for the risk level to begin to fall and a much longer time for the risk to fall to baseline levels of non-smokers!
2. Eat sensibly. Don't overdose on fatty stuff especially those fried food and fast food. Happily go overboard on salads and fish (Salmon, Sardines, Mackeral, Albacore tuna, Herring, Sword fish and Lake trout are recomended with an intake of at least two portions per week totalling of 120gms).
3. Try to get some exercise (other than walking around the house).
4. Get yearly health check especially if you have a family member who has had a similar problem (even if you are only 35 or even if you are a woman).
5. Cholesterol gets deposited in the arteries as yearly as 2 years on! So keep the kids also off unhealthy diet (once in a while a stop at the pizza joint or burger stall should be ok!).
If you have any questions, feel free to ask! We have a cardiac team on our panel!
Stem Cells
Today's headlines carry the exciting news how 'a dead heart beats again'! Amazing, yes. Researchers from the University of Minnesota namely Prof. Doris Taylor and her team, acheived the feat by a unique method: The stripped the heart of a dead rat of all cells, leaving the extra-cellular matrix and hence the 'backbone' of the structure alone intact. They repopulated this 'skeleton' with immature cells. Four days later contractions were observed. Eight days later, the world's first 'bio-artificial' heart was pumping, though at an efficiency of 2% compared to the adult heart!
Stem cells are certainly the way to fairy-lore in medicine. The problem yet to be overcome appears to me to be how to make these cells learn to fuction physiologically like the cells they successfully anatomically replicate. Stem cells become myocardiac cells, but they need to learn to function like the myocardium. Let us hope this break-through comes up sooner than later, for the benefit of the thousands who need them!
In the meanwhile, if anyone has news on any more/other break-throughs in on-going stem cell research in India or elsewhere to treat cardiac failure, peripheral vascular disease, paraplegia, chronic renal failure, cirrhosis or diabetes mellitus, do share your information in the 'comments' section.
Hopefully, this site can serve to link patients and physicians in such crucial areas on the cutting edge of medicine.
Stem cells are certainly the way to fairy-lore in medicine. The problem yet to be overcome appears to me to be how to make these cells learn to fuction physiologically like the cells they successfully anatomically replicate. Stem cells become myocardiac cells, but they need to learn to function like the myocardium. Let us hope this break-through comes up sooner than later, for the benefit of the thousands who need them!
In the meanwhile, if anyone has news on any more/other break-throughs in on-going stem cell research in India or elsewhere to treat cardiac failure, peripheral vascular disease, paraplegia, chronic renal failure, cirrhosis or diabetes mellitus, do share your information in the 'comments' section.
Hopefully, this site can serve to link patients and physicians in such crucial areas on the cutting edge of medicine.
To be or not to be: Medical/Surgical Termination of Pregnancy
Medical / Surgical Termination of Pregnancy might well be one of the most and hotly debated questions in history. Personally I think this should be classified in two categories: the unmarried young woman and the married mother.
The unmarried young woman presents the more heart-wrenching subject. I respect life. I did not and cannot create life and so I do not have authority to destroy it. I believe life is created the time the sperm and ova unite and form the unicellular zygote. This single cell comes with the blue print of life for the future individual. This one cell holds the key of life, or better still, is life.
Yet when a young woman walks into your OP pregnant, says she cannot be married for some reason, what do you do? If you don't do it, she is going to get it done anyway. She may go to a qualified practitioner (hopefully) of she may end up on a quack's table which may turn out catastrophic for the life of the young girl.
One bright morning, a girl of about 14 walked into my OP accompanied by a middle-aged man who introduced himself as her 'uncle'. She complained of 'abdominal pain'. On examining, she was obviously with child, the fundus about 20 to 24 weeks. I could hear the fetal heart. The child refused to open her mouth except to say she had 'abdodminal pain', refused to even accept there was a baby within her! The 'uncle' was in top hurry to get rid of the unwanted baggage. Much as I wept within for this little girl who was in no way prepared to be a mother, I could not bring myself to do an MTP. So finally I sent them away.
I know my hand would simply not have been able to insert that tablet of misoprost into her vagina. Even if she had come in the first trimester, I know I couldn't have done it, but I just cannot forget the girl or the blank look on her face. I do not know what became of her...
There were numerous married ladies who came in seeking MTP since either their career was peaking or they just could not afford one more, etc, etc. These I strived to convince. I drew pictures, showed posters and carefully preserved abortus specimen from naturally terminated pregnancies. Happily, a good many of them carried to term and went in for a good method of contraceptive after the delivery.
According to the NEJM: 30 March 2000 Volume 342:946-956, 'an estimated 26 million pregnancies are terminated legally each year throughout the world, and 20 million are terminated illegally, with more than 78,000 deaths.'
I hope that raw 14 year old was not one of them. I know I can still not go ahead with an MTP except if its medically indicated. I don't know which is the harder burden to carry in my soul: the life of the young mother or that of her unborn child.
The unmarried young woman presents the more heart-wrenching subject. I respect life. I did not and cannot create life and so I do not have authority to destroy it. I believe life is created the time the sperm and ova unite and form the unicellular zygote. This single cell comes with the blue print of life for the future individual. This one cell holds the key of life, or better still, is life.
Yet when a young woman walks into your OP pregnant, says she cannot be married for some reason, what do you do? If you don't do it, she is going to get it done anyway. She may go to a qualified practitioner (hopefully) of she may end up on a quack's table which may turn out catastrophic for the life of the young girl.
One bright morning, a girl of about 14 walked into my OP accompanied by a middle-aged man who introduced himself as her 'uncle'. She complained of 'abdominal pain'. On examining, she was obviously with child, the fundus about 20 to 24 weeks. I could hear the fetal heart. The child refused to open her mouth except to say she had 'abdodminal pain', refused to even accept there was a baby within her! The 'uncle' was in top hurry to get rid of the unwanted baggage. Much as I wept within for this little girl who was in no way prepared to be a mother, I could not bring myself to do an MTP. So finally I sent them away.
I know my hand would simply not have been able to insert that tablet of misoprost into her vagina. Even if she had come in the first trimester, I know I couldn't have done it, but I just cannot forget the girl or the blank look on her face. I do not know what became of her...
There were numerous married ladies who came in seeking MTP since either their career was peaking or they just could not afford one more, etc, etc. These I strived to convince. I drew pictures, showed posters and carefully preserved abortus specimen from naturally terminated pregnancies. Happily, a good many of them carried to term and went in for a good method of contraceptive after the delivery.
According to the NEJM: 30 March 2000 Volume 342:946-956, 'an estimated 26 million pregnancies are terminated legally each year throughout the world, and 20 million are terminated illegally, with more than 78,000 deaths.'
I hope that raw 14 year old was not one of them. I know I can still not go ahead with an MTP except if its medically indicated. I don't know which is the harder burden to carry in my soul: the life of the young mother or that of her unborn child.
Doctors' Diary
Rural life and rural people have their own innocent charm. Years ago, while working in a mission hospital in Mussorie, there was a young couple who walked into OP one morning. She was into her 5th month and came with pains. This was her 3rd or 4th pregnancy; all earlier ones had terminated with onset of pains about this time. Examination showed an incompetent cervix. We put a McDonald's stitch, admitted her and put her on bed rest till the pains could subside.
After couple of weeks, the pains had come down and the couple wanted to return; they had to care for their fields. We were aghast; returning meant a bumpy ride on a rickety jeep for hours through steep roads. Even if she did reach home safely, she was going to continue hard manual labor in all likelihood. If she did get pains, there was no other hospital nearby to go to for help. We were the closest and of course, all this distance away. Yet they insisted and we had to let her go. We explained all the risks of early pains with a McDonald's stitch and pleaded for her to come back when she started on her 8th month at the latest.
There wasn't a day in that time when my mind wouldn't have strayed to her, imagining her walking her fields, carrying bundles on her head, all with a McDonald's stitch!
Finally one morning, both husband and wife re-appeared in the hospital's portals. She was starting on her 8th month, was getting along fine and had come in for re-admission! We were overjoyed and greatly relieved! After a few weeks of bed rest, the McDonald's stitch was out and she progressed into labor and delivered a beautiful boy baby normally!
As I walked back home late that evening after conducting her delivery, with the dark sky and chill winds for company, I heard the sound of footfall behind. I hurried, not knowing who was out on a cold and lonely night like this (unless they had to deliver or conduct a delivery!). The footfall also increased pace with me. When I was almost at my door, I heard a voice call, "Doctorji, doctorji!"
I stopped and turned around. It was the young woman's husband, holding out a box of sweets!
"Doctorji, thank you! We are so happy! Please accept this!"
"Oh! I am so happy for you too! But I think you should give the sweets in the office, they will give all the staff. We don't take from patients..."
The young man refused to give up. "Doctorji, I have already given the staff. They told me this is what you would say, that is why I came here to give you. Please take this... Its from our family to yours."
He refused to budge. I could not bring myself to be blatantly rude and still say no. Reluctantly, I took the box of sweets going against years of die-hard training in our good old alma matter!
By the time I left Mussoorie, a few more corn cobs and garlic cloves were added to my list! To this day I savor the memories and the wonderful people, my patients, who made them for me...
After couple of weeks, the pains had come down and the couple wanted to return; they had to care for their fields. We were aghast; returning meant a bumpy ride on a rickety jeep for hours through steep roads. Even if she did reach home safely, she was going to continue hard manual labor in all likelihood. If she did get pains, there was no other hospital nearby to go to for help. We were the closest and of course, all this distance away. Yet they insisted and we had to let her go. We explained all the risks of early pains with a McDonald's stitch and pleaded for her to come back when she started on her 8th month at the latest.
There wasn't a day in that time when my mind wouldn't have strayed to her, imagining her walking her fields, carrying bundles on her head, all with a McDonald's stitch!
Finally one morning, both husband and wife re-appeared in the hospital's portals. She was starting on her 8th month, was getting along fine and had come in for re-admission! We were overjoyed and greatly relieved! After a few weeks of bed rest, the McDonald's stitch was out and she progressed into labor and delivered a beautiful boy baby normally!
As I walked back home late that evening after conducting her delivery, with the dark sky and chill winds for company, I heard the sound of footfall behind. I hurried, not knowing who was out on a cold and lonely night like this (unless they had to deliver or conduct a delivery!). The footfall also increased pace with me. When I was almost at my door, I heard a voice call, "Doctorji, doctorji!"
I stopped and turned around. It was the young woman's husband, holding out a box of sweets!
"Doctorji, thank you! We are so happy! Please accept this!"
"Oh! I am so happy for you too! But I think you should give the sweets in the office, they will give all the staff. We don't take from patients..."
The young man refused to give up. "Doctorji, I have already given the staff. They told me this is what you would say, that is why I came here to give you. Please take this... Its from our family to yours."
He refused to budge. I could not bring myself to be blatantly rude and still say no. Reluctantly, I took the box of sweets going against years of die-hard training in our good old alma matter!
By the time I left Mussoorie, a few more corn cobs and garlic cloves were added to my list! To this day I savor the memories and the wonderful people, my patients, who made them for me...
Home
I sit at home as I write this. What is home? Your nest, the place you come back to every night, the place you refresh and start your day from every morning... Isn't it always nice when you come home to a welcome? To warm hearts waiting for you? Of course!
That brings us to the whole topic of latchkey kids. Would it be better for a child to come home to the warm embrace of a loving parent or to take out a key from the pocket, open a cold house, switch on the lights, throw the bags down, pick a snack from the fridge, flick on the telly, flop down the sofa and ...
Most families are forced to have both parents working, so what do we do? Maybe one takes it easy till the li'l birdies fly away... Or switch off those cell phones and set apart some hours in the evenings and weekends just for the kids ... Perhaps a grandparent staying with the family might fill the gap. Different families come up with different solutions. Yet we cannot escape the reality that children need stability, identity, a feeling of being wanted, a feeling of not only being loved but cherished... these help build a strong, secure person with sincerity and integrity... What is the point in spending your whole life earning for your child and finally realizing when he or she is twenty the sweet child you once knew is now a slave to a bottle, a syringe or someone totally askew... Would you rather have not earned little less and see your child be stable and blessed?
Time once spent cannot be earned back. So plan your family time just as you plan your family money, spend it well and wisely and you will reap your dividends richly!
That brings us to the whole topic of latchkey kids. Would it be better for a child to come home to the warm embrace of a loving parent or to take out a key from the pocket, open a cold house, switch on the lights, throw the bags down, pick a snack from the fridge, flick on the telly, flop down the sofa and ...
Most families are forced to have both parents working, so what do we do? Maybe one takes it easy till the li'l birdies fly away... Or switch off those cell phones and set apart some hours in the evenings and weekends just for the kids ... Perhaps a grandparent staying with the family might fill the gap. Different families come up with different solutions. Yet we cannot escape the reality that children need stability, identity, a feeling of being wanted, a feeling of not only being loved but cherished... these help build a strong, secure person with sincerity and integrity... What is the point in spending your whole life earning for your child and finally realizing when he or she is twenty the sweet child you once knew is now a slave to a bottle, a syringe or someone totally askew... Would you rather have not earned little less and see your child be stable and blessed?
Time once spent cannot be earned back. So plan your family time just as you plan your family money, spend it well and wisely and you will reap your dividends richly!
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