Recently someone asked me about Merkel cell cancer. Relatively rare.
The website I suggested helped him - http://www.merkelcell.org/
Thought it might be worth sharing, in case more people need help with this condition.
Sunday, 29 April 2012
Hindu customs and hair loss
I have spent time doing oncology work in India and working with patients was very rewarding.
One day in the out-patient clinic, I met with three women consecutively who were to start chemotherapy. All three women would lose their hair and it was very distressing for each of them and their families.
Two days later, I suggested to one of these women to shave their hair and make a wig out of her own hair. It seemed like a good idea to me. It was NOT a good idea for her and her family. In traditional Hindu culture, a woman would shave her hair at the time of being widowed.
No more such suggestions. Ever!!
One day in the out-patient clinic, I met with three women consecutively who were to start chemotherapy. All three women would lose their hair and it was very distressing for each of them and their families.
Two days later, I suggested to one of these women to shave their hair and make a wig out of her own hair. It seemed like a good idea to me. It was NOT a good idea for her and her family. In traditional Hindu culture, a woman would shave her hair at the time of being widowed.
No more such suggestions. Ever!!
Hair loss and Chemotherapy
One of the biggest worries about chemotherapy is hair loss. It seems to be a bigger issue than even fatigue and reduced appetite. This is what I seem to find in clinical practice. The worry seems to be more in women than men, but both genders are worried.
A lot of people are really surprised when I tell them that they would not be losing their hair. All chemotherapy drugs are not the same. Some drugs cause hair loss, some do not.
A lot of people are really surprised when I tell them that they would not be losing their hair. All chemotherapy drugs are not the same. Some drugs cause hair loss, some do not.
GIST: Gastro Intestinal Stromal Tumours
GIST is a truly game changing cancer. It has been around for centuries, misdiagnosed as other types of cancers. In the past few years, GIST has found to have special markers and thus the diagnosis is definitive.
Treatment is to completely remove the tumour by surgery. This is possible when it is early stage. Once the cancer has spread, surgery is not possible (most times). Chemotherapy was as good as useless. Nothing seemed to work.
A few years ago, a pharmaceutical company launched a molecule called Imatinib (Glivec). This has changed everything for GIST. Now people with metastatic GIST, pop a pill a day and continue with life. Quite amazing.
Recent data has shown that even after surgery, Glivec should be given for at least 3 years.
Game changer. Looking for more such miracles.
Treatment is to completely remove the tumour by surgery. This is possible when it is early stage. Once the cancer has spread, surgery is not possible (most times). Chemotherapy was as good as useless. Nothing seemed to work.
A few years ago, a pharmaceutical company launched a molecule called Imatinib (Glivec). This has changed everything for GIST. Now people with metastatic GIST, pop a pill a day and continue with life. Quite amazing.
Recent data has shown that even after surgery, Glivec should be given for at least 3 years.
Game changer. Looking for more such miracles.
Waiting Time for Appointments
The huge problem is that once someone has been diagnosed to have cancer, or even if there is a suspicion of cancer; most families want an appointment with their doctor straightaway. This seems to be a valid request most times, as anxiety levels are HUGE.
As a specialist, we are usually keen to have a definitive diagnosis of cancer prior to an OPD review. The idea being that the patient's GP or doctor makes a diagnosis of cancer by a biopsy or needle aspiration and then makes the referral.
As a specialist, we are usually keen to have a definitive diagnosis of cancer prior to an OPD review. The idea being that the patient's GP or doctor makes a diagnosis of cancer by a biopsy or needle aspiration and then makes the referral.
Saturday, 21 April 2012
Depression
What is depression? Is it just something which needs to be shrugged off, 'cos someone is having a bad day or days? Or is it something which is a lot more deeper and needs a through evaluation? Which treatment helps - counselling or medicines?
In Crocodile Dundee (a great Aussie movie), the actor asks - why do you need a psychiatrist, don't you have mates to talk to?
Have we lost touch with each other and not willing to say the right things to friends, since it might offend the other person?
Ohh, too much to read up and find out.
In Crocodile Dundee (a great Aussie movie), the actor asks - why do you need a psychiatrist, don't you have mates to talk to?
Have we lost touch with each other and not willing to say the right things to friends, since it might offend the other person?
Ohh, too much to read up and find out.
Friday, 20 April 2012
Malaria
Wow. The number of people dying of malaria is rising by the decade. Apparently in 2010, over 1.2 million people died of malaria. Shocking. To think that just about a decade or so ago, we thought malaria was well controlled. It is back with a vengeance. A significantly amount of malaria is now thought to be multi-drug resistant.
Angry patients
One of the most intimidating experiences is to be confronted by an angry patient and their family/friends. They might be upset about the long waiting time or the services or whatever. In the process of getting angry, the primary intention of sorting out the medical problem gets buried (to some extent).
I have found it quite effective to let the angry patient rant about everything. When the run out of steam, try and work through the problem.
There have been a couple of patients, who refuse to listen and only yell. It is not worth breaking your head with them. Ask them to leave, or leave the room yourself. I have the right to work in a safe environment.
I have found it quite effective to let the angry patient rant about everything. When the run out of steam, try and work through the problem.
There have been a couple of patients, who refuse to listen and only yell. It is not worth breaking your head with them. Ask them to leave, or leave the room yourself. I have the right to work in a safe environment.
Thursday, 19 April 2012
Diabetes and Insulin
Patients on chemotherapy seem to have a real problem controlling their blood sugar levels. Most times it is due to the fact that we give steroids pre-chemo and post-chemotherapy to prevent allergic reactions and nausea. Diet control and even Tablet based therapies may not work optimally.
Insulin for a short time might be the way to go. It is worth exploring the option with your GP or specialist. If people are getting 4 - 6 cycles of chemotherapy, short course of Insulin is all that maybe required.
Insulin for a short time might be the way to go. It is worth exploring the option with your GP or specialist. If people are getting 4 - 6 cycles of chemotherapy, short course of Insulin is all that maybe required.
Stop smoking. Right now.
The number of people gasping to death from emphysema and bronchitis is worse than people dying of lung cancer. Smoking destroys the lung tissue and the lung airways, along with lots of other things in the body.
Pretty gruesome end. Not worth it. Lots more to life. Stop smoking now.
Pretty gruesome end. Not worth it. Lots more to life. Stop smoking now.
Which cancers are rising?
Interestingly, the majority of cancer rates have reached a plateau or are reducing, except for cancers like lung cancer in young women. Unfortunately they seem to be a group which is picking up habits like smoking.
The problem is that by the time, it get publicised and all that, so many young women would have suffered.
Stop smoking. Everyone. Right now.
The problem is that by the time, it get publicised and all that, so many young women would have suffered.
Stop smoking. Everyone. Right now.
Managing Articles and Research Documents
I have struggled to organize my research papers and articles. They are placed in folders within folders within folders. The Apple operating system (Lion or prior) helped with searching documents, but it was never the same.
Recently I started using "Papers" - http://www.mekentosj.com/papers/
Brilliant piece of software - mainly for Apple OS, but they are coming out with a Windows edition too. Works with iPhone and iPad too. All the devices sync with each other. Pretty cool.
Recently I started using "Papers" - http://www.mekentosj.com/papers/
Brilliant piece of software - mainly for Apple OS, but they are coming out with a Windows edition too. Works with iPhone and iPad too. All the devices sync with each other. Pretty cool.
Wednesday, 18 April 2012
Intervening for a Friend
A few weeks ago, one of my friends in the USA was found to have recurrence of bowel cancer. She was being tossed around with scans, blood tests and a possible biopsy. It was hard to tell her that she was getting sub-optimal care and needs to see another doctor. She agreed. Saw another doctor and got a PET scan done.
Last week she was operated upon and they have taken out the cancer completely. Fantastic. I am so thrilled. I bet she is too :)
Worth pushing for.
Last week she was operated upon and they have taken out the cancer completely. Fantastic. I am so thrilled. I bet she is too :)
Worth pushing for.
Death or Dying
I wonder what is worse - death or dying. I suspect most people are worried about the process of dying, with regard to pain or breathlessness; but there would be a fair number of people who are also worried about what would happen after they die. What would happen to them, their families, their friends, their assets, etc.
Difficult question. Personal. As always.
Difficult question. Personal. As always.
Research and Clinical Trials
Clinical Trials for medications and drugs are broadly divided in four groups or phases:
Phase 1: Very early type of research. In some types, it would be a "first in human" study
Phase 2: Studies would have shown the medication to be relatively safe and it is now being tested for efficacy
Phase 3: The safety and efficacy have been shown to be favourable, and now it is being tested against the present standard of care
Phase 4: This study is primarily to gain more information about the medication, as it has already been approved for routine use in the market
Enrolling onto clinical trials is a good thing. It gives access to newer molecules or different ways of using older molecules. It is possible that the full benefits of the study medication may never be seen in the patients enrolled on the study, bur future generations would benefit from the same.
All trials are governed via Ethics Committees, which may be locally or centrally based. They are the guardians of patients and their families, and would not give permission to conduct a study, unless they are convinced about safety.
The first principle remains - "First do no harm"
Phase 1: Very early type of research. In some types, it would be a "first in human" study
Phase 2: Studies would have shown the medication to be relatively safe and it is now being tested for efficacy
Phase 3: The safety and efficacy have been shown to be favourable, and now it is being tested against the present standard of care
Phase 4: This study is primarily to gain more information about the medication, as it has already been approved for routine use in the market
Enrolling onto clinical trials is a good thing. It gives access to newer molecules or different ways of using older molecules. It is possible that the full benefits of the study medication may never be seen in the patients enrolled on the study, bur future generations would benefit from the same.
All trials are governed via Ethics Committees, which may be locally or centrally based. They are the guardians of patients and their families, and would not give permission to conduct a study, unless they are convinced about safety.
The first principle remains - "First do no harm"
Pulmonary Embolism
One of the big problems with cancer is clots in the lung blood vessels. It is a significant cause of death in cancer patients. Most people do not really know or understand it about it.
Cancer is a condition which makes blood sticky. If you combine this with the fact that the patient is not very mobile, not drinking enough of fluid, is on chemotherapy via intravenous access device, is on medication which also affects the clotting of blood... it is a fairly strong combination for clot formation.
People can develop clots in their legs, which then breaks off and there are showers of clots in the lung blood vessels. A large blood clots in the lung vessels can potentially kill the patient.
The treatment is making the blood thinner with medications - heparin, heparin like drugs or warfarin.
The important issue being awareness of the condition. Sudden shortness of breath, cough, sharp chest pain, etc are some of the main symptoms.
Cancer is a condition which makes blood sticky. If you combine this with the fact that the patient is not very mobile, not drinking enough of fluid, is on chemotherapy via intravenous access device, is on medication which also affects the clotting of blood... it is a fairly strong combination for clot formation.
People can develop clots in their legs, which then breaks off and there are showers of clots in the lung blood vessels. A large blood clots in the lung vessels can potentially kill the patient.
The treatment is making the blood thinner with medications - heparin, heparin like drugs or warfarin.
The important issue being awareness of the condition. Sudden shortness of breath, cough, sharp chest pain, etc are some of the main symptoms.
Tuesday, 17 April 2012
Old age is not always a blessing
Some people seem to want to live forever. I think they have probably not met a lot of older people. As the body slows down and starts to break down, it gets worse with each passing day.
The mind is not as sharp, vision is not clear, the heart does not pump as well, breathing is an effort, passing urine is troublesome and opening the bowels is a major undertaking. In a large number of cases, family support fritters down as time passes on.
Watching your children, grand-children and great-grand-children is lovely, but comes at a price.
Meeting families who fully support their older members is an absolutely blessing.
The mind is not as sharp, vision is not clear, the heart does not pump as well, breathing is an effort, passing urine is troublesome and opening the bowels is a major undertaking. In a large number of cases, family support fritters down as time passes on.
Watching your children, grand-children and great-grand-children is lovely, but comes at a price.
Meeting families who fully support their older members is an absolutely blessing.
Monday, 16 April 2012
Negative Positives
English and Medicine are not always the most complimentary areas.
Patients are told by their doctors that:
- The disease has progressed - patients are happy, progress is a good word - but doctors mean that the disease has increased
- The lymph nodes are positive - patients are happy, positive is a good word - but doctors mean that the cancer has spread
- HER2 gene is positive - patients are happy, positive is a good word - but doctors mean that the cancer is more aggressive
Software for Blogging
I thought I should try a blogging software, so here I am using Blogsy. Am trying to figure out how to use it. Stay posted.
Humbling Experience
We have patients who thank the Unit at the completion of treatment (in cases of adjuvant therapy) or families who thank the Unit on behalf of the patient who have moved onto to another world. It really does feel humbling to know that we can do what we can, but ultimately things are not in our hands.
Blog posts
I am learning how the system works with blogs. I must say that Blogger is quite good. Youtube is good for learning how to modify html and Javascripts.
Each day is a new day.
Something to learn everyday.
Cancer Myths and More
The Cancer Council Australia supports a good website discussing various cancer myths and facts. Check it out at www.iheard.com.au
How much survival advantage is necessary to justify treatment?
Vital question. Stumps people nearly every time. How much benefit (with regard to time and quality of life) is necessary, to justify giving toxic treatment regimens? The answer is quite different from patients, their relatives, treating doctors and nurses. Very interesting.
Understanding the History of Cancer
The absolute best book to try and get a feel of the history of cancer is - "The Emperor of All Maladies". It is written by a Medical Oncologist in the USA and is a fantastic piece of writing. The book is not just medical jargon and is really good reading. I have marked a link on amazon.com, 'cos that was just the first link I got on a google search :)
http://www.amazon.com/The-Emperor-All-Maladies-Biography/dp/1439107955
I recommend the book to my Registrars and my patients. Both groups seem to enjoy it.
http://www.amazon.com/The-Emperor-All-Maladies-Biography/dp/1439107955
I recommend the book to my Registrars and my patients. Both groups seem to enjoy it.
Grumpy and Stern Doctors
I have often wondered why many doctors are grumpy and stern. Is it meant to be a part of our medical curriculum? Not sure. Maybe I slept through that part of those medicine lectures.
Oncology and Sympathy
Most people who realize that I work with cancer patients, are quite sympathetic towards me. Their logic is that most patients would die with cancer. The problem is that most people never hear about the bright side of oncology. They never hear about the patients who are cured and live long and fulfilling lives. They never hear about women and men, who go through chemotherapy and go on to have children and families. Oncology is a good field.
The Look Good Feel Better Program
One of the really cool things is the Look Good Feel Better Program. Very impressive when women get together and share their styles and make-up. Very supportive. Kudos to the cosmetic companies who support the program.
Check out http://lgfb.org.au
Check out http://lgfb.org.au
Prostate cancer
Sadly, prostate cancer hardly receives any support (as compared to something like breast cancer). Unfortunately, the illness affects "grumpy old men", which is probably not as glamorous or emotional as a young woman who is going to lose her breast.
Social Media and my Soul
I am getting more familiar with all this social media stuff. Neat stuff. At times. There are hundreds of ways and means to link all these blogs together. Looking up on the web - I do not understand most of this. Adding html links and SEO and whatever else.
The old fashioned way of just plugging on, might just work. If for nothing else, then at least for my soul.
The old fashioned way of just plugging on, might just work. If for nothing else, then at least for my soul.
Children and Cancer
I find it extremely difficult to deal with children who have cancer, and their families. It is the single biggest reason why I do not treat kids. Too hard. The doctors and nurses who treat paediatric malignancies are absolutely fantastic. More power to them.
The only favourable point about kiddie cancers are that they are relatively more treatable as compared to the adult cancers. The horrible part is failing.
The only favourable point about kiddie cancers are that they are relatively more treatable as compared to the adult cancers. The horrible part is failing.
Reading a blog
What does it take to get people to share thoughts on a blog? Is it easier to speak face to face, or type something online? Is there more freedom is being a real life person or being an avatar online? Truth is probably somewhere in the middle.
Sunday, 15 April 2012
Smoking
Smoking is an amazing addiction. I suspect a lot of smokers want to stop smoking, but cannot. Sad. But true.
How long is life meant to be?
Have you ever wondered how long is long enough, with regard to the number of years that we live? I am not quite sure about the answer.
Why do people wait?
I cannot quite understand why wait for so long prior to complaining about their treatment adverse events (side effects). They call up the hospital or come to the Emergency Dept, when things are really out of shape. Why do people wait for so long? Any clue?
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