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Decisions about surgery depend on many factors. You and your doctor will determine the kind of surgery that’s most appropriate for you based on the stage of the cancer, the "personality" of the cancer, and what is acceptable to you in terms of your long-term peace of mind. Dr. Geeta Kadayaprath - Best Breast Cancer Consultant in Delhi
SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… With improvements in chemotherapy, radiation therapy, hormonal treatment and targeted therapy, breast conservation surgery has now become the treatment of choice in select patients. While it is possible to conserve the breast in early breast cancer, it is possible to offer this treatment in patients with locally advanced breast cancer also, where chemotherapy is administered first to shrink the tumor. If the tumor shrinks towards the centre and is marked while the patient is on chemotherapy, it may be possible to conserve the breast when surgery is performed after completion of chemotherapy. The philosophy behind this paradigm shift is quite obvious- that long term outcomes in terms of disease free survival and overall survival is not different with either surgical procedures. The choice is real and scientific… For more information on breast cancer, please contact Dr Geeta Kadayaprath, Breast Surgeon, Max Cancer Centre, Delhi, India
I am a big fan of Angelina Jolie. So what is the big deal about it? Half of the human race is possibly her fan..her looks and her acting prowess has had the world swooning. I am her fan for a different reason. I haven’t followed her movies, her drop dead gorgeous looks or her personal life but I admire her for her courage. Some years ago, this remarkable lady announced to the world that she is having both her breasts removed. She knew that she was carrying a genetic mutation which made her susceptible to breast and ovarian cancer. Her family history was strong for both breast and ovarian cancer and once she tested positive for the mutation, she knew she carried a 60-80% risk of developing either of these cancers. She was faced with the prospect of prophylactic breast and ovarian surgeries. I can only imagine the sleepless nights, the battle within-to do or not to do, several rounds of long discussions with her doctors, family and friends, the impact on her career which relied heavily on glamour, her children... and so much more. And then she made that decision to have both her breasts removed and subsequently her ovaries. She shocked the world but at the same time catapulted herself to that realm of courage and fortitude that rarely people of her standing dare to tread. I joined her fan club and her story of courage became the benchmark for women caught in a similar situation. Why I recalled this story was when I encountered my own Angelina Jolie. This young lady of 35 had a very strong family history of breast, ovarian and colon cancer on her maternal side.Her husband was gutted when she was diagnosed with breast cancer. I advised her for a genetic consult while planning for her surgery. The genetic consultant had barely advised her gene testing and was discussing the possible implications, when she said that she had made up her mind. She very calmly told the consultant that irrespective of what the test says she was going ahead with bilateral prophylactic mastectomies and bilateral ovarian surgeries in the same sitting. She came to be and conveyed the same to me. It shook me inwardly and took me a while to gain my composure as her husband stood by her, rock solid in his support of her decision. ‘COURAGE’ as a word probably does not do justice to the tenacity with which one arrives at this supremely difficult decision. I have done these surgeries before and this one was certainly not the last. Such decisions are rationalised within the multidisciplinary board, the molecular oncologists, the psychologists, the family and most importantly, the patients!! While I see more of these Angeina Jolie clones, I will always hope and pray that these amazing ladies’ decision translates into long, meaningful and inspiring lives!
Yesterday I visited my niece and was on the phone talking to my patients, sorting things for them. When I finished, she asked me, ‘Isn’t your profession stressful?’ I was quick to say NO. The conviction in my tone has taken many years to come. I recall my early days as an oncologist and in particular, this vivacious young lady who had a relatively advanced colorectal cancer with involvement of her ovaries. She had undergone surgery elsewhere, 4 weeks prior to coming to our unit. Her abdominal wound lay open and was pouring out fecal matter and abrasive intestinal juices, consuming her skin.I could not come to terms with the unfairness of the situation, then. Why was this young lady with the most sparkling, hopeful eyes dealing with this horror? I wanted to pull her out of this mess and diligently did my best to improve her nutrition, take care of her wound and her medication. She and I would talk a lot- her dreams, her aspirations, her twins, her loving husband, her family...we became good friends! Her surgery was planned and executed well. She was recovering well and she wanted to be home to celebrate her twins’ birthday. I assured her she would. And then that day arrived, when she walked. She walked for the first time after 8 weeks. I was thrilled and went home thinking she would be out of the ICU the next day. I was going up to the hospital the next day when I got a call that she had had a cardiac arrest. I thought I had heard wrong. I ran up to the ICU and before I reached, she was gone. Pulmonary embolism had taken her away. I was distraught and I cried, rather howled, like I had lost one of my own.An elderly physician put an arm on my shoulder and said, ’ This is certainly not the last time you will have to deal with this. Don’t get attached to the outcome of what you do. Do your best but remain detached from the outcome’. Those words have stuck and I have grown since. My focus is entirely on what I can do for the person who sits across the table and entrusts his or her life to me. I do my best to understand the problem, execute treatment, handhold them and try and do whatever I can to make the experience as seamless as possible. Cancer outcomes are never a 100%. You do lose some at the end of the day but if I have contributed to making their life easier through their suffering, I have done something worthwhile. While it is easy to be overwhelmed by these difficult situations, I need to remain detached from them so that I can do more for those who need help. I have come a long way since, but it is not as if I am not affected by what happens to my patients, anymore. It is just that I have taken better charge of the emotional me and replaced it, not entirely, with the professional me!
ATTITUDE IS TRULY EVERYTHING The picture one would conjure up on seeing this beautiful old lady is that of a loving ‘dadi’ or ‘nani’ full of stories, weaving magic with her deft fingers as spools of thread became exquisite pieces of crochet art.She is all of 86 years old and continues to do all her chores without any help. She does not believe in stopping. And believe me she is quite extraordinary! I have known her for the last 8 years and every meeting with her is inspiring. At the age of 78 years, when many would will themselves to die at the simple pretext of a minor illness, this lady was diagnosed with pancreatic cancer. She had deep jaundice and she needed a Whipple’s procedure to get rid of the cancer. This surgery is one of the most challenging to even an experienced surgeon. She and her family were explained the pros and cons in view of her age and frail self. She was determined to see this through. The surgery went to plan but the postoperative period was stormy. She had a bloated abdomen, for which she was re-explored and found to have a twisted bit of intestine. It took her a month to recover and finally, she walked out of hospital, recovered fully.She refused any further treatment and said she felt fine. She would meet me every 3 months for a year and then she stopped coming. I had almost forgotten all about her, when she resurfaced again after almost 1 year. This time she came with an ulcerated mass in the right breast. She was 80 now. She did not want any other treatment except surgery. She had a surgery to remove the breast and the lymph nodes in the armpit. Fortunately, the disease was hormone sensitive. She said no to Radiation and accepted hormonal treatment. What does one say to this except that I was fortunate to witness this most wondrous display of an old lady’s grit and determination, willing herself to live on, in the face of not one but two cancers! She came to meet me five days ago. She is disease free. Her smile lit up her wrinkled face and her eyes sparkled as she said she had come to bless me. I, honestly had nothing to offer her. Did she even realise how inspiring she is? She wanted me to share her story with everyone and so here I am! Important lesson learnt..Attitude is truly everything!!!!
SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… When 32 year old Neena, an HR consultant in an MNC, walked into my clinic, accompanied by her husband and parents, I could sense an air of hopelessness surrounding this good looking young lady. The papers that were laid in front of me carried a needle biopsy report, which confirmed the diagnosis of breast cancer. Fortunately, for her, the size of the lump was about 2cms and there were no lymph nodes that I could feel in the armpit. There was no evidence of spread to the other organs on imaging. I soon realized she had been through the discussion of surgery and she had come to me for a second opinion. I soon found out why she had decided to come for a second opinion. She had been advised a modified radical mastectomy (complete removal of the breast along with the lymph nodes in the armpit). She was a successful career woman with everything going for her till yesterday and today she was grappling with this tough predicament- losing an organ, an integral part of her feminity to cancer- it was almost cruel!.......... ....To be continued.....watch this space for more.......
SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… In the 1960’s, the conviction that breast cancer was a systemic disease at inception and not a local disease, prompted trials to address one question- ‘Are we doing too much?’ Radical mastectomy was replaced by modified radical mastectomy- a procedure not as mutilating as radical mastectomy ( the chest muscles were preserved)but still one, which involved loss of an organ. Moreover, to a woman, it meant much more than the loss of an organ. It probably entailed a huge psychological blow besides casting a shadow on her feminity. She, being the woman she was, in those days, came to terms with this loss, in the best manner possible. All that mattered to her was her getting well, on her feet and ready to discharge the duties of a wife, mother, daughter and more. And there was really no choice then because the doctors treating her were also convinced that sacrificing the breast was the only chance of getting well. More tomorrow.....on Evolution of treatment
Today I complete 22 years of marriage and I thought this an opportune time to look back at my life with satisfaction. My marriage was arranged by my parents through mutual friends. My husband is an engineer and the one time we met before the process began, he had decided and I was still unsure. I was trying to peer into the crystal ball, hoping to figure out how this arrangement would work for me. I was training to be a surgeon, not a choice many sensible women at that time made. The questions kept me awake- would he understand the demands of my profession, the late hours, the middle-of-the-night zipping to hospital to deal with an emergency etc? Would he understand my need to study further, maybe go abroad and work hard to give myself a full fledged career? His being an engineer did not help the cause at all. And then I stopped thinking and gave in to the wishes of my parents. When I look back at those 22 years gone by, I have plenty to be grateful for. For a woman to pursue a full fledged career is never easy anywhere in the world.What you make of it has plenty to do with the support you have. The support I had was truly unconditional. I completed my post graduation after marriage. My in-laws wanted me to carry on, unhindered, with my studies.FRCS soon followed with my parents chipping in to look after my little daughter. I went for a year long fellowship to London, leaving my daughter behind with my husband and mother in law. And did I stop? And did he stop me from pursuing my dreams? Not once! We are all imperfect in our own ways but valuing people for their strengths is what sustains relationships. His presence in my life has been the star and I can only wish him the very best that life has on offer!!
THE ART OF SELFLESSNESS OF PURPOSE Three weeks ago, a thin built lady from a remote village in UP walked in with her sister and her nephew, who lived in Delhi. While they poured her story of being diagnosed with breast cancer, I could sense an underlying anger. The sister burst forth with the information that her elder sister’s husband is a farmer and had thrown her out on knowing the diagnosis. He refused to get her treated and had said that she was as good as dead to him. The sister was vehement and was certain that she would get her elder sister treated. That is exactly what she did. I operated upon the lady. On receiving the pathology report, I shared with her that her sister would require both chemotherapy and radiation. The patient’s husband also came for that consult and asked me if he could take his wife home before she started chemotherapy, to which I said he could. Hardly had they left the room, that the younger sister returned to my room, furious. She said, ‘ How did you even suggest that he could take her back home? He will not spare her. How could you undo the effort that I am putting in, to treat her?’ I was stumped!She went on to say that she would look after her and make sure she had her complete treatment. She told me that she was a person of modest means with a one room flat but she would arrange accommodation for her sister and get one of her nieces to look after her while she underwent treatment. There was that intense look of determination in her eyes when she said, ’ Doctor, no way am I going to let her go- I take her full responsibility!’ How many times do you come across such unsung heroes in your life? This young lady is a hero, championing the cause of her older sister who has no voice. Her sister has a husband who has only used her but refuses to stand by her as she readies herself for her biggest battle, yet. She has found an unlikely knight in shining armour in her younger sister, who, I am sure will brave the storms lying in store for her. It is not the money in your pocket that makes the world go round but it is the desire and the will to help that makes the world go round. I love the spunk of this lady and have loads to learn from her. Selflessness of purpose is what makes her so inspiring and restores my faith in humanity!!
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