Wednesday, March 27, 2013

The Cancer Pendulum- Does It Toll For You?

The Cancer Pendulum- Does It Toll For You?

(Even though this post is filled with complex concepts I have to tried to explain it in as simple a language as I could make it for everyone to understand but if you still find the medical jargon too difficult to grasp, please excuse, for it comes from a longstanding habit of writing in the obscure language so beloved by peer-reviewed scientific journals which never publish any article which can be understood easily or is in simple English)

 A few days ago I had a patient a female patient around 60 years who had consulted me for a long standing ulcer which was not healing and she was worried that it might be cancer. When I checked the patient I found out that she it was not as she had told me, she did not have the same ulcer for a long time but she was repeatedly getting new ulcers in the same area, but they were healing normally until a new one formed again. Based on the visual aspects I could see that it was not a cancer ulcer as the typical cancer features were missing, but the current trend being defensive medicine, i had to of course CYA with a battery of tests to rule out every possibility including cancer. As expected, all her tests came back negative and by the time the test results had come, her ulcer had also healed and she walked out both physically and emotionally satisfied. As she left she did something which is always abhorrent to me (typical Indian practice), she tried to fall on my feet to express her thanks. I scolded her that she was my mother’s age and shouldn't be doing this to embarrass me. And then she confessed that she had been living through hell for the past month or so, in fear of cancer and she couldn't eat, sleep or even think about life till i had told her it was all normal. After she left i thought over how much people fear the very word cancer. It’s as if a death sentence is pronounced on them with the very word of it. And that’s how the idea for this post came about - to explain the media hype on cancer and all the misconceptions about it.

Nowadays if you open any newspaper or any magazine the science section contains a screaming headline which says "such and such cancer was discovered" and then urges the government to take it as an urgent menace and allocate funds to investigate it. This is not just media hype because even the scientific community is reporting an increase in cancer cases worldwide with newer and newer varieties of cancer being reported daily which in turn leads us to the question of whether we are really developing so many new forms of cancer all of a sudden or are we just identifying more and more of them with modern and better diagnostic equipment? My vote would be for the later explanation.

Simply because, if say, a 100 years ago a small nodular thing was seen on an xray of the chest- what is known in trade language as a radiolucency of the lung- it would have been immediately attributed to that fall guy of all chronic diseases -tuberculosis. But not now- for with our current technological advances we have lots of different diagnostic methods to find out what it is - we can take a CT, or take a Contrast Ct (which involves injection of a colored solution- a contrast medium into that spot and again taking a ct to check for differences in color because cancer cells have a different color than normal cells), or take a FNAC (which involves pushing in a hollow needle called an aspiration needle into that spot and pulling out a little bit of its contents along with the needle to check under a microscope), or take a biopsy (which involves cutting up a little bit of tissue from that area and checking it under the microscope to see if they are indeed cancer cells) to see what it is.

Any and sometimes all of the above tests are employed nowadays whenever we see something the least bit suspicious. But in fact they are not all needed for each one of these tests can produce authentic and clear results without any doubts about the diagnosis. So much so that even small self healing conditions now become major health crises. The small nodule in the chest becomes a major cancer worry and whether it is just suspicious looking or definitely pre-cancerous the patient undergoes either surgery or radiation or chemotherapy to catch it an early stage - good riddance to it or what’s called as the prevention theory of medicine we currently follow.

But one thing we have to remember is, we still don’t know what caused the nodule to develop and what if anything made it turn cancerous. Because we still don’t know what causes cancer or specific cancers. Oh don’t take me wrong, the scientific community  has dozens of theories and causes for cancer formation- the most popular being the nature vs nurture theory. The first one says that cancer is natural- a result of the broken gene- all cancers are caused by our normal genes suddenly going bonkers and becoming cancerous. And a further offshoot of this is the theory that cancers are heritable- that we get not only our parents genes from them but also their cancers.  The other end of this pendulum is the theory that cancers are environmental diseases and that you get them from abusing your body and the environment around you. Everything and anything can be a direct cause for developing cancer unless you live cleanly and follow healthy living guidelines.

To explain this further let’s take the case of the most popular of all cancers- breast cancer (35/1000 women). I don’t call breast cancer as the most popular because it is the most commonly found cancer- it is because the American public believes that it is and what the American public believes is good for the rest of the world. Pardon me if I sound a little cynical here but i am not kidding but merely stating facts- the majority of medical research is financed by only one nation- America but the benefits are shared by all of us-the rest of the world. As such the Americans have a direct and disproportionate say in which disease they want to research or to find a cure for.

To extend this example further the American public is often scare mongered to support certain specific diseases by cleverly manipulated public relation campaigns. Hence as public clamor rises, more funds pour into that specific disease from the American government and from philanthropist foundations like the Gates Foundation. When university research teams hear about these new funds available they simply switch over to these new diseases because all researchers needs  funds to sustain themselves and having readymade grants for research allows them to hire more people to work for them. And as they work more and more on that specific disease they popularize it more and more to attract and retain their sources of funds. It becomes a cycle- if the disease is famous; the money is there and because the money is there the diseases becomes famous. And that’s how certain diseases suddenly become popular in the public consciousness and become the next big it AIDS, Cancer or the Obesity Epidemic.

Anyway to get back to breast cancer- at one time it was thought that breast cancer was a genetic disease spreading from mother to daughter. But as the researchers started investigating more and more into the genes which were seen in breast cancer patients (called BRCA's- the genes associated with breast cancer- which simply means they were found in breast cancer patients) and as more research was done, more and more such genes were found to be associated with breast cancer and scientists were naming them -breast cancer gene-1, gene-2 , gene-3 and so on and so forth till they themselves realized that there was no single identifiable gene which can be blamed for causing breast cancer and then the breast cancer specialists were caught in quandary about how to explain their own findings when some researcher somewhere suddenly thought up the cancer complex idea. Which merely means that if you cannot blame cancer on a single gene malfunction you can still blame it on all of them together and say you need a cluster of cancer genes- a whole bunch of genes to misfire - to cause cancer. This is still a theory and much of it is based on computer simulation and lab modeling and not verified on the ground. So the geneticists are hanging in there, still working their gene-counters trying to find the genetic holy grail of breast cancer.

And on the other end of the spectrum we have the environmentalist theorists. These guys have blamed everything from having sex at an early age to not having sex early enough- delayed virginity as cause for breast cancers. They have blamed wearing tight bras for breast cancer and they have blamed not wearing a bra at all as cause for breast cancer. They have blamed breast feeding for breast cancer and not breast feeding for breast cancer. In short they have blamed anything and everything without a definite clue. Anyone who follows these fast changing developments and the "scientific" advices will soon start doubting everything wondering which is safe. But till now, neither gene nor environment theories can wholly explain why breast cancer attacks certain patients, some in their fifties, some in their thirties, some with no children and some with plentiful grandchildren. No one knows anything with 100% certainty unless you happen to watch TV shows where the anchor confidently states that such and such new development means an end is found at last for this disease.

And so American women who keep getting these breast cancer updates on popular media are often scared enough to undergo extensive surgeries at the slightest bump they feel are often the driving force behind this entire scare mongering industry. Well you can’t really blame the Americans - their government is ready to throw unlimited amounts of money into bottomless wells on the chance that someday a cure might be found. Unlike our Indian government which operates on the principle that if they wait long enough we would all die of some communicable disease and save the government the trouble of providing funds for research on preventable diseases.

So to return to the original premise of this post- we still don’t have a reliable clue for why cancer occurs. We say that smoking is strongly associated with lung cancer- that is persons with lung cancer are often smokers. We say that HBV -the hepatitis B virus is associated with liver cancer. We say that HPV- the human papilloma virus is associated with cervical cancer. And this has kick started the most recent craze for finding viruses associated with cancers in the hope that cancer might be a viral disease and we can cure cancer by killing the virus or prevent cancer by vaccinating against the virus. The evidence is still out on that one and i for one would wait a bit more before agreeing wholeheartedly. And the most recent one i heard somewhere is the news that IVF or in vitro fertilization for childless couples can in some way cause uterine cancer. I am still digesting that news, working out how it can be and still don’t understand and am waiting for further authentic news.

Finally we come to the alternate lifestyle theorists who label that stress and everyday anxiety can cause cancer and practicing a healthy lifestyle choice can prevent cancer  - that is no smoking, no drinking, no sex and go live in an ashram and practice meditation for 20 hours a day. This is one of the most popular theories seen on line by the evidence of  the popularity of the shared advice columns seen on facebook and is also popular with the television media - as the photogenic new-agey gurus who propagate this kind of "stress kills you" theories are often seen on TV spouting blatant lies and pseudo-scientific drivel. These quacks and charlatans wouldn't recognize a cancer cell if they tripped and fell into one. All their mumbo-jumbo of transcendental meditation and achieving oneness and kriya yoga and stuff like that curing cancer is pure baloney and as believable as mother Teresa curing cancer by touching the patients. If somebody can show me that cancer can be cured with meditation- i would eat my hat, although i don’t wear one currently. And village people get as many cancers as city people do, just that they don’t recognize it or get treatment for it as much as the city folks do. So living in an ashram doing meditation does not guarantee you won’t get cancer and neither does being a vegetarian or a tee-totaler or a fitness freak or anything else you read in wellness magazines.

So to sum up, cancer is not really a common disease, and we need not live our lives worrying about it striking us. The reason for a perfectly normal cell to suddenly turn into a cancer cell is still not known definitely, for all we have are theories. We don’t have a single clear and guaranteed treatment for cancer because we still don’t understand how it works. The treatments we have available now- surgery, radiotherapy, chemotherapy etc work fine with some cancers but not all- for these can come back at any time (recurrence). All of these treatments are based on destroying all the cells of that particular affected area in the hope of destroying the cancer cells also- which is pretty drastic when you compare it to burning down the house to get rid of termites. There are certain new treatments in the pipeline- like interleukins, interferon’s and immuno-proteins of which much is expected in the future. Finally nothing keeps a person as healthy as having a robust immune system. Every day, somewhere, some cell of yours is going crazy and turning cancerous, but that efficient and ever vigilant guardian of your body, your immune system is cleaning it up pronto without alarming you. Throughout an average person’s life their immune cells clean up a hundred different cancers from their body without their knowing anything about it at all till they die of old age. And finally we should hope- fingers crossed that somewhere, someone, some lonely scientist in a laboratory is even now working out the definitive reason for what causes cancer. Let’s cheer him on, shall we?

P.S. pictures are always borrowed from Google Images available under open source. Ethically I am not permitted to use my actual patient photos under the doctor-patient confidentiality clause.

Sunday, March 24, 2013

A for Alumni and V for Varnashram

A for Alumni and V for Varnashram

So there I was at yet another alumni meet after a gap of almost three years at Fusion 9 restaurant in Sterling Road, Quality Inn Aruna, and the first thing which struck me was how aged the rest of my batch mates looked to be followed by the sudden doubt over whether this was how I looked to them too. On further reflection I discounted that possibility as I had just that morning peeked into the mirror and had looked pretty much the same as ever if you discount the receding hairline at the temples which in fact gave me a very distinguished George Clooney look. 

As is usual in such alumni meets after the opening rounds of exchanging pleasantries the talk veered around to the fact of our respective career developments and it was at that point I came to the belated realization that Manu was right. The varnashram theory actually makes sense practically. As I sat there listening to the talk around me I slowly came to the realization that if only I had chosen law as my dad had wanted me to all those years ago, instead of opting for a career in medicine as I had done just to make a point, I would have been in a much better position professionally and financially by now.  I could have benefited from the family connections much like all my friends around me who had followed their respective fathers into the family profession, who made use of their parents’ knowledge, contacts and large networks to get ahead in the profession as 2nd and 3rd generation followers. Except for me, idiot that I was, who opted to be a teenage rebel, to chart a separate path in life, to sink or swim on my own because I wanted the tag of a self made man untainted by any family influence. Well to look at it honestly there are indeed people who succeed in achieving a big success for themselves on their own as first generation pioneers. But lacking their outstanding abilities I should have opted for the safety net of family support and an existing sinecure instead of choosing to strike out on my own with my limited talents.

Oh, I still believe I am the best surgeon around and as everyone keeps telling me I have the fastest hands at the hospital. I was even the best of my graduating batch by a far margin as per the unanimous opinion of my then professors. But I have come to the belated realization that it’s not enough being the best at your work unless you also get adequate breaks at the right time to showcase your talent. If you don’t get those opportunities you are left to languish at the middle of the pile with the also ran's. And this is precisely the area where the second generation people have an edge. They have expert advice right at home to guide them past the pitfalls and errors which the first generation people are bound to make and learn on their own. They get taken on by the right mentors because their father knows so and so who in turn knows so and so and would be happy to help train somebody who is so much pedigreed. When it comes to jobs they are the first choice picks in existing vacancies for coveted positions and amidst intense competitions. When all else fails they have the security of knowing that they have the old family firm to fall back on and they could easily go and join their fathers or their grandfathers hospital at the beginning post of chairman or managing director or chief surgeon and never anything lesser.

All of which I could have had too if only I has studied law too and gone for the old standby family profession. As my father keeps repeating I kicked over the pot on my own and can’t cry over its spilling. If I had opted for law, which I had also qualified for at the time of choosing a career, by now I would be at the top echelons of the legal profession. Of that I have no doubt. Add my father’s legal acumen and my own innate talents of persistence and thinking out-of-the-box and I am sure that I could have made for myself a very successful career in law. But having foregone that advantage of having a family background and opting to do something which no one in the family is even remotely associated with, I have to resolve all my professional dilemmas on my own. Like for instance what to do when the owner of the hospital makes his newly qualified fresher of a nephew the chief of surgery and asks me to work under him. Which he is perfectly within his rights to demand as it is his hospital and his nephew and blood is thicker than water, talent or experience be damned.

And that’s when i decided that I would henceforth advice every youngster to do the conventional thing and join the family profession if he didn’t want to regret his choice later on in life when nothing can be done about it. You might succeed in carving a path for yourself with your own talents if you lived in the US of A. But in India it’s all about contacts, about knowing the right people, about push and pull and being born in the  appropriate caste or religion and you disregard the golden rules at your own risk  We might pretend to be a modern nation but we are not actually, for we are still steeped in the age old superstitions of son succeeding father, a Parsi succeeding another parsi etc like Sidhartha Mallaya succeeding Vijay Mallaya at King Fisher, Cyrus Mistry succeeding Ratan Tata at Tata and co etc. And Manu dharma wins every time.

To come back to the premise of this post, yes, we had a great time at the alumni meet reminiscing over how all our old girlfriends would now look like. And how lucky we were not to marry them. And the few usual fights of the type of why did you interfere in my love were also resolved amicably this time as a sign of growing maturity among the guys. And we parted promising to meet again soon and make it a regular habit at shorter time intervals and not every three years or more to meet again.

P.S. As I type this I can hear in the background the FM music channel playing "Budhi ulla manidhar ellam vetri kanbadhillai…..vetri petru manidhar ellam budhi sali ellai" in Comedian Chandra Babus inimitable voice - here.

Thursday, March 21, 2013

Is Spoken Love Sweeter?

Is Spoken Love Sweeter?

I happened to read this blog post recently written by my friend Shruti about how men find it difficult to express their love to their loved ones. It gave me pause and food for thought. Obviously, I can’t speak for all men but I would like to take a stab at explaining the why and wherefore of men being unable to express their love to the women they love. If you think I am doing this altruistically out of some universal love for the brotherhood of mankind, perish the thought, this accusation seems aimed at me too and I welcome this opportunity to explain. People who know me personally know that I am quite articulate generally but put me in front of a girl I love and I am straight forward tongue-tied. I would rather stare dumbly at her, eyes glazed over and look to be in a world of my own rather than try to impress her with flowing words professing my eternal love for her.  Having had the same feedback that I am not expressive when it comes to love, this is a novel attempt to set the record straight on my part, for I can henceforth refer all my future lovers to this blogpost, to explain why I was standing there like a statue just ogling at them.  

To make my point I would have to dip into the archives and share a few personal anecdotes if you don’t mind. A few years ago I fell in love with a girl who had a habit of always being late to everything. She never gave a damn for punctuality, which was so opposite to my character of fussing on doing things at their proper time. So whenever we planned to meet for watching a movie, I would be there at the theater first waiting and waiting and waiting for her to show up but she would reach late, so late that we would routinely miss the first ten minutes of the film and would have to get to our seats in the darkness stamping on others feet. Anyway there I would be, perched on the topmost step of Abirami theatre and as soon as she entered through the main gate and made her way up the steps towards me, what I would feel was a, I can only compare it to a dizziness at the first glimpse of her, even from a distance. I know now, after so many years of analysis  that my heart must have filled with so much love at that first glimpse of her that my heartbeat and pulse rate must have gone up to stratospheric heights resulting in the dizziness I felt. Thank god I didn’t faint.

But right then I would just stand there watching from the top of the stairs as she climbed up towards me, my heart trying to jump up out of my body every step she took nearer and nearer to me. It is a totally indescribable feeling and even now I struggle to put it in appropriate words. As she stared at me in exasperation at my woody expression and tongue-tied state, would she have believed me if I had told her that the very sight of her, drove my heart into doing somersaults and handsprings? When she finally came up the stairs towards me all my fatigue from the waiting, all my anger at missing the first part of the movie,  everything would evaporate except my pleasure at being with her and i would stand there just looking at her, drinking her in, while she would bustle about as if i was the culprit in wasting time by standing there like a statue and would order me to follow her into the theater and then later on would complain constantly about how i never had a loving word for her but always stood there staring speechless like an idiot. 

How could I explain, how could I put it into so many meaningless words that when she came near me my heart just jumps around and my tongue cleaves to the floor of my mouth and hence all I would be able to speak would be a croak if I opened my mouth and I was delirious with joy in seeing her and that’s the reason I stood there grinning like an idiot. I mean, I could say all this by taking the time out to write an elaborate blog post, but to put all this in words on the go? Can mere words suffice to express such heartfelt emotions? I find language inadequate to supply me with the necessary words to explain the mysteries of the heart. And hence I surmise that men in love, in true love are unable to find the right words to express their feelings of that magical moment. You cannot compress a saga into a haiku can you? Being cryptic doesn’t do justice to the emotions of love.

I would like to add a clarification here that all the above explanations are for real love, the till death do us part variety of love and not the fake hey, we work together at the same firm, we are of the same caste, plus you look good baby, so let me flirt with you, kind of pretend-love. For there, these rules do not apply. There, the words would flow easily off the tongue, because the heart has no work to do and its all brain driven. So men can lie easily to a girl about love forever when there is no real love involved. Guys who are fluent talkers when it comes to expressing their love are most often players who have said similar lines to a dozen girls before.  Their words however eloquent and touching are just from the mouth and never reaches their eyes.

As I said before true love is far more difficult to embrace with words and can’t be explained that easily, however many times you keep falling in love. For it’s a fallacy that love happens only once and people cannot fall in true love again. Any time you fall for another person, if that love is a true emotion, you go through the same tongue-tied statue phase. No exceptions. The reason they say that first love is special is because when it happens you don’t often recognize what you are going through and you are taken by surprise when you finally realize that "oh so this is love? This is what it feels like?". And that’s why first love is special.

Which takes me back many years ago to that magical moment when i fell in love for the first time ever. Like everyone else, I too didn’t recognize what it was and it took me time to understand what I was going through. All I knew then was that I had talked to that girl that morning and by afternoon I was sick and feverish and had to spend three days in bed. I couldn’t guess till a long time later that what I had was a feverish love and had not caught a viral fever as I believed at first. And everyday my mother used to ask me "not going to college today? and I would reply "but I am still burning with fever" and she would feel my forehead and tell me "but you are cold outside" and I would reply "but I am burning up inside" and it took stupid old me three days of full time thinking lying a-bed to process my feelings and realize "Kya yehi hai pyar'u hai? Yejo mujhe ho'nna tha, dekha na tha, samjhan'na tha, ab jann'na na tha". Yep it took me that long but once I figured it out, i got out of bed, went back to college and got into a fight with two other guys vying to win the heart of that same girl and that is a story for a different day. The point is how could I have made that girl understand that the first time we talked she gave me a three day fever and explain it as a proof of my love? Such are the practical difficulties men experience in expressing their love.

To conclude, I don’t know if it’s the same with women but for men it’s the most damnably difficult task to express their love. First of all there is the fear of not being taken seriously, being called absurd, being laughed at or being friend-zoned like "I thought of you as a friend only, why did you say this and spoil it all?”. And even if that does not happen, it still is difficult to pour the bubbling emotions of the soul into words and structured sentences. If you women want us men to show you how much we love you don’t wait to hear it in our words, just look into our eyes. The joy of true love can never be hidden from the eyes. Why do you still need words?

P.S. The song reference is from the Hindi Film “Mast” (1999) directed by Ram Gopal Varma and starring Aftab Shivdasani, Urmila MAtondkar and Antara Mali. The music is Sandeep Chowta, an underrated music director and sung by Sonu Nigham and Sunidhi Chouhan. If you would like to watch it here’s the link on Youtube