Disclaimer

All the information contained within this blog is intended to be general in nature and should not be used as a substitute for a visit to the doctor. The views expressed in this blog are personal views of the author and are not related or directed towards anyone in particular. Although every effort is made to ensure that the content within this blog is accurate, but it is not official in anyway. Please consult a doctor or health care provider.

Saturday, 28 February 2015

Gallbladder Cancer -Magnetic Resonance Imaging

Magnetic Resonance Imaging( MRI), scan uses magnetic field and radio waves to create detailed view of the body from inside ( organs, tissues, bones).

Purpose

MRI scan is mostly used to diagnose issues of brains and spinal cord. Major issues being
  • Tumors
  • Aneurysms
  • Injuries in the spinal cord
  • Ailments of the eyes and ears
  • Stroke
  • Multiple sclerosis
In certain cases, the doctors recommend  MRI scan, when CT scan is not able to provide the desired information.

In certain types of cancer such as the bladder and the cervical - especially  in the early stage MRI scan is better then CT scan. MRI scan provides high resolution images of the tumor, enabling the doctors to know about the size of the tumor and how deep it has grown into the tissues.

MRI scan can be exceptionally useful in showing whether the tissue(s) left after the treatment is over are cancerous or not.

Risk
  • Patients having any type of metallic or electronics implants (Pacemaker,Metal clips, Artificial heart valve, joint prostheses etc)  in the body should inform the  doctor before hand as it can can be dangerous and also effect the MRI.
  • Pregnant women should discuss with the doctor before going for the scan. 
  • Patients with liver and kidney ailments


Process

MRI machine is a long tube but with both the ends open. Its painless process but since the machine makes loud noises, therefore it is advised to wear ear plugs while taking the scan.

Usually lasts up to an hour, sometimes may be more.

Results

Radiologist are specialized doctors who can interpret these images from the scan. He will send the findings to the Doctor, who in turn will discuss these findings with the patients and family members.


I love you, Papa!

Friday, 27 February 2015

Fight Cancer

For all those, who are fighting cancer in some way

In words of Franklin.D.Roosevelt

When you come to the end of your rope, tie a knot and hang on....

Keep fighting, you are almost there!

I love you, Papa!

Monday, 23 February 2015

Gallbladder Cancer- PET Scan

Positron Emission Tomography(or PET Scan) : Shows how the body tissues look like and how they are functioning. A PET scan or a combined CT-PET scan enables your oncologist to ascertain your condition in a more elaborate manner.

Purpose
  • Cancer detection
  • Determine the stage of cancer
  • Find out how far the cancer has spread
  • Diagnose the mass or lump is cancerous or not
  • Helps your oncologist to decide the best treatment for your cancer
  • Determine if the treatment is working
  • Diagnose cancer relapse
In cases, after an individual has received treatment for cancer. A CT scan is used to find out if there are still any signs of cancer. There may be tissues that had survived the treatment but may not be alive. A PET Scan confirms whether the tissues left are active(cancerous) or not.

A PET scan is a successful way to study the chemical activity in body parts or organs.

Useful 

PET scans must be done with utmost care especially, when certain types of cancer are not visible in PET scans. Sometimes non cancerous growth may appear cancerous. PET scans are mostly helpful in the following types of cancer
  • Pancreatic
  • Brain
  • Melanoma
  • Breast
  • Thyroid
  • Lymphoma
  • Prostate
  • Esophageal
  • Cervical
  • Lungs
  • Colorectal
How PET Scan works?

Cancer cells have higher metabolic rate then normal body cells. Therefore these( cancer cells) show up as bright spots in PET scan.

A PET scan uses a radioactive tracer (drug) to show the activity. A radioactive material is injected in the body depending upon the body part for which the PET scan is being conducted). The tracer collects in the areas where there is high chemical activity- which generally are the affected areas. These affected areas show up as bright spot in the PET scan. 

PET Scan is a expensive procedure. And may not available in all the hospitals. At times, you may have to go to some other hospital to get the scan done. 

I was fortunate, that the hospital my father was being treated was well equipped, Therefore I din't have to go anywhere for any of the tests, scans etc. Otherwise it would have been really difficult as papa's mobility had considerably reduced- owing to the spread of disease, weakness due to the treatment.

PET scans are not painful. PET scans take 15-45 minutes to complete.

Risk Involved

It is said to be  absolutely safe for the patient. The radiation( from radioactive injection) generally fades away in few hours from the patients body. But It is recommended that the patient drinks lots of liquid after the scan to flush the radioactive drugs out from the body.

Pregnant women should not take the test. She should not go near the patient(who just had PET scan) at least for next 6hrs.

In case of  feeding mothers - they can feed their babies after 6hrs. But is advisable if they can get someone else to feed the baby for the next 24hrs (though, the mother can express the milk after 6hrs, it is absolutely safe)

Results

After the scan the reports are send to the radiologist ( doctors specialized in reading such reports), who then sends his final finding to the doctor ( Oncologist)

I love you, Papa!

Friday, 20 February 2015

Gallbladder Cancer - Blood Tests

  • Liver Function Test( LFT)
  • Complete blood count (CBC)
  • CEA and CA 19-9

Complete blood count (CBC): measures the amount of different types of blood cells present in your blood (given sample). Blood cancers may be detected by using this test-  presence of  abnormal cells in the blood

CEA and CA 19-9: CEA (Carcinoembryonic antigen) and Ca 19-9 (Carbohydrate antigen 19-9)
are  the  two blood tests mainly used to follow patients with known cancer.

Liver Function Test( LFT): The oncologist (or treating doctor) will ask you to get the blood tests to ascertain the functioning of liver.
  • Liver function tests (LFTs) measure various chemicals in the blood made by the liver. 
  • Any abnormal result, may indicate a problem with liver. Also this test may help in finding the root cause.
  • As a routine precaution, to know whether  the chemotherapy medicines are causing any side effects.
My father, had to undergo these tests every time he visited the hospital. Any abnormal variation in the result meant- no chemotherapy. Sometimes he needed blood transfusions and at times blood platelets .

I love you, Papa!

Thursday, 12 February 2015

Palliative Care Vs Hospice

Palliative care and Hospice, both focus on making life easier for the person diagnosed with some chronic or terminal illness. Looking platonically, there is not much difference between the two. But there few major difference that are important and be taken care of.  

Palliative Care
  • A patient can receive palliative care for cancer or any another serious illness. 
  • Palliative care is dedicated to improving the quality of life by dealing with the symptoms from an illness( curative care).
  • Palliative team generally comprises of professionals- Doctors, Nurses, Psychologist, Psychiatrist, Dietitian, Social workers.
  • Palliative care is usually given in Hospital, Specialized treatment centers, Nursing Clinics, or Hospice Institutions.
  • Palliative care can be received at any stage of the illness and by anyone. with serious illness regardless of the life expectancy
Hospice
  • Hospice focusses on making life comfortable for the few months besides easing the pain and dealing with emotional issues.
  • Hospice teams comprises of the immediate family members of the patient and visiting Doctors, Nurses, Volunteers, Social workers.  
  • Hospice is in majority administered at home. The family member of the patient play a vital role. Though there are many specialized hospice centers or homes when a patient can get round-the-clock care.
  • Hospice care is for patients where death is imminent i.e they have less then 6-months to live
  • A patient can receive palliative care at hospice centers.
I love you, Papa!

Wednesday, 11 February 2015

Stages in Gallbladder Cancer

Cancer staging, is basically the process of ascertaining the spread of cancer in the body and what is its origin. Staging traces the gravity of the cancer in an individual depending upon  epicenter of the origin and how far has it spread.

Staging is mainly based on the following factors
  1. Site of origin of the tumor
  2. Size of tumor and the extent of tumors
  3. Has the cancer reached the lymph nodes
  4. Metastasis ( spread to distant organs)
Stages of Cancer

Stage 0 (Carcinoma in situ)Abnormal cell growth is found in the innermost (mucosal) layer of the gallbladder; these abnormal cells may in future become cancer.

Stage 1 (First) 

Cancer has started and has spread beyond the innermost (mucosal) layer to a layer of tissue with blood vessels or to the muscle layer.

Stage 2 (Second)

Cancer has spread beyond the middle (muscle) layer to the connective tissue around the layer.

Stage 3 (Three)

Stage 3A- Cancer has spread through the thin layers of tissue that cover the gallbladder and/or to the liver and/or to one nearby organ (stomach, pancreas, colon, small intestine or bile ducts outside of the liver)

Stage 3B- Cancer has spread to neighboring lymph nodes and beyond the inner layer of the gallbladder to a layer of tissue with blood vessels. OR

Spread to the muscle layer; or beyond the middle (muscle) layer to the connective tissue around the muscle. OR

Spread through the thin layers of tissue that cover the gallbladder and/or to the liver and/or to one neighboring organ

Stage 4 (Four)

Stage 4ACancer has spread to a main blood vessel of the liver or to 2 or more nearby organs or areas other than the liver. Cancer may have spread to nearby lymph nodes.

Stage 4BCancer has spread to either lymph nodes along large arteries in the abdomen and/or near the lower part of the backbone or to organs or areas far away from the gallbladder

Management

The stages are also grouped depending upon the treatment. There treatment can be divided into two groups:

Localized (Stage I): cancer is found in the wall of the gallbladder and can be completely removed by surgery.

Un-resectable (Stage II, Stage III, and Stage IV): cancer has spread through the wall of the gallbladder to surrounding tissues or organs or throughout the abdominal cavity. Except in patients whose cancer has spread only to lymph nodes, the cancer is un-resectable ( surgery cannot be performed).

Cancer keeps coming back!

Cancer that has returned after it has been treated is known as "recurrent cancer". The cancer may come back in the gallbladder or other body parts. If there is a recurrence, the cancer may need to be staged again, known as re-staging (as explained above).

I love you, Papa!

Tuesday, 10 February 2015

The Gallbladder and Cancer

Gallbladder
What is Gallbladder?

The gallbladder is a pear-shaped organ that lies just below the liver in the right upper abdomen.

The gallbladder stores bile, a yellow, brown or greenish liquid made by the liver that aids in digestion of  fat.

When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct.

This tube( common bile duct) connects the gallbladder and liver to the duodenum, first part of the small intestine.

Gallbladder (Anatomy)
The wall of the gallbladder has 3 main layers of tissue.
  1. Innermost Layer (Mucosal) 
  2. Middle Layer (Muscularis) 
  3. Outer Layer (Serosal )
Gallbladder cancer starts from the innermost layer and then subsequently spreads to the other layers. Gallbladder cancer is difficult to detect initially, primarily because there are no visible  symptoms. And when the symptoms emerge they are symptoms of various other problems and by then its too late.

Risk Factor(s )
  • Porcelain gallbladder (Chronic gallbladder inflammation)
  • Gall stone (Cholelithiasis)
  • Gallbladder polyps
  • Chronic salmonella infection
  • Cyst in the bile duct
  • Age
  • Ethnicity
  • Gender ( more prevalent among women’s)
Symptom(s)
  • Abdominal pain
  • Loss of appetite
  • Nausea or vomiting
  • Fever and bloating
  • Jaundice
Treatment
  • Mainly depends on the extent to which the cancer has spread.
  • If surgery is still an option.
  • If cancer has returned.
  • General health and age of the patient.
  • Gallbladder cancer can be cured only if it is found in early stages ( Stage 1 or Stage 2)  i.e before it has spread to other organs.
After the cancer has spread to other body parts, nothing much can be done. Palliative treatment remains the only option. Palliative care aims at improving the patient’s quality of life by controlling symptoms and complications as a result of disease and treatment.

I love you, Papa!

Monday, 9 February 2015

Support Groups or Therapy Groups

Being diagnosed with cancer can be the most devastating experience in a person's life. He may experience various emotions which can be very depressing. And depressions in itself is a warning signal. It is important to realize that being depressed will not help, as fighting cancer is not easy and will be a long and a tough battle. 

To overcome, fears, anger, depression, anxiety, state of loss -joining "support group" is a great idea. And in most of the case, the patients have shown remarkable improvement in their  confidence while coping with their illness.

Support groups bring together people facing similar issues- illness, relationship problems or major life changing events.

These support groups or therapy groups help in dealing with the emotional aspects of cancer. During these group meetings one can share their inner most feelings and challenges at the same time learn from others who are already fighting cancer .

Benefits of joining support groups 
  • Feeling less lonely 
  • Provide information and comfort
  • Gaining a sense of empowerment and control
  • Teach  skills to cope with the illness
  • Talking openly and honestly about your feelings
  • Reducing distress, depression or anxiety 
  • Developing a better understanding of your condition and what to expect
  • Offers a place for people to share common concerns and emotional support.
List of Support Groups in New Delhi

Cancer Sahyog
Indian Cancer Society, Q5A Jangpura Extn., New Delhi - 110014
Phone number: +91 11 4319572, +91 11 4314907
http://www.indiancancersociety.org/

CanSupport 
Kanak Durga Basti Vikas Kendra 
Sector 12, R. K. Puram 
New Delhi ‐110022 
Ph 011‐26102851/69 
Email: cansup_india@hotmail.com 
http://www.cansupport.org

Cancer Patients Aid Association
C-1 Mayfair Tower, Charmwood Village, Distt. Faridabad 12009
Phone number: +91 5273 8252881

Tej Ram Memorial Cancer Society 
28/1, East Punjabi Bagh, 
New Delhi 

Global Cancer Concern India (GCCI) 
S‐18/4, DLF Phase III 
Gurgaon 122002, Haryana 
Phone: 0124‐2564473‐75 
Fax: 0124‐2564476 
Email: gcci@vsnl.com 
www.globalcancer.org

Laryngectomee Club of India
F 11A (G-8 Area)
Near Hari Nagar Clock Tower
New Delhi 64
Tel: 011 25404659
Sh. S P Goel, President
http://www.laryngectomeeclubindia.org/

Mastectomees Association 
Sahi Hospital, Jangpura
New Delhi
Tel: 011 24319802, 24314086
Dr. Santosh Sood, President
Tel: 011 26121856

Sometimes patients don't want to share their grief with their loved ones and are confused regarding their life and treatment. The best in this scenario are the "support groups". Sharing concerns with survivors or people who are still fighting with cancer, can be remarkably reassuring and help the patient to be more focused and motivated towards their own treatment.

Patients have confessed, that they found it easier to talk to a complete stranger and felt relieved after discussing their anxieties and issues. They felt more comfortable with the doctors, their family members, their own self  and felt hopeful regarding their treatment.

Patients can know about these "support groups" through the hospital/medical centre where they are undergoing treatment.  In case the patients needs professional help,  their oncologist should be able to recommend someone.

I love you, Papa!

Sunday, 8 February 2015

Palliative Care Centers in Delhi

Palliative care is an attempt to improve the quality of life of terminally ill people through channelized treatment. It aims at management of pain and other associated needs like medical services, emotional and spiritual resources of the patient and his family.

Symptoms

Palliative care targets at curing the pain and other by effects of the treatment ( usually chemotherapy and radiation therapy). Most of patient suffer from all the following symptom at some  stage of their treatment:
  • Nausea
  • Anxiety
  • Depression
  • Delirium
  • Constipation
  • Dyspnea
  • Fatigue 
  • Insomnia
The Team : Palliative care team usually comprises of  a specialist, psychiatrist or psychologists, social workers and a dietitian

Below is the list of Palliative Care Centers in Delhi

All India Institute of Medical Sciences (AIIMS)
N. Delhi-110022    
Dr. Sushma Bhatnagar
011-26588227
shumob@yahoo.com

83 Akriti Apartments, 62, I.P.Extension, Delhi – 110092
Mr. Amza
Secretary

Kanak Durga Basti Vikas Kendra  Sector-12, R K Puram
N. Delhi-110022
Ms. Harmala Gupta
President
011-26102851, 26102869
Fax:  011-26102859            
harmalagupta@cansupport.org

115, C-13, Sector -111
Rohini, Delhi
Dr. A. K. Dewan
Chairman of Trust  
011- 27013311
Fax :  022-28459885  
dewan.ajay@gmail.com

239 Ghalib Apartments, Parwana Road
Pitampura, Delhi 110034.
91 9810931743,
91 9410707108
info@gangapremhospice.org

Shanti Avedna Sadan, first Hospice center in India for the care of the terminally ill Cancer patients.

Shanti Avedna Sadan
1-Factory Road, Near Safdarjung Hospital,
New Delhi 110029
Tel. 91-11-26195092
Fax. 91-11- 26193142
Email: shantiavednadelhi@vsnl.net

I love you, Papa!

Saturday, 7 February 2015

Morphine in palliative care

The best way to treat pain is assessing the pain. Knowing the root cause of the pain will help the doctor to prescribe the best type of medication.The medication can rage from a combination of different pain killers and their dosages.

Generally morphine is given to patients, when end is mostly obvious and there is no hope. For most of the patients- who are given morphine, It is generally not the stage of the cancer, but the degree of the pain endured by the patient.  The pain is constant and continuous.

Assessing Pain

To treat the pain, It is extremely important that it is analyzed properly with careful observation. The best way to assess the pain is to get the patient to talk, be involved in the treatment. Apart from this the family of the patient can monitor the patient( at least once a day) taking into consideration the following factors. 
  • Physical effects 
  • Practical Impact
  • Emotional factors. 
  • Spiritual needs
Route(s) to administer Morphine
  • Oral 
  • Rectal
  • Sublingual
  • Subcutaneous
  • Intramuscular
  • Intravenous. 
  • Transdermal (The most common used nowadays)
Towards the end, pain becomes stubborn and responds poorly to opioids. No drugs or most of the drugs fail to provide relief from pain. However, morphine- one of the oldest drug is still used extensively in palliative care for the patients with fast approaching end.

Intolerance to Morphine

The patient tolerance to morphine can be attributed to the following factors
  • Exposure to opioids in the past. 
  • Hereditary
  • Opioids providing no relief
  • Rate of dose titration. 
  • Additional treatment being given. 
  • Disease related 
  • Kidney and liver function.
The best way to improve  morphine intolerance is to start with a low initial dosage and gradually titrate upwards. Despite of best efforts, if things don’t change then consider substituting the opioid. 

If the condition still persist, try changing the route in which the opioid is administered. If still there is no change in the condition, then probably the pain was not assessed properly, look for other causes of pain. Besides, it is important to manage the side effects with additional medication.

I love you, Papa!

Friday, 6 February 2015

Opioids for CANCER pain

In my previous post I have talked about “PAIN” relief in cancer. In this post, I will be talking about about opioids- drugs which are used to provide some relief from the constant "difficult" pain.

With each passing day, cancer becoming more aggressive, pain becomes a 'constant' part of life. The pain is not only acute but is chronic and with time, it tends to become more uncontrollable. At this stage doctors prescribe OPIOIDS.

What are opioids?

Opioids are medicines that are used to provide relief from moderate to  severe pain( usually in cancer) .These medicines work on the principle of "reducing the intensity" of the pain signals being sent to the brain and affect those areas controlling these senses, and thereby considerably minimising the effects of the painful signals.

Opioids act much like endorphins-  natural substances created by the body to restrict or limit pain. Some of them work better than others in terms of providing  relief from terrible pain. 

Opioids were once formulated from the opium poppy( plant), but today many pharmaceutical companies are creating these drugs synthetically in laboratory, though addiction to these drugs still remains a critical issue .

Types of Opioids

Severe Pain
  • Morphine 
  • Buprenorphine
  • Fentanyl and Alfentanil  
  • Hydromorphone 
  • Diamorphine
  • Methadone
  • Oxycodone 
Moderate to mild pain 
  • Tramadol
  • Codeine 
All  of the above mentioned drugs are available at drugs store strictly on prescription. 

Side effects

Most of the people taking these drugs over a period of time develop a kind of tolerance to these drugs. Therefore, the doctor has to prescribe higher dosage to provide relief from pain  or the other reason can be  increase in pain due to the advancement of the disease. 

A little  increases in the dosage or a change in the type of medicine will help in relieving the pain.

Common Side-effects
  • Hallucinations
  • Confusion
  • Vivid dreams 
  • Myoclonic jerks.
  • Sedation
  • Nausea and vomiting 
  • Constipation
  • Dry mouth 
  • Itchy Skin 
  • Coughing,wheezing, and shortness of breath
  • Difficulty in passing urine
  • Blurred vision
All these symptoms are common, and usually the treating doctors provide medicine to help overcome these effects. 

Im my personal view these symptoms never actually go away. Though the doctor’s do prescribe some medications to control these symptoms, but they prove to be of little or no help. Eventually all the symptoms emerge. ( In case of my father, where I tried my level best to read about the symptoms before hand, so that I could "prevent" them from emerging. With absolutely no result, my father went away!)

Towards the end, when pain becomes “difficult", the body has become resistant to opioids and nothing helps- the focus should be on making life easy- good palliative care.

Because you love them, tell them, show them- be with them. They need you, for the last time!

I love you papa!

Wednesday, 4 February 2015

Cancer- Dealing with pain

As CANCER advances, pain only increases. Treatment is almost over. Nothing much can be done now medically, only efforts to reduce the pain can be done ( Palliative Care).  Around 2/3 of the patients suffering from cancer experience acute pain. The pain is almost unbearable for the patient and is equally painful for you to see your loved one in pain. 

For treating pain, Doctors use all sorts of medicines - from simple drugs like Paracetamol (Analgesics) to Morphine (Opioids). Honestly nothing helps, but if the medicines are given timely  and in proper dosage, then they are of some help. The patient do experience some relief, if the pain has been analyzed properly and timely.

A study conducted by doctors in UK, says that Tolerance to pain can be Increased in the following ways
  • Rest 
  • Diversion
  • Physiotherapy 
  • Relaxation therapy
  • Empathy 
  • Support from family
  • Listening to Music
  • Expressing emotionally
Tolerance to pain is reduced by
  • Anxiety
  • Sadness
  • Introvert Attitude
  • Insomnia
  • Socially Cut-off
  • Fear
  • Fatigue
  • Anger
  • Mental Separation
  • Depression
Pain can be described as physical expression of social, spiritual and psychological isolation. To feel pain, one need not suffer. Dealing with pain, a lot of effort is required that too in a very organized and a sensitive way.
  • Proper Medication
  • Counseling
  • Other Therapies
  • Spiritual Support
Apart from all  of the mentioned above, support from family plays a pivotal role in making life easy for your loved ones. Talk to them, make them express, listen to them-After all you love them and this is the least you can do for them.

I love you Papa!