http://DRGEETAKADAYAPRATH.COM
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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
For many types of breast cancer, the most effective treatment has been surgery followed by chemotherapy. But how quickly patients should undergo chemotherapy has always been an open question. Dr. Geeta Kadayaprath - Best Breast Oncologist in Delhi
It is not rare for me to see patients presenting with locally advanced breast cancer or metastatic cancer. Many times, I would wonder why they came in late. Till a few years back, I would judge the educated ones more harshly and enquire in my mind what education had done for them. I stopped judging them a few years ago especially after scratching their tough exteriors a bit! Six years ago, this elderly lady, speaking in impeccable English almost stumbled into my office. She was pale and weak and her daughter informed me that she had a bleeding ulcer in her left breast. I examined her and found a 15 cm large bleeding, ulcerated mass in her left breast. Her blood tests showed she was awfully low on Hemoglobin. I quickly arranged for a biopsy and also had a PET CT done, almost certain, that her disease would have spread. Thankfully, I was proved wrong. She was given blood transfusions and chemotherapy was started. She was an epitome of courage and went through her chemotherapy, surgery and radiation with a quiet resilience. During the course of her treatment, I asked her why she had presented so late. What she said shook me!She said she had a paralysed husband to look after and she had been doing that for the past 4 years. She knew about the lump and that it was growing. It is just that her husband’s need was greater. That is when the judging stopped. We may boast of a secure social fabric but many times we see these lone wagers, fighting their own battles. Their health becomes secondary. Life is not easy for many. Bless her!She is well. Her dear husband passed away 3 years ago and she runs an NGO to promote forgotten skills among women in rural Haryana. I am truly proud to have known her!
RISING TO THE OCCASION Yesterday, this beautiful young lady of 33 walked into my room. I could see she had had chemotherapy as a smart bandana adorned her bald head. She was accompanied by her mother and her husband. Her dazzling smile and her confidence as she took me through the journey of nursing a 6 month old baby, of discovering a lump which was labelled benign at first, of the lump growing in a month and she, of her own volition going for a biopsy and discovering she had breast cancer, shook me! She had visited 3 or 4 hospitals for various reasons and is on the verge of completing chemotherapy. She had come to meet me to discuss the surgical options and the implications. She told me that she was scared of needles and pain but her composed demeanour conveyed something else. I could see, I was having the privilege of interacting with a woman of utmost strength, resilience, poise and maturity way beyond her years. Her smile never left her face. Her mother contributed positively in equal measure but the sadness in her eyes of seeing her little girl suffer did not escape my notice. She required to have an injection to up her white cell count. She went to the nurse in the treatment room for the same and showed her a prescription for the same on her mobile, from a different hub of the same centre as ours. She refused without thinking what she could have done to help her-a cardinal mistake! The nurse was following a process, which said no medication without prescription, which was fine. What she did not do, was figure out a method to solve the problem. She could have got a print out, on our institute’s letter head and cross checked with the prescribing doctor and administered the medication. What happened next was no surprise. The mother was outraged. She had accompanied her daughter across half of Delhi for a consult and this Nay from the sister, truly rocked her frail boat. She truly took the nurse to task for being unhelpful and uncaring. The situation was brought to my notice.The matter was sorted out, a printout of the prescription was taken and the injection was done. However, the bitter taste in the mouth remained! I know for a certainty, that the only people who go to hospital, happily, are doctors and the staff at work. The ailing come, as they don’t have an option. They entrust us with the job of sending them back, cured or relieved of their ailment. We, as caregivers, should never forget to look beyond and see the footprints that they have left behind, as they walk the difficult path to meet us. There is a story, sometimes, most heart rending, that we need to know- a story that should only raise our level of empathy. Each one of us has to walk that extra mile, go beyond our call of duty to ensure that we do our best for the person sitting across the table, entrusting us with making some of the toughest decisions of their lives. We, as professionals, have to really rise to the occasion, every single time!
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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