An 80-year-old man who was recovering from a recent stroke and a complex medical history presented to us with a recent history of shortness of breath and wheezing for two days. He had undergone a tracheostomy during his stroke treatment due to prolonged ventilation, and it was initially suspected that he had a post-tracheostomy stenosis. He underwent evaluation by pulmonology and a scan revealed a mass in the mid-posterior tracheal wall, roughly 3 cm in length and obstructing the lumen by >80% with focal invasion of the cricoid ring, which forms the cartilaginous base of the voice box on which the vocal cords sit. Endoscopy showed that the tumor was obstructing the airway with each expired breath. It was suspected to be cancerous. After evaluation by the head and neck surgery and anesthesia teams, multiple plans were discussed to completely remove the tumor and re-establish the airway.

Complete resection of the upper trachea and the cricoid ring (the cartilaginous base of the voice box framework) would likely be too high-risk a surgery for the patient to withstand, and the previous tracheostomy scar would increase the likelihood of failure. A pure bronchoscopy approach where the tumor could be completely removed using an endoscope also would not be feasible since there was a risk of bleeding and airway obstruction, and the location of the tumor made complete removal unlikely. After extensive discussion, a hybrid approach was planned. Under local anesthesia, the previous tracheal scar was freed, an anterior tracheal opening was created, and the patient was administered general anesthesia. After that bronchoscopy debulking was performed to remove most of the tumor from the lumen. A carbon dioxide fiber laser was then used to completely excise the tumor from within the trachea up to the cricoid ring. The opening in the trachea was then carefully closed. The patient was safely extubated and was completely relieved of his airway obstruction, discharged home on day 5. This was a novel approach, not having been described before for the treatment of these tumors, which allowed adequate access and complete removal, with minimal side-effects of surgery and quick recovery.

Treatment of complex airway problems pose a major challenge to even experienced teams. Limited working space and complex anatomy make approaches difficult and working in the airway while allowing the patient to breathe pose numerous challenges. Hybrid approaches allows the best of both worlds – bronchoscopy approaches allow minimal access and quick recovery, while surgery allow definitive access and completeness of treatment. Newer technologies like laser and cryotherapy allow precise treatment with very little collateral damage to the surrounding normal tissue. Dr Vivek Gundappa, Consultant Pomologist notes, “Tracheal masses are rare; they present with severe respiratory distress whether cancerous or not, and a multi-disciplinary approach is essential to mitigate them”.

Coordinated approaches between airway surgeons, interventional pulmonologists, and anesthetists allow low complication rates and quick return to function. In addition to cancer, other problems include post-tracheostomy scarring and fibrosis, post-acid-ingestion injuries, and benign tumors. Dr Narayana Subramaniam, Senior Consultant and Director of Head and Neck Surgery and Oncology and Director of Clinical Innovation commented, “This gentleman had a complex tumor and a previous surgery in the same site which made treatment difficult. Additionally, he had a complex medical history that required a tailor-made approach that reduced the risk of extensive surgery while being effective. We were happy to offer him a good result with excellent coordination and planning between surgeons, pulmonologists, and anesthetists. The Sparsh Yelahanka Complex Airway Clinic offers multi-disciplinary care to patients with airway problems. With significant expertise in interventional pulmonology, surgery, anesthesiology, radiology, and pathology, as well as the best technology, we can offer the best quality care for people with these difficult groups of disorders.

By: Dr Narayana Subramaniam, Senior Consultant and Director Head and Neck Surgery and Oncology and Director of Clinical Innovation, Sparsh Hospital

In today's fast-paced world, maintaining a healthy lifestyle is crucial for overall well-being. We focus on healthy eating, regular exercise, and mental well-being, but often overlook a critical aspect of cancer prevention: understanding our genetic heritage. Knowing your family history can help identify genetic cancer risks, empowering you to take proactive steps toward prevention.

The Importance of Family History

Family history plays a significant role in assessing cancer risk. If multiple relatives have been diagnosed with cancer, especially at a young age, it may indicate a genetic predisposition. Certain genetic mutations can increase the risk of developing specific types of cancer.

Types of Genetic Cancer Risks

BRCA1 and BRCA2 Mutations

Mutations in the BRCA1 and BRCA2 genes significantly increase the risk of breast and ovarian cancers. These genes normally produce proteins that help repair damaged DNA, but when mutated, can lead to uncontrolled cell growth and cancer. Women with BRCA1 or BRCA2 mutations have a 45-72% lifetime risk of developing breast cancer and a 20-40% risk of ovarian cancer.

Lynch Syndrome

Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), increases the risk of various cancers, including colorectal, endometrial, ovarian, stomach, small intestine, and other cancers. This condition is caused by mutations in DNA mismatch repair genes, such as MLH1, MSH2, MSH6, and PMS2.

Familial Adenomatous Polyposis (FAP)

Familial adenomatous polyposis (FAP) is a genetic condition that increases the risk of colorectal cancer. Caused by mutations in the APC gene, FAP leads to the development of hundreds to thousands of polyps in the colon and rectum, which can become cancerous if left untreated.

Li-Fraumeni Syndrome

Li-Fraumeni syndrome is a rare genetic disorder that increases the risk of multiple cancers, including breast, brain, osteosarcoma (bone cancer), soft tissue sarcoma, and adrenocortical cancer. This condition is caused by mutations in the TP53 tumor suppressor gene.

Other Genetic Cancer Risks

Other genetic mutations associated with increased cancer risk include:

●      Cowden syndrome: Increases risk of breast, thyroid, and endometrial cancers.

●      Peutz-Jeghers syndrome: Increases risk of colorectal, breast, and ovarian cancers.

●      Multiple endocrine neoplasia (MEN): Increases risk of thyroid, parathyroid, and adrenal gland cancers.

●      Hereditary breast and ovarian cancer (HBOC): Increases risk of breast and ovarian cancers.

Knowing your family history is crucial in understanding genetic cancer risks. By acknowledging and addressing these risks, you can take proactive steps toward cancer prevention. Embrace the power of knowledge and break the family cycle of cancer.

By:- Dr. R Shrikanth, Consultant-Medical oncology, HCG NMR Cancer Centre, Hubli

Osteoporosis, often referred to as the “silent disease,” weakens bones to the point where they are easily fractured. While this condition affects millions globally, Indian women are disproportionately at risk. As we mark World Osteoporosis Day on October 20th, it is crucial to understand why Indian women are more susceptible to this debilitating disease and what steps can be taken to reduce this risk.

What is Osteoporosis?

Osteoporosis is a condition characterized by the loss of bone mass and deterioration of bone tissue. This leads to fragile bones that are prone to fractures, even from minor falls or, in severe cases, from sneezing or bending over. Women, particularly postmenopausal women, are at greater risk due to the drop in estrogen levels, a hormone that protects bones.

The Situation in India

India is home to more than 230 million postmenopausal women, a group highly vulnerable to osteoporosis. Studies show that Indian women develop osteoporosis at an earlier age compared to their Western counterparts, with a majority affected after the age of 40. The reasons behind this heightened susceptibility are multifaceted, ranging from dietary deficiencies to lifestyle choices, genetic predisposition, and cultural factors.

Key Factors Contributing to Osteoporosis in Indian Women

              1.           Nutritional Deficiencies

A major contributor to osteoporosis in Indian women is widespread malnutrition, especially deficiencies in calcium and vitamin D. Calcium is essential for building and maintaining strong bones, but Indian diets, especially vegetarian ones, are often low in calcium-rich foods like dairy products. Moreover, lactose intolerance is common in India, leading many women to avoid milk-based products.

Vitamin D deficiency is another major concern. Despite abundant sunlight, over 70% of Indians are vitamin D deficient. This can be attributed to limited sun exposure due to cultural practices such as wearing clothing that covers most of the body, and the use of sunscreens or spending time indoors. Vitamin D is essential for calcium absorption, and its deficiency further exacerbates the risk of developing weak bones.

              2.           Early Menopause and Low Estrogen Levels

Indian women, on average, experience menopause at an earlier age (around 47-49 years) compared to women in Western countries. Early menopause leads to a premature drop in estrogen levels, which accelerates bone loss. In addition, conditions such as polycystic ovary syndrome (PCOS) and hysterectomy performed at a younger age further contribute to decreased estrogen levels, making bones more susceptible to osteoporosis.

              3.           Genetic Factors

Genetic predisposition also plays a significant role. Studies indicate that women from certain ethnic backgrounds, including South Asians, have lower peak bone mass, which makes them more vulnerable to bone loss as they age. Indian women, especially those with a family history of osteoporosis, are at higher risk.

              4.           Sedentary Lifestyle and Lack of Exercise

Physical inactivity is a major risk factor for osteoporosis. With urbanization and changing lifestyles, many Indian women are becoming increasingly sedentary. Lack of weight-bearing exercises like walking, running, or resistance training contributes to reduced bone density. Coupled with poor dietary habits, this sedentary lifestyle accelerates bone deterioration.

              5.           Cultural and Societal Factors

Cultural norms and practices also play a role in making Indian women more prone to osteoporosis. Traditional roles often prioritize family over personal health, leading many women to neglect their own nutritional needs. Additionally, the pressure to remain slim often results in restrictive diets that are low in essential nutrients, further increasing the risk of osteoporosis.

              6.           Inadequate Awareness and Screening

Awareness about osteoporosis and the importance of bone health remains low in India. Routine screening for bone density is uncommon, particularly in rural areas. Most women only realize they have osteoporosis after suffering a fracture, at which point the disease is already advanced.

Preventing Osteoporosis: What Can Be Done?

While Indian women are at higher risk of developing osteoporosis, there are several preventive measures that can be taken:

              1.           Increase Calcium and Vitamin D Intake

Ensure adequate consumption of calcium-rich foods like dairy products, leafy greens, nuts, and fortified cereals. Vitamin D supplements or sensible sun exposure can also help in maintaining healthy bone mass.

              2.           Regular Exercise

Incorporate weight-bearing and resistance exercises into daily routines. Activities like brisk walking, running, and yoga can strengthen bones and improve overall health.

              3.           Early Screening and Bone Health Monitoring

Women, particularly those above 50, should undergo bone density tests to assess their risk for osteoporosis. Early detection allows for timely interventions such as medications or lifestyle changes.

              4.           Hormone Replacement Therapy (HRT)

For women undergoing early menopause, HRT can help maintain estrogen levels, thereby reducing the risk of osteoporosis. However, this should be done under medical supervision due to potential side effects.

              5.           Lifestyle Modifications

Avoid smoking, excessive alcohol consumption, and restrictive dieting. A balanced diet and a healthy lifestyle can significantly lower the risk of osteoporosis.

Conclusion

Osteoporosis is a growing concern for Indian women, but with greater awareness, early screening, and lifestyle changes, it is possible to prevent and manage this condition. This World Osteoporosis Day, let’s encourage women to prioritize their bone health. Simple steps like improving nutrition, staying active, and undergoing regular health checks can make a significant difference in reducing the burden of osteoporosis among Indian women.

By addressing the unique challenges faced by Indian women, we can help ensure healthier, stronger bones for future generations.

By Dr. David Chandy

Director - Endocrinology & Diabetology, Sir H. N. Reliance Foundation Hospital

In the world of health and wellness, understanding the nuances of diseases can often feel overwhelming. With a wealth of information available, it's essential to focus on the specifics that matter most to us. Among the various health concerns, cancer remains a significant topic of discussion. Its stages, types, and implications can differ widely, influencing not only treatment decisions but also emotional well-being.

What Is Stage 0 Breast Cancer?

Stage 0 breast cancer, often referred to as ductal carcinoma in situ (DCIS), is a non-invasive form of breast cancer. In this stage, abnormal cells are present in the lining of the breast ducts but have not spread beyond this area. Stage 0 breast cancer is an early and often very treatable stage, as the cancer cells are contained within the ducts and have not spread to surrounding breast tissue.

Symptoms of Stage 0 Breast Cancer

Often, Stage 0 breast cancer may not present any noticeable symptoms. However, some women may experience:

• Breast Lumps: Although DCIS is non-invasive, some women might feel a lump in the breast. This lump is usually detected during a routine screening.

Changes in Breast Shape or Size: Subtle changes in the shape or size of the breast may occur, though these are often not significant.

Nipple Discharge: Unusual discharge from the nipple may be reported in some cases, but it is not common.

Skin Changes: The skin of the breast may show changes, such as dimpling or a texture that appears different from surrounding tissue.

Diagnosis of Stage 0 Breast Cancer

Diagnosing Stage 0 breast cancer typically involves:

Mammograms: Routine mammograms can detect abnormalities that may indicate DCIS.

Breast Biopsy: When an abnormal area is detected, a biopsy may be done to confirm the presence of cancerous or abnormal cells.

Imaging Tests: Additional imaging, such as ultrasounds or MRIs, may be used for further evaluation.

Treatment Options for Stage 0 Breast Cancer

Treatment for Stage 0 breast cancer is highly effective and often includes:

Surgery: The most common treatment option involves surgical procedures such as lumpectomy (removing the abnormal tissue) or mastectomy (removing one or both breasts).

Radiation Therapy: After surgery, radiation therapy may be advised to target any remaining cancer cells and lower the risk of recurrence.

Hormonal Therapy: If the DCIS is hormone receptor-positive, hormonal therapy may be prescribed to reduce the chances of developing invasive breast cancer in the future.

Does It Pose Life-Threatening Risk?

The outlook for Stage 0 breast cancer is generally very positive, with a high survival rate. Since it is non-invasive and usually detected early, many patients can expect positive outcomes with appropriate treatment.

While Stage 0 breast cancer is not immediately life-threatening, it can progress to invasive breast cancer if left untreated. Regular monitoring and treatment are essential to prevent this progression.

The diagnosis of any form of cancer can be emotionally challenging. Support from healthcare providers, counselors, and support groups can be invaluable during this time.

In conclusion, while Stage 0 breast cancer may sound alarming, it is important to view it in context. With appropriate screening and timely intervention, individuals diagnosed with this condition can manage their health effectively. Awareness and education about Stage 0 breast cancer can lead to earlier detection and treatment, ultimately reducing the risk of progression to more invasive forms of the disease. By prioritizing health and staying informed, individuals can take proactive steps in their wellness journey, fostering a sense of control and empowerment in the face of a complex health landscape.

A 53 year old fisherman suffering from acute lower back pain and loss of sensation in his legs recently underwent a successful surgery at Wockhardt Hospitals, Mumbai Central. The case, handled by Dr. Mazda K. Turel, Brain and Spine Surgeon, demonstrated the life-changing impact of timely medical intervention for patients with severe spinal issues.

The patient arrived at the Emergency Room (ER) with intense lower back pain, loss of movement in his feet, and numbness in the groin. Additionally, he experienced severe urinary retention, indicating potential neurological involvement. An MRI scan revealed a massive disc herniation at the L3-L4 level, causing significant compression of the nerve roots. The severity of the disc prolapse required immediate surgical intervention to prevent permanent neurological damage.

Dr. Mazda K. Turel performed a minimally invasive surgery to address the disc herniation. A 2 cm incision was made in the patient’s back, and a series of tubes were used to dilate the muscles without cutting them, a hallmark of modern minimally invasive techniques. The extruded disc was removed, relieving pressure on the affected nerves and restoring normalcy to the spinal structure.

Post-surgery, the patient experienced significant pain relief and gradually regained strength and sensation in his legs. Under the guidance of the hospital's physiotherapy team, he was able to sit, walk with assistance, and eventually regain his ability to walk independently over the course of his recovery. The patient's urinary function also returned to normal, and the catheter was successfully removed a month after surgery.

Dr. Mazda K. Turel, Brain and Spine Surgeon at Wockhardt Hospitals, stated, “This case demonstrates how timely surgical intervention can significantly improve outcomes for patients with severe spinal conditions. The success of this surgery underscores the importance of advanced minimally invasive techniques in restoring a patient’s quality of life.”

Three months post-surgery, the patient had recovered fully, with no neurological deficits, and resumed his regular activities. This case highlights the effectiveness of minimally invasive spinal surgery in treating severe disc herniation cases and the potential for patients to regain normal function when timely intervention is performed.

Dr. Shantling Nigudgi, Sr. Consultant Radiation/Clinical oncologist, HCG Cancer Centre, Kalaburagi

The road to wellness requires more than just medical attention; it demands a holistic approach that encompasses physical, emotional, and mental well-being. By adopting a healthy lifestyle, managing side effects, and seeking support, individuals can reclaim their vitality, redefine their normal, and emerge stronger and more resilient than ever before. Chemotherapy is a life-altering experience that not only affects the body but also transforms one's lifestyle. As cancer patients complete their treatment, they embark on a journey of recovery, rediscovery, and rebuilding.

After completing chemotherapy, patients often experience a mix of emotions - relief, hope, and uncertainty. While chemotherapy is a crucial step in cancer treatment, the road to recovery can be challenging. Post-chemotherapy care is vital to manage side effects, prevent complications, and improve overall well-being.

Managing Side Effects

Chemotherapy can cause a range of side effects, including fatigue, nausea, hair loss, and mouth sores. Patients may also experience neuropathy, cognitive impairment, and emotional changes. It's essential to discuss these side effects with your healthcare team to develop a plan for managing them. This may include medication, lifestyle modifications, and alternative therapies like acupuncture or meditation.

Nutrition and Hydration

A balanced diet is crucial during the recovery phase. Focus on consuming nutrient-rich foods, such as vegetables, whole grains, lean proteins, and healthy fats. Avoid spicy or heavy foods that can irritate the digestive system. Staying hydrated is also vital, aim for at least eight glasses of water per day. Consider consulting a registered dietitian for personalized nutrition advice.

Rest and Relaxation

Adequate rest is vital to allow your body to recover from the physical and emotional toll of chemotherapy. Aim for 7-8 hours of sleep per night and take naps during the day if needed. Engage in relaxing activities like reading, listening to music, or practicing yoga or deep breathing exercises.

Follow-Up Care

Regular follow-up appointments with your healthcare team are crucial to monitor your progress, manage side effects, and adjust your treatment plan as needed. Be sure to keep track of your appointments, test results, and medication schedule.

Emotional Support

Chemotherapy can take a toll on mental health, leading to anxiety, depression, and emotional distress. Don't hesitate to reach out to family, friends, or support groups for emotional support. Consider seeking professional help from a therapist or counselor if needed.

Returning to Normal Activities

As you recover, it's essential to gradually return to normal activities, including work, exercise, and socializing. Start with small, manageable steps, and be patient with yourself. Listen to your body and rest when needed.

Preventing Infections

Chemotherapy can weaken your immune system, making you more susceptible to infections. Practice good hygiene, avoid crowded areas, and get vaccinated.

Post-chemotherapy care is a critical phase of cancer treatment. By understanding and managing side effects, maintaining a healthy lifestyle, and staying connected with your healthcare team, you can navigate the recovery process with confidence.