Life’s Speed breakers- Reblogged!

Don’t Call Cancer as C word! Call it CANCER and face life’s challenges up front!

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This is a blog written by me in 2015; today for some reason I felt that its a good idea to reblog the same!

Life patterns have changed for many in my generation in a way, at least I had never expected. In our parents’ generation 58/60 was the age for retirement. In those days most people retired and quietly went into the sunset. Deaths within a few years of retirement were very common, one of the reasons could have been there was nothing to look forward to! This was true in case of males, but women somehow remained busy with household chores, helping their daughters/ daughter in laws and grandchildren.

Our generation has seen things from bullock carts to electric/hybrid cars, snail mail (भारतीय डाक सेवा) to WhatsApp and god knows what in future! Going has been generally good. In our generations people try to work as long as possible because of reasonably good health, opportunities and will! When in life things are following a normal course, one tends to forget the human fallibility. Heart attacks, cancers, dementia, and accidents always happen in other homes not in my home! So we tend to breeze through and generally are in cruise control or auto pilot mode. We tend to forget that there can be speed breakers in our lives. I am writing about how I “flew” over a speed breaker, had rough landing and managed to go into “cruise control” mode again.

 Why this blog?

In life we have to face difficulties starting from family difficulties, to financial difficulties, health difficulties and so on. I thought I should share my experience with others to let them know that these are surmountable provided we keep a positive attitude in tough situations. Of course HIS blessings are the first thing you should have!! Which of above mentioned difficulties are tough to handle, everybody will have different opinion but in my opinion the above mentioned sequence is in reducing degree of difficulties. It is always good to have financial soundness plus decent insurance coverage. This puts your mind at rest about the expenses involved.

These tough times could be overcome mainly due family support and positive attitude. (By family I mean the family, extended family and friends) Probably the saying, “Tough get going when times are tough” is very apt here. During my treatment phase I have seen a patient go down as he did not have good family support. He required hospitalization and his wife never came to meet him! She was afraid of hospitals; he never recovered. So when there is a critical event in your home, it is not only you but your whole close family goes through tough times. Even if one cog in the system is weak, handling the same can be very very difficult. I was lucky we had no weak links!!

I have chosen to give this date wise activity to explain how my family and I took quick decisions to move fast with treatment. As they say Time (and Cancer) wait for nobody!!

The Story

I was continuing with my profession and was 64 years of age, in November 2013. Though my life was not very high speed life, it was reasonably busy. I was cruising in my life with manageable health issues and my mind set was as per previously mentioned thoughts, in short I thought I was infallible.

One fine day, I woke up with a squeaky voice (in retrospect, voice quality had changed a couple of weeks before) and thought maybe some oily foods or cooler weather is causing issues. I went to my ENT friend Vijay for the check-up; he suggested usual gargling and minor medication and said “call me when you get well!” After a couple of more check-ups and medications, including steroids Vijay said some more check-ups are needed. I was guided to Dr. Sant;

1st Dec 2013

On that day there was some health issue for our new born grand-daughter Rhea; I told Jaya and Priya that I will go alone for the check-up. I almost decided to go alone but Deepti insisted that Raju will go with me! Check-up was done using Stroboscope and Dr.  Sant said, Pramod I wish my diagnosis is wrong, but I am yet to make incorrect diagnosis. “You have cancerous growth on your left vocal cord and that is the reason for change in voice”! What a speed breaker! I bumped my head on the roof, was almost thrown on the wind screen! From Dr. Sant’s office, called Jaya and discussed. Called Dr. Atul (my nephew and physician) and immediately at 8 pm we went for CAT scan to check the spread, if any. Luckily no spread! On the way, ate something; diagnosis did not prevent me from getting hungry!

3rd Dec 2013

Second meeting with Dr. Sant and he had con call with Dr. Vijay and Dr. Bokil, Onco surgeon. Plan decided. 7th Dec Excisional Biopsy by Dr. Sant at Sahyadri Hospital.

7th Dec 2013

On 6th evening got myself admitted in the hospital, again Raju was great help! He stayed with me for the night. At admission counter, clerk said please get the patient; I said I am the patient! She was surprised, maybe I looked impatient!! At night, doctors wanted to take X-Ray. I walked out of the room towards X Ray area but the helper came rushing and said I must use wheelchair! I said why; he said that was the protocol and besides that doctors will blow him out if I don’t use wheelchair! Biopsy done on 7th, looks like everything went as expected. Was back in the room with major pain in the throat. Was back home in the evening, again Raju and Deepti took us home.

10th Dec 2013

The results declared, Dr. Sant passed with flying colours, cancer was confirmed.

14th Dec 2013

After discussions with Dr. Bokil, went to Ruby Hall to finalize radiation stuff with Dr. Maiya, Radiation Oncologist. Plan fixed. Dr. Maiya had told us at the beginning of the treatment, that in cancer treatment, upto 60% cure is due to family and positivity; balance 40% consists of medicines, doctors and equipment. If one remains positive, medicines and treatment are more effective.

  • Immunotherapy intravenous weekly- total 8 doses
  • 34 radiations

20th Dec 2013

First dose of immunotherapy given in ICU (just in case) and the radiations to be started within 2/3 days. Feeding tube inserted by Dr. Bokil through the nose for later use.

23rd Dec 2013

First radiation given; same day moved to new home next to Priya for easy management of the baby and grandpa!

Fell into a routine of leaving for Ruby hall 6.20 am daily.

24th January 2014

Radiation put on hold due to cough and minor fever. General weakness felt as Steroids, Antibiotics and drugs to check blood/sugar taking its toll! Sugar level checked thrice a day. Difficulty in swallowing solid food starts. A couple of feeds of liquid diet started. Body rash in head, neck and on back but manageable. Throat pain begins and so do pain killers; followed by cough bouts especially at night. I was not hospitalised but was at home right through.

2nd February 2014

Switched over 100% to liquid formula for adults; there are two of us on liquid formula in the house, grandfather competing with grand-daughter! For me it was delta change of switching from solid diet to liquid diet but for Jaya it was a logistics nightmare. Giving me first feed at 5 am so that we could leave home for Radiation at 6.20 am. Needed eight feeds to keep me going and in the whole process I lost only about 3 kgs. (Atul said weight goes down upto 10/15 kgs sometimes) My last daily feed was at 11 pm. Logistics for this feed was 15 minutes preparation, 15 minutes for feed and 15 minutes cleaning the stuff. Eight such feeds in a day plus tablets three times a day was also a feed because I could not swallow!! Plus managing day to day chores at home!! Phew! Plus managing phone calls, visitors (we had requested all to differ visits) How Jaya managed!!

16th February

Jaya had a very strong migraine attack and had to be hospitalised. On her way to hospital she called Ashwini, who rushed. She and Priya managed last couple of days of my feeds and otherwise!

20th February

Final radiation treatment!

Family Support

During all this process Dr. Gauri our niece came and stayed with us for 5/6 days. Priya was trying her best to support even while nursing the baby. Our son Sachin came from USA and stayed for two weeks. Last three days of the treatment was logistics nightmare. Jaya collapsed due to all the stress. She had an attack of relief migraine. Jaya went to hospital and checked in like hotel check in, got herself treated for 3 days, paid her bill and came back! Who managed me during this period? Our other niece Ashwini rushed at 1 hr notice and managed with some help from Priya. Who managed Jaya, God and family!! Of course Raju and Deepti were there to support all the time. Dada and Pushpatai was there for moral support. Situ, Ashwini and Anish came so did Mai & Nilkanthrao. Jaya’s brother Nanda a great support for logistics. Nikhil & Sushil were also a great help.

Friends Support

Jayprakash took Jaya to hospital when she had migraine attack, Sanjay came and met. Sharya, Ram Prabhu, Prakash Raykar came from Mumbai to meet. Chandru, Bhave, Bhide, Dada Parulekar, Santosh, Ajit, Pakya Nirgudakar (in spite of his own issues) barged in. Vijay & Madhuri came down from Mumbai. Jaya requested, Sudip, Rufus and many others to differ visit as she was getting overwhelmed! But Ranjith had come from Australia so came in with Rufus. Saurabh dropped in from Mumbai. There were so many emails, WhatsApp messages and so forth which was a reassurance that help was just one phone call away. I may have missed some names for which I may be pardoned!!

Unknown parameters

Initially I did not even know that there will be 34 radiations, I thought just one or two radiations and it’s done. I also did not know that immunotherapy was a full day affair of intravenous drug, and potassium support. Weekly blood/urine tests were also not known to me!!I also did not know that I had to wear Spiderman type of mask during Radiations!! Prognosis was the unknown factor but Doctors started indicating that cancer of vocal cords is a non-spreadable variety and there were chances that recurrence may not happen as the spread was also minimum. Fear of the unknown, honestly it was never there!

Medical fraternity professionalism

Atul, as the physician, was as usual there to indicate what can and cannot happen. Dr Maiya, Radiation Oncologist, was very clear in his thoughts and explained to us the complete roadmap during the treatment; it was like when the real issues will start, when they will taper off, what are the precautions to be taken; he was available 24/7 which luckily was not needed.

Emergencies

Once I was required to rush for chest x ray due to persistent cough, but things turned out to be normal. Once there was an indication of kidney function issue but Atul reassured that things were under control. No other emergencies cropped up.

Recovery

Dr. Maiya had explained how recovery will happen by talking my language, in graphical form. It took exactly same path indicated by Dr. Maiya. Within ¾ days of last radiation, I could switch back to bland but solid food. My throat condition would not allow me cold, sour, hot stuff. But it felt good to eat normal food. During first week of recovery, while surfing on the net, bought two tickets for Cricket World Cup final at MCG, (in March 2015!) maybe my way of declaring to myself that I am on recovery path. Started some normal activities, small walk, office for a couple of hours a day on alternate days, and then daily office for four hours. In June I started full fledge office and in July I started with out of Pune travel for work. During this phase some weakness was felt. Later on I started to drive  myself to travel outside Pune. On the whole recovery path was normal with no hick ups. Mental challenge was more than the physical challenge.

October 2015

Except the throat infections, I now do not have any issues. Throat area was directly bombarded with Radiations, so I am sure throat infections will keep on coming at more than normal frequency for some time. Life is back to normal; once in a while I have started thinking that I am infallible!! I travelled to Australia, will be travelling end of October to meet my sons’ family in Seattle. Travel for work is normal plus the greatest benefit is we had 2/3 get together meetings with friends!! What more can one want from life! I can confidently say that I am back to cruising mode thanks to Him, thanks to family and friends!

 

Good Samaritans!!

Doctors as a group are good Samaritans. Most of them are in the service of humanity, money of course matters but of many doctors that I have met and know of, are good human beings. My friend Vijay sent me a video in which a physician was speaking about heart ailments. This doctor had a very nice way of putting things across in a humorous way. He was putting his thoughts across that heart ailments can be cured without surgery, angioplasty and invasive procedures in general. Vijay asked me if this is really possible. When he asked me this question the whole kaleidoscope of my interactions with doctors, throughout my life, passed by quickly. This made me think of two things, about doctors in general and about getting well with their help.

My first reaction was that, when  doctors treated you as individual doctors they were simply good to superb, as is natural in any group of people. They always cared for you, they would try to give least amount of medicines as possible, and try and allow the nature to take its course; they would intervene only if needed. Over a period I have observed that doctors explain things in details about your ailment. On the flip side I know a doctor who instead of explaining gives you a link to his YouTube presentation about your ailment, which I thought was very impersonal.

The personal attention however changes when you are required to go to hospitals, where you are theoretically in a corporate environment. You would expect quick and efficient actions followed by continuous tracking as would be expected, as patients go to hospitals only when such need arises. I do not know what happens in that environment but things are sometimes at the other extreme. You will see inefficiency galore, delays, late responses, doctors just not being available and so on. (Oh don’t worry the intern will take care of you!) I remember when I was required to take my father to a large hospital due to heart attack. He was admitted under a senior physician. After initial checkups I was promised that the senior physician will shortly come and see my father. After a couple of hours I was coolly told that the doctor will now come the next day as he was now busy in his consulting rooms. For me it was it was simple, if the senior doctor is too busy to see my father then I would rather go to another hospital. When I said this to the junior doctor, he said we should not do that as my father was critical! I said if he is critical then why the senior doctor is not checking him? Within 15 minutes the senior doctor came!

I remember a case of one of our relatives; he was admitted to a major hospital due to stroke. He had diabetes, he was on dialysis, and he had high blood pressure. For two days doctors would just not share details hence I was called to talk to them. Hospital was trying to force a brain surgery on the patient (had put him on ventilator) but as layman I could see that it was meaningless. I took a young doctor to side and asked him his blunt opinion; he said the patients’ brain is 85% damaged and he has no hopes; he gave a sad smile and said well looks like commercial aspects have taken over the case! We managed to remove him from that hospital to another one where we knew the doctors well. Doctors gave the same opinion and advised that he should be allowed to die peacefully! We did!

But I know of a physician who treated a friend of mine for heart ailment; my friend did not have sufficient insurance coverage to have bypass surgery. This doctor explained to my friend how this can be handled without surgery but he needs a drastic life style change. This was 20 years back; my friend and I had coffee last week!

This reminds me of a story told to me by a young doctor. He was working for a small hospital. He checked a patient and felt that no tests were needed. So he let the patient go. When the hospital owner came he asked the details. When he shared details about this patient, the owner said “Is my father going to pay installments for the new test machine?” Our friend simply said “looks like it” and calmly resigned and walked out!

A student hurt himself while playing badminton. His friends took him to a large hospital. When his parents reached the hospital this student was very upset and said “Dad lets go elsewhere”. His father told him to let the doctors handle the basics then they can move. The student said that they took x ray of his ankle and later found out that the doctor had forgotten to put the film in the machine!

The stories can go on and on! But as in life there are good doctors and there are not so good doctors. There will always be some black sheep. But why the basics change in large hospitals is beyond my understanding. Are doctors not good managers? Are good managers incapable of handling intricacies involved in running a hospital? Well hospitals these days have software to handle their administrative work. What a hospital system does is to provide services required by patients. This is very similar to running a hotel or running an automotive workshop. These two also provide services. Did you ever find that garages and hotels took 3 to 4 hours to give you or your vehicle a discharge? Why is that hospitals take so long to discharge a patient? On the other side, I have experienced an extremely efficiently run pathological lab. They are very efficient and at stipulated time you get your reports by email! But the norm is inefficiency.

Coming back to the video, the doctor aptly said that if you want to get well then the patient has to follow ALL things told by the doctor.  He gave an example saying that if a tank has 15 holes, how can you fill it up completely? It is obvious that ALL 15 holes need to be blocked to fill up the tank. A patient with liver issues says what is going happen if I take a peg or two of whiskey? Then the patient is asking for trouble. A senior physician once told me that in diabetes, most of the patients keep on having issues as they do not follow the basic discipline of diet, medicine and exercise! He said a very small percentage of patients have really erratic body responses and have a tough time as diabetes remains erratic even after following ALL instructions. He also told me a story of a disciplined patient who in yearly checkups found that he had very high diabetes. But by following the regimen to the last dot on I’s and slash on T’s, in three years’ time the patient has become non diabetic, with medicines!

Friends I wrote this blog to suggest how health issues are handled and need to be handled. These thoughts come to mind probably because I am a senior citizen now!! I will add a few more points. All “Pathys” are as good as the doctor who uses them. Each pathy has its own benefits and down sides plus limitations. When you are having jaundice there is no known cure available in Allopathy! You have to take Liv 52. Similarly other pathys also have limitations. But we should not be very rigid in our thoughts about up & down sides. That Allopathy has certain side effects is a known fact but that does not mean there are no good sides! Allopathy is the best researched pathy and offers cures to many ailments, even the toughest of the ailments. Homeopathy and Ayurved have their own advantages and limitations. What happens is after reading something about side effects of Allopathy, some people tend to just ignore it, to me at least, and it is to their own peril. There are diseases like cancer, dementia and many such tough ones. Very strong Allopathy medicines are also not able overcome such ailments. In such cases people should NOT experiment! I will share with you an anecdote about a patient with blood pressure problems. He went to the doctor and got himself checked. His BP was 200/120! Doctor suggested that he get himself admitted to a hospital or take 100% rest at home for at least four days and then prescribed to him strong medicines. The patient probably did not understand the meaning of 200/120. He asked the doctor, “I am worried about Allopathy side effects. Can you tell me the side effects and try to reduce the dose”. Doctor said, “Let us experiment later, and at this stage let us act fast”. Patient still insisted on knowing about side effects before starting the treatment. Doctor gave him all the details and said, “As against these side effects, if you do not take medicines there is only one side effect”. Patient said “what is it?” Doctor said, “You may die”. Amen!!