At the peak of happiness!

Mirror, Mirror on the wall, who is fairest of them all? This sentence is from the Snow White fairy-tale. Her mother wants the mirror to reply. In the German language, the fair is interpreted clearly as “beauty”. But English interpretation is a little different. Fair in English is about the colour and complexion of the skin. Even in the white race, the “fair” or with the paler skin or blonde is considered more beautiful. But when we talk of the weather, fair means pleasant weather.

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Similarly, a question came to mind, who is the happiest of all? What is the meaning of happiness and what is our interpretation of happy? Happiness is a feeling or showing pleasure or contentment. The same question can be asked to happiness mirror. Who is the happiest of all? The obvious answer is the babies. Their primary needs are food and sleep. If they get their feed, on time, they have the least of the worries in this world. They will go to sleep when they feel sleepy irrespective of what is happening around them. But then we don’t remain babies, all our life.

I get a feeling that the older people would be the happiest among all groups. I am sure that you have already thought that Pramod is getting older and senile. But look at the things from the view of old people. Old means old, I am young as I will complete 70 this year.

Thinking like an older person is thinking about resilience and focusing on “what is”, as opposed to “what is not” — accepting your mortality by not being so afraid of it. When you are older, you view the time horizons in front of you differently. You understand that the days are finite, and we might as well enjoy the ones we have left. The waking up in the morning and saying, “Thank God for another day” is an indication of accepting the truth. I had read a joke about old age. A person tells his friend, “Look, buddy, my doctor told me the other day to think positively. He said that if you wake up and find that you do not have a single aching part in your body, safely assume that you are dead. Don’t bother even to get up!”  That was the doctor’s way of telling us to accept the facts of life.

As we grow old, we tend to forget some things, but it is selective forgetfulness. I was treated for cancer from December 2013 to February 2014. I was required to take 34 Radiations along with Immunotherapy. These caused me body rash, cough and a lot of pain in the neck, no pun intended. I took a lot of pain killers in those days. But I don’t remember these things much; I only have a vague memory of the trauma I faced. Selective forgetfulness is the gift given to us by old age. A study says that we become forgetful, but we forget more adverse events from our life. The corollary to the phenomenon is that we become happier. We also learn over a period that bad things in life are not special treatment meted out only to us. Everybody goes through different situations. Knowing this does not reduce the effect such traumas have on us. But it reduces impact knowing that it is a common problem.

You come to understand that the quality of our lives isn’t based on the events of our lives. It’s in reaction to the events in our lives. That’s a useful thing, to realise “I don’t have control over some of the events in my life, like the weather, but I actively have a say in how I respond to the weather.”

Which is the relevant keyword in our thinking? Happiness or Choice, to me it’s “Choice.” It’s declaring that you won’t be defined or determined by the circumstances of your life. You have a say in this. That declaration is liberating. That liberation is happiness. Happiness isn’t just the thing you choose; it’s the act of choosing it that makes you happy.

There are various things that we can do to improve our thinking and quality of life. If someone has depression, it is a condition that needs to be treated and not something that will go away by thought. It also won’t ensure that you will have a better future. But positive thinking will make sure that you look at at your life in such a way, that at your current situation feels happier. We should focus on “what is” and not “what we don’t have”! The younger people always think oppositely, as they believe that life is infinite!

To understand happiness at a particular stage, a person needs to be of that age. We were all children at some stage; hence we know what makes children happy! But when younger people interact with older ones, they don’t understand the real needs of the old people. We say that this old man or a woman talks too much. The issue is that as you grow older, you get less and fewer opportunities to talk.

On top of that, one can have hearing issues. So, the conversation can become difficult. Very few younger people will understand these issues, but many times it is the younger ones who decide the needs of older people. At old age, if people develop the ability to accept life’s realities, life’s experience is much more enjoyable. These people don’t need to fight hard to achieve their targets, as their targets are always short term targets. They know their financial and physical limitations and need to accommodate within whatever they have!

Friends, people of my age group sometimes have family responsibilities. But the older group does not have any such issues. Try and make the lives of older people happier. On my way to the gym, I see an old man sitting in the home premises watching things. Once I went and chatted with him for 15 minutes. He did not want me to go. He is 95 years of age and had most of his faculties intact. Near my home, there is an old people’s home. Once early morning, I had gone out to take some photographs. A group of three old people was chatting outside the gate of the home. I stopped and had an interaction with them. I could get away only after an hour or so. All of them wanted to talk; it appeared that it was their primary need. They called another friend who came out, and also joined the chat. From their face, I could see that they enjoyed the conversation very much. I was only asking a few questions to take things forward.

I am confident that older people are the ones who are the happiest in their lives provided they get the right atmosphere and the proper support. Their needs are minimal; others need to find some time for them! Don’t forget that we are also going to reach that phase at some time, hopefully! So, it will be a good idea to propagate such a thought process in society! Let us make a beginning somewhere !

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Medical illiteracy!

Us non-medical people are known for their Medical illiteracy! But my recent experience tells me that people from the medical field are also not far from us, when some event, which does not happen on day to day basis, occurs. At least Jaya and I have a curiosity bug so whenever someone known to us has a health event, which we don’t know much about, we go to Google baba and ask him questions, I think sometimes he gets fed up of our questioning!

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is dependent on individual and  communication skills of lay persons and professionals. 

I was detected with vocal cord carcinoma five years back, I avoid using word cancer, as carcinoma sounds fancier! I was hardly aware of the treatment. The only words I knew were radiations and chemotherapy! Sachin, Priya (She is a doctor)and Jaya took up the googling part and I opted to face radiations! I thought at that time, that one or two radiations are given to attack and hopefully beat the cancer back. Then maybe a few chemo tablets, and I would be done! But that is not how it was done. For my carcinoma, Immunotherapy was a better treatment in place of Chemo. There were 34 radiations! I simply did not know anything about cancer treatment. Ok, I will share with you the knowledge I picked up. 1 or 2 radiations are given as a palliative treatment when the patient is in real pain. But in that case, it is not THE treatment. When the possibility of a patient getting cured is good, 20/30/40 radiations are given depending on factors too complex for me to understand. Various improved therapies are given as newer ones are made available to mankind. Chemo remains cost effective, as it is a well proven old therapy.

Recently, a friend called me to seek an appointment with a neuro physician from my family. His 40-year daughter had difficulty in walking. Our common orthopaedic surgeon friend suggested taking advise of a neuro physician. They took the treatment and the lady is advised a certain injection to be taken, life-long! This lady had finally reached a doctor, five years late. The story does not end here. My friend while talking with the doctor said that he also has diabetes which is well under control. But he also said that he was required to perform dialysis twice a week, most of his teeth are damaged due to diabetes. What is the meaning of controlled diabetes? Do these people give such a low importance to their health? How can they not know about the illness they have after what they go through? Do they not want to accept it? How could my friend say that he has controlled diabetes?

I have chatted with a few friends, who are doctors. The various reasons for the apathy shown have come out. Mainly its human nature to avoid facing facts! If I do my yearly check-up and find that there is an issue, instead, why not delay it by a few months. Some are like butterflies, who go from one doctor to another and keep on going. This they do till they get an advise which is close to their expectation. I know of someone who went to ten different doctors for his cartilage problem. Nine said that surgery is needed, one said let us try medicines and physiotherapy. When asked, he claims that he is doing good, but cannot ride his big bike, his leg pains. Cannot drive a non-automatic car as he is in pain if he is required to operate the clutch pedal.

Then there are some patients, who have monetary difficulties, which is understandable. Some have a marriage in the family so will get themselves operated after the marriage, acceptable. But some will postpone their blood sugar checking, want to do it after they come back from their dream holiday! Reason? If sugar values are bad then they can’t binge on their holidays. A friend is doing Dixit diet, recent “In Thing”, making rounds on WhatsApp! It’s a good program suggested by a medical doctor, with a rider. Take it up under your doctor’s advice. This friend binged on ice creams and sodas and chocolates for a couple of months. On checking, for sugar value found them alarming; in normal course too, he is a dibetic. A month after starting this diet, his sugar values miraculously improved, they still showed that he has diabetes. He is claiming that due to this diet, there was a terrific improvement. The simple fact was that since he binged his values were bad and when he stopped those sweet things his values improved!

Now here is a very interesting story. Here both husband and wife are doctors. The lady is having some symptoms for 15 days. Initially, her husband says, oh you are getting old now. So, to prove him wrong, she would try and show that things are normal. After a few days, her husband says, “See, I was telling you, show positive intent and you will be all right.” She calls Jaya (they are friends) and shares her health issues. Jaya suggested that she should see a specialist. Four more days are wasted in this. Finally, she goes to see the specialist! Both were somehow bent on following their physician’s advice, rather than meeting a specialist. The husband drops her at the clinic and goes for some “important work”; to him she is just making a fuss. The specialist checks her, does some tests. The doctor diagnoses a major health issue and insists that she should immediately get hospitalized. Our friend says, “Is it ok if I get hospitalized later in the evening after my husband comes back?” Specialist insists and gets her hospitalized. She said that 15 days back when the first symptoms were felt, there was a possibility that a major event had started in her body. Fortunately, it has not culminated in a catastrophe. We need to arrest this event as early as possible.

With both being doctors they are expected to have better knowledge. Why they did not want to meet the specialist? In the best case scenario, the result would be a false alarm. But life is never simple. The catastrophe did not happen but her body was hurtling in that direction. How do you analyze this event? What could have led this couple, especially the husband with a casual approach? Even after treatment had started, he did not meet the specialist for two days, to ask details. One day we went to meet her. In the same hospital, we met a common friend, also a doctor! Our friend still does not want to accept the diagnosis, it seems. He told the common friend, “My wife is having suspected xxx!”

Another case was a person who had some uneasiness, he could not use his left hand to get his two-wheeler down from the stand. His left eye looked to be drooping. After a couple of days, he took a decision to see an eye specialist! He explained the details but the doctor felt that eyesight  was ok; the beauty was that the eye doctor also did not realize that something different was happening. To cut the story short he was forced to see the correct specialist. The specialist on checking said that a major event could be happening in his body. He was rushed to the hospital and in a couple of days, he underwent brain surgery; he was fast going towards stroke. In a couple of months more, he needed to undergo triple heart bypass surgery. Ok, I understand that a commoner may not understand that he was going to have brain stroke. But when left eye and left hand were having a problem, he should have gone to a physician at least! Though finally, it was a neuro physician who diagnosed the issue. When the body is near such a catastrophe, I am sure there is a strong signal from the body that something is seriously wrong! But people just seem to miss it!

How to make people aware of such things? How to train them to look for body signals? My worry is if trained doctors can misjudge the situation so badly, non-doctors are obviously going find it difficult. Body or mind has the natural instinct of fight or flight. Why such instincts do not come into act in situations mentioned?

Friends, I strongly urge all of you to be safe rather being sorry! Don’t go by statement that doctors always squeeze you! They only work for money these days. Don’t keep on doctor hopping. Go back to GP concept. Keep on going to the same physician regularly. He or she will always give you the right pointers as they know about your health conditions the best. And don’t avoid or postpone that yearly check-up. Its for us!

Cancer Survivor!

Cancer Survivor

A cancer survivor is a term used to describe cancer patients who did not die though they had cancer. To me this a very derogatory term. I have undergone cancer treatment five years back. I came out of the illness successfully. Why call such a person a survivor? The patient has experienced a significant treatment, faced it bravely, lived with dignity, how can the patient be called a survivor?

The word “Survivor” has the following definitions which I am trying to understand.

These definitions give a different flavour to the experience of going through cancer treatment. About 50 to 70 years back, C-word was a scary word and anyone who had cancer, it was assumed that the result would be death. Hence the term survivor came in use. Due to early detection, improved treatments, family and friends’ support, these days not everybody detected with cancer, dies within a short duration. In fact % of people recovering the condition has gone up, drastically. Following points have jointly changed cancer scenario so much that I do not like being called cancer survivor. Why not a heart attack survivor? Why not a stroke survivor? Why not a nephritis survivor?

I will share with you the information that I gathered while I was undergoing the treatment.

In recent times there have been significant changes in cancer management due to

  1. Early detection

With awareness, with improved diagnostic tools people do go to their doctors early. It is proven that early detection improves the chances of getting cured like any other disease.

  1. Advanced imaging technologies have created sophisticated diagnostics.

In olden days the only way to look inside the body was an x-ray or by surgery. With CAT scans, MRI’s doctors can really “see” inside and can even understand the different types, by looking at images.

  1. Improvements in chemotherapy and its side effects

You will be surprised to know that in developed country England, first Oncology department was established as late as in 1970. The word chemotherapy brought out pictures of a patient losing hair on the scalp, patients having terrible side effects like diarrhoea. But so much progress has taken place in this science that these symptoms are not seen in some patients. Instead of intravenous chemotherapy, now chemo tablets are available. The cost of the treatment has also gone down substantially.

  1. The advent of treatments like Immunotherapy which is used against certain types of cancer
  • Stimulating your immune system to work harder or smarter to attack cancer cells
  • Giving you immune system components, such as man-made immune system proteins
  • This treatment is still costly but very useful in a specific type of cancers.
  • Sometimes this is given in place of chemotherapy
  • I was treated with Immunotherapy instead of Chemotherapy and had reasonably fewer side effects with no hair loss at all and minor weight loss.
  1. Progress in surgical techniques which allows lesser and lesser removal of tissues.

In olden days, surgeries used to be drastic and a lot of body tissues were cut away. When I was in school, one of my father’s friend had cancer in the facial area. His left side including the left nostril was removed! In my case, luckily, the only surgery that was needed was for a biopsy!

Now with improving surgical techniques where surgeons use probes, many times surgery is not drastic.

  1. Radiation treatment
  • There have been tremendous changes in radiation therapy. It appears that Radiation therapy will be the cancer treatment of the 21st century. Two significant new methods have been proven and are used extensively
  • Image-guided radiation therapy (IGRT) is the use of imaging during radiation therapy to improve the precision and accuracy of treatment delivery. IGRT is used to treat tumours in areas of the body that move, such as the lungs.
  • Intensity-modulated radiotherapy (IMRT) uses linear accelerators to safely and painlessly deliver precise radiation doses to a tumour while minimising the exposure to surrounding healthy tissue.
  • The radiation oncologist will speak with you to determine whether IMRT is the most appropriate treatment for you. If so, your doctor will perform a physical exam and take a CT scan to conduct a treatment simulation session. Other imaging procedures may be used to help determine the exact shape and location of your tumour, and a device may be created to help you maintain the same position during each treatment. Your doctor will give you specific instructions based on the type of exam being performed. I was treated with IGRT.
  1. Progress in awareness
  • Perhaps the most significant change of the past 60 years has been in our attitudes. It’s no longer a disease to be mentioned in hushed tones, and increasing survival rates mean that more and more people are alive to share their story of beating cancer.
  • People no longer must hide a diagnosis of cancer for fear of what others might think, and numerous celebrities have gone public with their personal stories. Fundraising events for cancer charities are commonplace, generating significant money for research, advocacy and support.
  • But, more importantly, we’ve also seen a significant change in public awareness about the things that can cause cancer and the warning signs to look out. Many organisations are working hard to improve early diagnosis of cancer by raising awareness of symptoms amongst public and health professionals.
  • But sadly, one thing has not changed. Some people still believe in alternative medicines. These treatments rarely cure patients in large numbers. These people finally go for treatments discussed above, but many times its too late!
  1. Progress in preventing cancer

The reason why someone gets cancer are many

  • Scientists have slowly understood that it can be caused by some viruses also!
  • Smoking is the number one reason for cancer
  • But some cancers also show hereditary links, out of which obesity is one of the main reasons

Friends, I have tried to explain the progress in the management of cancer. Deaths due to cancer are decreasing year by year, but the number of cases is increasing. The reason is our life expectancy has gone up, and the possibility of cancer increases with age. Another cause is smoking control; smoking is controlled world over in public areas. Smoking reduction is another reason for the decrease.

I am sure now you have understood why I am unhappy with the term cancer survivor. Now it is no more a dreaded C word. Any person undergoing a significant health issue is nervous, tense and uneasy till the cure is achieved. Some achieve it; others don’t! Heart attack deaths are even more in numbers than cancer deaths, but people somehow accept heart attack event readily. One good thing is now people openly talk about cancer! Public figures like Manisha Koirala, Sonali Bendre, Cyclist Armstrong are some names. On a personal level, I was moving around for three months with a feeding tube inserted in my nose. A friend asked me why I did not cover my face with a scarf to hide the tube when I came out in public? I asked him, “Why should I do it? I am undergoing treatment, and the tube is my major support device. There is nothing to be ashamed of to hide it!” Help cancer patients to remain more dignified by treating their disease like any other significant disease by NOT using the word Cancer Survivor!

Two facets of our mind!

Human is a funny creature and human mind is even funnier! How our mind will react to a situation is difficult to tell. I am not sure but the reactions of mind are generally consistent in similar situations. At least I hope so! In routine situations which generally get repeated in our lives, reactions of the mind will be quite consistent, most of the time. Like sometimes, getting late while going to office. Our mind calculates the average time required, considering traffic patterns, time of the day when you are traveling. Then our mind internally calculates the time to leave from home, so that we reach on time! It helps you recalibrating so as to reduce your anxiety.

Do two humans react in the same way? No never. I feel that how one’s mind reacts, depends on the how you grew up right from childhood. The environment in which you have grown up, shapes the mould of how you react or how you decide. But do you really know how your mind will react to a certain situation? No, you won’t know especially in difficult situations. I found this when I was undergoing cancer treatment a few years back.

My treatment was going on for about three months, it included a treatment called immunotherapy and radiations. During the first one week, there were not many effects on my body. My body started reacting from the second weak onwards. I would get coughing bouts, I had rash on my back and on my head. Jaya tells me that I used to have a tough time because of the coughing bouts and sometimes had trouble because of the rash. My mind it seems is designed to not remember difficult and tough periods during difficult times. Honestly, I do not remember most of the details that caused the problems. Yes, I remember that there were many issues but Jaya remembers the details more than I do! Maybe I am lucky that by design, my mind forgets the difficult part of the process. I remember the basics but do not remember any details.

I did a bit of research on internet and it looks like there is a lot of research done on “our two selves”! This research is done mainly about these two selves and how their behaviour helps humans to take decisions in life or react in life! Wow, I honestly had not heard anything about these two fellas! This research is done mainly in the field of psychology! Well known expert and Nobel Laureate Kahneman says about this, “I am my remembering self, and the experiencing self, who does my living, is like a stranger to me.”

This thought process can be a bit confusing to begin with but once we understand it, its meaning is simple but fascinating. Suppose that you are on a holiday with your small kids. It is a well-planned holiday but with kids around things can be a little complex. Basically, adults take a holiday to enjoy change of scene, different places and food; add to that the family time. Children do not to love any change in their steady state life, so they are a little uncomfortable with daily travel, new hotels (they may be posh but they are not home). With this uncertainty, they are a little quirky. Now here is the concept. The experiencing self is the “you” who in the moment lives through the event. The remembering self is the “you” that writes the history. With discomfort of both adults and kids, the experience of holiday can be stressful while it is on but the memory of the holiday that forms in the mind of adults, after the holiday is that of happiness. The remembering self is the one that that takes decisions, for future! This means though during the holiday, there was stress, overall experience was a good one.

It is also the remembering self that is consulted when planning the future. Choices are made, based on the remembering self’s construction of what happened in the past. Now here’s the problem. The experiencing self and the remembering self don’t agree on what happened.

An experiment was conducted where subjects had a hand immersed in ice water at a temperature that causes moderate pain. They were told that they would have three trials. While the hand was in the water the other hand used a keyboard to continuously record their level of pain. The first trial lasted 60 seconds. The second trial lasted 90 seconds, however in the last 30 seconds the water was slowly warmed by 1 degree (better but still painful). For the third trial, they were allowed to choose which of the first two trials was less disagreeable, and repeat that one.

Eighty percent of the subjects who reported experiencing some decrease in their pain in the last 30 seconds of the second trial chose to repeat the 90-second experience! In other words, their remembering self-selected the option that required an additional 30 seconds of suffering.

What is the conclusion from the experiment? The duration did not matter but end result mattered. In the second method, pain started diminishing as the temperature was increased. Though the trial was longer, people preferred that trial.

Coming back to my cancer treatment. Treatment lasted for three months. My pain and difficulties increased with time. But my overall experience was satisfactory; why was it so? When the treatment ended, the doctors told me that everything worked out well. Since my cancer turned out to be non- spreadable variety, chances of recurrence were almost nil! My mind processed the end result and probably made me forget the pain and issues during treatment phase. My remembering self, processed the information that I wanted! So, am I happy?

Being happy used to be a simple process, now it is difficult to discuss this as it has become a complex process as our knowledge level goes up. It turns out that the word “happiness” is just not a useful word anymore, because we apply it to too many different things.

The second thing is a confusion between experience and memory, between being happy in your life, and being happy about your life or happy with your life. And those are two very different concepts, and they’re both clubbed in the notion of happiness.

Friends, will our mind work this way when events like, business loss, break-up in relationships, loss of job? Don’t forget that remembering self also remembers the peak events (best or the worst) from any process!

Maybe, some of you might just want to chuck the complex theory we have discussed,  and be happy the old way! Cheers!

Bravado or Truth!

The other day my niece’s husband Dr. Makarand asked me a very pertinent question. He said, “Kaka when you were going through treatment for cancer, we all could see that you were very positive during and after the treatment. Can you share with me if this was Bravado or that is what you really felt?” It was a very valid question. In the face of tough situation as the cliché goes, “Tough get Going”! It is all fine to mention clichés, make a show of not being bothered or nor showing any concern. 

Makarand’s question got my thought process going and I went back four years, to 2013 Dec 1st, when my cancer was detected. This detection was done by Dr. Sant in his clinic and set the wheels rolling. Raju was with me; when we came out from the clinic Raju said, “You don’t worry, I will drive the car.” We had taken my car. I told him, “Oh, come on! What has diagnosis got to do with my driving the car? In fact, first let us eat something as I am hungry.” Our next step was the hospital where Atul was waiting for me to get the CAT scan done, to check the extent of spread. What were the thoughts in mind, besides deciding what to eat? Honestly, I did not feel worried, afraid or did not have a question in my mind “Why me?”. In the CAT it was found that there was no spread and the growth looked local. Was I relieved. I don’t remember having any specific feeling of relief.  

It was decided to perform the biopsy on 7th December. We took a family decision that managing newly born Kittu and my cancer treatment cannot be handled together, in our regular home. We had already hired one condo next to Priya’s. We took a decision to move stuff to the new condo. Next 4/5 days we were busy moving our stuff to this condo. That week was very busy, and I did not have time to think of anything other than shifting furniture. Did I have apprehensions about the result of the biopsy? Not really because Dr. Sant was very confident that growth was cancerous. I had totally believed in his judgment and did not get unduly worried when Lab confirmation was received on 10th Dec. 

Another ten days in deciding the logistics and getting the drug from Pharma Company. Jaya and I were busy setting up the new condo, plus my work continued. When I was told that the first immunotherapy was to be given in an ICU, I did feel apprehensive. What is the reason for ICU? What can happen? What can go wrong? Somehow, I had a feeling that cancer had luckily been detected at a very early phase then why this sudden change in threat level? I asked my Onco surgeon. He said, “Pramod, this is just a precaution we are taking. Once in a blue moon some patients have reaction against the drug hence this step.” I was relieved and was back to my normal mood.  

Ignorance reduces your anxiety levels. When the cancer was detected, I was told that there would be Radiation therapy along with Immunotherapy. My lack of knowledge prepared me for a couple of radiation sittings. When we had our discussion with Radiation Oncologist, the doctor told me that there will be 32 to 34 sittings. For a moment, I was stunned. But when the doctor explained, I understood the process. He said that 1 or 2 radiations are given in case of patients who have tough cancer and need palliative treatment. He also said that when chances of overcoming the cancer are good, number of sittings are more and depend on different factors. Knowledge acquired, I was back to normal way of thinking.  

Coming back to the question asked by Makarand. Was I truly not much concerned or was it my bravado? I can safely conclude that it was not my bravado. Why was I not worried? Why do people get worried? It is natural to get worried, anxious, it is ok to get terrified also. There are some situations in life which tend make even tough people panicky! In my case, I do not know why I was not worried. Maybe I have learnt to take things in stride. Maybe my mind is such that I move on. I am a normal human and I also get anxious, worried but somehow, I never remember being afraid of a situation. Maybe I have never faced a situation which can scare me,yet. Rather than being brave or tough, I feel that I am a normal person who is little luckier than others, who was never required to face a situation where I was almost required to give up. Another possible reason could be that I am pragmatic and accept situations which are not under my control.  

Am I the person to preach people how to handle the difficult situations? Definitely not! But I can share my experience with others. Did I pray to god? No, I believe in some high-level spirit which can be called God. But I am not into prayers, since childhood. I have always seen my father doing Namaskar to God but he was never into prayers and pooja! This was imbibed in me from childhood. Other than this, I always had great support from Jaya and my children, especially during my tough phase. Positivity of the whole family including my nephews and nieces went a long way I keeping me balanced.  

Makarand, yes, I was really not afraid, nor did any of us panic! It was not bravado but overall managing the whole situation as a project, keeping emotions in control, when it was necessitated. Thank you for asking me this question which made me introspect about the tough phase in our life, it was not only my life! I have not done something great that I can advise people but I have suggestions for all who get into any tough situation; it could be illness, it could be family issues, it could be money issues. Be in it together, face the situation upfront. Acceptance is the key to fighting back. Every fight is winnable to an extent. Leave rest to Him!  

Life’s Speedbreakers


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!