Dental Gum!

For this blog, I have used the title as Dental Gum (गम in Hindi). गम in Hindi means sorrows. People usually connect dental treatment with fear, pain, and sorrows. First, let me make a disclaimer or two. 

  • My daughter Priya is a Pediatric Dentist 
  • I had my first dental treatment at the age of 65, that too because I went through cancer treatment and had 34 radiation sittings. I was treated for dental caries. 

I somehow have the feeling that a person’s dental health quality is hereditary! My grandmother could eat raw mango (Kairi) easily in her eighties. I have the same ability, but I have a way to go.  

I chose the subject because I read an article about horror stories about dentists, in the US. Well, as in any field some people do not follow the ethics and can be called black sheep. Making a general statement about any whole group of professionals is incorrect. But not that I am not going to tell any horror stories (as I have taken dental treatment only once), but I will share with you some anecdotes shared by Priya with me.  

First things first, I have been brushing my teeth only once a day, I don’t do any flossing. I have never used any special brushes or toothpaste. I have had my share of chocolates and ice-creams, colas and candies. I have a sweet tooth, but now I don’t consume these things. So my heridetary theory should be ok!

Once I asked Priya about her young patients. I asked her, “How tough is it to handle the kids on the  chair?” She said, Baba, once my patients get confidence about me, they are straightforward to handle. It is their mothers who are difficult to handle. 

I am going to share anecdotes about patients, their parents, general situations in dentistry. Sometimes it is funny, many times it is surprising, but probably human behaviour remains very similar in different situations.  

Priya was treating a fouryearboy. He was very cooperative, but sometimes he needed a kid-glove treatment, pun, of course, is intended. One day he came inside, goggles and all; a la Salman Khan. He was a big fan of Salman. He came inside, sat on the chair and Priya started the work. After about ten minutes he signalled to Priya to stop. Priya stopped and asked him the reason. Without replying he indicated her to allow him to get down from the chair. Priya complied, he got down. He put on his goggles, put both his thumbs in the trouser pockets. He danced to the tune of the Hindi song, “Hud Hud Dabangg, Dabangg; after a couple of minutes, he stopped, climbed back in the chair and signalled Priya to restart the work! 

Some patients are too busy to take their kids to the doctor. There was one such lady, the same age as that of Priya. She always claimed that only time she could get her child to the clinic was 8 pm on a Saturday. After all, she was in IT. She would always tell Priya how difficult it was in IT and so on. Once the lady came almost twenty minutes late for the appointment and Priya had her next patient in another clinic. They met on the staircase; the lady started her usual dialogues of being in IT, but her hands were full of stuff bought in the malls. Priya apologised and said that she could not treat her child as her next patient was waiting at another clinic. The lady was upset, and before she could start her diatribe, Priya told her, “Look, I am a doctor, and I don’t know anything about IT. But let me share some personal information with you. My mother is handling Nvidia operations in Pune, my father runs his software business for the last 15 years, and my elder brother is working in Microsoft at Seattle for some time. So, there is a possibility that I may know a few things about IT, by induction. One more thing, when I was a child, my parents used to take me to doctors, whenever it was needed, without bothering about time and the day. Thank you!” The lady never spoke about IT stuff with Priya again. 

One lady came with her child. The child was fitted with a crown, and the child was not supposed to eat chocolates for obvious reasons. While eating the chocolate, the crown came out and was misplaced. Priya told her, “ I had told you not to give chocolates to the kid. Why did you not follow instructions?”  The treatment was done, and the crown fitted again; when she was asked to pay the money, she simply refused to pay saying that it was Priya’s fault, chocolate was incidental. Priya let her go and instructed her team not to give an appointment to that patient again!  

The next episode could be an incorrect diagnosis or was it the socalled horror story; I am not sure! I felt that it was a case of the wrong diagnosis. An eightmonthold child was brought to the clinic; Priya was surprised, as generally such small babies rarely have any teeth. The mother told her the following story. A couple of days back while the mother was cleaning the babies mouth, she saw a gold tooth in the baby’s mouth. She took the baby to three or four doctors, and all of them said that the gold tooth needs to extracted; treatment needed to be done under general anaesthesia. Since the baby was very young parents were not too keen about the procedure. Somebody suggested to them Priya’s name, and they came to the clinic. Priya looked at the child and saw what was inside. She had a small instrument in her hand. She put the instrument in the babies mouth and plucked the golden “Tooth”; it a piece of gold that was stuck in the baby’s gum. Out came a small earring. Priya gave it to the mother. It was the mother’s earring; she had never realised that it was missing. Somehow it had fallen and went into the baby’s mouth and became the “Golden Tooth”! The tears of joy came in the parent’s eyes! The father asked Priya “Doctor what will be the charges?” Priya said, “No charges; I am happy that I could do this without any anaesthesia”!  

How trial by media can affect a professional career can be seen in the following anecdote. A child was being treated by a dentist. He checked up with parents if any medicine was being given to the child. The mother said that they were not giving any other medicines. The doctor gave the local anaesthesia and started the treatment. After some time he felt that the child was becoming listless. They rushed the child, to the next door paediatrician. From there they rushed to the hospital. But the child died. The trial by media started; the newspapers showed the doctors name and the photograph of the clinic. The baby’s parents gave statements and hid the fact that there was another treatment being given to the child! The medical council did its investigations and in the end, found out that the dentist and the paediatrician had followed the correct procedures. But all the media trial and photographs in the newspapers made life very difficult for the dentist. He left Pune and moved to another city!  

Friends, life can be exciting, rewarding and tough at the same time for professionals. But some times, one loses control over the situation, and things do get haywire. Customer is always the king or a queen; the kings and the queens also can go overboard and need to be told so. But at the end of the day, professionals have to remain true to their profession and continue to perform! Don’t forget to show the smiling face, especially when a child is being treated.

 

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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!