IF SHE DISCOVERS A BREAST LUMP?

The discovery of a breast lump usually causes anxiety bordering on panic among many women. Most rush to the nearest doctor and plunge into a morass of illogical investigations and treatment, including surgery. Needless to say, many a woman regrets th is headlong rush at a later point of time.

Incomplete assessment and treatment, a false perception of cancer risk, a lifelong commitment to intensive and needless breast cancer screening, emotional and economic exhaustion are but a few fall outs that result from all this.
Lack of awareness

There are other women who in contrast are blissfully oblivious to the presence of a breast lump. A lack of breast awareness is often engendered by cultural inhibition and a conviction that once breast feeding is complete, the breasts are of no importance. Yet others do note the presence of a lump but assume rightly or wrongly that it will "go away". Often it requires a friend or family member to coax these women into seeing a doctor.

It is important to note that breast lumps are a common problem and the majority are benign. Lumps are usually discovered by the woman herself and only occasionally by doctors. A woman who is breast-aware tends to discover them early and obviously a painful lump is noted early in contrast to a painless lump.

What should a woman do if she discovers a breast lump? It is important not to panic. Approach a healthcare provider without loss of time. It is prudent at this stage to ask for a referral to a breast specialist (invariably a surgeon). This trend has become established in the developed countries after research showed significant benefits in outcome when a woman with breast disease is treated by a breast specialist.
Thorough examination

Next the patient will be subjected to a thorough examination by the surgeon to determine whether the woman truly has a lump. Often prominent breast tissue is mistaken to be a "lump". Breast imaging follows: mammogram in women over 35 years and an ultrasound scan in younger women. This is followed in the same sitting, if warranted, by an image guided needle biopsy of various levels of sophistication. On no account should a woman agree to bypass these steps and go straight for an open surgical biopsy. This can lead to serious repercussions in breast cancer management.

After comprehensive evaluation, (which may take four to five days) the treatment options can be discussed. With the dramatic and ongoing advances in the field of breast diseases, the emphasis is on individualised treatment. This may be in the form of clinical surveillance, medication or surgery according to the need. By and large there is no need for "emergency" surgery and even for cancers, a delay of a few days or even one or two weeks is of no medical consequence.
Don’t be short changed ?

The late 20th century saw a paradigm shift in the management of breast diseases, both benign disease and cancer. This came about due to two powerful influences: the women’s movement and mounting research evidence on the best methods to treat breast disease.

The First European Breast Cancer Conference held in 1998 issued the famous Florence statement: that all women (at least in western Europe) should have access to multidisciplinary breast clinics and that all breast related health services should have mandatory quality assurance. An important ground level consequence is that national guidelines were created in countries like the U.S., Canada, New Zealand, Australia to improve breast cancer outcomes. The impact was a fall in breast cancer death rates in these countries.

A powerful message of these guidelines is that only surgeons with a special interest in breast disease should treat patients with breast cancer and breast disease. The benefits are greater accuracy of diagnosis, better quality of treatment and a reduction in morbidity and mortality.
Indian situation

By contrast India is seeing rising incidence of breast cancer, high incidence of advanced breast cancer and shameful death rates. Indeed there are no national guidelines on how services should be organised, delivered and monitored within our socio economic constraints.

It is up to Indian women’s groups to push the medical profession and the Government to look at breast disease as a national issue.

Our women must assert their rights to get the best possible treatment and refuse to be short-changed as their western counterparts did nearly 50 years ago.

Spiralling costs

The advances in breast cancer medicine and surgery have been progressing at a prodigious rate. The crunch is that the best methods of diagnosis and treatment come at a cost.

In a highly specialised and evolving field such as breast cancer treatment, even diagnosis is an expensive business. A few thousand rupees need to be set aside just for assessment of the cancer. If in addition, genetic tests are required, the bill for this alone is about Rs. 50,000. But this elaborate evaluation helps individualise breast cancer treatment and enhances efficacy of treatment. Surviving a few years more without cancer is the direct result of this individualisation. It is indeed a balance between money and life.
Financial implications

Treatment in the form of surgery, chemotherapy and radiotherapy follows and is financially crippling. Families need a few lakhs of rupees to get the best in terms of the latest chemotherapy drugs of added efficacy or the latest machines for better and safer delivery of radiation.

Today we have special drugs such as anti-breast cancer antibodies, which can be given to selected patients to control the cancer remarkably well. The cost of these injections is approximately Rs.1,00,000 per dose. These drugs need to be given every three weeks for close to a year. To meet the bills, families have been known to reduce themselves to penury. The tragedy is that many do not survive.

Whom does one blame for this financial juggernaut: The government, the private sector or the multinational companies? Or the patient for asking to live in peace for a few more years?
Why see a specialist

• It gives better local control of cancer.

• It improves the survival of the patient significantly.

• The patient has greater satisfaction with the treatment.

• The patients receive greater psychosocial support.

• The patients have improved quality of life after treatment.

• It is cost effective to be treated by breast specialists in the long run.
If you discover a lump

• Ask to be referred to a breast specialist.

• Undertake investigations as per specialist advice.

• Wait for the full evaluation.

• Heed the specialist’s advice.

• Do not seek multiple medical opinions, particularly from "non specialists".

• Be reassured that the majority of breast lumps are benign.

• Even if you have a cancer, do not lose heart. It can be controlled effectively.
Tips to contain costs

• Ask to be referred to a breast specialist early.

• Do not undertake investigations without professional guidance.

• Adhering to international treatment guidelines contains costs in the long run.

• Be part of a breast cancer support group, on going information helps contain costs.

BALANCED DIET MEANS ?

Surviving the seduction of miracle-promising weight-loss programmes, fad-diets and food-fads is tough. After all, these are times when we have deep concerns about fitness for cosmetic and health reasons. Tougher still is making sense of their conflicting claims on the best ways to get fit.

However, doctors and nutritionists say the secret to lasting good health is not a quick weight-loss plan, fad-diet, or gorging on ‘super-foods’ but building Good Eating Habits. This means consistently watching what you eat –– planning each meal and its timing, following simple, golden rules.
Balance check

A balanced meal sounds simple but most times we slip up eating more of one food over the other because it’s our favourite or easier to source and/or cook. Result: nutritional imbalances.

Suja Mathai, nutritionist, Soukya, Bangalore, says: "Ensure your meal incorporates the five food groups: cereals and grains; pulses and legumes; fruits and vegetables; milk and meat products; nuts and oilseeds/oil."

Dr. Kalpagam Polasa, Deputy Director, National Institute of Nutrition, Hyderabad, advises: "The largest servings must be cereal-based; followed by vegetables and fruits; milk and milk products; pulses/non-veg protein; and lastly fat, oils and sugars."

Drink two litres of water daily to maintain body’s water-balance, flush out toxins, prevent dehydration and build-up of kidney stones, etc.

Go Organic. Avoid foods bred on artificial pesticides and fertilizer. Organic products are difficult to source, but make that effort. Or grow a kitchen garden.

Trim portion size. It’s directly proportional to waist-size. Moderation is the key to healthy eating.

Though, says Suja, moderation is a subjective term; one man’s moderation may be another’s excess. Therefore, each person should determine for himself or in consultation with a nutritionist, how much they need to add or cut down and of what, given their current constitution.

General rule: cut down first on fat intake (butter, cheese, oil, nuts, fried food), and then carbohydrates (rice/wheat, potatoes, mango, sapota, banana).
When good becomes bad

Limit portions even of healthy foods. Olive oil is healthy but an olive-oil drenched vegetable/pesto-sauce isn’t.

Vitamin tablets are beneficial but overdosing on certain varieties is counterproductive, causing health problems. Salad is great but not one smothered with mayonnaise.

Eat plenty of greens. They provide iron, fibre, calcium, and prevent indigestion, constipation.

Minimalism is in. Cook using minimum oil/ghee/butter. Unfortunately, some ruin that effect by smearing that dry roti or roasted papad with oil/butter/ghee or adding dollops of ghee to steamed, starch-drained rice.

You can’t do away with oil, ghee and butter; some of it’s actually healthy. Only, minimise their use. Steaming, broiling, roasting and poaching are healthy alternatives to deep-frying, shallow-frying, sautéing in lots of oil/ghee.
Don’t recycle oil

Avoid recycled oil or ghee. It’s rich in cancer-causing carcinogens. Sadly, many Indian homes, restaurants and street-food vendors repeatedly recycle cooking-oil/ghee. Seen that deadly brackish oil in simmering woks at street-food peddlers?

Homemakers and singles who celebrate today’s easy availability of sweets/snacks at condiment shops or supermarket shelves could be trading in convenience for ill-health. Ideally, home-cook these if you must have them.

Dr. Polasa explains: "Oils heated repeatedly at high temperatures for long time result in formation of peroxides and other chemicals, which are mutagenic (can cause changes in RNA, DNA); and of heart-damaging transfatty acids."

Go Natural. Fresh fruits and vegetables (including garlic, onion) are weapons against cancer, digestive ailments, heart disease. And wherever possible, with their fibre-rich peels on. Fruits and veggies prevent clotting tendency and protect arterial walls, says Prof. K. Srinath Reddy, eminent Delhi-based cardiologist and WHO consultant.

Conversely, limit foods high in cholesterol, saturated fat, transfat, salt and added sugar; like creamy pastries, cakes, chocolates, doughnuts, cheeseburgers, French fries, soft drinks, namkeens, sweets; Reddy adds.

Vitamin tablets are health-aids but your natural diet is the better source, says Mumbai-based physician Dr. Gireesh Mansukhani.
Travel discipline

The high-flying professional travelling 20 days a month often complains of lack of control over diet. Actually, she/he’s not that helpless. For example, from bread-baskets in planes choose multigrain or brown bread over transfat-rich croissants. At restaurants, order salad and fruits with each meal. Check menus for low-calorie options/health foods.

Or, design your own meal. For a snack, ask for a sandwich of multigrain/brown bread with filling of spinach and low-fat cheese; eaten with fresh-fruit juice/yoghurt.

A meal could be soup; dry rotis; steamed veggies/grilled fish; salad; skimmed-milk yoghurt; and fresh-fruit dessert.

Most hotels will give you customised meals if informed in advance. Carry bottled water when leaving the hotel and ensure you have downed two one-litre bottles by the end of the day. Best of all, ask your family doctor who knows your body-type and medical history, for a list of healthy-meal combos to order when travelling.
Regular timings

Adhere to regular meal-timings. Else, your body is thrown off-balance attempting to compensate. Also, eat a good breakfast, followed by a moderate lunch and light dinner, advises Dr. Polasa. "High-fatty meals are particularly to be avoided at dinner as there is little physical activity after consumption, so unused excessive calories are converted into fat stored in the body."

Go slow. "Chewing slowly," says Dr. Polasa, "prevents excess intake as satiety is reached 10 to 15 minutes after commencing food intake."

Finally, when it comes to the overall good-health menu, eating right is a major but not the only item. For best results, include: Regular exercise; regular check-ups. no -smoking; a package of positive thinking; yoga; and meditation.

HOW CAN ONE PREVENT STYES?

Boils on the eyelids (styes) are due to bacterial infection of glands present at the root of the eyelashes.

Treatment comprises hot water fomentation — hold a towel soaked in hot water over the area for five minutes — and using antibiotic drops or ointment for a week. Pain relievers are also prescribed. Oral antibiotics are held in reserve for those with severe infection that may lead to an abscess.

Tarsal cysts or chalazions are formed when vertically placed oil glands (meibomian glands) in the tarsal plates of the lids get blocked at their openings in the lid margins. This results in a pooling of the secretions, which usually increases with time. Occasionally this may get infected, resulting in a boil. A large chalazion requires a minor surgical procedure with a niche only on the inner side of the lid rendering aesthetic satisfaction of the patient.

Persistent boils tend to occur conventionally in diabetics, those with refractive errors, itchy eyes (those who frequently rub eyes) or are associated with lid margin infection called blepharitis.

Further questioning revealed that his working hours were 8.00 a.m. to midnight and that he could snatch only a four-hour nap. He was advised to sleep at least seven hours to build up immunity to combat the staphylococcal germs normally present around the lids.

The most common cause for repeated eruptions of boils on the eyelids is lack of adequate or quality sleep. Any prescription for infection of lids also includes control of blood sugar or correction of power.