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Funny things do happen in life!

Here I am writing my beloved column again. Six weeks ago I would not have said that. But when you feel ill you find out how much people love you. How much they care about you. For the first few days I could not help but cry… literally cry like a baby. Feeling sorry for myself, feeling sorry for my family and touched by the love and care I received from everyone who came to see me in the hospital, sent me funny, inspiring emails, phone calls, greeting cards, flowers and yummy chocolates, fruits and cakes.

The doctors, nurses and all the members of the hospital staff who looked after me or I ran into were nothing but kind and generous. I was proud to say that I used to work with these wonderful people. They hadn’t forgotten me. I love you guys! When I was under the influence of medication, I vaguely remember kissing (on the cheeks!) and hugging some doctors, nurses, x-ray technicians (male and female… made sure everybody was covered). I love them so much. But they cannot sue me because I was under the influence of medication.

What is depressing is my ill health occurred one day after I finished five-weeks full time course in photography at SAIT in Calgary. I am hopeful one day I will be able to use my skills and take beautiful pictures.

As you all know, strange things happen in life. Sometimes they are wonderful and sometimes they are not. Sometimes you get a chance to write about it and sometimes you don’t. Sometimes you get a chance to laugh about it and sometimes not. But we have to be positive although sometimes it is hard to do that. During my downtime, I decided to follow my own advice – listen to my doctors (and my wife and children) and watch funny movies and listen to music. Laughing for few hours a day helped me a lot.

Talking about laughter reminds me of my new book, “Doctor B’s Eight Steps to Wellness” published by General Store Publishing House. I have ordered copies to be sold locally and I will make an appropriate announcement in the next few days.

In life, quite often, we get a chance to make choices. But when it comes to good health, what choice do we have? Who would opt for bad health? Probably nobody. If you are one who has decided to stay in good health then you have made the right choice. That is a good start.

Remember, to stay healthy you don’t have to make a large investment of money. What you have to do is invest some time in a day to find that joy of good health and happiness. Now, don’t tell me time is money. When it comes to your health time is more than money… does that sound right?

OK let me find out what my book says. It says if I want to stay healthy then I should read my book over and over again. Find out about healthy eating, exercise, stress relief, sleep, sexual empowerment, laughter, and meditation. Then go have some fun and be healthy. Good deal. Talk to you again soon. Love you all.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Restless Leg Syndrome Leads to Restless Sleep

After a night of restless sleep. (iStockphoto)
After a night of restless sleep. (iStockphoto)

Recently, one of my friends was diagnosed with restless leg syndrome (RLS). It is also known as Ekbom’s syndrome. It is a movement disorder. Important thing to remember is that it is not a psychological or emotional condition. It is thought to be a neurological disorder and it is believed that a brain chemical known as dopamine is involved.

About three to 15 per cent of the population is affected by RLS. It is more common in women than men. The prevalence increases with age. There may be a family history of the condition. Some medications can trigger RLS.

Individuals suffering from this disorder have a distressing need or urge to move the legs, usually accompanied by an uncomfortable, deep-seated sensation in the legs that is brought on by rest (sitting or lying down), relieved with moving or walking, or worse at night or in the evening.

RLS can be associated with involuntary limb movements while patient is awake and/or periodic limb movements (PLM) while patient is asleep. Studies show that more than 80 per cent of people with RLS also have PLMs. But the majority of people with PLMs do not have RLS.

The diagnosis of RLS is based on the clinical history. RLS may be a symptom of iron deficiency therefore the iron status should be assessed. Overnight sleep study may be helpful. There is no good medication to control the symptoms.

If you have unexplained leg pain then discuss your symptoms with your doctor and get proper investigations done at a sleep clinic.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Significance of BRCA genes in ovarian cancer.

International symbol of breast cancer awareness. (iStockphoto)
International symbol of breast cancer awareness. (iStockphoto)

First, it was Angelina Jolie, who had a double mastectomy because of increased genetic risk of breast cancer due to the presence of BRCA gene. The presence of BRCA gene also increases the risk of ovarian cancer. We know that if you have a family history of ovarian cancer then the risk of ovarian cancer increases amongst women in that family.

Take for example the recent announcement that Pierce Brosnan’s daughter Charlotte Emily died of ovarian cancer at age 42. Brosnan is a former James Bond star whose first wife, Cassandra (Charlotte’s mother), was also killed by the same disease in 1991 when she was 43. I am not sure if Charlotte Emily’s BRCA status is known.

There are two types of BRCA genes known as BRCA1 and BRCA2. BRCA is an abbreviation for breast cancer. These genes are tumour suppressor genes and once they undergo changes (mutation), their capacity to normally prevent cancer from developing is lost. It is now known that women found to have mutations in the genes have a very high risk of developing breast and ovarian cancers.

The genetic mutations are not common. About one in 500 to one in 1,000 individuals will carry a mutation or a gene change in one or another of these genes. It generally occurs amongst people who tend to stay together and don’t have offspring with people from other types of ethnicities. Experts say these mutations tend to stay within one group of individuals.

What distinguishes BRCA1 and BRCA2 genes is where they’re located in the chromosomes. There are also slight differences in terms of the types of cancers associated with the two genes.

The main difference in the two genes is that carriers of the BRCA1 gene mutation have a slightly increased risk of ovarian cancer compared to those with BRCA2. It is also known that carriers of BRCA2 genes have risks of different types of cancers, including pancreatic cancer and melanoma.

For ovarian cancer, women with a mutated BRCA1 gene have a 25 to 65 per cent lifetime risk of developing the disease. Those with a mutated BRCA2 gene have a 15 to 20 per cent chance of developing ovarian cancer.

For men, it is little different. For men with the BRCA2 mutation, there’s an increased risk of both prostate and breast cancers.

Who can ask for BRCA genetic testing?

There has to be a strong family history of cancer. The cancer must have occurred in young ages within the family and if you are a member of ethnic groups known to be affected then you would be eligible. If you don’t meet the criteria but still want to be tested then you can go south of the border and get yourself tested for about $3,000.

Early detection of breast cancer has dramatically changed the prognosis of the disease. We cannot say the same thing about ovarian cancer because we do not have any tests for early detection.

Each year, about 2400 Canadian women are diagnosed with ovarian cancer. Sadly, 1700 women with the disease die each year. In North America, ovarian cancer is the second most common gynecologic malignant disease and is the leading cause of death among women with gynecologic cancer.

More than 60 per cent of the women are in advanced stage when first diagnosed. Their five year survival rate is less than 30 per cent. Their prognosis is poor and they have very few treatment options. Some studies have reported higher survival rates of greater than 90 per cent in women with stage one disease. Only 25 per cent of the women are diagnosed early.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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There are various surgical options for patients with breast cancer.

Doctor and patient. (iStockphoto)
Doctor and patient. (iStockphoto)

Recently, actress Angelina Jolie announced that she underwent a preventive double mastectomy after learning that she carries a mutation of the BRCA1 gene, which sharply increases her risk of developing breast cancer and ovarian cancer. This announcement again increased the discussion in the media about the choices women have when it comes to breast cancer surgery.

Not all women need a double mastectomy if they have breast cancer in one breast. About one in 200 women in North America carries a BRCA1 or BRCA2 mutation. But among certain ethnic groups the prevalence is considerably higher. Notably, the frequency in those of Ashkenazi Jewish ancestry is one in 50. Other groups with high frequencies of mutations include women from Iceland and Poland.

For the vast majority of women, who have no BRCA gene mutation, the following surgical options are available:

-Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following: a) Lumpectomy: Surgery to remove a tumor (lump) and a small amount of normal tissue around it. b) Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. The lining over the chest muscles below the cancer may also be removed. This procedure is also called a segmental mastectomy. These patients may also have some of the lymph nodes under the arm removed for biopsy. Quite often these patients require radiotherapy after surgery.

-Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. Most of the time these patients do not require radiotherapy after surgery.

-Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.

If the size of the growth in the breast is relatively big (locally advanced cancer) then the patient receives chemotherapy before surgery to shrink the tumor. Treatment given before surgery is called neoadjuvant therapy.

Treatment after surgery consists of radiation therapy, chemotherapy and hormonal therapy even if the doctor removes all the cancer that can be seen at the time of the surgery. This is to kill any cancer cells that are left behind. Treatment given after the surgery, to reduce the risk of recurrence, is called adjuvant therapy. Again, not all breast cancer patients require adjuvant therapy. Your oncologist decides on this depending on the stage of the cancer, what kind of surgery you had and what is your risk of having cancer recur.

Women who opt to have their breast completely removed can have breast reconstruction done. Breast reconstruction may be done at the time of the mastectomy or at a future time.

Some of you must have heard about sentinel lymph node biopsy in cancer surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. This is biopsied. If it is negative for cancer cells then it may not be necessary to remove more lymph nodes.

This is a very simplified way to explain to you what kind of treatment options are available for women with breast cancer. In each case, your surgeon and oncologist will advise you what your options are. Because of the technology, experience and expertise of our doctors, the prognosis of breast cancer has improved a lot. So do not panic. There is plenty of help for women with breast cancer.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!