Health’care’ makes the diference, says Dr Mukta Krishnan
By Vikas Vaidya
While treating any patient, care from within makes a difference. Barring a few hospitals, the care part seemed absent. If suppose in cancer patients, chemotherapy is required which is given through veins, here the care part comes. Repeated pricks should not be there on hand, else it gets burnt. PICC (peripheraly inserted central catheters) is the only good option. The chemotherapy is given for six months so PICC is the only good option, says Dr. Mukta Krishnan, Consultant Onco-physician, at Canada.
The estimated number of new cancers in India per year is about 8 lakhs and over 3.5 lakhs people die of cancer each year. For treatment of cancer we have mainly three options, surgery, chemotherapy or combination of surgery and chemotherapy. Despite curative surgeries patient may require chemotherapy. Hence chemotherapy remains as one of the important treatment in cancers not only in India but in world, pointed Dr Krishnan.
Dr Krishnan said, “First, the patients feel doubts about such procedures but we counsel them and then we go for PICC. Supportive care improves the condition of the patient. For example, I am MD Medicine but I requested to my hospital that I want to learn pain management. We need to tell patients that we are telling them certain things to do which would minimise side-effects. In Cancer, the fear factor is the dominating one. It is doctor’s duty to pull out patients out of that fear. In Canada I learnt to communicate with the patients. There, patients have their own rights.
Dr Krishnan said, “Most of the chemotherapy drugs are to be given by IV (intravenous route) while less are in tablet forms. We have superficial veins (veins which we see just beneath the skin) and deep veins (more important veins) in the body. Superficial veins in the body are mainly required for giving fluids, antibiotics; withdrawing blood for investigations, blood transfusions etc. It requires less expertise to puncture the superficial veins and hence can be easily punctured by medical or paramedical staffs (nurses) and hence should be protected.”
If the toxic chemotherapy drugs are given through superficial veins the veins will get inflamed and will get blocked forever. Nearly all cancers will require many sittings of IV chemotherapy, and hence if only superficial veins are used for chemotherapy nearly all will get blocked in course of time. If chemotherapy drug leaks out of vein in subcutaneous tissue it may cause patchy skin gangrene with big non-healing ulcer at the site of IV line. The patients of cancer besides chemotherapy will get admitted for multiple times for dehydration, blood transfusions, recurrent infections and many more complications in his/her life time and if these superficial veins are blocked the their life becomes miserable and these patients may then always require puncture of deep veins for basic medical supports. The punctures of deep veins are mainly reserved for treatment in very sick patients.
In western world, a standard of care for IV chemotherapy is PORTS or PICC lines. A Port is an infusion catheter located subcutaneously either in your arm or your chest, and is connected by a soft, slim catheter tube that goes through your vein all the way to your heart. This catheter protects your vein during treatment. The port is an entry point that doctor/ nurse can find each time you come for a treatment, and it can be used for a blood draw, as well as infusion of drugs. Your chemotherapy doctor / nurse will use a special type of needle to access your port, and won't have to hunt for a good vein to use. As the port is subcutaneously placed nothing is seen from outside. Patients of ports can take shower, swim like any other normal person. You do not feel drug being infused through ports during chemotherapy injections. Besides being costly and a small surgical procedure for insertion it has few side effects like infections & thrombosis.
PICC (peripheraly inserted central catheters) lines are inserted in patients with cancer mainly when patients require short term chemotherapy or if patients refuse insertion of ports. Besides infection & thrombosis main disadvantage with PICC lines is the a hub of the catheter which hangs out of the body till its purpose is over. But no chemotherapy in western world is given without Ports or PICC lines say Dr. Mukta Krishnan.
Dr. Rajesh Mundhada, Dr. Atul Rewatkar, Consultant Interventional Radiologist, Pulse Clinic and Hospital said that one should preserve the superficial veins of the upper limbs from permanent damage from chemotherapy drugs and should use only Ports or PICC lines for chemotherapy as done in major metropolis cities in the country.
The estimated number of new cancers in India per year is about 8 lakhs and over 3.5 lakhs people die of cancer each year. For treatment of cancer we have mainly three options, surgery, chemotherapy or combination of surgery and chemotherapy. Despite curative surgeries patient may require chemotherapy. Hence chemotherapy remains as one of the important treatment in cancers not only in India but in world, pointed Dr Krishnan.
Dr Krishnan said, “First, the patients feel doubts about such procedures but we counsel them and then we go for PICC. Supportive care improves the condition of the patient. For example, I am MD Medicine but I requested to my hospital that I want to learn pain management. We need to tell patients that we are telling them certain things to do which would minimise side-effects. In Cancer, the fear factor is the dominating one. It is doctor’s duty to pull out patients out of that fear. In Canada I learnt to communicate with the patients. There, patients have their own rights.
Dr Krishnan said, “Most of the chemotherapy drugs are to be given by IV (intravenous route) while less are in tablet forms. We have superficial veins (veins which we see just beneath the skin) and deep veins (more important veins) in the body. Superficial veins in the body are mainly required for giving fluids, antibiotics; withdrawing blood for investigations, blood transfusions etc. It requires less expertise to puncture the superficial veins and hence can be easily punctured by medical or paramedical staffs (nurses) and hence should be protected.”
If the toxic chemotherapy drugs are given through superficial veins the veins will get inflamed and will get blocked forever. Nearly all cancers will require many sittings of IV chemotherapy, and hence if only superficial veins are used for chemotherapy nearly all will get blocked in course of time. If chemotherapy drug leaks out of vein in subcutaneous tissue it may cause patchy skin gangrene with big non-healing ulcer at the site of IV line. The patients of cancer besides chemotherapy will get admitted for multiple times for dehydration, blood transfusions, recurrent infections and many more complications in his/her life time and if these superficial veins are blocked the their life becomes miserable and these patients may then always require puncture of deep veins for basic medical supports. The punctures of deep veins are mainly reserved for treatment in very sick patients.
In western world, a standard of care for IV chemotherapy is PORTS or PICC lines. A Port is an infusion catheter located subcutaneously either in your arm or your chest, and is connected by a soft, slim catheter tube that goes through your vein all the way to your heart. This catheter protects your vein during treatment. The port is an entry point that doctor/ nurse can find each time you come for a treatment, and it can be used for a blood draw, as well as infusion of drugs. Your chemotherapy doctor / nurse will use a special type of needle to access your port, and won't have to hunt for a good vein to use. As the port is subcutaneously placed nothing is seen from outside. Patients of ports can take shower, swim like any other normal person. You do not feel drug being infused through ports during chemotherapy injections. Besides being costly and a small surgical procedure for insertion it has few side effects like infections & thrombosis.
PICC (peripheraly inserted central catheters) lines are inserted in patients with cancer mainly when patients require short term chemotherapy or if patients refuse insertion of ports. Besides infection & thrombosis main disadvantage with PICC lines is the a hub of the catheter which hangs out of the body till its purpose is over. But no chemotherapy in western world is given without Ports or PICC lines say Dr. Mukta Krishnan.
Dr. Rajesh Mundhada, Dr. Atul Rewatkar, Consultant Interventional Radiologist, Pulse Clinic and Hospital said that one should preserve the superficial veins of the upper limbs from permanent damage from chemotherapy drugs and should use only Ports or PICC lines for chemotherapy as done in major metropolis cities in the country.
We want to come back to India
After completing MBBS from Indira Gandhi Government Medical College and Hospital (IGGMCH), Dr Mukta Krishnan did MD from Government Medical College and Hospital (GMCH). She and her husband Dr Murali Krishnan (a Nephrologist and product of Nagpur) did a training in Royal Victoria Regional Health Centre. Whether Krishnan couple want to come back to India? Dr Mukta’s instantaneous reply was - ‘Yes, we share a common dream to come back to India. We are introducing our children to the culture of India. The children too fond of India which is our motherland,” said misty-eyed Dr Mukta.
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The complication rates of treatment of Cancer in India at international Top Cancer Hospitals in Hyderabad , are bare minimum. Hyderabad Medical Hospitals offering International patients services programs to foreign patients including accommodation and travel arrangements.
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