Every day brings a new surprise in the life of a doctor but there are some cases which just make you feel angry & helpless and today’s case was exactly the same. Our receptionist had fixed an appointment and when she told me that it is for a 11 year old girl, I probably thought that she is going to turn out be a case of juvenile hypertrophy (enlargement) of the breast but what I saw when I examined the patient left me in a state of shock.
This sweet looking 11 year old kid walked in with her parents and they started telling me the history that she underwent a surgery of the right breast to remove a benign lesion (fibroadenoma) 2 months back and they came to our unit because the girl had noticed another lesion on the left side. Breast surgery at 11 years is usually not recommended as it hampers with the development of the breast during puberty and I immediately knew that something will not be right when I examine the patient. Examination of the girl turned out to be quite shocking. The surgeon (who was actually a gynecologist in a rural set-up) removed not only the lump but also the entire breast tissue on the right side leaving behind just a long scar on the chest (image). It took me a couple of minutes to get in terms with what I was seeing and multiple thoughts started running through my head after that:
1. My initial reaction was that of anger towards the doctor who had done such a surgery without properly examining the patient or documenting it. Her notes before surgery mentioned no examination findings and the only thing written was ”work-up for surgery”. She had fortunately not examined the other breast, which also had a small lump and I am sure had she examined it, she would have done the same thing on the left side as well.
2. I felt sad for the girl & her parents very well knowing that there is going to be no development of the breast of the right side and the patient will probably have to go for an implant later on in her life.
3. This case reinforced the fact that breast surgery needs to come up as a dedicated branch in India, in order to prevent such cases. Also more awareness needs to be created among people regarding this branch and the fact that it does not deal with only breast cancer. Benign breast diseases are often ignored by patients and they usually approach local doctors for their treatment.
4. This case also reinforced the point regarding proper notes & documentation in all patients. This patient can easily take the doctor who did such a surgery to court and that doctor will have nothing in her defense
5. This case was a real eye opener with regards to the lack of knowledge which general practitioners/ general surgeons / gynecologists have regarding breast disorders and this needs to be addressed by proper refresher courses for these doctors.
Mammography is a vital tool used for screening & diagnosing breast lumps (benign & malignant). In this new thread, I will be sharing some interesting mammograms every week, which I see in my practice.
Calcified Fibroadenoma in a 32 year old lady.
H/o lump in the left breast for the last 12 years. Not increasing in size & Painless.
X-ray mammography revealed an area of dense calficification (macrocalcification) at 9-10 o’ clock position.
Case # 2:
X-ray mammogram highlighting the difference between benign & malignant lymph nodes in the axilla.
History: 45 year old lady with an enlarging right breast lump x 4 months
On examination: 4×4 cm hard breast lump in the upper outer quadrant of the right breast with palpable axillary LN.
Mammogram showing the primary lesion (cancerous growth) in the right breast and malignant axillary LN on the right side (rounded LN with loss of fatty hilum).
Benign LN can be seen in the left axilla (with preserved fatty hilum).
The second mammography picture highlights the difference between malignant (right) & benign (left) lymph nodes in the axilla
Information provided by:
Dr. Rohan Khandelwal
Consultant, Breast Oncosurgeon
W Pratiksha Hospital
India is probably the birth place of Holistic Medicine and all branches of holistic medicine are widely practiced in India. The problem is that practitioners of some of these branches don’t disseminate the correct information about their branch and give false hope of cure to suffering patients.
During my medical career, I have come across many patients who have become a victim of such practice and have had to pay dearly for following these quacks. Personally, I feel that all branches have a role to play in today’s healthcare system, provided the practitioners know their limitations and they refer patients to the proper doctors, if the disease is beyond the scope of their branch.
In an effort to spread the right information about Holistic Medicine, we have started a new blog – The Holistic Rx. This website will feature articles pertaining to all branches of medicine and will be backed by scientific evidence.
After having been a part of numerous Google hangouts & twitter chats related to the global Breast cancer scenario in the past, I (@docrohan) finally got a chance to discuss the Indian scenario with a film-maker (who is in the process of shooting a film on breast cancer – @1001BCnights) & two Indian breast cancer survivors & breast cancer advocates (@lathasrinivasan & @alpana_u). We had an active twitter chat lasting almost one hour, where we discussed about the various issues being faced by breast cancer patients in India.
The excerpts of the twitter chat can be read by following this link – https://storify.com/Realtalkies/bcindia-twitter-chat
Our next chat is on 17th July and we expect another active & informative twitter chat on that day.
We are starting a series of twitter chats, which will focus on the issues faced by breast cancer patients and survivors in India. This is a first of its kind initiative, which will highlight the ‘Indian scenario.’ This chat is going to be hosted by @realtalkies on twitter.
The details of the chat are mentioned in the images. Feel free to join in and contribute in this important discussion.
Follow me during this chat on Twitter: @docrohan
I will be discussing some the issues raised by me in the blog post – “Is cancer diagnosis a social death sentence in India”
Details of #BCIndia Twitter chat