My article on “Is Left Handedness a handicap in Surgical Training” published in Health Spectrum Magazine

Screen Shot 2016-06-03 at 6.16.49 pm

Click here to read the full article

Advertisements

Role of a mentor in Surgical Residency

I met my mentor yesterday during a conference and introduced him to a few of my students. One of the students asked him about the “role of a mentor in surgical residency?”
I am sharing his reply for the benefit of others.
To mention particularly there is no training in surgery without a mentor. If we try to define “surgical training”, it revolves around the mentor-mentee or guru-shishya relationship. While you may learn certain steps from YouTube and other resources, a few intricate practical details can only and only be taught by a guru. A mentor is a term derived from an old Greek legend in which a king who was heading for a war had to leave his son in the care of his very close friend, instead of leaving him to his wife and Mentor grew up to be a very wise and noble king. 
You watch your mentor operating, walking, talking, his mannerism, his attitude towards care of his patients and virtually follow him in everything you do. The role of a mentor is unlimited. It is vital and mandatory to have a guru in your life.
He ended by quoting Kabir’s famous couplet –

Guru govind dono khade, kaake lagu paaye

Balihari guru aapno, govind diyo bataye
“Teacher and Lord are both there, whom to be adore. but teacher you are great, who told us that god is greater”

Breast Cancer Awareness Talk & Screening OPD’s

Breast Services

To promote Breast Cancer Awareness and Screening, the Department of Breast Diseases & Oncology is organizing a Free OPD & Breast Cancer Awareness Talk on Sunday, 27th September. We will be continuing with the Awareness talks all through October in celebration of the International Breast Cancer Awareness Month.

End of the South Indian Sojourn

Leaving Bangalore after the end of my fellowship turned out to be quite an emotional affair. This was the first time I was away from home for so long and my seniors and colleagues in the department made me feel quite comfortable during the tenure of my course.

Working with each one of them turned out to be an amazing experience in which I learned the necessary skills in the best possible atmosphere and I am definitely going to miss all of them in the future.

Now looking forward to my next stint in America. 🙂

image

With Dr. Anthony - one of the best surgeons I have worked under...cool, calm and composed

image

With Dr. Archana - who was always willing to teach and help

image

Meera ma'am - who was an important link between the doctors and the patients. Learnt a lot about life from her.

image

Breast care nurses - the most dedicated lot I have seen. They were responsible for the seamless functioning of the unit.

Shocking case – Mastectomy done for an 11 yr old girl!!

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:

IMG_20140725_115525

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.

 

Importance of regular follow-up after Breast Cancer Treatment

It was quite sad to see this 68 year old lady come to the clinic yesterday. She was diagnosed with left breast cancer two years back and was treated with MRM, adjuvant chemotherapy and hormonal therapy at a private hospital. After her treatment was completed, she did not visit the oncologist again thinking that she has been cured and for the last 6 months she had been harboring this growth over the chest wall, which turned out to be a local recurrence.

Local recurrence after mastectomy

Local recurrence after mastectomy

Patients tend to think that when the treatment is over, they are cured of the disease, but that is not the case. Patients need to visit their oncologists/ doctors regularly after the completion of their treatment and this case points out the importance of correct and regular follow-up after breast cancer treatment.

The current guidelines regarding follow-up of breast cancer patients are:

  1. History & physical examination: Every three to six months for the first three years after the first treatment, every six to 12 months for years four and five, and every year thereafter.
  2. Mammography: If mastectomy has been done, then annual mammograms of the opposite breast. If  breast conservation has been done, then B/L mammography should be done annually.
  3.  Breast self-examination. Perform a breast self-examination every month. This procedure is not a substitute for a mammogram.
  4. Pelvic examination. If the patient is on Tamoxifen, annual gynecological check-up should be done because tamoxifen can increase the chances of uterine cancer.

One reason which deters patients from going on regular follow-ups is the fact that some doctors order unnecessary tests during these visits. One should be aware that the following tests are NOT recommended for regular follow-up care of breast cancer patients:

  • Blood tests like CBC, LFT, KFT
  • Chest x-ray
  • Bone scan
  • CT scan
  • FDG PET scan
  • Breast MRI
  • Breast cancer tumor markers – CA 15-3, CA. 27.29, CEA

39 fibroadenomas removed using just two incisions!!

Yesterday, we performed a marathon fibroadenoma surgery, where we removed 39 fibroadenomas from both the breasts (19 from the right breast and 20 from the left) just by making one incision in each breast. We used a crescent incision in both the breasts and comfortably removed fibroadenomas measuring as big as 5-6 cms through that incision. The entire procedure lasted 2 hours and the patient was discharged the same day.

Although the smaller fibroadenomas could have been left behind (because they are not malignant) but the patient was very apprehensive about them and wanted all of them removed. The importance of the single incision (periareolar crescent) is that it makes the end cosmetic result quite good. I am sharing some intra-operative pictures in this post. Will update the post-operative and follow-up pictures soon.

Marking of the crescent incision.

Marking of the crescent incision.

 Fibroadenomas marked along with the incision. Smaller lesions were not marked.


Fibroadenomas marked along with the incision. Smaller lesions were not marked.

 

6x7 cm fibroadenoma removed through the incision

6×7 cm fibroadenoma removed through the incision

 

5x5 cm lesion removed through the left breast

5×5 cm lesion removed through the left breast

 

Starting the closure. Will share the post-op and follow up pictures soon

Starting the closure. Will share the post-op and follow up pictures soon