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January 9, 2017 By Dr Ashwin Nanda 1 Comment

You are as ‘Old’ as your Prostate

Mr Rebello, sitting in front of me recalled his plight of waking up 2-3 times every night to void urine instead of only once as before. Initially, he assumed it was due to winter but, when the problem persisted in summer as well, he blamed it on his poorly controlled diabetes. He was 65 yrs of age when he began to experience this. He didn’t bother visiting his physician since he had made peace with his high blood sugars as he had no control over his eating habits.

How he wished he hadn’t assumed and instead consulted his physician. After 2 yrs he moved to another city and didn’t feel up to the task of finding a new physician to follow up with. Five years down the line, after his 70th birthday, he began experiencing lower back pain which he again concluded was due to ageing. Only when the pain became persistent and unbearable, he met an Orthopedic who after examination and X-rays diagnosed him with a collapsed vertebral fracture. He was crestfallen when the cause of his vertebral fracture was pinned down to ‘PROSTATE CANCER’.

Going back to the time when Mr Rebello was 65 yrs old, he overlooked the fact that the frequency of urination was normal during the day. Had high sugar been the cause, the issue would have bothered him during the day as well. Actually, this was the first symptom that his prostate gland was enlarged. Undiagnosed and untreated over 5 yrs the non-cancerous enlargement of the prostate had turned cancerous and spread to his backbone.

Let’s try to make sense about what the prostate gland is, its enlargement and when does it translate into cancer.

The Prostate Gland: Location in the body and function.

The image below shows the location of the prostate gland in the body which is present only in males. It is located below the urinary bladder. The prostate secretes the fluid that nourishes and protects sperms. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperms as semen. In the prostatic cells, the male sex hormone testosterone gets converted to dihydrotestosterone (DHT) which causes the cells to grow resulting in an increase in its size.

Normally, the prostate gland is approximately the size of a walnut. As the size increases with age (which can start as early as 40 yrs) it starts to obstruct the urine outflow as shown in the image.

Symptoms of Prostatic enlargement:

A weak or slow urinary stream.
A feeling of incomplete bladder emptying.
Difficulty starting urination.
Frequent urination.
The urgency to urinate.
Getting up frequently at night to urinate.
A urinary stream that starts and stops.
Straining to urinate.

Medically enlarged prostate which is not cancerous is called Benign Prostatic Hyperplasia (BPH).

As the gland keeps getting enlarged, there are mutations in the DNA of its cells causing it to grow uncontrolled and abnormally resulting in cancer.

The saving grace in this entire process is that prostatic enlargement can be diagnosed early and controlled thereby preventing cancer.

DIAGNOSTIC MODALITIES:

Sonography of the prostate gland is advised once a man turns 50 yrs to establish if enlargement has started. If there is a family history of prostate cancer then it should be done as early as 40 yrs.
A blood test called Prostate Specific Antigen(PSA) should be done. Very high values are suggestive of cancer whereas in the enlargement phase the values remain < 4 units.

If you are facing any of the above symptoms, you must visit a Urologist who will diagnose and prescribe medication for the same. Incase medicines are not effective, one might have to opt for surgery.

In Mr Rebello’s case, since cancer had already developed, radiotherapy was first given to shrink the size of the prostate, post which surgery was performed to remove the cancerous gland. Cancer which had spread to his backbone was controlled by a combination of chemo and hormonal therapy.

Risk Factors for prostatic enlargement and cancer:

Age – prevalence increases markedly with age. The gland grows at a rate of 2 – 2.5 % annually in older men.

Genetics – 50% men undergoing surgery for BPH < 60 yrs of age have inheritable form of the disease.

PREVENTION:

Apart from timely diagnosis and treatment, being physically active, controlling Diabetes and weight are known to reduce enlargement of the gland. Diet rich in antioxidants and vitamins is also beneficial in prevention along with avoiding red meat.

Image credit – prostate.net

January 3, 2017 By Ruta Satam 1 Comment

2016 Report Card: Karma activities at GOQii

GOQii has been working with Non-profit organizations as its Karma partners in promoting and spreading awareness for different causes. Karma activities are also based on the premise that doing Karma keeps you healthy. Just to reiterate inspired by Mahatma Gandhi’s journey of 390 KM, for every 390 steps tracked through your GOQii activity tracker band, you earn one Karma point. These points are then converted into monetary donations that is donated to charity sponsored by our Karma partner.

It’s been two successful years now and we have charities listed on the GOQii app that are successfully funded by the Donor partners.

Here are two recent causes that we have contributed to.

Millions of children in India go to bed hungry because their parents/guardians are not able to purchase food for them. Most of them drop out from schools so that they can help their parents and supplement the family income.

Ratna Nidhi Charitable Trust’s-Food for Education Program distributes free food prepared at our kitchens on a daily basis, to poor children if they attend any formal or non-formal educational class. It thus combines food with education-we now have a child who is educated and well fed also. The programme has been very effective in arresting the drop-out rate in schools.

Ratna Nidhi’s food has been treated by the beneficiaries as “Homely Balanced and Tasty”. Not for profit, the food has a flavour of compassion, and tender loving care.

As of today, the organisation feeds more than 4500 Children daily through its approximately 50 centres all over Mumbai including the suburbs. The Mid Day Meal is cooked at the Food Center by the special team of cooks under Ratna Nidhi’s representatives’ direct supervision.

The food partners are identified carefully and after the detailed need evaluation. These are generally Non-aided vernacular schools who do not qualify for the Govt. Mid-Day-Meal, Pre-schools in Urban Areas, Night schools who do not receive any of the welfare benefits and Street Children NGO’s who provide shelter.

The meals are packed for various partner schools and Balwadis. A special delivery system ensures that the food reaches the children by lunch time on a daily basis.

A simple meal for children each day that improves nourishment, increase weight, boosted attentiveness in class and ensures a healthy educated future.

Empowering Women against Violence:-

Moving from children let us now talk of women empowerment. After children, it’s the women who get abused the most and hence empowering women against violence is paramount.

How often have you come across a story in the newspapers or television about violence against women? Every day is the answer. Violence against women and girls is a bitter reality in India. As many as one-third of women and girls in the age group 15-49 have experienced physical violence, about one in 10 have experienced some form of sexual violence [Source: National Family Health Survey Round III (2005-2006)].

Yet, violence against women and girls, particularly domestic violence, is unavoidable. Many of us think and justify that violence by intimate partners is normal, and therefore acceptable. We need to change this very thinking that normalises violence against women and girls. We all have a role in preventing such violence.

The story of a 9 year old girl Mynah, who was married to a 20-year-old man, is an example to stand up against violence. Her husband repeatedly subjected her to intimate partner violence. After hearing of her experience, counsellors of Oxfam India advised Mynah to file a case under the Protection of Women from Domestic Violence Act, 2005. Mynah took the brave decision to take control of her life. She continued with her studies, with the court’s intervention, she has got compensation. She has also remarried according to her own wish.

Oxfam India programmes are currently active in the six focus states of Assam, Bihar, Chhattisgarh, Jharkhand, Odisha and Uttar Pradesh.

Oxfam India has been working to reduce the acceptance of violence against women and girls. They have reached out to more than 42,000 women to end violence in their lives and established 23 support centres within formal and informal locations to provide psycho-social counselling and legal aid to women facing this issue in their lives.

Together, we need to make sure that perceptions, attitudes and behaviours towards women and girls change so that gender-based discrimination comes to an end. With your help, this is what Oxfam India hopes to achieve in the future through supporting women like Mynah.

What has GOQii been doing in the Karma space in the last two years?

Here are some of the activities that we have conducted for players as well as our employees in the last two years…..

One of the biggest on ground Karma event that we are a part of is the 100 KM Oxfam Trailwalk where GOQii players and employees participate and walk 100 km to raise awareness and support a cause.

Part from this we have had regular activities in GOQii office. This year we had a session with Greensole, a social venture that collects discarded shoes, refurbishes them and makes comfortable footwear for the underprivileged.

We also did something interesting this Christmas. While last year we went to a home that housed children with Cancer and spent few hours with the kids by playing and dancing with them, this year we celebrated Christmas in the most unique way. GOQii employees played secret santa to orphaned children of an orphanage in Chembur and also employees pledged for various basic commodities like Rice, dal, wheat, Oil etc and donated to the orphanage.

December 1, 2016 By Dr Manali Rao Leave a Comment

Living Healthy with HIV – Reality or Myth

Have you seen the latest#CondomEmoji campaign by Durex, the Global Sexual-well-being brand depicting an “Umbrella with Raindrops”? This was the unofficial safe sex emoji launched ahead of World AIDS Day today. It was an interesting campaign to communicate ‘Safe Sex’ among the young adults. The campaign called for putting a safe sex emoji on every smartphone in order to help young people communicate about safe sex. The campaign has trended both on Twitter and Facebook with supporters from over 160 countries backing the movement.

The survey findings noted while more than 60 per cent of young people surveyed admitted to being uncomfortable discussing safe sex, 72 per cent of respondents admitted that they found it easier to express emotions using emojis and more than three quarters admitted that they use emojis to discuss sex and relationships.

Why is this discomfort about talking of sex or sex related diseases such as HIV/Aids even in the 21st Century?
One of my earliest memories of AIDS would be the movie PHILADELPHIA where Tom Hanks sues his Company for being fired from his workspace for being HIV positive.

Whenever we hear the word AIDS or HIV the word itself it creates a lot of fear and makes one judgmental. This is not the case only among the lay man but also is the case equal judgment, not only among general public but also within the medical fraternity. Unfortunately more than a the disease, AIDS is considered to be a social stigma and a taboo.
It’s become imperative to understand why this stigma is attached to HIV/AIDS?

AIDS (Acquired Immunodeficiency Syndrome) as we all know is a syndrome caused by the Human Immunodeficiency Virus (HIV) which directly attacks the immune system of the patient leaving the body vulnerable to a host of infections. Aids is the last stage of HIV infection where the disease progresses and the body can no longer defend itself leading to more severe infections, malignancies and eventually death (if left untreated).
Let me try to look into the ways one can get infected with this Virus which are considered some of the main reasons for fear and stigma.

1. Unprotected sex- with an individual who is infected with HIV is the biggest cause of new HIV cases be it vaginal or anal sex. Oral sex also predisposes one to HIV if there are any cuts, ulcers or sores in the mouth. Wearing a condom is the easiest way to protect yourself and your partner against the disease. Unprotected Sex is more prevalent among young adults.
2. Blood transfusion with infected blood. This is one of the most unfortunate ways to contract the disease as the recipient is unaware of the blood being infected. It is always a good idea to make sure that the blood has been screened for HIV infection.
3. HIV infected mother can pass on the virus to her baby during pregnancy lactation or even delivery. These mothers can now take treatment to protect their babies.
4. Sharing razors or needles with infected people also puts you at risk of contracting the virus like in the case of drug abuse or needle prick in hospital.
In short the virus can be transmitted through infected blood, semen and vaginal fluids. In fact, when the disease first came to light in India, it was the sex workers and their clients who had the maximum prevalence followed by truck drivers.

The latest ‘DIPPER’ at night campaign where the Condom is disguised as the dipper is a great way to create awareness among truck drivers in India to frequent sex workers often.
But, honestly it’s not so bad as it’s been made out to be over the years. Currently, experiments are being conducted to find a cure for this disease. The good news in India is that we are seeing an overall reduction in HIV infections among the adult population.

According to more recent National AIDS Control Organisation data, India has demonstrated an overall reduction of 57 percent in estimated annual new HIV infections (among adult population) from 0.274 million in 2000 to 0.116 million in 2011.

India has the third largest number of people living with HIV in the world, according WHO.

LIVING WITH HIV / AIDS:

It’s not as bad. One can live with HIV.

The diagnosis is confirmed by a blood test and depending on the extent of severity of the immune deficiency, anti-viral medication is started which improves the number of immune cells which help fight infections and restore near normal life.

The medicines though expensive are distributed free of cost to patients at Government and NGO run clinics.Psychological help for not getting overwhelmed after the diagnosis, is also readily available. Confiding in a trusted person who won’t be judgmental. Judgmental helps in calming your nerves.

One must realize and believe that they can live to their potential inspite of being HIV positive. Having social and emotional support is very essential, hence patients must not isolate themselves from their near and dear ones and f.amily and friends should also not ostracize the patient.

The Constitution of India prevents any discrimination against anyone having HIV and AIDS and neither is it a legal ground for dismissal from occupational services.

Patients living with HIV must maintain a healthy lifestyle just like diabetics or any other chronic disorders. Having a healthy diet and exercising regularly are a must to boost your immunity along with the medication. Till date HIV and AIDS has no cure but anti-retroviral therapy (ART medicines) are helping people live a healthy and happy life for almost 2 to 3 decades.

Currently, Art drugs have become ‘very good’ at controlling infection but patients need use the medication for life. If they stop the treatment, the virus rapidly replicates, eventually leading to the fatal AIDS disease.

Pregnant mothers have successfully delivered children without HIV with the help of anti-viral medication.
Lot of research by brilliant minds is being done around the globe to find more effective medicines and a cure.
HIV facts to know

• According to the WHO, more than 70 million people have been infected with HIV so far and about 35 million people have died of from the virus.

• In 2015, an estimated 36.7 million people were living with HIV and so far the infection remains incurable.

November 3, 2016 By Dr Darshana Salve 1 Comment

BE – AWARE: CERVICAL CANCER

Recently, I received a call from a friend whose aunt complained of post-menopausal bleeding. My first thought was could it be ‘cervical cancer’ but, I did not voice my concern, instead asked her to take her aunt for a PAP SMEAR Test.

Unfortunately, the results indeed matched my concern. She was diagnosed to have Cervical cancer. This was not the first time that I had come across a case of Cervical Cancer as the numbers have been on the rise for the last decade.

According to a study titled Epidemiology of cervical cancer with special focus on India, every year in India 1,22,844 women are diagnosed with cervical cancer and 67,477 die from the disease. India has a population of 432.2 million women aged 15 years and older who are at risk of developing cancer. It is the 2nd most common cancer in women aged 15–44 years.

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404964)

As per world statistics, India’s contribution to cervical cancer cases is 25.4%. Majority of the Indian women diagnosed with cervical cancer have never been screened for the disease and around 70% of these cases present in advance stages due to absence of any organized cervical cancer screening program. The most important risk factor for development of cervical cancer is persistent infection by a high-risk subset of Human Papilloma Virus (HPV). Cervical cancer being the third most common cancer in the world, very little is known about it among the masses.

What is cervical cancer?

Cervical cancer is a disease that develops very slowly and begins with the precancerous condition known as dysplasia. Dysplasia is easily detected in a routine pap smear and is treatable.

High risk
1)Sexual history- has had multiple sexual partners OR established sexual relations before the age of 18 OR has a partner who has had sexual contact with a woman with HPV infection.
2) Smoking
3) Weakened Immunity
4) Giving birth at very young age
5) Long-term use of contraceptive pills
6) Family history

You need to look out for these signs

1) Bleeding that occurs between regular menstrual periods.
2) Bleeding after sexual intercourse, douching, or pelvic exam.
3) Menstrual periods that lasts longer and are heavier than before.
4) Bleeding after completingMenopause.
5) Increased vaginal discharge.
6) Pelvic pain

If you have noticed any of these symptoms, kindly consult your Doctor at the earliest.

Prevention:

As we know Prevention is better than Cure especially for any cancer, creating awareness becomes the first step towards that milestone.

Lifestyle plays an important role in the prevention of cervical cancer. Foods that are rich in Flavonoids (apples, black beans, broccoli, cabbage, garlic, onion, soy, and spinach), Folate (Avocados, strawberries, oranges, lentils) and Carotenoids (Carrots, sweet potatoes, pumpkin) are seen to reduce the chances of cervical cancer.

Other than diet make sure you follow the below habits to keep Cervical cancer at bay;

Regular Screening (PAP SMEAR) post the age of 30
HPV vaccine (most effective when administered before start of sexual intercourse)
Practising Safe sex
Avoid Multiple sexual partners
Delaying first sexual intercourse
NoSmoking

There is an HPV Vaccination that is certified by the Indian Academy of Pediatrics (IAP). 2 doses of either of the two HPV vaccines for adolescent/pre-adolescent girls aged 9-14 years is recommended. However, this vaccination is optional. One should consult a Gynaecologist to know more about the vaccine and how it helps.

It is always better to be safe than sorry and as we have now seen. Being safe is the best way to prevent Cervical cancer.