ALIVE JULY-AUG 2017

Bone Cancer : Breaking the Myths Dr. Rajat Gupta
M.S (Ortho),D.N.B (Ortho)
What is Bone Cancer? M.Ch (Ortho),MNAMS
Consultant Orthopaedics Oncology

INDUS INTERNATIONAL HOSPITAL

Bone cancer is malignant tumour of the bones which can spread to lungs or other parts of the body. It may have arisen primarily from Year 10 Vol. 20, July-August, 2017, Chandigarh
the bone itself (primary bone cancer) or more commonly, may have spread to the bones (secondary bone cancer) from cancer of
some other body organ like Breast cancer, Prostate cancer etc. A Health & Wellness Magazine by INDUS HOSPITALS, MOHALI(Pb.) India

Symptoms ORGAN
DONATION DAY
Primary bone cancer usually occurs in growing children and young adolescents, whereas, secondary bone cancer usually occurs in
older age group.Usually,the patient experiences pain in the affected area, which over the time, gets worse and continues. There may 13th August
also be swelling in the involved region. It can cause weakening of bones resulting in fracture. Some patients may attribute these
symptoms to any prior antecedent trauma. Unintentional weight loss may also be seen. Sometimes, these patients are wrongly being COMMITTED TO BUILDING BETTER HEALTHCARE
treated for infection, thus delaying the correct treatment which may have a bearing on the final outcome.
The Latest techniques and treatment to ensure an Active, Healthy, Independent Lifestyle.
How common is Bone Cancer?

Secondary bone cancer is the most common type of bone cancer with bone being the third most common site of cancer spread
(metastasis) from other organs. However, primary bone cancers are rare accounting for less than 1% of all cancers.

Causes of bone cancer?

Certain patients are at a greater risk for bone cancer which include:
- Patients who have received prior radiation therapy
- Patients with a history of Paget's Disease
- Patients with hereditary retinoblastoma - a type of eye cancer that
most commonly affects very young children
- Patients with Li-Fraumeni syndrome - a rare genetic condition

How is it diagnosed?

A patient suspected with bone cancer needs to be investigated thoroughly with blood tests, Xrays, MRI to look for local extent of
disease. Since bone cancer can spread to lungs and other bones, staging of the disease is done either with whole body PET CT or a
bone scan with CT Chest. Alongwith that, a biopsy (usually with a needle) is required to establish the diagnosis. It's important to do
biopsy from the correct site since wrong biopsy site can be detrimental in limb salvage and can result in amputation (cutting the
limb). Therefore, it's recommended that the biopsy should always be done by the surgeon (Orthopaedic Oncologist)who will be doing
the final surgery for bone cancer.

Treatment

Treatment of bone cancer is a multidisciplinary approach requiring an Orthopaedic Oncologist (Bone & Soft tissue tumour specialist),
Medical Oncologist (Chemotherapy Specialist), Radiation Oncologist (Radiotherapy specialist) and Pathologist (Specialist in tissue
diagnosis).Usually in primary bone cancers, chemotherapy is given to the patient followed by surgery to remove the diseased bone
which is further followed by adjuvant chemotherapy. Limb salvage surgery is possible nowadays for bone cancers in which the part of
the bone involved with tumour is removed surgically (rather than cutting the whole limb) and the defect is reconstructed with
artificial joint, thereby saving the limb. In some cases, the cancerous bone so removed is given very high dose of radiation so as to kill
all the cancer cells and the sterilised bone so formed is fixed back to the parent bone with the help of plates and screws, a technique
commonly called as Extra Corporeal Radiation Therapy (ECRT).In children, since the artificial joint will not grow as the child grows
leading to unequal limb lengths over a period of time, the defect can be reconstructed with expandable joint which can be
lengthened as the child grows which allows to maintain limb length equality at the time of skeletal maturity.

Is cure possible in bone cancer?

With the current chemotherapy regimesand advanced surgical technology, cure is possible in upto 70-75%patients with primary bone
cancer. In patients with secondary bone cancer, cure can still be achieved depending upon the primary cancer and the extent of
disease. In advanced cases also, a lot can be done to control the disease and give a quality of life to the patient.

Do's and Don'ts in various Radiological Tests Dr.Rajveer Singh
DNB-Radiodiagnosis

INDUS INTERNATIONAL HOSPITAL

The field of “Radiology” has today expanded far beyond the confines of “Dark Room”. There was a time when doing an X-Ray involved
putting a heavy cassette in a stand, asking the patient to hold breath till he would start choking, then taking that cassette to the dark
room, soaking that cassette in countless chemicals then drying the fuzzy X-Ray film so formed. Today, all this is a story. Today,
Radiology has emerged as a full-fledged specialty and has come to be popularly known as “Radiodiagnosis”.
The field of Radiodiagnosis today deals with a spectrum of machines. Most of those machines are very expensive and are often
imported from Western Countries. Due to this reason, these machines and the doctors who operate on them are still concentrated in
metropolitans and bigger cities.
Indus International Hospital, Derabassi, has become a pioneer not only in installing these expensive equipments but also in having
the most trained staff who handles these machines. The hospital is also installing a “1.5 Tesla MRI” machine which will be first of its
kind in this region. The process of installation is already underway.

Coloproctology Fest at What to do and not to do
INDUS INTERNATIONAL HOSPITAL by- Meril Endo-Surgery
before and during these procedures.
CME on Chronic Myelogenous Leukemia & Awareness of Head Injury
By Dr.Sumeet Singh & Dr. Sandeep Kukkar CT Scan

Do's Don't's-

- Avoid eating 6 hours before the scan. - Avoid CT Scan if you are pregnant.
- Clear your bowels in the morning. - Do not worry. Relax. CT Scan is a simple
- Drink plenty of water.
- Bring past medical documents/reports. test that is completed in 2-5 minutes.

Note – Fasting of 6 hours is required only for CT scan of abdomen and for scans where a contrast dye needs to be injected in the

Ultrasound Don't's-
Do's
- Do not void urine. Try to hold to
- Avoid eating 6 hours before comfortable state.
the ultrasound.
- Drink plenty of water. Hold urine to Note – The above instructions are meant for ultrasound of
comfortable state. the abdomen only. For ultrasound of any other part of the
- Clear your bowels in the morning. body, you need to fast and hold urine.
- Bring past medical documents/reports.

Doppler Tests Don't's-
Do's
- Do not fast. Eat as per your routine.
- Bring past medical documents/reports. - Do not wear tight outfits.
- Wear loose/comfortable clothes.

Dr. Sandeep Kukkar M.D, D.M. Oncology 4:30 to 18:00 hrs X-RAY Don't's-
Dr. Eshaan Kaushik MBBS,MS ENT 10:30 to17:00 hrs Do's
Dr. Jasbir Singh MBBS,MCh Plastic Surgeon 9:00 to13:00 hrs - Do not fast. Eat as per your routine.
Dr. Vikram Singh Rana MBBS,MD,DNB Cardiology 9:00 to 17:00 hrs - Bring past medical documents/reports - Do not wear tight outfits.
Dr. Phiza Aggarwal MBBS,MD Pathology 9:00 to 15:00 hrs
Dr. Parminder Gill MBBS,MD,CICC Microbiologist 10:00 to 16:00 hrs MRI

Do's Don't's-

- Fasting for 6 hours before the scan. - Do not panic. MRI machines make
- Drink plenty of water. coarse sounds. This is a normal process
- Bring past medical documents/reports

Do not wear any metallic article on your body. Tell the doctor if you have anything metallic within your
body like stents, bone nails, prostheses etc.

Dr. Gaurav Maheshwari Dr.Kamya Garg
M.S, MRCS, DNB (Gastroenterology) B.Sc, PGD,M.Sc (DFSM)
GI Surgeon
INDUS INTERNATIONAL HOSPITAL
INDUS INTERNATIONAL HOSPITAL
7Diet Tips for
Can Colorectal Cancer Be Prevented? Polycystic Ovary
Syndrome (PCOS)
One swears by whole meal bread, one by sour milk, vegetarianism is the only road to salvation for some, others insist not
only on vegetables alone, but on eating those raw. At one time the only thing that matters is calories, at another time they are Polycystic ovary syndrome (PCOS) affects up to 15–20% of women of reproductive age.It occurs when levels of certain hormones are
crazy about vitamins and roughage. The scientific truth may be put quite briefly : eat moderately, have an ordinary mixed diet out of balance, leading to the growth of fluid-filled sacs on the ovaries.
and don’t worry. Symptoms include: Irregular or absent periods, hair loss, excess hair growth on face, acne, weight gain, depression and fertility
problems. PCOS is also associated with a higher risk of type 2 diabetes, heart disease and obesity.
Sir Robert Hutchinson, in Newcastle Medical Journal 1932, Vol 12 Unfortunately, there is no cure for PCOS. However, one of the first-line treatments is diet and lifestyle changes.In fact, in overweight
women, as little as a 5% weight loss can restore irregular periods and boost ovulation.
Population based time trend studies show a rising trend in the incidence of coclon and rectal cancers in India. Worrisome is
the finding that the incidence rates of colon cancers are much higher in young and urban population, suggesting that life styles Try a Low-GI Diet
and dietary habits are important in the causation of these cancers. This also means that with eceonomic transition from a low
income to middle income economy, there will be a big increase in the burden of colorectal cancers in India. The low-GI diet usually consists of eating whole fruits and vegetables, whole grains, lean protein and healthy fats. It also involves
There is no sure way to prevent colorectal cancer. But, there are things you can do that might help lower your risk, such as avoiding most processed or refined carbs, including sugary foods and drinks.A low-GI diet can have many health benefits, especially
changing the risk factors that you can control. for women who have PCOS-driven insulin resistance.One study found that menstrual regularity improved in 95% of women on a low-
GI, weight loss diet, compared to 63% of women on a standard weight loss diet .
Colorectal Cancer Screening :- Another study including 60% overweight women with PCOS found that following a high-protein, low-GI, weight loss diet improved
insulin sensitivity and reduced levels of inflammatory markers, compared to a standard weight loss diet.
Screening is the process of looking for cancer or pre-cancer in people who have no symtpoms of the diseases. Regular
colorectal cancer screening is one of the most powerful weapons for preventing colorectal cancer. Don't Skimp on Breakfast
From the time the first abnormal cells start to grow into polyps, it usually takes about 10-15 years for them to develop into
colorectal cancer. With regular screening, most polyps can be found and removed before they have the chance to turn into Women with PCOS are encouraged to eat regular meals.A study found that making breakfast the biggest meal and dinner the
cancer. Screening can also find colorectal cancer early, when it is highly curable. smallest may help balance out the hormones associated with PCOS.
Screening is recommended starting at age 50 for people who are not at increased risk of colorectal cancer. There are several Eating a larger breakfast and smaller evening meal may help improve hormone levels and improve ovulation in women with PCOS.
different screening options for Colortectal Cancer. However, more research is needed.
Low levels of dietary Calcium have been linked with an increased risk of colorectal cancer in some studies. Other studies
suggest that increasing calcium intake may lower colorectal cancer risk. Calcium is important for a number of health reasons Eat Enough Healthy Fats
aside from possible effects on cancer risk. Calcium is important for a number of the health reasons aside from possible effects
on cancer risk. But because of the possible increased risk of prostrate cancer in men with high calcium intake, we do not An adequate supply of healthy fats, including omega-3 fatty acids, has been shown to help balance your hormones and improve
recommend increasing calcium intake specifically to try to lower colorectal cancer risk. insulin levels in women with PCOS .
Calcium and Vitamin D might work together to reduce colorectal cancer risk, as Vitamin D aids in the body’s absorption of Some healthy fats include oily fish, avocados, olive oil and unsalted nuts and seeds.
Calcium. Still, not all studies have found that supplements of these nutrients reduce risk,
A few studies have found a possible link between a diet that is high in Magnesium and reduced colorectal cancer risk, Cut Down on Carbs
especially among women. More reserach is needed to determine if this link exists.
In women with PCOS, a moderate reduction in carbs reduces insulin and testosterone levels and improves insulin sensitivity. It may
Non-steroidal anti-inflammatory drugs (NSAIDs) also result in greater weight loss.

Many studies have found that the people who regularly take Aspirin or other non-steroidal anti-inflammatory drugs ((NSAIDs), Eat Plenty of Lean Protein
such as Ibuprofen (Motrin, Advil) and Naproxen (Aleve), have a lower risk of colorectal cancer and polyps.
But Aspirin and other NSAIDs can cause serious or even life threatening side effects such as bleeding from stomach, irritation In women with PCOS, consuming a higher-protein diet is associated with a reduced appetite, lower insulin and lower testosterone
or stomach ulcers. which may outweigh the benefits of these medicines for the general public. For this reason, most experts levels, compared to a higher-carb diet. As a result, a high-protein diet is likely to be much more filling and reduce insulin levels, both
don’t recommend taking NSAIDs just to lower colorectal cancer risk if you are someone at average risk. of which can have positive effects on PCOS symptoms.
However, for some people in their 50s who have an elevated risk of Heart Disease, where low dose Aspirin is found to be Be sure to include plenty of healthy protein sources in your diet, such as lean meat, fish, eggs, beans and some dairy products.
beneficial, the Aspirin may also have the adde3d benefit of reducing the risk of colorectal cancer.
Because Aspirin or other NSAIDs can have serious side effects, check with your doctor before starting any of them on a Stay Active
regular basis.
Regular exercise has many health benefits, especially for women with PCOS. In overweight and obese women with PCOS, body
Hormone Replacement therapy for Women composition improved when exercise was combined with a weight loss diet. In fact, just three hours of exercise per week has been
shown to improve insulin sensitivity and reduce belly fat in women with PCOS.
Taking estrogen and progesterone after menopause (sometimes called menopausal hormone therapy or combined hormone
replacement therapy) may reduce a woman’s risk of developing colorectal cancer, but cancers found in women taking these Some Supplements May Be Helpful
hormones after menopause may be at a more advanced stage.
Because taking estrogen and progesterone after menopause can also inrease a woman’s risk of heart disease, blood clots, and Taking vitamin D and chromium supplements may help improve symptoms of PCOS, especially if women are deficient.
cancers of the breast and lung, it is not commonly recommended just to reduce colorectal cancer. Supplementing with 1,000 mcg of chromium for two months improved insulin sensitivity by up to 38% in obese women with PCOS.
While there is no cure for PCOS, choosing the right nutrition can lead to happy and healthy living.

PREVENTING RENAL STONES

Calcium Oxalate Stones Dr. Manish Singla
Never Underestimate Your Sweat MBBS,MS,MCh
Urologist

INDUS INTERNATIONAL HOSPITAL

Heavy exercise or hot weather may lead to loss of water through sweating which leads to less urine production. This can lead to
stone-causing minerals to settle in the urinary tract and may cause stones.
Remedy: Increase Fluid Intake. The best method in preventing stones is to drink more water which dilutes your urine. Fluid intake
needs to be increased to 10 -12 standard cups (250mL) in a 24-hour period which gives a total of 2.5-3 L. Ideal fluid choices include
water, citrus juices and carbonated mineral water beverages.

Maintain Calcium Intake (Calcium is Not the Enemy)

You need to maintain normal calcium intake!
Restricting calcium intake can actually produce kidney stones. Unless there is a specific abnormality detected through blood tests,
calcium stones are not normally due a calcium excess in the body.
Calcium is important in maintaining bone health and especially guarding against osteoporosis as you get older.

Cut the Oxalate

Calcium oxalate is the most common kidney stones. Oxalate is naturally found in many foods, including
fruits and vegetables, nuts and seeds, grains, legumes, and even chocolate and tea. Some examples of
foods that contain high levels of oxalate include: peanuts, rhubarb, spinach, beets, chocolate and sweet
potatoes. Moderating intake of these foods may be beneficial for people who form calcium oxalate stones.

Reducing Protein Intake

Excessive protein intake can result in an acidic urine and form uric acid stones. An important goal is to stay within a healthy weight
range for your height. As a general recommendation, limit your daily protein intake to 350 grams per day in total of beef, poultry, fish
and pork. This will easily provide enough protein for the body's daily requirements.
An easy rule of thumb for estimating portion size is 100 grams of meat is roughly the size to cover the palm on your hand.

Decrease Salt Intake

You should consume less than 2000 mg/ day of sodium. This is equivalent to one teaspoon of salt per day.
The human body carefully regulates its salt levels. When excess salt excreted in the urine, calcium is also produced. In other words,
the more salt your kidneys filter, the more calcium you form in the urine. Excess calcium in the urine can lead to new stone formation
by binding with other minerals.

Preventing Uric acid Stones ICONS OF HEALTHCARE GLOBAL SUMMIT AND AWARDS-2017

Uric acid stones are formed by a diet high in animal proteins, or from excessive uric acid production from within the body. Most of The 2nd Icons of Healthcare Summit – a pan Asia forum deliberating the challenges in healthcare delivery & celebrating excellence by BERG
these stones can be prevented from making the urine less acidic which results in the uric acid being in a dissolved state. Singapore was hosted in Singapore on July 21, amidst the presence of medical professionals, healthcare providers and medtech experts from
This can be achieved in the majority of patients by alkalinizing the urine using oral bicarbonate preparations (main ingredient of India, Singapore, Mauritius, Nepal & Oman. Organised by Singapore-headquartered Business Excellence & Research Group Pte Ltd (BERG),
baking soda), and drinking plenty of oral fluids to keep the urine dilute. In some circumstances an oral prescription medication called the summit witnessed deliberations over some of the key aspects and opportunities for healthcare delivery across Asia.
allopurinol may be used to prevent excessive internal production of uric acid within the body.
Focussed on “Connected Health & Disruptive Technology” the Icons of Healthcare 2017 exchanged strategies around remote patient
Preventing Infection or Struvite stones monitoring solutions, data management, personalised solutions, insurance & market entry barriers impacting Innovation.

Skills of urological surgeon in treating complex stones, is the most important factor here. Infection stones require complete stone Following the conference, the 2017 Icons of Healthcare Awards were also presented to bring professionals and institutions to world stage
clearance by minimally invasive surgical means and antibiotics. The prevention of these stones from recurring is best achieved by and celebrate their successes. Indus Healthcare, Punjab was awarded the Leading Tertiary Care Hospital Group award.
being vigilant against developing further urinary tract infections. Drinking plenty of fluids is helpful in this regard.

Preventing cystine stones

Treatment of cystine stones requires a coordinated team approach consisting ideally of an urological surgeon, renal physician and
dietician. Stone episodes typically start during early-adulthood and are recurrent throughout life. Regular minimally invasive stone
treatments (retrograde intrarenal surgery and laser treatment, percutaneous nephrolithotomy) maybe required periodically to keep
on top of the situation before the stone burden become too large. Drinking plenty of fluids, typically over 3L of fluids each day is
needed in most patients. Diligent alkalinisation of urine with taking potassium citrate or bicarbonates is mandatory and need regular
monitoring using pH test strips. A low methionine diet with the aid of a dietician is helpful. Medical therapy (d-penicillamine or
captopril) is best instituted as a last line of treatment by a renal physician with regular blood count monitoring.

What if u ignore?

Passing a kidney stone is often described as one of the most painful experiences a person can have, but unfortunately, it's not always
a one-time event. If you have had one stone, you are at increased risk of having another stone. Those who have developed stones are
at approximately 50% risk for developing another within 5 to 10 years. Long term obstructing kidney stones can cause chronic kidney
disease leading to kidney failure.