Common post surgery sequelae felt as below….so don’t be worried

• You will feel some tightness in your chest and armpit after surgery. This is normal, and the tightness will decrease as you do your exercises.
• Many women have burning, tingling, numbness, or soreness on the back of the arm and/or on the chest wall. This is because the surgery can irritate some of your nerves. These feelings might increase a few days after surgery. But keep doing your exercises unless you notice unusual swelling or tenderness. (If this happens, let your doctor know about it right away.) 
• It may be helpful to do the exercises after a warm shower when muscles are warm and relaxed.
• Begin exercises the day after your surgery.
• Plan to take your pain medication 20 to 30 minutes before doing your exercises.
• Breathe deeply and often as you do each exercise.
• Do the exercises 3 times a day, every day, until you have regained full range of motion in your arm(s).
• Wear comfortable, loose clothing when doing the exercises.
• Do the exercises slowly until you feel a gentle stretch. Hold each stretch at the end of the motion and slowly count to 5. It’s normal to feel some pulling as you stretch the skin and muscles that have been shortened because of the surgery. Do not bounce or make any jerky movements when doing any of the exercises. You should not feel pain as you do them, only gentle stretching.

Stage 1: Exercises to do while you still have your drain(s) in place

1. Pump It Up

This exercise helps reduce swelling after surgery by using your muscles as a pump to improve the circulation in your affected arm (on the same side as your surgery).

1. Lie on your unaffected side with your affected arm straight out, resting on a pillow.
2. Slowly bend your elbow while making a fist at the same time.
3. Next, slowly straighten your elbow while opening your fist at the same time.
4. Repeat this pumping motion 15 to 25 times.

If you had surgery on both sides of your chest, repeat the exercise lying on the opposite side of your body.

2. Shoulder Circles

This exercise can be done sitting or standing. It’s a good warm-up exercise and can help relieve tension in your shoulders.

1. Lift both shoulders up toward your ears. Keep your chin tucked in slightly.
2. Gently rotate both shoulders forward, and then slowly down and back, making a circle.
3. Make 5 slow circles in one direction, then switch and make 5 slow circles in the opposite direction.

3. Arm Lifts

This exercise can be done sitting or standing. It helps improve movement in your shoulders.

1. Clasp your hands together in front of your chest. Point your elbows out. 
2. Slowly lift your arms upwards until you feel a gentle stretch, but no pain.
3. Hold for 5 to 10 seconds and then slowly return to the start position. 
4. Repeat 5 to 10 times.

4. Shoulder Blade Squeeze

This exercise can be done sitting (without resting your back on the chair) or standing. It helps to stretch your chest muscles.

1. Hold your arms at your side against your body with your elbows bent. 
2. Slowly bring your elbows straight backwards, while squeezing your shoulder blades together to feel a gentle stretch.
3. Hold this position for 5 to 10 seconds and then slowly return to the start position. 
4. Remember to keep breathing throughout the stretch. 
5. Repeat 5 to 10 times.

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Stage 2: Exercises to do after your drain(s) have been removed

You no longer need to do the previous exercises.

1. Wand Exercise

You will need a “wand” to do this exercise – try a broom handle, stick or cane.

1. Lie on your back with your knees bent. Hold the wand with both hands. Your hands should be as wide apart as your shoulders. 
2. Lift the wand over your head as far as you can until you feel a stretch. Your unaffected arm will help lift the wand higher.
3. Hold for 5 seconds, then gently lower your arms. 
4. Repeat 5 to 10 times.

To progress, repeat exercise with hands slightly wider than your hips or shoulders.

2. Winging It

This exercise helps stretch the front of your chest and shoulder.

1. Lie on your back with your knees bent. Touch your fingertips to your ears with your elbows pointed to the ceiling.
2. Move your elbows apart until you feel a gentle stretch, but no pain.
3. Hold this position for 5 to 10 seconds and then slowly return to the start position.
4. Remember to keep breathing throughout the stretch.
5. Repeat 5 to 10 times.

3. Snow Angel

This exercise helps to stretch the tight tissue in the armpit area and increases movement in your shoulders.

1. Lie on your back and extend your arms out at your sides. 
2. Move your arms up over your head, leading with your thumbs, eventually touching your fingers at the top.
3. Next, move your arms back down to your sides (as if you’re making an angel in the snow). 
4. Repeat 5 to 10 times.

4. Wall Climbing

This exercise helps increase movement in your shoulder. Try to reach a little higher on the wall each day. This exercise is done in 2 positions – A) facing the wall and B) with your affected side to the wall.

a. Facing the wall

1. Stand facing the wall.
2. Place the palm of your hand (of your affected arm) flat against the wall.
3. Slowly slide your hand up the wall as high as you can go until you feel a stretch, but no pain.
4. Hold for 5 to 10 seconds
5. Return to the start position.
6. Repeat 5 to 10 times.

If you had surgery on both sides of your chest, repeat this exercise with your other arm.

b. Side wall stretch

1. Stand with your affected side to the wall.
2. Place the palm of your hand flat against the wall.
3. Slowly slide your hand up the wall as high as you can go until you feel a stretch. Do not rotate your body toward the wall. Keep your body facing forward even if it means you can’t go up as high.
4. Hold for 5 to 10 seconds.
5. Return to the start position.
6. Repeat 5 to 10 times.

5. Side Bends

This exercise is more advanced and can be performed once a day when you feel ready.

1. Sit in a chair and clasp your hands together in your lap.
2. Slowly lift your arms over your head.
3. Bend at your waist to move your body to the right. Use your right hand to gently pull your left arm a little farther to the right. Keep yourself firmly planted on the chair.
4. Hold this position for 5 seconds and then slowly return to the start position.
5. Repeat this stretch to the left side, using your left hand to pull your right arm farther.
6. Repeat 5 to 10 times on each side.

Remember, it may take 6 to 8 weeks to regain full movement of your arm(s). If you continue to have difficulties regaining full movement in your arm(s) and shoulder(s) after this time, please ask your surgeon for a referral to physiotherapy and occupational therapy for follow-up.

Other activities:

It is safe to do light housework during the first 6 weeks after surgery. Do only short periods at a time and rest in between. You can start heavier activities after 6 weeks. Always let pain be your guide – a little discomfort is okay but more pain could mean you are doing too much.

On the day of surgery:

• Food after surgery: Patient may initially take clear liquids and preferably water 6 hrs after surgery i.e. after full recovery. If tolerated and patient desires, soft diet may be given as per patient’s wish. 

• Position after surgery: Better to remain 30- 45 degree head and back inclined up till full recovery.

• Post op treatment: Nurses will give the IV fluids as per instruction and sugars will be timely checked as ordered. Antibiotics,anti acidity  and pain medications will be given on day 1. 

• Patient’s previous medicines for comorbidities like blood pressure or diabetes etc can be resumed after the physician’s advice.

• Dressings: Dressing will be changed before discharge. It is advisable to actively learn and follow the dressing technique so relatives can do it at home as required.

Post anesthesia recovery symptomes:

You may feel drowsy and have minor side effects after your procedure or surgery with anesthesia. These side effects include:

• Sore throat            • Headache            • Muscle aches     • Dizziness off and on 

• Nausea                   • Vomiting (rarely) 

Some of these symptoms may be from the pain medicine you are taking. The side effects from anesthesia usually go away quickly in the hours after your procedure. Still, it may take several days for your body to recover from the stress of surgery and anesthesia.

Urinary retention (not being able to urinate) may occur after some procedures. If you are unable to urinate within 8 hours of going home after your procedure, or if your bladder feels painful and full, call the duty doctor or inform the nurse. In some patients, temporary insertion of a urinary catheter may be required.

At home care:

• Dressing: it is desirable to change the dressings at home daily. Patients can take showers, especially if plastic coated dressing is applied. After a week, soap and water can be applied to surgical site as well. Always dab it dry and clean the wound with propranolol [cutasept] or chlorhexidine based solution. Apply mupirocin ointment on the suture line.  Keep a thin layer of sterile gauze pieces dressing and secure it with micropore tape or use ready made tegaderm with pad dressings. 

• Wound inspection: it is important to note any collection, discharge, redness or pus from the wound. In doubtful circumstances readily click a photo and send across to the clinic number or doctor, else meet the doctor in the clinic.

• Patient will be given pain medications and antibiotics which can make the patient constipated. Increasing fluid, fiber and fruits in your diet may be helpful in avoiding this problem.  You may return to a normal diet immediately following surgery.  

• If you notice swelling in your hand or arm, it is expected at times post surgery: 

 Use 2 to 3 pillows to raise your arm higher than your heart. Do this a few times a day. You can raise your arm while you sit, lie on your back or lie on your side.

Raise your arm and slowly open and close your fist 10 times. This acts like a pump and helps drain fluid out of your arm. 

• Return to your daily activities as tolerated.

• You will return to the clinic a week following surgery. At this appointment, we will remove your dressings and you will receive pathology results from your pathologist. Further action plans can be sketched out after that.

• Suture removal is usually done after 2 weeks.
• NEVER EVER TO USE THE UPPER LIMB ON DISEASE SIDE FOR BLOOD PRESSURE MEASUREMENT, DRAWING BLOOD , INJECTIONS OR iv CANNULA 
• Drain care and removal: the tubes coming out from the operated area have a vacuumised box attached. It needs to be emptied daily at a fixed time so that the fluid in each 24 hrs can be measured. Date Wise charting of fluid output helps us in determining the time when the drain pipes can be safely removed. Details of drain care are given later separately. It is advisable to learn the emptying and recharging of drain while the nursing staff is doing.

When should I call  my doctor?

•  You have bleeding that soaks your dressing;
• Temperature taken by mouth between 38-38.2° C (100.4-100.8°F) for one hour or more, or a temperature that is 38.3°C (100.9°F) or above; or  temperature taken under the arm between 37.5-37.7° C (99.5-99.9°F) for one hour or more, or a temperature that is 37.8°C (100° F) or above;
•  If you have chills;
• You have any sign of infection: redness, increased pain, swelling, foul-smelling drainage, or increase in the amount of drainage from your wound;
• You notice an increasing fullness of your skin where your drain site was;
• You have concerns that cannot wait until your follow- up visit.

In case of severe emergency, reach out to the nearest specialist or hospital if your doctor is not available or reachable.

Cancer is a disease due to change in our genetic material. Hence such cells are characterized by unrestricted growth of cells that is independent of need, body signals and lack the cell mortality unlike normal cells. so such ever proliferation immortal sort of cells produce a big toll on our body as they consume lots of nourishment instead of other normal vital tissues. Hence cancer is a dangerous disease.

Cancer incidence in our country is on tremendous rise and soon it will be No1 disease as far as total number of affected population and the death toll too. Thus a lot of efforts need to be put in control and more importantly prevention of such disease. Following are the simple measures that can significantly reduce cancer risk.

AVOID TOBACCO:

Tobacco in any form is dangerous and can cause cancers in multiple organs. It is the single largest and preventable cause for cancer. It accounts for almost 40 % of total cancer burden in India. Despite the media publicity and warning signs on cigarette packs and tobacco pouches, the consumption of these products hasn’t yet ceased. Hence a stringent public awareness and deaddiction programs are a must and be made available at multiple accessible places.

HEALTHY DIET:

Diet has a great role in normal growth of an individual. However with the changing trends in food, food habits, food storages, fast food, pesticides, genetically modified animals and plants used in food have greatly increased the risk of cancers.

one need to consume 1/4 portion of diet as raw fruits and vegetables. They provide good antioxidants and vitamins apart from the loads of fiber contents. The vitamins and antioxidants aid in neutralizing the cancer causing agents and fibers in diet reduce the contact period with gut and aids in excretion of harmful substances.

NO ALCOHOL:

Alcohol has become a status symbol for many and habit or addiction for the rest consumers. However both the subset of people do not understand the gravity of issues like cancer which are invited with each peg of liquor. Alcohol is itself harmful for oral cavity, esophagus, stomach, gut, liver and pancreas.

It also increases the solubility of other cancer causing agents and help in their absorption in blood. So its role is not additive but multiplicative in cancer causation. Alcohol habit can only be prevented by public awareness and deaddiction facilities.

EXERCISE:

Daily moderate exercise helps in maintain circulation, muscle activity, good lung and heart compliances. It as well utilizes the stored excess fats and sugars in body and thus keeps the weight under control. Obesity contributes to 15% of cancer load. Exercise is an effective method to keep it under control.

BREAST FEEDING:

The risk of breast cancer is less in the ladies who have breast fed the kids at least for first 6 months. It is a protective factor hence need to be advocated among the young mothers.

VACCINES:

Human papilloma virus causes cervical, anal or perianal cancers, oral and pharyngeal cancers. Thus vaccine against HPV is postulated to prevent these cancers. the two dosages are to be administered to young teens ie 9-12 years ideally and maximum up to 26 years, more importantly to the ladies not exposed to sexual intercourse.

Hepatitis B is also a preventable cause for liver cancer. The vaccine against HBV is effective and time tested.

CANCER SCREENINGHK:

Screening is evaluation of apparently asymptomatic population to find out disease under evaluation. the effective screening detects many early cancers that are curable. Screening may detect pre cancerous conditions or high risk individuals that can be treated in time to prevent cancers completely.

AVOID TOO MUCH SUNLIGHT:

though sunlight is essential source of vit D, excess of it may expose one to the harmful U V rays. UV rays are known to produce skin cancers like Basal cell carcinoma etc. Use of sunscreens and avoiding long exposure to sun may prevent skin cancers

The magnitude of problem globally:

Cancer is a leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018.

The most common cancers are:

• Lung (2.09 million cases)
• Breast (2.09 million cases)
• Colorectal (1.80 million cases)
• Prostate (1.28 million cases)
• Skin cancer (non-melanoma) (1.04 million cases)

• Stomach (1.03 million cases)

Cancer is the second leading cause of death globally, and is responsible for an estimated 9.6 million deaths in 2018. Globally, about 1 in 6 deaths is due to cancer.

Approximately 70% of deaths from cancer occur in low- and middle-income countries like India.

The most common causes of cancer death are cancers of:

• Lung (1.76 million deaths)
• Colorectal (862 000 deaths)
• Stomach (783 000 deaths)
• Liver (782 000 deaths)
• Breast (627 000 deaths)

What causes cancer?

Cancer arises from the transformation of normal cells into tumour cells in a multistage process that generally progresses from a pre-cancerous lesion to a malignant tumour. These changes are the result of the interaction between a person’s genetic factors and 3 categories of external agents, including:

• Physical carcinogens, such as ultraviolet and ionizing radiation;
• Chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant), and arsenic (a drinking water contaminant); and
• Biological carcinogens, such as infections from certain viruses, bacteria, or parasites.

Ageing is another fundamental factor for the development of cancer. The incidence of cancer rises dramatically with age, most likely due to a build-up of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older.

Risk factors for cancers

Tobacco use, alcohol use, unhealthy diet, and physical inactivity are major cancer risk factors worldwide and are also the 4 shared risk factors for other non-communicable diseases.

Some chronic infections are risk factors for cancer and have major relevance in low- and middle-income countries. Approximately 15% of cancers diagnosed in 2012 were attributed to carcinogenic infections, including Helicobacter pylori, Human papillomavirus (HPV), Hepatitis B virus, Hepatitis C virus, and Epstein-Barr virus.

Hepatitis B and C virus and some types of HPV increase the risk for liver and cervical cancer, respectively. Infection with HIV substantially increases the risk of cancers such as cervical cancer.

Reducing the cancer burden

Between 30–50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. The cancer burden can also be reduced through early detection of cancer and management of patients who develop cancer. Many cancers have a high chance of cure if diagnosed early and treated adequately.

Modify and avoid risk factors

Modifying or avoiding key risk factors can significantly reduce the burden of cancer. These risk factors include:

• tobacco use including cigarettes and smokeless tobacco
• being overweight or obese
• unhealthy diet with low fruit and vegetable intake
• lack of physical activity
• alcohol use
• sexually transmitted HPV-infection
• infection by hepatitis or other carcinogenic infections
• ionizing and ultraviolet radiation
• urban air pollution
• indoor smoke from household use of solid fuels.

Tobacco use is the single most important risk factor for cancer and is responsible for approximately 22% of cancer-related deaths globally.

Late-stage presentation and inaccessible diagnosis and treatment are common. In 2017, only 26% of low-income countries reported having pathology services generally available in the public sector. More than 90% of high-income countries reported treatment services are available compared to less than 30% of low-income countries.

Only 1 in 5 low- and middle-income countries have the necessary data to drive cancer policy

Dr Hitendra Patil                                                  

Consultant Surgical Oncologist                     

 Website: www.drhitendra.com

Director, Suyog Cancer Clinics.                                    

www.suyogcancerclinics.com   

As we all know the most common cancers affecting males and females are concerned with the diet. The diet brings in the carcinogens in loads inside the human body. Food is though mainly the need but largely a fad too, when we look at the urbanization of diet in our Indian cultures. As do the lifestyle and food, our cancer statistics too are aping the west.

Below is the brief insight into the commonly encountered food items that are strongly related to cancers. Top 10 Cancer Causing Foods: need to know them to cut Cancer Risk significantly:

 1. Genetically Modified Foods (GMOs): 

The rapidly growing industry of genetically modified crops are infiltrating our food supply at an alarming rate. More than 90% of our grains, fruits and vegetables are now genetically modified. This fairly new practice is the source of many debates. Experts agree that adequate testing was not done before GMO foods were added to the ingredient listing of thousands of products. In other words, no one – including the growers and manufacturers of GMO foods – knows the long-term effect they will have on human health. Look for GMO-free labels whenever possible or buy organic (which always means a product is not genetically modified).

 2. Microwave Popcorn: 

From the chemically-lined bag to the actual contents, microwave popcorn is at the centre of lung cancer debates around the world. Not only are the kernels and oil likely GMO (which the manufacturer does not have to disclose) unless organic, the fumes released from artificial butter flavouring contain diacetyl, which is toxic to humans. Make your own organic popcorn the old-fashioned way – it tastes better, doesn’t release toxic fumes, and is a healthier choice for you.

3. Canned Goods:  

Most cans are lined with a product called bisphenol-A (BPA), which has been shown to genetically alter the brain cells of rats. Many plastic goods, thermal paper, water lines, and many dental composites also contain BPA. Help protect your DNA by sticking to fresh or frozen vegetables that have no added ingredients for your family’s table! These are better for you and available year-round.

4. Grilled Red Meat: 

While grilled food can taste delicious, scientists have discovered that preparing meats in this way – especially processed meats like hot dogs – releases a carcinogen called heterocyclic aromatic amines. When you grill red meat to the point of well-done, it changes the chemical and molecular structure of the meat. You’re better off baking, broiling, or preparing meat in a skillet than on the grill.

5. Refined Sugar: 

The biggest cancer-causing food (by far) is high-fructose corn syrup (HFCS) and other refined sugars. Even brown sugar is highly refined white sugar with some of the removed molasses added back in for flavour and colour. Refined sugars (and foods made with them) are the source of major insulin spikes and feed the growth of cancer cells. Since the majority of the sugar supply in the U.S. is made using genetically modified (GMO) sugar beets, a healthier option is organic honey, coconut sugar, or maple sugar.

6. Salted, Pickled, and Smoked Foods:

These products typically contain preservatives, such as nitrates, which are intended to prolong shelf life. The additives used in processed foods can accumulate in your body over time. Eventually, such toxins cause damage at the cellular level and lead to diseases like cancer. When smoked foods are cooked at high temperatures, the nitrates are converted to the much more dangerous nitrites. (Note: By pickled foods we don’t mean the fermented foods you make at home.)

7. Soda and Carbonated Beverages: 

Sodas have been at the centre of the health debate for two decades as a major cancer-causing food. Filled with high-fructose corn syrup (HFCS), dyes, and a host of other chemicals, they are very bad for every aspect of your health. They provide zero nutritional value and rob your body of the nutrients you get from other foods. Adding “diet” to the label means you’re also likely consuming aspartame – which is no better than rat poison to human cells.

8. White Flour:

When flour is refined, all nutritional value is removed. Then it’s bleached with chlorine gas to make it more appealing to consumers. The glycaemic index for white flour is very high – meaning it spikes your insulin levels without providing nutritional fuel. Carbohydrates are converted to sugars by your body, so excessive products that contain white flour can lead to increased insulin resistance. Simple sugars (like refined carbohydrates) are the preferred fuel source for cancer.

9. Farmed Fish: 

Commercial fish farming involves raising an incredible number of fish (such as salmon), in a crowded environment. More than 60% of the salmon comes from a farming operation where they are treated with antibiotics, pesticides, and other carcinogenic chemicals to try and control the bacterial, viral, and parasitic outbreaks that result from cramming so many fish in a small space. Farmed fish also don’t have as much omega-3 as wild salmon.

10. Hydrogenated Oils:

Vegetable oils are chemically extracted from their source, chemically treated, and more chemicals are added to change the smell and taste. They’re packed with unhealthy omega-6 fats (that Americans already consume way too much of) and have been proven to alter the structure of our cell membranes.

 4 Steps to Help Prevent Cancer:

In addition to the 10 foods listed above, also be sure to avoid any food labelled as “diet” “light” or “fat-free.” In order to remove fat or natural calories, they are replaced with chemicals that are dangerous to your body. Instead of consuming food products that manufacturers claim is “good for you” –

Follow these four anti-cancer diet tips to prevent cancer the easy way:

1. Eat organic whenever possible. 

2. Choose raw or clean food items in diet

3. Fill half your plate each meal with non-starchy vegetables. If you eat animal products, make sure they’re pastured and grass-fed meats and dairy goods (including eggs). Use only high-quality oils such as coconut oil, olive oil, ghee, or grass-fed butter.

4.  Cut back drastically on grains and sugars.

Not only will eliminating these foods lower your cancer risk, you’re going to feel (and look) better from the inside out. Now that you know what the top cancer-causing foods are, what are you going to do about their presence in your kitchen and your daily eating plan?