Endoscopy after 40

Understanding the Silent Threat

Our bodies are complex machines. Sometimes, parts of this machine can develop problems without showing any early warning signs. This is especially true for your digestive system.

One such silent problem is cancer of the gut. While it might sound scary, the good news is that we can often find it early which makes it much easier to treat. This is where a screening endoscopy comes in.

The Indian Context

In India, unfortunately, many people are diagnosed with gut-related cancers at advanced stages. This often makes treatment difficult and reduces the chances of a full recovery. To change this, it's crucial to adopt preventive measures.

The Importance of Screening

A screening endoscopy is a simple procedure where a thin, flexible tube with a camera is gently inserted into your digestive tract. This allows us to examine the lining of your food pipe, stomach, and intestines for any abnormalities.

• Early Detection: We can often spot tiny, precancerous changes or even early-stage cancers that cause no symptoms. This gives us a chance to treat them before they become a bigger problem.
• Prevention: Removing precancerous growths can prevent cancer from developing altogether.
• Peace of Mind: Knowing your digestive system is healthy can significantly reduce worry and anxiety.
• Incidental findings: We can pick up non-cancerous ailments which could be causing you problems and treat them effectively 

When to Consider a Screening Endoscopy

While general recommendations suggest starting screening at 40, it’s essential to discuss your personal risk factors with your doctor. If you have a family history of gut-related cancers or other risk factors, you might need to start earlier.

Remember, prevention is always better than cure. A simple endoscopy can save your life. Don’t delay this important step in taking care of your health.

The reason for writing this at this time:

I came across a rare case of the Melkersson-Rosenthal Syndrome. 

That’s patient incidentally came for his endoscopy to check for Crohn’s disease.

The symptoms of Melkersson-Rosenthal Syndrome (MRS) present as a triad of:

1. persistent or recurrent upper lip oedema (oedema is a build-up of body fluid), 

2. relapsing facial paralysis and 

3. a fissure tongue. 

MRS is commonly associated with the more well known Crohn’s disease, a form of inflammatory bowel disease, diagnosed with a colonoscopy on routine investigations.

If you or your loved ones are diagnosed with Crohn’s, make sure to keep a look out for the triad of symptoms and ask your doctor about if any present themselves. 

A little extra caution goes a long way!

Preventing Cancer from HPV - For Girls and Boys both!

  

 Short answer -  Yes!

Most cervical cancers are associated with human papillomavirus (HPV).  It can spread through sex and from some types of skin-to skin-contact. Gardasil 9 is an HPV vaccine approved by the GOI and can be used for both girls and boys. This vaccine can prevent most cases of cervical cancer if the vaccine is given before girls or women are exposed to the virus. This vaccine can also prevent vaginal and vulvar cancer. In addition, the vaccine can prevent genital warts, anal cancers, and mouth, throat, head and neck cancers in women and men.

 

When exactly should the HPV vaccine be offered?

The recommendation is for HPV vaccine to be given to girls and boys between ages 11 and 12. It can be given as early as age 9. It's ideal for girls and boys to receive the vaccine before they have sexual contact and are exposed to HPV. The response to the vaccine is better at younger ages than it is at older ages.

The CDC recommends that all 11- and 12-year-olds receive two doses of HPV vaccine at least six months apart. Younger adolescents ages 9 and 10 and teens ages 13 and 14 also can receive vaccination on the two-dose schedule. Research has shown that the two-dose schedule is effective for children under 15.

Teens and young adults who begin the vaccine series later, at ages 15 through 26, should receive three doses of the vaccine.

 

Does the HPV vaccine offer benefits if you're already sexually active?

Yes. Even if you already have one strain of HPV, you could still benefit from the vaccine because it can protect you from other strains that you don't yet have. However, none of the vaccines can treat an existing HPV infection. The vaccines protect you only from specific strains of HPV you haven't been exposed to already.

 

Does the HPV vaccine carry any health risks or side effects?

The HPV vaccine has been found to be safe in many studies.

Overall, the effects are usually mild. The most common side effects of HPV vaccines include soreness, swelling or redness at the injection site.

 

What is the dosage for Gardasil Vaccine (HPV)?

Gardasil 0.5 ml is injected intramuscularly as three separate doses. The first dose is administered at the patient's convenience, the second dose two months after the first dose, and the third dose six months after the first dose.

 

Why is HPV vaccination recommended?

1. One out of 4 women who die of cervical cancer is from India.
2. Every seven minutes one woman dies of cervical cancer in India.
3. Cervical cancer kills roughly 67,477 Indian women annually.
4. Human Papilloma Virus (HPV) has been detected in 99.7% of all cases of Cervical Cancer worldwide.
5. This is the highest level of the associated pathogen known to be a major cause for a human form of Cancer.
6. HPV types 16 and 18 are responsible for 82% of cervical cancers in India.

Does it apply only to girls or do boys have to take it as well?

There is increasing evidence that boys are infected with HPV as well. MSD has launched the gender neutral Gardasil 9 in India. The rationale behind this is that the vaccine would prevent Genital warts, oral cancers, penile cancers, anal cancers and precancerous lesions, especially in homosexual identities. 
(https://www.livemint.com/companies/news/msd-india-launches-9-valent-human-papillomavirus-vaccine-gardasil9-11632914111895.html)

India has also launched its own vaccine under the name Cervivac made by the Serum Institute which brings down the cost considerably 

Do get in touch with me for any further information you may need. I'll be happy to help!

Meanwhile, here are some more newspaper articles for the movement currently on in India.

https://www.hindustantimes.com/india/is-hpv-vaccine-safe-for-my-daughter-yes/story-4gBa5z5rDtxREhNJ6lzzQP.html

https://www.news18.com/news/buzz/dear-indian-women-did-you-know-that-there-is-a-vaccine-for-cervical-cancer-3390860.html

IAP (Indian Association of Pediatricians) - https://acvip.org/parents/columns/cervical-cancer.php

Time to think

I was standing at a red signal the other day and happened to look around at a few cars alongside me as well as some two wheelers. Almost all of them whipped out their cell phone the moment they came to a halt. 

It suddenly struck me that all of these people must have something really important to do on their phones. So much so, that even a 80 sec signal stop compelled them to bring it out and start scrolling through stuff.

While I was thinking this, I also realised that the only reason I could think of this is that I was at the signal and not actively doing anything. This made sense. My brain could afford to think only because I had nothing to think about (!?!) 

This post was literally born in those 80 seconds. I thought of all our lives, how we end up as slaves to the ecosystem around us. How many of us have done the same I wondered? Searching for answers in my closed cranial ecosystem, I began to recall all the times when I had people around me who stared into their phones, not because of some work, but simply because there was nothing to do but wait!

Consider this a social experiment and if you could humour me with some honesty, I'd like to ask the following of you:

Remember how we used to stand at our windows or balconies (those that haven't been taken in) and stare out and think of the day?

Our commute use to be time to reflect on the day and plan our work for the remainder of the day or the next day, was it not?

Would you ever just sit at the window of the bus and look out and imagine what was going on in the lives of the passers-by?

Had you ever woken up in the morning and given yourself 10 mins to just lay there and think? 

Remember walking on your own with your 'thoughts' and not with your 'phone'?

Ever sat alone in a cafe or tapri sipping on chai/coffee just to think?

Almost all these scenarios have been replaced with the cell screen taking the part of the thinker!

Is it even surprising that the generation today can't think of keeping their minds idle for even a minute lest the horror of thought enter! They are onto the phone screen in an instant. 

What evil is this? How much content can we even consume? How is it not boring anymore?

At the end of the 70th second on the signal timer, I had an evil thought of my own - I should make a note of this on the phone so I don't forget it. Then I admonished myself and forced myself to commit it to memory. I returned to my work place and promptly forgot about it while working and getting on the internet for calls and work!

Then a radical thought hit me about two paragraphs before this. Perhaps, its time we had a period in school for 20 minutes where the kids are just told to do nothing. No input to the brain, only output allowed. No putting your head down and taking a nap. Just sit there and think! 

Shudder the thought!