GOOD MORNING DOCTOR - Prof.JOHN KURAKAR Dr Manju Kurakar"s words

 GOOD MORNING DOCTOR -

 Prof.JOHN KURAKAR 

Dr Manju Kurakar"s words

25 November 2021, it was a busy day, Evening I was just chit chatting with my friends in wats app group. Suddenly my mother’s message popped up in Colgate group, it’s our family group. I kept scrolling to the days behind in the family group. The memories of each day began to flood my mind.The dark clouds of uncertainty loomed overhead, as torrential rains and the threat of mudslides and landslides cast a somber shadow over the days. In the midst of this, a glimmer of hope emerged – the memory of my father's face, a reminder of the tears that often filled his eyes. Yet, beyond the sorrow, he stood as a noble example of survival, a model of courage who had walked from the dark days to the light, fighting and emerging victorious. On November 25, 2021, my father, age 69, went to see a urologist after experiencing a minor urinary infection. Upon examination, the doctor suggested an Ultrasound scan, as there might be a possible problem with his prostate gland. For the last two long years, the fear of COVID19 had kept us from going home, this year decided to make the journey. On November 25, 2021, my father, age 69, went to see a urologist after experiencing a minor urinary infection. Upon examination, the doctor suggested an Ultrasound scan, as there might be a possible problem with his prostate gland. For the last two long years, the fear of COVID19 had kept us from going home, This year decided to make the journey to home. My father had hoped that all health concerns could be resolved before the arrival of his DR.MANJU KURAKAR'S WORDS - Dr. Manju Kurakar 9 Prof.JOHN KURAKAR children and grandchildren. A wish that now seemed uncertain. He was happy when he took an ultrasound scan and found out that there was only a small inflammation of the prostate gland and it could be solved with medicine. But the radiologist suspected a abnormality at the end of the large intestine. He decided to see a gastroenterologist to clear that doubt. Little did we know that the journey would lead to a dark cave without light. The path ahead was shrouded in uncertainty, but the resilience and strength that he had demonstrated in the past gave me the courage to face whatever lay in store. The gastro specialist who examined my father did not see any problem at first glance. But he said he could do a colonoscopy. Colonoscopy is recommended for everyone after age 50. A long tube with a camera attached is passed through the anus to expertly examine the rectum and colon. December 3, 2021, I was coming back from my hospital in the evening. My father's colonoscopy report arrived on my phone, revealing 'Carcinoma Anorectum.' As a maxillofacial surgeon familiar with the horrors of cancer, I was shocked to learn it was cancer. My heart raced with anxiety as I struggled with the daunting task of figuring out how to break the news to my father. The Gastroenterologist took a CT scan that very day . We fervently hoped it would reveal only the early stages of cancer. However, when the results arrived, they showed T3 N2 Mx, indicating that the tumor was over 6 cm in size and had spread to nearby lymph nodes. That means it was Stage III cancer. The following days were spent searching for the best hospital and a specialized Gastro surgeon in Kerala. During this time, I struggled to focus on my patients at the hospital in Pune, as my thoughts were constantly consumed by my father’s condition. His face appeared in my mind whenever I treated elderly patients. I rushed to see 10 GOOD MORNING DOCTOR an oncologist who worked at my hospital. It became clear that the cancer was far more advanced than initially thought, having spread beyond the stage where it could be completely eradicated. Radiation and chemotherapy were now essential. But surgery was unavoidable. The surgery would be extensive; it would involve the removing the muscles, lymph nodes, and surrounding tissues of the rectum and anus. Dr. Lekawale, the Oncosurgeon who did Mch in surgical oncology from RCC Thiruvantha puram currently working in a reputed medical college Pune explained this in detail to me. It felt like darkness was descending on my eyes, my face flushed, and my eyes filled with tears. The doctor tried to reassure me. I thanked the doctor and left the cabin. I couldn't bring myself to tell my father about this treatment approach. Thanks to the timely intervention of my good friends and Saly chechi, we were able to consult the highly skilled doctors Dr. Pavithran and Dr. Sudheendran at Amrita Hospital in Kochi. Dr. Pavithran is a professor of Medical Oncology. Dr. Sudheendran is professor in the Gastrointestinal Surgery department. He is not only an expert in his field but also a genuinely kind-hearted person. Manu and I soughtmultiple opinions from various doctors. Both of us found that the treatment approaches recommended by the doctors in Pune and Mumbai were consistent with the one suggested by Dr. Sudheendran at Amrita. When my father learned about this treatment plan, he sat in silence. Mom mentioned that he had been quietly shedding tears. The doctor recommended an MRI scan. After leaving doctor's office, my father asked Mom whether this treatment was truly necessary. The MRI confirmed that the cancer was indeed at Stage III. Given the tumor's size, chemotherapy would be required to shrink it sufficiently for removal. While waiting in Dr. Pavithran's room for chemotherapy, 11 Prof.JOHN KURAKAR we could hear cries of pain coming from the nearby observation room. I worried that my father might not be able to withstand the chemotherapy. Dr. Pavithran explained that chemotherapy alone wouldn’t be sufficient to reduce the tumor and that radiation therapy would also be necessary. However, before starting radiation, Dr. Pavithran wanted to assess whether the cancer had spread to other parts of the body. He suspected that a small cyst-like lesion in the liver might be cancer spread. To resolve this suspicion, he recommended a PET scan, which scans the entire body to check for cancer cells. The PET scanresults were reassuring in that the rectal cancer had not spread to other parts of the body. However, another problem was discovered: there was another tumor in the throat, indicating thyroid cancer. Learning that there was another type of cancer in the body devastated us. We didn’t see anytrace of fatigue on my father’s face; he appeared cheerful despite the circumstances. Moncy Uncle and Rashmi Aunty from Thrissur were with us, and they asked, “How can your dad be so cheerful even after everything he’s going through?” Their question both surprised and puzzled me. My father responded “If I become fearful, the next generation will also become fearful. I don’t want anyone to call me a coward.” He added “we are all role models for the younger generation”. There was concern that the throat tumor might have spread to the lungs. To rule this out, a biopsy was performed through the lungs (EBVS), a procedure that was extremely painful. Even now, the memory of the doctor who conducted the biopsy and the associated instruments haunts my father's nightmares. By God’s grace, thebiopsy results came back negative, indicating that the thyroid cancer had not spread to other parts of the body. This was a tremendous relief. He was referred to the Radiation Department by Dr. Pavithran for radiation treatment. Dr. Haridas is friendly and compassionate expert who takes the time to 12 GOOD MORNING DOCTOR address his patients' anxieties and concerns, offering thorough explanations and support and under his care, the radiation treatment lasted for 25 days. He mentioned that radiation might only reduce the tumour by up to 20%. I chose not to tell my father this, as I didn't want to undermine his confidence. Instead, we placed everything in God's hands and trusted him completely. It was crucial to attend every session of radiation without missing a day, as missing even one session would result in losing an entire cycle. Radiation required utmost attention and punctuality. The first few weeks of treatment went by without much difficulty. Along with radiation, he also had to take chemotherapy pills. Each day, as he took five pills, he would secretly consume honey and candy to avoid nausea and vomiting, which caused me great sadness. Despite this, he kept his sadness hidden, managing to maintain a cheerful demeanor and playfully interacting with everyone When the finalcycle of radiation happened, things took a turn for the worse. The cancer cells and surrounding tissues became severely inflamed and turned into painful sores. He experienced unbearable pain along with severe diarrhea, which was more than he could endure. Even after completing radiation, the sores took over two weeks to heal. Seeing my father, who endured this pain with a brave face and continued to smile and talk to everyone, was heart-wrenching for us. He might have thought that enduring this pain would help eliminate the cancer through radiation. We chose not to tell him that radiation could only reduce the tumor by 20% to prevent him from losing his positive energy and spirit. Every day, I hadthe support of my college friends and colleagues. Through Dr. Pushkar Gawande,I came to know about the Rasayu Ayurveda Cancer Center. His wife Dr. Poonam Gawande is working at Rasayu Ayurveda Cancer Center Pune. We were looking to avoid surgery, and decided to start Ayurvedic treatment. However, according to the experts at Rasayu, delaying the treatment was not advisable. It was not possible to avoid 13 Prof.JOHN KURAKAR surgery through medication alone. Nonetheless, we chose to complete one cycle of Rasayu’s treatment. Along with chemotherapy and radiation, we completed a cycle of Rasayu’s treatment. We heard that organic turmeric has cancer killing effect. The main active ingredient in turmeric is curcumin or diferuloyl methane. Laboratory studies have shown curcumin has anti cancer effects on cancer cells. Recognizing the potential benefits of turmeric, we decided to incorporate turmeric into our treatment approach as well. We learned that the Kottakkal Ayurveda Hospital also had cancer medicines and decided to try that too. By mid-January 2022, my father’s chemotherapy and radiation were completed. After radiation, atwo-month recovery period was necessary before surgery to allow the radiation wounds to heal. Knowing that there was a break before the next examination provided us with some relief. However, the prospect of the daunting APR (Abdominoperineal Resection) surgery continued to weigh heavily on our minds. During this time, our journey was fueled by the search for the inspiration from those who had triumphed rectal cancer and APR surgery. In the two-month interval, the Tumor Board recommended the removal of the thyroid. The sudden recommendation of another surgery terrified us. Following Dr. Haridas's advice, we consulted Dr. Subramania Iyer, the Head of the Plastic Surgery Department. Dr. Subramania Iyer is a highly renowned plastic surgeon, known for performing the first successful double-hand surgery in India. Despite his achievements and accolades, he is equally noted for his humility and grace. We approached him with a lot of mental stress and doubts. We arrived his OPD at 12 noon, but were able to see him at 5:30 PM only due to the high volume of patients. All our worries and mental struggles dissolved once we met him. The thyroid issue had been present for the past 10 years. It had not been troublesome at that time, but the surgeon advised that it was best to remove it. The fear of potential damage to speech function was what initially made 14 GOOD MORNING DOCTOR my father hesitant about the surgery. However, the consultation with Dr. Subramania Iyer instilled a lot of confidence in him. The thyroid surgery was performed on February 8, 2022. He was discharged from the hospital just two days later without much difficulty. The plastic surgeons are experts in performing aesthetically pleasing surgeries, and even now, the scar from the surgery is barely visible. It was indeed a beautifully executed thyroid surgery. My father’s voice even gained more clarity. After some time, wereceived the report of the thyroidectomy, which confirmed Follicular carcinoma.It was established that the cancer was present in the entire thyroid gland. Dr. Subramania Iyer advised that to prevent the cancer cells from spreading to other parts of the body, a radioactive iodine therapy was necessary. We were initially disheartened, thinking that there was no end to the treatment. However, Dr. Subramania Iyer reassured us, saying that a single session of radioactive iodine therapy would be sufficient. We were relieved to hear that it required just one dose. With a small sense of relief, we went to the Nuclear Medicine Department to meet Dr. Shanmughan. Dr. Shanmughan is a highly efficient doctor, but due to his busy schedule, he had limited time to address all our concerns. Ideally Radioactive iodine therapy will be given one month after thyroid surgery. Ideally, radioactive iodine therapy is administered about one month after thyroid surgery. This interval allows for the depletion of residual thyroid hormones in the body and enables TSH levels to rise, which enhances the effectiveness of the therapy. However, due to the need for APR surgery within a strict one-month timeframe, we faced a challenging situation. Before the APR surgery, it was crucial to replenish thyroid hormones to ensure normal metabolic function and prevent potential complications. Balancing these requirements was certainly a complex task for us. We then learned about the R-TSH injection, which could potentially address this issue. Each injection cost around one lakh rupees, and taking two injections was required to increase TSH levels. We spent two 15 Prof.JOHN KURAKAR lakh rupees within three days on R-TSH injections. During this period, we were advised to avoid iodine-containing foods, fish, and iodized salt. After that, we underwent the radioactive iodine scan. The scan report revealed that a few thyroid cancer cells remained under the bed of the thyroid gland. To completely eliminate these cells, additional radioactive iodine treatment was needed. Although this treatment seems straightforward, it causes significant psychological stress for those who experience it. The isolation, living in a small room for two days without seeing anyone, and the food delivered through a small window can be distressing for anyone. After consuming the radioactive iodine, a significant amount of radiation is emitted from the body, which is harmful. There is a risk that close individuals could also develop cancer from this exposure. We brought myfather to the isolation room with a box full of motivational books, fruits, and a mobile phone. Only he knew how he managed to endure two days alone in a room without seeing or speaking to anyone. Food was delivered through a small window, and the isolation, reminiscent of what COVID-19 patients experienced, was a pain he recalled vividly. After two days, he was discharged. The joy he felt upon seeing my mother outside the isolation ward was indescribable. Since it took about two weeks for the radiation to completely leave his body, he had to continue living in isolation for that period. We booked two rooms at the Amritha Guest House, preparing one room specifically for him. The enforced distance between even close family members took a toll on his mental well-being. Despite the emotional strain, my father kept his spirits up and persevered. On March 18, 2022,we had the second MRI scan. This scan was to determine how much the tumor hadreduced after chemotherapy and radiation. According to Dr. Haridas's prognosis, there would be a 20% chance of reduction. The noise of the first MRI scan was unbearable for my father, but after our continuous 16 GOOD MORNING DOCTOR encouragement, he agreed to undergo the MRI scan again. To our amazement and with divine grace, the tumor had reduced by 50%. Whether it was due to chemotherapy, radiation, the benefits of Rasayu, the effectiveness of Kottakkal Ayurveda medicine, or the potency of turmeric, we did not know. We preferred to believe that it was the work of a higher power. With this report inhand, Manu and I rushed to meet Dr. Sudheendran. We went to find out if, giventhe improvement, surgery could be avoided or perhaps made less extensive. However, the result was disappointing. The doctor said that the surgery had to be an APR and there was no possibility of changing this. With heavy hearts, we left the doctor's office and encountered a nurse who specialized in colostomy. She explained about the surgery and the post-operative lifestyle, and introduced us some colostomy patients living as role models. Among them was a couple who had recently delivered twins. Their life was a marvel to us. Mr. Shiju, 35 year old, had lived with a colostomy bag for last 15 years and was a vibrant, youthful individual. He had achieved everything he wanted in life. Meeting him, we quickly became his admirers. Since Atul Kurakar was studying at Amrita Dental College, Georgekutty Uppapan and Sally Chechi were living close to the hospital, they provided significant help and support to my father and mother. Georgekutty Uppapan’s presence was a great comfort to my father. The date for the APR surgery arrived. It was on March 22, 2022. We were then busy preparing for the pre-anesthesia fitness (PAC) check-up. After thyroid removal, it was crucial to take medication to manage body weight. Maintaining a euthyroid (normal thyroid hormone) state is indeed essential before proceeding with any surgery. This is because proper thyroid hormone levels are critical for the body's metabolic stability, wound healing, and overall physiological balance. Inadequate thyroid hormone levels can lead to complications such as poor wound healing, increased risk of infections, and other systemic issues. The endocrinologist prescribed Thyroxine 17 Prof.JOHN KURAKAR 125 for my father. On March 20, 2022, my father was admitted to the hospital. We hoped that the time until March 22 would pass quickly. To ease my father's anxiety, we visited Changampuzha Park. The cool breeze in the park provided a brief respite for our minds. Later, we went to St. George’s Church in Idappalli, where we felt that not a single tear shed in the churchyard would be in vain. We felt an overwhelming sense of divine presence and a complete faith that an invisible force would guide us.On March 21, we went through the pre-surgery tests. In the afternoon, My father was given medications to clear his bowels. After drinking the solution, his stomach was thoroughly emptied ten to fifteen times. To distract him from worrying about the surgery, we created several important videos, including topics on environmental conservation, the poet Changampuzha and water conservation. We focused on keeping my father engaged and entertained. That morning, March 22, 2022, began at 5 AM as we prepared for the day and awaited the call to the operating room. Despite my father's attempts to lighten the mood with jokes, our underlying anxiety continued to grow. At 7:30 AM, the wheelchair came to take him to the pre-op room. I stayed with him while the anesthesiologist checked him one more time and ensured everything was in order. My father changed into the OT gown and was wheeled in on a stretcher. He closed his eyes and surrendered everything to God. I was left with a deep sense of uncertainty, wondering if I would see him again. We were instructed to wait in the waiting room. The waiting was excruciating, with every minute feeling like an hour. Sally Chechi also stayed with us. By noon, we hadn’t received any updates from the operating theatre. Hunger and thirst were non-issues; the tension was overwhelming. Unable to bear the anxiety, I decided to take a walk. As if sent by divine intervention, I saw Dr. Sudheendran passing by. I called out loudly, "Sir, how is my father?" Dr. Sudheendran had eight surgeries scheduled that day, and no doctor could handle eight surgeries simultaneously. The surgery for my father was 18 GOOD MORNING DOCTOR conducted by Dr. Binoy and Dr. Vijhay Ganesh, under the supervision of Dr. Sudheendran. However, Dr. Sudheendran, in the midst of his busy schedule, seemed to have momentarily forgotten about my father. When I asked Dr. Sudheendran, he couldn't provide a clear answer at that moment. However, he immediately went to my father's theatre. We waited anxiously, and our fear grew when we couldn't see my father. At 9 PM, Dr.Sudheendran called me and informed that the surgery was completed but that there had been some difficulties. He said stitches were being placed and that my father would be moved to the ICU in about half an hour. By around 10 PM, my father was moved to the ICU after a 12-hour-long surgery. As I waited, my anxiety intensified. Dr. Vijay Ganesh, a final-year MCh student, called us in and provided a detailed explanation of the surgery, even showing us the removed tumor. I was so overwhelmed that I struggled to find words. When we went into the ICU to see my father, we found him with his legs elevated and bound in stockings. Seeing him in this state after waking from anesthesia was disorienting. Manu broke down in tears upon seeing him, and none of us could sleep that night. After waking fromanesthesia, my father requested for water in the ICU. After such a long surgery, the minimum wait time for drinking water is six hours. None of the ICU nurses gave him water. On March 22, World Water Day, he was frustrated that he couldn't get even a drop of water. He expressed his frustration to the nurses, who later informed me of his discomfort. When I saw my father in the morning, he was visibly upset about not having received water. I tried to comfort him by explaining that the delay was due to the extended duration of the surgery. Despite the challenges of the procedure, I reassured him that it had been completed successfully, which seemed to bring him some relief. Shortly afterward, a nurse, with softened heart, moistened a cloth with water and gently soothed his lips. 19 Prof.JOHN KURAKAR On the morning ofMarch 23, at 7 AM, Dr. Sudheendran visited the ICU to check on the patients whohad undergone surgery the previous day. After such a lengthy and complex procedure, the doctor had assumed my father would still be unconscious and had not approached his bed. When my father greeted him with a "Good Morning, Doctor," Dr. Sudheendran was momentarily shocked. He hurried to my father's side and asked, "How do you feel now?" Expecting a different response, Dr. Sudheendran was surprised when my father replied, "I am fine." My father then mentioned, "It would have been nice to have some water." Realizing that my father was in good spirits despite the long and serious surgery, Dr. Sudheendran ordered some biscuits and lemon juice for him. However, due to hospital protocols, my father had to wait an additional four hours before receiving the lemon juice. Seeing my father's strong will to recover, Dr. Sudheendran was pleased and decided to transfer him to a regular hospital room that evening.From that day until the end of April, we spent every day and night in the hospital room. During this challenging time, Dr. Vijay Ganesh was like a guardian angel, a son, and a sibling, constantly by my father's side. He took on the crucial role of caring for my father, administering medication to his wounds, and addressing our concerns about the colostomy bag. For days on end, Dr. Vijay was always nearby, helping us understand and manage the situation with unwavering support. After several days, a discharge was written, and we hoped we could finally go home. But that very morning, things took a turn. We were devastated to find that the wound, which we had hoped was healing, had started showing pus drainage, a sign of infection. We were left in a state of complete dismay. The Gastrosurgery team realized that they could no longer manage the case and referred it to the Plastic surgery department at Amrita Hospital. Plastic surgeon Dr. Sandeep came to examine my father and explained that the infection could not be treated with medication alone and that my father would need to undergo another surgery. 20 GOOD MORNING DOCTOR Due to the previous radiation treatment, the tissues inside the abdomen had been necrosed, making it difficult for the wound to 1to consult Dr. Rajesh at Apollo Hospital in Mumbai. Dr. Rajesh, known for his gentle and attentive approach, was taken aback by my father's medical history. He reassured my father with the comforting words, "The elephant has gone; only the tail is left. Don't worry, the tail will also be gone soon”. Dr. Rajesh's reassuring words brought great comfort to my father. He told him, "You are very close to the goal," and recommended seeing Dr. Salil Patkar to begin post-chemotherapy treatment. Dr. Salil Patkar, a compassionate medical oncologist, proposed a treatment plan consistent with Dr. Pavithran’s approach at Amrita. This plan included six cycles of chemotherapy over two weeks, with daily doses of 500 mg of Tab Capecitabine. The medication caused significant discomfort for my father, including nausea, vomiting, leg cramps, pain in his legs, skin irritation, and general weakness. Despite these severe challenges, my father’s resilience and mental fortitude were truly remarkable. As one issue wasaddressed, another problem seemed to emerge. The urinary catheter placed on March 22 needed frequent replacements, yet my father continued to experience urinary retention. Walking with the urinary bag proved very difficult for him. After extensive searching, we discovered a leg bag for urine that could be strapped to the leg, which provided temporary relief for my father. We consulted several urologists in Mumbai regarding the urinary obstruction, but none were helpful. The search for a solution continued, leading me to learn about Dr. Anupama Patankar’s father, Dr. Suresh Patankar, in Pune. After 20 years of service at BJ Medical College, Dr. Patankar founded his own Urology hospital, ACE Hospital, in Pune. He is renowned for his innovative treatment methods and ongoing research in urology. Dr. Anupama Patankar is Professor in Department of Prosthodontics in our hospital, Sinhgad Dental College Pune Dr. Suresh Patankar’s approach seamlessly combined modern medical prac- 21 Prof.JOHN KURAKAR tices with Ayurvedic treatments, showcasing a holistic understanding of health. From the moment we met him, it was clear that he was the right doctor for my father. Dr. Patankar, a gentle and compassionate specialist, seemed to be around my father’s age and demonstrated profound empathy and consideration. Upon meeting my father, Dr. Patankar, with a smile, asked, "Don't you want to remove the urinary tube?" Thanks to his effective treatment, the tube was successfully removed within a month. However, complete urinary voiding was still challenging, so he recommended Clean Intermittent Catheterization (CIC) to help drain residual urine. This procedure requires meticulousness and hygiene, and it is usually difficult for most people to learn. It demands patience and mindfulness. My father quickly mastered this technique and continued it for approximately four months. By November 2022, as a result of Dr. Patankar's ongoing expert care, he was able to completely void urine normally and discontinued the CIC. The joy on my father’s face, reflecting the resolution of each problem, was immense. As Paulo Coelho aptly puts it, “And when you want something, all the universe conspires in helping you to achieve it.” It’s crucial forolder adults to exercise caution when entering the bathroom to avoid accidents, such as slips and falls. Anti-slip mats are essential for safety. Unfortunately, due to the application of oil on his legs, my father slipped and fell in the bathroom. Hearing the commotion, my mother rushed from the kitchen, kicked open the locked bathroom door, and found my father lying on the floor. With great presence of mind and strength, my mother helped my father get up and quickly called Manu, who works as a system manager at SBI Navi Mumbai. Manu promptly took my father to Apollo Hospital in Navi Mumbai. An X-ray revealed a fracture in his shoulder joint, casting a shadow of despair over us. The hospital doctor immediately recommended surgery. We consulted Dr. Sameer, an orthopedic surgeon in Navi Mumbai, who was very courteous. Following the doctor's advice, surgery was performed 22 GOOD MORNING DOCTOR at Reliance Hospital, where the shoulder ball (humeral head) was fixed with an orthopedic plate and screws. To improve the range of motion, physiotherapy was necessary. After a month of physiotherapy, my father was able to raise his left arm up to shoulder level. As I was deeply immersed in the process, reflecting on the difficulties, pain, tensions, and dark, hopeless days we had endured over the past years, I suddenly received a call from my mother. Hearing her voice was like witnessing the sky clear after a storm, bringing a much-needed smile to my face. By God's grace, myfather is able to convey a powerful message to the younger generation: "Success is determined by your own confidence and fortitude. A hero is an ordinary individual who finds the strength to persevere and endure despite overwhelming obstacles”. He showed that cancer is not the end of life but a battle, and one must see themselves as a warrior. "Cancer is just one chapter in your life's book, not the whole story. It is merely a page in the book of life, not the entire book. Don't lose hope. Even though the sun sets behind the mountains, it rises again with renewed energy the next day. Never let your faith in God and your inner confidence waver. Just like the phoenix rising from the ashes, you must transcend this chapter of cancer and soar high."