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Difficulty Swallowing? Dysphagia in Cancer #BlogchatterA2Z

By on 8


Difficulty swallowing or dysphagia is a common ENT complaint. It’s the ENT surgeon bread -butter version complaint. Today I will tell you about the danger hidden behind such a common and innocuous symptom.

A few months back a 75-year-old man had come to my clinic with his daughter-in-law. The complaint was the inability to swallow food for one month. On detailed questioning, the initial complaint of dysphagia started almost two months back with on and off the review by quacks(you know my thoughts about that) and alternative therapy. He had never visited an ENT doctor for his complaints. He also had not been given any prescriptions for alternative medical therapy.

He was suffering so much, that swallowing his own saliva was difficult. He was severely dehydrated, hardly ate anything. But he was still smoking. Without going into too many details, I can tell you that his HRCT of the thorax(chest) showed a growth obstructing more than two-third of his food pipe. I referred them to Apollo Kolkata and Tata Medical Centre Kolkata and explained to them about the need for urgent intervention.

Time is crucial for malignancies as such and more so for your breathing tubes and food pipe.If every time you swallow saliva

It has a long list of causes and can be divided easily into acute or chronic.
The most infectious condition with pain throat also has difficulty swallowing like in tonsillitis and Pharyngitis. If you have hawking, repeated clearing of the throat and a postnasal drip, that can cause dysphagia too.

When it’s difficulty swallowing with pain, its called odynophagia.

Fear of swallowing or Phagophagia occurs in Rabies, hysteria, tetanus
Globus hystericus is a sensation of a lump in the throat often associated in chronic anemia and common in women.

Difficulty Swallowing
Difficulty Swallowing

Today I will talk about malignancy causing dysphagia and the signs you should be aware of.

The Early warnings

Its the progressively increasing painless difficulty swallowing. Most common in a smoker with a history of regular high volume alcohol intake. Presenting with maybe a hot potato voice is cause for worry /Cancer of the upper part of the throat, often present with difficulty swallowing. So does cancer of the esophagus.

There may or may not be a lump in the throat/change of voice and difficulty breathing. Sudden significant unexplained weight loss is common in cancer of food pipe.

Anything more than two weeks’ duration needs the help of diagnostic tests . A Fibreoptic laryngoscopy is an office procedure to have a peek into the pharynx/larynx and pyriform fossa. If that looks clear, you need a Barium, swallow esophagus, and a CECT Neck and HRCT thorax as further workup.


As a rule of thumb, if the malignancy arises from the vocal cords and then spreads to food pipe, hoarseness precedes dysphagia.

Malignancy causing Dysphagia

Pharyngeal malignancy
Oesophageal malignancy
Laryngeal malignancy involving food pipe.

How is the Health of the Nation: The report is an eye-opener!

Health of the Nation Report
Apollo Pro Health


Treatment depends on the site, size, spread, and type of cancer.
Prognosis is dependent on histological type, local spread, metastasis, and patient profile. In more cases, the correlation between smoking and alcohol abuse is very high in such cancers. Surgery and adjuvant therapy are planned after a full review . Nowadays Proton therapy is another modality that is considered.

Cancer of the Tongue: Chewing habits to chew on!

By on 12

Cancer!The C-word which now has competition from Corona.Just like COVID19 prevention, with lockdown and social distancing
, for this cancer prevention works.

The slightly raised edges, feeling of roughness, giving rise to a small nodule that breaks down and forms an ulcer. The ulcer doesn’t heal with all your self-medication, alternative medicines and several multivitamin tablets supplied by the friendly pharmacy shop owner. This is, in short, the life story of cancer of the tongue

I have written about throat cancer and extensively about mouth cancer. Cancer of the tongue falls under mouth cancer or oral cancer, and broadly the treatment policy follows a similar pattern.It often follows the abuse of gutkha paan masala and other tobacco chewing habits.

If you want some different reading material with the letter C, try Coronavirus outbreak, Taiwan fight with New Corona virus:why they ignored Chinese data, or Home Quarantine For Corona: the right way

How does tongue cancer present?

It can present in the anterior two-thirds(45%) or posterior one-third of the tongue. The majority of those in the anterior part is seen at the lateral border of the tongue.
Nonhealing ulcer of the tongue.
A raised area with areas of ulcer and tissue piled up. There may be bleeding from the tongue.
The doctor will take a wedge biopsy or an excisional biopsy depending on the size of the lesion.

In uncontrolled diabetes, a nonhealing ulcer may often confuse clinical diagnosis.

On palpation of the tumor/ulcer, it most often will have an indurated base In advanced cases there will be a pain in the tongue
There will be difficulty in complete protrusion of tongue and difficulty articulating clearly. This happens due to the spread to the floor of the mouth.

If cancer involves the posterior part and base of the tongue, the treatment is often difficult.
A neck lump is an indication of spread to the neck or may be due to secondary inflammatory changes in the lymph node. Loosening of teeth of the lower jaw indicates, spread to the mandible,if not proved otherwise.

Where can Tongue Cancer it spread?


The floor of the mouth.
Mandible(lower jaw).

Cancer of the posterior part of the tongue can spread to tonsils, pharynx and into the larynx
Most people (70%)will have neck mass at presentation. Sometimes neck nodes on both sides may be involved.

CANCER OF THE TONGUE
CARCINOMA TONGUE

What tests will be needed?

Diagnostic tests involve biopsy, FNAC MRI tongue, and imaging for the neck and chest. Mandibular involvement and status of dentition need to be evaluated.

The MRI of the tongue and a CECT of the neck and chest helps us know about the spread of the disease.

An FNAC from the neck mass will help in finding out the nature of the neck lump, and the biopsy of the tongue ulcer will help us know about the tongue lesion.

Treatment often involves.


Treating primary lesions depending on size. Excision is done with adequate margin and reconstruction depending on mass resected. The neck needs to be treated. A combination of surgery and radiotherapy may give best results

Preoperative counseling:Why is it crucial?

To stop all addictions.

Treat withdrawal symptoms.

Improve lung function.

Improve oral hygiene.

The potential need for tracheostomy and loss of voice explained.

The possible need for re-construction with flaps explained.

Speech therapy needed postoperatively.

Explanation regarding Adjuvant radiotherapy/chemotherapy or both, depending on tumor-free margin after biopsy report.

Need for post-operative followup at a Head Neck Cancer /tumor clinic.

Battery in toys: You better avoid!

By on 9

BATTERY!Not something you want your children to play with
As a Postgrad trainee in Safdarjung two, emergency cases really pushed our buttons. Tracheostomy in the ER and little kids swallowing batteries or inserting in nose and ears.


Now tracheostomy is a topic for another chapter, but the battery is something I need to warn you against. Those cute little cars and battery-operated toys may have disc battery (looks like a coin ) or small button batteries. Both are dangerous in little hands. They have a tendency to insert it in ears, nose, or swallowing it.

The Good news

With a button battery in ear or nose depending on size, they can be seen on Xray and removed with or without anesthesia. Button battery on being swallowed, may pass out through stool and not cause any problem. These are all good outcomes.

The Bad News

The worrying issues are when the button battery is missed by a parent who brings the child late to the ER. If in the nose it can cause septal perforation nasal bleeding and more.

In the ear, it can cause the destruction of the tympanic membrane and middle ear structure, potentially harming hearing ability.

But the biggest problem is probably a swallowed disc battery when it gets stuck in the food pipe or eso[phagus. That can be life-threatening.

After 3 hours, it starts leaking chemicals that first burn the mucosa, then the muscle layer and the serous layer or outer covering of food pipe. Once that happens, a potentially fatal condition called mediastinitis can occur.
All this can be avoided if you don’t give toys whose batteries can be taken out by prying fingers.

How is the Health of the Nation: The report is an eye-opener!

Health of the Nation Report
Apollo Pro Health

In case such an unfortunate incident occurs, you need to visit the ER quickly. It requires an ENT department facility for removal with a hypopharyngoscopy or Esophagoscopy general anesthesia and a pediatric ICU setup, for potential complications. Remember, prevention is definitely better than cure.


In Kolkata, all the Government Medical Colleges have an Emergency facility for ENT, and so does most other Government Medical Colleges in Delhi. For other places, you can also check online for the services offered.

Battery in toys :you better avoid

Acute Otitis Media: When the ear aches! (Plus book free) #BlogchatterA2Z

By on 14

Earache is common in growing children. It may be due to wax,acute otitis media, otomycosis, and airplane ear. Earache due to Acute otitis media is one of the commonest conditions children come to me with. But what exactly is Acute otitis media or AOM?

Acute Otitis Media:This can cause earache and ear discharge too!

Whenever doctors say it’s an acute condition, we mean that the duration of the illness is possibly less than three months or 12 weeks old. In case something is more than 12 weeks in duration, it becomes chronic.

How is the Health of the Nation: The report is an eye-opener!

Health of the Nation Report
Apollo Pro Health

Acute otitis media is a condition in which the mucosal lining of the middle ear gets inflamed and can cause earache, blocked feeling in the ear, decreased hearing, and fever.


When the inflammation increases, then there may be fluid accumulating in the middle ear. This infected fluid causes the eardrum to bulge outside, increasing the severity of pain and is often accompanied by high-grade fever. If the condition is not reviewed by an ENT surgeon, then the eardrum can burst under pressure giving rise to discharge of mucopurulent discharge from ear, This is often followed by a decrease in earache.


When something like this happens, it’s called ASOM or Acute suppurative Otitis Media. This condition is common in children and in lower socio-economic conditions. With increasing age as the tendency of repeated URI and ear infections decreases. But maybe in those with Allergic Sinusitis and Allergic Rhinitis the problem may persist even as adults.

The eustachian tube in children is shorter and at a lesser angle to the horizontal than that in adults. This causes more secretion to accumulate. That’s why children are more at risk of developing Acute otitis media. Also, breastfeeding in a supine position can cause regurgitation of milk into the middle ear through the eustachian tube and can aggravate the problem.


What you need to know if your child has ear discharge for the first time.


You must consult an ENT surgeon for an opinion regarding the Tympanic membrane. One episode of ASOM and a proper course of antibiotics will help in the healing of the eardrum. But in the case of recurrent cold, the same ear may discharge repeatedly.

The plan is to stop recurrent URI and improving the child’s immunity goes a long way in helping with this. In the case of a runny nose for more than five days, the same problem can recur. Remember, if you have a cold, your child can catch it too.


What do you need to do?

Prevent cold and flu s as far as possible Visit a doctor if cold for more than 2 days. Avoid breastfeeding in the supine position and always have the head end elevated while feeding. In case of persistent or recurrent Acute otitis media a full battery of tests may be needed.

Why does the mucous discharge occur in Otitis media?

Your middle ear (the part of your ear behind the eardrum, containing ear ossicles ) has plenty of mucous-secreting glands.

Otitis(ear) media(middle) is the condition when there is inflammation of the middle ear. It can be acute, chronic, or another variant called secretory otitis media. Mucoid discharge from the ear occurs, when there is inflammation of the middle ear mucosa, associated with a defect in the tympanic membrane. Typically this condition may be associated with Allergic Rhinitis.

Why does negative intratympanic pressure occur in the stage of tubal occlusion of AOM?

The eustachian tube connects your middle ear with the nasopharynx (the part of your throat behind the nose), and gets blocked during cold/URI, due to edema. The mechanism of maintaining air pressure inside the middle ear gets hampered, causing negative middle ear pressure. The negative pressure causes inward bowing of the tympanic membrane known as retraction; This causes pain in the ear.

Due to the inflammation in the middle ear mucosa as the cells start secreting fluids, the air in the middle ear gets progressively reduced. But as more and more mucous gets accumulated, the eardrum then starts bulging outward with severe pain.That happens in AOM or acute otitis media. The eardrum looks like a pus-filled balloon that can burst if not appropriately treated.

Why acute otitis media occurs:Cause of Earache
Acute Otitis Media : When the Ear aches!

How quickly can a perforated eardrum recover from damage?

Traumatic ear perforation can heal by 7 to 10 days—the latest by three months. The ear meanwhile needs to be dry with appropriate medicines, prevent water entry strictly..

Ear perforation due to infection like Chronic Otitis media, however, need surgery. Initially, ear drops, but the definitive treatment is surgery for chronic otitis media.

Ear problems and Solutions

ENT Telehealth consultation

Homeschooling(Online School) in India: Counting fun Math for first graders #CauseAchatter

By on 1

Homeschooling in India? Do people even do that? They do . But it wasn’t really popular until the New Coronavirus crisis made children’s education become collateral damage.


Do you need help homeschooling? I am glad that I have experience tutoring, otherwise, this would be tough times. If you want me to teach your kid EVS, biology send me a mail at dramrita@healthwealthbridge.com.Otherwise just subscribe to get all the resource updates in your inbox as they come.

It’s not just about keeping children occupied. It’s about their golden years of learning. While I was planning on creating resources slowly, the lockdown due to the current COVID19 situation raced things up. It now means I need to keep things running smoothly, as far as possible when it comes to teaching my daughter.

Image courtesy the little A.Misra

Because this time will never come back and we must do what we can with what we have where we are .
While writing for Cause a chatter, I didn’t know we would be under a lockdown and homeschooling my daughter during this period.

Luckily I was tutoring my child for the last two years helped by my husband .So this year,when Blogchatter told us to champion a cause for Causeachatter I thought I should do my part about helping children study wherever they are .

Many parents work in remote locations and families split up or shift when the child becomes school going.The biggest reason behind this is,often the access to better educational resources in bigger cities.What if resources were available everywhere? Would this help people?Both free and paid resources online, to enable quality education for those who seek, that’s the goal.


I loved going to school,learning, playtime and growing with friends. Nothing can replace that. But for times like now and uncertain futures, we can all plan to make children learn wherever they are, if they have an internet connectivity.


The interesting thing about the internet is,there are a lot of free resources everywhere. The important thing is to have a structure as well as have fun while learning. That’s what primary education needs most. Once the child has fun satisfying their curiosity, they keep on finding ways to know more.


That’s why when I started planning about writing for cause a chatter I decided to create resources ,eBooks, worksheets, and make digital everything I have taught my daughter and am teaching .Internet does give you lots of options to learn depending on how deep your pockets are .That’s why sharing resources and also sharing the first of my educational resource available on Amazon.


I think as parents we can be careful about a balance between STEM education and right brained thinking.That’s why I will initially be sharing resources in STEM subject following the CBSE guidelines.

Now math’s is a subject,which is important in real life and academic life. Until we make it about relevance it stops making sense.


So how to make counting fun?


Count everything together at home.
Count her building blocks while you pick them up with her.
Count her pencils and rubbers and crayons. Help her make piles of different colored crayons and then count them together.
Ask her to teach you how to count in pretend play.
Ask her to count the pots, pans, cups in your kitchen.
She can also help you count your lipsticks and nail polishes.
The more she counts real life stuff, the better she gets. It also gives her a sense of accomplishment.

Interesting trivia about the Counting fun ebook:

All the iillustrations are doodled by my seven year old.She helped create this resource.It helps me and we have fun creating projects like this together.

Human body :Fun facts for kids

Know about Counting Fun maths for First graders

I am writing this for Cause A Chatter with Blogchatter .

If you want a cool Creative play idea,watch the Papermaking video below.Don’t forget to subscribe to my newsletter and follow my blog for updates about all the resources I will be sharing.

CODE M Review: Entertainment in times of #Lockdown

By on 2

If you are staying home and staying safe, I will be sharing something or other with you every day.  That’s what  I said and that’s what I will do.But the problem is in distressing times, we need entertainment which de-stresses.  For me, that’s watching thrillers or reading thrillers.

Code M on ZEE5 is a Hindi Web series I watched.  It also has Tamil and Telugu versions.  It stars Jennifer Winget, Rajat Kapoor, and Tanuj Varwani.  This is incidentally Jennifer Winget’s digital debut as Monica Mehra. The plot is about a terrorist encounter where Army Lawyer Monica Mehra is given the case of the unfortunate death of Major Ajay, during a terrorist encounter. 

I liked the idea of an Army lawyer looking for the truth about an encounter.  Rajat Kapoor as her superior gives it the right dose of seriousness and stops it from becoming chick flickish. After a tip-off from a source a group of Army men reach a suspected terrorist den.  There is firing from both sides and during the event two of the alleged terrorists and one army officer, Major Ajay dies.  The problem for the army starts when the terrorist’s mother self-emolliates and the media goes crazy trying to find the truth . Among the allegations and counter-allegations,  its  Monica Mehra who must find the truth.

While initially the mystery looks straight forward, she uncovers discrepancies in narratives.  Major Ajay was going to be Rajat Kapoor’s son in law. This unfortunate turn of events made the encounter personal too.  The public perception of a fake encounter made the investigation tricky and Monica’s job difficult. But she peels off layers from the mystery during the investigation.  Monica realizes during her investigation, that no one really wants her to find out what happened and the truth is not what it seems.

As she famously says

There are three version of an event

Mine

Yours

What really happened .

The truth is different,depending on who  is the  narrator .It’s a plot with plenty of twists and turns and action to keep you on the edge . Jennifer Winget is a favourite and she looks good ,strong and means business.

What I adored in Code M

  • Jennifer Winget in the action scenes.
  • How the plot unravels .
  • The mystery itself.

What really works  for me

  • Jennifer Winget
  • Jennifer Winget
  • Jennifer Winger

I said Jennifer Winget three times  because I like her work; a lot.  She is the USP behind this binge worthy ZEE5 show.

What needs more work ?

  • A racier plot.
  • The background score needs work.
  • A little tighter editing

Where to watch ?

 On ZEE5.

Production by Juggernaut Productions for ALT Balaji and ZEE5.  The series stars Jennifer Winget, Tanuj Virwani and Rajat Kapoor.

Who is it for?

If you have always like thrillers, you can definitely watch this show.

If you like strong women as central characters in thrillers, then this series will not disappoint.

If you look watching Army mysteries.

Plus if you are a Jennifer Winget fan like me, you will enjoy watching the show.

Disclaimer: The review for ZEE 5 show is based on the first few episodes.

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