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How and why of breast cancer?
Breasts have milk producing glands as well as connective tissue including fat, fibrous tissue, nerves, blood vessels, etc. Milk produced in the glands reaches the exterior through a network of ducts. Most cancers develop in milk producing glands and ducts and later continue to grow and spread to lymph nodes in armpit as well as distant organs.
Warning signs and symptoms:
Given the high incidence of breast cancer, knowing the symptoms helps in early identification. Read on to know more. Pay extra attention if there is a family history.
- Appearance of a lump in the breasts or the armpits
- Any change in the size, shape, or contour of the breasts
- Presence of a watery or bloody discharge from the nipple
- The breast or the nipple turning red
- Sudden thickening of breast tissue or skin that continues for a while
- Change in the feel or look of the skin (dimpling, puckering, scaliness, reddishness, warmth, etc.)
- Hardening of the tissue under the breast skin
- Difference in appearance or feel of one area in comparison with other areas
The presence of any of these or a combination of these symptoms should be an indication for a detailed check-up. As mentioned, early diagnosis helps in improving outcome. Treatment is also easier with early stage of disease. It is also good to know risk factors, which also indicate if you need to watch for symptoms.
- Family history: Breast cancer can run in families, and if you have close relative(s) with breast cancer, watch out for symptoms. Family member or self have a positive test for BRCA1 and BRCA2 Family history of other cancers Age Women over the age of 40 years are at an increased risk of developing breast cancer.
- Hormones: Increased use of estrogen increases the chances of developing breast cancer. Therefore, women who have used birth control pills for long time or are on hormone replacement therapy are at greater risk.
- Abnormal gynaecologic milestones: Women who have abnormal menstrual milestones are more predisposed to developing breast cancer. For instance, girls who have start of menstrual cycles before age of 12, get pregnant after 30, and reach menopause after 55. Women with menstrual irregularities including cycles earlier than 26 days and later than 29 days are also likely to have hormonal issues and are, therefore, at higher risk of breast cancer.
- Other factors: Smoking, alcohol consumption, and obesity also increase the chances of a woman developing breast cancer."
What is ECMO?
Like dialysis for unfunctional kidney, Ecmo for unfunctional lung.
Ecmo stands for extracorporeal membrane oxygenation. It is a method of giving oxygen for the body when icu pateint lungs and/or heart are not able to supply oxygen on their own.
Why ICU pateint put on ECMO?
Doctors place ICU patients on ECMO when patients are not able to supply oxygen to the body.
When a patient’s lungs fail, he/she first is intubated (breathing tube) and hooked up to a ventilator (breathing machine).
However, sometimes lungs are so damaged that providing oxygen through intubation is not enough.
This is when doctors turn to v-v ecmo.
A heart can fail for many reasons including heart attack, pulmonary embolism, bad valve disease, or worsening heart failure. When a heart fails, doctors try to fix the underlying problem. They may also start medications (called ionotropes) to help improve the pump function of the heart. If medications are not enough, doctors will turn to v-a ecmo.
How long can someone stay on ecmo?
That is a complicated question. Due to the risks of ecmo discussed above, doctors try to keep patients on ecmo for as short a time as possible. Often patient will be on ecmo for several days up to 1-2 weeks. Every day, several blood and imaging tests are done to determine if a patient is ready to come off ecmo. As the technology of ecmo improves, hopefully side effects will decrease and patients can remain on ecmo for longer periods of time.
What is the difference between ecmo and a ventilator (breathing machine)?
Both ecmo and a ventilator aim to provide oxygen to the body when the patient’s own lungs and breathing are failing. The ventilator assists the patient’s own lungs by pushing oxygen with pressure into the lungs. Ecmo instead provides oxygen directly via a catheter placed in a patient’s vein or artery. We almost always try oxygenating a patient with a ventilator first. However, when a patient’s lungs are too sick for this, we turn to ecmo to assist in providing oxygen to the body. V-v ecmo provides oxygen through a vein. This blood then has to travel to the heart and be pumped around the rest of the body through arteries. Therefore, with v-v ecmo or with a ventilator, a patient must have a well-functioning heart to get the oxygen pumped throughout the body. V-a ecmo has the additional advantage of pumping blood directly to arteries. This “by-passes” the heart and is therefore the method of ecmo we use when a patient’s heart is failing.
I have slip disc l4, l5 Should I avoid carrying weights. More over what are the exercise I must follow?
I am having problem in my spinal cord disc L4 -L5. With some loss of fluid. Now my knee joint also getting pain. What you wil suggest.
Uterine fibroids are the most frequently occurring tumors in the female reproductive system. These are non-cancerous, grow in or on a female’s uterus, and is curable. Many women above the age of 40 suffers from Uterine Fibroids. These Fibroids can grow as a single tumour or can grow in multiple numbers in the Uterus. The size of these fibroids may vary from a tiny spec to as large as a grape. In very rare cases, the fibroid becomes excessively large. However, such an occurrence is unusual. Homeopathy has several treatments to cure Uterine Fibroids:
- Uterine Fibroids- These tumors are benign (non-cancerous) in nature. The growth of the fibroids raises from the uterine muscle layers. Fibroids occur in women who fall under the standard age group of conceiving a child. Uterine Fibroids originate from uterus muscle cells that start growing unusually and gradually and give rise to the formation of a benign tumor.
- Uterine Fibroid and Homeopathy- In the treatment of fibroids, many homeopathic remedies are used. All of these homeopathic treatments are proven and valid. Fibroids are treated accordingly after the treatments condition matches with the patient’s symptoms of the fibroid. Once the proper matching is found then that particular homeopathic treatment is conducted to cure the fibroid of the patient. Following are a few effective homeopathic medicines that are used to treat the Uterine Fibroids.
- Phosphorus- When there is profuse and prolonged bleeding along with uterine fibroids, one of the best homeopathic medicines is Phosphorus.
- Calcarea Carb- A few women with uterine fibroids may experience sweating, anxiety, and/or a sensation of coldness. For such women, Calcarea Carb is one of the best homeopathic medicine. A Calcarea Carb patient is usually obese and has a tendency to sweats a lot. The patient might have a pungent odor, and the menses may last for too long. There are can also be itching and burning sensations in the genitals, prior to menses.
- Thlaspi Bursa Pastoris- This Natural substance is yet another Homeopathic medicine that works wonders in curing Uterine Fibroids. In some Fibroid cases where there is profuse and heavy bleeding during menses, this medicine helps extensively.
- Sepia- When the uterine fibroids come with indifference, irritability, and bearing down pains, Sepia is a good homeopathic treatment to choose. There is a sharp pain in the lower abdomen region. The patient feels as if there will be an outflow of everything through her vagina. To block the jutting out of the contents, the patient might feel the urge to sit cross-legged. The periods are too late and scanty. During coition, there may be a pain in the vagina as well.
Women with fibroids may experience heavy menstrual bleeding, pelvic pain, and such symptoms. However, the fibroids being non-cancerous are not to be worried, and they can be cured with the help of the proper homeopathic treatment. If you wish to discuss about any specific problem, you can consult a Homeopath.
These two words are enough to instil anxiety and assumptions in the minds of many. Replete with prejudices, myths and malpractices, this disease is more feared than managed or treated. For example, how often have women wondered if wearing a bra can cause breast cancer? How often have your spouse or a loved one talked themselves out of a diagnosis, because they were shy of the procedure, and also because they thought that there was no way they could have the disease? How often have they concluded that they need to get their breasts removed knowing a close blood relative had the disease or undergo an extremely painful chemotherapy regime if they were diagnosed with breast cancer?
Wondering and presuming these things isn’t their fault- it’s because of the general lack of awareness and hence, several myths the disease brings in its wake. In this section, we answer some of the most common myths surrounding breast cancer, in detail. It is of utmost importance to make women aware of these myths since this often leads to bad practices such as avoiding proper check-ups, which ultimately culminates into the delay in diagnosis treatment breast cancer, which can prove to be fatal.
Myth: Breast cancer risk is very low.
Fact: This misconception is one of the leading causes of a late diagnosis in India. Breast cancer is the most common cancer in Indian women, and according to the National Cancer Registry Program of India, it accounts for 27% of all cancer in women, as of 2012. About 1.5 lakh new cases are diagnosed every year of which, 0.75 lakh cases succumb to the disease within the 1st five years. India has the dubious distinction of having the highest incidence-to-mortality conversion in the world attributed to lack of awareness about symptoms, late-stage detection and poor treatment outcomes. In our country, this disease occurs at a much younger, premenopausal age, that is, the average age of around 45 in India as compared to 65 in the West. Approximately 1 in 22 Indian women carries a lifetime risk of developing the disease. Also, approximately 1 in 3 breast cancers will be identified as a triple negative breast cancer which is a aggressive breast cancer and is most prevalent in Indian women, compared to the 10-15% risk in other ethnicities.
Owing to the assumption that the risk is low and that cancer occurs at a much later age group, middle-aged women at a higher risk of breast cancer shy away from diagnosis and do not get annual mammograms done. In fact, according to a study carried out in Oldham, England in 2010, only 35% of Asian women were likely to attend the routine check-up done by National Health Service of England, as opposed to 70% of non-Asian women. The reasons behind shying away from getting an annual check-up done after 40 years of age could be ignorance, financial reasons, discomfort with the check-up procedure or anxiety of the reports. Regardless, this inertia in undergoing routine medically advised check-up of the breasts can result in missing an early diagnosis which then decreases the chances of effective treatment of the disease. At our clinic, we have seen cases where breast cancer has been diagnosed at a very early stage because the women underwent annual mammograms, and thus could be easily managed and cured. It is our humble request to all the women to break their inhibitions and get an annual breast check-up done under the supervision of a breast cancer expert after the age of 40.
Myth: If a woman is diagnosed with breast cancer, her breasts will be removed (mastectomized).
Fact: If breast cancer occurs, then there is 80% chance that the breasts will not be removed. Most women will have a single cancerous lump in their breast and the breast can always be saved by a well-planned, cosmetic surgery. Breast reconstruction is done in the same procedure with the same anaesthesia, resulting in better-looking breasts and cosmetics as they can be lifted and shaped according to the patient’s desire. A questionnaire conducted by our centre reported no depression and out of 147 patients surveyed, most were very satisfied with the reconstruction outcomes (94%). Mastectomy, or breast removal surgery, is performed in few percentages of patients- may be 20%, where there are multiple tumours. Therefore, it is of utmost importance that a woman does not fear the outcome of a diagnosis and delay getting examined altogether. Such bad practice can result in an advanced-stage breast cancer, which could have been diagnosed at an early stage and treated, now being treated by mastectomy, owing to the consequent delay in treatment.
Myth: General health check-ups are excellent for every diagnosis, including breast cancer.
Fact: This is one of the biggest and most dangerous myths. General health check-ups cannot diagnose any cancer, let alone breast cancer. Therefore it is pivotal for a woman to get a mammogram and clinical breast examination done at a specialized breast health centre, under the care of specialists and professionals. National expert panels do not recommend general health check-ups. The Canadian Task Force on the Periodic Health Examination as well as the United States Preventative Service Task Force, recommended focused health checks, as opposed to general ones, in 1979 and 1989, respectively. One review published in the Cochrane Library by Krogsbøllet al. in 2012 reported that “general health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes”, based on the trials that they conducted. According to an article published in 2015, in which a joint analysis was undertaken by medical liability insurers (Doctors Co. and CRICO, USA), amongst the 562 malpractice claims between 2009 to 2014, 39% related to the alleged negligent treatment of patients, including misinterpretation of diagnostic studies in general health check-up schemes.
In general, it is believed that about 48% of the delayed-diagnosis cases involved radiology, with primary care physicians or other clinicians have misread or misinterpreted the radiology report. General health check-ups is also a scheme by hospitals to pick up patients for treatment, with surgeons performing open breast biopsies (i.e, a surgical procedure where a cut is made through the skin to expose and remove tissues), which is an obsolete diagnostic modality for breast cancer. In fact, in America, according to sources, a doctor doing an open breast biopsy is liable to lose his registration. The biopsies should be done after careful radiological investigation and are only minimally invasive needle biopsies. Due to such myths and malpractices, women are afraid to present themselves for diagnosis, because they fear that every lump will be removed with a surgery. The fact is that out of 100 women presented with lumps, maybe 1 or 2 actually need a surgery.
Myth: Chemotherapy and radiation therapy should be avoided as they are extremely painful.
Fact: Both these types of therapies have been exaggerated to be ‘worse than death itself’. This is absolutely not true. Chemotherapy has improved leaps and bounds with drugs that are much easier to tolerate as they are targeted, which means that they predominantly affect the cancer cells and not the normal ones. Earlier, the known side effects of chemotherapy were nausea, vomiting, reduction of blood counts, and infections. Today with current improvements in the drugs with chemotherapy as well as antidotes against complications, chemotherapy has become extremely safe and the side effects have substantially reduced. In fact, some determined women take chemo and go to work. The only major, common side effect of chemotherapy as of today is the hair loss which is a temporary and reversible phenomenon A daycare facility is extremely proficient with the treatment, with most of the regimens needing just 5 hours or less. Many hospitals admit patients for chemotherapy, more for financial gains than an actual need for inpatient admission procedures. At our facility, chemotherapy is a procedure requiring maximum 5 hours, with loungers and personalized TVs, a counsellor and a nutritionist for free, private consultation in a spa-like ambience.
There are fewer side-effects of radiotherapy as well if done by adept radiotherapists and physicists with extremely sophisticated and state-of-the-art equipment. Both these procedures are extremely safe, with the woman not even needing hospitalization.
Myth: Wearing a bra, antiperspirants and deodorants can cause breast cancer.
Fact: It is due to the existence of these myths that the focus has been shifted from the actual risk factors to such obsolete ones. None of the aforementioned items has been shown to cause breast cancer. The real risk factors leading to breast cancer are of two types: the modifiable and the non-modifiable. The modifiable risk factors include alcohol, smoking, sedentary lifestyle, obesity, birth control pills, hormone replacement therapy, not breastfeeding and not having children or having them late. The non-modifiable ones include genetics, having a family history of breast cancer, older age, exposure to radiation, race and ethnicity, early menarche and late menopause. Most of the modifiable risk factors can be avoided if one took care of their health, diet and got sufficient exercise.
Myth: If a woman has a family history of breast cancer, she is likely to develop breast cancer as well.
Fact: While it is true that women who have a family history of breast cancer are at a higher risk of getting the disease, it is also true that most women who have breast cancer have no family history of the disease. Statistically, only 10% of the women diagnosed with breast cancer have a family history.
So what should you do if you have a family history of this disease?
That depends on your relation to that particular family member.
If you have a first-degree relative with breast cancer, that is, if your mother, sister or daughter developed breast cancer under the age of 50, you should consider some form of regular diagnostic breast imaging as well as genetic testing.
When should you consider it?
Starting ten years before the age of your relative’s diagnosis.
Having a first-degree male relative with breast cancer- however rare, but a clinically observed phenomenon also raises a woman’s risk of getting breast cancer.
If you have a second-degree relative with breast cancer, such as a grandmother or an aunt, your risk increases moderately, however, definitely not as much if you had a first-degree relative with breast cancer.
If you have multiple generations diagnosed with breast cancer on the same side of the family, or if there are several individuals who are first-degree relatives to one another or several family members diagnosed at the age of 50, you should be careful, as you have an increased probability of having a defective breast cancer-causing gene, given your breast cancer-prone family history.
In such scenarios, you should consult with a breast cancer specialist and undergo appropriate genetic testing only after prior genetic counselling of the family.