Cervical cancer

"Cervical cancer is one of the most common cancers among women worldwide. The incidence of death and disability from this cancer are very high. The need is therefore for the prevention and control of cervical cancer at an early stage."- World Health Organisation

“Ahhhh…..god…Nayana, please help……..”

*Thud*

Nayana had just turned off her headphone when she heard something fall and turned around to see what it was. Kirti, her sister-in-law, was lying on the floor, clutching her abdomen and crying in pain.

“Crap…." she ran to her. "What happened…..” she tried to help Kirti to her feet . Kirti yelped in pain unable to stand.

“Ok, relax,  I’ll call for help..” No one was at home and panicking she dialed for the family doctor. Luckily he lived just a few blocks away.

“How did you fall down?”

“Ahhh…I….ahh..no…”

 “Don’t bother answering, relax, keep breathing…yea, good girl….keep breathing… Here comes the doc."

After examining her, Dr. Prasad had a worried look on his face.

“I think she needs to see her gynaecologist right away. I have given her a jab for the pain now, but the sooner you take her to the hospital the better.”

“What’s wrong doc?” Nayana had a worried look on her face.

“Lot of things could be wrong, but I don’t want to speculate without a proper probe. Just take her, ok?”

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“Kirti, how long have you been having this pain?” asked Dr.Roopa, Kirti’s gynaecologist.

“ For some time now, doctor, must be around a couple of years, but I usually had dull aches lasting four to five minutes, which would go off on its own. Never this sharp.”

“Any abnormality in your monthly cycles or anything else you can think of?”

“No, but now a days there’s a lot of pain during urination.”

“Why did you wait so long to come and see me?”

“I was taking painkillers, it subdued the pain and I didn’t think it was serious.”

“Why do you have to self-medicate? Anyway, have you ever got a Pap smear test done before.”

“No”

“Well, I’ll do a pelvic examination first. Don’t panic, I am using a Colposcope to have a look at your cervix. It may cause you a little discomfort. We’ll get a Pap smear test done too. Are you on any medications?”

“No. What’s wrong with me doctor.”

“Let’s find out. Now lie down and I want you to relax.”

“Ahhhh….it hurts terribly doctor….” Kirti was screaming again. “Oh my god, what’s all this blood?”

“The examination must have caused irritation in the cervix. It’s ok. I’ll ask the nurse to  help you.”

Dr.Roopa looked worried too as she left Kirti in the examination room to change and sat down on her chair.

“Doc…is everything ok?” Nayana had a huge question mark on her face.

“Nayana, does anyone in your sister-in-law’s family have a history of cervical cancer or any other cancer?”

“I think her grandmother died of cancer. I am not sure what cancer it was. But why do you ask?”

“You are more predisposed to cancer if you have a genetic history.”

“What? Kirti has cancer?”

 “I am not saying she has. Her symptoms look like that. And it seems pretty bad too. Even the pelvic examination was painful for her. And she bled during the check up. The irritation of the cervix can cause bleeding if the cervix is not healthy. These can be cervical cancer symptoms.  Painful urination is another symptom. But I am surprised that she did not come to me sooner. Symptoms usually occur in advanced stages. I am also surprised that she has never got a Pap test done.”

“What is a Pap test Doctor?”

 “A Pap test, also known as a Pap smear or a cervical smear, is a simple tool used to screen for cervical cancer. Pap tests are important because they can find cervical cancer or abnormal cells that can lead to cervical cancer.” she explained.

“Ideally,” she continued, “Once a woman is in her productive age, a Pap test should be done every three years, unless your doctor says otherwise. Cervical cancer symptoms often go unnoticed because they mimic so many other ailments. Many women pass these symptoms off as PMS or ovulation pains. The bottom line is that you should not ignore your symptoms or wait for them to go away on their own. Self-diagnosing through information found on the internet is not recommended, either.”


“I can’t believe she has cancer.” Nayana was reduced to tears.

“I have taken a cervical smear sample and sent to the lab, we can expect the results in two weeks. Don’t draw your own conclusions. Let’s wait and hope it is nothing.”

Kirti had been listening to ever word and now they hung heavy on her head like Damocles sword. She buried her face in her hands and sobbed.

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“Why me?” she sobbed harder on the way back home as Nayana struggled for words of encouragement.

“Come now, cheer up yaar, the results have not yet come. It will be nothing, trust me, you’ll be fine.”

As they broke the news to their family, everyone was shocked. Most of all, Jai, Kirti’s husband.

He tried to think of something cheerful to say.

“You’ll be fine, love, we are all with you"

                                                                     ***************            

Two weeks seemed like a hundred years and when the call finally came, Kirti could not muster courage to pick up the call. She passed her phone to Nayana. Nayana spoke to the doctor.

"Yes doc, we’ll see you immediately.”

“What did she say?”

“Let’s go to the hospital Kirti.”

“It’s positive isn’t it?”

“Yes.”

“I’ll take her to the hospital Nayana” said Jai putting a comforting hand on Kirti’s shoulders.

“Sure Bhaiya, come along. She needs all the support she can get.”

                                                  ********************

“Jai, the tests are positive for cervical cancer. I want her to get some more tests done.”

She wrote down on her prescription pad.
Chest X ray
CT scan
Lymphangiogram
Ultrasound

 "How did she get the cancer? I though it affects women with multiple partners."

"Human papilloma virus (HPV) infection is a sexually transmitted virus that causes cervical cancer. The reasons could be many.

1. Cervical cancer-causing HPV types are nearly always transmitted as a result of sexual contact with an infected individual. Women who have had many sexual partners generally have a higher risk of becoming infected with HPV, which raises their risk of developing cervical cancer. There is also a link between becoming sexually active at a young age and a higher risk of cervical cancer.

2. If a woman develops cervical cancer it does not mean she had several sexual partners, or became sexually active earlier than most other females. It is just a risk factor. Women who only ever had one sexual partner can develop cervical cancer.

3. Smoking increases the risk of developing many cancers, including cervical cancer.

4. People with weakened immune systems, such as those with HIV/AIDS, or transplant recipients taking immunosuppressive medications have a higher risk of developing cervical cancer. 

5. A woman who experiences a high level of stress over a sustained period of time may be undermining her ability to fight off HPV and be at increased risk of developing cervical cancer.

6. Women who gave birth before the age of 17 are significantly more likely to develop cervical cancer compared to women who had their first baby when they were aged 25 or over.

7. Women who have had at least three children in separate pregnancies are more likely to develop cervical cancer compared to women who never had children.

8. Long-term use of the contraceptive pill slightly raises a woman's risk.

9. Women who become infected with chlamydia, gonorrhea or syphillis have a higher risk of developing cervical cancer..

10. Women in deprived areas have significantly higher rates of cervical cancer, compared to women who live in other areas. Higher rates are also found in women of working age in manual jobs, compared to women in non-manual jobs .

 “How bad is it doc?” asked Jai,beads of perspiration starting to form on his forehead.

“When caught early, it is curable. Even with advanced stages included, the overall chance of surviving at least five years, with likelihood of a full cure, is still better than 70%. Only when the cancer spreads to distant organs does prognosis for five-year survival dip below 20%. Recurrent cervical cancer carries an even lower chance of survival.”

“What are Kirti’s chances?”

“These tests will help us find out how bad it is. Whether the cancer has spread to other parts, like her lymph, pelvis and other parts of her body.”

“Is it in its early stages?” he asked.

“Cervical cancer is a slow-progressing disease. It can take years before cervical pre-cancer develops into cervical cancer. Of course, it can happen sooner in some women, but for most it takes several years. If she had been getting regular Pap smears, then any cervical abnormalities would have been detected.

Pain is not an early cervical cancer symptom. Therefore, she should not have waited to feel pain before seeing a doctor. It looks advanced to me.”

                                            ******************

The results of the tests were not encouraging either. Dr.Roopa’s eyes conveyed that all was not well as she read the report. Taking a deep breath and placing an understanding hand around Kirti, she announced, “Stage IIIB”

“What does that mean doctor?”

 “Stage IIIB means her cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureters ,that is, the tubes that connect the kidneys to the bladder. She has pain on urination because the cancer has spread to her bladder. In stage IIIB, cancer cells may also have spread to the lymph nodes in the pelvis.”

“What next?” Jai was shattered that someone as delicate as Kirti, would have to suffer so much.

“We’ll discuss our options with an oncologist, whether he would recommend surgery or radiation.”

“She’s just 32, doctor, how could this happen to her?” Jai could not bear to think all this was happening to her.

“Cervical cancer can affect any woman. That is why screenings are extremely important because they can help doctors find abnormal cells before cancer develops. Finding and treating abnormal cells can prevent most cervical cancer, and treatment is more likely to be effective if cancer is found early.

In fact, if your doctor thinks you are at risk, she may even ask you taken vaccination for its prevention. But the problem is women somehow seem to ignore their health. Your doctor can tell you when you should begin having Pap tests, how often you should have them, and when you can stop having them. This is especially important for women who have a higher-than-average risk of cervical cancer.”

“Doctor, I will bring the entire women folk in our house, my mother, sister and bhabhi to you, I am sure none of them has ever got a pap smear test or vaccination done. I don't want anyone suffering like this again."

"I wish all men thought like you. Had you known about the screening earlier, Kirti could have been spared this trauma. ”
                                     

                                                     *****************

(If you are a woman in your productive age, get a Pap smear test done soon, and if you a man, you know what to do!)

Trust....

Cobwebs on the corners of the mind,

With a spidery thought in its midst,

An unsuspecting fly of trust flits by,

Only to be gnawed and nipped.

            A mammoth arachnid that’s learnt,

            That trust does not always beget one,

            A time when it was a butterfly,

            Spreading its wings in the sun.

Cruelly clipped by master fate,

And replaced with a murkier twist,

Slowly that’ll transform too,

Could it be spared the tryst?

             How oh how do I bring back,

             My butterfly back to life?

             Erase the agony, the pain, the suffering,

             The vengeance and all the strife.

Will the tiny drops of morning dew,

And the first bright rays of the sun,

Wash away the cobwebs and,

Bring back the colours and fun?

             Perhaps it has not the muscle,

             To blanket the hurt and fear,

             A storm maybe, will wash the dirt,

             In its grimness, bring back the cheer.

Valentine couple -part two

read part 1 here.

Nitika had become Akash's baby, depending on him for every single need. She knew he was always there, nurturing her like a mother does. Apart from the pain of not being able to do anything other than lying down, she did not have any regrets.

I met them again after an year. Her eyes smiled, taking over the job from her lips which could barely move. She tried bringing her thumb and index finger together, looking affectionately at Akash and her kids, signalling, what a wonderful family god had given her!  She rolled her eyes upward and then closed them as if in prayer. I knew she meant that she had so much to thank her master for. She looked at Akash and a tear rolled down her eye, and yet it was so full of love for him. She was thankful for him, for her children, who never thought of her as a burden.

"She does that each day, signalling with her eyes and fingers, trying to tell us how grateful she is to me, to her children and to her god. But I tell her, how grateful I am to her, that she chose not to let go."

A stray strand of hair on her face seemed to annoy her, and I straightened it for her,and pushed it behind her ears.She blinked.

"You see that? She thinks she is being a baby, but she is actually my queen. She is on her "Simhasan" all day long, giving me instructions on how to run her palace.' he laughed. " And we keep running around like her "mantris" . I love the sparkle of her eyes, and the glow on her face, doesn't she look as charming as she was when I married her?"

"You bet she does, Akash" I had got my smile back. I shouldn't being feeling sorry these guys. Atleast not when they were themselves carrying on with life as if nothing had happened. Who was I to spoil their party?

But when your time is up, no love is great enough to bring you back, no prayers are powerful enough to turn back the wheels of time, and no tears are moving enough to melt the heart of your master. When he calls, you must heed his call and leave to meet him.

I had been in the middle of a vacation, when Akash called me. Worry was writ large in his voice.

"Everything ok, Akash?"

"Nitu has had a massive heart attack. We have rushed her to Orange city hospital, can you come over?"

"I'll be there by evening, don't worry everything will be fine", I tried to reassure him without really believing in it myself. Would things be fine?

She struggled for a couple of days before she eventually left to meet her maker. When he brought her home for the funeral, she looked at peace and I thought I could even see a smile on her face. Akash was surprisingly calm and I feared he would go into depression, if he did not come to terms with her loss.

"Akash," I placed a hand on his shoulder, struggling for words," Let her go. She will be safe in his hands too. You looked after her well. She would have been so proud of you and your children. Look at the smile and calm on her face."

"I had to, didn't I? She looked after us tirelessly for the first half of our married life. I am glad I could tell her how much I respected her and her love for us. I am thankful to god he gave me the opportunity to take care of her. If she had left us the day she had a stroke 13 years ago, I would have lost that chance. Anyway we never felt she was any different than us. She didn't have the mobility, but otherwise she was perfect in all other respects. I am happy she left us with a smile."

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(image courtesy: google)

Unrequitted love!

The beautiful earth smiled,

As she saw the first grey cloud,

Would her knight in shining armour,

Call out to her aloud?

Would he pour down upon her,

In his arms would her embrace?

Caress and tease and kiss her,

Make her heart pound and race?

She’d pined for him for long,

Bore the separation, the pang,

Living by memoirs of happier times,

When together they danced and sang.

He had drenched her with so much love,

She had blossomed into colours of every hue,

He had crowned her with his rainbow ring,

It had killed her to bid adieu.

Hearing him thunder and glow,

She was bedewed with mounting athirst,

Oh, there he comes, he felt him touch,

Upon her silken crust.

The magical moment she’d waited for,

Arrived, but sans all its glory,

For he came down with a force so torrid,

Shattered her with his fury.

Crushing her with all his might,

Destroyed her from deep within,

The beautiful flowers, the dancing trees,

Gave in, leaving her barren.

He raged and stormed all day and night,

And tore her soul apart,

She wondered why his love had soured,

Why hate had filled his heart?

As though by some crafted design,

He disappeared into the clouds,

Never to be seen or heard again,

In mystery it was shroud!

Through days and weeks and months,

She waited and pined for him,

Her lovely colours rusted away,

Her brightness starting to dim.

The sun shone bright and golden,

It burned her delicate skin,

Parched for his love and care,

She turned to stone within.

Would she ever be able,

To trust anyone else again?

Her heart and mind, body and soul,

Shattered by the deceitful rain.

Girl-friend..?

“Mom, which is the tallest mountain in the world?” asked my elder one with a Let-me-test-your-IQ look on his face.

Pat came my reply,“ ‘Mount Everest’, whoever wouldn’t  know it?”

“Wrong mom, it’s Mauna Key, in the pacific ocean.” He corrected me, launching into a detailed explanation why it was the tallest.

While I admired how he had become a walking encyclopedia in our house, I was a little worried about his social skills. Was he making friends? I decided to ask him.

“Beta, who is your best friend in school?”

He seemed to ponder for a while before asking me back, “Girl or boy?”

Oh, so he had friends among girls too. Good for him, he is not as shy as I thought he was!

“Both” I wanted to know.

“Aadya and Samanyu.”

He had spoken to me about the boy, how they had been always fighting at first and then they became best buddies. But the girl..? Why didn’t he tell me? I must ask…

“Hmm…nice name, Aadya. New girl in class?”

“Oh, didn’t I tell you before, she’s my girlfriend.” He said as a matter of fact.

Did he just say girlfriend? For god’s sake he was not even 9, and here he was talking of girlfriends!

“Of course, girl-friends and boy-friends..”

“No, not girlfriend as in girl-friend, but girlfriend.” He said without batting an eyelid.

I was suddenly very uncomfortable. A 9 year old explaining to me the difference between girl-friend and girlfriend, ha! But I carried it on like a normal chat.

“Great, and how did you two become friends, I am sure there’s an interesting story like the one with Samanyu.” I said trying to sound pleasant.

“ Yea, mom, I was playing with my friends, running around when I crashed into Aadya. She was so angry that she wanted to complain to the teacher. I gave her a friendship band and said sorry, and she did not complain. Isn’t that sweet? Then she got a friendship band the next day and gave to another friend asking him to give it to me. And then we became the best of friends! To me, she’s extra special.”

“Sweet..”

Hubby dearest was looking at me quite amused at our conversation. He signaled at me to stop. When the elder one went out to play, I went back to my hubby.

“Oh my god, look at this generation. Can you imagine a girlfriend at 9 years?”

“For god’s sake, he is only a child. Stop going into overdrive”

“Overdrive? He knows the difference between girl-friend and girlfriend.”

“Don’t be silly, he is growing up and seeing so much around him. It is natural for him to feel and talk that way. I’d be worried if he didn’t!” he winked.

“You bet, he is going to bring a girl home one day and say, mom, she is your bahu.”

He burst out laughing. “Oh you and that screwed up brain of yours. Be thankful that he trusts you enough to tell you every single happening in his life. Now, don’t you scare him with your silly thoughts and advices that he stops being open with you.”

Now, that was a thought. I was indeed being silly.

“I guess you are right. By the way, who was your first girlfriend?”

Hubby dearest had a far away look in his eyes and a smile beginning to spread on his lips.

“I was in class 4, and she taught us Maths….Sarika Ma’m, yes that was her name….”

“Really?”  My ears were all perked up. “….And…” I asked rolling my eyes.

“And what? that’s it!” he baulked looking at me , standing with my hand on my hips. “Oh no,not again…”he said shaking his head,  eyes closed as if in thought.

(image courtesy :google)