Thread by @drnitinyashas

"Doctor, the cancer has spread to the brain. Would he be alive for atleast 3-4months? There are so many things we want to do for him " 2 children enquiring about their elderly father brought in with seizures
Read on this miraculous story.
#CancerAwareness #oncology #MedTwitter

An elderly patient who was diagnosed as #lungcancer 2 years back presented to the ER at 5 pm with multiple episodes of seizures. He couldnt speak, recognise his daughters and was having slurring of speech. His consciousness levels were low
#CancerAwareness #oncology #MedTwitter

A MRI of the brain done showed one of the most tragic sights-multiple areas of the brain affected by Cancer deposits. In the image you can see them as the fluffy white spots.
#lungcancer #MedTwitter #oncology

Such an advanced disease with involvement of the brain, nothing could have been done a decade back. patients would have been sent home, asked family to spend as much time as available and give medicines to keep them comfortable.
#oncology #MedTwitter

However #oncology in the field of #lungcancer has advanced a lot . It is the era of #PrecisionMedicine .
#Cancers arise as a result of errors in the software of our body- the DNA and these errors are termed mutations
This patient's tumour had a mutation called ALK
#MedTwitter

The good thing is that ALK in #lungcancer has oral tablets available. Imagine the advance that for an aggresive cancer which has spread to the brain , we are now talking about using oral tablets and not chemotherapy- the wonder of science
#oncology #MedTwitter

We counselled the relatives that there is an option of trying targeted therapy with oral tablets. these do cross the blood brain barrier and can have good efficacy.But given his current critical situation, would there be enough time for the tablets to act.

Furthermore the tablets were expensive.
The relatives were determined that they would do all that they could to try to better his health.
They decided they would not shift to ICU & put him on ventilator/dialysis, but for everything else they were ready to give a "chance"-

A chance was all that was needed. We first tried to stabilise him. Gave him steroids & other medicines to lower the increased pressure in his brain &
We inserted a tube through his nose to the stomach to take care of nutrition &to prevent food from going into lungs.
#MedTwitter

That is when we realised we had a problem. The expensive tablet comes in the form of a capsule. TO give the capsule through the nasogastric tube was not possible. We were stuck . Expensive tablet ordered, the one last hope now fading away due to a technical difficulty.

But the power of the #Internet . the power of #science
We read up case reports from Japan where the capsule was opened and the contents were given through the NG tube.
We discussed with the family about this possibility and limited data behind it and they agreed

Slowly but surely we noticed some improvement. He opened his eyes, began responding, attempted speech after 10 days.
But was this the Calm before the storm #MedTwitter #oncology #lungcancer

He suddenly became breathless, saturation dropped to 60%, his respiratory effort increased.
Was it the cancer growing? Was all hope lost?
Fortunately a CT done showed the brain lesion were stable but he had developed a bad pneumonia- common in the elderly admitted in the hospital

After increased antibiotics, suctioning of the secretions, he slowly improved. His neurological status also started improving.
After 1 month in the hospital, he could make eye contact, respond and was awake & alert.
We discharged him

after 3 months the daughters entered the OPD first. there is a foreboding when only the relatives come and not the patient.
And then they showed us this MRI and the WONDER of MODERN ONCOLOGY.
NEAR COMPLETE DISAPPEARNCE OF THE TUMOUR
#MedTwitter #lungcancer #oncology #hope

And then the patient walked in. Talking, Laughing , speaking,
And i lay transfixed at the MRI and how the tumours in just 3 months lost a battle to innocuous appearing oral tablets . The mighty #lungcancer meeting its match in #PrecisionMedicine
#Medtwt #MedTwitter #oncology

As a Oncology resident in my first year, I learnt from my professor Dr. Amit the skills of communciation, counselling and seeing hope based on science.

The act of trying to find case reports of opening capsule and giving through the NG proved decisive- the quality of not giving up and finding innovative solutions from my professor Dr. Poonam

This happened in 2018. Its close to 5 years now &the gentleman reaching 75 years is enjoing the walks in park, playing with his grandchildren & reflecting on a dream of pursuing a PhD .
The tumour kept at bay , the body guarded by the mighty targeted therapy

The tale doesnt end. The Journey goes on. This happened in 2018. The patient is now crossing almost 5 years of survival, 5 years filled with laughter, moments of walking in the park, playing with grandchildren & reflecting on dreams to pursue a PhD.
Age is just a number #gerionc

This is how #Cancer is being beaten.
Yes the medicines are expensive and out of reach most of the times But its a matter of time & with policy interventions that accessibility improves.
But the journey of advances to conquer the #emperor of all maladies needs to continue.

Grateful to have had my residency at the amazing Manipal Comprehensive Cancer Centre , Old airport road , Bangalore & thrilled to be back working as part of the same team with mentors par excellence as I strive 2 deliver evidence based care wit compassion across diff units.