Palliative care at MIMS

What is palliative care? Is it synonymous to hospice? Does it mean terminal care alone ?

     

            Palliative care is an approach that improves the quality of life of patients and their families facing the problem  associated with life threatening  illness, through the prevention and  relief of  suffering by means of early identification  and impeccable assessment and  treatment of pain and other problems physical, psychosocial and spiritual. 

            Palliative care is a patient  centered approach . It is  death accepting but also life enhancing,  and offers a support system to the patient to live as actively as possible until death. 54 lakhs of people in India require palliative care. Palliative care comprises of co-ordinated services in home and hospital, as day care  and specialized centers extending till bereavement. Malabar area has  set a role model for community based,  palliative service in the world.

            At MIMS MOC, we opened a pain and  palliative clinic on 07-07-12. Palliative services are extended on a OP and IP basis. Extended support is provided to patients  even  at the point when active cancer treatment ceases. Thus active  medical care continue to palliate the patient  from his symptoms.

Collaborative Clinics

✗     Pain clinic -In associate with  Anesthesiology and Radiation Oncology Departments.

✗     Counseling Clinic - Psychiatric social worker

✗     Lymphoedema Clinic  - In association with  the physiotherapy Department

✗     Rehab Clinic - In association with the physiotherapy Department & rehabilitation.

Services

1. Symptom management in advanced cancer[Aiming for highest measure of patient comfort.

2. Pain management

3. Op /IP/Day care services

4. Terminal care/Sedation for terminally distressed patient

5. Abdominal paracentesis/Thoracentesis/Wound care.

6. Counseling sessions /Breaking bad new sessions

           

            We strive to bring quality care to cancer and beyond at, MOC, palliative clinic. Home care services will be our upcoming facility in the near future.

By  
Dr.Vineetha Rijju (MBBS, BCCPM, FPM) has specialization in Palliative Oncology.

About MIMS Hospital:The Malabar institute of Medical sciences Ltd (MIMS), the first NABH Accredited multi specialty Hospital in India, is situated in the heart of Calicut (Kozhikode), Kerala, India. It is a pioneer hospital in India renowned for its excellent medical expertise, nursing care and quality of diagnostic services. For more details : Visit http://www.mimsindia.com
Visit for other Articles:

DONATE ORGAN, DONATE LIFE

      Who can donate organs ?

h    First Hybrid Cardiac Surgery North Kerala,India

    Dr. Moopens’Foundation offers Free Heart Surgery for Afghan Girl in MIMS Calicut

 

Follow Us OnTwitter

Follow Us OnGoogle Plus

Pin It OnPintrest

Like Us On Face book    

Footsteps of Radiotherappy

Radiotherapy, one of the three pillars of cancer treatment [others including Chemotherapy and Surgery] involves the utilization of ionizing radiations [X –rays /Gamma Rays/Electrons/protons] for treating a variety of malignancies and also a few benign disease like craniopharyngioma, Neurofibromatosis, etc.,

Evolution of Radiotherapy

Radiation Oncology has evolved systematically and at the same time –by leaps and bounds from the days of Radium;Cobalt 60; kilo voltage X-Rays to the era of linear Accelerators /mega voltage X-rays and Iridium –192.

Fine- tuning of the evolutionary accomplishments has resulted in high precision treatment delivery.

Evolution of Technology

v  Conventional Radiotherapy

Employs treatment fields with regular, geometric dimensions [Square/rectangle, etc.]. However, this was wrought with avoidable irradiation of normal tissues surrounding the tumor areas resulting in:

a)      Under-dosing of tumor areas

b)      Higher normal tissue morbidity

v  3 D conformal RT

delivers radiation  to irregularly shaped fields – conforming to tumor volume , while protecting normal tissues to some extent with the aid of  multi-leaf collimators [MLC] of centimeter caliber

v  IMRT

With the advent of advanced treatment planning software systems , which could  process more complex planning algorithms , coupled with better image registration and machine up gradation-Intensity Modulated Radiotherapy[IMRT]-revolutionized radiation oncology at the turn of 21^st century.

The salient advantages of IMRT are:

a)      CT based slice –by slice planning

b)      Treatment of concave target volumes

c)      Effective dose limitation of organs at risk –eg:- Parotid/Rectum/Lung /Heart etc.,

d)      Millimetre –level of precision of dose delivery-achieved with the aid of micro-multi leaf collimators

e)      Higher tumoricidal dose delivery thereby providing better therapeutic index.

v  Gating

Image gated RT using 4D CT & Infra –red sensitive fiducials has found great use in treatment of cancers in mobile organs -classically lung tumors.

v  Rapid Arc

Ultrarapid IMRT delivery with least possible intra fraction variation enbabled by state of the art software.

Other recent advances include

a)      DART [Dynamic adaptive RT]

b)      Tomotherapy

c)      True Beam and the list goes on & on…

By
Dr. Sathish Padmanabhan (MBBS, MDRT) has specialization in Radiation Oncology.  

About MIMS Hospital:The Malabar institute of Medical sciences Ltd (MIMS), the first NABH Accredited multi specialty Hospital in India, is situated in the heart of Calicut (Kozhikode), Kerala, India. It is a pioneer hospital in India renowned for its excellent medical expertise, nursing care and quality of diagnostic services. For more details : Visit http://www.mimsindia.com
Visit for other Articles:

DONATE ORGAN, DONATE LIFE

      Who can donate organs ?

h    First Hybrid Cardiac Surgery North Kerala,India

    Dr. Moopens’Foundation offers Free Heart Surgery for Afghan Girl in MIMS Calicut

 

Follow Us OnTwitter

Follow Us OnGoogle Plus

Pin It OnPintrest

Like Us On Face book    

Advances in Surgical Oncology

"There must be a final limit to the development of manipulative surgery, knife cannot always have fresh fields for conquest. That limit is nearly reached, very little remains for the boldest to devise or the most dextrous to perform." 

These were the words of Sir John Erichsen which was published in Lancet , 1873. However all the phenomenal  advances in surgery has been after this period. Thanks to the development of anesthesia, bacteriology, antisepsis, radiology and blood transfusion which made surgery humane.

The treatment of cancer has been documented as early as 1600 BC in the Edwin Smith's papyrus. Surgery as a treatment for cancer  remained the only modality for a very long time, with medical and radiation oncology being the newest additions. Surgery for cancer has also traversed an all familiar path of conservatism to radicality and then for rationalized surgery, which was the result of better understanding of the tumor biology and advances in allied specialities in oncology. Oncological surgery was equated with mutilation and radicality, however the changing paradigm in cancer surgery has been the organ preservation and improving the quality of life.

Breast cancer surgery: Surgery for breast cancer has come a long way from Halstedian mastectomy to breast conservation to the current standard of oncoplastic surgeries and sentinel node biopsies.Thus many of the women are spared the mutilating effects of mastectomy and can preserve the form and aesthetics of the breast.

Muskuloskeletal Tumors: Amputations were the rule in extremity tumor has now been relegated to a position where it is performed as a last resort or for specific reasons. This has been possible due to advances on medical oncology, radiation oncology and prosthesis industry. Titanium custom megaprosthesis has been a boon in the treatment of these tumors , thereby salvaging many a limbs.

Reconstructive Surgery: Advances in reconstruction mainly through microvascular free flaps  has helped in reconstruction and restoration of many of the mutilating defect resulting from radical resections.

Minimally Invasive Surgey: Selected GI, Gynaecological, Thoracic and Urological malignancies can now be extripated using minimally invasive techniques and this has been possible mainly due to advances in Laparoscopic surgeries and developement of robotic surgeries.

"To sure sometimes, relive often and comfort always."

Dr Dileep Damodaran MS, DNB,  Mch (Surg Onco)

Surgical Oncology, MIMS
Dr Dileep Damodaran completed training from Cancer Institute Adyar, in the field of Cancer Surgery.

About MIMS Hospital:

The Malabar institute of Medical sciences Ltd (MIMS), the first NABH Accredited multi specialty Hospital in India, is situated in the heart of Calicut (Kozhikode), Kerala, India. It is a pioneer hospital in India renowned for its excellent medical expertise, nursing care and quality of diagnostic services. For more details : Visit http://www.mimsindia.com

Also Read Other Articles
Globalization & Healthcare: Understanding Health & Medical Tourism
First Hybrid Cardiac Surgery North Kerala,India
MIMS Witnessed one more Cadaver transplant Surgery

Follow Us OnTwitter

Follow Us OnGoogle Plus

Pin It OnPintrest

Like Us On Face book     

For Other Article visit:

Who can donate organs ?

First Hybrid Cardiac Surgery North Kerala,India

Dr. Moopens’Foundation offers Free Heart Surgery for Afghan Girl in MIMS Calicut

MIMS witnessed the world’s first 3D Laparoscopic approach for giant renal vein aneurysm and successful auto transplantation

 

Scarless Endoscopic Thyroidectomy

Surgery for the thyroid gland is usually done throgh a transverse incision in the lower part of the front of the neck. Most people especially unmarried women and men hesitate to undergo the surgery because of this reason. Though this scar will hardly be recognizable in a small group of patient, in the others it will remain prominent. The problem is that it is impossible to predict the behavior of the scar.

 Picture of classical scar

Surgeons have been incessantly trying out methods to decrease the size of the scar or totally avoid the scar. A new technique of Endoscopic Thyroidectomy is now available. In this the thyroid is approached thro the region of the axilla and the side of the breast by Keyhole method (called the Axillo Breast approach). Using the conventional laparoscope and instruments the thyroid is dissected and removed. Since suturing is not practical  in this type of surgery , ultrasonic cutting instruments are used for cutting and coagulation of blood vessels at the same time. The final scars will be small and at areas covered by the dress.

Diagram showing the approach

  

The first Endoscopic Thyroidectomy in Kerala was done at the MIMS hospital Calicut, in the general surgery department, in Nov 2011. A right Hemithyroidectomy (Removal of the Right half of the thyroid) was done on a 39 yr old lady. The second operation of this type was done on a young unmarried girl recently. Removal of the whole thyroid gland also can be done by the same technique. The time take for the operation is slightly higher than the conventional procedure.

While performing a Thyroidectomy, the surgeon needs to identify and preserve the nerves to the voice box (larynx) and also the minute parathyroid glands which are situated just behind the thyroid. Damage to the nerve can cause changes in the voice and damage to the parathyroid glands can cause the blood calcium levels to become low. In the Endoscopic method the magnification provided by the endoscope facilitates this more objectively. 

Endoscopic view of  nerve and parathyroid glands
 

Since the scars are small, the pain is less and the patients are happy to go home earlier. The term minimally invasive may be a misnomer for this operation since the areas that are dissected are more than in the conventional thyroidectomy. The advantage mainly lies in the situation and the size of the scars. 

Choosing the cases suitable for endoscopic thyroidectomy is important. Patients with very large goiters, Thyrotoxicosis, thyroiditis, thyroid cancers and recurrent thyroid swellings are not the ideal candidates for this surgery. This approach is a boon for those who need thyroid surgery but are worried about a scar in the neck.

Dr. Rojan Kuruvilla

Sr. Consultant Surgeon, Department General Surgery, MIMS Calicut.

Dr. Rojan did his MBBS and MS from Medical College, Calicut.  After two years as junior surgeon at the AKG Memorial Hospital, Kannur, he joined the department of surgery at the Christian College, Vellore, as Senior lecturer in surgery and continued in that capacity for five years. During this period he obtained the Diplomat of the National Board in Surgery. Following this, he went on to U.K and worked as Registrar in Surgery at the North Thames rotation for three years and completed FRCS from Edinburgh during that period. On his return, he went on to head the Department of Surgery at Pushpagiri Hospital in Thiruvalla before joining MIMS. His special interests include Thyroid, Parathyroid, Endovenous surgery for varicose veins and Laparoscopic Hernia Surgery in which he gained training and expertise while he was abroad. He has one of the largerst series of focused Parathyroidectomy in the state.The first Scarless Endoscopic Thyroidectomy Surgery in Kerala was done by him in Nov 2011. 

About MIMS Hospital:

Malabar Institute of Medical Sciences Ltd (MIMS) is an NABH Accredited hospitals in  Kerala renowned for its excellent medical expertise and diagnostic services. It is located at the heart of Calicut and administered by highly qualified medical professionals. The hospital has an emergency and trauma care unit supported by a blood bank. It is one of the best hospitals in India renowned for quality service and patient safety.
Visit http://www.mimsindia.com