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» Feb 2012
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ISSN 2277 - 8004

Editor in chief
Dr Ajay Kumar Dewan

Editorial board
Dr DC Doval
Dr Rupali Dewan
Dr SK Sharma
Dr Abhinav Dewan
Nani Ma

Web editors
Pooja Dogra
Steven Lopresti

Co-web editor
Mridul Dewan

Disclaimer
The statements and opinions contained in the articles of the India Journal of Best Supportive Care are solely those of the individual authors and contributors, and do not necessarily reflect the opinions or recommendations of the publisher. The publisher disclaims responsibility of any injury to persons or property resulting from any ideas or products referred to in the articles or adverrtisements.

Printed, published & edited by Ganga Prem Hospice
Dr Ajay Kumar Dewan, Editor on behalf of Center of Palliative Care, Ganga Prem Hospice, Rishikesh

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CONTENTS
» Care vs Cure
» Treating Cancer with Neuropathy and Pranic Healing
» Quality of Life through Yoga
» Skin Cancer: Causes, Prevention, Symptoms & Treatment

Indian Journal of Best Supportive Care
June 2012

Care vs Cure
by Dr AK Dewan

In general, oncologists and nurses are more comfortable while treating patients if the goal is cure. Even hospitals have become centers of curing rather than caring. Cure is interpreted as removal of physical disease focused on anatomical lesions. Cancer has been perceived as an organ dysfunction rather than as an illness which affects the whole person. Doctors' perception of cure is centered on the disease in terms of five year survival. There may be iatrogenic side effects (treatment related complications) which may linger on even after many years of cure. The treatment of the chronically ill is not very satisfying because the treatment is long and non measurable.

There is emphasis on acute hospital beds. There is scarcity of beds for patients requiring extended care for chronic illness. The health care system will have to be revised so that care of chronically ill will be seen as rewarding as the cure of acute conditions. As the aging population in our country is growing and the number of cancer survivors is increasing, we need to develop training programmes for health professionals specializing in care of aged and cancer survivors.

Sometimes a conflict exists between technical care and personal care. In this modern era, time to listen to patients may be perceived as a luxury. Medical training concentrates on clinical competence and there is a danger that compassion and empathy may become redundant. Personal care is different from technical care whose results can be quantified. Personal care respects the dignity of the patient and acknowledges his humanity.

The word "care" has its roots in the Gothic "kara," meaning to grieve, experience sorrow, cry out with. The person who truly cares (personal care) must join with the person in pain. Sometimes that is all that can be done, which is hard for anyone to accept, and especially hard for doctors, who are trained as mechanics, not healers or caregivers. But the doctor can heal, even if he or she cannot cure. What the sick and the dying most need from those around them is an acknowledgement of their shared humanity. If he has nothing to offer medically, he can still offer a hug or a hand to acknowledge the pain of a fellow human being.

I don't mean to suggest that this kind of care is easy, especially when we are caring for someone who may be close to death. That takes great courage. I know, you feel insecure, don't know what to say, don't know what to do. But please believe me, if you care, you can't go wrong. Just admit that you care. I am reminded of a day recently when a patient I was visiting reached out her hand to me as I started to walk out of the ICU. She was on a ventilator and could not speak and she wrote to me, "You won't leave me?" I said, "I have to leave now because I have to reach O.T." She wrote again, this time in bigger letters, "But you won't leave me?" Then I understood what she was really saying. I told her that of course I would never leave her, but would always be there when she needed me. That was all she wanted, and that is something I can give her, even when I can help her in no other way.

If you are a healer, you will offer hope as long as your patient wishes to continue fighting. Hope and love cure people when medicine and surgery can't. Nobody's disease is hopeless, but many people are. Unfortunately, hope and love are the most neglected remedies. Hope is useful when things are hopeless. Hope is useful in many ways. You must remember, however, that the hope referred to is the patient's, not the doctor's. As the "attending" physician, you must learn to pay attention to what hope means to each individual patient.

Let us raise "care" to the level of "cure" in the value system of the healthcare. It is our job to defeat the pain of living, not death.

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Treating Cancer with Neuropathy and
Pranic Healing
by M. S. Sundarajan

What is Cancer?
Cancer is a collection of abnormal proteins in different organs. Treatment is to destroy the abnormal proteins and to arrest their development in the formative stage.

Obsessive desires and ambitions can be a significant reason for the physical manifestation of tumours. Prevention of cancer involves not to resist whatever happens in our life and to have a “let go” attitude. A joyful heart can also avoid the formation of abnormal proteins. Some say that even factors from past lives can play a role in getting this disease.

Physical reasons for getting this condition are mainly due to digestion, i.e. food is not digested properly, causing a reduction in glyco-nutrients which increases the formation of abnormal proteins that lead to the development of cancer. So we have to chew our food properly in order to digest it well. Eating the right level of food can also make you stronger. Emotional balance can also avoid the formation of abnormal proteins. Contentment in life without too much demand or expectation can help one to achieve this balance.

Our Approach
Generally when cancer patients come to us they come with either 4th stage (advanced stage) cancer or after starting chemotherapy. We treat them accordingly. When patients go to their medical care providers and are told that they have cancer, the first casualty is a loss of their hope or faith. So when they come to us we give them full moral support and help them to accept the condition as it is. We do this by counselling.

We also help them to revive their immune system. They come with a lot of pain and we help them to bear and reduce the pain by activating certain organs positively. We explain to them about death and the effect that their thought process has on the general functioning of their system. Fear of death can hasten the process of death in a cancer patient. We make patients understand about the importance of the Present and bring them to a stress-free emotional state. We change their diet to make them feel lighter and better in themselves. We also help them to achieve a feeling state of painlessness, by reducing their subjective feeling of pain intensity. When their troubles are lessened in their subjective world, their life span can be expanded with a minimum of pain or even painlessly, and then they can prepare for a smooth withdrawal.

The following methods are used to achieve the best results for our patients:

1. Pranic Healing
2. Neurotherapy for organ function and chemical balance
3. Hypnotherapy with counselling, introducing the patient to the understanding that the soul continues after the death of the body.
4. Ozone Therapy

What is Neurotherapy?
Neurotherapy restores the biochemical imbalance of the body, by stimulating various organs to function normally and to release the required chemicals in optimum quantities. In Neurotherapy, pressure is applied to alter the flow of blood to a specific region of the body, mainly with the feet and occasionally with the hands for a period of 6 to 40 seconds. The pressure is then released so that the blood flow is modified to activate or de-activate the concerned nerves, glands or organs. This may be repeated as per the requirements of the patient, so as to maintain homeostasis of the body's biochemical forces, which in turn restores health.

Hormones secreted from the endocrine glands, including the pituitary, act on specific target organs in the body, by specific hormone release. When hormones in the blood reach their desired levels, the release of the respective hormone is regulated. The release is arrested in normal functioning by the process of Negative Feedback, i.e. a signal is given that further hormone release is not needed. The pituitary gland can stimulate all the endocrine glands except the thymus, the parathyroid and the medulla part of the adrenal glands. It controls the thyroid, both the adrenal cortices, ovaries and the testes. Whenever there is a deficiency of a particular hormone, Neurotherapy can stimulate the pituitary or hypothalamus to secrete a stimulating hormone for that gland in order to correct the deficiency.

Another interesting physiological fact is that our brain has 100 billion neurons and the spinal cord has 100 million neurons. 12 main types of chemicals are secreted by them. If these chemicals are not formed properly, conditions such as Parkinson's Disease can develop. Diseases are created by a disturbance in this balance. When it is corrected, the patient is healed. This balancing process is possible with Neurotherapy.

When the T-Memory cells of the thymus gland do not work properly, it produces antibodies against the body's own proteins and cells. For example, if the proteins of the synovial membrane of the joints enter the blood, the thymus will form antibodies against these proteins. These antibodies then affect the synovial membrane of the joints and cause arthritis. This is called auto-immunity. Allopathic medicine treats this with steroids to suppress the production of antibodies. Neurotherapy acts by stimulating the adrenal cortex to produce the required steroids in the right quantity automatically, and therefore it does not have any side-effects.

What is Reiki/Pranic Healing?
Reiki is described as a holistic therapy which brings about healing on the physical, mental, emotional and spiritual levels. The essential premise of the therapy is that energy flows through the practitioner's hands whenever the hands are placed on or held near a potential recipient, who is clothed. Furthermore, it is asserted that the energy is in itself intelligent, making diagnosis unnecessary.

It has been used to heal countless people. The principle is simple. We know that every living being possesses the inborn ability to heal itself. Pranic healing simply enhances this healing process by utilising the energy of life. This energy is called Prana in Sanskrit and means life force.

Case Studies
There are two cases which I would like to mention here.

Case One
The first case is a lady, aged 32 years, from Chennai who came with 2nd stage Leukaemia in 1998. She had twice undergone Chemotherapy in Chennai. I wasn't in a position to interfere with her medical treatment plan, so I started to give Pranic Healing by distance and occasionally in person, over a period of time. This was accompanied by good counselling since the lady had determined to get rid of the disease slowly.

She started responding by becoming energetic and gradually more hopeful. The enlarged lymph nodes stopped growing and since the commencement of the Healing Sessions (over a period of 6 to 8 months), no new nodes have formed. She has maintained normal physical health and this year, in 2009, she has no cancer symptoms. She is living in Pondicherry and is therefore available for follow-up treatment. We use Reiki and Pranic Healing with colours.

Case Two
The second case is a lady, aged 65, from Bangalore who was treated by us last year in Pondicherry. She came to us with breast cancer which had spread into her liver and bones i.e. 4th stage (Advanced Stage). There was not any hope of recovery and she had been asked to undergo chemotherapy as the ultimate therapy. The patient decided not to receive chemotherapy at this stage and made a definitive decision to seek our help.

I explained to her that since the cancer has proceeded to an advanced stage, we were prepared to help reduce her symptoms such as depression and severe back pain. She agreed and she was given vigorous neurotherapy treatment to reduce stress. We released the blocked energy with Pranic Healing.

Through neurotherapy, we activated the pancreas and immune system and in her self assessment, she informed us that her pain had reduced. She had better life perception and her suffering was reduced. Ozone therapy was given through the rectum over 10 sessions and 10 days to strengthen the immune system. She left feeling less pain and with more hope, courage and confidence. We taught the treatment process to her daughter so she could help with her mother's pain management. After two months of treatment in Bangalore again her symptoms started worsening. Her food intake had reduced and bowel movements had become hampered. She was admitted to the Intensive Care Unit of a local nursing home. After 10 days, she passed away peacefully and throughout this time her daughter kept us informed of her condition.

The patient's daughter sent us the following letter:

“I, Jyothi, daughter of Shanthamma, would firstly like to thank Mr. Sundarajan and Akila for their abundant healing and guidance. My mother was diagnosed with breast cancer in the month of April 2008. When my mother showed me, I was shocked and immediately took her to the doctor. After lot of medical investigation, the doctor finally told us that she was suffering from breast cancer and that it had spread to her bones. This meant she was in the 4th stage and chemotherapy was the only way to keep her alive or can I say, push her into hell. My mother knew the side effects of this treatment and refused it.

Then, I consulted Mr. Sundarajan. He suggested that I take her to Pondicherry. I took her to Pondicherry in the second week of April and we stayed there for more than 20 days. They started to heal her in their own way which was beneficial. She was on her toes doing her own work and walking in the hot sun from their clinic to the Guesthouse and also to the lunch hall. She even used to go to the Ashram. She was very happy during her stay but we had to come back in the first week of May. After she came back we continued the treatment which was shown to us. However, her liver became infected and she developed jaundice. She was hospitalized for one week. We kept her alone for her pain management. She had a peaceful departure without much suffering on the morning of June 14 at 6.30am. Thank you very much.”

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Quality of Life through Yoga
by Dr Pooja Maddela

“If we could see the miracle of a single flower clearly, our whole life would change.”
Buddha

Yoga and Quality of Life
Quality of life can be enhanced by the quality of our perception and level of awareness. Our perception capabilities depend upon our state of mind. Purity of thought can create pure states of mind which in turn directs our body to feel stable and comfortable. Living in the present moment is nothing but a celebration of who we are. When we know that we do not have control over our past and future, it is always good to focus on ‘now'. This awareness in the present moment is key to finding happiness in our lives which in turn enhances the quality of life. By changing our perception, we can change our consciousness and this will bring transformation in our lives.

Change of perception = change in consciousness = quality of life.

True Happiness
If we are happy because of something, then it is temporary. We should not identify with things that we have. Yoga teaches us to be content with what we have. This brings satisfaction to our life and leads to a reduction in our cravings or desires. By practicing santosha (contentment) we achieve true happiness which is permanent. When we taste the sweetness of life through happiness and the bitterness of life through acceptance then there is no fear of death and we can accept dying as a natural process.

Role of Detachment
Attachment to material things and family can leads to the manifestation of disease. (P. V. Karambelkar) For example, grief due to the death of a spouse can lead to the development of lung problems. So it is all about how we perceive things that happen in life. It is not wrong to have money and things. It is the attachment towards those things that create problems. Through the practice of contentment we get rid of attachment and develop detachment and are able to be in the present moment of life. This will help us to accept everything in life including death. (Swami Satyananda Saraswati, 2006)

Role of Mind
Our mind has the power to achieve everything. We need to learn how to use it and also to believe in the power of our mind. According to Patanjali's Yoga Sutras the root cause of unhappiness is ignorance of one's real nature. It can be solved only by knowing the true self. We need to eliminate raga (the attitude of liking for our choice) and dwesha (dislike for something) in order to achieve a pure state of mind. When there is balance in these, then there can be balance of mind. The Yogic view is that suffering arises because of avidya (ignorance). It is a mistaken idea which leads to the 'I feeling' and the consequent attachment, hatred and clinging in life. All these are the root causes of pain. To overcome pain we need to cultivate wisdom.

Support
A caring approach and love can bring transformation in anything. There is nothing that is impossible if we make our mind positive. Quality of life is not just about maintaining one's health and happiness. It is also about looking after others as we look after ourselves. Not harming anyone through words, thoughts and actions will result in a feeling of evenness or equanimity towards all beings. We need to show and share love with family members and others. Love within the home makes a lot of difference in our lives. Where there is love there is unity and love has the power to change consciousness and bring quality to our lives.

Yoga Practices
The following asanas (positions) and practices can help enhance our quality of life.

1. Simple joint movements:
Releases energy blockages and supplies prana in the body.

2. Chest openers:
Maintains the energy field of the heart and gets rid of attachment. Cultivates kindness and compassion, keeps our lungs and heart in balance.

3. Camel riding Releases prana in the spinal column and soothes the nervous system.

4. A twist:
Keeps our liver happy and releases anger. Twists are cleansing for the body.

5. Co-ordination movements:
Helps one to focus in the present moment.

6. Pranayama:
Deep abdominal breaths, left and right nostril breaths, alternate nostril breathing helps to calm the mind and think more clearly.

7. Chanting:
Aum Sound has the power to vibrate every cell in the body and brings transformation in the mind.

8. Silence:
Five minutes of silence everyday is very good to restore the energy in the body and helps to quieten the mind.

"I am not afraid of tomorrow, for I have seen yesterday and I love today."
William Allen White

References
P. V. Karambelkar. Patanjali Yoga Sutras (pp. 35 - 37)
Swami Satyananda Saraswati. (2006) Four Chapters of Freedom (pp. 65 - 67)

Bibliography
Muktibodananda, S, S., (2004). Swara Yoga.
Muktihodhananda, S., (1993). Hatha Yoga Pradipika.
Nagarathna, R., & Nagendra, H. R. (2001). Integrated Approach of Yoga Therapy for Positive Health.
Swami Satyananda Saraswati., (2004) Yoga and Kriya
Swami Satyananda Saraswati., (2002) Asana Pranayama Mudra Bandha Munger:

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Skin Cancer: Causes, Prevention, Symptoms & Treatment
by Dr Charu Sharma

I really do think that any deep crisis in one's life is an opportunity change it into something very special. I would like to take this opportunity to help in understanding the disease of skin cancer and also to suggest a few precautions which can help in reducing the risk of contracting the disease.

Skin cancer is one of the most common of all human cancers and living with it can present many new challenges for the patient and for his/her family and friends. Many people feel anxious and depressed; some people feel angry and resentful; others feel helpless and defeated. But it is possible to be happy without having perfect health... Thank goodness our happiness doesn't come from our body, but from our heart. I believe in this and hope faith will help others in believing the same.

Cancer
Cancer occurs when normal cells undergo a transformation during which they grow and multiply without normal controls. As the cells multiply, they form a mass called a tumor. Tumors of the skin are often referred to as lesions. Tumors are cancerous only if they are malignant. This means that they encroach on and invade neighboring tissues because of their uncontrolled growth. Tumors may also travel to remote organs via the bloodstream or lymphatic system. Tumors overwhelm surrounding tissues by invading their space and taking the oxygen and nutrients they need to survive and function.

Skin cancers
Skin cancers are of three major types: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. The vast majority of skin cancers are BCCs or SCCs. While malignant, these are unlikely to spread to other parts of the body. They may be locally disfiguring if not treated early. A small but significant number of skin cancers are malignant melanomas. Malignant melanoma is a highly aggressive cancer that tends to spread to other parts of the body. These cancers may be fatal if not treated early.

Like many cancers, skin cancers start as precancerous lesions. These precancerous lesions are changes in skin that are not cancer but could become cancer over time. Medical professionals often refer to these changes as dysplasia. Some specific dysplastic changes that occur in skin are as follows:

  • Actinic keratosis is a patch of red or brown, scaly, rough skin, which can develop into squamous cell carcinoma.
  • Dysplastic nevi are abnormal moles. These can develop into melanoma over time. Dysplastic nevi are not cancer, but they can become cancer. People with dysplastic nevi often have a lot of them, perhaps as many as 100 or more. They are usually irregular in shape, with notched or fading borders.

Causes of skin cancer
Ultraviolet (UV) light exposure, most commonly from sunlight, is the most frequent cause of skin cancer.

Other important causes of skin cancer include the following:

  • Use of tanning booths (not a common cause in India)
  • Immunosuppression—impairment of the immune system
  • Exposure to unusually high levels of X-rays
  • Contact with certain chemicals: arsenic (miners, sheep shearers, and farmers), hydrocarbons in tar, oils and soot (may cause squamous cell carcinoma)

The following people are at greatest risk

  • People with fair skin, especially types that freckle, sunburn easily
  • People with light (blond or red) hair and blue or green eyes
  • Those with certain genetic disorders that deplete skin pigment such as albinism, xeroderma, pigmentosum
  • People who have already been treated for skin cancer
  • People with numerous moles, unusual moles, or large moles that were present at birth
  • People with close family members who have developed skin cancer
  • People who had at least one severe sunburn early in life

Basal cell carcinomas and squamous cell carcinomas are more common in older people. Melanomas are more common in younger people 25-29 years of age.

Prevention
You can reduce your risk of getting skin cancer.

  • Limit sun exposure. Attempt to avoid the sun's intense rays between 10 a.m. and 3 p.m.
  • Apply sunscreen frequently. Use a sunscreen with sun protection factor (SPF) of at least 15 both before and during sun exposure. Select products that block both UVA and UVB light.
  • If you are likely to sunburn, wear long sleeves and a wide-brimmed hat.
  • Perform regular self examinations of your skin and note any changes.
  • Healthy diet.

Symptoms of skin cancer
A basal cell carcinoma (BCC) usually looks like a raised, smooth, pearly bump on the sun-exposed skin of the head, neck, or shoulders.

A squamous cell carcinoma (SCC) is commonly a well-defined, red, scaling, thickened patch on sun-exposed skin.

The majority of malignant melanomas are brown to black pigmented lesions. Warning signs include change in size, shape, color, or elevation of a mole. The appearance of a new mole during adulthood, or new pain, itching, ulceration, or bleeding of an existing mole should all be checked by a health-care provider.

The following easy-to-remember guideline, "ABCD," is useful for identifying malignant melanoma:

  • Asymmetry. One side of the lesion does not look like the other.
  • Border irregularity. Margins may be notched or irregular.
  • Color. Melanomas are often a mixture of black, tan, brown, blue, red, or white.
  • Diameter. Cancerous lesions are usually larger than 6 mm across (about the size of a pencil eraser), but any change in size may be significant.

Many people, especially those who have fair coloring or have had extensive sun exposure, should periodically check their entire body for suggestive moles and lesions.

Examinations and tests
If you have a worrisome mole or other lesion, a dermatologist will examine the entire skin surface. A sample of skin (biopsy) will be taken so that the suspicious area of skin can be examined under a microscope.

A biopsy can almost always be done in a dermatologist's clinic. If a biopsy shows that you have malignant melanoma, you will probably undergo further blood tests, a chest X-ray and other tests as needed.

Treatment of skin cancer
Treatment for basal cell carcinoma and squamous cell carcinoma is straightforward. Usually, surgical removal of the lesion is adequate. Small lesions may be removed through a variety of techniques, including simple excision (cutting it away), electrodesiccation and curettage (burning the tissue with an electric needle), and cryosurgery (freezing the area with liquid nitrogen). Larger tumors, lesions in high-risk locations, recurrent tumors, and lesions in cosmetically sensitive areas are removed by Mohs micrographic surgery. The surgeon carefully removes tissue, layer by layer, until cancer-free tissue is reached. When treated properly, the cure rate for both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) approaches 95%.

Malignant melanoma, however, may require several treatment methods, including surgery, radiation therapy and chemotherapy. Because of the complexity of treatment decisions, patients with malignant melanoma may benefit from the combined expertise of a dermatologist, a cancer surgeon, and an oncologist.

"Turn your face to the sun and the shadows fall behind you. Turn your worries and pain over to God."
Dr Charu

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