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Letter to the Editor
Holistic Approach in Cancers and Chronic Diseases
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Sir,
Introduction
Expensive medical care, toxic side effects,
fear of cancer treatment has led to renewed interest in Complementary and Alternative medicine(CAM), not only for treatment of cancer but for many chronic diseases where modern medicine has no satisfactory answers.1
Case Report
A 65 years old male presented with chief complaint of swellings on Rt. Side of neck since 1 month. No h/o fever, sudden loss of weight, pruritus, also no h/o cough, evening rise of fever. Past history, Personal history were not significant.
O/E :- Patient was afebrile, pulse 78/min, blood pressure 126/82 mm Hg. No pallor, clubbing, icterus.
L/E :- Multiple discrete lymph nodes present in Rt. Post. Cervical and Rt. Supraclavicular region which were firm, non tender. S/E:- P/A no organomegaly, no free fluid. RS/CVS/CNS-NAD. [Ann Arbour stage-IA]
His Hb-12.2, CBC-11,200, ESR-45 mm. Liver functions, renal profile and blood sugars were within normal limits. X-ray chest did not reveal any abnormality. Lymph node biopsy was suggestive of Hodgkin’s disease – mixed cellularity, which was further confirmed by immunohistochemistry which showed CD15 +ve, CD 30+ve, Epithelial membrane antigen +ve in large cells and Leucocyte common antigen (CD 45 +ve).
Sonography of neck revealed multiple discrete nodes with largest node measuring 3.8 x 2.1 cm. Lateral to Rt. Common carotid artery. Sonography of abdomen was suggestive of fatty liver with cholelithiasis only.
Patient was advised chemotherapy –ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) regimen for 4 cycles on day 1 and day 15. After first cycle of chemotherapy patient complained of exertional breathlessness which was even present at rest and palpitation, which was diagnosed as Adriamycin induced early cardiomyopathy and ECG was done.
Due to side effects and fear of chemotherapy, patient stopped chemotherapy and did not receive second cycle of chemotherapy. Later on patient was convinced for Alternative medicine. Herbal medicine (Leaf therapy) was given for 3 months. Patient was symptomatically cured and lymph nodes became impalpable. Patient was followed up for one year and during this period haemogram repeated and patient had no complaints.
Discussion
Despite its enormous success, contemporary western biomedicine has features that can discourage patients: many diseases; especially chronic ones, are not cured or even adequately ameliorated; existing treatments can impose serious adverse reactions; and care is fragmented and impersonal. CAM, despite its lack of proof , appeals to many because its practitioners are optimistic and care is provided in a ‘holistic’ fashion, meaning that the broader medical, social, and emotional contexts of illness are considered in designing treatment plan.2
Because of very high cure rate in patient with Hodgkin’s disease, long term complications have become major focus for clinical research. In some series, patient with early stage disease, more patient died from late complications of therapy than from Hodgkin’s disease itself. This is particularly true in patient with localized disease.
The most serious late side effects include second malignancies and cardiac injury. The development of carcinoma as a complication of treatment for Hodgkin’s disease has become major problem. These tumours usually occurs > 10 years after treatment and are associated with radiotherapy.3
An array of unproven modalities will always be used by patient under our care. Many choices are entirely innocuous and can be accommodated in context of large diagnostic and therapeutic interventions. Some should be actively discouraged. Along the way, scientific evidences will drive many CAM approaches out of favour. Some modalities will garner sufficient support to become part of mainstream care.2
Diagnostic and Therapeutic interventions + CAM + Preventive measures =HOLISTIC APPROACH, will help us to deal cancer safely and effectively; with focus on basic cause rather than just destroying neoplastic cells.
References
1. Arvind Kulkarni. Is cancer caused by virus? BH Journal, April 2002; 44(2): 246-248
2. Stephen E Straus. Complementary and Alternative medicine. In: Kasper, Braunwald, Fauci et al. Editors: Harrison’s Principles of Internal Medicine, 16th edition, McGraw-Hill publication. 2005;66-70.
3. James O. Armitage, Dan L. Longo. Malignancies of Lymphoid cells. In: Kasper, Braunwald, Fauci et al. Editors: Harrison’s Principle of Internal Medicine, 16th edition, McGraw-Hill publication. 2005; 641-55.
Paras M Dedhia
Intern, Grant Medical College and JJ Group of Hospitals. |
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ALCOHOL DRINKING PATTERNS HAVE DIFFERENT CHD OUTCOMES IN MEN AND WOMEN
The inverse association between drinking alcohol and risk of coronary heart disease (CHD) seems to be independent of drinking frequency in women but not in men. Tolstrup and colleagues looked at alcohol drinking patterns in a cohort of more than 50,000 middle aged women and men free of cardiovascular disease at baseline. After a median follow-up of six years, women who drank alcohol on at least one day a week had a reduced risk of CHD compared with those who drank less often, but above this frequency intake mattered more than frequency. Among men, frequency mattered more than intake, with the lowest risk in those who drank daily.
BMJ, 2006; 332 : 1244. |
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