A wish for Pakistan

My dear Pakistan.
I love you so much.
I love your resilience.
I love your passion.
I love your ‘never give up’ attitude.

I love your emotion.

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You don’t have to make sense.
You don’t have to excel.
You don’t have to be the best place in the world to live.

You are my home, and I love you unconditionally.
But if I may, I would like to make a wish for you.

It is a well meaning wish.

A wish out of love and concern.

It is not a wish for self respect, for we can muster that any time emotion strikes.
It is not a wish for self reliance, for that ship sailed long ago.
And it is not a wish for better leaders. We get the leaders we deserve.
My dear Pakistan, my one wish for you is a wish for clarity.

That’s it.
Clarity.
Nothing too big or fancy.
Just clarity.

A brief moment in the sun, to see things as they are, and not as they are imagined.

Clarity of purpose – to define the state you wish to be. It is not enough to be against something. You have to stand for something. 
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Pakistan Army (پاک فوج) Pakistani Armed Forces Troops Soldier helping tribal Operation Rah-e-Nijat South Waziristan Administered Tribal Areas War in North-West Black Thunderstorm fata people  (4)

 

 

 

 

 

 

Clarity of conscience – to provide your citizens, all of them, the security and opportunity they deserve.

 

 

Clarity of thought – to recognize the enemy. Perhaps the enemy is within. 

 

 

A brief moment of clarity.
A brief moment in the sun.
Devoid of emotion and conspiracy theories.
Free of politics and grand standing.

Uncluttered.

Untangled.

Clarity.

World Cancer Day

Cancer is an ominous word. A scary word. Unfortunately, it is also a very common word. Virtually everyone knows someone who has cancer. Virtually everyone has lost someone to it. Cancer is the second leading cause of death in Pakistan, surpassed only by heart disease.
February 4th was World Cancer Day.  It is a good opportunity to  day to talk about cancer and the havoc it causes in so many lives. According to data from the Punjab Cancer Registry, cancer of the breast is the most common type of cancer in Pakistan. It is important to make women aware of the risk of breast cancer, and the importance of detecting it early.
Here are some important facts about breast cancer:

1. You Don’t Need Many Risk Factors
Unlike lung cancer and smoking, there is no one overwhelming risk factor for breast cancer. In fact, the biggest risk factor for developing breast cancer is simply being a woman! No, I have not lost my mind. It is true. While men can develop breast caner, it is about 100 times more common in women. In fact, studies suggest that one in eight women will develop breast cancer in her lifetime. And most of those women who do develop breast cancer do not have any family history of breast cancer.
That is why it is important to know that any woman can get breast cancer. You don’t have to be a certain age or belong to a certain family to get it.
2. Early Detection is Key
It is sad whenever a woman loses her battle against breast cancer. It is sadder still when the battle could have been won, if only she had spoken up about the mass she felt in her breast. Many women don’t want to draw attention to themselves and their medical needs. The reasons vary; some are shy to talk about their illness, while others don’t want to put a burdon on the family’s resources. Unfortunately, when the mass doesn’t go away and these women finally do visit the doctor, it is often very late. Cancer which might have been curable a few months earlier has by then spread beyond the breast.
It is important to do away with the taboo of talking about breast cancer. It is important for women to come forward as soon as they feel a lump in the breast.
3. There is Life After Cancer
A diagnosis of cancer is not the end of the story. Not anymore. There have been many significant advances made in the treatment of cancer. There are all sorts of treatment options that doctors can use to fight breast cancer. From surgery to radiation therapy, and from hormonal manipulation to targeted gene therapy, there are a host of treatment options.

Do you know someone who has cancer? How did they cope? What are some suggestions you can give to people fighting cancer?

Frozen Section – Diagnosis in a hurry!

‘It is negative. All margins are clear.’ These were the very words the surgeon wanted to hear.

‘Thank you,’ he said. ‘Please let me know when the final report is ready.’
This was the exchange between myself and a surgeon whose patient was still under anaesthesia. Now, knowing that the entire tumor had been removed, the surgeon was going to close the patient.
This is how a frozen section works. The surgeon removes a piece of tissue (biopsy specimen) and sends it to the pathologist. The pathologist quite literally freezes the tissue, then cuts thin slices (sections) of the specimen which are put on a slide and stained. Once the slide is ready, the pathologist examines the tissue under the microscope  to render a diagnosis. The surgeon’s next move, whether to continue removing more tissue or stop and close the patient, depends entirely on the frozen section diagnosis.
The pathologist’s job during a frozen section is rife with stress. While routine processing of a biopsy specimen is performed overnight, a frozen section specimen is proceseed within minutes. The pathology lab can perform a large number of special stains to assist in making the right diagnosis, but these are of no use during a frozen section – there simply isn’t enough time! The whole process is a race against the clock. In most cases  a diagnosis has to be given within 20 minutes of receiving the specimen. That is an incredibly small amount of time, but that is all that the pathologist can get, for while he does his thing, the patient is in the hands of the anaesthetist, who keeps the patient ‘under’ just in case more surgery needs to be performed.
While a frozen section is not needed for most surgeries, it is very useful when the surgeon is operating to remove a tumor. Using frozen section, the pathologist can inform the surgeon if the entire tumor has been removed, or if there is tumor present at the margins. In the latter case, the surgeon can remove more tisse from the site in question during the same surgical procedure, saving the patient time, money, and most importatly, the risk of complications that comes with any surgicalprocedure.

The idea of  a frozen section technique was first introduced more than a hundred years ago in the United States. Needless to say the technique has evolved greatly, with many advances coming in the last two decades. My father’s generation of pathologists used to freeze intra-operative specimens in deep freezers, and then cut sections using Treet platinum blades. Today we use solid steel bars and −26 degree chambers which can freeze the specimen in 45 seconds, and then use a precision microtome that can cut sections as thin as 3 micrometers.

Frozen Section slide: This lymph node shows metastatic carcinoma.
All these techniques however don’t make one oune of a difference when you are the pathologist, the slide is under your microscope, and the surgery team is anxious to hear from you. The pressure is immense. It is the ultimate exercise in focus and discipline. Is is benign or malignant? Is the margin clear or not? Is it in situ or invasive? These are serious questions, and the answers are not always simple, especially when the clock is ticking and the phone keeps ringing. It is a lonely moment. There usually isn’t enough time to seek a second opinion. What happens to the patient next depends entirely on what you say.

Of course, nothing beats the feeling you get either, knowing that in this moment, by doing the very best you can do, you are making a real and positive impact in the life of your patient.
And that is why I became a doctor.

Of Course You Had a Heart Attack!

I have an uncle who I love dearly. He is a wonderful person who treats everyone with respect and humility. He likes to make people laugh at his jokes. Everyone enjoys his company. He has two kids; a son and a daughter. The son is doing his O’ levels and the daughter is about to finish her BBA. Whenever we meet I chide him about his one bad habit – chain smoking. Like a broken record I tell him about the increased risk of heart and lung disease. He, of course, in his usual jolly ways, laughs off all my warnings.

 

Last year on a routine September morning, my uncle had a heart attack.  He had been getting dressed for work when he felt that ominous chest pain. All of a sudden he was breathless and his chest started to feel tight. His wife saw him as he fell to the floor gasping for air. She screamed in panic, and before too long he was being rushed to the hospital. He was fortunate to make it in time. He ended up having bypass surgery, and lived to tell about it.

 

Many are not so lucky.

 

I think a lot of people can relate. Virtually everyone knows someone who has heart disease. Just about everyone has lost someone to a heart attack. By some estimates heart disease accounts for almost a third of all deaths in our society. This is an incredibly high toll, and it is entirely within our powers to reduce it.

 

Women are just as likely to have a heart attack

It is a myth that heart disease affects only old, rich men. The fact of the matter is that heart disease does not discriminate. Women are just as likely as men to have heart disease. Heart disease can and does affect young people. And of course, illness does not care how much money you have in your pocket

 

 

The level of awareness about heart disease is a lot higher today than it was just twenty years ago. People are more aware about the risks of a high cholesterol level. They know smoking is not good for them. They know being overweight is a risk factor for diabetes and heart disease. Unfortunately this heightened awareness has not been accompanied by a decline in heart disease. In fact the incidence of heart disease is higher than ever before.

More than awareness and education, I believe it is a matter of attitude. As a society we tend to be cavalier about everything. We like to pretend that we are immune to consequence. Whatever happens to someone else, it won’t happen to us. And whatever we do to our body, it won’t eventually break down. Unfortunately this attitude fuels some of most self-destructive habits.

There’s only so much a heart can take!

This reckless attitude towards smoking led to my uncle’s first heart attack, and I am sad to say that it will cost him his life, for he has not learnt from his painful experience. In fact, instead of finally quitting once and for all, he has resumed smoking! He believes that now that he has ‘new pipes’ supplying the heart, he won’t have another heart attack for a long time to come.

 I don’t even know what to say anymore.

Dengue Fever – Give Govt Credit

There is a low level outbreak of Dengue Fever in Lahore and its outskirts. Over the last few weeks almost a hundred patients have tested positive for the Dengue virus. Every day the media gives the public an updated count of how many patients have been diagnosed with Dengue Fever. Sometimes the media is so dutiful in its duty to inform that the reports include the names of the suspected Dengue patients as well!

Every patient is important. Even one case of Dengue Fever is one too many. Having said that, if we look at the size of the outbreak, it is much, much smaller than had been anticipated by the World Health Organization.

The Government has run a massive public awareness campaign

For the last several months the Government of Punjab has been conducting detailed and exhaustive surveillace for Aedes mosquitoesthat spread the Dengue virus. Survey teams have been looking everywhere in Lahore for any small collection of still water. Almost to the point of harrassment, the government and its operatives have been fixated on making sure that there is no fertile ground for the breeding of  mosquitoes. This effort has been accompanied by a massive public awareness campaign. Countless seminars have been held in schools and colleges. There has been a major drive to educate the public on how to prevent Dengue Fever.

CM Punjab Deserves Credit

This timely focus on prevention of an outbreak seems to be paying dividends. At least for now it appears that the massive outbreak that was expected as a follow up to last year’s epidemic has been curtailed. Who can forget the chaos and panic last year.  Thousands and thousands of patients were suffering from Dengue Fever. Heavy criticism was directed at the government for failing to curb the spread of Dengue Fever.

We are not completely out of the woods yet. The outbreak could flare up still. But if we do manage to make it through the next three weeks without a significant increase in Dengue Fever cases, we will have indeed performed a modern-day miracle. And the credit should go to the relentless efforts of the Government of Punjab.