When Your Kidneys Fail:

Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.

How Transplantation Works:

Kidney transplantation is a procedure that places a healthy kidney from another person into your body. This one new kidney takes over the work of your two failed kidneys.

A surgeon places the new kidney inside your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Your blood flows through the new kidney, which makes urine, just like your own kidneys did when they were healthy. Unless they are causing infection or high blood pressure, your own kidneys are left in place

Transplant Operation:

If you have a living donor, you'll schedule the operation in advance. You and your donor will be operated on at the same time, usually in side-by-side rooms. One team of surgeons will perform the nephrectomy-that is, the removal of the kidney from the donor-while another prepares the recipient for placement of the donated kidney.

If you're on a waiting list for a deceased donor kidney, you must be ready to hurry to the hospital as soon as a kidney becomes available. Once there, you'll give a blood sample for the antibody cross-match test. If you have a negative cross-match, it means that your antibodies don't react and the transplantation can proceed.
You'll be given a general anesthetic to make you sleep during the operation, which usually takes 3 or 4 hours. The surgeon will make a small cut in your lower abdomen. The artery and vein from the new kidney will be attached to your artery and vein. The ureter from the new kidney will be connected to your bladder.
Often, the new kidney will start making urine as soon as your blood starts flowing through it, but sometimes a few weeks pass before it starts working.

Palliative care aims to improve quality of life and relieve suffering for patients with advanced illness and those close to them by specifically addressing communication, symptom management, coordination of care, psychosocial and spiritual realms, grief and bereavement support, and legal and ethical concerns. It has an interdisciplinary focus and may co-exist with curative and life-prolonging treatment. Palliative care is a key component of appropriate, routine medical care, especially for clinicians caring for older adults. In revisiting Mrs. B, the many needs of a typical elderly patient are apparent, as are the gaps in the current level of care. A discussion of prognosis and goals of care is a potential starting point. This includes obtaining input from an oncologist with regard to treatment options for Mrs. B's metastatic breast cancer and her pathologic hip fracture. Soliciting her treatment goals in the context of her chronic obstructive pulmonary disease and significant recent decline is the next challenge.

Pain, dyspnea, constipation, anorexia, and anxiety could then be addressed with pointed assessment and symptom-specific management. Code status discussion, communication with her support network, and care coordination for her increased care needs would follow. Hospice should be introduced as a potential option. Advance care planning might also be initiated. Psychological and spiritual support needs could also be explored in time. Clearly, there is much to be done for Mrs. B and her loved ones in clarifying and coordinating whatever path comes to be. Older patients and their families face prolonged courses of chronic disease and gradual decline. Physicians caring for these patients need to be expert in the domains of palliative care so these patients and their families can receive the best quality of care while they are still living full lives and later as they approach the end of life.

What is breast cancer?

ANSWER- Breast cancer is an abnormal cancerous growth of cells in the breast, most common presentation being a lump in the breast.

Am I at a risk for breast cancer?

ANSWER- The risk factors include:

• Advanced age
• Obesity
• Smoking
• Excessive alcohol
• Hormone replacement therapy
• Family history of breast cancer
• Menarche at an early age or late menopause
• Having no children

When should one suspect having breast cancer?

ANSWER- Suspect breast cancer if you have any of the following-

•  Lump in the breast
• Dimpling or puckering of the skin on the breast
• Scaly , red or swollen breast skin
• Inward turning of the nipple
• Abnormal /bloody discharge from the nipple
• Unusual persistent pain
• Swelling or discomfort in the armpit  

How can one prevent Breast cancer?

ANSWER- Tips for breast cancer prevention:

• Avoid becoming overweight-Obesity increase the risk of breast cancer after menopause, the time of life when breast cancer most often occurs.
• Eat healthy: A diet rich in vegetables , fruits & low on fatty foods, refined carbohydrates & sugared drinks. Eat whole grains, lean meat such as chicken/fish and choose vegetable oils over animal fats.
• Remain physically active: Research suggests that increased physical activity even when begun later in life , reduces overall breast cancer risk by about 10-30%.All it takes is moderate exercise like a 30 minute walk five days a week to get this protective effect.
• Drink little or no alcohol: Alcohol use is associated with an increased risk of breast cancer. Women should limit intake to no more than one drink per day, regardless of the type of alcohol.
• Don't smoke : Research suggests that long term smoking is associated with increased risk of breast cancer in some women.
• Breast feeding: Women who breast feed their babies for atleast a year have a lower risk of developing breast cancer.
• Avoid Hormone replacement therapy: If you have to take hormones to manage menopausal symptoms, avoid usage for a very long time.
• Get regular screening done for breast cancer
• Breast self-examination: Helps in early detection of breast cancer .

 A good nutrition is very important for Cancer patients undergoing treatment.

It helps them-

• Maintain well-being & improve the body's ability to fight infection. In short, helps build body's immune system.
• Helps them to cope better with the effects of treatment and recover sooner.
• Maintain their weight , helps them feel better about themselves and
• It also helps wounds and damaged tissues to heal better. This is the most important reason , whether after surgery, radiotherapy, chemotherapy or any other medical treatment.

WHAT DOES EATING WELL MEAN?

Eating well means giving your body the food it needs to keep working properly.

The best way to 'eat well' is to eat a variety of foods from the following five food groups everyday.

1. Cereals & Breads                                 5-6 serves

2. Vegetables & Fruits                              5-6 serves

3. Milk & milk products                            2-3 serves

4. Meats or legumes                                2 serves

5. Fat                                                            1 tablespoon

6. Fluids: This is an essential part of any diet. Aim for atleast 6-8 glasses of fluids per day. These may include:

Water/ Lassi/ Milk/ Buttermilk/ Soups/ Green tea/ Milk shakes/ Juices/Coconut water.

Tea & Coffee may be taken in moderation as they have littel nutritive value & so also soft drinks, as they contain extra calories & can also increase acidity.

Complan & Resources are high in protein & energy & may be included.

Alcohol in moderation may be taken to stimulate appetite  but should be avoided in case of sore mouth &  throat , heartburn( acidity) or diarrhoea.

IMPORTANT:

• If the patient is not eating enough and is losing weight, he will need more proteins & calories in his diet , to help stop weight loss.
• If the weight is within normal range, efforts must be made to maintain his weight.
• If he is overweight, then also, he must aim at maintaining that weight that weight during treatment. His nutrition will suffer if he loses weight.Weight loss should be considered only after completion of treatment and that also after discussing with the doctor.

VERY IMPORTANT:

• There is no known diet, food, vitamin or mineral supplement that will cure cancer. Therefore, patients should be advised not to follow any other diet which may be promoted as 'natural remedies'. These diets are often found to be lacking in essential nutrients, due to elimination of some types of food & often require use of supplements which may be harmful to the body. Also, these are also often rigid & monotonous and could cause further loss of weight. Apart from them being expensive , they could interfere with the treatment.

HOW CANCER TREATMENT CAN AFFECT EATING:

All methods of treating cancer namely surgery, radiation or chemotherapy are very powerful. Although these treatments target the cancer cells in the body, they can sometimes damage the normal cells as well. This may produce unpleasant side- effects that cause eating problems. Side -effects vary from patient to patient, the part of the body being treated, length of treatment or the dose of treatment. Patients may also experience loss of appetite when they are upset, worried or afraid.

• Surgery- Surgery increases the need for good nutrition because it puts stress on the body. It may slow down digestion or lessen the ability of the mouth, throat & stomach to work properly or make them sore. During this time, the patient may receive nutrients through a tube in the nose or stomach & be put on aliquid diet.
• Radiation- Radiation to the head & neck or chest area may cause dry mouth/sore mouth/ sore throat/ difficulty in swallowing/ change in taste of food and or dental problems. Treatment in the stomach area may cause nausea, vomiting, diarrhoea.
• Chemotherapy- Chemotherapy may cause any of the following: Nausea & vomiting, loss of appetite, diarrhoea, constipation, sore mouth or throat, weight gain, change in the taste of food.

COPING WITH/ OVERCOMING COMMON PROBLEMS

Some suggestions have been offered here but trial & error is also a very good way of finding solutions to suit individual needs. However, for specific dietary advice, do consult your doctor.

• LOSS OF APPETITE: This is caused by a lot of factors such as worry, stress, treatment schedule, medication etc; The patient will not feel hungry but the body needs nourishment. So try the following-

Try & keep a regular eating pattern.

Eat small nourishing meals but more frequntly ( Nibble on something every 2-3 hours)

Avoid fluids at meal times but drink nourishing fluids in between meals.

Gentle exercise can stimulate appetite.

Make every meal time a family occasion-something to look forward to!

• LOSS OF WEIGHT: If the patient is underweight or is losing weight , he needs to include more protein & calories in his diet.

For extra protein, include foods such as cheese/milk/milk powder/ Complan/Resource/yoghurt/eggs/nuts/wheat germ/meat/fish/beans & legumes/ soya products etc;

For extra calories, incorporate foods high in fats & sugar, such as butter/cream/salad dressings/mayonnaise/honey/jam/dry fruits/eggs etc;

• NAUSEA & VOMITING: This could be caused by the cancer itself or by its treatment. The patient should be advised to-

Ask the doctor for medicine to control nausea/vomiting. Eat small frequent meals because NOT EATING WORSENS THE NAUSEA.

Try foods like dry toast, crackers , yoghurt & biscuits. Drink fewer liquids with meals.

Eat slowly.

Avoid food with strong odors & cooking smells.

Try cold foods or eat at room temperature,

Avoid eating in a room  that is  too stuffy or warm.

Avoid fatty, rich & spicy food.

Take cold clear fluids.

Wear loose clothes.

Avoid eating one or two hours before treatment.

Rest after meals but try and avoid lying flat on your back

• CHEWING & SWALLOWING PROBLEMS ( SORE THROAT/MOUTH)

Some of the treatments can cause mouth or throat sores/ulcers. The treatment may change the amount of saliva in your mouth or cause dryness. This could make your mouth feel hot & swallowing painful. The patient experiences dryness of the lips  & tooth & gum problems may occur. In all of the above cases, try the following-

It is essential to ensure good or