While, drowsiness, headache, dry mouth, nausea are very commonly reported side effects seen with a frequency of more than 10 percent, both diarrhoea and constipation have been reported commonly. Other commonly reported adverse effects which might significantly impact the quality of life in advanced cancer include sleep disturbances and sexual dysfunction. While efficacy is considered… — read more

Despite making arrangements (in my head and otherwise) and laying out my plans on the OPD table and in rigorous discussions at the bedside, calls and messages have been pouring in from patients, expressing surprise at my decision to desert them, for a new position. Of course, this might all serve as a timely reminder… — read more

Having joined a brand new position with the promise of leadership intertwined in the responsibility metrics, relationships with team members become a palpable entity and reconciling these abstract concerns with the demands of the role looks set to assume mythical proportions. The first referral from the oncology team itself becomes a minor event, with the… — read more

Aimed at acknowledging the lung-brain axis, behavioral-functional and psychosocial-spiritual dimensions of the breathlessness experience. Also takes into account integrated mechanisms, differing phenotypes of the same complaint and response to therapy. May be used to predict and target responses to treatment. A circular bidirectional relationship where breathlessness and anxiety constitute inseparable entities has also been proposed.… — read more

The charade of the ongoing state of the “patient next door” (under a different team or specialty) and its impact on my decision making continues to generate some fodder for thought. Am I to be repulsed by the cries and pleas for assistance, repeatedly underlining their desperation? Is repulsion the expected human response, as I… — read more

Responsible for the metabolism of 75 per cent of all drugs, responsible for the oxidative metabolism of drugs and endogenous substrates. Endogenous substrates metabolised by CYP450 include fatty acids, eicosanoids, steroids and bile acids. The highest concentration of CYP450 isoenzymes is found in the Liver. About 70 per cent of the total CYP450 content in… — read more

Lately, I have been sensing a tearing urgency to affix pain with palliation. Of positioning the performance of pain procedures as a skill essential to the definition of specialized palliation. I have been trying to temper my lack of surprise at this egregious positioning, given that this might represent the skill set of self-anointed experts.… — read more

While training to become the third postgraduate in the country to secure the MD Palliative medicine qualification, the terminology goals of care or the term ceiling of care never became a part of my working vocabulary. Perhaps this had a lot to do with the absence of postgraduate beds during that time, rather than my… — read more

I have often wrestled with the unenviable task of defining the skill set suited to the designation of a palliative oncologist. I have tried to do so in my presentation on “case presentation in  palliative medicine”, which received the MASCC scholarship award in 2021, where initiating chemotherapy was the main prerequisite for the position and… — read more

Sherlock – “I fear this is no mere fancy of the bowels, but a most grievous obstruction—tragically real, and cruel in its consequence. A certain cause of death. ” I have been struggling with the fact that my patients with malignant bowel obstruction have an extremely poor survival, and this combined with the damning realization… — read more