Awareness is the key to Prevent Suicide

Suicide…the last act of a depressed, dejected and despondent being, which they choose as a last resort to solve their life’s problems. But is suicide really a solution? Although the body can be freed from worldly pain through suicide, can the soul?

According to statistics from the WHO, there is an average of 1 suicide every 40 seconds all over the world. This means while you’re taking a sip of your cup of tea, , somewhere in the world someone is voluntarily taking a vacation from life. Even Bangladeshi statistics for suicide are quite alarming. According to sources, a total of 14,436 people died due to suicide in Bangladesh last year alone, which is 70% more than the total number of deaths due to corona in the first year of the country’s corona epidemic. But as much as we have been able to stay aware and take precautions for the corona epidemic and other physical problems, have we been equally aware and prepared to resist this silent killer called suicide?

The first important step in preventing suicide is to find out the reasons why a person chooses this path. Suicide is usually the ultimate manifestation of some mental disorder, one of which is depression. Sufferers of depression, often failing to achieve any dreams or goals, feel that their lives are meaningless at some point; as a result, they seek salvation through suicide. People may also choose this extreme approach due to stress, relationship problems, fear of loss of respect, family problems, physical pain, drug addiction and psychological abuse. According to WHO statistics, suicide rates are higher among people under the age of 30. Men are more vulnerable than women. On the other hand, apart from these regular reasons, the financial crisis caused due to the ongoing coronavirus epidemic, tension in relationships and depression caused by loneliness, the tendency of people to commit suicide has increased significantly.

There are several signs shown by a person at risk of suicide, which can largely help in predicting their decision. This is because suicidal tendencies don’t develop overnight. On the contrary, after a long period of time, the person loses his will to live when depression and shame accumulate in their mind. During this time, various negative thoughts are seen in the speech and activities of the person. Self-hatred, guilt, feeling like a burden to others etc. emerge in their conversations. Such people tend to be restless, get easily irritated by everything and distance themselves from friends and family. They even start searching online for various suicide execution plans.

A suicidal person’s thoughts usually go round and round in circles, and at some point, they unknowingly push themselves towards suicide. Therefore, a person at risk of suicide can mostly be helped by family members and close friends. In many cases, a suicidal person has communicated his or her thoughts directly or indirectly to those close to them through social media. Therefore, it is important to discuss with loved ones as soon as any such symptoms are seen. They need to be convinced that suicide is not a solution to the problem and that it is possible to find alternative ways to solve it. In addition, any deadly and dangerous material should be kept out of the reach of these vulnerable people. Above all, the person at risk should be referred to psychiatrists and psychologists as soon as possible. This is because proper care and counselling can help turn a suicidal person away from this path.

Loving yourself and those you love, and a little attention and care from your loved ones can prevent this silent killer called suicide. Negative thoughts like suicide can be eradicated only by making life meaningful and enjoyable through social values, mutual harmony and understanding. This requires education, discussion and above all, awareness. So let us be aware and help others to be aware. Let awareness be the key to prevent suicide.


Fabia Alam
Evercare Hospital Dhaka

Heart disease: the new concern for young people

In today’s world, heart disease, cardiac arrest or heart attack is considered to be one of the leading causes of death. At one time, it was thought that only the elderly were at risk of heart attacks. That notion is now deemed irrelevant due to the current situation, where young and middle-aged people are now suffering from heart attacks.

Around 20 million people worldwide die from cardiovascular disease each year, accounting for about 32% of global deaths. 60% of these deaths are due to heart attacks; coronary heart disease accounts for three-quarters of deaths in low- and middle-income countries in South Asia. In developing countries like Bangladesh, the risk of death due to heart disease is about 14.31%. In the last 10 years, the death rate due to heart attacks has increased 35 times for men and 48 times for women in Bangladesh. What is most alarming, however, is that incidents of heart attacks are gradually increasing among the younger generation.

Although common, many people may not know what a heart attack is or why it happens. For their convenience, I would like to convey the information that Myocardial Infarction, heart attack or whatever you may call it, is a medical complication when blood flow to the heart suddenly stops due to an obstruction. Plaque, also known as a block, is usually formed by the accumulation of fat and cholesterol in blood vessels. It is one of the main causes of a heart attack. Simply put, a blocked artery blocks the flow of oxygenated blood to a part of the heart, which results in a heart attack. If the blocked artery cannot be reopened quickly, the part of the heart that was supplied blood by that artery stops working, leading to death.

Symptoms usually appear days or weeks before a heart attack. If a doctor is consulted, the risk of death decreases with proper treatment; but in case of a sudden heart attack, the risk of death is quite high. A sudden heart attack is undoubtedly a large shock for the body and there is no specific age at which it occurs. Rather, the risk increases when there are inconsistencies in your lifestyle, consumption of unhealthy food, genetic problems, stress etc. But to think that it is asymptomatic because it occurs suddenly is the wrong assumption to make. Some of the symptoms of a sudden heart attack are constant pain or pressure in the chest, which lasts for a few minutes and can happen intermittently; you may feel pain while working, and then feel better while taking a rest. Besides this, nausea, indigestion, excessive sweating, fatigue etc. are some common symptoms of a sudden heart attack; but it is not the same case for everyone. On the other hand, another possible cause of death due to heart attack is post-Covid heart problems. Many who have recovered from Covid-19 have experienced blood clotting problems, which increases the risk of heart attacks.

It is true that the risk of heart attack increases as you get older. It also goes without saying that the risk skyrockets if there are problems with the heart and blood vessels.

Except nowadays, incidents of heart attacks are increasing at a significant rate even at a young age. The last 10 years of Global statistics show that heart attack rates among young and middle-aged adults have increased by 2% per year. According to doctors, inconsistent changes in modern lifestyles and physical inactivity are the two major reasons for increased problems in the heart and blood vessels. Incidents of heart attacks among young people are increasing day by day due to excessive smoking, lack of physical activity, not enough sleep, weight gain, excessive anxiety, eating unhealthy food, especially fat and cholesterol-rich food, diabetes, unhealthy lifestyle, hereditary causes etc. – but what is the best way to cure it?

The answer is very simple. Young or old, a heart attack can be life-threatening for anyone. Even if it doesn’t result in death, it can cause serious damage to your health. So, you need to get used to a lifestyle that does not increase the risk of heart problems. Eat food that does not clog blood vessels. Do things that keep your body active. The steps you can take to maintain this are to keep heart-friendly healthy food in your diet, exercise daily, avoid drugs and tobacco products, keep yourself cheerful, and if there is a history of a heart attack in your family, get screened from a young age. Even if not immediately, the risk of heart attack will decrease gradually.

Every living being must taste death; but a premature death is something no one desires. Heart attacks have become one of the leading causes of premature deaths among young people in recent times. So, everyone must be aware, and become interested in living a healthy life to prevent deaths due to heart attacks.

Prof. Dr. A.Q.M. Reza
Coordinator & Senior Consultant- Cardiology
Evercare Hospital Dhaka

Advanced treatment for Uterine cancer now in Bangladesh

41-year-old Piara Begum, a resident of Bhola. She was suffering from a tumour, situated in her uterus, for 9 years. It was initially small in size, so she did not consider it a major problem; but slowly the tumour started to grow in size, increasing her problems. At one point, her condition worsened and abnormal bleeding started. When Piara Begum did not receive any solutions from her local doctor in Bhola, she was moved to Evercare Hospital in Dhaka.

Her treatment started under Dr. Monowara Begum, Senior Consultant and Coordinator of the Department of Obstetrics and Gynaecology at Evercare Hospital Dhaka. Diagnoses revealed that Piara Begum had endometrial polyps in her uterus, due to which she was bleeding continuously. Anaemia was also diagnosed due to this bleeding. This was temporarily solved by supplying her with two bags of blood. Dr. Monowara Begum decided to remove the patient’s tumour through an immediate laparoscopic hysterectomy. Piara Begum’s tumour removal was successful. Dr. Monowara Begum sent the patient’s removed tumour for a biopsy. As everything had been done properly, and there were no complications after the surgery after one day of observation, the patient was discharged.

A few days later, when Dr. Monowara Begum received the patient’s biopsy report, she found that the tumour had turned into cancer because it had been in the patient’s body for such a long time. Piara Begum’s grade-3 stage-2 endometrioid cancer had infected more than 50% of her uterus. So, to save the patient at this stage, the doctor decided to perform lymphadenectomy again through laparoscopy and then radiotherapy. The patient underwent lymphadenectomy followed by the removal of her ovaries along with the affected part of the pelvic lymph nodes, and radiotherapy for further treatment of the cancer. For this purpose, Piara Begum was taken to the operation table for the second time and was operated on successfully.

Laparoscopic surgery is now well known to everyone. Today many surgeries are done this way. Surgery through laparoscopy is less painful as minimal or small cuts are made in the patient’s body and the wound heals faster. Therefore, the patient does not require any long post-operative observation. The patient can soon return to a normal life.

Although laparoscopy is used to treat cancer surgery in foreign countries, it was not common in Bangladesh until now. Recently, cancer surgery is being carried out through laparoscopy in Evercare Hospital Dhaka. If the patient’s cancer is in the early stage, then it is possible to treat it with this method of surgery. Evercare Hospital Dhaka is always ready to provide better and more effective treatments to patients through new technologies.

Due to the skillful hands of Dr. Monowara Begum, Senior Consultant and Coordinator of the Department of Obstetrics and Gynaecology at Evercare Hospital Dhaka, Bhola resident Piara Begum is now clear of danger. After two such major surgeries, the patient had no complications and is slowly recovering. She also expressed her gratitude for the sincere support she received from everyone after being admitted to Evercare Hospital Dhaka.

Heart Disease: Getting Serious About Prevention

Here’s one more way men and women are equal: neither sex should have heart disease.

New data:

Last year, Finnish investigators showed that 4 of 5 heart attacks in men could be avoided. All the men had to do were five things: be modestly active, eat a good diet, not smoke, drink alcohol moderately and maintain a normal body weight.  The findings of this robust study made an impression on the cardiology community. But it was a study of just men.

This year, a group of American researchers reported similar results in women. In the Nurses’ Health Study, women had to do six things to avoid heart disease: not smoke, keep a normal body weight, exercise 2.5 hours per week, eat a good diet, drink less than 1 alcoholic drink per day and watch less than 7 hours of TV each week. In this 20-year study, the 23-44 year-old nurses who made those basic choices were 73% less likely to get heart disease. These were nearly the same odds as the Finnish men.

There was a bonus in the Nurses Health Study. The same six lifestyle factors prevented 93% of diabetes and 57% of high blood pressure in women.


A note on watching too much TV: three studies published this month showed inactivity—sitting for long periods–was linked to higher rates of heart disease and even death. Although regular exercise lowered the risk,  it did not eliminate it. (Athletes with desk jobs pay attention to that.)

Although the research on “sitting disease” is still early, not sitting in one place for hours at a time may be an important way to live longer and better.

Changing the language:

Perhaps the most important thing about this new research is its effect on the language of heart disease prevention. Rather than treating diseases like high blood pressure and high cholesterol, doctors are looking at the basic and fundamental things that keep us from getting heart disease. Moving our bodies, making wise food and drink choices, not smoking and getting away from white screens will deliver far more health than any pill or capsule.

I know what you may be thinking: This is not new.

That’s partly true. But what’s different is that these studies are changing the way doctors think. They may now emphasize lifestyle changes before drugs. More doctors are writing prescriptions for exercise.

Remember these numbers: four out of five.

For four out of five men or women, heart disease need not happen. It is not necessary. It is not normal to let heart disease do this to us.

How to Get a Handle on Your High Blood Pressure

High blood pressure is a condition that patients tend to dangerously underestimate – many people just don’t take it very seriously. But they should. It’s a leading cause of death and disability; in fact, it’s been estimated that high blood pressure is a primary or contributing cause of over 400,000 deaths per year – that amounts to more than 1,100 deaths per day.

So why aren’t we more afraid of it?

I think the answer is a mix of familiarity and treatability. The recent statistics show that roughly 50% of adults have it – so most of us probably know someone with high blood pressure. And most of us are aware that it is treatable – we can take medications and make lifestyle to keep it under control.

The problem is, we’re not keeping it under control.

According to the CDC, only about ½ of those with high blood pressure are adequately controlling their condition. Some people are unaware that they have high blood pressure. Others are reluctant to take high blood pressure medications because of real or perceived side effects; or maybe they don’t want to (or can’t) make the needed lifestyle changes. But one of the biggest reasons people aren’t controlling their blood pressure is that they’re having trouble getting an accurate view of what their blood pressure numbers are exactly.

In the past, high blood pressure was determined by the blood pressure reading your get in your doctor’s office. But data has shown that blood pressures in the doctor’s office are often not accurate – even up to up to 65% of the time.

So, if you have, or are concerned that you have, high blood pressure, monitoring your readings away from your doctor’s office is crucial.

Here are the recommendations I give to my patients about monitoring blood pressure at home:

  1. Get a monitor where the cuff goes on your upper arm.  And make sure it’s the right size for you. Well-rated devices cost between $25 and $100.
  2. Sit quietly for at least 5 minutes before you take your blood pressure.  Make sure the cuff is on your bare arm and not over clothes.
  3. Vary the time of day that you check your blood pressure. Record your results and bring them with you to your next doctor’s appointment.

Blood pressure greater than 180/120 mm Hg is called a hypertensive crisis.  If you aren’t having any symptoms, it may be reasonable to wait 5 minutes and check it again before contacting your health care professional. If you are having any concerning symptoms (at any level of blood pressure), such as chest or back pain, shortness of breath, numbness or weakness or difficulty with your vision or speaking, you should call 911 immediately. 

Appropriately monitoring your blood pressure is an important opportunity for you and your doctor to work together to make sure you get the best treatment for your blood pressure.

Not All Blocked Arteries Should Be Fixed. Here’s Why

If you think all heart artery blockages should be fixed, you’re not alone. For years, cardiologists also thought if we can open a blocked artery with a stent or a balloon, we should.

It makes sense, but in some cases, it’s wrong. Let me explain.

Reviewed by James Beckerman on 9/9/2019

Doug is a 67-year-old man who came to see me because he feels like he’s a little slower during vigorous exercise than he should be. He doesn’t have chest pain or shortness of breath, and his endurance is good, but he’s not able to keep up as well as he wants. Part of the investigation into his symptoms included an exercise treadmill test – a stress test – which indicated ischemia, meaning it showed the possibility of blockages in his heart arteries.

An exercise stress test is useful, but isn’t highly accurate. So, to confirm a positive stress test, we usually run an additional test to look at the arteries themselves. In Doug’s case, I recommended a CT coronary angiogram, which is an x-ray test that directly evaluates the heart arteries to assess for blockages. Doug’s study showed a highly narrowed artery in his heart. Importantly, this artery was a minor one that provided blood to a relatively small area of his heart. When I told him the results, he was initially surprised I didn’t recommend fixing this blockage with a stent.

Who Needs a Heart Artery Stent?

There are almost one million heart artery procedures (called PCI’s or percutaneous interventions) done each year in the U.S., making them among the most common surgeries performed. But, recent research suggests some of these surgeries may not be necessary.

In broad terms, heart artery stents are performed in two situations. One is during a heart attack or an impending heart attack. This is called acute heart disease. The other is when stress tests or other heart artery tests discover blockages. This is called stable heart disease.

During a heart attack, it is well accepted that opening the heart artery with a stent procedure is beneficial. There is solid research evidence that opening the artery lowers the risk of death, further damage to the heart, and future heart failure.

However, the same is NOT true for most blocked heart arteries discovered by stress-testing when the patient is not having a heart attack.

While it seems logical that opening blocked heart arteries would be helpful, multiple research trials have not shown a benefit to fixing blocked arteries in stable patients.

One of the first large research studies that showed opening blocked heart arteries in stable patients did not save lives was the COURAGE trial. This study compared people who had heart artery blockages treated with stents and medications to those treated with just medications. After following these individuals for almost five years on average, there was no difference in death rates or heart attack rates between the two groups.

The result was a surprise for many cardiologists, and the study was criticized for several potential flaws.

However, a more recent trial showed the same lack of benefit for stents in stable patients.

The ISCHEMIA trial of over 5,000 people with a blockage in a major heart artery were randomized to fixing the blockage and medications or just medications. Just like the COURAGE trial, the study found no differences in death, heart attack, heart failure, or hospitalization between the two groups.

It is now generally accepted that stents in blocked heart arteries in patients who are not having a heart attack do not lower the risk of death or future heart attack. However, the COURAGE and ISCHEMIA trials did show a decrease in chest pain for those who had stents compared to medical treatment alone, but even this benefit is controversial

The decision to perform a stent in a heart artery involves weighing the risks and benefits. In the case of heart artery stents, the risks of the procedure are known. While infrequent, serious complications such as heart attack, stroke, or even death can occur in less than 1% of cases. Bleeding complications, kidney damage, or an allergic reaction are more common, although still infrequent.

However, if there is no benefit to the procedure, ANY risk is unacceptable.

The decision to perform a stent procedure is a complex one. There are numerous factors to consider, too many to explain in a single article. So, to decide the best course for you, have a thoughtful discussion with your doctor to explore the medical risks, benefits, and alternatives, balanced with your values and goals.

After I reviewed the medical information with Doug, we decided that his symptoms were unlikely due to his heart artery blockage. Since a stent was probably not going to help him feel better, and we knew it would not lower his risk for death or heart attack, we decided on treating his heart artery disease medically. We started an aggressive prevention treatment regimen that included excellent blood pressure and cholesterol control, along with his healthy lifestyle.

One year later, he continues to do well.

High Blood Pressure? These 3 Things Could Save Your Life

If you’re concerned about your high blood pressure, you’re right to be. High blood pressure is called the silent killer for a reason.Although high blood pressure typically doesn’t cause symptoms, it has a devastating effect on our health. High blood pressure is the primary or contributing cause of more than 1,300 deaths every day in the U.S. That’s someone dying almost every minute. It’s one of the leading causes of two of our most feared diseases, heart attack and stroke, and also increases the risk for dementia and kidney failure.

How to Check Your Blood Pressure

Roll up your sleeve and slide on that blood pressure cuff. It’s important to check how well your heart pumps blood.


These numbers are frightening, but here is something even more striking.

Almost all the deaths, diseases, and disabilities caused by high blood pressure are preventable.

We just aren’t doing it.

The Surgeon General’s Call To Action To Control Hypertension notes that only 1 in 4 people with high blood pressure have it under control.

As a cardiologist, I think this is unacceptable, so I have come up with the three most important things I want all my patients to know about lowering their blood pressure — and possibly saving their lives.

1. Know your numbers.

If possible, check your blood pressure at home. Reliable automatic blood pressure cuffs (get the ones that wrap around your upper arm) are inexpensive and widely available.

Although it is tempting to rely on the blood pressure from your doctor’s visits, the reality is these blood pressures are more likely to be inaccurate than not. Regularly checking your blood pressure at home — it’s critically important to sit quietly for 5 minutes before taking it — will set you up to be your own blood pressure expert and help guide your doctor in the best treatment options for your blood pressure. Talk to your doctor about how often to check your blood pressure and when. Empty your bladder beforehand, and wait at least 30 minutes after exercise, smoking, or drinking caffeine.

2. Treat the cause of your high blood pressure.

If you had a continuously running kitchen faucet, you wouldn’t treat it by bringing a mop. You would turn the faucet off. The same logic applies when treating your blood pressure. If you have a cause, the best treatment will be eliminating the cause.

Common causes of high blood pressure include:

  • Sedentary lifestyle — Even modest levels of activity can lower your blood pressure and minimize medications.
  • Eating highly processed food — Particularly if high in sodium
  • Being at an unhealthy weight — Losing 5%-10% of your weight can lower your blood pressure as much or more than any medication.
  • Excess alcohol — More than a drink a day can increase your blood pressure.
  • Untreated sleep apnea — Experts estimate 30%-50% of people with high blood pressure have sleep apnea, most untreated. If you snore, don’t wake up feeling rested, or your partner notices you periodically stop breathing while asleep, ask your doctor if you should be checked for sleep apnea.
  • Primary aldosteronism — This is a hormone problem once thought to be quite rare, but recent research has shown it to be relatively common. If your blood pressure is not well controlled on several medications, ask your doctor if high aldosterone levels could be the cause.

Talk to your doctor about what may be causing your high blood pressure. Certainly genetics are important, but experts estimate half or more of high blood pressure is caused by factors we have control over.

3. Take your medications.

Nobody wants to take medications. I get it. And I’m a firm believer we all should be selective about any medicines we take (including supplements) and know the benefits and risks.

However, if you know your blood pressure is regularly over 130/80 — even after doing all you can to treat high blood pressure causes — not taking your blood pressure medications puts you at higher risk of heart attack, stroke, and early death. The first-line blood pressure medications are effective, inexpensive, and have a low risk for side effects. It is critically important to work with your doctor to have a strategy for treating your blood pressure that makes sense to you and controls your blood pressure.

Although high blood pressure often doesn’t cause symptoms, its effects on our health are potentially devastating. But you have more control than you may have realized to lower your risk for heart attack, stroke, and early death. By following the three steps above, you are well on your way to controlling your blood pressure — and not becoming a statistic.

6 Simple Rules to Heart Healthy Eating

What is a heart healthy diet?

When I first became a cardiologist about 15 years ago, the answer to this question seemed simple. It was a low-cholesterol, low-fat diet. Unfortunately, that answer ended up falling apart. Turns out, eating foods with cholesterol probably doesn’t have much influence on your cholesterol levels; but eating processed, packaged foods with a “low fat” label has been terrible for our health.

Today, the answer to the heart healthy diet question is more controversial. Is it low carb? Plant-based, vegan, Mediterranean, gluten free, DASH? The list goes on, and each diet has their advocates.

But who is right? Unfortunately, the “experts” haven’t been very helpful. Each one seems to have research and reasons “proving” why their diet is best (and why you should buy their book).

There was a time when I wasn’t sure what to tell my patients about a heart healthy diet.  So I did my own research. I read the important papers, attended conferences, talked to the experts and my patients to see if I could cut through the noise to come to a simple message I could share with my patients.

In the beginning, the more I learned, the more confusing it was. Research findings were often conflicting and seemed to change weekly. Each diet had testimonials of success –  even the ones that seemed to directly contradict each other. In the end though, I came to see that we have been overcomplicating the task of eating well.

Here are the tips I give to my patients who are looking for a heart healthy diet (and by diet I mean the type of foods you usually eat, not restrictive eating to lose weight).

6 Simple Rules to Heart Healthy Eating

1. There is no one “right” diet for everyone

The beauty – and challenge – of medicine is how different we are and how the same treatment can lead to different responses in different people. A medication that saves one person’s life can cause a life-threatening side effect in another.

The same principle applies to diet. While one person may have amazing results with a certain diet, that does not mean you will have those same results. And just because a diet doesn’t work for you, doesn’t mean you failed – it may just mean that diet wasn’t right for you.

2. You should like it (even better if you love it)

Even if we had research that proved that one diet is best (and we don’t), if you won’t eat it, it won’t do you any good. We don’t do well when we feel deprived, and if you’re eating food you don’t like, you’re setting yourself up to fail.

Find a healthy eating style you love and that loves you back. There are too many great tasting and healthy options to settle for food you don’t like.

3. Avoid highly processed foods

If you only follow one of these 6 rules, make it this one. About 70% of the US diet is highly processed foods and it’s a major contributor to the obesity, diabetes and high blood pressure epidemics.

What are highly processed foods? There are several definitions, but here is one I like. Processed food is manufactured food, typically high in added sugars (like high fructose corn syrup) or refined grains (for example, white flour or white rice).  These foods often contain many ingredients you would not recognize as food such as preservatives and other chemicals.

4. Include vegetables and other plant based foods

Mom was right. Eat your vegetables. Every reputable expert recommends that vegetables and other plant based foods should be a big part of your diet.

This doesn’t mean you need to be vegetarian (I’m not), but the simple act of getting planet-based foods into most of your meals can do wonders for your heart health.

5. Portion size still counts

Even if it’s healthy food, eating too much is still, well, too much.

Slowing down, eating mindfully, and serving your meals on smaller plates are all proven strategies to decrease the amount you eat without feeling like you are going hungry.

6. Eat at home

Who has time to cook anymore? YOU do! Cooking at home can be quicker than going out, and the benefits are indisputable. Better quality food, lower cost, a stronger connection with loved ones, and a healthier weight are just some of the benefits of home cooked meals.

You don’t have to be a master chef to put good quality, nutritious food on your table. Start with one or 2 “go to” meals that you enjoy and can prepare quickly.  Or you could try one of the many meal delivery services that are available.

Eating heart healthy is not one size fits all, nor is it written in stone. For most of us, it’s a constant process of trying new things and judging the response. To make things easier, you can start with one of the major diets (i.e. Mediterranean, DASH, vegan, Paleo, etc.) and adapt it to your tastes and needs, or you can start with your own creation.

As long as you follow the 6 rules, you will be able to find YOUR best heart healthy diet!

Could COVID-19 Be Causing Strokes? Know the Signs

A new, and frightening, expression of COVID-19 infection has surfaced. Numerous physicians around the world are reporting a possibly increased risk for blood clots in patients with COVID-19.

Blood clots (what doctors call thrombosis) are particularly worrisome because of the potential consequences. Blood clots in the veins can travel to the lungs (which is called pulmonary embolus), a potentially life-threatening problem. Blood clots in the arterial system are even more alarming because these can lead to heart attacks, strokes, and amputations.

COVID-19 appears to increase blood clots in both the arteries and the veins. Although all of the studies are small and observational at this point, one study from the Netherlands showed that 31% of subjects with COVID-19 in the ICU developed blood clots despite usual measures to prevent clotting. Another small study from China showed that 25% of the COVID-19 patients developed blood clots in the veins. These are shockingly high numbers.

Physicians are particularly troubled by this possible blood clotting issue for several reasons. One is that the usual treatments (such as blood thinner medications) aren’t working for some patients. Another reason is the report of COVID-19 positive people as young as their 30’s experiencing large strokes that are more typically seen in a much older population.

More information is needed to understand if this is a true correlation between COVID-19 and blood clotting disorder, what the mechanism is, and, most importantly, how to prevent and treat it. 

For now, be aware that there’s reason to suspect that COVID-19 could possibly put any of us at risk for stroke.

So, be alert for stroke symptoms – sudden weakness, numbness, trouble speaking, seeing, or the onset of a severe headache without other explanation – even if you wouldn’t ordinarily need to be concerned about stroke risk, and even without other signs of COVID-19 infection.

If you do experience symptoms that may be stroke-related, it is critically important to seek urgent medical attention. Timing is crucial because the best treatments for these types of stroke need to be delivered in the first 3 hours of symptoms to be most effective. As stroke neurologists like to say, “Time is brain.”

And if you suspect a stroke in someone else, act F.A.S.T.:

F.A.S.T. stands for:

F—Face: Ask the person to smile. Does one side of the face droop?

A—Arms: Ask the person to raise both arms. Does one arm drift downward?

S—Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?

T—Time: If you see any of these signs, call 9-1-1 right away.

Understandably, some are reluctant to go to the hospital during the COVID-19 pandemic, but when it comes to a stroke, the consequences of delaying medical treatment could be devastating. Do not delay. Call 911 if anyone has these symptoms.

How to Avoid the Diabetes/Heart Disease Connection

If you have diabetes, is it inevitable that you’ll end up with heart disease as well? Traditional teaching suggested that it was, or at least highly likely – if you were diagnosed with diabetes, you were automatically categorized at “high risk.” But more recent data suggest that, with a little work, you can stay out of that high risk category – even with diabetes.

This research not only provides hope, but also a road map to lowering your risk for heart disease.

John’s Story

John had been told for years that diabetes increases his risk for heart disease, but he didn’t take the risk very seriously until chest pain and pressure led to the discovery of a blocked artery. We inserted a stent that opened his artery and relieved his pain, but the experience left John deeply concerned about his future health. He worried that he had missed his chance, that the damage was already done because he didn’t pay attention to his health when he was younger.

John’s new interest in his health resulted in some big changes. He started participating in cardiac rehab and exercising every day. He is eating nutritious food and has already lost 10 pounds! He is taking his medications and his blood sugar and cholesterol numbers are much improved.

But he is wondering if that is enough? Does he need to do more, or will his efforts even make a difference?

Diabetes and Heart Disease

One of the first major research studies to show that people with diabetes were at very high risk for heart disease was published in 1998. This was eye-opening to the medical community and led to a change in the way doctors treat patients with diabetes. Based on the recommendations from researchers, we began taking an aggressive preventive approach for all patients with diabetes, emphasizing lower blood pressure, improved blood sugar and statin medications. Around ten years later, a small study looked at the effects of this “multifactorial” approach to prevention and found that it does, in fact, lower the risk of death and heart disease in patients with diabetes. And now we have evidence in large populations that death rates and heart disease rates are falling in patients with diabetes.

These research findings are important because they show that heart disease is not inevitable if you have diabetes. A recent study goes a step further, not only showing that some people with diabetes can lower their risk for heart disease and stroke to the same levels as those without diabetes, but also provides a 5-step road map on how to do it.

(Lots of) Hope for People with Diabetes

A recently published study in the New England Journal of Medicine of over 1.6 million people showed that if 5 good health targets are met, those with diabetes have a similar risk for death, heart attack and stroke as those without.

Those 5 good health targets are:

  • Good blood sugar control (Hemoglobin A1C < 7.0%)
  • Good blood pressure control (Systolic blood pressure < 140 mm Hg, Diastolic < 80 mm Hg)
  • No protein in the urine
  • Not smoking
  • Good LDL cholesterol (LDL < 97 mg/dL)

We now have good evidence that if you have diabetes, you have a lot of control over your risk for heart disease. John was very happy to hear the news that his recent efforts are likely to pay big dividends for his future health. If you have diabetes, work with your doctor to identify the ways you can manage your diabetes and not let it manage you.

Would You Recognize the Symptoms of a Heart Attack?

Someone dies of heart disease in the United States about every 40 seconds. And more than one in three of those deaths occur suddenly – something doctors call “sudden cardiac death.”

Here’s why this is important. Most of the people with sudden cardiac death had symptoms in the hours and days before dying; they either just didn’t recognize the signs as worrisome or ignored them. Many of these people missed the signs because they didn’t think they could be at risk for heart disease – they were fit, they exercised, they felt strong.

Just like Rob.

Rob was training for his 4th Iron Man when he started to notice his throat felt dry during strenuous parts of his training. He ignored it at first, but it was getting worse. Rob began to feel the throat dryness earlier in his bike rides and even started to feel it when he wasn’t training. When he mentioned his symptoms to his wife, she insisted that he seek medical attention.

Ultimately, Rob ended up in the emergency room, where it was confirmed that he was having a heart attack. He had an urgent heart catheterization, which found not one, but two blocked heart arteries. He had stents put in to open the arteries, and fortunately only had mild damage to his heart.

Rob had never considered the possibility that he could have a heart problem. Sure, he had a family history of heart disease, and his cholesterol wasn’t great, but people with heart problems had chest pain – and they weren’t Ironmen!

Rob was fortunate that he wasn’t one of the 300,000 people who die each year in the US from sudden cardiac death. I have several patients with similar stories. They had symptoms that were recognized too late to prevent significant heart damage. But unlike many others, at least these patients were able to tell their story.

The message is that symptoms of heart disease are complex. It’s not just chest pain or pressure that radiates to the left arm. There is a lot of individual variation in how heart disease presents, making it a challenge for all of us, including doctors, to determine when symptoms are heart-related.

Here is the information I want everyone to know about possible heart symptoms.

  1. Symptoms that occur with physical activity or emotional stress and go away with rest – like what Rob experienced – need to be evaluated by a medical professional.
  2. Symptoms such as chest pain or pressure, nausea, indigestion, or heartburn that aren’t going away – particularly if associated with shortness of breath, sweating, palpitations, or feeling like you will pass out need to be evaluated by a medical professional urgently. Don’t drive yourself to the hospital, but call 911.
  3. If you’re concerned, I’m concerned. Be safe and have your symptoms evaluated by a medical professional. It’s much better to be told it isn’t your heart than to find out too late that it is.

Rob’s story was a success because it ended well. He has resumed participating in Ironman competitions, although he doesn’t push himself to the limits anymore. More importantly, he has continued his duties as a loving father and husband.

Recognize the possible symptoms of heart disease. Don’t become a statistic.


Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide, causing more than 32 lac deaths in 2019. COPD is a highly prevalent and grossly underdiagnosed public health problem in Bangladeshi adults aged 40 years or older. Illiteracy, smoking and biomass fuel burning are modifiable determinants of COPD. It is estimated from a population study that between 10-13% of people above the age of 40 in Bangladesh fulfil the international criteria for diagnosing COPD. Older age, male sex, illiteracy, underweight, history of smoking (both current and former), history of asthma and solid fuel use were significant predictors of COPD.

Chronic obstructive pulmonary disease, or COPD, describes a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed. COPD is a common, preventable, and treatable chronic lung disease which affects men and women worldwide.

Abnormalities in the small airways of the lungs lead to limitation of airflow in and out of the lungs. A number of processes cause the airways to become narrow. There may be destruction of parts of the lung, mucus blocking the airways, and inflammation and swelling of the airway lining.

COPD usually develops because of long-term damage to your lungs from breathing in a harmful substance, usually cigarette smoke, as well as smoke from other sources and air pollution.

Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD) worldwide. The majority of people with COPD are current or former smokers. There is a huge amount of evidence that links tobacco smoking with COPD:

Between 15% and 20% of smokers develop COPD.

Up to 90% of COPD cases are the result of lung damage caused by smoking.

Tobacco smoking is the cause of 90% of deaths that are related to COPD.

The risk of developing COPD gets higher the more years a person smokes, and the more they smoke per day. However, the good news is that it is never too late to stop smoking. When people smoke tobacco, they breathe tiny particles of irritants into their lungs each time they inhale the smoke. This has two damaging effects:

The small airways inside the lungs become swollen and inflamed.

The lining of these airways produces a larger amount of secretions to trap the irritants.

The combined result of these effects is that the airways become thickened and narrowed because of the swelling and mucus. This reduces the amount of air that can flow through them. The increased amount of mucus also causes a persistent cough, in an attempt to clear the airways. Over a period of time, this constant irritation and inflammation in the airways causes many smokers to develop COPD.

If a smoker is also regularly exposed to other kinds of irritants that can cause COPD, then his or her risk of getting this condition is even higher. For example, smokers who also work in an environment where they are exposed to toxic fumes, chemicals, or dusts have a much higher chance of getting COPD than their co-workers who do not smoke.

Research also shows that women who smoke experience worse respiratory symptoms than men who smoke the same amount. This means that female smokers may be more likely to develop COPD than male smokers.

Jobs where people are exposed to dust, fumes and chemicals can also contribute to developing COPD. There is strong research evidence that COPD can be caused or made worse by dusts, fumes and irritating gases at work. Work related COPD is a priority because of the human costs in terms of suffering, its effects on the quality of life and the financial costs due to working days lost and medical treatment.

You’re most likely to develop COPD if you’re over 35 and are, or have been, a smoker or had chest problems as a child. Some people are more affected than others by breathing in noxious materials. COPD does seem to run in families, so if your parents had chest problems then your own risk is higher.

There is no cure for COPD but early diagnosis and treatment are important to slow the progression of symptoms and reduce the risk of flare-ups.

COPD should be suspected if a person has typical symptoms, and the diagnosis confirmed by a breathing test called spirometry, which measures how the lungs are working. In low- and middle-income countries, spirometry is often not available and so the diagnosis may be missed. 

There are several actions that people with COPD can take to improve their overall health and help control their COPD:

  • stop smoking: people with COPD should be offered support to quit smoking;
  • take regular exercise; and
  • get vaccinated against pneumonia, influenza and coronavirus. 

Inhaled medication can be used to improve symptoms and reduce flare-ups. There are different types of inhaled medication which work in different ways and can be given in combination inhalers, if available. Inhalers must be taken using the correct technique, and in some cases with a spacer device to help deliver the medication into the airways more effectively.

As COPD progresses, people find it more difficult to carry out their normal daily activities, often due to breathlessness. There may be a considerable financial burden due to limitation of workplace and home productivity, and costs of medical treatment.

During flare-ups, people with COPD find their symptoms become much worse – they may need to receive extra treatment at home or be admitted to hospital for emergency care. Severe flare-ups can be life-threatening. People with COPD often have other medical conditions such as heart disease, osteoporosis, musculoskeletal disorders, lung cancer, depression and anxiety.

As COPD constitutes a huge hidden burden of disease in people of 40 years of age or older in Bangladesh, it has become a major public health problem here and there should be more research and action to be directed toward preventive measures and intensive efforts must be made to target smoking cessation and reduction of indoor air pollution due to biomass fuel burning.

Dr. Ziaul Huq

Senior Consultant

Respiratory Medicine

Evercare Hospital Dhaka

How to Be a Better Advocate for Yourself as a Patient

The ability to advocate yourself, especially as a breast cancer patient, can be incredibly powerful in shaping your cancer experience. It took me a while to realize that as a patient, I have an active and very important role in my medical care.

Yet I also realize that we’re never taught how to navigate the world of medicine from the patient seat. As a result, it’s easy to feel overwhelmed and develop frustration and confusion regarding your diagnosis and treatments — which is the last thing you need on top of dealing with the emotional impact of a cancer diagnosis.

By practicing the following steps, you can conquer your medical journey by getting your care team on your page, on your terms, and with your best interest in mind.

Do Your Homework

Doctor: “Do you have any questions?”

You: Blank stare

You, 5 minutes later as you’re driving away from the office: “Oh yeah, I forgot to ask her about that rash, and I needed a prescription refill. … ”

Sound familiar? Our most burning concerns tend to escape us just as we sit down in front of our doctor to talk about them. It happens to all of us. Your doctor has an agenda for your appointment, and you can, too. By preparing for your office visits, you can optimize your time with them to meet all of your needs. I start by writing down all of my questions as they come to me so that when I’m with the doctor, I’m ready to have them addressed.

The same goes for any symptoms I’ve experienced since my last visit. Is my headache worse than usual or have I noticed some new swelling? I jot down the symptoms and any relevant details, like when they occurred, how long they lasted, and whether I took any treatments or not. Writing this down while it’s fresh in my mind makes it easier for me to share with your doctor.

Lastly, I bring all of my current medications (the bottles or a list of them) and new medical records, like test results or a consultation visit with a specialist to the visit with me. This helps keep the doctor up to date on how my health is being managed outside of their care.

Pro tip: State your agenda at the beginning of your visit so your doctor can tailor the appointment to address your concerns appropriately. For example, if you have a follow-up visit after chemo to see how you’re tolerating the medication(s) but you also have questions about an upcoming test they ordered, mention this at the start of your appointment. That way, your doctor can make sure to allocate enough time for your questions. Waiting until the last 2 minutes of the appointment to raise your questions can be a disservice to you, as you may not receive a thorough or fulfilling enough answer.

Ask Questions

Many patients feel intimidated by the idea of asking questions because they don’t want the provider to think they’re questioning their expertise. Others have a strong desire to please the doctor and try to do so by not questioning them. (Research backs this up.) That being said, I know that if I have a question or don’t understand something the doctor said, I absolutely deserve to ask for clarification about all matters pertaining to my health.

Misunderstanding your health care can lead to unnecessary fear, anxiety, and confusion that could be relieved by a simple clarification. Thus, I think a patient-provider relationship functions best when you maintain two-way communication. And remember: There’s no such thing as a stupid question! Even if I ask the same question more than once or ask the same question to different providers.

If you’re not sure what to ask, here are a few questions that have helped me understand more about my health:

When you get a diagnosis:

  • What is my diagnosis?
  • How did I get this diagnosis? (From symptoms? From a lab test?)
  • What does this diagnosis mean?
  • What’s the prognosis, or expected course, of this diagnosis?

When considering tests or treatment options:

  • What are my options?
  • What’s the purpose or goal of each option?
  • What are the potential risks of each option?
  • What are the potential benefits of each option?
  • What would you do and why?

Pro tip: The amount of information you receive at your doctor visit can be daunting and difficult to remember. Ask how you can access this information after the visit to refer to or share with others (for example, a printed handout, email summary, or written notes).

Be Honest       

Although honesty with my provider can be uncomfortable or embarrassing, it’s truly the best policy. No matter what I’m sharing with the doctor, it’s only beneficial to disclose exactly what’s going on and what I’m thinking. Often, medical decisions are made and actions are taken (or avoided) based on the information I provide, so it’s vital to be honest and tell my doctor everything.

This extends beyond symptoms you may be experiencing to your preferences or even your satisfaction with the provider. Your health is more than just what’s happening with your body, and it all can impact your health experience. Don’t be shy. For example, I have a preference for female providers only, so when my female oncologist left the practice and I was reassigned to a male provider, I called the office to tell them I needed to see a female provider. Arrangements were made for that to happen.

Most important, if you sense an issue with your provider or feel your relationship is tense or troublesome, please say something. It’s best to bring it to their attention, as they may not even be aware of your experience. This allows them an opportunity to clarify their behavior and intentions and/or adjust it appropriately.

Pro tip: State your preferences ASAP. For instance, everyone has different preferences about how they receive information — you might want to know the details of each test result and what it means, you could prefer a one-line summary, or maybe you’d rather the doctor explain it to a loved one instead. Don’t make your provider guess — be clear and tell them exactly how you want to receive medical information.

Being a patient isn’t easy. It can feel like cancer robs us of so many important pieces of ourselves, with our control as individuals being the most devastating loss. By following these steps, you can harness your power as a patient and guide your experience based on your values and desires.

My Oncologist Is My Rock

My relationship with my oncologist is a critical and cherished one. She is as much a part of my cancer battle as I am — the light guiding me through the muddy, shady path. In my urgent situation, I didn’t find her through a comprehensive selection process or from others’ recommendations. Rather, it was a series of chances that united us, but I know now she was meant to be my oncologist.

On paper, it may seem obvious why we got along so well. We’re both female, we’re both physicians and we’re both mothers. Although we related in these aspects, the depth of our relationship ultimately had nothing to do with either of these commonalities. I attribute my experience with my oncologist to her humanity and excellence as a provider.

I will never forget the first time I entered her exam room as a mentally disheveled young woman who’d recently received a devastating cancer diagnosis. She sat directly in front of me, our knees almost touching. Then she met my gaze with her graceful blue eyes and introduced herself. In that moment, I felt her genuine and comforting presence. An overwhelming sense of relief washed over me and the tears started to flow.

“We are going to figure this out,” she affirmed. I had no idea what kind of breast cancer I had, if I needed surgery or radiation, or if I was going to live or die, but I felt the power of having my oncologist with me, on my side.

In each and every conversation we had my oncologist remained receptive and patient, which deepened my conviction in her. Through all of my questioning — sometimes repeating questions (thank you chemo brain!) — she listened, kindly explained, and then checked my understanding to see if she’d answered my question. Although I know the busy, time-restricted schedule she worked within, I never felt it. When we were together, all her attention was on me.

I wasn’t just a patient in her office. I was a busy person with a budding family and career who happened to be diagnosed with breast cancer. My cancer connected us, but our conversations spanned all topics of life and I know I was heard because time after time my oncologist demonstrated that she understood me.

She acknowledged my beliefs, my values, and my goals. As she presented the best treatment options, she did so objectively, or “by the book,” and then explored each with me through my lens of my life. In this manner, my oncologist gained my trust. I knew she was acting in my best interest. I didn’t have to say many words for her to understand exactly what I was thinking; sometimes even before I realized what I was feeling, she knew. And it amazed me. She truly got me.

Being able to have this connection with my oncologist was incredibly empowering and positively impacted my experience with breast cancer. I am so grateful to have had her by my side. All individuals with cancer deserve to trust and receive the grace and compassion of their oncologist as I did.

When I Heard ‘Breast Cancer’, I Wasn’t Sure I’d Have a Future

I always suspected I might get cancer. My maternal side is riddled with cancer. My mother had ovarian cancer when she was pregnant with me in her late 20s. My grandmother had cervical cancer in her mid-40s. An aunt had breast cancer in her early 50s. I assumed it would only be a matter of time before I would be added to the family cancer tree, but I never thought it would happen before I had even turned 40.

I was able to receive a preventative mammogram at 35 due to family history. It was clear, and I was told to come back when I was 40.

Two months after my 39th birthday, I spotted a circular bruise on the back of my left arm and found what felt like a large hard fist near my left underarm. I called my primary care doctor, and she immediately wrote an order for a diagnostic mammogram, which then led to a biopsy.

My biopsy was on a late Friday afternoon on 9/11/15. It felt wrong and scary to have a biopsy of the mass in my left breast on such a nationally tragic day. I was told the results would be available within 24 to 48 hours. Since I was the last patient of that day, I was expecting the results either Tuesday or Wednesday.

So when my cellphone rang at 3:05 p.m. that Monday, I instinctively knew I should answer it even though I didn’t recognize the number. When I flash back to this memory, it is like I am suspended above my work cubicle, watching everything unfold.

I see myself running down the hall into an empty conference room.

I see my eyes filling with tears yet widening in disbelief.

I see my hand shaking while holding my phone.

“Megan-Claire, you have invasive lobular breast cancer. We don’t know the stage yet. You need to get a pen and paper and take some notes because time is of the essence.”

I will never forget the fear and panic crushed me like a tsunami after receiving the cancer call. Once I met my medical team, I was officially diagnosed with Stage IIA invasive lobular, ER+/PR+, HER2- in the left breast. It is the second most common type of breast cancer, but only accounts for about 10% to 15% of all invasive breast cancers.

It’s crazy how hearing those words completely changed the trajectory of my life. Every plan and dream I had up to that point became frozen because I didn’t know if I would survive breast cancer. I wasn’t even sure I would have a future.

Since I was diagnosed under age 40, I was often the youngest person in the infusion room. I had to work during all my treatments. I wasn’t even close to the typical retirement age. Fortunately, I was able to find fantastic online support aimed at adolescent and young adult cancer survivors (AYA) through organizations like Elephants and Tea, GRYT Health, and Stupid Cancer.

My diagnosis forced me down a path that no one could fully prepare for, including coming face-to-face with my own mortality at 39. I’ve survived 16 rounds of chemo, eight total surgeries, 33 radiation treatments, blood transfusions, multiple infections, and infertility.

Life is fleeting. The fear of the unknown and getting scans every 6 months for 10 years pushes me to live life with renewed passion and purpose because tomorrow is not promised.

How I Changed My Relationship With Fear

I’m 32 and I have no family history of breast cancer. So when my doctor ordered a mammogram, it seemed like an unnecessary test. I was certain the lump I had felt in my breast was simply a cyst or a fibroadenoma — two of the most common benign breast tumors. Breast cancer hadn’t even crossed my mind.

When I received my diagnosis of invasive ductal carcinoma, I was in disbelief, emotionally labile (that’s doctor speak for shaky), and confused. I kept asking myself:

  • How did I get cancer? 
  • How long has it been growing in my body?
  • Could it have been detected sooner if I performed regular breast self-exams?

Fixated on these questions, I drowned in devastation and denial, searching for something to blame for the fact that I had cancer. Every cause has an effect, right? But I’ll never know what caused me to get breast cancer.

It’s only natural to wonder how the hell I got to this point, but staying stalled in my past didn’t serve me in my current situation — a newly diagnosed breast cancer patient who needed to get a port placed to start chemotherapy ASAP.

I wasn’t ready to accept this new label, so I opened my mind to explore what it felt like to have cancer. I examined the thoughts and feelings coursing through my body, noting one sensation that prevailed: fear.

Fear of the unknown, fear of pain and suffering, fear of loss, and fear of death.

I didn’t want to feel fear. (Who does?) We’re taught that fear is bad, fear feels awful, and that we should avoid fear at all costs. Yet the more I resisted it, the more it seemed to persist, and the worse I felt. So I tried something different: I allowed it. I figured, what did I have to lose now?

Allowing my fear to surface, I noted it as a heaviness in my core that radiated icy-hot spikes through my limbs and a blossoming, steamy fullness in my cheeks. Fear didn’t feel good, by any means, but by sitting in it I realized that my fear, like all of my emotions, was just a vibration in my body. Nothing more — what a relief this was! Like that, my fear of feeling fear melted away.

I learned to recognize my fear, acknowledge it (“Hi, fear, I see you”) and sit with it until it went away. Sometimes it lasted longer than others, like in the days approaching my first chemo session, but it always passed. This is a secret every cancer patient needs to know, especially, when you’re diagnosed: Face your feelings, feel your feelings, and the feelings will fade away.

The more I practiced this process, the easier it became to experience all the emotions that arose when I was diagnosed with breast cancer. In fact, understanding myself in this way brought me clarity as to how I wanted to proceed as a young mom and doctor diagnosed with breast cancer and ultimately shaped my strength through my breast cancer journey.

No one ever expects to be diagnosed with cancer or is prepared for their own response to such news. If you’ve been diagnosed with cancer, I encourage you to approach your emotional experience with compassion and curiosity. Allow and acknowledge all of your emotions and move forward in your cancer journey empowered. You can’t control cancer, but you can control how you experience it.

Identifying Breast Cancer and Keeping it At Bay

When cells in one’s breasts begin to grow abnormally and uncontrollably, the disease is called breast cancer, a leading cause of cancer in women all over the world. Approximately 1 in every 8 women worldwide is expected to develop breast cancer during her lifetime. Only 1% of breast cancer patients are biologically male.

Although exact countrywide statistics are not presently available to us, it is clear from hospital data that the number of breast cancer patients in Bangladesh is increasing on a yearly basis. There are numerous reasons for the increased number of breast cancer incidences in Bangladesh. Thanks to wider availability of common diagnostic facilities, we are seeing a higher number of breast cancer diagnoses.

Risk Factors for Breast Cancer

There are some risk factors which may be managed in order to avoid breast cancer. Men and women who heavily drink alcohol are both at greater risk of developing breast cancer. Women who are physically inactive are more likely to develop breast cancer, as are overweight and obese women, particularly after menopause. Also after menopause, if a woman has been taking hormone replacement therapy for a long period of time, the risk of breast cancer is higher.

A woman’s reproductive history might also pose a significant risk factor for breast cancer. If she has been taking certain contraceptive pills for a long time, bore a child after 30 years of age, is intentionally childless, or did not breastfeed any children she bore, she is at greater risk of breast cancer.

Besides these, there are some risk factors which, unfortunately, cannot be changed. Being a woman, especially one older than 50 years, is the biggest risk factor for breast cancer development (and in fact, most cases of breast cancer are found in women over the age of 50). Genetic mutations, inherited changes to certain genes such as BRCA 1 and BRCA, make breast cancer more likely for women at an earlier age when they are premenopausal.

Another risk factor we can not change is early age of starting menstrual cycle (i.e. before 9 years of age) and late menopause (i.e. menstruation till 55 years).

Symptoms of Breast Cancer

It’s important for any woman, and even men, to know the signs which might indicate the presence of breast cancer. Note that while different people have different symptoms, some may not have any symptoms at all.

Look for signs that your breasts might be afflicted by cancer. If one finds a new lump in the breast or armpit (axilla), experiences itching or swelling of part of the breast, notices irritation or dimpling of breast skin, experiences pain or notices redness or flaking of the nipple, observes that the size/shape of the breast has changed, or secretes any nipple discharge other than milk (such as blood), one might have breast cancer.

Breast Cancer Screening

During a breast cancer screening, a woman’s breasts are checked for cancer before there are signs or symptoms of the disease. During a screening, breast cancer is detected at an early stage to ensure that the cure rate can be high with the help of appropriate preventive treatments. As breast cancer incidence among Bangladeshi women is highest between the ages of 45 to 74 years, it is a good practice to do a screening mammogram test every 2 years.

How Breast Cancer is Diagnosed

The diagnosis of breast cancer can be undertaken in multiple ways. The following tests can help to detect breast cancer: breast ultrasonography, diagnostic mammogram, breast MRI (when and if needed), biopsy (core needle biopsy/open biopsy for histopathological diagnosis, and FNAC.

FNAC is used for cytological diagnosis and carried out if the lump size is very small, usually less than 1cm, making it impossible to use a biopsy needle. FNACs tests can give false negative results, in up to 15% of cases. Another disadvantage is that immunohistochemistry tests are usually not done from FNAC specimens.

Another way of diagnosing breast cancer is through immunohistochemistry (IHC). Carrying out IHC tests helps us to find out the type of cancer, oncologists can decide on the treatment options and the future of the patient can be predicted. IHC tests measure ER (Estrogen Receptor) status, PR (Progesterone Receptor) status, HER2 (Human Epidermal Receptor 2) status, Ki67 status, P53 status.

Treatment of Breast Cancer

After breast cancer has been detected, it can be treated in several ways. It depends on the type of breast cancer and on how far it has spread. People with breast cancer often get more than one kind of treatment. Treatment options for breast cancer include surgery, chemotherapy, radiotherapy, hormone therapy, targeted therapy, and immunotherapy.

How to Lower the Risk of Breast Cancer

Predicting the onset of breast cancer might be difficult. However, there are certain steps one can take in order to lower their risk of developing breast cancer. By maintaining a healthy weight, exercising regularly, abstaining from consuming alcohol or limiting alcohol intake, avoiding certain oral contraceptive pills, foregoing Hormone Replacement Therapy (HRT) and breastfeeding one’s child, one might hope to keep breast cancer at bay.