Hello everyone. I'm Dr. Pracha Eamranond, Chief Medical Officer at Doctorpedia.
And today I have the pleasure of introducing Dr. Ruchi Garg.
She's the National Director of Gynecologic Oncology at the
Cancer Treatment Centers of America. Welcome Ruchi.
Hello Pracha. Thank you for having me here.
So can you tell our audience a little bit about yourself?
Sure. So as Dr. Eamranond announced,
that I am a gynecologic oncologist and what does that mean?
So a gynecologic oncologist
is a physician who is trained to do both gynecologic surgeries
and full comprehensive care there,
but also comprehensive cancer care as it relates to what I call
"below the belt," female reproductive organ cancers.
We're the only surgical oncology physicians who are trained to
provide care from diagnosis to comprehensive completion of cancer.
Great. Thank you Dr. Garg for explaining that to us.
I think even as a physician myself,
sometimes it's hard to articulate to patients the importance of gyn-onc and what
someone like Dr. Garg can do. So can you give us just an example, Ruchi,
about how
a patient in your world has been impacted by your care?
I'll just give you an example of a patient that I took care of last year.
I think not just because how she impacted my career or
how I impacted her care,
but also how she impacted me and my career and my
impression of how to deal with everything that happened last year
in the pandemic. So this is a young,
healthy female patient who presented in --
she was in her early forties. She presented right around February,
March of 2020 last year,
just when the shutdown was starting,
she was having some pelvic discomfort.
She was thinking whether I should go to the emergency room,
but because of all the concerns she decided not to,
she tried to reach out to her physicians and really could
not because at that time, even as physicians, many of the outpatient clinics,
the primary care, so they really, none of us knew how to deal with it.
So many of the primary care offices had shut down from providing care
to their patients for a little while. Well,
the patient's symptoms progressed through this time period.
And again, they were really severe,
sometime in early summer,
she again decided not to go to the emergency room and she was just too afraid.
And finally was able to get in with a provider who immediately got her
in with me.
This is a patient who showed up at my office on Thursday,
probably around 4, 5 PM.
And I literally added her onto my surgical schedule the next day.
This was the worst abdomen that I had ever seen.
Even on examination in my office. Her abdomen was rigid,
hot, tender, couldn't even touch it.
She had obvious discoloration on her abdomen.
When we got into the operating room, as soon as I made the first cut,
all of this odor-filled pus
came out of that belly.
What had happened is that this patient had an ovarian mass that
had twisted, got infected,
infected her whole abdomen and had had time to continue to infect her whole
abdomen, go through the fascia. In fact, the fascia.
So the fascia is the strong layer of the abdominal wall that keeps all our
abdominal contents in. Infected her muscle wall,
completely underneath,
all of the tissue underneath her skin and infected her skin.
I had to call trauma surgeons in during that surgery.
We ended up taking much of her abdominal wall, the skin,
the contents underneath the muscle, the fascia,
we had to leave her abdomen open for several days.
She had to come back to the operating room a couple of times to get what's
called washout, to get all of that infection material out.
And then they had to reconstruct her abdomen with mesh.
Just a few months prior to that,
she was a healthy 40 year old woman who took pride in taking care
of herself.
And none of this had to happen if she had just been able to
get early medical care.
Right. So we were talking about this yesterday.
This is such an important take home message, really, which is,
you want to make sure that you are followed by a health care provider who can
actually follow your symptoms. We're seeing so much delayed diagnosis,
delayed treatment. And so this is a very dramatic case, Ruchi,
and it really makes me feel great that we have folks like you who are able to
manage the complexity of these patients.
And we've shared stories seeing how care is provided around the
world. We're lucky in this country to have so many services that we've had.
Dr. Garg and I have worked in the same hospital at Johns Hopkins.
I won't tell you who preceded who, but... [Ruchi laughs] Yes.
We have access to so much care,
yet I think the world of gynecologic oncology is
relatively unknown to a lot of patients and even healthcare
providers. So really understanding
how do we access care and how do we access education.
I mean, for patients,
it's really important that we understand the different ways in which we can
access cancer care outside of individual visits with a doctor,
for example.
And that's why I think there's a huge opportunity here for digital health to
really play a role in educating patients across the continuum. So Ruchi,
tell us, what would be some of your take home messages to our audience,
as they're navigating the pandemic, the post-pandemic,
here in the United States and around the world.
I think one of the biggest take home message is that if you have
persistent symptoms that are abnormal for you, do not ignore them.
Seek out medical care, pandemic or not, okay?
Pandemic allowed us to move on or make progress towards telemedicine.
And that's important. Ask your doctor,
do you have an opportunity to talk to your practitioner just via telemedicine,
at least so that you can get some medical advice on the symptoms you're having.
In my world, if you're having abdominal pain,
bloating, or urinary frequency,
that combination of symptoms could mean an early sign for ovarian cancer.
If you're having any kind of abnormal bleeding after menopause,
even if it's a trickle spot, that could mean an early sign for uterine cancer.
80% of uterine cancer patients present just like that, just with one spot.
Any kind of abnormal pap smear that needs follow-up, don't ignore it.
Don't ignore it during this pandemic. Any kind of bleeding after intercourse,
those could all be signs of early cervical cancer. Why?
Because the natural course of other diseases continues,
pandemic or not.
So I'm going to drive home this point even further, Ruchi,
because I actually talked to one of my patients that I've been following for
about 15 years and she had, because of the pandemic, delayed her care,
but luckily she had access to a gynecologic oncologist in my network. And,
even though she came in with more advanced cancer,
she was able to get treatment very quickly.
And I would say really not only being proactive about symptoms,
like you've just described Ruchi, but understanding how you access care.
So for me as a primary care doctor,
I love when my patients write to me on our patient portal.
So I can actually get back to them same day.
You don't have to wait until the next appointment to ask a question.
If you're having symptoms that could be concerning,
those things should be managed right away.
And with telemedicine and with our current capacity to move forward in digital
health, I think there are a lot of ways which we can improve health.
And so thank you, Dr. Garg, for being with us.
And thank you for tuning in.
We really appreciate your participation and feel free to ask us questions at any
time. We're available 24/7, through Doctorpedia.com.