Taking the right decisions at the right time is important when it comes to matters of health.

By Dr Ulhas Ganu

Man is the only animal who is invariably quick to justify his actions even though sometimes these are proven to be inappropriate. My management studies professor used to instruct us to get answers for 5Ws and 1H. The Ws, according to him, was ‘What’, ‘When’, ‘Where’ ‘Whom’, and ‘Why’ while the ‘H’ stood for ‘How’. What happened? When did it happen? Where did it happen? Why did that happen that way? Who should you refer to? He had categorically ruled out the question, Who, as he said we ourselves are the ones who have to do the necessary thing; hence it stands answered automatically. Two other professors, viz. professors of Management Practices and Human Resource Development also insisted that the question, who made the wrong decision, or the mistake, needs to be avoided as it fixes responsibility and discourages people from taking up responsibilities for work later. However, for us, in day-to-day life, the question ‘Who’ is definitely important.

In recent years, a mounting body of evidence has suggested that increasing wealth, economic opportunities and education have led to better health, more life expectancy and hence, a growing and aging population. Such global transitions are also associated with less favorable consequences like the increasing prospects of, and accessibility to, unhealthy lifestyle behaviors, increased consumption of highly calorific foods and a reduction in physical activity. The cumulative impact of these lifestyle choices has led to an increase in the burden of non-communicable diseases in many low- and middle-income countries, including India. Our food, clothing and other habits are influenced by the advertisements that bombard us, and articles that are especially published to modulate our behavior.

I recently heard of an unusual case of tongue cancer in a 42-year old woman from a well-to-do family. Novices at all, and a clean lifestyle. It was unusual. We have known for more than 5 decades that not only are vices (like tobacco use) responsible for oral cancer but those sharp teeth causing irritation or injury can damage a set of cells in the mouth where regular friction occurs, the tongue is the obvious tissue to get damaged. A repeated injury to the same set of cells induces more generations of those cells compared with other cells in the mouth cavity. That may lead to abnormal cell production and perhaps malignancy later.

Let us visit the 5 Ws mentioned above again. What a wonderful guideline it provides! The answers to the questions would be: Whom to meet: appropriate doctor followed by How to go ahead provides the road map for decision-making. For early diagnosis of cancer, seven warning signals have been promoted:

• Change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in the breast or elsewhere
• Indigestion or difficulty in swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness

As the American Cancer Society stresses, signs and symptoms are both signals of injury and illness, signals that something is not right in the body. We must understand that a symptom is something that is felt or noticed by the person who has it but may not be easily seen by anyone else. Hence in life, the question: Who should respond and the answer ‘I myself ’ is equally important. A single sign need not be cancer, yet neglecting it for long is not advisable. What caused the injury that led to tongue cancer in the lady mentioned above may remain unknown. As my dentist always says, a visit to a dentist every 6 months for a routine check-up costs nothing but helps a lot if anything is wrong. The lady was lucky enough to visit a doctor on time, who, after a 15-day routine therapy, asked for a biopsy which resulted in the diagnosis of early-stage squamous cell carcinoma. She stood a good chance because of asking 5Ws and 1H for getting the right answers. Asking appropriate questions to get answers is the key.