HER Ca­reer

Kota talks treat­ment, early de­tec­tion

The Sentinel-Record - HER - Hot Springs - - Contents - Story by Lind­sey Wells, pho­tog­ra­phy by Mara Kuhn

Dr. Man­jusha Kota has been prac­tic­ing as a med­i­cal on­col­o­gist and hema­tol­o­gist in Arkansas since 2005. She com­pleted her in­ter­nal medicine res­i­dency and hema­tol­ogy-on­col­ogy fel­low­ship at the Univer­sity of Arkansas for Med­i­cal Sciences in Lit­tle Rock. In Hot Springs, she worked for five and a half years at Mercy Cancer Cen­ter be­fore open­ing her own of­fice, Kota Cancer Clinic, at 180 Med­i­cal Park Place, Suite 201, across from Na­tional Park Med­i­cal Cen­ter.

How did you get into the med­i­cal field?

MK: My grand­mother was a nurse. She went into nurs­ing school but she didn't get to prac­tice. She didn't get a job be­cause she was an of­fi­cer's wife, so she didn't stay at one place all the time, and my grand­fa­ther at the time said, `No, I don't need you to work.' But ever since I was lit­tle I spent my child­hood mostly with my ma­ter­nal grand­mother and she en­cour­aged me to get into the med­i­cal field ever since I was 2 or 3.

Why did you choose on­col­ogy/ hema­tol­ogy ver­sus any other field of medicine?

MK: I would say it's a pas­sion. In med­i­cal school I wanted to be a sur­geon. I was good in surgery, had medals in surgery at my med­i­cal school in In­dia. I came over here and had a 2-month-old to look af­ter and be­came a sin­gle mom, so I had to change my field to gen­eral medicine where the life of a medicine res­i­dent was a lit­tle bit eas­ier than a surgery res­i­dent

where you never came home. You would be work­ing and you wouldn't be able to raise your child or see your baby. I didn't make up my mind (about what I wanted to do) un­til my sec­ond or third year. This ba­si­cally was a path that fell into my lap, like how God hands it over to you on a plat­ter, that's what hap­pened. Would I do some­thing else? No. This is what I love.

What's the dif­fer­ence be­tween on­col­ogy and hema­tol­ogy?

MK: On­col­ogy is the signs of ma­lig­nant trans­for­ma­tion. So, ma­lig­nancy is some­thing when the cells do not know when to stop grow­ing. Any­thing that is over­done and does not know when to stop. When we were lit­tle bitty sin­gle cells in our mother's womb, our genes had pro­grams on how many cells to grow, how long our nails are go­ing to be, how long our hair is go­ing to be, what is the color of our eyes, what's the color of our eye­brows, what's the color of our gums, and what is our skin color go­ing to be, how much pig­ment and melanin we have in each cell. What hap­pens in cancer cells is those check­points are bro­ken, putting it in a nut­shell. Those cells do not know that they have brakes so they keep grow­ing and grow­ing. For cancer to metas­ta­size they say the tip of a ball­point pen is the amount needed for it to start hav­ing blood ves­sels, so when you form blood ves­sels, those lit­tle cells es­cape to dif­fer­ent places. The study of on­col­ogy is ba­si­cally where you are try­ing to con­trol and pro­mote re­gres­sion. Ba­si­cally you want to stop those cells from grow­ing and you want them to drop dead.

Hema­tol­ogy is the study of blood. Our blood is made in the bone mar­row. Some peo­ple are born with cer­tain con­di­tions and dis­eases, cer­tain ge­net­ics. Some peo­ple have an over­growth of white cells, that is leukemia. Some peo­ple have low platelets. Our goal is to bal­ance those things out. Ane­mia comes into this. Pa­tients with low platelets bleed a lot. Ane­mia is com­mon in young women, ba­si­cally who have heavy men­stru­a­tion and things like that.

Are any of your fam­ily mem­bers in the med­i­cal field?

MK: We have a lot of physi­cians in the fam­ily. My cousins, all of my cousins on my dad's side are physi­cians. They're prac­tic­ing all across the world though so ac­tu­ally we have physi­cians, sur­geons, den­tists in the sec­ond and third gen­er­a­tions. Our cousins' kids are older and in med school. My dad is de­ceased; he died about 10 years ago. My mom and dad were both col­lege pro­fes­sors in In­dia. They taught bi­ol­ogy. They were ed­u­ca­tors, they be­lieved in get­ting a good ed­u­ca­tion and they be­lieved in hard work. They be­lieved in, `You work hard, you reap the ben­e­fits and the con­se­quences de­pend­ing upon the work that you put in.'

What is a typ­i­cal day in the of­fice like?

MK: The day starts early in the morn­ing around 7-7:30 a.m. when I make my round in the hos­pi­tal, see all the hos­pi­tal pa­tients, and see what needs to be done over there. Then I come to the clinic around 8:30-9 a.m., de­pend­ing upon the pa­tient load. From 9-9:30 a.m. we're see­ing pa­tients. We do have a chemo room and we do our own treat­ments here.

What is the best treat­ment for breast cancer?

MK: There's dif­fer­ent va­ri­eties of breast cancer and each (treat­ment) is tai­lored to what the pa­tient's cancer shows. In a sense, the treat­ment is stan­dard, but the doses vary de­pend­ing upon the per­son's kid­ney func­tion, liver func­tion, heart func­tion and dif­fer­ent things. There's also tar­geted ther­apy.

What is the most ac­cu­rate di­ag­nos­tic pro­to­col for the early de­tec­tion of breast cancer?

MK: Self breast ex­ams. Ev­ery woman over the age of 30 or 25 needs to do them, be­cause you know your body, when there are changes, so at least once a month. You just make sure that you don't miss a breast cancer. A lump in the breast, a lump that is hard, that's not painful, but is some­thing that's to­tally dif­fer­ent and seems to be grow­ing in size. You need to worry about it, you need to make sure you seek care and bring it to the at­ten­tion of your provider who will then run the tests.

How can you pre­vent the devel­op­ment of breast cancer?

MK: Early de­tec­tion. There are also ge­netic mu­ta­tions. Pa­tients with those ge­netic mu­ta­tions, that means that it runs in fam­i­lies so when you know that your aunt, your grand­mother, your grand­mother's sis­ter all had it, it's a good idea for you to be tested. It's the cost of those tests that pre­vent most women from seek­ing care. The other part of it is that most women are scared when they're go­ing for these tests that they don't want to be la­beled. The la­bel­ing of the ge­netic ab­nor­mal­ity by the in­sur­ance com­pa­nies. So, those pa­tients that have those ge­netic mu­ta­tions, you can pre­vent it by putting them through mas­tec­tomies. Af­ter they fin­ish their child­bear­ing age you just go on and send them to a ge­netic coun­selor who will give you the risk of it com­ing back and they will rec­om­mend a hys­terec­tomy, lumpec­tomy, what­ever needs to be done.

What treat­ment ad­vance­ments have taken place since you be­gan prac­tic­ing?

MK: A lot. There's a lot of tar­get ther­apy, there's a lot of pills, there's a lot of dif­fer­ent med­i­ca­tions that are com­ing down the pipe­line.

What ad­vice do you have for women who want to get into on­col­ogy/hema­tol­ogy?

MK: It's a pas­sion. You carry it home with you. You care about your pa­tients. You will ex­cel in which­ever one you do but the ba­sic con­cept is you have to see them as hu­mans that are suf­fer­ing. You see them where they are. The other thing is that it re­quires a lot of men­tal strength be­cause some­times they do get their strength from you.

What are your fa­vorite and least fa­vorite parts of your job?

MK: It's get­ting them good news that their treat­ment has worked. That's the best part. The least fa­vorite is telling some­body that we've reached the end of the road and that I would rec­om­mend hos­pice. Hos­pice is a good op­tion and it's a beau­ti­ful tran­si­tion of care that's avail­able in this coun­try, but not in other coun­tries. Hos­pice ac­tu­ally comes in and takes care of them and the fam­ily mem­bers for one year. Grief coun­sel­ing and a whole bunch of other re­sources are avail­able for them.

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