Kota talks treatment, early detection
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.