‘Life Interrupted’: Lessons Learned About the Importance of Oral Cancer Screening, Early Detection and Treatment

When I finished my oral and maxillofacial surgery training, I started as an employee in a group practice with several doctors. I was full of hopes and dreams: I tried to become a better dentist and surgeon by regularly attending seminars, courses and dental conferences. I planned on getting married and starting a family and the opportunity to become a practice owner. I wanted to pass my board exam. I wanted to know more about how insurance companies work. I wanted to help my patients do better. I had so many goals to create an insurrection career for the next few years.

dr. hung

All sorts of thoughts went through my head as I imagined my future life. I constantly felt a mixture of excitement and nervousness. I looked forward to a potentially long and fulfilling career with the foundations I’ve built through years of hard work.

My story is not unique. In fact, it is a common story shared by many.

As new dentists move from dental schools to the practice, there are times that can be overwhelming, taking our focus away from tunnel vision on teeth. It is of utmost importance that we as dentists must treat the patient as a whole: the dental examination and a comprehensive head and neck examination. Check the oral mucosa, palate, tongue, floor of the mouth, oropharynx and check the neck for asymmetry or hardening of the lymph nodes. Ask about your patient’s social history and medical history. Perform a biopsy and refer to an oral and maxillofacial surgeon early. Two pairs of eyes are better than one. Many early oral cancers cannot be detected with the naked eye and some benign lesions have transformation potential into malignant lesions. Therefore, visible lesions should be biopsied and monitored closely. Malignant lesions require staging and a multidisciplinary approach by specialists: oncological surgeons, medical oncologist radiologists and other medical specialists. Early detection and referral are wise.

dr. Manu Dua

The last thing on my mind as a new dentist would be, what if everything that awaits me is taken away? What if my presence no longer existed? What if all the schooling and hard work just evaporates?

Everything unimaginable turned out to be what happened to a new dentist, the late Dr. Manu Dua. dr. Dua was born in the United Arab Emirates and immigrated with his parents to Calgary, Canada at the age of 13.

He was diagnosed with squamous carcinoma of the tongue at the age of 33 and sadly passed away in March 2021 at the age of 34. He was not given the opportunity to contribute further to humanity and left many loved ones heartbroken. Before he left this world, writing became an outlet. He wrote essays on life, sickness and death during the period of his illness with wisdom beyond his age to make us rethink our priorities. After his death, his essays were written by his sister, Dr. Parul Dua Makkar, compiled into a book “Life Interrupted: Dr. Dua’s Survival Guide.”

Recently I had the opportunity to meet my friend Dr. Parul Dua Makkar, a general dentist practicing in Long Island, New York, to discuss her brother’s short but incredible life journey, the philosophies of human life and its fragility. I want to share these life lessons with you.

dr. Manu Dua, a new dentist and entrepreneur with a business background, established an impressive award-winning dental clinic in Calgary within a short time of graduating from the University of British Columbia in Vancouver. One day he discovered an ulcer on the left side of his tongue. He and his oral surgeon discussed the lesion and he was given steroids.

He didn’t have the biopsy done until months later because he wasn’t in the high-risk group. Steroids gave him no relief. Biopsy was finally performed when the lesion became symptomatic and had turned ominous. The biopsy result brought Dr. Dua the diagnosis of a stage 2 squamous cell carinoma of the tongue, in a person who had no risk factors. He drank no alcohol and was not a tobacco user of any kind. He was young and otherwise healthy at the time of diagnosis.

dr. Parul Dua Makkar

He then underwent a hemiglossectomy. Within the space of eight months, in April 2020, the cancer returned. He then underwent another surgery and received a total of 33 treatments of radiation and chemotherapy. Then he made the decision to sell his clinic amid the COVID-19 pandemic in hopes of healing and recovering. Recurrences found in the lymph nodes, in turn, spread to the lungs. The metastatic lung tumor had grown four times in size over a period of eight months, rendering it useless. PET scans showed lesions up to the pelvic bone. In December 2020, he had pulmonary pleurosis and a chest port was placed to drain fluid. The fluid buildup made it difficult for him to breathe, talk and move. He died in March 2021 due to metastases.

The Death of Dr. Dua can be attributed to the delay in diagnosis and treatment as the last thing on a new dentist’s mind would be oral cancer diagnosis: When you think of oral cancer, the images of an elderly person smoking and drinking come to mind . He didn’t fit the stereotype. He once helped a female patient diagnose her oral cancer and she eventually survived.

Being the primary caregiver for my late father who died of prostate cancer, I was immediately captivated by the book “Life Interrupted.” I knew Dr. Manu Dua not when he was alive. However, as I read the passages, I felt him sitting in front of me, teaching me life lessons in the most serious way, opening my mind to perspectives new to me, and reminding me of what I knew but hadn’t yet. to forget. As his life was peeled off layer by layer, he came into total peace with the situation and with himself.

When you realize that there is a finite time ahead of you, you gain new perspectives on life. The hardest thing for Dr. Parul Dua Makkar, the sister of Dr. Manu Dua, were the travel restrictions due to COVID-19. She was waiting for the PCR test before she could travel to Canada when she learned that her brother had organ failure and then died. dr. Parul Dua Makkar would never want her brother to pick her up from the airport again. From their parents, their son will never come home with the question, “What are we eating?” As a person who lost a parent to cancer, and as a mother of two, I sobbed solemnly. The pain was immense.

From our telephone interview, I would like to share the excerpts of the interview in which Dr. Parul Dua Makkar is quoted as her messages to all dentists:

  • Grief is sometimes very isolating. People who haven’t experienced it don’t get it. Sometimes sadness strikes like a tsunami that takes my breath away. Sometimes in silent tears and sometimes in happy memories.
  • I want to remind people, especially our young people, that oral cancer is on the rise. Cancers have no limits of age, gender, education, etc. Pay attention to the signs and symptoms, advocate for ourselves and for our patients and the doctors to work together.
  • As a young dentist, we are all going to make mistakes. That’s why it’s called the practice of dentistry, even though we don’t all know everything, we’re constantly learning. Getting that license comes with a lot of privileges, a lot of trust. So when you’re in that chair treating that patient, your primary focus should be that patient and that patient’s well-being. Listen to your patient, talk to your patient. Take those extra few minutes to feel around. Don’t just focus on the tooth, really focus on the overall care.
  • Be loyal to work, be loyal to work, and be loyal to your patients. At the end of the day they go home, they have a family to go back to.
  • You don’t know everything. You cannot know everything. You learn. It is the practice of dentistry. So, if you make a mistake, confess, learn and improve yourself.
  • Don’t deal with insurance. Treat people.

Life is beautiful and life is difficult. Being interrupted is unfair to say the least. The contributions and life lessons of Dr. However, Manu Dua are huge to me on a personal level, and I would like to get his last post from “Life Interrupted” to all of you as self-affirmations.

“One of the most important things I have learned in these turbulent and difficult times is to accept the loss of control and keep riding the wave day after day…I understand that every day is a new journey and I focus on the getting through the days enjoying small victories and having full faith that the future will unfold as it should, and my worries and fears are normal but fruitless, and will not help me set a new path in life. What is absolutely necessary is inner peace, strength and true belief that there will be a better life in this world or the next.”

dr. Cathy Hung is an AAOMS Fellow with a solo practice in New Jersey. She is an alumna of the ADA Institute for Diversity in Leadership program and author, speaker, and coach on cultural competence and female leadership. Her first book “Pulling Wisdom: fill the gaps in cross-cultural communication” is currently available in the ADA bookstore as a practice management tool. She recently published her second book, “Behind Her Scalpel: A Practical Guide to Oral and Maxillofacial Surgery and Stories from Female Surgeons,” an IDL project hoping to close the gender gap. She is a certified professional life coach from Pulling Wisdom Coaching and Workshops, LLC to help struggling female and/or minority professionals gain confidence and excel in the professional world. She was recognized by Benco Dental in 2020 as one of Lucy Hobb’s Project’s “Women who inspire”.

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