Yvlskogo graduate and graduate student at UCLA after studying in the United States and worked for eight years, having achieved recognition and best practice in a clinic in Los Angeles, he suddenly moved to Moscow. Dr. Vladimir Nosov, head of the gynecology clinic and cancers of the European Medical Center, told why he came back, why there is no classical oncology patients than Hollywood are different from ours, and what it takes to defeat the deadly disease.
Yesterday I had an operation, which lasted seven. Women more than a year ago did not completely remove the tumor which eventually gave many metastases, remove them took us seven hours. Oncological surgery usually last three to five hours or more. The main thing in our work — to completely remove the tumor, metastases and, if necessary, the lymph nodes around. This is the most complex and lengthy activity, but the most important thing: there is no metastasis, most likely there will be no recurrence. That’s what I chose oncology, are immediately visible result: look what was before and what happened after, and get enormous satisfaction.
Cancer can be cured, it is just a diagnosis, not a sentence. Although we still have many educated people think otherwise. It is scientifically proven that if within five years after treatment, the tumor has not reappeared, it already appears unlikely. Another issue is that the survival rate for the first five years is different in different countries. For example, after ovarian cancer in the United States survive for about forty percent of patients in Russia, even according to official figures, about ten percent less. There is much to play a role: early diagnosis, quality of chemotherapy, but more importantly, it is the optimal amount of surgery when the tumor is completely removed and all metastases — is key to success. In Russia do, to put it mildly, not always.
The medicine brought me fight and complicated trauma jaw. I was ten years old, four hours I lay on the operating table, a few days in intensive care with blood poisoning, three weeks in the House. Then if I was born again, and this my second life I strongly wanted to be a doctor to save people like me saved. But dentists are still afraid.
After a fifth-year medical academy I was at Yale for the first time, won the presidential scholarship. Then he returned to Russia, entered the residency. Somehow on night duty senior colleagues directly stated that it would take me to surgery, because just to teach and nurture their competitors is not going to. Then me and peremknulo. Residency I soon gave up, handed a diploma certifying exams in the United States and enrolled in a residency at Yale. At the first duty at the Clinical Center at Yale University I was handed a scalpel, and I did own caesarean section.
The main difference of Russian and American experience: you learn here two years in residency and then say experts, despite the fact that serious operations you let a senior colleagues in five years or ten. The American residency, I studied for five years and it was the most difficult years of my life, but the most useful: sometimes had to work a hundred-hundred and twenty hours a week, for two days without sleep. The prestigious Yale University study, but patients there come across very different — and the homeless, drug addicts and pregnant women and victims of violence. It was an invaluable experience. Then I entered the fellowship (something like a post-graduate) to the University of California, UCLA. For three years there I did more nine operations. In Russia, many people do not believe that this is possible, but in America, doctors are such a school.
I’ve known people treated at UCLA, this is Los Angeles. I treated my mom Angelina Jolie. This is not a matter of medical secrecy about his heavy inheritance Angelina talked a lot in the press. I think it’s important to talk to as many women know about such a possibility, it will help save many lives. From communicating with family Angelina I still have fond memories, very nice and quite arrogant people. It seems to me that the decision Jolie prophylactically remove the breast and ovarian completely justified. Breast cancer we can often catch the early stages, if screened regularly, but with ovarian cancer is much more difficult, eighty percent of the cases we find it in the latter stages when the chances of successful treatment are slim. Therefore, if a woman has a gene mutation BRCA, we recommend that after 35 years prophylactically removed ovaries and tubes, it reduces the risk of an order of magnitude.
Having spent eight years in America, I felt that quality development is over, how to finish levels in a computer game. I guess I could try to become head of the department, to open his own practice, but it would not be something special. Doing normal career within the American system was bored. Then I bought a ticket to Moscow.
I like being able to do something that no one or almost no one around does not. The ability to change the system or build their own, to teach some of the young surgeons that know how to himself. Make something qualitatively new. That I’m here doing.
I do not believe "classic oncology". In my opinion, a beautiful word for hidden outdated methods that are not always justified — large abdominal surgery and complete removal of organs. For example, in cervical cancer and the cervix is removed, and the entire uterus, ovaries and even. Of course, after that a woman can never have children. Often, however, with the same success it is possible to remove only the cervix and uterus and ovaries save woman to bear a child.
Even if at the same cervical cancer need to remove the uterus and then carry out radiotherapy, we can keep the ovaries and hem them up into the abdominal cavity so that they do not fall into the area of exposure. It is important for young women. Of course, it alone will not be able to give birth, but can take her eggs artificially fertilized with sperm of her husband, and to plant a surrogate mother. Many of my patients who have gone through it, could make their own children. Another problem "classical" approach — abdominal surgery, but has long been the same operation can be done laparoscopically through small incisions. Thus avoiding the huge scars, but most importantly, the patient recovers faster. And the time for it is very expensive, because surgery is often needed chemicals or radiation therapy to kill any remaining microscopic nodules. If you start early in therapy after surgery, the chances to defeat the disease is much higher.
I chose the European Medical Center because there are all opportunities to work at the level I was used to in America. Absolutely the same conditions and all of the equipment up to the robot "da Vinci" the latest model, which allows you to do complex operations with a jeweler’s precision. But most importantly, EMC understands that the competence of the doctors is the main capital of the company. The popular expression "global standards" is filled with a real sense, the modern doctors practice evidence-based medicine. I, as a man of the American school, it is very close. Like the fact that EMC is at the forefront of the patient, and then — a doctor, and only then — all the rest.
In oncology, much depends on the first meeting with the doctor. I was taught that it is important from the outset to make it clear to the patient that he should not have to fight the disease alone, that the hard way to go with him to the doctor who took it more than once or twice. Worldwide, cancer patients work not only oncologists and therapists to help patients stop being afraid of the disease and begin to fight with her. There is a whole science of psycho-oncology on how to adapt to the patient, how to switch from the devastating decadent mood on the creative. In Russia, it is a rarity, we -One of the few who teaches doctors and patients to these things.
I noticed that the patient in Russia are inclined to fatalism and do not like to make decisions. They say, they say, Doctor, I’m confused, tell me, as it should, and will do. The Americans, on the contrary, usually elicit the doctor all the details and want to make their own decisions. In fact, and fatalism, and shifting responsibility reduce the chances of successful treatment. If a person does not want to fight, losing the initiative, he quickly immersed in depression and self-pity, such a patient is hardly cured.
One patient hid from me that adopts Chinese herbs. After the surgery, she had a very strange internal bleeding is very severe complications. I am against dietary supplements, no one knows how they work and what their side effects. I have nothing against homeopathy, but not for the treatment of cancer, of course. I’ve had patients who refused surgery in favor of red wine, herbs and antioxidants, then returned a year later, when nothing can be done.
Neither the family nor the doctor does not have the right to hide the diagnosis. The more a patient is time to recognize the problem and go through all the stages from shock to acceptance, the better. By hiding the truth, we just robbed a patient, it’s never good.