Oncology/Hematology

Is there a difference between a good and bad prognosis? It depends.

Physician
December 14, 2016

It was recently pointed out that one of my partners had made an error in a patient’s electronic hospital chart. Did I want to correct the mistake? Curious, I looked at the computer screen. There in 12-point-black-on-white Cambria was the culprit documentation. The words were:

“Our therapy goal is palliative. Prognosis is good.”

Now, this was clearly not what the author had intended. In common practice when someone is so sick that …

Read more…

This is one of the most difficult tasks that physicians perform

Physician
November 30, 2016

“It’s strange how the worst day of your life often starts just like any other.”
– Joanna Cannon

I prepare for each clinic by reviewing the tests and scans of the patients who will be seen that day. Today, I am dismayed as I read a report for a longstanding patient. The news is not good; his scan shows that his cancer has returned.

Twenty years ago on a day like today, I …

Read more…

The pink bag that symbolizes how far this physician has come

Physician
October 30, 2016

img_1365

When I graduated from medical school, my dad gave me several hundred dollars with instructions to buy something special. It was a kind gesture, but the pressure to self-select a meaningful gift was almost too much.

I wanted something to commemorate my transition from student to doctor. Books, stethoscopes, and the like seemed so uninventive. I wanted something for residency that would be …

Read more…

Did a prostate cancer test save actor Ben Stiller’s life?

Conditions
October 12, 2016

Ben Stiller—one of the few comedians on this side of the pond who can make me laugh—said prostate-specific antigen (PSA) testing saved his life. I suspect he wasn’t being funny. Stiller had Gleason Grade 7 localized prostate cancer.

Is he right?

The honest answer is that we don’t know for certain. Before I get granular, we must visit proof, level of proof and burden of proof. The statement, “there’s …

Read more…

There are limits to what a careful physician can do

Physician
July 15, 2016

Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, …

Read more…

Poised at the abyss: A wife faces her neurologist husband’s brain cancer

Conditions
July 11, 2016

My husband, Mark, called me at my practice. “I’ve been working on something; I need you to come home now.” He spoke definitively, urgently. “Is it the kids?” I was instinctively anxious. “No, not the kids, just come home now.”

6 p.m., a cool evening, an ordinary day. The life before the fact. And then life afterward, irrevocably and catastrophically changed.

A tense ride home, then the revelation. “I’ve been having difficulty …

Read more…

The question doctors should ask before ordering a test

Physician
June 8, 2016

Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do.

Why do doctors over order? These same people thought a …

Read more…

This pediatrician learned why it’s so important to listen to a parent

Physician
May 8, 2016

Medicine can wear down our hearts and souls.  My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency.  By that final year of training, I was no longer certain medicine was really the right choice for me.  I was struggling with the notion that after almost 11 years of education, the destination was not quite …

Read more…

When patients cry, please don’t do this

Physician
May 2, 2016

Just three weeks earlier, she had noticed something strange about one of her breasts. An irregular shape. Her daughter brought her to the doctor, and soon the patient, I’ll call her Amanda, was diagnosed with breast cancer, stage “to be determined.” In fact, she was now in an oncologist’s office, learning what tests she would receive to determine the extent of her tumor. And sitting between her and the doctor …

Read more…

Learn the physical exam by following an oncologist

Education
April 23, 2016

asco-logo “Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
– Sir William Osler, “The Father of Modern Medicine” (1849–1919)

In this modern era of oncology, the potential extent of malignant spread is staged by high-quality scans. Further, when …

Read more…

Visualize the abnormal prostate with Medcomic

Conditions
April 3, 2016

The Abnormal Prostate

In this Medcomic, we’ll visualize three common abnormalities of the prostate.  Let’s meet our new friends. On the left is Burney and he could certainly benefit from a trial of antibiotics and an analgesic. The large fellow in the middle straining to urinate goes by the name of Turp. On the far right is Grampa Addy, currently dealing with the …

Read more…

A doctor shares the secrets of cancer survivors

Conditions
February 26, 2016

Disclaimer: I have never had cancer. Therefore, at the most basic level, I do not have the right to pontificate about dealing with the dread disease. Rather, I have been the servant and support of those that struggle with cancer. I thought it might be of some assistance to share my observations from the other side of the bed rail. Perhaps, their secrets of survival may help you.

Cancer is a …

Read more…

ADVERTISEMENT

The end can be sudden in advanced cancer

Conditions
February 8, 2016

It was after shoveling winter snow that Brett began to cough. It was a dry cough, a morning cough, a “smoker’s cough.” It persisted, grew deeper. Several weeks later, there was a particularly harsh cough and in the sink was a crimson blob. Frightened, he called his doctor.

For 71 years old, Brett looked healthy. His lung exam was clear and the cough was gone. A case of bronchitis?   The chest …

Read more…

A nurse is confronted with the death of his mother

Conditions
February 5, 2016

It will be six months since my mother passed away.

I kept my mother’s illness a secret. Not because I was ashamed and embarrassed but I did not want to advertise to the entire world of what she was going through out of respect to her and my family. So you sit there, put on a front like everything is cool and continue on your daily routine, until one day everything …

Read more…

A letter to myself as a first-year oncology resident

Physician
January 15, 2016

I’m writing to you from the future — approximately ten years from where you are now. You’re a few months into your medical oncology residency, just beginning to assimilate to the flow of your daily responsibilities as a doctor committed to the diagnosis and treatment of cancer.

You hate living in upstate New York, and are dreading the upcoming winter and the associated endless piles of snow and sub-zero temperature nights …

Read more…

ADVERTISEMENT

I’m not worried about colon cancer. I’m worried about the potential colonoscopy.

Physician
January 2, 2016

“Don’t forget to bring that stool card back in, OK?”

As he walked out of the room, carrying his portable oxygen, he turned back, with the nasal cannula in his nose, and replied, “I’ll get it back to you soon.  I’d hate to have colon cancer.”

At this point, I’d hate for him to have a positive occult blood card.  I could really care less about colon cancer.  Colon cancer isn’t going …

Read more…

How the meat industry is acting like big tobacco

Physician
December 26, 2015

Recently, the World Health Organization (WHO) released its report condemning processed meat as a group 1 human carcinogen — a classification that includes such notorious companions as tobacco smoking, smokeless tobacco, and second-hand smoke. This is not surprising considering that processed meat contains many of the same known or probable carcinogens as cigarette smoke, like heterocyclic amines and N-nitrosamines.

Red meat was labeled in the runner-up category as a …

Read more…

When an advocate goes too far in the exam room

Conditions
December 10, 2015

asco-logoWhen is an advocate not an advocate? When should a spouse step back and let the husband make a treatment decision? When should an adult child of a man with prostate cancer let their father decide what is best for him? These are questions that, fortunately, I don’t have to ask all that often. Most men I see for prostate cancer …

Read more…

ADVERTISEMENT

It is time for an honest conversation about money and cancer

Physician
September 22, 2015

There are two, old, particularly nasty rumors, about cash and cancer. The first, which seems to be fading, is that scientists cured the disease long ago, but the pharmaceutical industry suppresses the cure so they can get rich selling worthless therapies. This never made sense to me, since the company or person that cures cancer will be rich beyond anyone’s wildest dreams. In addition, I have personally known several thousand …

Read more…

22
pages