Sara was treated for multiple myeloma in the mid-90s and had a stem cell transplant seven years ago. When I asked her husband how she was doing, he said, “Pretty well … just the gift of a little edema in one arm and some neuropathy in her feet.”
On one hand you think, “Hey! That’s great! Those little gifts — those side effects — are a small price to pay.”
You are taking care of a patient with metastatic pancreatic cancer. The disease has spread, surgery is not an option and second line chemotherapy has failed. He is in pain, but is poorly compliant with narcotic directions. He keeps falling down the stairs. His wife cries all the time. The family is desperate for help. The patient is in the office with loved ones, looking for guidance.
The Institute of Medicine (IOM) recently released a report on the state of cancer care in the United States. The IOM generally knows what it’s talking about. It’s a non-profit, non-governmental advisory group essentially. To get on one of their advisory boards you have to be a national, if not international, expert in whatever field is being studied. According to the cancer advisory board, the state of cancer care in …
The urologist broke the news: “Out of 12 cores, three were positive for cancer, so you have a small amount of cancer.”
He would soon explain the treatment choices — surgery, radiation, or active surveillance (watching the cancer closely with blood tests and biopsies). He described each option in elaborate detail, because he knew that the “right choice” would depend on what his 70-year-old patient thought about the pros and cons …
A recent study has concluded that women with breast cancer who failed to get annual mammograms are more likely to die from their disease than those who had annual mammograms, and argues that more frequent mammograms are warranted in women under age 40. Unfortunately, despite all the media attention this study is getting, I don’t think the researcher’s conclusions are supported by the study results.
The researchers did a retrospective medical record …
When I was young, one of my favorite stories was O. Henry’s “The Gift of the Magi.” Originally published in 1905, the short story became standard fare in public school reading classes and I doubt that there are any of you out there who have not read it. But just in case — the story is about a young couple, poor and deeply in love. At Christmas, they have no …
Cancer screening is of little benefit in persons with dementia but can cause very serious harms. Older persons with dementia have limited life expectancies which makes any benefit from cancer screening very unlikely. This is because cancer screening works by identifying a cancer many years (generally at least 5-10 years) before it would threaten health.
But cancer screening tests cause lots of burdens when given to persons with dementia. The …
Joan was 42, married, but appeared to be younger than that. Her husband was with her when we first met, as was her beautiful two-year-old son. “We couldn’t get a baby sitter, if you can believe that!” she said.
Sarah was 38 and was also married. She and I were closer to the same age, which was not lost on either of …
I wish I had known earlier that survivorship care is neither a do-it-yourself project nor is it something that I can simply hand off to experts. There is no stable set of signs, signals and test protocols that, if followed assiduously — and that come up negative — means I am protected from a recurrence, new cancer or late effects of treatment. Observation, expertise and self-knowledge by both me and …
As a pathologist, I am one step removed from the patient. This is comforting for the most part. I render my diagnosis and another clinician communicates it to the patient. It is best this way — I have no treatment options in my own doctor toolbox to give meaning to the words I communicate. I learned this the hard way — in fellowship training.
When I was about ten years old, swimming on a Texas swim team, I remember hearing that the child of one of the local coaches had been diagnosed with leukemia. The idea of a kid dying of an untreatable disease was so foreign to me that I am sure that I have blocked out most of the details. I do know that the child died, and it didn’t take very …
I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat.
That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …
I’ve dedicated my entire career to helping those diagnosed with cancer cope better, so they can regain the best quality of life possible. I was heartened by a recent New York Times article detailing efforts by the National Cancer Institute (NCI) to change the definition of cancer and potentially eliminate the use of the word for those diagnoses that might never …
Lung cancer screening CT took its most important step toward widespread implementation last week when the U.S. Preventive Services Task Force (USPSTF) released a draft of its forthcoming recommendation that the 9 million U.S. people meet entry criteria for the National Lung Screening Trial (age 55-79, with 30+ pack-years smoking history and quit < 15 years) should undergo yearly low-dose lung cancer screening CT.
Not long from now, the last cancer will be defeated, and even today most with the dread disease survive. However, many still fall. This leaves us with one of the toughest questions of life. How long do you continue to fight, when death is certain? When does striving become vain hope which drains quality and creates only suffering? What makes struggle worth the …
Having cancer has infected me and many others with the irritating tendency to view any persistent, troubling symptom through the lens of a recurrence or a diagnosis of a new primary cancer. A friend of mine who is nearly five years post-kidney cancer treatment casually remarked the other day that he needed to see a doctor about his sore ankle: it could be arthritis, but it might be cancer, of …
We’ve all heard the phrase, “When you come to a fork in the road, take it.” Well, that saying may hold particular relevance while reviewing a new research report published in theNew England Journal of Medicine.
The report is an important one. It is an 18 year follow-up of a study designed to show whether the use of …
When I was a resident in radiation oncology, I thought I already knew a lot about medicine. After all, I had just completed an internal medicine residency, and had taken and passed my boards. Needless to say, I was more than a little bit irritated the first time a patient “coded” in the radiation therapy department and I was shoved out of the way by the intern on the code …
A 51-year-old man is evaluated for a 6-month history of increased fatigue and decreased exercise tolerance. He is otherwise well with no significant medical history.
On physical examination, temperature is 37.3 °C (99.1 °F), blood pressure is 115/75 mm Hg, pulse rate is 76/min, and respiration rate is 14/min. The abdomen is soft with no …
I was lying in bed, watching something with my son when a chat message popped up on screen. It was my dear friend, Narin, whom I haven’t seen in years but remain in contact with (thanks to the wonders of social media).
“Did you hear that Dave died?” she had written. “I just read it in our college alumni magazine. I am so …
