Oncology and hematology

2,498 articles · Since 2004

Articles, page 69

MKSAP: 65-year-old man with daytime somnolence

March 16, 2013Mar 16, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 65-year-old man is evaluated for a 2-year history of daytime somnolence, snoring, and apneic episodes during the night as witnessed by his wife.…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 65-year-old man is evaluated for a 2-year history of daytime somnolence, snoring, and apneic episodes during the night as witnessed by his wife. He does not have blurred vision, tinnitus, or headache. He has no cardiopulmonary symptoms and does not smoke cigarettes. The patient has hypertension for which he takes lisinopril and atenolol.

On …

Physician voices

The fine balance between hope and cope in cancer patients

James C. Salwitz, MD

March 15, 2013Mar 15, 20138

At tumor board recently, we discussed what we tell our patients about prognosis. Some oncologists give detailed information, including specific survival times. Others never discuss the future, and let the events of the illness teach patient and family. All try to adjust what they say by what the patient needs, because each physician expressed one core goal; “Whatever I say I don’t want the patient to lose hope.” I thought …

Physician voices

The importance of saying goodbye at the end of life

Don S. Dizon, MD

March 14, 2013Mar 14, 201317

An email was waiting for me one morning from my wonderful nurse, Laura. "Very sad day," it said in the subject line. I opened the email quickly upon receiving it and read that one of my patients had died. This…

An email was waiting for me one morning from my wonderful nurse, Laura. “Very sad day,” it said in the subject line. I opened the email quickly upon receiving it and read that one of my patients had died. This age-old dilemma again made me wonder what I should do: Should I call the family? Send an email or a card …

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Conditions and diseases

Caring for the emotional needs of a cancer patient

Miranda Fielding, MD

March 10, 2013Mar 10, 20139

Multi-tasking has never been my forte and so I like to keep my schedule organized. Mondays, I see all of my on-treatment patients. Tuesdays and Thursdays I see new patients in consultation. Wednesdays are reserved for treatment planning and research projects. But Fridays—well, Fridays are usually the best day of the week. Not only is the weekend approaching, with time to spend on my menagerie and the ever present home …

Physician voices

When end of life approaches: 2 pathways of care

Jordan Grumet, MD

March 8, 2013Mar 8, 20132

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity. The woman lying on…

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity.

The woman lying on the gurney was motionless. Her chest moved up and down with a timid but halting regularity. The calmness of her face was in sharp contrast to the panicked despair of the …

Physician voices

I tried to find peace in the loneliness that comes after a death

Sarah E. Stumbar, MD

March 1, 2013Mar 1, 20133

You might be surprised to know that I'm lying here in bed still thinking of you two weeks after you've died. During the month that I watched you die, I often wondered what it felt like to be you, with…

You might be surprised to know that I’m lying here in bed still thinking of you two weeks after you’ve died.

During the month that I watched you die, I often wondered what it felt like to be you, with your deep, husky voice, rounded belly and stubborn anger. You’d once owned your own mechanic shop; now you were sitting here in a hospital bed, staring up at the medical team …

Patient voices

Accepting the inevitable: The last days with my Dad

Julie Saeger Nierenberg

February 28, 2013Feb 28, 201314

Dad didn’t feel like dying. He felt full of life and longing to live. He had more to do, more to say, more to feel, to taste, to write, to experience. He was angry and sad, disappointed and confused, scared…

For the past three years, I talked to him daily to be as close as I could. I listened as he told me everything he …

Physician voices

Do most patients with cancer receive proper prescriptions for pain?

James C. Salwitz, MD

February 28, 2013Feb 28, 2013

To state the obvious: 1) most advanced cancer patients have pain, and 2) we have excellent pain medications which can effectively treat more than 90% of cancer pain. Therefore, most patients with cancer receive proper prescriptions for pain. Obvious, yes?…

In Europe, Australia and North America narcotic analgesics are widely available, and frequently prescribed. While there is access, many patients, particularly those in certain groups such as seniors and …

Patient voices

Being chronically ill or in pain can feel like a full-time job

Toni Bernhard, JD

February 27, 2013Feb 27, 20136

Suffering from chronic pain or illness—or, as is often the case, both—can feel like a full-time job. One reason for this is that we must constantly assess and evaluate if we’re managing our health and our relationships as skillfully as…

Suffering from chronic pain or illness—or, as is often the case, both—can feel like a full-time job. One reason for this is that we must constantly assess and evaluate if we’re managing our health and our relationships as skillfully as possible. This ongoing decision making makes up a major part of the workload in this full-time job—a position we certainly never applied …

Physician voices

Smoking has become hidden in the shadow of obesity

Ishani Ganguli, MD

February 25, 2013Feb 25, 20134

I knew he was sick when he told me he'd thrown out his cigarettes on account of how badly he felt. Mr. P had gotten used to the breathlessness when he climbed stairs and the hacking, dry cough that followed…

I knew he was sick when he told me he’d thrown out his cigarettes on account of how badly he felt.

Mr. P had gotten used to the breathlessness when he climbed stairs and the hacking, dry cough that followed him everywhere. What else could he expect after smoking three packs a day since he was six years old? But he had shown …

Physician voices

Physicians: Improve the experience of communication

Don S. Dizon, MD

February 25, 2013Feb 25, 20138

One of the toughest situations in oncology is the discussion about next steps, particularly when it comes to treatment of recurrent or metastatic disease. I believe very much that it is realistic to offer a patient the hope of cancer as a “chronic disease,” that treatment can result in disease stability, even though I cannot predict how chronic “chronic” is.

I was …

Physician voices

Pathologists face a stark career choice

George Lundberg, MD

February 23, 2013Feb 23, 20132

Disclosure. I am a pathologist, and I work at the interface of molecular oncology and information technology. Approximately 600,000 American cancer patients emerge uncured from standard of care treatment by medicine, surgery, and radiation each year. That is 1,600 every…

Disclosure. I am a pathologist, and I work at the interface of molecular oncology and information technology.

Approximately 600,000 American cancer patients emerge uncured from standard of care treatment by medicine, surgery, and radiation each year. That is 1,600 every day. What then?

Enlightened palliation on the way to hospice care does make sense for many. But now there are additional options based upon emerging science.

Molecular testing of the actual cancer tissue …

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Pathologists face a stark career choice

Physician voices

What would you do if this was your parent? I honestly don’t know

Miranda Fielding, MD

February 19, 2013Feb 19, 201315

Yesterday I saw a 90-year old woman in consultation. She presented to the emergency room in September with abdominal pain, and in the process of working her up, a chest x-ray was taken which showed an infiltrate in her lingula,…

As it turned out, there was nothing wrong with her belly, but a follow up CT scan of her chest showed this …

Physician voices

Leukemia crept into my home and attacked my wife’s body

Rick Boulay, MD

February 15, 2013Feb 15, 20134

“Look at all those beautiful little white flowers,” I said to my wife. “I don’t remember seeing them there before.” In the neglected ten-by-thirty foot corner of our garden, a crop of white flowers began to emerge toward the end…

“Look at all those beautiful little white flowers,” I said to my wife. “I don’t remember seeing them there before.”

In the neglected ten-by-thirty foot corner of our garden, a crop of white flowers began to emerge toward the end of the summer.

“You never saw them because they are weeds,” my wife said.

“What do you mean … weeds?” I asked. “They are beautiful!”

“Weeds …

Patient voices

Diagnosed with brain cancer: An insurer adds to the nightmare

James Bliwas

February 11, 2013Feb 11, 201315

When my 40-year old sister was diagnosed with terminal brain cancer, her one, overriding wish as the days ticked down was to die in her own home with her husband Steve and me sitting next to her, eating meals she liked that we cooked as opposed to coping with the institutional food she was being served, and for her three beloved cats to be lying on the bed with her.

It …

Physician voices

I wonder what Lance Armstrong tells his kids

Jennifer Gunter, MD

February 7, 2013Feb 7, 2013

My membranes ruptured at 22 weeks during my pregnancy. It was the evening of July 5th, 2003. Two days later my first son was born and died. The task before me was bed rest and squeeze as many more days (hopefully weeks) out of the pregnancy as possible to save my other two sons. It was, to put it mildly, a very low time.

To pass the hours I read, slept, …

Patient voices

Experiencing the revolving door of physicians in the hospital

Elaine Waples

February 4, 2013Feb 4, 20133

Complications from my cancer sent me to the hospital again recently. The news that I was in trouble came unexpectedly from my oncologist’s office Thanksgiving eve, following a routine blood test. “Your liver numbers are out of whack.” My response…

I was diagnosed with a blocked bile duct and I …

Physician voices

Is Lance Armstrong really a bad guy?

Rob Lamberts, MD

February 4, 2013Feb 4, 201334

“Lance Armstrong is a bad guy who has done some very good things.” These are the words of a sports radio personality I listened to yesterday. He was obviously commenting on the confession (to my pal Oprah) by Armstrong about…

“Lance Armstrong is a bad guy who has done some very good things.”

These are the words of a sports radio personality I listened to yesterday. He was obviously commenting on the confession (to my pal Oprah) by Armstrong about his use of performance enhancing drugs. The sportscaster, along with many I heard talk on the subject, were not as upset by the …

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Is Lance Armstrong really a bad guy?

Physician voices

To CT scan or not: What is the ultimate goal of patients?

Erin Plute

February 1, 2013Feb 1, 201313

The patient – blue-eyed, red-haired, and healthy but worried looking – guided the doctor’s hand to just below the angle of her jaw, where a small lump was barely palpable. She had first noticed the swollen lymph node after a cold and thought nothing of it at the time. But five months later, it was still there. She knew it was nothing, …

Physician voices

In oncology, hoofbeats are nearly always from zebras

Miranda Fielding, MD

January 29, 2013Jan 29, 201368

It happened again today. A youngish man, age 59 (youth being relative these days) comes in for a consultation. His history began eighteen months ago when he started to notice hoarseness. Thinking he had laryngitis, he saw his primary care doctor. He was indeed diagnosed with laryngitis despite the fact that he had not been shouting for his grandson at the local soccer playoffs, nor had he had upper respiratory …

Oncology and hematology

Articles, page 69

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