This is the question I get asked the most: “So Doc, how do I know that this is working?” Sometimes my patients come to me with visible or palpable disease—something on the skin that they can see fading away, an enlarged lymph node in the neck that shrinks visibly during treatment, a lump or a bump that disappears, much to the gratification of both patient and doctor. But most of …
How do you know if cancer treatment is working?
I was recently sitting on an airplane on my way to a far off destination for a meeting preceded by a couple of days of rest and relaxation.
In and of itself, nothing particularly special about that except that maybe a couple of folks will be jealous. But to me, right now it is an incredible moment, the culmination …
I admire the strength and determination of cancer survivors
It’s no surprise that Americans are tilting the scales in the wrong direction. We are straining our waistlines and health coverage beyond the limits.
Unfortunately we live in a culture that promotes it.
Recently, I tuned into my favorite TV food channel to watch famous chefs create exotic dishes with quail eggs and artichokes. Instead I tapped into back-to-back shows that claimed to represent American food. The hosts were a well-known southern …
What being a cancer survivor has taught me about food
Starve a cold, feed a fever. Eat a balanced diet, don’t overeat, he is so thin he should fatten up before he wastes away, avoid junk food, she needs to keep her weight down. Our society is obsessed with food and food advice, and nowhere is that more true than when dealing with cancer.
Nearly 100% of the time when an oncologist sees a new patient, they are asked about nutrition. …
The importance of diet and nutrition in cancer patients
Sometimes, you can see cancer coming. What I mean is that when we sign up for that mammogram, or that PSA blood test, there has to be some tiny little part of us that says, “Ok, this time it’s my turn. This time I’m the one who’s going to get the call.”
Sometimes the cancer sneaks up on us—that nagging little cough that makes us want to—suddenly and belatedly—quit smoking. Or …
I want to be there when that cancer freight train hits
When I was 16 my dad had a heart attack. I still recall studying in my room when my mom came in to tell me he wasn’t feeling well. At the time, I was a volunteer in the emergency room at our local hospital, located in the tiny Pacific Island of Guam. I recall asking him what he was experiencing: …
Cancer makes you realize the gift of time
David Sampson, who is a colleague of mine here at the American Cancer Society, recently sent me a blog written by a woman well known in the breast cancer community who days previously had been diagnosed with recurrence of her breast cancer. The blog has captivated me, perhaps more so now that I have been facing some of my own …
Cancer survivors are truly remarkable people
We live in an age of patient empowerment. Medical students are now routinely taught that the “right choice” often depends on patient preferences—on how an individual patient weighs the pros and cons of her treatment alternatives. That means medical decisions depend, more than ever, on good communication. Physicians need to help patients understand their choices so that they can partner with their patients in discovering the best alternatives, ones personalized …
Good decision making often depends on good communication
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 24-year-old man undergoes follow-up evaluation for treatment of aplastic anemia. Two of his siblings are HLA-identical matches.
Laboratory studies:
| Hemoglobin | 8.3 g/dL (83 g/L) (following transfusion of 1 unit of irradiated packed erythrocytes last week) |
| Leukocyte count | 500/µL (0.5 × 109/L) with 23% neutrophils, 3% band forms, and 71% lymphocytes |
| Platelet count | 26,000/µL (26 × 109/L) |
| Reticulocyte count | 0.2% |
Review of the bone …
MKSAP: 24-year-old man with aplastic anemia
Is it possible to ignore a cancer? Prostate cancer infests almost 250,000 men in this country each year and will kill 28,000 men in the United States in 2012, over 200,000 around the world. Many lose their lives “too soon”, dying in their 60s or even their 50s. Nonetheless, authorities do not recommend the PSA blood test for routine screening of this disease. How can this make sense? Partly this …
Is it possible to ignore prostate cancer?
Metastatic (stage IV) colon cancer and lung cancer are fatal incurable illnesses. That doesn’t just mean they are life-threatening. A fatal incurable illness is one which has zero survivors. You don’t know anyone who had metastatic colon or lung cancer who survived and is no longer ill.
Chemotherapy is still occasionally used in such cases and sometimes can prolong life by a few months. Chemotherapy might also help temporarily alleviate some …
Do patients bond best with doctors who misinform them with optimism?
“You look amazing!” It was the first thing out of my mouth upon seeing Sharon.* She is a woman in her mid-seventies, and she has recurrent ovarian cancer.
We had met after she was diagnosed with recurrence, only five months after the end of her “curative” treatment. At the time, we talked about her life—how she had been a nurse before …
Not all cancer survivors have cancer
The American Cancer Society designated an October weekend “Suits and Sneakers Awareness Weekend” as part of its annual Coaches vs. Cancer program that featured well-dressed basketball coaches wearing “sneakers instead of dress shoes with their usual game attire during weekend games to demonstrate their support for the Society and the fight against cancer.”
The idea is to encourage people to exercise and eat a healthy diet to reduce …
How cancer awareness efforts can backfire
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It has been a long slog since we started our war on cancer here in the United States in 1971.
At times I am not certain that this has been so much of a war as opposed to a series of skirmishes that occasionally have produced incredible moments of optimism. But there have been a fair share of frustrations …
Facing the difficult issues when it comes to high quality cancer care
Marc Henderson, a 63-year-old African-American airport executive, isn’t afraid to ask his physician to do a blood test for prostate-specific antigen (PSA), a screening test for prostate cancer. “I’d rather know early on so that it can be treated, rather than sit around in denial until it’s too late,” he said. “If it’s going to help catch something, I have no problems with it.”
Henderson’s views aren’t unusual. For years, doctors …
Do black men need separate prostate cancer screening guidelines?
In his brilliant 1993 satire “Et Tu, Babe,” Mark Leyner proposed a new concept in body art, which is the specialty of “visceral tattoos.” The narrator travels to Mexico where his chest is opened and the insignia of a “guy surfing a wave of lava, wearing polka-dotted trunks,” is tattooed directly on his heart. The dye used shows up on CT scans and apparently women, especially x-ray technicians, love it. …
The deep psychic effects of medical care
I’ve come to believe that seriously sick people are often subject to some very interesting comments from well-intentioned non-sick people. They are frequently inspired by platitudes from self-help-books, Google chat rooms (heaven forbid), or beliefs that have been around for so long that they are a natural part of common discourse.
To be fair, when we are confronted with the uncomfortable task of talking to a sick person, our conversation can …
Attitude is half the battle when you’re sick
Nairobi, Kenya basks under a brilliant sun, its dusty frontier soul, noise, construction and vital humanity speak for a nation and a people rushing into the modern world. Full of ideas, growing exports and exploding industry, its expanding middle class has seized on education and commerce as the path to tomorrow. One of the richest nations in Africa, with a new Constitution and new hope, it races forward. Tragically, even …
A moral duty to help build healthier societies
There are an estimated 1,638,910 new cases of the dreadful disease diagnosed in 2012 in the United States, not including non-melanoma skin cancers.
Cancer is not just one disease but is a term that represents more than 100 diseases with different causes. The basic unit of life is cells, and cancer always begins in cells. When the normal process of cell growth and division is altered, these abnormal cells divide without …
It’s not all in the genes: How to reduce your risk of cancer
The word medicine, in today’s world, seems to indicate a hard science in search of cures for many kinds of human ailments, such as cancer. However, I believe that the true definition of medicine is the practice of healing. Medicine is both an art and a science because it involves both human and technological interaction. The art of compassionate care and social interaction must be combined with the science of …
Both the scientific and the social sides of medicine are needed
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