Sunday, January 26, 2014

How Long Have I Got Left?

Interesting opinion by a doctor diagnosed with cancer in today's New York Times.  He writes about longevity discussions and how he's dealing with  his own mortality.

Illustration:  Tucker Nichols for the New York Times

I have had the same conversations with my doctors with similar answers.  It's hard when your own mortality is front and center. I think it's important to enjoy life, stop worrying and do the best you can with this new information.  Easier said than done though....

Friday, January 17, 2014

Controversial Dual Editorials about Cancer Care

Last week, Emma and Bill Keller, both writers, she for Britain’s The Guardian and he for The New York Times, wrote editorials for their respective papers about how much detail one should divulge publicly when dying of cancer. Ms. Keller’s op-ed was published on January 8th and it was titled “Forget funeral selfies. What are the ethics of tweeting a terminal illness?”  She specifically describes the blog and tweets of Lisa Bonchek Adams, a 44 year old stage 4 cancer patient who is married with 3 children and is writing an “unsparing narrative” of her cancer treatments and journey towards death. Some excerpts from the editorial follow:

“Adams is dying out loud”
“As her condition declined, her tweets amped up both in frequency and intensity. I couldn't stop reading…but I felt embarrassed at my voyeurism. Should there be boundaries in this kind of experience? Is there such a thing as TMI? Are her tweets a grim equivalent of deathbed selfies, one step further than funeral selfies? Why am I so obsessed?”
“She describes a fantastic set up at Sloan-Kettering, where she can order what she wants to eat at any time of day or night and get as much pain medication as she needs from a dedicated and compassionate "team", but there is no mention of the cost.”
The snarky tone of this editorial generated a lot of outraged response in The Guardian.  In addition, Emma Keller has had email and twitter communications with Lisa Bonchek Adams but did not disclose to her that she would be using the content of those communications in an article.  Because of this journalistic transgression, The Guardian withdrew her editorial from the website.  Below is an archived copy of the piece:
Because of the outrage and in defense of his wife’s editorial, Bill Keller penned an op-ed in The New York Times on Monday January 13 called “Heroic Measures”.  This editorial is not quite as critical as Emma’s but also generated quite of lot of outrage.  At least the NYT did not remove it from their website.  Here are a few points from Mr. Keller’s editorial:
“A rapt audience of several thousand follows her unsparing narrative of mastectomy, chemotherapy, radiation, biopsies and scans, pumps and drains and catheters, grueling drug trials and grim side effects, along with her posts on how to tell the children, potshots at the breast cancer lobby, poetry and resolute calls to “persevere.”
“In October 2012 I wrote about my father-in-law’s death from cancer in a British hospital. There, more routinely than in the United States, patients are offered the option of being unplugged from everything except pain killers and allowed to slip peacefully from life. His death seemed to me a humane and honorable alternative to the frantic medical trench warfare that often makes an expensive misery of death in America."
“Lisa Adams’s choice is in a sense the opposite. Her aim was to buy as much time as possible to watch her three children grow up. So she is all about heroic measures.”
“The first thing I would say is that her decision to treat her terminal disease as a military campaign has worked for her. Her relationship with the hospital provides her with intensive, premium medical care, including not just constant maintenance and aggressive treatment but such Sloan-Kettering amenities as the Caring Canines program, in which patients get a playful cuddle with visiting dogs.”
“In any case, I cannot imagine Lisa Adams reaching a point where resistance gives way to acceptance. That is entirely her choice, and deserving of our respect."
Below is a link to Bill Keller’s editorial:
I found these two editorials quite interesting.  Aside from the controversy and publicity that this writing generated, they raise important questions about privacy, discussion of death, whether cancer is a battle or a disease, the cost of treatment and how hospitals might benefit from patients who are in the public domain.  Amy Bonchek Adams had to know that these two writers were going to write about her cancer, blog and tweets because they were both communicating with her prior to the publication of these pieces.   I was uncomfortable with the tone of Emma Keller’s editorial but not so much with Bill's attempt at clarification.  I do not believe that blogging and tweeting about cancer is “too much information (TMI)”.  If one doesn’t want to read it, they don’t have to. It’s up to the patient to decide if she/he wants to fight with debilitating treatments until they die or if they want to die quietly without them.  I have been impressed with the NYT’s bringing articles to the forefront on many facets of cancer, sometimes quite prominently.  These conversations need to be more public.

Thursday, January 16, 2014

First Post-Surgical CT Scan

Yesterday I had my first post-surgical CT scan.  This is described on the report as a “restaging” scan.  Dr. Chan showed me the before and after scans. There are a lot fewer white areas or tumors now.  The only impression that was in the report was “mild associated mesenteric fat stranding and nodularity is noted, likely postsurgical in etiology”.  Dr. Chan said this is because I have not fully healed from the surgery as it was only 4 months ago.  I’m not really sure exactly what “fat stranding” is and after googling it, I’m still in the dark.  As long as the doctor is not too concerned, neither am I.  The remaining few small tumors in my liver stayed unchanged. 

I am mostly recovered from my surgery but I still do have some lingering gastrointestinal stress.  This can manifest itself in very bad gas pains, both in my chest and abdominal area.  I have not identified a particular food or time of day that could be the cause of this discomfort.  Sometime it lasts for 5-6 hours before going away.  I occasionally have massive diarrhea, similar to a colonoscopy prep that is quite disruptive and disturbing.   I had this twice in December. I know the first time was because I ate too much fatty food, but the other time I did not so couldn’t identify the cause.  I have not had the really bad diarrhea in January yet so hopefully that problem has passed.   Dr. Chan suggested I try Prilosec this month to see if it alleviates the gas problem. 
All in all, I’m doing ok and today marks my new CT baseline. 

Sunday, January 5, 2014

Why Everyone Seems to Have Cancer

This is the headline article (Op-Ed) in today’s Sunday Review section of The New York Times (NYT).  It is written by a former NYT reporter and author of a book called The Cancer Chronicles that was well reviewed a few months ago.  I have not read the book.  The author discusses why heart disease deaths have declined substantially from 38 deaths per 10,000 people in 1958 to 18 deaths per 10,000 people in 2010. Concurrently, cancer deaths at 19 per 10,000 in 1958 have only declined to 17 per 10,000 in 2010.  The basic premise of the article is that “heart disease and cancer are primarily diseases of aging.  Fewer people succumbing to one means more people living long enough to die from the other”.  He explains that deaths from heart disease have declined due to “diet, exercise and medicines for blood pressure and cholesterol.  When problems arise, they can often be treated as mechanical problems – clogged piping, worn-out valves – for which there may be a temporary fix”. “Because of these interventions, people between the ages of 55 and 84 are increasingly likely to die from cancer than heart disease.  The increase in longevity has been why the statistics show more cancer deaths.  “A century ago, average life expectancy was in the low to mid-50’s.  Now it is almost 79. The median age of cancer death is 72”.  There is a very interesting graphic that illustrates these statistics – it is in the link below:

The author is pessimistic about a cure for cancer. “It is not so much a disease as a phenomenon, the result of a basic evolutionary compromise. As a body lives and grows, its cells are constantly dividing, copying their DNA — this vast genetic library — and bequeathing it to the daughter cells. They in turn pass it to their own progeny: copies of copies of copies. Along the way, errors inevitably occur. Some are caused by carcinogens but most are random misprints.”   He says that most of the improvement in cancer longevity statistics comes from prevention and from improvements in mortality from childhood cancers.  The author goes on to say “for most cancers the only identifiable cause is entropy, the random genetic mutations that are an inevitable part of multicellular life.” 

The full article is in the link below:
This is a realistic article that does not give false hope about an imminent cure for cancer.  Interesting reading.