Humbling Experience

I just came from a lecture by a Chinese Prof. who has a cancer hospital in China (Fuda Cancer hospital). What is strange, was it didn't use therapies from China, but rather technologies from the USA. They have cryoablation, photodynamic therapies, dendritic cell vaccines, immunotherapy as well as chemoablation.

They claimed to have a very good success rate in increasing survival. Patients from all over have come to this hospital in Guangzhuo.

From the website, you will see some video clips of news programs about their successes especially on the patient with a large neurofibroma.

All I can say is, Prof. Xue is a brave man who will not back down on any case as long as he thinks its doable. I'm sure a lot of his colleagues would have disagreed with some of his decision to operate.

Dichloroacetate: a cheap but effective cancer drug?

This drug, Dichloroacetate (DCA) has been in the news for the past few weeks now, ever since its paper was published in the Cancer Cell journals. It showed that it can actually kill off the cancer cells by programmed cell death or apoptosis, without even harming the normal cells. A caveat though, its only been tested on mice with tumors.

However, DCA has been used for a long time now, treating patients with lactic acidosis. What is great and promising, is that this drug is cheap, and only the use of DCA AS A CHEMO DRUG has been patented by the primary investigator. The subtance itself is not.

In fact, in the Official website of the University of Alberta, they have already gotten funds for further research on humans, I presume. And of the countries that was mentioned to have given funds is my own country, the Philippines.

Wow!!! I wonder who those person/s are? I'm sure they are not doctors. :)

Cancer Survivors rides' of their lives

Often people and patients alike ask me the question of how the diagnosis of cancer will affect their lives. This question for me is one of the most important, since it will significantly affect likewise, how they will deal with it.

To make the answer as brief and as close to reality as possible, I make an analogy to it as a roller coaster ride. It is, literally a roller coaster ride! When we are sick and recovering, we climb up the rails slowly, and the steeper the angle, or sicker you are, the slower the recovery will be, and yet when you reach the plateau, you feel so good again, but its not too long. Then you get sick again, the fall is sometimes so quick, you didn't know what happened.

When patients hear this, sometimes they get so disconcerted, but like all roller coaster rides, it has to end. It is how we look at it, how we react and how we laugh or cry as we follow the troughs of life.

To some people, its a frightening adventure, and yet to some, they take it with courage and acceptance.

So who do you think will take the ride and get on with life?

Technorati Tags: cancer, roller coaster, cancer survivors, cancer stories

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Epoetin and cancer risk

Just got a mail that warned of FDA imposing a warning on the use of Epoetin alpha on patients with cancer. Epoetin and the other drugs of the same class are given to people with low RBCs, including patients with chronic renal disease as well as those undergoing chemotherapy.

These drugs increase the amount of RBCs which are important to cancer patients undergoing chemotherapy. However, with this warning, it will cause some apprehensions now on the part of patients and doctors alike. Chemotherapy and cancer itself, can lower your blood cells.

I' m sure a lot of doctors now will think twice before giving any of these drugs. I hope that the doctors and patients will now try to look at how to improve your anemia with nutrition which, IMHO, is the best way to go about it.

I use a lot of the "Wonderful but cheap" Malunggay! (Moringa oleifera) Its very much available here in the Philippines. I ask my patients to juice them, in fact when their RBCs go down, I immediately know that they are not taking them!

Our present national hero, Manny Pacquiao, eats it before a fight! That's how much the trust of Manny to the strength giving characteristics of malunggay.

Stem Cells

I just came across a product that is claimed to have stimulating effect on a body's own stem cells. This is not like other products that uses embryos, placental tissues or from other animals. Its from Spirulina.

This would definitely be good for vegetarians and those who are against embryo harvesting.

The question remains, is that if it really does what it claims to do. There is only one study on the effect on this product among healthy volunteers. I would love to see if it can do the same for sick persons. And secondly, if it really can help improve the condition of a sick person.

I'm a bit skeptic until proven otherwise. But I would love it if this thing works. Its definitely cheaper and a better alternative

Anti-angiogenesis

I've been doing research lately on the effect of anti-angiogenesis on cancer growth. I'm sure there are a lot of studies on it, specfically for the VEGF inhibitors for lung and colorectal cancers. But that's not the only thing that is out there.

There are a lot of herbs that also seem to arrest tumor growth by killing off the arteries that feed it. One of them is the shark cartilage. The pioneer in this field is Dr. Folkman who even wrote a chapter in the the Harrison's textbook of Medicine.

I feel sorry for the sharks but the cartilage of sharks do have anti-angiogenic factors. We just need to come up with a good way of extracting it and using it for real patients not just on cells and animals. I guess you can't patent something like that until you make a synthethic version of it.

Spilling the Beans

Yesterday, I just had a chat with a patient of mine who had stage 4 liver cancer. Like all the other conversations I had, it was just about what they were doing and what do they plan to do in the near future. I always ask this question, especially to  very ill patients, in order for them to focus on something other than their illness.

But suddenly, the conversation shifted to his problem of sleep. He stated that he wouldn't be able to sleep and that he would somehow get memories of his past. Like a movie playing at an accelerated rate, it recounted his past life ever since he could remember.

I was a bit happy for him, for this is part of the healing. The healing of the past hurts in his life, which was I would definitely say, very traumatic for anyone. Being left an orphan from a well-to-do family, he was "sold" to his second family. It was very painful for him more since he could distinctively remember he had a sister, who he has never seen again.

And yet... I was sad. For patients to be having "life reviews," it will definitely mean either they  get well or move on to the next life.
I've seen it already a few times, and this one is no exception. I just hope he will be liberated from these pains soon. Its the emotional pain that will not go away or be dulled by any pain killer.

Bravery: Women vs Men

I recently had a Breast Cancer patient with an already oozing lesion on the nipple area. She was advised to have chemotherapy prior to surgery. She refused to do the chemo, feeling that it will hasten her poor health.

Instead, she opted to have all those Vit C, B17 injections. Lost and unable to express what she really wanted to do. Unfortunately, all the MDs who told her to do this and that did not inform her that her tumor will not shrink that fast with those procedures. When she came to me for help, I explained to her, the REAL condition, and still adamant against the chemotherapy.

I see great courage when I see this kind of persons. They will hold on to their belief even if their family and friends have advised otherwise. She is the 3rd patient to refuse chemotherapy altogether without even trying one session.

I salute them for their courage, though only God will know if their beliefs will be their folly. My first patient also breast cancer, refused all conventional treatments. Her tumor was bigger than a watermelon but disappeared completely, only to metastasize to her lungs 2 years later. It was a sad moment for me. She held on that belief until the very end.

My second patient, also breast cancer, held that firm belief. Only this time, the tumor actually shrunk from 4cm to almost 0.5 cm at this time. I am quite certain that the tumour will disappear completely with her treatments, and she will not develop any metastasis anytime soon though.

This just exemplifies the courage of these extraordinary women. I have yet to encounter that same courage in men. In fact, men are less inclined to hold on a belief or principle when they are sick, and seem to be more passive with their choosing of treatment options.

Experience is the Best

When I was just a "new, out-of-the box, ready to take the world" doctor, I felt that I know whatever there is to learn about medicine and taking care of people. I expected and felt that I can be as good, and maybe "even better" than other doctors (how stupid and arrogant).

Everything there is to learn is in the books, journals, websites and all the places that doctors read to be abreast with the current medical practices.

Until, finally with only more than 7 years of practive and a few hundreds of patients, I realized what I have not learned in the books, lecture halls, workshops, and dissections.
The human face of medicine and treating patients. It's not about science, it about art. Merging the science with the art of "healing patients."

That's what you don't learn and what they don't teach you in school.

Before I use to wonder, how come this doctor has so many patients when you look at their academic and clinical skills, it is at par with everyone else, and yet another doctor who has had several papers he authored appeared in prestigious journals, have flies as his regular patients?

Last few days, I somehow felt that now I know what it was that separated the good doctors from the "popular doctors". The art of talking, reassuring and making sure patients are satisfied with all their concerns while at the same time, using the science of medicine in alleviating the problems patients have,and expecting the troubles ahead of time.

Lighter Side of Life

I was explaining to my patients the downside of drinking Coke, specifically how much acidic it is and how much sugar it contains. To further prove my point and make it clear that it is not healthy to drinking this stuff, I told him about how a can of Coke can literally digest the teeth and nails when these are soaked. Moreover, that a can of Coke can unclog pipes.

His reply was: "Wow, that Coke thing is real scary, good thing I drink Pepsi!"

Lost voices

This is the second time in less than a month where in I have had the opportunity to see 2 patients with lung cancer who have lost their voices. Both of whom are very much eager to gain their voice and be able to be "normal" again.

It must be hard to have a diagnosis of cancer and even harder of not having a voice and be able to communicate what they want and what they want to say to their loved ones.

Just had a talk with one of my previous patient with lung cancer stage IV. She is not walking anymore due to the metastasis to her spine, but she is still strong and fighting. I am amazed at her inner strength and emotional stability. Likewise, the strong family support that she is getting.

This is so opposite the lung cancer patient with brain metastasis, whose wife is so negative and and unbelieving in what we are trying
to achieve for her husband.  Even if she doesn't believe what we are doing, I will understand and accept.
But to see that she doesn't even help with what his husband is going through, that for me is unacceptable.

Cancer support is the most important thing a patient needs. Loneliness, despair, anxiety and worry adds exponentially to an already stressed individual. I have seen time and time again, how the family acts and support their loved ones from a disease, will somehow predict their survival.

My next step is to form a cancer support group. I hope and wish that we can make it happen at the soonest possible time.

Back from Vacation

Just got back from the a well-needed vacation!!! I had a some sun burning issues right now, hahahaha! The Boracay beach is still looking white and clean, though I notice it's not as clean as it used to be. When you see cigarette butts floating, you start wondering what else is there that you can't see or haven't seen. Yucks!

I hope that they will able to maintain its pristine beaches. It's one of the few beaches where I have been that fishes are also swimming beside you eventhough you are not even 5 feet away from the shoreline.

I guess its back to work for me.

Depression?

Met my friends whom I have been with for the longest possible time. Everyone is now successful in their respective fields. And one of the friend asked me: "Don't you get depressed when one of your patients died, that's why I didn't want to be in the clinical setting." He is a hospital administrator for their hospital.

I suddenly stopped and didn't know how to reply to that question. At that moment in time, I realized: "I think I am, but I am not fully aware of the extent or depth of that emotion."

My reply was, shrinking away from further questioning: "Of course, a little bit." But the truth is, I really don't know, and do I really want to explore that area?

In my med school and I'm sure in almost all the med schools out there, students aren't trained or at least informed of how to handle the emotional and psychological effects of patients' questioning, pestering, pleading, and worse suffering and death itself. WE all were just thrown into the proverbial lion's den and fend for ourselves for whatever physical and psychoemotional asteriods that come into our direction.

Sure there are also psychiatrists, but honestly, how can they treat fellow collegues esp if they themselves suffer the same affliction. And how can you "stay unattached" as much as possible? Only robots and reptilian-based creatures can do that, being cold and steady without emotions.

What will keep the doctors sane after long years of practice?

Blogging

I've been tweaking my blog site lately and I would say that I am a bit amused at how my site looks with all the funny buttons here and there.
Guess, I am a little envious of some of the blog sites that are featured in the "Blogosphere" though for what reason I'm not yet certain. Maybe I want to be famous too! hahahaha.
But I'm happy and contented that I can express myself without fear of reprisal or unwanted criticism from my patients or from fellow doctors.
Until I saw Doctor Anonymous! I said to myself, I don't want to be like him, hounded and all. I feel sorry for him that he is Anonymous no more. Me don't want that, I want to remain anonymous for the longest possible time :)

Lung Cancer with Brain Mets

Its going to be a hard case, this one. I have doubts that the patient and his wife are really going to realize the importance of doing things the natural way. I fear that I might not be able to help them since the patient is still in a state of denial, while the wife is leaning towards chemotherapy. But after the 10 sessions of radiotherapy and the lost hair, isn't it enough to show the wife that her husband might not be able to withstand chemotherapy.
I saw using the SCIO that he's in a lot of stress, not only because of the cancer but more because of the financial difficulties now and waht lies ahead, with the chemotherapy drugs which will cost more than 100,000 for them ($2000) each session.
I hope I can help them at least for the time being.

Genes and then some

I have seen a lot of my patients who have done chemotherapy, radiotherapy or both. But almost all of them somehow will ultimately fail or failed to finish the course because of poor tolerance to the side effects or tumor doesn't respond or even becomes bigger.

Recently, more and more research have come out about the importance of doing genetic profiling of the tumor to get an overall picture of the prognosis as well as which chemotherapeutic agents willl be effective.

I wish that we here in the Philippines, will adopt that and spare patients from trial and error. Though I know that this will be unlikely in the near future since, all medical expenses will be paid by the patients.

Sad to say, our medical insurance in the Philippines, deliberately or not, excluded cancer for coverage and left people to spend a preposterous amount on chemotherapy. And adding insult would be that chemotherapy drug or drugs will eventually go to waste since the patients will not finish a course. Leaving the patient in pain, frustration and disgust to their fate.

Sleepless

I can't seem to sleep these past few days. I keep thinking of my past and present patients who I am and have taken care of. It seems that I am rationalizing things that are already been done or things that were inevitable.

Weird, maybe my subconscious is tryng to tell me something!!! I have to know what is it soon, or I go crazy. I can't stop thinking especially of a new patient with lung cancer with metastasis to the brain, that is going to be a bit more difficult. I hope I can help him fast!

Nutrition in Cancer

I just came back from seeing my patient with liver cancer who had just had a t-tube placed due to the blockage of the bile ducts. He is still weak from the surgery and the hospitalization. In fact, I felt a sense of desperation on his part, mainly because he is usually strong and up and about even after being with the liver cancer and all for the past 5 years.

I think its fantastic that this person is able to deal with it sans despair, until now. So I had to talk and coerce him to take things one at a time and give his body enough time to recover. Of course, as we age, our recovery time lengthens, what more if he has cancer.

What was striking was the fact that one of his doctors told him he can only have 3 eggs /week!! I was aghast!!! He is a vegetarian so where else aside from beans can he get the necessary protein? Eggs have one of the most complete set of nutrition that is easily available. He doesn't have high cholesterol, my god, he is suffering from malnutrition.

I wish that the doctors will re evaluate their philosophies (note not knowledge coz most physicians aren't well versed in nutrition) and update the current thinking with real hard facts.

I remember a patient told me that his pediatrician told her to stop taking omega 3 oil because she was breast feeding (another jaw opener) My reply was, if thats the case, then why in the world is Omega 3 specifically DHA incorporated in infants' formula?

My wish is that at least the doctors will start reading rather than listening to med reps!

Passed away

I am totally shocked right now, knowing that one of my patients had just passed away. He was just hospitalized for pneumonia but apparently, things got worse than better. I was already looking forward of seeing him again, after his wife called and told me that he was looking to see me too!

His condition was bad, having liver cancer but no metastasis to other organs at that point in time. He was, I would deduce a good chance of surviving for at least 2 years without any pain or complications. Looking back now, I still feel and think of the same assessment. I guess I forgot to include his overall outlook in life. He was a bit bitter and angry for the past events of his life.

We were going to that point of dealing his emotions, but things got worse day by day, to the point that he was hospitalized.

As previously posted, I am really apprehensive of cancer patients going to the hospitals due to the fact that their immune system is totally shot if not non-existent. Definitely, the case here exemplify this scenario AGAIN.

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Recovery

Its been a slow week for me, and therefore more time to read and reflect really. I feel as if our Creator has told me to slow down for a moment and think about what I have done right and WRONG. Most especially the wrong part.

I remember a quote from someone saying like: "To make a right decision requires experience, and to gain experience is to make the wrong decision."

Ouch, I wish it would be that easy if it were not for the life of a person on the line, however I have yet to see a major blunder and I really am very careful what I do and give my patients.

My liver cancer patients are slowly coming back to life ( I really hope so) I will see them this week or the next, following their hospitalization, one for pneumonia, the other for tube placement (his bile ducts were obstructed due to the tumor, despite the fact that we were already seeing regression of the tumor from the outside) Well, you cant get every tumor all at the same time.

But I am optimistic that the treatment we are doing will continually and without interruptions, make the tumors with a BIG S, will gradually go away PERMANENTLY!