Dr. Bob's Corner

There are many things that bind healthcare workers and their patients together.  We both share a common humanity.  We all have the need for good health and we all need to take care of ourselves.   I try to emphasize this to my patients, my colleagues, nurses and other employees in my practice.

Taking care of oneself is a very personal notion.  Each person would have a different definition of what “taking care of” means.  Some cancer patients would say it’s taking a nap to fight the fatigue of chemotherapy or spending extra time with loved ones in order to feel more connected.  Some patients would say it’s taking a vacation to a place that they have always longed see. For healthcare providers, many of the same things would be also true.  Taking a vacation, taking an opportunity to rest, and taking time to exercise are all things that might important.  For me, “taking care of me” means mostly being with family, spending time with my children and being part of their lives.  It also means exercising.  Rarely do I feel better than just after exercising hard on the treadmill.

I think another thing that the patients and healthcare providers can do to take care of themselves is to set realistic goals. Understanding that regardless of their situation in life that one can make goals in order to make their lives better is so important.  I have a young, single mother who was treated in the past for non-Hodgkin's lymphoma.  Prior to her treatment, she was employed in a challenging job.  She was able to take care of her children and keep all of the” many balls that she juggled in the air at the same time”.  Then her diagnosis and subsequent treatment with chemotherapy and radiation therapy cut much of her energy. Much of her ability to keep those many juggling balls in the air is now gone. We had a long discussion recently about her not being the same as what she was before her treatment. I stressed to her that she may not be able to be the same as she was before her diagnosis but she is now something even more remarkable. She is now cancer survivor.  Unfortunately, the likelihood is that her body, her energy level and her memory will never be the same as before her diagnosis and treatment.  She may never get back to the point where she can return to her previous job. She still can take pride in reaching new goals. She still can strive to be the best mother for her children and set some new goals that may in fact lead her to somewhere that she cannot yet imagine.  In other words, she needs to take care of herself.  She needs to understand that her diagnosis of cancer has likely changed her permanently. Accepting this and at the same time moving on from the grief and disappointment is vital.

One of the wonderful things that inspires me and makes me love my job as much as I do is seeing patients adapt and overcoming their diseases. Many find unique ways of taking care of themselves that ultimately inspire me to take care of myself.

I love finding reports on natural ways of fighting cancer. This study is great. I can't wait to see more research into this juice. 

 Pomegranate Juice May Slow Prostate Cancer

April 26, 2009 -- Drinking 8 ounces of pomegranate juice daily may slow the progression of localized prostate cancer ( prostate cancer that hasn't spread), a new study shows.

The study included 48 men who had surgery or radiation therapy to treat localized prostate cancer.

When the study started in 2003, the men's PSA levels were doubling every 15 months. In prostate cancer patients, PSA (prostate specific antigen) is used to monitor their cancer.

All of the men drank 8 ounces of pomegranate juice daily, and that slowed down the time it took for their PSA levels to double, as the researchers reported in 2006.

After that, the researchers -- who included Stanford University urologist Allan Pantuck, MD -- kept following the patients every three months. Fifteen of the patients stayed with the study for up to 64 months (a little more than five years), and it typically took four times longer for their PSA levels to double when they were drinking pomegranate juice, compared to their PSA doubling time at the study's start.

The results were presented at the American Urological Association's 104th annual scientific meeting in Chicago.

Five of the six researchers who conducted the study disclose ties to POM Wonderful, which makes the pomegranate juice used in the study.

In 2007, another team of researchers bought pomegranates, made their own pomegranate juice, and tested it against human prostate cancer cells grafted into mice. Those tumors grew slower than other tumors treated with a placebo solution.

I cannot believe what I heard.  The President held the news conference on healthcare reforms and like many Americans; I listened with great interest to what he had to say.  Of all Americans in this country, this legislation will likely affect my job in future more than most.  I fully expect it cut my pay, make my life more complicated and likely make it more difficult to take care of the patients as I see fit. I have been willing up to now to keep an open mind about President Obama's healthcare plans.  I believe that it is a wonderful goal of this country to insure healthcare for the maximum amount of our population..

Last night, however, one exchange angered me. When President Obama said that the physicians make decisions to take out children's tonsils based on economics.  I believe that the vast majority of physicians do their job and make the decisions for their patients based on what they believe is best for the patient.  It is true in oncology that part of my income is derived from giving patients chemotherapy, giving them radiation therapy, and following their disease on CT scans, but I would like to assure the president that I would give everything that I own, all my retirement if cancer would just disappear.  I would be more than happy to be put out of business if cancer no longer existed.  I am truly saddened that The President of The United States would characterize the profession that I have been a part of and have been proud to be a part of in such a demeaning, dark and ugly way.

The human condition is a messy one.  The human body is designed to produce or secrete endless number of fluids and by-products. Despite all the many billions of dollars that people spend on perfumes, sanitizing wipes, soaps, shampoos, and colognes our bodies continue this process around the clock.  To most people, these secretions and fluids smell and are to be flushed, wiped or disposed off as quickly as possible.  In medicine, however, these secretions are incredibly vital to the diagnosis of diseases and their therapy.  From the chloride sweat test used to make the diagnosis of cystic fibrosis, to the complex serum chemistries that we do on blood, these fluids and secretions provide a fertile ground to test for possible diseases.  The analysis of these fluids and secretions is becoming ever more advanced. We are finding small bits of cancer in blood called circulating tumor cells, at the molecular level we are doing protein analyses and gene analysis on blood and blood cells. Tissue that is removed at the time of a surgery is being diced, mashed and processed to give us an ever expanding ability to diagnose and predict the prognosis of patients with cancer.

The human condition is one of endless production of these fluids.  Our bone marrow with its ability to produce a near endless supply of blood, our stomachs producing gastric acids, and our livers producing bile to help in our digestion are examples. Our sweat glands produce sweat in an effort to cool our bodies during exercise and in the heat of the summer. Our kidneys produce an ever continuing supply of urine to dispose of endless amounts of wastes that must be processed and removed from our body.

So much of what we worry about in many diseases today is based on the transmission of these secretions.  Hospitals wipe down rooms to prevent coming in contact with aerosolized respiratory secretions. We wear rubber gloves to prevent the touching of skin to decrease the transmission of Staph infections. We do not enter a patient’s room without spraying out hands full of antimicrobial foam.  We are seemingly in a constant battle to rid our patients and ourselves of the various secretions that are vital and really honestly make us human.  The human condition can never ever be a sterile condition.  We will never ever be rid the waste products that are produced by life.  I find it amazing how this complex organism that we call the human body can make such an almost seemingly endless number of secretions and how our mind has spent hundreds of years trying to come up with ways to cover up, remove, and suppress these secretions.

My family and I went to the movie theater last month to see the Disney production of “Earth”. I enjoyed this film immensely and would recommend this to anyone.  The main point of this film is that our earth is an incredibly special place and that a very unique set of circumstances has led to its ability to sustain and support life.  I believe it is a wonderful testimony to man's wanting to do good that such a film had been made.

I would never call myself an environmentalist, so much of my professional life has been dedicated to taking care of humans. The environment around me has always been seemingly second place in my heart.  I do realize how important this planet that we live on. If we are not good stewards of this planet we run the risk of destroying its ability to sustain life.  I do believe as we deplete our planet and utilize its resources that illness and specifically cancer will become more likely and more prevalent.  I know the answers to the problems of green house gases and pollution are difficult; they are complex and the solutions may be costly. As a warrior of a different battle; the battle against cancer, I believe this other battle needs to be waged.  Ultimately, I think that the final triumph over cancer or pollution is a battle that will be well worth the cost.

Over Easter weekend, I read an article in Newsweek about the waning of Christianity in the United States.  The article talked about a recent poll that showed that increasing number of people indicated that they no longer believed in God.  I then had the opportunity to attend Easter Services at a church in Lincoln, Nebraska.  The church was full with every seat taken, the balcony full and this seemed to be the case for all three of the services that were going to be held on this special day.  I thought to myself what a stark contrast between what I saw and experienced on Easter Sunday morning and what was spelled out in the article in Newsweek.  I have increasingly become aware of the idea that faith and belief in a higher being makes such a difference in how people handle the diagnosis of cancer.  The patients whom I believe live longer, tolerate therapy better and in general have a better outcome are those with what I would describe as a deep faith.  I know that this may not be a purely scientific observation, but it is a belief that has been fostered over the 15 years that I have treated patients with cancer.

There is an old army adage that there are no atheists in foxholes and maybe the diagnosis of cancer brings patients to re-examine their lives and re-examine whether they in fact have faith.  I also feel that in today's world, being a Christian or someone who believes in God is maybe not seen as "cool."  I think it is en vogue to deny a faith in God.  On so many different levels, I feel that this is a mistake and I believe that in many cases it is just an act and that when push comes to shove, it is our human nature to turn to a higher being and seek help in times of stress.  I wonder what would happen if Newsweek had polled 1000 cancer patients.  I would suspect that the results might have been different.

My son and I visited two universities over the last several days. We looked at Belmont University in Nashville and Loyola University in New Orleans. It was a fun and interesting trip. Hours on the plane and many hours in a car gave us a chance to talk like we haven’t had in years. It has been an amazing transformation to watch him mature into a young man. We don’t agree on everything in life (music, politics’ etc.) but his thoughtfulness shows a level of maturity that I respect. As parents we hope and pray that our children “turn out right”. I think that is more important that they find their own way and develop a sense of themselves. If there is one thing that I hope I can give all my children is the idea that developing that sense of oneself is a lifelong process. It is one of the most fulfilling parts of life.

To be diagnosed with best cancer at the age of 25 must be one of the most difficult things a human can go through and endure. At twenty five people still feels invincible, with their whole life ahead of them. A patient of mine went through this almost five years ago. Chemotherapy, radiation therapy and nearly 5 years of antiestrogen therapy put many of her dreams on hold.  She had wanted a family with her new husband and looked forward to the possibility of having a child after her 5 years of antiestrogen therapy was completed. Over the last 5 years she has become one of my closest patients. I looked forward to her visits, as did all my staff. She is kind and always smiling.

Tragedy struck this week. After being only ill with the “flu” for one week she went to her home town doctor and was found to have a white blood cell count of 150 thousand (100 times normal).  The work up included a bone marrow biopsy which revealed the diagnosis of acute leukemia.  She is now in the second fight of her life. This leukemia is almost certainly related to her previous treatment for her breast cancer. How can this happen? It is a known complication of certain kinds of chemotherapy. The chemotherapy damages the bone marrow in some way that eventually allows the development of this kind of “secondary” cancer. This is a very rare but feared complication of the treatment of many kinds of cancers.

Treatment of her leukemia will require aggressive chemotherapy and eventually possible a bone marrow transplant. If she survives the first couple weeks of her treatment, which is in no way certain, she will face years of potential treatments and side effects. Her ability to have children has been lost. The amazing thing is her attitude has not changed. Despite the pain, fatigue, difficulty breathing, and the prospect of a long hospitalization her spirit and smile hasn’t dimmed. These are the characteristics that give her a fighting chance….. Everyone’s payers would help also. 

I was in Austin Texas recently for the American academy of Hospice and Palliative Care Medicine (AAHPM) meetings. This was my first trip to this organizations meeting. This specialty takes care of chronically ill and dying patients. It was a very different sort of meeting for me. Many of the national meetings that I have attended over the years have been so focused on the molecular basis of cancer. Don’t get me wrong, this is important and interesting but it also seems to sometimes forget the patients. The care of patients on a day to day basis has very little to do with the biochemical pathways of the medicines we use. Yes, these pathways ultimately determine the actions, responses and the side effects of the medicines but the individual response of patients is personal. It is unique to each patient. These pathways don’t even come close to determining the reaction of the patient both mentally, spiritually or emotionally.

The AAHPM meetings were different because the majority of the talks, lectures and meetings were focus directly on the patient. There were sessions on how to listen and talk to patients. There were studies on pain control, insomnia, and shortness of breath. The research that is going on in palliative medicine is in its infancy. Palliative medicine is a new medical specialty and the people who work in this field of medicine are on the “cutting edge and uncharted water “. There is an excitement and a passion that is difficult to describe. Talk of spirituality was freely overheard. The emotions, stresses and thoughts of patients, their care givers, and the professionals that care for them were the highest priority.

I think that the doctors, nurses, social workers and ministers that work in this new and expending field of medicine understand the finality of life. They are not so concerned with the statistical difference in survival between two chemotherapy drugs. They understand that we have a finite amount of time on the world and how we live is much more important than how long we live. I can’t wait for next year’s meeting in Boston.

I had the opportunity this month to host a remarkable guest into our practice, Dr. Jeremy Geffen.  Dr. Jeremy Geffen is a board-certified medical oncologist who has become a nationally and internationally recognized expert in integrative oncology.  Integrative medicine is the practice and study of alternative and complimentary therapies.  He came to Kansas City to present to our practice the possibility of bringing his incredibly unique and powerful program, The Seven Levels of Healing to our practice.  The Seven Levels of Healing is best described as a systematic journey that a newly diagnosed cancer patient takes under the direction of Dr. Geffen and highly trained coordinators to learn the best way in which to deal with their diagnosis. Below is the general outline of his remarkable program.

Lasting 7 weeks this Program is a unique education and support class that gives patients the needed resources to deal with the diagnosis of cancer. We are working hard to bring this program to our practice and are hoping to start the first classes this summer.

  Dr. Geffen originated this program in Boulder, Colorado where it has been met with great success.  He has presented the results and outcomes of this program at The Society for Integrative Oncology meeting and also at M.D. Anderson.  We are so excited to be a practice that will be participating in this unique effort to help our patient's deal with the sometimes overwhelming problems that they face as they struggle to comprehend and fight their diagnosis of cancer.  Our staff is also fired up about this program and its potential benefits for their own growth and the growth of our patients.

I would strongly encourage anyone who is battling cancer to seek out Dr. Geffen's website and read his book.  The book is a wonderful and powerful statement on the concept that the patients are whole beings.  Treatment of patients must be at every level of their being, including their mind, soul, body, and spirit, not just focused on chemotherapy, radiation therapy and other “traditional “therapies.