Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

How Cancer Survivors Are Picking Themselves Up And Moving Past The Worry

Thank God television and movie script writers are starting to “get it.” Cancer, “The Big C,” doesn’t always kill people, or maim them, or steal their dreams. Lately there have been new TV shows acknowledging cancer as part of life that many can live through. There’s a new movie coming called 50/50 about a young adult man with cancer (important to acknowledge it in this age group!). I hope he doesn’t die in the end. But from the preview, it’s clear he talks to people about it – including young women he is trying to date. It’s a comedy. On Showtime on cable TV there’s a series, The Big C, where actress Laura Linney plays a teacher with melanoma and a year to live. The good news is they had a second season!

My point is there are now nearly 12 million cancer survivors. Three of work them at Patient Power (one is me, almost 61, one is in her 50’s, one is just 18). More and more of us do not have just months or a year to live. We are true survivors. We have to start watching our cholesterol and taking baby aspirins, we have to watch our weight, plan for retirement or manage a fixed income. For the young one, it’s plan for college. We have to think about who we might vote for in the next election. We are LIVING! Maybe for a full lifespan, maybe not, but living each day with purpose.

Yes, it’s true there could be “another shoe” that drops, Read more »

*This blog post was originally published at Andrew's Blog*

The Case Of The Accidental Chemo Burn

One of the great things of being in a group practice is meeting and taking care of patients who may not necessarily be on your own personal patient panel. Walking into the room, I hear the patient say, “Doc, you gotta help me.” I see a red right forearm and on the “complaint” section, the nurse wrote “burn.”

So, I ask, “Well how did you burn your arm?” “Well, doc, I got cancer.” Hmm, that’s interesting. I didn’t make the connection until the next sentence. “It was my last treatment with chemotherapy about 2 weeks ago and for some reason, the needle slipped and the stuff went all over my arm. The cancer doc prescribed these pills, but they don’t seem to be helping. I asked the pharmacist about some salves and this is what they said.” He showed me a handful of creams and ointments purchased at the pharmacy.

Since I didn’t know this patient at all, I was leafing through a very thick paper chart to try to catch up. “Yeah, I’ve been coming to see Doc [name] for a long time now. I’m glad you were able to see me today since his schedule was full.” This very pleasant patient then told me about how they diagnosed his cancer – a tear came to his eye – it’s like he was re-living that moment again. Read more »

*This blog post was originally published at Doctor Anonymous*

How To Make A South African Surgeon Really Angry

In the old days sometimes confrontation was the only way to get things done. But sometimes anger lead one into useless and unnecessary confrontation. I recently spent some time with my old friend, swimmer’s chest and a story came to mind when that swimmer’s chest saved me from my own anger.

We were on call together. Quite early in the day the chemotherapist called me. He had apparently put a patient on the emergency list the previous day for a portacath and the case didn’t get done. This was due to the fact that the emergency list first did critical cases like actively bleeding patients before they did relatively stable patients. Something like a portacath would tend to get shifted down the list and may even stand over to the next day. This is what had happened here. He now wanted me to do the case.

“Sure I’ll do it” I said. “As long as it’s on the list as soon as it comes up I’ll be there.”

“I want it done now!” he retorted. I was not impressed.

“Well phone the anaesthetist on call and motivate for him to move it up the list.” I said helpfully.

“That is not my job! You will do that!”

It was clear we had a communication problem. Whenever I had a telephonic communication problem I would put down the phone and take the effort to go to the relevant person to sort it out face to face. Not only does it help to speak things out in person but the walk usually gave me time to calm down (there was more than enough residual anger in those old days to go around). This is what I did here. I turned to swimmer’s chest and told him to accompany me. Off we set at speed.

We walked into the chemotherapy ward and asked to see the relevant doctor. Soon he was there in front of me. swimmer’s chest hung back. I introduced myself and explained that I was more than willing to do the surgery but I had no control over the order of the list. That was entirely in the hands of the anaesthetists. If he felt the case needed to be done before the other cases on the emergency list then he should phone the anaesthetist and discuss it with him.

“You will phone the anaesthetist yourself and you will do this case right now!” he said.

I could feel my anger slowly turning into fury.

“No! you will!” as I said it I clenched my fists and took a step towards him. Swimmer’s chest realised things were on the verge of going south. He later told me he thought I was going to punch the guy. I denied this, but the thought was going through my mind at the time, I confess.

So my good friend stepped in front of me with his broad chest and nudged me backwards. He then started speaking to the chemo doc in a calm diplomatic voice. He also subtly and slowly (almost so one didn’t notice) ushered the guy further and further away from me. By the end of it we left with the chemo guy feeling that we were there for him and would do all we could. I don’t think he even had an idea of how enraged he had made me.

Walking away swimmer’s chest asked me if I was mad. I had only a few month’s of training left and something stupid like getting into a fight was just about all that could stand in the way of me becoming a surgeon.

Those times in the end brought out the worst in me. By the end of my studies I knew I needed to get away from it all. I had very nearly become something I did not like. After leaving pretoria I gradually rediscovered the true me again. It was still there to my relief.

*This blog post was originally published at other things amanzi*

When Chemo Saves Your Life: An Interview With Billy Tauzin

Billy Tauzin has spent most of his life in politics. He has been a member of the House of Representatives as both a democrat and a republican, though his recent experience with a rare and usually terminal cancer (duodenal adenocarcinoma) radically changed his career path and trajectory. I caught up with Mr. Tauzin by phone at the America’s Agenda conference in Miami. You may listen to our podcast conversation or read my summary of our discussion below.

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Dr. Val: Tell me a little bit about your intestinal cancer and how that changed the course of your life.

Tauzin: I was in the process of finishing up a 25-year career in Congress when one night I had a sudden, massive bleed. I was taken to the hospital and was diagnosed with a rare cancer with a poor prognosis: duodenal adenocarcinoma. There was a hole in my intestine, right next to my pancreas.

I went to Johns Hopkins to have a Whipple procedure – and as you know a Whipple procedure is one of the most aggressive types of surgery anyone can endure. They kind of split you open like a fish, pull out your innards and restructure you. They had to remove part of my stomach, intestines, and pancreas, and then reconnected it with new ducts and channels. The Whipple was supposed to cure me, but unfortunately I found out (at a follow up visit at MD Anderson) that there was still cancer in my body.

The doctor told me very frankly that I was going to die.

Dr. Val: Tell me about the experimental drug that you were introduced to at that point.

Tauzin: My doctor reviewed my options with me: I could undergo another surgery, but that would probably kill me and would be unlikely to cure the cancer. They had no approved protocol for people in my position, but there was a drug (called Avastin) that had been successful in treating colon cancer – but was not yet approved for duodenal adenocarcinoma.  The drug works by cutting off the blood supply to tumors – which meant that the drug could either damage my healing process or kill the cancer. My wife and I decided to take the risk because we had very little to lose. It was really a choice between “going to die” (my current situation) and “might die” (Avastin could cure me).

It’s a good thing we tried Avastin because it worked like a miracle. By the end of my first round of chemotherapy, the radiologist couldn’t even find the tumor on my CT scans. It was gone. I completed several courses of chemo and radiation and I’ve been cancer-free for over 5 years now.

Dr. Val: Did this miraculous recovery influence your decision to become the CEO of Phrma?

Tauzin: After I recovered from cancer, I was fortunate to be offered many different job opportunities. However, my wife looked at me and said, “You know Billy, you really ought to go to work for the people who saved your life.” And I thought, “If there’s a meaning in why I’m alive today – then surely it must be to use my experience to help patients like me across the world.”

Dr. Val: So what are you hoping to achieve at the America’s Agenda conference in Miami?

Tauzin: This conference is unusual in that we’ve gathered together a group of very disparate voices from different perspectives – labor, business, health plans, trade associations, academic medicine, etc. hosted by Donna Shalala (former Secretary of HHS) at the University of Miami. We are trying to define our commonalities so we can influence health reform more effectively.

Washington is all about differences – it’s partisan, it’s mean, and I’ve been on both sides of the aisle. I can tell you that there are good people in both parties, but they’d never know it because they consider each other enemies. What we’re trying to say here is: patients don’t sign in as democrat or republican when they register at a hospital. They sign in as sick people. This is not a partisan issue. We have a sick care system that needs to be a health care system.

Dr. Val: What should the Obama administration choose as their top priorities for health reform?

Tauzin: First of all we need to recognize that we spend 75 cents of every dollar on the damage done by 5 chronic diseases (including diabetes, heart disease, mental health, cancer, and lung disease). We must focus our system on early detection and prevention of these diseases, so that we manage them well and avoid the costly toll they take when untreated. We’re destined to be a poorer, sicker society if we don’t get insurance coverage for every American. We need insurance to provide early detection, prevention, and good management of our chronic diseases. How we do that is debatable. But we need to get there.


Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »