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Overheard From A Breast Oncologist

slimsmokes10241KFC and Komen? BucketsfortheCure.com? “Why don’t they just put a pink ribbon on a pack of cigarettes?”

*This blog post was originally published at Terra Sigillata*

HRT And The “Window Hypothesis”: Hope Or Hype?

It’s only Wednesday, and so far three patients have come to their office visits carrying Cynthia Gorney’s article from Sunday’s New York Times entitled “The Estrogen Dilemma.”

The article explores the stories of three women who found relief from perimenopausal symptoms by using hormone replacement, framing the discussion in the larger context of what is being called the “window hypothesis” — the idea that starting estrogen replacement in the perimenopause and continuing it into later life may be neuroprotective and even cardioprotective, in contrast to beginning its use 10 or more years after menopause, where it can trigger heart disease, stroke and dementia. Read more »

*This blog post was originally published at The Blog that Ate Manhattan*

When Cancer Patients Opt For Quackery Over Clinical Trials

So my cousin emailed me the other night. She had a breast cancer recurrence about 6 years ago. Before you feel too sorry for her, however, know this: She’s doing great, moving from one targeted treatment/chemotherapy/laser knife procedure to another. Her doctors are fabulous. Her attitude is amazing. And, as she constantly tells us, she feels great and is loving life. No, this isn’t about her. It’s about her friend, the one she emailed me about.

Her friend was diagnosed with an early stage of an aggressive form of non-small cell lung cancer a year ago. After chemotherapy, a CT scan this summer showed her lungs clear of cancer; but a followup CT scan last week showed some spots. This woman had participated in a clinical trial during her first round of treatment and her doctor wanted her to join another clinical trial. But my cousin’s friend is freaked out; she doesn’t want to feel like a “guinea pig.” So when her daughter suggested she see a doctor who specializes in an unproven and experimental therapy called insulin potentiation therapy, she was ready to call for an appointment. Read more »

*This blog post was originally published at Debra Gordon's Musings on Medicine and Health Care*

New Hospital Policy Leaves Cancer Patient In Tears

cryingpatientA dear friend of mine (let’s call her Amanda) has metastatic breast cancer. She’s far outlived her life expectancy, thanks to advances in targeted chemotherapy, but is beginning to need more medical care. She’s the divorced mom of two teens, with a loving extended family who keeps a close eye on her.

When Amanda was recently admitted to her local hospital with abdominal pain, a new policy resulted in some unintended consequences. While she was still in the Emergency Department, a nurse came by to ask if Amanda wanted to be an organ donor. The family members – keenly aware of her grave prognosis – assumed that the nurse knew about the cancer, and was asking this question because it had been determined that Amanda was about to die.

Tearful sobs ensued. Amanda’s sister called me the next day to tell me the news. Read more »

Breast Cancer: How One Surgeon Protected A Patient From Another Surgeon

After having spoken about when you seem to know more than your consultant, I was reminded of another incident from my internship year where a colleague of mine taught me that sometimes it is best to do certain things under cover of darkness.

The patient (a sangoma) turned up at the surgery clinic one day. My colleague asked her what the problem was. Without uttering a word she lifted up her shirt to expose her breasts. The left one had a massive tumour that had fungated through the skin probably some time ago. There was a large stinking cauliflower-like mass with central ulceration that caused a fist sized cavity right up to the chest wall. The smell was also remarkable. Read more »

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

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…

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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…

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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…

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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…

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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…

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