July 20th, 2008 by Dr. Val Jones in Expert Interviews
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This is part 2 of an interview with urologist Mark Schoenberg. Please click here for part one of the interview.
Dr. Val: How is bladder cancer treated?
Dr. Schoenberg: Bladder cancer can be grouped into two categories: non-invasive disease and invasive disease. About 80-90% of the time the cancer is formed by the cells of the inner lining of the bladder, ureters, and kidneys and is non-invasive. This type of bladder cancer doesn’t spread or invade the bladder wall, so it doesn’t threaten the life of the patient, but it can recur.
Non-invasive cancers are usually removed surgically via a scope that is inserted into the bladder via the urethra, and then afterwards there are a variety of medicines that can be infused into the bladder. Those medicines are like a kind of weed killer for bladder cancer.
Unfortunately up to 20% of patients have invasive tumors at the time that they are diagnosed. Once the bladder cancer has spread outside the bladder wall, surgery is needed to remove the primary tumor and then IV chemotherapy and sometimes radiation therapy are needed to treat the life threatening, metastatic disease.
Dr. Val: Is there any way to screen for bladder cancer?
Dr. Schoenberg: Unfortunately at this time urine tests for bladder cancer are very expensive, and they don’t detect cancer reliably. However, many researchers (including myself) are currently on a hunt for specific bladder cancer markers that are inexpensive and reliable. Once we find such a marker or group of markers, it would make sense to begin screening — at the very least — high risk groups such as smokers or people with occupational exposures to chemicals.
Dr. Val: What are the most promising advancements in bladder cancer treatment? Is there new research in the pipeline that could improve its diagnosis or treatment?
Dr. Schoenberg: There are two different areas of research interest in bladder cancer. The diagnostics arena — finding cancer more efficiently, effectively, and less invasively — and the therapeutics arena — developing new tools, drugs, and agents to get rid of cancer cells.
On the diagnostic front, molecular diagnostic researchers are looking at abnormal cancer proteins and DNA that can be detected in urine samples. Because of this research, in the next 5-10 years it wouldn’t surprise me if we no longer had to rely on cystoscopes for the diagnosis of bladder cancer. Also we’d like to develop molecular and genetic profiles in order to risk-stratify people more successfully (i.e. figure out who is at greater risk for bladder cancer, and make sure they get tested).
On the treatment front, there are a number of companies developing targeted therapies for bladder cancer. It’s possible that these therapies will reduce the risk of progression and recurrence in people with bladder cancer.
Unfortunately, bladder cancer has only attracted a fraction of the research dollars that other cancers have in patients in the same demographic (like pancreatic cancer). In fact, NIH funding for bladder cancer research is pitifully small and shrinking, despite the fact that there are 600,000 Americans who have bladder cancer right now. Not only that, but bladder cancer is one of the most expensive cancers to treat – because it requires repeated cystoscopies, catheter-based infusions, repeat surgeries, and sometimes chemo and radiation. Bladder cancer treatment costs Americans about 1 billion dollars a year.
Dr. Val: Why isn’t bladder cancer receiving the research funding it deserves?
Dr. Schoenberg: Successful cancer groups have highly visible champions for the disease – like Lance Armstrong for testicular cancer, or Susan G. Koman for breast cancer. Research funding seems to be strongly influenced by highly visible people getting out there and making a ruckus. We need powerful spokespeople to help Diane Quale at the Bladder Cancer Association Network to get the word out.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 18th, 2008 by Dr. Val Jones in True Stories
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This alarming story (h/t KevinMD) of a physician attacked by a drug-seeker reminded me of my intern year. I worked in an inner city hospital in New York, and was scheduled to work in the “detox unit” for a full month. We interns had mixed feelings about our “detox month” – on the one hand, the patients were generally healthy and were unlikely to need blood draws, procedures, spinal taps, intubations, and such. This meant less work to do during our shifts. On the other hand, the patients were hardened drug users, often with a history of violence — and let’s just say that depleting the system of all the heroin, crack, alcohol, and various other substances didn’t tend to put them in the best mood.
I personally did not enjoy my detox month. I’d prefer a “crashing” ICU patient any day over a beligerant, hep C positive man trying to threaten me into giving him an additional dose of colace. And frankly, as a woman it was kind of scary to be around these guys. I never knew if they were going to snap, and no matter how many security guards are around, a lot of damage can happen in the 60 seconds or so it takes them to get to you.
One night the “detox resident” appeared for duty. His shift started at 11pm and the day shift nurses were eager to get home. The security guards were changing shift as well, and had not entered the lock-down area inside the unit. The resident went in alone. Suddenly, one of the patients snapped, and grabbed the unsuspecting doctor by the throat. The patient threw him up against the wall and punched him in the face, breaking his nose and fracturing his eye socket. Blood flew everywhere and the resident tried to fight back to defend himself. Unfortunately he was no match for the 250 pound patient, and sustained a few kicks to the ribs before the security guards were able to subdue the man. The resident was transferred off the detox unit rotation and given an extra week of vacation. I was the intern who was asked to fill in for him.
I felt somewhat paranoid that month, and refused to be inside the lock down area without a security guard within 15 feet of me. Fortunately, I was not physically attacked – I only experienced verbal abuse and the occasional very awkward conversation about genital deformities.
But it was a real wake up call for me – medicine can be a risky business, and white coats do not protect against psychotic aggression. I guess it’s just one of the risks we take in caring for all-comers.
***
Addendum: here’s another example of doctors being abused by narcotic-seekers.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 17th, 2008 by Dr. Val Jones in Uncategorized
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I’m really looking forward to this medical blog meeting in DC. Here is the media release – I hope to see you there!
On Tuesday, July 29, the Kaiser Family Foundation is sponsoring a discussion about the growing influence of blogs on health news and policy debates. Only in the past few years has the blogosphere become mainstream. In the health policy arena, we now see policymakers, journalists, researchers and interest groups utilizing this new media tool to deliver information to their audiences.
The briefing will highlight how the traditional health policy world has embraced blogging and will feature a keynote address by U.S. Department of Health and Human Services Secretary Michael Leavitt, the first cabinet officer to author an official blog, followed by a moderated discussion with a variety of health policy bloggers and a media analyst.
Questions to be explored with the panelists include: Why do individuals and organizations blog? How does blogging impact the broader work of an organization? Are there different standards used when blogging versus other writing? Have blogs impacted the news business significantly? What kind of influence are blogs having on political and policy debates?
Welcome and Introduction Drew Altman, President and Chief Executive Officer, Kaiser Family Foundation
Keynote Address The Honorable Michael O. Leavitt Secretary, U.S. Department of Health and Human Services
Panel Discussion Vicky Rideout (moderator) Vice President, Kaiser Family Foundation and Director, Kaiser Forum on Health Journalism and the News Business
Jacob Goldstein, Wall Street Journal
Michael Cannon, Cato Institute
Ezra Klein, American Prospect Magazine
John McDonough, Office of Senator Edward Kennedy and formerly of Health Care for All in Massachusetts
Tom Rosenstiel, Center for Excellence in Journalism
WHEN: Tuesday, July 29, lunch served at 12:30 p.m. and program begins at 1:00 p.m. Add this event to your Outlook Calendar (Please note that all times are ET). WHERE: Barabara Jordan Conference Center , 1330 G Street, NW , Washington , DC . For those who cannot attend, the event will be webcast live. RSVP: If you plan to attend the event, please send your name and affiliation to rsvp@kff.org.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 16th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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A non English-speaking husband and wife went to a rural ER because the wife had chest pain. The ER staff was unable to understand their language and did not have an interpreter. Since the husband was trying to explain his wife’s chest pain to the doctors, they thought he also had chest pain. Both patients were admitted to rule out MI (a heart attack). They stayed overnight and both had a full, negative cardiac workup. The husband complied with the workup, figuring he was getting free care and a place to stay next to his wife. His wife’s symptoms resolved on their own. (via Rural Doctoring)
Did you know that there are medical diagnosis codes for almost everything under the sun? Yes, even an “accident involving a spacecraft injuring the occupant of the spacecraft.” (via KevinMD)
A hospital pharmacy cancelled a surgeon’s order of antibiotics after a young patient survived a ruptured appendix (with pus in the abdomen). They were adhering to a new protocol that required all antibiotics to be discontinued 24 hours after any surgery. If the surgeon hadn’t noticed the inappropriate application of this new rule, his patient could have become septic and died. This is just another example of the oversimplification of medicine that is becoming more and more common these days. (via Buckeye Surgeon)
The ACP Internist blog posts a weekly “Medical News of the Obvious.” Here are two goodies:
Parents of twins report more anxiety and sleeping difficulties in the year after birth than parents of single children, according to a study presented at the 24th annual meeting of the European Society of Human Reproduction and Embryology (via Science Daily). I wonder why?
This study, courtesy of the Washington Post, finds that auto deaths decline as gas prices rise because– ta da!– there are fewer people on the road to kill or be killed. And that is especially the case for those subgroups (like teenagers) who don’t have as much money to burn on gassin’ up.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 16th, 2008 by Dr. Val Jones in Celebrity Interviews, Patient Interviews
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Bob Schieffer is broadcast journalism’s most experienced Washington reporter. He has covered Washington for CBS News for more than 30 years, and has been the anchor for Face The Nation (one of the longest-running news programs in the history of television) since 1991. I had the privilege of interviewing him about his bladder cancer at the CBS studios today. It is Bob’s sincere hope that his story will inspire others to seek medical help at the first sign of bladder cancer, and also gain comfort from knowing that they are not alone.
This is part two of our interview series. Click here for part one.
Dr. Val: Do you have any advice for patients facing bladder cancer?
Schieffer: Bladder cancer is a very insidious disease, you can have it for a long time without knowing that you have it. At the first sign of blood in the urine, you need to go to the doctor. I think men are often reluctant to go to the doctor, and their tendency may be to attribute blood in their urine to a muscle strain of some kind. But waiting is a dangerous proposition. When I think of my own situation, I realize that even waiting another week or two could have put me into a whole different risk category and I might not be where I am today.
Cancer research is such an evolving field – that if you can keep yourself alive today, there may be a cure tomorrow. That’s the good news about this. The bad news is that we spend about as much on cancer research in a year as we do on one day in Iraq. I don’t know anyone in the cancer community who doesn’t believe that if we invested enough money in it we’d find cures.
Dr. Val: Was it hard for you to speak publicly about your cancer?
Schieffer: Tony Snow and I became really good friends, and we both felt that we had an obligation to talk about our conditions in order to promote cancer awareness. Hamilton Jordan was also a good friend of mine, and he devoted his life to raising awareness. He survived 5 cancers though the 6th one got him. I was a very private person before all this started, and when Hamilton found out I had cancer he called me and said that I really needed to get out and talk about it because I have the opportunity to have an impact on so many people.
As it turned out, I went on Don Imus’ radio show one morning and talked about it, and soon afterwards Wolf Blitzer asked me to be on his show on CNN. I must have received 600 emails from people thanking me for talking about my situation – some were glad to know how to recognize potential bladder cancer, and others told me they no longer felt alone in their cancer experience because they knew that I was going through it too. At that point, I thought to myself that speaking out about my cancer might have been the most important thing I’ve done so far as a journalist. If one person goes to see their doctor when they first notice blood in their urine, then I may have had a part in saving a life.
Bladder cancer is a “below the belt” disease and people are reluctant to talk about it. I think it’s really important to help people get past this barrier. It is nothing to be ashamed of, there’s nothing wrong with you as a person – it’s just that a certain percent of us are going to get bladder cancer.
Dr. Val: How do people get plugged in to the cancer community to get the help they need?
Schieffer: What I’ve noticed is that when you get cancer, you become acqainted with everyone else who has it. There’s a kind of natural networking that occurs when you participate in meetings and events. However, I’d encourage people affected by bladder cancer to go to the Bladder Cancer Advocacy Network. The founder, Diane Quale, left her job as an attorney to create the advocacy group after her husband was diagnosed with bladder cancer. She has raised hundreds of thousands of dollars for the cause, although sadly her husband lost his battle with bladder cancer a few weeks ago.
Hamilton Jordan told me this, “You have to take control of your disease. Nobody is going to be more interested in it than you. It’s your life, so you’re the one who has the most invested in this. Just Google ‘bladder cancer’ and learn as much as you can about it.”
When you go to a doctor, especially with cancer, it’s invaluable to get a second opinion. I got a second opinion from a wonderful physician at Johns Hopkins, Dr. Mark Schoenberg. And Dr. Schoenberg told me this: “A doctor is like a good craftsman. A good craftsman is always happy to show his work to other craftsmen. It’s the guy who isn’t really sure what he’s doing who doesn’t want to discuss his work with somebody else in the field.”
Dr. Val: What’s your bottom line about cancer?
Schieffer: Cancer is not something to be embarrassed about. It’s something that happens to us and needs to be dealt with. When the doctor tells you that you have cancer, it is not the death sentence that it once was. Cancer research is advancing every day and we’re finding new ways to fight the disease. There’s no need to say, “I have cancer — this is it” but rather, “I have cancer and what do I need to do about it?” And then you have to do it.
*Visit the bladder cancer center at Revolution Health*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
