I hadn’t planned on writing about Suzanne Somers again so soon. After all, I haven’t yet received the promotional copy of her book (Knockout: Interviews with Doctors Who Are Curing Cancer–And How to Prevent Getting It in the First Place) that a most generous reader has sent to me, and I didn’t think I’d have a chance until a few days after the book arrived. However, something’s been bothering me since yesterday’s post, and it’s bothering me enough that I think it deserves a followup post of its own. I alluded to it briefly during part of my post, but I really think it’s something to be explored in a little more depth, particularly since Chapter 1 of Knockout is available online. Also, look again (if you can stand it) or for the first time at Somers’ interview with Ann Curry:
In Chapter 1, Somers describes a cancer scare. Specifically, she describes an incident in which she was brought to the hospital with what sounds like an anaphylactic reaction of some sort and was misdiagnosed with what she calls “full body cancer.” Now, I don’t know what “full body cancer” is, but I do know what full body stupid is, and Somers has it in spades.
Be that as it may, I do want to say right here that I’m not referring to Somers’ “full body stupid” because of her misdiagnosis. It’s quite possible that she was misdiagnosed with widespread metastasis from her breast cancer. I also don’t want to under estimate how much it probably scared her. Imagine yourself having survived breast cancer and then, eight years later, being admitted to a hospital for something else and being told that you had widespread metastases. It’s a horrible thing, if it really happened the way Somers said it happened.
Color me somewhat skeptical, however. Certain elements of Somers’ whole story sound a bit fishy. Moreover, note how, on the interview, Somers declines to identify the hospital. Right at the outset, I wondered why that is and see a couple of likely reasons. First, she’s scared of being sued. Of course, if you’re a celebrity and the truth is on your side you probably don’t have much worry about being sued. In such a case, it’s far more likely that the entity suing would get the worst of it, at least as far as negative publicity. More likely, Somers knows that, whatever hospital she had been admitted to and whatever doctors had cared for her, patient confidentiality and HIPAA law prevents the hospital and doctors from discussing her case–or even admitting that Somers was a patient. Indeed, neither the hospital nor any of the health care professionals involved with Somers care can discuss her case without her explicit permission. Their hands are completely tied, and Somers can say whatever she wants without fear that anyone will contradict her. That’s why it disturbs me that no one who has interviewed Somers yet has asked her a handful of very obvious–and inconvenient–questions, namely:
- At what hospital were you hospitalized and when?
- Who were your doctors?
- Will you release some of your medical records and allow your doctors to speak about your hospitalization?
- If not, why not?
These are questions that need be asked in addition to questions about Somers’ support for Nicholas Gonzalez, whose pancreatic cancer “protocol” was recently shown to be worse than useless.
Now, on to the story:
I wake up. I can’t breathe. I am choking, being strangled to death; it feels like there are two hands around my neck squeezing tighter and tighter. My body is covered head to toe with welts and a horrible rash: the itching and burning is unbearable.
The rash is in my ears, in my nose, in my vagina, on the bottoms of my feet, everywhere — under my arms, my scalp, the back of my neck. Every single inch of my body is covered with welts except my face. I don’t know why. I struggle to the telephone and call one of the doctors I trust. I start to tell him what is happening, and he stops me: “You are in danger. Go to the hospital right now.” I knew it. I could feel that my breath was running out.
Right off the bat, to me this sounds like an allergic reaction to something or an anaphylactic reaction. It could be something else (more later), but the first thing that comes to mind is an allergic reaction. Indeed, upon hearing this story, I couldn’t help but wonder if one of the many supplements that Somers takes on a routine basis was the cause. Did she start any new supplements recently? Certainly I’d wonder about that. Regardless of the initial cause, it certainly sounded as though the E.R. docs thought she had some sort of allergic reaction going. They treated her appropriately with Benadryl, Albuterol, and steroids. Even someone as dim as Somers realized that:
I say to the doctor, “It seems to me that I’ve either been poisoned or am having some kind of serious allergic reaction to something. I mean, doesn’t that make sense? The rash, the strangling, the asphyxiation. Sounds classic, doesn’t it?”
“We don’t know. A CAT scan will tell us. I really recommend you do this,” the doctor says. “Next time you might not be so lucky — you might not get here in time. You were almost out.”
Why the doctor insisted on a CT scan, who knows? I don’t, and certainly Somers doesn’t give enough information for me to make a particularly educated guess. A CT scan is not generally the test of choice for diagnosing the cause of anaphylaxis or respiratory distress, which is what it sure sounds as though she was being treated for. Maybe doctors saw a mass on chest X-ray. Who knows? It doesn’t make a lot of sense. There may have been other findings on physical examination that suggested that a CT scan might be indicated. Again, in this chapter, at least, Somers doesn’t give us enough information to judge. She does, however, engage in typical pseudoscientific thinking. While acknowledging that those evil pharmaceuticals had saved her life, still she can’t help but hate on them:
I am now dressed in a blue hospital gown, and so far I’ve been reinforced by three rounds of oxygen and albuterol. I’m starting to feel normal again. Drugs have been my lifesaver this time. This is what they are for. Knowing the toxicity of all chemical drugs, I’ve already started thinking about the supplement regime and detox treatments I’ll have when I get out of here, to get all the residue of pharmaceuticals out of me. I’m hopeful this will be the one and only time I have to resort to Western drugs.
Remember, whenever you hear an alt-med maven say “Western medicine” (shades of Bill Maher!), what that alt-med maven is really referring to is science-based medicine. As for supplements, if they have anything in them that does anything physiological, they contain drugs. There is no difference between drugs found in pharmaceuticals and drugs found in supplements, other than that the drugs found in supplements are adulterated with all sorts of stuff. There is no magical difference between the two. They both contain chemicals, and the body responds to chemicals through its biochemistry. Nothing makes supplements magically immune to the laws of physics and chemistry. Moreover, “detox” treatments are completely unnecessary quackery. Somers’ body is more than capable of “detoxing” away those evil “Western” pharmaceuticals through its own amazing abilities. Somers appears to think that “Western” pharmaceuticals somehow leave their taint behind. Maybe she thinks the proteins in her body have a “memory” in the same way that homeopaths claim that water has “memory” and that the taint has to be somehow purged, just as a Catholic believes that confession purges sins or certain Muslim sects think that self-flagellation will purge them of their evil. It really is religious thinking, that Somers was somehow “contaminated” by “Western” pharmaceuticals and needs to have that “contamination” removed.
But I digress. So what did the CT scan find? This, apparently:
We have very bad news,” he continued. My heart started pounding, like it was jumping out of my chest. “You have a mass in your lung; it looks like the cancer has metastasized to your liver. We don’t know what is wrong with your liver, but it is so enlarged that it is filling your entire abdomen. You have so many tumors in your chest we can’t count them, and they all have masses in them, and you have a blood clot, and you have pneumonia. So we are going to check you into the hospital and start treating the blood clot because that will kill you first.”
Now, we already know that Somers did not, in fact, have cancer. I’ll get to that shortly. In the meantime, let’s take a look at what she says about her oncologist:
The oncologist comes into my room. He has the bedside manner of a moose: no compassion, no tenderness, no cautious approach. He sits in the chair with his arms folded defensively.
“You’ve got cancer. I just looked at your CAT scan and it’s everywhere,” he says matter-of-factly.
“Everywhere?” I ask, stunned. “Everywhere?”
“Everywhere,” he states, like he’s telling me he got tickets to the Lakers game. “Your lungs, your liver, tumors around your heart … I’ve never seen so much cancer.”
So the oncologist who saw Somers first was a world-class dick. It’s quite possible. Not every doctor has a good bedside manner, and some have a horrendous bedside manner. Sadly, some of them are oncologists, even though if there’s a specialty that really needs a good bedside manner, it’s that of medical oncologist. On the other hand, I just learned again not too long ago that the oncologist may not have been as bad as that, if my recent experience was any indication. A while back, I saw a patient with breast cancer in her hospital room, a woman I had operated on. I thought I had calmly laid out the situation, reassured her that her tumor was treatable, and told her that she might not need chemotherapy. About an hour later I got a frantic page from the floor. The patient was in tears, and the family was in an uproar. I don’t know how I had done it, but I had somehow given this patient the impression that her situation was hopeless. When her family arrived to take her home she was crying. Apparently she had interpreted my telling her that she might not need chemotherapy (mainly because of her age and tumor characteristics) as telling her that it was pointless to treat her more. I relearned a valuable lesson that day, one I need to relearn occasionally, unfortunately, namely that patients don’t always interpret what I tell them the way I think they will and that sometimes how I view a conversation may be very different than how the patient viewed the conversation. Fortunately, I was able to reassure everyone and correct the misconceptions that had been left, but I did not feel too good about my bedside manner that day. In fact, I felt for a while like the worst doctor in the world.
On the other hand, let’s just assume that Somers’ oncologist was a flaming asshole. it’s the worst case for “Western medicine” and it is not as uncommon as I’d like to admit. Besides, it’s easier. In that case, I’d say, “So what?” I’m sorry that her oncologist was a jerk. There’s no excuse for that. However, one nasty doctor does not invalidate “Western medicine,” nor does the occurrence of a misdiagnosis.
In any case, it’s quite possible that there was a bit of Somers hearing things one way when her doctors weren’t telling it the way she interpreted them as telling her. The reason I say that is because she goes on and on about how, over six days, doctors told her she needed chemotherapy, something that seemed quite unlikely to me when I read the story. The reason is that, in general, oncologists are very reluctant to give chemotherapy to someone without a definite tissue diagnosis proving that they have cancer, be it metastatic cancer or any cancer. This is doubly true in a case like what Somers describes in her book. Widespread cancer could be a recurrence of her breast cancer (especially given Somers’ proclivity to pump herself full of “bioidentical hormones” after having been treated for an estrogen receptor-positive cancer), but in a 63-year-old woman, there are lots of other possible malignancies. What would be used for breast cancer might not work very well against, say, colon cancer or ovarian cancer, another likely possibility. Another reason I seriously question whether doctors were pushing hard for chemotherapy in a mere six days is because, if they truly thought she had such a massively widespread recurrence of her breast cancer, particularly an estrogen receptor-positive breast cancer, all treatment would be palliative. Consequently, the first rule is to do as little as possible to relieve symptoms. Most likely, an oncologist would have chosen to treat Somers first with an anti-estrogen drug, probably an aromatase inhibitor (no Tamoxifen if she had blood clots causing that much trouble!) and then seen how she did. Chemotherapy would be reserved for the case in which antiestrogen therapy failed. It might not even be used at all if the likelihood of success is tiny; in such cases, hospice would be recommended.
But the first thing that any competent oncologist would demand is a tissue diagnosis, either from a needle biopsy or other tissue, to prove that there was cancer and to identify the type of cancer, so that the correct chemotherapy could chosen. As I said, there’s something very fishy about Somers’ story. It just doesn’t add up very well. What I suspect to have happened is that perhaps the oncologist did have a conversation about a probable need for chemotherapy, and, like my conversation with my postoperative patient, Somers saw the conversation differently from how her doctors did. She probably viewed various “what if” conversations or “if this is recurrent breast cancer, then you will need this” conversations as “pressuring” her to take chemotherapy. If her oncologist wasn’t particularly warm and fuzzy and patient, she might have interpreted his recommendations that way even more.
Ultimately, Somers did get a biopsy. She describes it in her interview above, “They cut into my neck and went in and took a piece of my lung, a piece of one of the so-called tumors around my heart turned out it was not cancer at all.”
So what was it? Well, as I said before, I guess I’ll have to wait until the book arrives to find out. My first guess, though, was sarcoidosis, likely with a pneumonia complicating it. Even though she’s on the old side for a first presentation of sarcoidosis, which usually hits people between 20-40, in retrospect Somers’ presentation was pretty classic, as this article shows:
What are symptoms of sarcoidosis?
Shortness of breath (dyspnea) and a cough that won’t go away can be among the first symptoms of sarcoidosis. But sarcoidosis can also show up suddenly with the appearance of skin rashes. Red bumps (erythema nodosum) on the face, arms, or shins and inflammation of the eyes are also common symptoms.
It is not unusual, however, for sarcoidosis symptoms to be more general. Weight loss, fatigue, night sweats, fever, or just an overall feeling of ill health can also be clues to the disease.
Those tumors around Somers’ heart? They were probably enlarged hilar lymph nodes, which are classic for sarcoidosis, which can also be associated with shortness of breath. I could, of course, be wrong. I’ll find out soon enough. Or maybe not. It wouldn’t surprise me if Somers never tells her readers exactly what she had–or even knows exactly what she had. From what I can gather she appears to have had a blood clot, which made the E.R. docs worry about a pulmonary embolus, and she had all these masses “around her heart,” as well as an enlarged liver. Sarcoidosis may account for it, but there are certainly other possibilities to account for the apparent misdiagnosis.In the meantime, while I await the arrival of Knockout (of my neurons), perhaps my internal medicine colleagues could weigh in on the differential diagnosis of Somers’ presentation as reported in her book. As I sometimes say with false modesty, I’m just a dumb surgeon.
Whatever Somers had, I guess we can blame an oncologist with a bad bedside manner, doctors too quick to leap in and tell her she had widespread metastatic cancer before getting a tissue diagnosis, and what appears to be an understandable (at least initially) misdiagnosis for her latest book. Of all the people this sort of thing had to happen to, it had to happen to someone who is so prone to pseudoscience that she saw this all as a validation that her distrust of “Western medicine” must be right and that all those “brave maverick doctors” who are allegedly “curing cancer” must be right. The result is a book that lionizes quacks like Nicholas Gonzalez under the guise of bringing “hope” to cancer patients.
I’m beginning to ask myself if I really want to go through with my project of blogging this book, but I’ll steel myself up and do it–again, at least as long as my sanity can handle it. Hopefully I’ll finish my project by Thanksgiving. The things I do for my readers. Or to my readers. I haven’t quite made up my mind about that.
ADDENDUM: Don’t forget, send some “inconvenient questions” to Larry King Live. Somers is going to be appearing on the show on Friday night. Chief among them: Will you release some of your medical records or give your physicians permission to speak about your diagnosis and treatment? My guess is that what Somers understood of her treatment and diagnosis is related to her actual diagnosis and treatment mainly by coincidence.