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Farewell! a long farewell, to all my greatness! This is the state of man: to-day he puts forth The tender leaves of hopes; to-morrow blossoms, And bears his blushing honours thick upon him; The third day comes a frost, a killing frost, And, when he thinks, good easy man, full surely His greatness is a-ripening, nips his root, And then he falls, as I do. -Henry VIII, Act III, Scene ii It is time for The Cheerful Oncologist to sign out. I have decided to take a holiday from writing and therefore am cutting the cord from ScienceBlogs. I send thanks to those readers who put up with my malarkey…
Dr. Scott Berry, a medical oncologist at the University of Toronto, has written an interesting essay in this month's Journal of Clinical Oncology entitled "Just Say Die." His point is that doctors are hesitant to use the words "die" or "death" when counselling patients who are in the process of doing exactly that - dying: Die is a short, simple word. The problem is that I rarely use it when I speak to my dying patients, and I don't think I'm alone. According to Dr. Berry, one of the reasons why we eschew the "D" word when talking to patients about their prognosis is to avoid upsetting them…
If you have an important point to make, don't try to be subtle or clever. Use a pile driver. Hit the point once. Then come back and hit it again. Then hit it a third time-a tremendous whack. -Winston Churchill Point number one: "Work-related stress can kill, study finds" Point number one again: "The team conducted seven surveys over a 12-year period and found chronically stressed workers -- people determined to be under severe pressure in the first two of the surveys -- had a 68 percent higher risk of developing heart disease." Point number one a third time: "Stressed workers eat unhealthy…
The New York Times has a story published last Friday about American men traveling to Mexico to receive a treatment for prostate cancer that is not approved in the United States. The article implies that this treatment is an unproven entity and may be unethical. I'm not so certain about this, so let's take a look. The treatment is called High-Intensity Focused Ultrasound, or HIFU. The title of the story is: "Despite Doubts, Cancer Therapy Draws Patients" Doubts? Who's doubting the treatment - the doctors who perform it? The company who makes the product? The patients themselves? Of…
When used deftly, words can be incisive tools of communication. Finding the best word to describe an emotion or idea tumbling around inside of one's brain should be an exciting and rewarding experience. Such mental exercises keep one's wits sharp while relaying information in a vivid, often memorable manner, such as when Winston Churchill described the expected role of the Allies in World War II: "In War: Resolution. In Defeat: Defiance. In Victory: Magnanimity. In Peace: Good Will." Notice how he distilled the essence of these powerful concepts down to just a few words. We all enjoy…
The following is a hypothetical advertisement seen on a community sign, let's say by a bus stop. ARE YOU EXPERIENCING ANY OF THESE SYMPTOMS? *chest pain, pressure, discomfort, tightness or squeezing, with or without nausea / sweating *inability to breathe *loss of consciousness *worst headache of your life including at least the past six incarnations *uncontrollable vomiting, or vomiting up blood *hemorrhage from the rectum, with or without light-headedness *traumatic injury *abdominal pain that is severe enough to interfere with your ability to remain upright, not to mention remain calm,…
"You should think it over - you'd feel so much better if you took a transfusion." My patient lay in her hospital bed, head at the proper thirty degrees of comfort, staring at some private point on the wall across the room. Her anemia had worsened and I couldn't tell if it was from the effects of cancer or of chemotherapy. It didn't really matter since the treatment was the same: two half-liter units of merlot-colored blood, courtesy of a pair of anonymous angels of mercy, also known as donors. "I really don't want to do that." "You don't have to, but getting two bags of blood will help…
"Obesity now a 'lifestyle' choice for Americans, expert says" "Waistline grows along with economy" "Wealth and Waistlines - A new book explains how the obesity epidemic has been shaped by economics, and what we can do to reverse the trend" The Fattening of America, by Eric A. Finkelstein and Laurie Zuckerman, is a fascinating new book proffering an economic explanation as to why more and more Americans are obese - I think. I haven't read it but that didn't stop me from perusing the news stories coming out on Dr. Finkelstein's analysis of obesity and its relationship to our modern economy. If…
That last post was my 300th since I joined the ScienceBlogs community in August of 2006. I usually don't comment about my personal life but I must confess to a certain feeling of satisfaction on reaching the 300 mark, as I never thought I'd last this long. Since creating my alter ego over three years ago I have enjoyed setting him loose on the unsuspecting blogosphere. Coincidentally, over this same time period my practice has become much busier, not to mention my family plus my snooty dog who requires more attention than Marc Antony gave the Queen of the Nile. This makes it hard to find…
A study from Duke University reveals that oncologists who hear an expression of emotional concern from their patients respond with an empathic statement only 22% of the time. In other words, patients who share feelings of distress such as anger, discouragement or fear with their doctors are likely to receive no recognition of their suffering nor any emotional support in return. As a medical oncologist I find this embarrassing. By identifying how seldom oncologists provide empathic support to patients, the study illuminates the potential benefit of teaching such skills to doctors. Previous…
"Pain is inevitable. Suffering is optional." Most all of us like to receive sound medical advice, even if we have no intention of following it. Perhaps this is why some experts relay information in a style reminiscent of filling the lifeboats of the Titanic. By trumpeting alarums for diseases deemed potentially life-threatening, doctors forget how easy it is to spook the general public. Hey, I'm scared enough as it is - God help my physician if I read a list of symptoms followed by the words "See Your Doctor Immediately!" I might just defenestrate myself to get to the emergency room…
If you are an athlete or are just committed to exercising regularly, no matter what your age is, what do you do if your doctor tells you to stop it? I'll give you three possible responses: 1. "You're the doctor - if you say to stop running I'll stop." 2. "How do you know that this is the right decision? What's your experience with this?" 3. "Thanks, Doc!" (followed by this interior monologue [bowdlerized version]: "#### him! That fat ############. I'm going for a bike ride the minute I get home.") The correct answer is below the fold. Ahem...as usual, this was a trick question.…
A new study from Johns Hopkins shows that by sampling oral tissue from patients with a history of head and neck cancer doctors can predict with some accuracy the presence of a recurrence or of another primary tumor (presumably from the oropharynx). I found a couple of things about this report fascinating - first, the oropharyngeal tissue was not obtained by performing blind biopsies, which requires general anesthesia and O.R. time. Rather, the cells were collected by the patients themselves in a simple manner - gargling and spitting, and who doesn't love to do that, especially while…
"What Is Assertiveness?: Assertiveness is the ability to express one's feelings and assert one's rights while respecting the feelings and rights of others. Assertive communication is appropriately direct, open and honest, and clarifies one's needs to the other person." "What Are the Benefits of Assertiveness?: Assertiveness affects many areas of life. Assertive people tend to have fewer conflicts in their dealings with others, which translates into much less stress in their lives. They get their needs met (which also means less stressing over unmet needs), and help others get their needs met…
In addition to heart disease, hypertension, cancer and diabetes, obesity has been linked to sleep apnea, job absenteeism, bad breath, even isolated findings such as an increased risk of dying from prostate cancer after definitive treatment. Wouldn't most of us agree that it is in our best health interests to keep our weight down? Okay, and wouldn't all of us agree that we gain weight by putting things inside of our mouths and then swallowing them? And don't these things contain nutrients that, if swallowed in excess of what is needed for metabolism, are stored in our bodies as adipose…
I've been trying to think of some New Year's Resolutions that are germane to living in our modern world (this is just a polite way of saying "Grow up! You can't spend your entire life living like you did when your were fifteen"). Don't get me wrong - I enjoyed being a teenager, but am even happier that I am now old enough to reflect on how to refine my delicate existence on Mother Earth, rather than just worry about where my next pizza is coming from. It's time to abandon any hope of salvaging 2007 from the savages of our critics. Those of us who have not used this year wisely, who have…
"It is a fair, even-handed, noble adjustment of things, that while there is infection in disease and sorrow, there is nothing in the world so irresistibly contagious as laughter and good-humour." - Charles Dickens, A Christmas Carol Dear Friends, Whether you live in good health or poor, may you travel well on your journey, and may your eyes face the horizon with courage. May all your regrets dissolve like the dust from your footsteps, and may your find enough strength within to fulfill those dreams you deem worthy of the sacrifice. May pain and sorrow, that cannot survive the sting of good…
"7 Medical Myths Even Doctors Believe" Uh oh...I hate it when they raise serious questions about the strength of my medical training. Go ahead and give me the list and I'll confess as to whether or not I fell for these myths; if fact, how do I know that I'm not in the right? Aren't doctors known for their stubbornness? So there! Anyway, go ahead. 1. We use only 10 percent of our brains. Disagree. Based on the intellectual prowess manifested by our country's top role models I say no more than 3% of neurons available for duty are ever put into action. 2. You should drink at least eight…
Here's more discouraging news about the consequences of living without health insurance: Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles. In this study done by the American Cancer Society, researchers looked at a database of 600,000 cancer patients from 1500 different hospitals and documented the percentage alive five years after their diagnosis. The patients were all under age 65 and were separated into three different…
"Drinking green tea may fight prostate cancer" To: MSNBC Chief Editor Re: Headline writers Dear Sir: It has come to our attention that many of your readers are misinterpreting the headlines of news stories you post on MSNBC. We bring this to your attention in order to forestall any unfortunate behavior that could be linked to anyone acting on a potentially misleading headline posted on your site. For example, the lead listed above implies that drinking green tea may be an effective treatment for prostate cancer. As the body of your story correctly states, what the researchers from Japan…