I’m coming up on my two year anniversary and I am nervous.

Ok, so, on June 3rd of this year, it will be two years since I was discharged from the hospital after my stem cell transplant for my second cancer. This is about how far I got when I thought I was in the clear from my first cancer, so I am nervous. I just have to make it beyond this point to be able to believe that my cancer free status will stick,

I decided to go big with the second one…brain cancer! Primary CNS lymphoma. Thank the lord it was a treatable one, but still scary and awful nonetheless. I thought to myself at the time what the heck? Two cancers in four years! Something had to be messed up in my baseline so I thought a do over was what was needed. I have to admit I didn’t fully understand what a grueling and terrifying process that was going to be. Let me explain. First, they have to determine that your cancer is fully treated and in remission. That in and of itself is not easy task with months and months of inpatient chemo. Then, you get not long enough of a break before launching into the stem cell process.

The stem cell process needs to be done within a certain time window as to not allow the freshly treated cancer to return. You need to first inject yourself with what’s called granulocyte colony stimulating factor to get you white blood cells/stem cells to rocket themselves into the millions! Then, you have a triple lumen inserted into your chest that you get to mess around with for a long time to make the harvesting process easier. Then you spend the majority of a day getting harvested through that port. It’s kind of like a reverse plasma pheresis machine that is drawing them out of you for hours. I think I broke records that day with how many I was able to donate to myself and how quickly they came out. I think I was only there for about six hours as opposed to the normal 8 or 10 or 12. I think I overshot the donation mark by several million.

Then, you get another little break and then it’s into the hospital you go. You have to stay anywhere from ten days to a full month. Here is where the real danger begins. The goal of this hospitalization is to blast you with chemo until your white cell numbers are so low that they need to be manually counted! This kind of chemo is so fierce it will have you having crazy diarrhea and nausea and having to shower ever two hours so your skin does not peel off. It is real cannon ball type stuff. It drops your hemoglobin and platelets down to transfusion levels as well. Then, here is where the timing gets really tricky. They need to plan your antibiotics actually BEFORE your immune system bottoms out entirely. Otherwise, you start getting all those terrible infections that a normal immune system would fight against.

Unfortunately, I was not so lucky. My antibiotics were started a little late in my opinion and I got three different infections. I was septic, somewhat out of my head. I had a fever. I had rigors, which are the kind of shakes that literally make it hard to talk or move or do anything. They are very scary. You have to do some really strong narcotics to even make a dent in them. Also, when you have all those infections, you are not allowed to leave your room to do the walking necessary to further stimulate your immune system to take the new cells and regenerate. You are kind of defeated at both ends. That just added to the frustration and fear because I was very motivated to help myself in my own recovery and that got in the way of that.

But, even so, I was able to get out of that hospital in ten days anyway! I think it was a combination of all the prayers, baseline decent health, and force of my own inner strength. I am so so grateful for all of that. There is a part of me to this day that would like to be a part of educating the hospital staff further so something like this doesn’t happened to someone else. Unfortunately, no one was up for that education so those attempts went nowhere.

Overall, I am extremely grateful to even be alive to be writing this for you. There is nothing better than getting to open your eyes in your own bed next to your husband and hanging out with your kids and pets. Nothing. I already had a great appreciation for everything around me but now it is magnified even further. So, my final thoughts are to concentrate on my upcoming anniversary with as little fear as possible,and try to embrace all my future possibilities. Cheers to everyone’s good health and embracing what you have!

Have a great day and a Happy Easter!

Dr. Katz

You actually listened to me doctor!

This wonderful statement was said to me at a patient appointment the other day. These words both fill me with happiness and joy and sadness at the same time. I am thrilled to hear them, but I find it unsatisfying and somewhat sad that I was the first person to take this patient’s concerns seriously and even bother to address them. This patient had been to so many doctors and desperately attempted to ask so many questions, all for naught. She left every previous physician office with no answers and only more frustrations rather than solutions.

This is NOT how it is supposed to be folks! We are supposed to listen! We are supposed to be invested! We are supposed to love our job enough to do it well and to the fullest of our capability! We are not supposed to just barely show up as if we are forcing ourselves through drudgery or see so many patients in a day that we just file them through like some sort of herd. We need to listen. We need to provide individualized, thorough, compassionate care to every single patient that walks in the door. We need to let go of any preconceived notions that we may have heard elsewhere or told by someone else. We need to let go of any held on judgements based on previous experience. The only person that matters is that patient that walks in the door. Let’s get our crap together people and do the job that we were meant to do.

If you are a patient out there who has felt neglected, frustrated, and not listened to, please reach out until you find a physician that does listen. You are worth it!

Ponder this for a moment and have an amazing day.

Dr. Katz

Just think, two years ago my friends and family were throwing a benefit for my brain cancer and now today, I am playing in a concert instead!

Wow! Just wow! A whole crap ton of good has happened in just two years. I am sitting here on my couch, with a head full of hair, looking outside at all the Michigan winter goodness. I am not nauseated. I am not bald. I am not waiting to hear if I am going to live or die. My dogs are passed out next to me. I am blogging comfortably to all of you!

This is really freaking awesome. I am feeling so grateful and so at peace. I am grateful to just be alive and on this planet. I am grateful to feel well enough to pause to almost complain(lol) about daily trivial things. I am proud and amazed that both of my businesses still exist. I am grateful for my awesome family. I am grateful for my amazing staff. Yep, lots of gratitude here for sure. I can’t stop talking about it.

Just think about this for a minute, only two years ago I wasn’t completely sure that I was going to make it out of that second cancer. Yep, SECOND CANCER! As if one wasn’t enough somehow. Ok, I say that facetiously. Any cancer is more than enough. Sometimes, if you don’t take a minute to joke, you run the risk of being too emotional all the time.

Have all my significant hardships and health issues taken a toll? Well, of course they have! Who wouldn’t have a healthy side of ptsd at times after all I have been through. That is a normal response. I still have times where a random or twinge or perceived symptom somewhere shoots me over the edge in a second, until I have time to take a breath and regroup and remember that the present is very different than the past. I am not perfect at this but I am working on it. I work on this not over-reacting thing like every single day.

Still, having said all that, my overall attitude is one of gratitude. For all those of you out there who cannot fathom how I could feel blessed in anyway, think again! It is a matter of perspective my friends! The bottom line is that I still have the pleasure of existence on this planet! I am still able to care for my family! I am still able to take care of women everywhere! What’s not a blessing about that?! Yep, I’m gonna go with the I am blessed attitude. Have a fantastic day everyone! Embrace what you got. You never know when it could be taken away. Enjoy what’s good right now dangit!

Dr. Katz

Hormone safety= actual exam and proper follow up

First I want to shout out a huge hurray that we have finally refuted/retracted that study from decades ago that hormones were bad. Personally I ignored it anyway because I knew it was done wrong, in the wrong age group on women that already had preexisting risks of all the complications mentioned. I refused to let women suffer and kept on prescribing, in the right patient, with the right risk profile, and with the proper follow up. And, guess what? No one got cancer or got harmed or died. Sounds good right?

So, nowadays, well, actually this has been going on for awhile, everyone thinks that they can easily become hormone experts and prescribe whatever they want to anyone. They are literally handing them out like candy on Halloween. It sounds good, but here’s what they are missing. They are not examining anybody, which the patient incorrectly perceives as a bonus. They are not doing any ultrasounds on those with an intact uterus to see what is going on in the pelvis. And, most of them are relying on some outsourced lab to tell them what to prescribe in the first place and ending up putting patients on doses that are way above what is recommended. To top it off, they are not following up or screening them properly in any way and potential harm risks are missed.

I am going to say once again, how potentially egregious this approach is. Yes, I know I have said this many times, but it bears repeating. I keep seeing patients over and over again who have been going to these non-hormone experts and getting all kinds of hormones and then they finally end up seeing me, probably only because they are tired of paying cash not for an exchange in the quality of care. Then, I need to sit them down and explain how an exam and an ultrasound are necessary so that I can pre-evaluate for any risks or problems before we even start. I get it, I am not ready to provide the instant fix without any patient responsibility or any responsibility from me. Yes, that is true. I am determined not to intentionally cause harm. I also, tend to not rely on anyone else’s information and obtain my own before proceeding. This is sadly a problem for some because they perceive that a limited amount of time and investment and efficiency alone should be their own qualifying characteristics of good care.

I need to please ask all of you to reconsider before using these non-hormone expert alternative options. They are often expensive for one. Also, they are often actually dangerous. Just in these last three months alone, I have had a return of patients from the past who left to pursue these alternative options, only to return over ten years later to seek care from me again, and find out that they now actually have cancer that was missed while they were never getting examined or followed up properly. These are heartbreaking and preventable situations. I feel saddened as I need to tell them what is actually going on because they had been previously convinced that everything was good and paid a lot of money too. Nonetheless, despite these sad and potentially frightening situations, it is my job to protect and care for them properly. It makes me end up being what they see as the bad guy, when in reality I am the one trying to rescue them before it is too late.

I just need to say it one more time. Please reconsider before going to one of these places for hormones or women’s care. If it is a well-meaning primary care provider who doesn’t know better not to give estrogen alone to a patient with an intact uterus or a fancy beautiful place that requires no actual physical exam or ultrasound, please reconsider. By using these resources, you are, in fact, putting yourself in potential danger.

Dr. Katz

Nope, blood ties do not entitle or excuse you.

For those of you that have read my autobiography, Me Myself and My Story, you already know that there is whole lot of family issues, abuses, tragedies, mental health trouble that has flowed freely throughout my life. Having said all that, I still am grateful that I have turned out the way that I did and I am proud of the person I choose to be. Part of the point of writing that autobiography was not to be a vengeful tell all, it was hopefully to point out that any person still possesses the right to choose a better direction somehow if they want to. I like to think that I am a prime example of that.

Having said that, yes, there have been multiple family members that I have not been close to for years for various reasons. Some of them took in negative input fed to them by others with no opportunity for me to repute it. I didn’t even know that was going on in the first place. Fortunately a lot of those folks have come around and are now in my life again and I am very grateful. There were a lot of years wasted and missed though.

To add to this, I realize that I have done things that have upset people. In my perspective, those things were done with a purpose and intention for good and for protection. I have sent people to prison for abuse. I have spoken my mind at public gatherings. I have dismissed certain people from my life when their level of toxicity crossed the boundary that I had set and was literally compromising my mental and physical health. I do not regret any of these actions. They are what I had to do to protect myself and my family. I have to admit, I do not understand those who force themselves into family holidays and gatherings despite a long history of abuse and mistreatment. I am not sure if they feel that they don’t have any choice or if they are supposed to because there are blood ties involved. Either way, it only allows further damage and abuse to continue. I have seen many people dismiss past wrongs with no concrete apology or resolution. I understand that forgiveness is divine, but for myself, I need at least a little actualization that it happened in the first place or even the two little words “I’m sorry.” for that to be enough for me to re-interact. I feel like that is a minimum requirement to say the least. I have come to realize the phrase friends are the family that you chose is quite accurate. As much time as I have struggled to maintain family relationships, I have not noticed all the friends and non-toxic family members that are right there waiting to spend time with me. This is something that I have vowed to strive better for in my future. This is a plan that I am going to stick with.

I just want to end this explaining myself session with some words of advice and self-advocacy. No blood ties justify or excuse terrible or abusive behavior. It is within your power to seek out non-toxic relationships for the benefit of yourself and your mental health. It is sometimes a very difficult decision, but is definitely the healthier one.

Have a peaceful day.

Dr. Katz

Let me explain to you why I know about more than just the vagina.

I get asked or questioned all the time about how I seem to have knowledge about things that are not just about the pelvis. People say things like how do you know about that? Aren’t you just a lady doctor? Don’t you just care about the vagina? How do you know about anything else well enough to make recommendations about other health issues. I think that literally other physicians, internists, and family practitioners are somehow threatened or feel insecure about this.

Trust me, there are no worries here. Let me explain. I was fortunate enough to have completed my training in the 90s. During this time, Obgyn was temporarily reclassified as primary care. Therefore, during my residency, I got training in family practice, internal medicine, er, surgical ICU, in addition to my root Obgyn training. I am very grateful for this because it has allowed me to know more than just my specialty. I also make it my business to keep up on the latest in these other health issues as well. Do I portend to know more than a family practitioner? No. In addition to that there should be no worries about my taking over the care of your patient. I am well aware of my limitations and know exactly when to refer the patient back to you for further direction and care. I am now and have always been a physician who knows her boundaries and limits. I am also aware that we should all be members of the same patient team and should be willing to work together for the patient’s interest. That should always be our mutual goal. Have a great day everybody.

Dr. Katz

Haters

The late Kobe Bryant once said,” Haters are a good problem to have. Nobody hates the good ones. They hate the great ones.” Hmm. He might have been on to something there. Every time I have an experience with a hater, it always gives me pause. I hear or look at the comments and then I feel compelled to go back and look at my office records and my detailed notes to search for the possibility that I went wrong somewhere. I have to tell you, the vast majority of the time, the person’s statements and accusations are false, sometimes wildly so, or at least skewed to the point of their perceived advantage without containing concrete facts.

Yes, I initially fall for it every time. I’m thinking, oh my god, they really think that?! They really think that is true?! As most good physicians with a conscience, we are always striving to do the best for our patients and guide them appropriately. This sometimes requires steering them in the opposite direction of their potentially bad choices. I realize that this technique does not jive with everyone, but I would not truly be doing my job to the best of my ability if I didn’t. So, I don’t plan on changing my strategy any time soon.

The other potentially sticky point about haters is they always get to strike first and get their word out there and sometimes you don’t even get a heads up that it is happening in order to construct a well thought out response. By their first strike method, their opinion resonates with readers and listeners sometimes before you even get to know it’s happening. You know what they say about social media. If it’s on Facebook or Google it must be true right? Well, wrong. Neither Facebook or Google prechecks to make sure that the person has even visited the place or person so whatever you are reading could even be by someone who has never even had contact with whatever they are talking about. At least Google now sometimes gives you a heads up if someone posts about you on Google maps. I have regretfully even had people post that I killed their child, which is definitely something that has never happened.

So, yes the haters can potentially cause damage or mislead. They will always vex me to an extent. I will probably always be looking and verifying. But, when I really think about it, having a hater might be just like Kobe said. It might be that my reach is so far and wide that even the smallest unhappy people with nothing better to do than spread hate are paying attention too. I am going to chose to accept the fact that these folks are just a natural consequence of putting yourself out there to the public. Well, I am going to keep doing it.

Dr. Katz

I can’t help myself. I have to ask. How is a 40-hour course going to be enough training to cover what is has taken me 16 years plus multiple decades to perfect?

I am seeing those ads again about women and menopause. I am seeing the adds that promise that anyone can become a certified menopause coach in just 40 hours and at their own pace. 40 hours and you know it all and charge women whatever you want for your help. Hmm. It sounds too good to be true. Was that all I needed to do? Just take some 40 hour course and I would have been all set years and years ago? No undergraduate.? No medical school? No years of residency specializing in Obgyn and women’s health? No decades of private practice with ongoing and continuous learning to continue to improve my quality of care and guidance that I offer women? It could have just been done with an online course so I could go on and charge women cash for what I offer?

I gotta tell ya, I’m not buying it. I have no regrets about all my extensive investment both monetarily and mentally in my training. It has taken me all this time and continues to take me more continuing time and more learning every day to continue to offer my full attention and concentration to devoting my life to caring for women of all ages. It is what I do. It is who I am. It is what I have spent my life creating. I feel that it requires much more time and devotion than just a 40 hour course.

I continue to be saddened and disappointed about our continuing efforts to diminish the role of physicians in the care of patients everywhere. I understand that there are a lot of you out there who may have been hurt or not gotten the results or attention that you have needed from physicians or health care professionals in the past. I also understand that this makes you resentful and you want to spread this resentment to the medical community in general. I urge you that this is a mistake. There are good, intelligent and well-meaning physicians out there. There are those of us who have the compassion to listen and have good intentions and have your best interests at heart. I urge all of you before you go spending money on these seemingly good short-cut options, please reconsider and seek healthcare and coaching from actual properly certified physicians and medical professionals.

It’s not really true that it’s over. The facts of being a cancer patient.

I saw a post from a friend of mine that really touched my heart and I want to talk about it. This friend has a lovely daughter that suffered from cancer and then a relapse and is having continuing health issues that are saddening and frustrating. It’s as if the initial battle is over but the long-term war is still going. Worse yet, my friend has the impression that no one understands or cares.

Well, I’ll tell ya right now that I understand AND care! This is a firsthand testimonial for me as well. I am a two-time successful cancer warrior with all kinds of ongoing health issues and consequenes. I am grateful to report that I successfully battled both hodgkins lymphoma and primary cns lymphoma. Yep that’s right, whole body cancer and brain cancer, all in a four-year time span. And yet, I am very grateful to report that I still get to be here to crab about it. That is awesome! Who thought I would still even be here in as recently as two years ago. Yep, definitely a big win. Also, I have decided to turn my crazy experiences around and create positive things out of them like my Chemo Peeps group on Facebook. I have decided to use what I went through to help others and pick up the slack for everyone else who is potentially letting them down. I am totally in!

As far as my poor friend, I completely get how if even the acute battle is over, the ongoing war continues, probably forever or at least five years or so. This is why I am afraid to even use the word survivor because I think it implies a kind of permanence that is not really realistic. Heck, I am not even a total of five years out from my first cancer, much less the second. Wow that is a lot to think about. I have all kinds of ongoing medical issues that are the result of my cancers and the treatment for my cancers.

Let’s rattle off a partial list. My thyroid was destroyed with my first cancer treatment, which was not picked up right away until I was almost comatose from sleepiness. That is an ongoing juggling battle to titrate the correct dose so I can remain upright and not have my hair and skin get too dry and fall out. I now have a recurrence of my sleep apnea due to the crazy thyroid and all the fluid weight I retained after all the steroids. Hello cpap my old friend. I have ongoing neuropathies and myalgias that are very unpredictable and sometimes make it hard to move any given day, but I press on anyway. I have all kinds of side effects from the Keppra I was put on at the time when my brain was so full of cancer it was seizing uncontrollably and put me into a coma. We are talking Keppra rage, weird neuropathies, tingles in all the wrong places, crazy reflux, etc. Thank goodness I am on less Keppra now so the side effects are less, but not absent. Realistically, I know I am always going to need it though because I have enough scarring left in my brain because of the treatment that that alone can cause seizures even though the tumors are gone. My diabetes has gone a little nutty as well but I am busy wrastling that back under control with additional medication.

Let’s also talk about the left over emotional and psychological consequences. Yes. Yes. I have a certain amount of ptsd and mistrust after all my medical craziness. I get the slightest twinge and quickly assume the worst, before I try to self-calm and re realize that it is not likely. It takes me a minute though. I have had to go back on my Prozac for this and resume therapy to manage my emotional consequences and help me maintain any sense of calm.

I also get bothered by the fact that as a patient, you essentially have the perception that you have become boring after your particular physician’s part of your treatment is over. It’s as if their little tunnel approach excuses them from caring significantly about you afterward. Again, I am not saying that this is intentional, but I really feel that they have to be better about maintaining a vested interest after your acute treatment is over. It is by far not over for you and they still make you follow up at inconvenient times for at least five years afterward. I feel like this should mean more to them.

The bottom line is, yes, it is correct that the long-term war is still ongoing even after acute phase treatment has been completed. It does matter what you are still going through. Many people are unable to understand this, but, I have to admit, I don’t really need them to or want them to. I don’t wish on anyone what I have been through. This is not an experience I want to share with anyone. It is terrible and draining and awful. I am going to choose to support others and be there if they need me and share stories and support as needed. That’s all I can do at this point. We all need help sometimes regardless of what the issue is at the moment. I hope we can all try to be there for each other. Have the best day that you can and never stop advocating for yourself. That’s all for now.

Dr. Katz

Do you understand now why you should actually care if your partner has pain with sex?

I hear a lot of patients lately telling me that they are having pain with sex, but they feel obligated to continue because their husbands have needs. Umm. What???? You are in pain but you have to muscle through because he has needs? Mandatory suffering? What is this craziness?

Then, it gets somehow worse and I actually ask them if they have brought this up to their partners and most of the women actually say no. Or worse, they say they brought it up and got kind of brushed off and told they need to deal with it or their relationship is over or that their partner has no idea how to help them or doesn’t even want to try. Again, whaaaat?!

Ok, let’s refresh on what a relationship should be in the first place. A relationship should be a healthy, deep, emotional and complex bond between two individuals that encourages each of the persons to live their best and most fulfilled lives. It is not a one-sided show, or at least it shouldn’t be. Both parties should be invested in the other’s happiness, wellness, and future.

Well, on that note, we are going to launch forth into the discussion of pain with sex. It matters guys. You can think about it in an empathetic way or in a mutual beneficial way. The empathetic way would be to look at it as realizing your partner is having pain and want to help because you care about them. The mutually beneficial way would be to realize that it would actually benefit you both to seek treatment for your partner’s pain. Why you ask? Because if they are in less pain, they might actually want to have sex because they won’t be afraid that it will hurt! See where I am going here?

Bottom line is, I am encouraging you to care if your partner has pain. I am encouraging you to help them seek help, from someone like me, for their issues and begin the steps to revitalize your intimate relationship. It will benefit you both …and it’s the right thing to do!.

Dr. Katz