Today’s the Day!

The day has finally arrived, after multiple snafus, fits, and stops: the first chemo treatment! Hurray?! Is that the right response? I’m just not sure. All I know is that we showed up, I have my Star Wars shirt on, my port is accessed and drugs are flowing. Look out Hodgkins! It is on!. I am literally getting chemo right now. I can feel my eye fluttering like I am getting a migraine. I can feel my heart fluttering but I think that is just nerves. Of course, my long gone reflux resurfaced almost immediately. Weirdly, my hump on my neck started hurting almost right away. Maybe that means the drugs are already doing battle with my nodes!. Yess!…but owww at the same time!..lol

So let’s talk about chemotherapy for a minute. What the hell is it? Chemotherapy or chemo is a type of cancer treatment that involves giving multi anti cancer medications through an iv or port with the idea to try to cure the patient of cancer. It can also be given to prolong a patient’s life. It can also be given to reduce symptoms. (Palliative therapy).

There are three main kinds of chemo therapy: straight chemotherapy, hormone therapy, and targeted therapy. Now straight chemo is kind of old school. It aims at DNA damage or inhibiting replication by sending intracellular poisons right into the cancer cells..and unfortunately any other rapidly dividing cells like your stomach and hair.

Hormonal therapies, on the other hand are medicine with specific genetic and molecular targets that focuses on inhibiting growth of endocrine hormones like estrogen for breast cancer and andeogens foe prostate cancer.

Targeted therapy targets a different kind of growth inhibition. Targeted therapy is drugs that inhibit growth signals by inhibiting receptor tyrosine kinase at the cell surface.

Any of these three types of therapy are truly systemic therapy for cancer. This means that they are injected into the venous system and can therefore reach cancer anywhere in the body.

Because chemo is usually considered cytotoxic, it naturally affects dividing cells. The assumption is that the cancer cells will be dividing rapidly. While this is true, other cells in your body are also dividing rapidly in your bone marrow, your hair, your digestive tract. So, that explains the nausea, vomitting, hair loss, and low white blood cells and platelets. Side effects people! Yuck! But, I gotta tell ya, I will take them if it means getting rid of the cancer. Have a great day everybody!

Dr. Katz

Bye Bye Gourmet Dinners..or…how are these mofos gonna make it without me?

Now remember, this is just for fun….

I can see it already. The countdown to chemo has started. 5 days from now I will receive my first 5 hour installment of a combination of poisons and immunotherapy. Yippee! Bring on the side effects! Let’s get this show on the road! One step closer to a cure!( I hope) Bring on the easter egg look! Now we are really getting somewhere! Finally moving in a positive direction!

It all sounds “good” doesn’t it? Just what I have been anxiously waiting for all these months with all the delays etc. Feeling weirdly nervouscited, terrified, and good about it all at once. But then, I flashed back to the conversation that my chemo nurse had with my husband at our last visit. He was trying to be funny and made a silly remark about how my the quality of dinners at our house has really elevated since I have been home so much and that at least there was one benefit of me having cancer. The nurse kind of glared at him and said, “Mister, you can kiss those gourmet meals goodbye for now because I can guarantee that she won’t have the energy to do it.” He looked kind of stunned. Literally that thought had not occurred to him until that exact moment…lol I could see his wheels spinning; No more chicken cordon bleu. No more baked ribeye with a parmesan crust. OMG! I couldn’t help myself. I started laughing. Seriously dude? Last time I checked, more than one person in our house knew how to cook. Someone else can run frantically home at lunch and throw something in the oven with the timer for later. I started to visualize the mounds of take out containers in the filthy kitchen of unwashed dishes. I started hearing the pitiful whining of human beings wasting away. Then I realized that gourmet dinners were not the only thing that was going to go the way of the dodo. OMG! I was going to have to concentrate on myself and getting rest and not taking care of everything for everybody. Oh my lord who was going to keep track of everybody’s schedules without me nagging all the time? Were they going to have to be responsible for making it to their own appointments? Find their own rides? Was my daughter going to have to finally get her long overdue driver’s license? Were the dogs ever going to be let out to go to the bathroom? Was the house just going to be awash in filth all the time? Were any bills ever going to be paid on time? Oh man! I really started snowballing. I was in charge of a lot more than I ever stopped to consider. Mind you, I had already started the family on my own version of achieve your independence boot camp, but was it going to be enough? Lol….I guess we will have to wait and see. I’ll get back to you.

Dr. Katz

Sometimes it’s hard not to get jealous

Being a cancer patient definitely has it’s challenges. I think we all can agree. Feeling sick, fatigue, nausea, loss of appetite, hair loss, shortness of breath are the things that we tend to think of first as the top issues that cancer patients face. However, there is another challenge that insidiously creeps it’s way into your life: envy and resentment. It’s not good. It affects your mood and your relationships. It is just as unpredictable as the cancer itself. It can make you wallow in self pity, even when you don’t mean to. It can make you lash out at the people that care about you and are trying to help you. What am I talking about exactly? I am talking about that feeling of jealousy and resentment that creeps up on you over time that you misdirect toward anyone in the way. What do you become jealous and resentful of?: anyone that is living a full life and doing what they want when you can’t! You become like that puppy dog at the window hoping to go for a ride in the car somewhere, anywhere. The real you spends your time encouraging everyone around you to keep living and do what they love, even if you are sick. Then the other you starts muttering under your breath, crying and cursing them as they leave you. It is completely ridiculous I know and it’s unfair both to you and the people in your life. It basically boils down to emotional abuse for all of you. Nothing good can come of it. I have done it myself.

However, as I sit chastising and judging myself for doing it, I also have to realize that some of these confusing emotions have to come with the territory. It is only natural for you to feel out of control emotions in a pretty out of control situation. I mean c’mon, the cancer is already unpredictably calling most of the shots when it comes to day to day physical living. Why wouldn’t your emotions be all over the place? I think the key is not that those emotions are there, but what you do with them. You can’t erase your feelings, but you can try to control yourself so they don’t run other people over like some kind of freight train. Don’t bite the hand that feeds you. Don’t lash out at the people trying to help you. That won’t help resolve the feelings and only leaves you feeling bad about yourself. That certainly won’t help you heal any faster. Here is where therapy has come in very handy, at least for me. I highly recommend it and I think every patient facing serious illness should have it. It is a much better option to let out those feelings to a paid professional who is trained in how to help you deal with them, rather than blasting your family who is only trying to help you. It might just save your relationships.

Dr.Katz

Man! It’s lonely being a patient right now!

Yet another reason to hate what changes Covid has brought to the world. It seems like no aspect of our lives has gone unchanged or untouched. A lot of it has been inconvenience like not being able to go to concerts and having to wear masks everywhere, which a lot of us complain about, but yet our lives have still gone on. Other restrictions have been down right tragic like not being able to see loved ones for gatherings, accompany them to the doctor or even visit them in the hospital when they are sick. Even with some of the restrictions lifted or modified, it is a lonely lonely time to be a patient right now.

It is study proven that family support increases the likelihood of successful treatment and recovery, whether that be from surgery, addiction, or cancer. So, what have we done? We have completely eliminated that extra advantage with the Covid restrictions. I feel like we have failed patients because we didn’t even consider other options. Patients have had to go alone to complicated doctor appointments. We all know that it is always better to have more than one set of ears to listen, especially when it comes to complicated diagnoses and instructions. Patients have had to go through chemo treatments alone with no one to pass the time with. Sometimes those sessions last for 8 hours. For a while, patients were languishing in the hospital with no visitors, unless their case became terminal, at which point all communication opportunities and precious time were already gone and families experienced twice the loss: the loss of the loved one and the loss of the time they could have shared. When I was in the hospital in January, there were patients that had been on the oncology floor for almost a month with no visitors, fighting for their lives with no family support.

Back to reality. Of course, I understand the concern for spread of the virus and the potential consequences. But now we have rapid tests for covid. We could test visitors and assess for positivity in a potentially expedient manner. I know what you are going to say. The tests could be false negative. Yes that is true. Nothing is 100% fool proof and there could be risks. I understand how serious it is. However, my educated crystal ball says that we are going to look back on this time period and notice that recovery rates for all hospital-based illness went down by at least 25%. At this point, I am just not sure that the tradeoff has been worth it. None of those lonely patients will ever get that time back.

Dr. Katz

Some Patients are More Fragile Than Others or, the Importance of the Healthcare Team

Doctors and health care teams listen up! I have something to say! Some patients are more fragile than others. What the hell does this mean? It means that you have to be extra careful what you say to them. It means that you have to be extra thoughtful before you speak to them. It means that you need to do your research before you open your mouth and accidentally freak them out. You as the physician are part of a team and the whole team has to communicate with each other so that everyone has the same information. The patient does not need to hear different and/or conflicting information from each source. This only leads to potential panic and confusion and makes it difficult for the patient to follow through and get the care that they need. To you it may seem like a simple oversight. To the patient, it can seem like the end of the world.

This really applies to all patients, but the group I have in mind at the moment are cancer patients. This group of patients literally has their lives in your hands. They hang on your every word. They are depending on you to help them get to the other side of their illness with an intensity that is greater than patients with other diseases. You have a direct impact on their physical AND mental health, both of which are key to their survival. Think about it for a second. Anything you say to them is regarding a disease that could kill them. You tell them if they qualify for clinical trials. You tell them what chemo or radiation they will get. You talk about costs. You have to talk to them if their cancer is not responding like you hoped. Sometimes you have to tell them they are going to die. Every word out of your mouth carries the weight of their future. One bit of discouraging news may not just mean a bad day for them. It may affect the rest of their lives. No. I am not exaggerating. It is really that important.

The bottom line is that the healthcare team has to be a cohesive, thoughtful, compassionate, comprehensive unit. Patient’s lives, mental health, and physical health depend on it.

Dr. Katz

Every day CAN’T be a good day. It’s just not statistically possible.

Boy is that the truth. I have been priding myself on having a good day, good attitude, and positive mojo as much as possible with everything going on….even when I’m gasping for air and unwinding like a clock or repeating a test for the 100th time. But sometimes, I am just mad and frustrated and over it. Sometimes I have a bad day. I really can’t afford to beat myself up about it like I do. Just another something to work on. For me, I have to realize that a bad day is not purposeful or the result of something that I did. They just happen sometimes. I have to just let it roll and move on. Dwelling on it won’t help me or anyone else.

Trust me, I want to be a role model for myself and for patients. I want to be the one to bridge the lack of adequate communication gap between the patient and the doctor. This is who I truly am. But sometimes, I am just a patient who doesn’t know what the hell she is doing because I have never done this before.

This experience has made me realize even more how poorly we communicate the details of every day care. I want to be part of the solution in helping patients through the tough stuff the right way. I am already thinking of ways that I could participate in facilitating change in the care of cancer patients.

The first thing that I would change is to provide all patients with a navigator to help them wade through this process, not just the ones in a study or with a “more popular” cancer. It goes with what I have said before. All cancers matter. All cancers are scary. All cancers could potentially kill you.. Every patient needs someone to help them through outside of their family.. The more appointments and doctors get added to the team, the more confusing and potentially convoluted things get. Our family members are the ones closest to us and they love us,but they have never done this before either. They don’t know how to instruct us and they can’t really understand what we are going through. I hope to God that they never have to.

This brings me to the second change that I would make in the cancer patient process. I would assign each patient a mentor….someone who has been through it before..someone who can really understand first hand. I know it helps me when I ask a question about a symptom I’m having if I can speak to someone who actually had it and made it through. Actually those conversations have more impact on me than asking my doctor about it. I realize that there are cancer support groups out there, but I am talking about one on one mentoring.

Another thing that I would like to change in the process is to provide mental health support and counseling to every patient. We always say that attitude is everything and that quality mental health has a positive impact on healing. It seems logical then that each patient should have their own counselor or therapist to talk to regularly. It just makes sense.

I guess that even on my bad days I am still trying to do something productive. I really can’t just let it go. I know that things are not always going to go the way that I want and sometimes I won’t accomplish a darn thing besides survive to the next day. It is just so hard mentally to think about letting some illness get the better of you, even for a day. I guess the better way to think about it would be to realize that your body is telling you that you need a break today so you can get to the next day. After all, it’s a marathon,not a sprint. Ok. I’ll work on that.

Dr.Katz