Is it ever going to be over?

Right now, I feel like we all have divided up our lives into two categories: pre-pandemic and during pandemic. I find myself using and thinking the phrase “before the pandemic” all the time. Before the pandemic I used to go to concerts and go on trips. Before the pandemic I had regular outings with friends. Before the pandemic, I didn’t think twice about going out. Before the pandemic, I had freedom. Before the pandemic, I didn’t weight out every single social decision against the possible consequences. Now that has all changed. It’s not all bad. There is nothing wrong with actually weighing your decisions a little more carefully rather than flinging yourself into everything. On top of that, I have to admit that I have gained from the extra caution in the world now that I have cancer. I was already getting used to social distancing before my diagnosis. Now the reality of my vulnerable and immunosuppressed state is not such a shock. I have already been practicing the precautions. It is pretty much life as usual.

Still, I wish it were over. I understand all the precautions and the waiting to lift restrictions until more vaccine is distributed. I am just inpatient, even though the increased freedoms won’t really apply to me. I just want to see my friends and family live a little more. I just want to see them happier again. I feel like everyone is in the same boat. It’s ok to be frustrated. It is human nature.

Here is what I don’t understand. We have more than one vaccine now. Despite the perception that these vaccines are somehow new or rushed, the technology being used has been around for the last ten years or so. Yes, we are having issues with the order of availability. That is true. But, we are attempting distribution the best that we can. I say this even though my own hospital ran out of vaccine for me and I had to travel to get mine because other vaccine groups opened up before all of us physicians were vaccinated. Nonetheless, I was grateful to get it when I was able to, even though there was a significant wait. So, we have these vaccines, which are what people have been clamoring for all these months, and yet, many people are still declining them? The scare techniques against the vaccine are particularly insidious and unfortunately, effective. What is the point? The vaccine is our best option to get us closer to this all being over. Why holler and demand for answers and solutions and just shut them out once we get them? I get that there may be risks with the vaccine. There are risks with anything. But, I am here to tell ya, the risks of Covid are much greater than any risks the vaccine could impose. I guess it all boils down to one big question. If we really want is for this to be over, why aren’t we more willing to do what it takes to make that happen?

Dr. Katz

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

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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

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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

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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

Waiting for my PET scan

The big day is finally here. Pet scan day! What is a Pet scan you ask? A pet scan is a nuclear metabolic scan. Typical protocol goes something like this. You check in

They check your blood sugar to make sure it is below 200. Then they have you wait an hour to let the glucose spread through your body to your now starving cells. (You had to fast for this). Then yiu go through a machine that scans you from your head to your knees kind of like a CT scan, but more claustrophobic. The scan itself takes about 20 minutes. It looks for what’s called hot spots. These hit spots are areas of increased uptake of that glucose and increased metabolic activity. Since we know that cancer cells are rocking it out with devious metabolic workup more than your normal cells, those hot spots are likely to be areas of cancer. These results let you know at a cellular level where you are really starting from before you start chemo . It is usually a prerequisite to have a Pet scan before being able to participate in any clinical trials as well. Even though I have been waiting for this scan for what seems like forever, now that the day is here the reality of it is kind of hitting me like a ton of bricks. It didn’t help that I barely slept last night and woke up feeling 80 years old either. I am usually not the guest of honor at a pity party but oh man I almost threw one this morning….lol. Oh well. Time to put my party hat away. Time to dive in. I’ll let ya know how it turns out.

Dr. Katz

Takin it easy is not the same thing as being a prisoner.

Oh man am I having trouble with that distinction lately! First of all, limitations have never really been my jam to say the least. I have been a patient more than I care to admit in my lifetime. You know, multiple surgeries, medical emergencies, accidents, time off work, the whole nine yards. I am usually the one who is walking the halls just hours after emergency surgery. I am not a stay tied down kind of person. Now that the universe decided that cancer with chemo plus a pandemic was a good idea, I am looking at a whole lot more than just some temporary limitations. There is no way around it. I feel like I am looking at house arrest for months. Let’s face it, I will be immunosuppressed, on top of having cancer, in the midst of an ongoing pandemic. I can’t afford to take chances so I need to suck it up.

Yes, I exaggerated. I won’t exactly be on house arrest. I am going to work when I can. I will need to leave the house for doctor appointments. I just won’t be going out of my way to go out to dinner or take unnecessary risks. I probably won’t be doing any hospital procedures either. It’s just being smart. To be honest, it won’t be that different from what is going on now, except for the fact that the chemo I will be on shoves me from the mild risk category to the top of the highest risk category when it comes to death from infection and Covid. Yippee! This is not the kind of line that I wanted to cut to the front of.

In my rational moments, it all makes sense. There is no point in fighting hard to dodge the cancer bullet if I am just going to open myself up to the Covid one. That would be ridiculous. The restrictions are in place to help keep me safe and see this thing through to the end. I choose to follow them. I know that. And, it’s not as if there isn’t enough Netflix to go around to entertain me.

There are other things that I worry about though. Yes, believe it or not I worry about being bored, even though I am working on a book, a podcast, a blog and I try to post daily updates. I worry about having too much time to think which runs the risk of being counterproductive and focused on worrying with nothing to distract me. I worry about resenting my family and friends as the pandemic restrictions lift and life resumes again while I watch vicariously through a proverbial window. I worry about being consumed with guilt from letting people down. I realize that everyone is being tremendously understanding now, but everybody has their limits. See! I wouldn’t have so much time to overthink all of this unless I was on restrictions!…lol

Oh who am I kidding? No one really has to enforce my restrictions. My body takes care of that nicely. I never know which version of me is going to lift her head off the pillow in the morning: the one that is raring to go for several hours or the one that gets short of breath after about three steps and has to sit back down. It is a real Wheel of Fortune going on around here and I am definitely not the big winner the majority of the time. I am kidding myself to think that I could really change that even if I wanted to right now. It is what it is. The only real choice that I get to have control over is my attitude and my willingness to accept the advice of my doctors. I have to realize that this is not their first rodeo and that they do actually know what’s best based on experience, knowledge, and training. Like I am always saying, I need to be a team player in my healthcare. If coach says I need to sit on the bench for a bit, well then I better just sit.

Dr. Katz