Hematology and Oncology

Hey everyone, how are YOU? I am asked this question by many people every day. For those that don’t know please allow me to fill you in. Approximately 16 months ago I started to experience sciatica. Unfortunately, it progressed to the point that I needed to try different modalities of treatment. As time passed, I found it not only hard to walk but stand more than a few minutes at a time. I fell to my knees on multiple occasions. Of course, nobody knew what was going on because I really did not want people to know. My day is filled with taking care of people who have life-threatening issues going on. My issue seemed small at the time. Did the pain make it harder to focus and do the job I needed to do? Yes, but that’s exactly what I did. Focused more and worked harder. Of course, this really didn’t help my issue. After trying multiple epidural injections (4), physical therapy and multiple medications to no avail I finally realized that surgery would be needed.

I underwent a discectomy on June 26th. The surgery went smoothly. I was hospitalized for a day and went home in good spirits. I thought I was fixed! Upon arriving home which took approximately 4 hours (surgery was at Ascension hospital on Moross road in East Detroit) I said hi to my kids and proceeded to go for a walk with my wife. We trotted down the driveway only to make it about 200 feet before my pain was back. At that point although I never will admit it out loud, a tear fell from my eye. My wife had to walk back and get a vehicle to pick me up as I just could not take another step. I knew that I had re-herniated my disc by simply walking. Not good! It was certainly not the surgeon’s fault. It is known to happen and unfortunately, it happened to me. It is now June 27th, and, in a few days, I was back to work. Of course, I’m now in more discomfort and pain than before.

It would be 2 long months before my next surgery. After discussing my case with the neurosurgeon downstate (we don’t have one in Alpena,) we decided that this problem could still be solved. I needed a lumbar fusion. I knew this was the next step, however, one that I was not looking forward to. I’m sure we all know someone who has had back surgery, specifically a fusion. Sometimes they turn out and sometimes they don’t. I would be lying if I said I wasn’t worried. Why 2 months’? Well, I had registered to take my board exam about 1 year earlier which was scheduled to take place on August 22nd. I could not and would not miss it. This board recertification exam needs to be taken every 10 years. I had already been studying for over 6 months and if I had the surgery, I would have likely not been in good enough shape to take such an important exam. After a couple months of excruciating pain and a very important board re-certifying exam (I passed) the time was near.

The day I had been anticipating was here (August 26th). It was going to be the start of better things to come. My lumbar fusion was supposed to last between 1.5-2 hours, however, lasted 4.5 hours. My neurosurgeon told me that I had developed so much scar tissue from the prior surgery that it was more tedious than planned. Bless my wife who was sitting in the waiting room wondering what the heck was going on.

As I awoke from anesthesia, I was greeted with the worst muscle spasm that I had ever experienced in my life. The spasm encompassed my entire lower half from the waist down. It brought tears to my eyes and made me cry out in pain like never before. This pain had made the pain from my herniated disc seem trivial. I wanted to die! I don’t remember what happened next and I assume I was given medicine to help. After the spasm stopped and my faculties started to return, I remember being wheeled down a hallway asking if my wife knew I was ok. Isn’t it funny that even through some of our most difficulty times we always seem to worry about our loved ones?

Once in my room my wife and I finally reunited. I was sure happy to see her and I’m sure she felt the same. Everything was fine for a while, but it was not long before I could feel another muscle spasm starting. Thankfully my good friend had just left as I really did not want him to see what was about to happen. As the spasm was starting, I asked my wife to get a nurse, however, she did not quite understand the urgency. It was too late. The spasm had taken hold of my lower half and the worst pain I had every felt in my life for a second time was encompassing my body. A nurse arrived and my wife said the look of fear on her face was one that would be hard to forget. At that point, I didn’t care what happened to me, if, the pain stopped. The pain was even more intense than the first spasm. It finally abated and I went to sleep. Throughout my hospital stay I would remain on 1000 mg of a muscle relaxer every 6 hours around the clock and thankfully the spasms although present were much more tolerable. I would end up spending 5 days in the hospital that usually came with a 3 day stay. Discharge day arrived and we were on our way back home. I had initially told the staff I would be back in 2 weeks; however, it would be 3 until I was back. With the help of my wife and because of the shape I had kept myself in prior to the surgery, I was back working much sooner than the surgeon and other people anticipated. My surgeon was amazed. In fact, when I talked to him on the phone 4 weeks post-op, he thought I was still off work. I was told that most people take 2-3 months off to recover. Although back to work I was still recovering and in fact, as of today am still recovering. I believe that for a body to heal it must move. I want you all to know that is why I push activity so hard at appointments. A body is meant to move. A lack of mobility leads to more fatigue, weakness, infections and blood clots. I am back working out (slow as a snail) but back to the gym. I still have some left sided back pain and no flexibility at this time, but it will come. I am thankful for this.

Why do I tell you all of this? For sympathy? I think most of you know me better than that. I’m telling you this because I get to learn so much about YOU every day that I think it is only fair to share a little about me. I get the privilege to learn about your life, your kids, grandkids and other loved ones. I feel blessed to be able to be part of your journey. Yes, I realize since you are seeing me the journey has taken a rockier road, nonetheless, it is still your journey and I get to be part of it.

There is a song called “Chapters” by Brett Young, if you have not listened to it you should. Not everything turns out how we want it to. We can do things throughout our lives to put the odds in our favor, however, in the end it may not turn out how we expect it to. As part of my job, I get to tell people they are cured of deadly diseases (happens more often than you are probably thinking to yourselves) and I also get to be part of their journey out of this world to what I believe is going to be a better place. Those who do not know, I am a practicing Catholic and truly count on my belief in God to get me through my days and my journey.

As we continue to turn the pages and move on to our next chapter let us remember that even if things don’t turn out like we want, how we react to the situation will influence how the next chapter starts and ultimately ends.

I am sure that most are aware that my partner has stopped practicing medicine. This has left me as the only practicing oncologist and hematologist in the surrounding area. I have acquired quite the patient load and am working diligently to make sure that the needs of our community is met. I would like all to know that the care provided by the cancer center will continue to be of high quality as always as we look to find me a new partner. In the meantime, I will continue to provide ALL patients with efficient and compassionate care in their time of need. We will have a locum here for a few days every other week and I am pleased to let you know that Dr. Donnell is also back helping  out from time to time. Hard to believe he mentored me 18 years ago as I was a medical student. I had spent 1 month in the newly built cancer center learning what I knew I wanted to do for the rest of my life.

I know it has been awhile since I last posted and I am sure that in the future the interval between posts will not be as long.

This blog is going to be somewhat different from the prior ones. I am not going to write about a specific cancer but instead going to use this as an opportunity to thank everyone for their support and maybe try to give a few words of “wisdom.”

This year has been quite a world wind with the addition and implementation of our new electronic health record EPIC. It took some getting used to and continues to provide some challenges, however, in the end it is what we have and I believe it will only get easier and  benefit the people of our community. Thank you to all who have had to put up with the implementation “glitches” as we all know there were a few. Hopefully, those coming into the cancer center now think that things are flowing smoother.

Our director of oncology services has moved on to bigger and better things, however, we have another one who I believe is going to help propel our center into an even more robust one. I would like to thank our past director for all that he has done.  He has been supportive and helped me every step of the way since day one. He helped pave the way to make the cancer center better for our patients. He did what was right when it came to the staff and never wavered in what he knew was the right thing to do. He truly cares for the people of this community and I know that as time goes by he will continue to work to make things even better down the road.

My partner. Where do I start? She is one of the best partners any hematologist/oncologist could ask for. Working with her was awesome and from day #1 it was like we had been working together forever. Having a partner like her made it very easy to come to Alpena and practice medicine. I would like all to know that the care she provided was top-notch and that every patient she took care of was with complete and total compassion. I realize her patients know this, however, I want everyone to know. It was so nice to have a person that I could trust to take care of my patients, friends and the rest of the community while I was away on vacation, keeping current with continuing medical education or elsewhere.

To the cancer center staff. After being here for 8 years you are like my extended family. I want you all to know that I appreciate and I have heard from so many people what a wonderful job you do. I know firsthand how difficult is to work in this field but can honestly say you all make it look so easy. The care, compassion and skill you bring to the cancer center day in and out does not go unnoticed. Not by me or by anyone in this community. Keep fighting the good fight because the people of our community need us and deserve the best!

The year 2017 was by far the fastest year of my life. My dad always told me that as I got older time would go faster. As a kid I was not so convinced of this, however, as I get older and busier (not only with work but family) there is no doubt that this is true.  Although the year has flown by (2018 is going even faster) and there have been some rocky times, looking back one thing is true. Every day is a gift and each of us need to do all we can to help others in their toughest of times. It is not always easy or glamorous but I truly believe it helps to nurture the soul. I also believe it helps to propel us to even greater things. We have so many great members of this community. Living in Alpena is one of the best decisions I have ever made in my life. My professional colleagues, friends and family have all made my time here in Alpena truly wonderful. As the years go by I am convinced that things will continue to improve and our community will become stronger.

Until the next blog.

May everyone have a blessed, healthy and happy year!

The new electronic health record is live at the hospital and the Jet’s 7th/8th grade football season is over. If anyone is wondering we finished 4-3 on the season.  We had a great group of boys! I can now spend a little more time doing other things such as continuing this blog…..

We have made tremendous advances in most cancers when it comes to improving overall survival, however, pancreatic cancer is not one of them. This cancer is a “non-relenting” beast among beasts.

There will be approximately 54,000 cases of pancreatic cancer diagnosed this year and approximately 43,000 people will die from it.  Pancreatic cancer is the 4th most common cause of cancer related death in males and females. The incidence is about the same between the sexes.  Per the NCCN (National Comprehensive Cancer Network) the incidence of pancreatic cancer actually increased from 1999-2008. It is thought that possible contributing factors include the obesity epidemic, the aging population and others.  As stated above, the mortality rate of pancreatic cancer has not changed throughout the years which is a very unfortunate thing.

Risk factors associated with pancreatic cancer include: obesity, smoking, certain chemical (benzene, asbestos, pesticides and others,) heavy alcohol use, chronic pancreatitis and diabetes. There are also genetic causes of pancreatic cancer. Familial malignant melanoma syndrome (FAMM) is a syndrome associated with melanoma’s and pancreatic cancer.  Many people are now familiar with BRCA gene because of Angelina Jolie, however, did you know that this gene also increases your risk for pancreatic cancer? The BRCA 2 gene has a better association with pancreatic cancer than does the BRCA 1 gene.

Unfortunately, pancreatic cancer is usually detected late in its course. Potential warning signs include but are not limited to: weight loss, jaundice, abdominal pain, new onset diabetes, and others. There are however, no early warning signs for this devastating disease.

When physician’s think about pancreatic cancer we think of this cancer in clinical terms. What I mean by that is we break this cancer into one that is resectable, borderline resectable or unresectable. This will determine how we approach it and whether or not it is potentially curable. When one is diagnosed with pancreatic adenocarcinoma without surgery it can’t be cured. There are many imaging modalities used to assess this cancer including CT scans, MRI’s, endoscopic ultrasounds and PET scans.

The treatment of pancreatic cancer can include one or any combination of the following modalities: surgery, radiation and chemotherapy. There are many ways to approach pancreatic cancer if not already metastasized (spread) to other areas of the body. We can give neo-adjuvant (meaning prior to surgery) chemotherapy +/- radiation therapy or surgery can be performed first followed by chemotherapy. There are guidelines physician’s can follow, however, places all around this Country approach pancreatic cancer differently. I would encourage anyone diagnosed with pancreatic cancer to seek out clinical trials if at all possible.

In the end, pancreatic cancer remains a very tough disease to treat. Hopefully, over time there will be new advances that allow us to detect this cancer earlier in the hopes of improving the bleak overall survival associated with this disease.  I remain hopeful that better systemic therapies will come to the forefront to fight this beast. For all out there struggling with pancreatic cancer do not lose hope and know that there are many people out there fighting to make this disease a thing of the past.

I would first like to say I am sorry for not posting a blog in awhile. Life is super busy!

Skin cancer is the most commonly diagnosed cancer in the United States. Basal cell carcinoma and squamous cell carcinoma are two types of skin cancer that are usually less aggressive cancers and cured by excision. Melanoma, however, is quite different.

Approximately 76,000 cases of melanoma will be diagnosed this year with a little over 10,000 people dying from it(1).  The estimated number of people with melanoma may be much higher because many superficial melanomas taken care of in the outpatient setting may not be recorded.  With the incidence of almost all cancers on the decline, melanoma is an exception. The incidence of melanoma is increasing faster in males than any other cancer. In females it is increasing faster than all cancers except for lung cancer.  It is estimated that the lifetime risk of developing a melanoma in females is 1 in 34 and for males 1 in 53.

Risk factors associated with melanoma include a prior history of melanoma, a history of dysplastic nevi, a family history of melanoma and there are also some genetic mutations associated with melanoma. Excessive sun exposure, as well as, artificial tanning beds using UV rays contribute to the development of melanoma.

Melanoma can occur in many different areas.  In men, the most common areas are the back and chest. In women, the legs. There are different types of melanoma. Superficial spreading melanoma is the most common type and can grow for years. Approximately 70% of melanomas are this type according to the National Cancer Institute.  Nodular melanoma represents approximately 15% of melanomas. It occurs as a “bump” and can grow deep into the layers of the skin quite quickly. Acral-lentiginous melanoma occur more frequently in those with darker skin. The National Cancer Institute estimates that this melanoma represents about 70% of melanomas in African Americans and ~50% in Asians. Acral-lentiginous melanoma can appear on the palms of the hands, soles of the feet and under the nails.  Lentigo maligna melanoma is most commonly found on the arms, face, and legs. The areas that see chronic sun exposure.  Amelanotic melanoma is a rare type which can be hard to diagnose/spot due to the lack of pigment.  Ocular melanoma represents about 3% of melanomas.

It is estimated that 84% of melanomas present at a localized stage, 9 % with regional disease (involvement of the lymph nodes) and 4% with distant disease (1) Those who present with early stage localized melanomas which are 1.0 mm thick or less have an approximate 90% 5-year overall survival rate.  Those with a melanoma greater than 1mm in thickness have a 5-year survival between 50-90% . The variability depends on whether or not the melanoma is ulcerated (worse prognostic factor) and the mitotic rate (more mitoses=worse prognosis.) Those with disease which has spread to lymph nodes have a 5-year overall survival varies between 20-70% depending lymph node burden.  Those with melanoma that has spread to the organs have a much poorer prognosis. However, with the advent of immunotherapy people are living longer and obtaining remissions for a greater period of time.

Treatment of melanoma includes surgery, chemotherapy,  immunotherapy and targeted agents. Cytokines such as interferon alpha and interleukin are sometimes used. Chemotherapy had been the mainstay for metastatic melanoma until the approval of targeted and immunotherapeutic agents. Immunotherapeutic drugs help to stimulate ones own immune system which then “fights” the cancer. These agents include: Yervoy, Opdivo and Keytruda. Targeted agents work by inhibiting cancer cells from growing by blocking signals/pathways.  These agents are given if someone is noted to have a specific mutation in the BRAF gene.  There is also an oncolytic virus (Imlygic) which is a modified herpes virus.  It is injected into melanomas or lymph nodes which then “tricks” the immune system to attack the cancer.

When out and about please don’t forget to use sunscreen. Burns are not healthy and obviously can damage your skin, as well as, cause one of the most deadly cancers. Fortunately, we are making progress against melanoma, however, prevention is the key.

1. Siegel RL, Miller KD, Jemel A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65:5-29.

Colon cancer is the second leading cause of death in men and third leading cause of death in women in the United States. It is the fourth most commonly diagnosed cancer. There is estimated to be approximately 96,000 cases diagnosed this year with approximately 50,000 people dying from it in the same year. Between the years 2004 and 2013 the incidence of colon cancer decreased at a rate of approximately 3% per year for adults older than 50. However, colon cancer rates have increased during this same period by 2% per year in those younger than 50. This has been mostly due to an increase in the number of rectal cancer cases, however, colon cancer is certainly an important contributor.  Currently, the mortality rate is down 50% from its peak. This is thought to be due to better cancer prevention, screening (meaning earlier detection) and better treatments.

Colon cancer typically starts out as a polyp which over time takes on dysplastic or cancerous changes eventually turning into cancer. It starts in the inner lining of the colon and can grow through the remaining linings over time. If a polyp is detected early enough and cut out the risk of cancer dramatically drops.  The two most common types of polyps are hyperplastic polyps which usually are not associated with cancer and adenomatous polyps which are considered pre-cancerous polyps.

Early stage colon cancer which is when it is most curable rarely has signs/symptoms associated with it. That is why screening is so important. We will touch on this in a bit.  Signs and symptoms of colon cancer can include: a change in bowel habits, narrower (pencil-like) stool, blood in the stool, pain during bowel movements (tenesmus,) and lower abdominal cramping. There are of course other things to look out for which include weight loss and loss of appetite, however, these are less specific and can be associated with many, many disease processes.

Risk factors associated with colon cancer are both modifiable and non-modifiable. The risk factors we have control over include: smoking, consumption of red meat, obesity, physical inactivity, heavy alcohol consumption and lack of fruits and vegetables. I often get asked about red meat consumption in my clinic due to the fact that it is often talked about on the internet. To be clear, the International Agency for Research on Cancer classified processed meat as a carcinogen in 2016 due to the fact that consumption was consistently linked to colon cancer. Non-modifiable risk factors would include hereditary genetic syndromes such as Lynch Syndrome and Familial Adenomatous Polyposis Syndrome . Also included in this is the inflammatory bowel disorders such as Crohn’s disease and ulcerative colitis.

The current recommendation is to have a screening test performed at the age of 50 for both men and women who are of average risk.  There are different screening tests available, however, in my opinion the best one is a colonoscopy.  This allows for complete visualization of the colon, as well as, affording the opportunity during the procedure to remove any precancerous polyps which may exist. Other  potential screening tests include: fecal occult blood testing, fecal immunochemical testing, double-contrast barium enema, flexible sigmoidoscopy, stool DNA test or CT colonography.  Which test is done determines how often it should be done and should something be found then a colonoscopy would need to be performed to further assess the potential abnormality.

Treatment of early colon cancer is surgery. If, during surgery positive lymph nodes are detected or the colon cancer has perforated the wall of the intestine chemotherapy is usually recommended. At this time, chemotherapy for 6 month’s (a dose every 2 weeks) is recommended. However, studies are ongoing to see if certain groups of people may be able to undergo a shorter course of therapy. Time will tell, however, the last study was promising. If the metastatic colon cancer is diagnosed then chemotherapy and/or targeted therapy is recommended.

I can’t stress enough the importance of screening for this cancer. I unfortunately see many people who have never had a screening test.  The fear of having a colonoscopy is real and understood, however, those who have it done invariably tell me that it was “no big deal.” People tell me the worst part of a colonoscopy is the not the procedure itself but the prep or “clean-out” prior to the procedure. Having a good prep is very important because the better the prep, the better the physician performing the colonoscopy can see the inside of your intestines allowing to see all potential lesions present.

My advice to you is to not be afraid. We medical professionals do and see things everyday that can be embarrassing for people. We get it, we understand and although it may be embarrassing to you it still needs to be done. We as health care professionals also have to have these screening procedures done and although nobody really likes to do them there is no doubt that lives are saved when they are done.  Don’t let fear or embarrassment cost you your life. Get screened!!

First, a few quick facts on cancer (you can find these on the American Cancer Society website)

-Approximately 1.7 million cases of cancer will be diagnosed this year

-Approximately 595,00 people will die from cancer this year

-Cancer is a disease of older people, >85% of all cancers are in those greater than the age of 50

-Cancer is the second leading cause of death exceeded only by heart disease and it accounts for nearly 25% of all deaths

-Lifetime probability of developing cancer is ~40% for males and 38% for females

-Lifetime probability of dying from cancer in males is approximately 22% while for females it is 19%

I think we can all agree that smoking is bad for ones health. I also did not write this to make anyone feel bad because of the terrible habit they have developed.  I truly hope that this information will make the current smokers try a little harder and the non-smokers never want to start or restart.

Believe me, I know that the tobacco companies knew what they were doing when they created that cancer stick. Now, let’s take a moment to go over some of the facts about smoking.

Lung cancer is the leading cause of cancer death in the United States and cigarette smoking accounts for almost all cases. What that simply means is, lung cancer is the most preventable cancer in this Country. Smoking and its direct and indirect effects lead to approximately 440,000 deaths per year.

Compared to non-smokers, men who smoke are 25 times more likely to develop lung cancer and women are almost 26 times mores likely.

Besides lung cancer, smoking is known to increase the risk of 17 other cancers. Examples include: kidney, bladder, esophageal, stomach, pancreas, breast, colon, rectal and acute myeloid leukemia to name a few.

Cigarette smoking has declined since the Surgeon General  report in 1964, however, approximately 20% of males and 16% females continue to smoke.

Each year approximately 45,000 non-smoking adults die of lung cancer and heart disease as a result of second-hand smoke.

What’s in a cigarette? Lead, arsenic, acetone (found in nail polish remover), benzene, formaldehyde, nicotine and about 600 other ingredients! However, when burned these 600 ingredients lead to approximately 7000 chemicals! You can find this information on the American Lung Association website.

Between 2009 and 2012 smoking attributable economic costs were between $289 and $333 billion dollars each year.

9 out of 10 smokers start before the age of 18.

More than 20 million Americans have died from smoking since 1964.

On average smokers die 13-14 years earlier than non-smokers.

Smokers today are more likely to develop lung cancer than smokers in 1964 (can find this and other information at Betobaccofree.hhs.gov)

A recent study lead by Ohio State University researchers found evidence that microscopic ventilation holes in the filters of cigarettes could be contributing to the incidence/rates of adenocarcinoma of the lung and have asked the FDA to review to see if the ventilation holes should be prohibited.

As you can see, there are many facts to back up the fact that smoking is one of the most dangerous things you can do. These in all honesty are just a few. However, if you smoke it is not to late to quit. There are many options available out there to help you along the difficult journey.

Here are a few resources if you would like to learn more about tobacco, as well as, ways to quit

https://www.cancer.org/content/cancer/en_header.html

https://betobaccofree.hhs.gov/

http://www.lung.org/

P.S. if you enjoy these please go to my webpage: hemoncdoc.com and subscribe to the blog via email. That way you are updated each time a new blog is posted.

Thank you

When we think of cancer, we think of smoking, alcohol, genetics and other things. Does anyone think of viruses? What if I were to tell you that there are viruses that cause cancer? Would you believe it?  A virus is a very small organism that can’t be seen with a light microscope. It takes what is known as an electron microscope to see a virus. These viruses enter our cells and replicate by using our machinery. Viruses then insert their DNA or RNA into our cells and this is what can lead to cancer.

The Human Papilloma Virus (HPV) is the most commonly sexually transmitted disease in the world.  In fact, most people who have had sex have been infected with HPV. For most, our immune system clears the virus, however, in those where immune surveillance fails cancer can develop. There are many types of this virus but certain ones are more apt to cause cancer. The HPV is what can contribute to  genital warts, cervical cancer, anal, vaginal, vulva and even oropharyngeal head and neck carcinoma. Did you know that we are in an epidemic of head and neck cancers caused by the human papilloma virus? We are seeing more and more patients who are younger, non-drinkers and non-smokers (which typically contribute to the disease.)

Of importance is the fact that there are vaccines available against the human papilloma virus for those between the ages of 9 through 26. Vaccines, as you know help prevent disease. Could you imagine preventing a cancer simply by giving a vaccine? The problem is that there is too much misinformation out there along with too many scare tactics. We have an opportunity to protect the ones we love most, however, quite a few people fail to act on it. I know as a parent I will do everything to protect my children, so why not vaccinate? Our vaccination rates in all reality are dismal in my opinion.

Another virus implicated in cancer is the Epstein-Barr Virus (EBV.) This virus can cause nasopharyngeal carcinoma which is a head and neck cancer along with lymphoma.  This is the same virus that causes mononucleosis. This is an extremely common virus and almost all people are infected with it by their teen years. That being said, it is not common to get a cancer from it. Infection by no means is a guarantee that one of the aforementioned cancers will be diagnosed. It is rather the exception.

There are yet other viruses that can lead to cancer. Hepatitis B and hepatitis C are viruses passed through unprotected sex, sharing of needles, childbirth and very rarely blood. Our blood is screened very well today. Per the National Heart, Lung and Blood Institute the odds of getting hepatitis B from a blood transfusion is 1 in 205,000. The odds of getting hepatitis C is 1 in 2,00,000. These viruses can lead to liver cancer. They contribute to cancer by the chronic infection/inflammation and eventually the cirrhosis that develops. It is important to know that there are millions infected with hepatitis in this Country but less than 5% will develop cancer. In those who develop cirrhosis about 1 in 5 will develop liver cancer.

There is a vaccine to prevent hepatitis B, however, not hepatitis C. As a health care worker I have had the hepatitis B vaccine which is a series of shots. Hepatitis B is less likely to contribute to cancer because it does not lead to chronic infection as frequently as hepatitis C, however, it is still possible.

There are other viruses that can cause cancer, however, these are much less common and therefore won’t be discussed in this blog. Should there be interest please contact me and I will be more than happy to discuss at a later date and time.

Walking into an oncology clinic has to be one of the most terrifying moments of one’s life. Not knowing what to expect instills fear into the hearts of all. So, what is cancer?  Simply put, it is a cell that continues to divide without limitation.  You see, normally our body, which is made up of trillions of cells that are constantly turning over. What I mean is, cells are made and then eventually die in something known as programmed cell death (apoptosis.)  However, when cancer arises signals are lost which usually lead to programmed cell death. Instead of the cells dying in a controlled fashion, they grow uncontrollably.

Patients who enter my clinic ask me all of the time, “why me?” Unfortunately, I don’t have the answer. Why can someone who has smoked their entire life not develop cancer and instead die of natural causes at the age of 90? Why does a young child not old enough to know what tobacco or alcohol is suffer from such a terrible disease such as cancer? I wish I knew.  In fact,  I wish people much smarter than am could get down to the bottom of this so that we can continue to move forward and cure this terrible disease (which is not one disease but a collection of diseases characterized under one name….cancer.) You see, if cancer were the same in every person and acted the same in every person it would be much easier to cure. This is not the case.  I would like to refer you to the following address. Please just copy and paste into a new browser to learn about the bad luck of random mutations

http://www.hopkinsmedicine.org/news/media/releases/bad_luck_of_random_mutations_plays_predominant_role_in_cancer_study_shows

This article and research shows that sometimes it is just bad luck that cancer develops. That is not to say we can’t control certain factors and help with what’s called primary prevention. For example, not smoking would be an example of primary prevention. Another example would be keeping one’s weight under control. Did you know it is estimated that approximately 50% of endometrial (uterine) cancers are caused by obesity?

We must keep moving forward with further research, determination and education to continue to improve on the survival rates of cancer. Contrary to the belief of many people, cancer can be cured. Of course, it is always better to live a life which helps to prevent cancer in the first place. Onward we must march, like soldiers ready to fight and conquer the enemy!

Next up: viruses and cancer

Each and every discussion I have with a patient is different when it comes to end of life and I never know which direction we are going to go.

Looking someone in the eyes and telling them they are going to die soon is no small feat. It is one that eats me up just a little each and every time. I must say, I learn with each and every conversation I have. Some surprisingly go very easy and others are extremely difficult.

I still remember my very first patient in fellowship. A 19 year-old with sarcoma of the leg which had spread to distant areas of his body. Once out of the hospital I treated him with chemotherapy and he did well for quite some time. As a matter of fact, as time passed we each got to know each other well. We had many discussion about death and what the future held. Near the end I learned that he had built out of wood his own casket knowing that he would die soon. Could this have been easy? What was he thinking?  I learned from the very beginning he knew his death was close and he took control of his life. He never let cancer control it. He never wanted to give up the fight and he did so to the very end.

A day which would become the last day we would see each other he presented to my clinic at the end of the day in a frail yet somewhat energetic state. Thankful that he was my last patient of the day not because I was tired but rather because I could spend extra time with him. You see, he knew this was our last meeting and he came bearing a gift. Two very small crown royal shots. My favorite drink and his. That day we toasted to our friendship and his life. He died shortly thereafter. He left me with memories and lessons learned.

As the years have gone by I realize that without death one can not live a life as intended. Could you imagine what life would be like without death? I would like everyone to think about this for a moment. Glorious things would become less glorious. Those precious moments we spend making memories would mean less and less. Death is a must because life without death is a life without meaning.