Author: Joanne Dragun, M.D.

When Yogi Caryn starts a practice she states, “Set an intention“. So let’s borrow her recommendation as we enter a new year. Rather than conjuring up a plan of action, why not make it as simple as possible? Put a smile on your face and wish yourself a ‘Good Morning!’ Don’t wait to say it to a stranger. Incorporate yourself into your well wishes, stating your intention to have a good day right from the start.

We know that smiling and positive affirmations change blood flow within the brain, so why not use them to stimulate an improved outlook? Positive thinking reduces memory loss and cognitive decline. Let it act as a directive for your day…. and new year. When you anticipate good, you are training your brain to look for the positive, not negative aspects of your day. Even acknowledging good in others brings more good into your own life. Could something so simple actually work?

When you step through the doors of the cancer center, for chemo, radiation, check ups, or scans, modifying your thoughts will bring a calm acceptance and improve your experience. I’ve seen my share of pulling of hair, gnashing of teeth, abject fear and even hostility. None of that improves a patient’s outcome. It’s why exam room one is such a sacred place for me. Transitioning the patient and family from ‘woe is me’ to action plans for power, success and even healing, not only changes the trajectory, it sets a tone and carves a path that is enlightened. What a wonderful gift when we can achieve this for ourselves and our family.

No, life is not easy. Disease is awful. Families are fractured. Finances are strained. Hearts are broken with loss. I would never minimize your pain. But if we can try something so simple that can affect our day, let’s do it every single morning in this new year. No time to wait. No diet or new year’s resolution required. Just a gift to ourselves that sets the tone for each day.
As we enter this New year, let us have hope. Let us look for joy. Let us give love to others and ourselves.

Walking the walk, I found myself on the receiving end of healthcare the past few months. Endoscopies, screening, stress tests and scans, blood work, all in efforts to stay strong and healthy. There are so many ways, especially with cancer that our lives are upended, best to be as prepared as we can for the battle.

For one of these events, I was waiting in a lobby, when I had such a lovely surprise. The wall right in front of me carried a former patient’s name. The annex was built by a generous couple who gave a very large donation to enhance care in the community. It was 10 years ago that I vividly recall his sharing his vision. “Doc, when I am done here, I have a mission!” Here his own Doctor was ready to benefit from that very concept which came to fruition.

This reminds me that with the many testimonials and videos, even by doctors, complaining about insurers, the meeting this week and advocacy day on the Hill where our committees lobby for us, so often it’s one person that can make a difference in thousands of lives. Also, it is not only the monetary donations. Often the help and sacrifice come in a ride to the doctors, making a meal, or listening.

Generosity enters our lives in so many ways and recognition and appreciation is critical and keeps the spirit giving. It is wonderful now to take a moment and remember that while healthcare is in the cross-hairs and far from perfect, we can add perspective. A real benefit is when someone stands up and offers help to another.

It is usually at no cost but time, at no ability but the knowledge that someone is hurting, at no consequence but benefit to another. In an imperfect system, maintain hope. We can all be the solution- no authorization needed.

Nothing sets my hair on fire like denial of care by insurers. I did not intend to remind again about getting best coverage, but this week’s event in NYC reiterates the need. If you haven’t had alot of healthcare you may not know the battle we are in.

Let me get this right. After 10-16 years of post graduate training, sacrifices, moves, 100 hour weeks, Doc can’t care for patients without insurers looking over their shoulders and saying, “Nope!” They even have to do surgery faster in case coverage for anesthesia runs out? (Ha! that was exposed this week and had to be rolled back- what a mess) Some retired Doc or those “working on the side” actually get hired by these companies and I battle with them every day- wasting precious time. They know I am right to give state of the art therapy with the best the US has to offer, but they have files of dialogue to rebut us. They even tried to hire me, can you imagine? My head would surely explode.

We worry about becoming England or Canada with months of waiting for care. But our own US companies have now usurped all the power. Tragic. At least this week the greed is exposed. Insider info: all Docs follow national guidelines for treatments. The insurers are infiltrating those to their benefit, “advising” how many treatments we should offer, what drugs are more cost effective, what scans they will permit, etc. Soon AI instead of their Doctors will be triaging this. Criminal.

Perhaps the shocking death of the CEO of the largest company will wake everyone up. I will be on a meeting with several leaders in our field this week. We are battling Medicare to provide coverage for new treatments. I will push hard to move this critical discussion ahead with a stand against these egregious practices. There are many of us who will fight for you. We refuse to join the companies and take the easy way out.

As a consumer who pays for the benefit, again…… always buy the best coverage even at cost to you . One drug, one test, one hospitalization will make up for your expense when it is covered and not denied. Medicare only covers 80% so you need supplemental coverage…. again get the best that requires the least authorization (aka push back.)

When a US Senator from PA spoke to our medical staff years ago, he said flatly, “Doctors have no power. The lawyers far out number you and they have it all!” He was a brilliant legal mind and a champion for cancer research before his own cancer battle. It was sobering to hear. When he finally needed us however, he didn’t go to a lawyer for care.

I am furious about seeding my power. Profits override brilliant, state of the art care. If we are complacent, we will get what we didn’t bother to work for. We must have a voice as patients and practitioners or accept the consequence. I strongly encourage doctors in the national organizations to lobby. Patients need a lobby as well.

If you do need care and your insurer pushes back, raise your voice. Medicare enjoys “sovereign immunity”and can’t be sued. But you can find a medical lawyer to sue an insurer if you are denied… and are denied again on appeal. That would be a handy use of the profession! Yes, it’s come to that. Stay as strong and healthy as you can. But when you need care, don’t have “buyer’s remorse”. Unfortunately the grim reminder this week is that these companies are not in the business of caring for our health. Exposure will help. Action is best. God Bless.

Why not? Just squeezing in another similarly titled email to your in-box. Small business Saturday, Cyber Monday, all an attempt for businesses to be made whole for the year and come out of the red, tapping our giving spirit.

You may be recovering from celebrating, traveling or entertaining this Thanksgiving. Hopefully ignored the malpractice-worthy advice of a resident psychiatrist who advocated to avoid family due to politics! These holidays will offer opportunities for us all to be made whole as well. The mother’s heart that leaps when her son or daughter arrives, every harsh word forgotten. When brothers and sisters long apart give awkward hugs and chuckles. When children and babies tolerate the pinching cheeks and loving kisses from grandparents. Every bit of love expressed, overwhelming any challenge.

We are reminded that with 8.2 billion people in the world, there are only a few who will love us unconditionally- and they are to be treasured. Next week patients will return with pics, a spring in their step and renewed purpose. Many will have been alone, but buoyed by a call or text reaching out. No one needs the turkey or the travel, but everyone needs to know they are valuable and that someone cares. It is good to remember in the bustle, that the holidays are a critical part of wellness. Once again we have the chance to give so much to a loved one by filling a heart and making them whole.

There was a palpable energy in the cancer center this week. The testing, scheduling, simulations (prep for radiation) even O.R. cases made for a frenetic feeling. The wonderful staff bullied me from one activity to another and I even traded my cute orange shoes for sneaks. What’s all the fuss for? The holidays are upon us!

But…. here is the interesting dichotomy: when I enter the exam rooms, everything changes. It’s like an alternate universe. The discussions slow and the events will not be rushed. In fact, many will be on hold while the holidays unfold. The patients are driving the discussion and the Doctor stops to listen (the whole point behind the “Listening to Cancer” book).

Again and again the patient takes the controls and I steer but give them the pedals. They will each decide the tempo and how their journey will modify, reflecting what is important to them. Patients are living their best lives even with cancer and while grateful for the care, move forward on their own terms, something I’ve always admired and encouraged. People are not putting off living for the cancer. Family, events, travel, living now come first. As I said to Jim from Philly, “You didn’t grow it overnight, it won’t go away that fast, so go home for Thanksgiving and see us the next week. What a relief for him. He bought tickets long before the diagnosis. He and I know next year may not be an option. Frank is flying to Minnesota (yikes!) to be with his 101 year old mother. Am I really going to tell him to stay for therapy? Heck no! So every patient I saw this week had a similar experience with Dr. Dragun….GO! Stop making cancer the focus. There is plenty of time for that, be with your loved ones, embrace them, play with the children, hold your parent’s hand. Cancer is selfish, we don’t have to be. I like the concept of bullying cancer.

And so this Thanksgiving, I am grateful to have the opportunity to guide patients, give permission, confidence and hope. In return I received lots of hugs, some had tears, but mostly they were all grateful, as am I. Let’s celebrate these amazing lives we have, even if our bodies “fail” us. Gratitude is an elixir that recharges, refocuses, regenerates and reminds. It may even reunite.

Wishing you, dear friends, a very Happy Thanksgiving to you and your families.

Did not see this coming. Once the pandemic allowed practices to bill for phone or video calls with your providers (and is still in effect), more efficiencies are developing. There is decreased availability of physician appointments, so the ability to discuss testing, plans for care, symptoms and prescribing in less labor intense ways, is a new normal. Sitting in a hologram box to talk with a patient, I find just weird.

Crescent Regional Hospital in Texas is evaluating this option so that the demeanor of the doctor and patient is in full “view”. I think it’s just a few steps away from an AI version of the doc “seeing” the patient. There may be value for rural hospitals, after a patient has been physically assessed by a physician in person, to call on a specialist at a university to “meet” a patient but a video conference can be used. This new version of “doc in the box” seems gimmicky.

Ok, I am a dinosaur who believes that “laying on of hands” is valuable. That, when a patient sees me for a life threatening disease, they deserve my full presence. Decisions change in the moment as the consult ensues. Just this week, one patient became agitated about the plan and so it was modified quickly. Another looked to his wife for help and I realized early dementia was the reason. Still another on exam was found to have a lymph node in his neck but was being seen for prostate cancer. A woman with an early stage breast cancer, on my exam had an enlarged liver and admitted on further questioning her bowel changes, requiring GI workup before we address the breast cancer. Enough? It’s all the time, so how am I supposed to gather this information through a hologram?

We cannot accommodate everyone for everything and so the use of physician extenders NP and PA’s are valuable assets. Also discussing by phone, instead of making elderly in-firmed patients present in front of us, is helpful.

And so, here is my expectation: make your consulting appointments with the physician. Accept followups with extenders, ask for tele-health visits for test results, medication refills or questions that do not require hands-on. A hologram? completely unnecessary. Not doing it. There are many new technologies advancing medicine that we all embrace. Your life and well being is directly impacted by thousands of improvements. But I stand by that when you need to be “seen”, you need to be examined. There is tremendous value in the in- person physical. I demand it for myself and family and so should you.

The comical young female monkeys breaking free from the monkey farm in South Carolina this week captured our imaginations. You can almost hear the collective squeals as they scampered out of the gate and get into mischief. This most intelligent of the breed has so much similarity with humans, that their efforts for research are critical to our own well being, but this week, they made a different contribution. We can take a page from their free wheeling escapades. Hmmm, I think there is so much more in common with us then just their brilliant brains.

Here is a perfect example: Mary was despondent when she arrived with the news of a rectal cancer. As a widow for only a year, she is still trying to manage on her own and at 83 has all the orthopedic issues complicating her ambulating. Initially she took a cab for her consult (unfamiliar or comfortable with ride share). It would be expensive for her to come daily. Ultimately, when a neighbor learned of her dilemma, she volunteered to bring Mary for appointments. In turn,Mary treated them both to lunch and they made an outing of it. Lately, there have been others who stepped up when her friend couldn’t. I’ve now seen at least three women bring Mary for her treatments. Her spirits are lifted with the camaraderie and all of the women are happy to have these scheduled events. They checked this week when Mary will complete and ring the bell so they could all come together.

What joy. An event that was devastating for Mary, over the weeks, turned into something really wonderful and worthwhile for several. I could almost see the halo of a strengthening immune system in the room. The laughter and gleam in their eyes, suggests there is a plan for their own monkey business adventures.

So back to the South Carolina monkeys. While they were bred for serious work, this week, their lighthearted mischievousness helps to reminds us that camaraderie and fun are at the very heart of nature.

Monday is Veterans Day. Thank you to all of our veterans and those sacrificing and serving to keep America safe.

Oh sure our heads are all spinning with the barrage of advertisements and press preceding the election. It’s dizzying and exhausting. But that’s not the reason for today’s message. Too often in the clinic I see a real physical reason for the head spinning. Gary couldn’t get out of the car. We carefully put him in a wheelchair. His BP was so low, he was markedly dehydrated and the radiation wasn’t going to help today. He had taken his blood pressure meds that morning to make it all worse. Off to the ER he went. Hazel came in about her breast cancer which turned out to be the least of her issues. An unrelated pain was treated with narcotics and the severe obstipation caused more pain and a vicious cycle. The narcotic ilius was more terrifying and challenging than the new cancer diagnosis.

Again and again, as a physician, I see patients with chronic use of drugs impacting their health. Meds from primary care, oncology, neurology, cardiology even psychiatry all piled into one person to their detriment- not health.

Take time to look on the web (drugs.com) and review the side effects of every one of your medications. You may find that when cardiac meds are added to your blood pressure pill, you can barely get out of the chair. If you are receiving chemo and radiation, the side effects may cause poor nutrition and dehydration, compounding the issue and suddenly someone who was hail and hearty is like a dish rag. I see it all the time.

And so, review your meds, evaluate your symptoms and present this info to your primary care or oncologist. They are not evaluating all of this with each visit so be empowered to stop your own head spinning. Meds are toxic, that’s why they are not over the counter. You get the inserts when you pick up your script, but we rarely look at the information they provide. It’s time. Your health is getting more and more complicated.

So let’s spin our way back to being healthy and strong and avoiding all of this toxic exposure as much as is possible. At some point, I don’t prescribe for symptoms, I prescribe for a problem that requires reversal. We can’t keep plying our precious bodies with more and more meds and then hope this results in some magical wellness. So let’s be smart, take control and help manage our own health. It’s all literally in your hands.

Halloween is here and its nice to see some playfulness in the centers. I encourage staff who wish to dress to be clever and fun, as opposed to ghoulish. No one wants Dracula with the bloody teeth taking their blood pressure. When I enter Exam room 1, I wonder if Billy is dressed as a Biker to get into the spirit. The burly, heavily bearded and tatted gruff guy doesn’t need a costume. He appears to be brushing off the therapy for lung cancer like a gnat. I have difficulty hearing his breath sounds with the stethoscope due to his large body habitus and since I am new to him I quietly say, “Smoking?” He is comically offended. “Doc, I did a lot of drugs, marijuana, coke and smoked my whole life, but when I had that heart attack a few years ago, I gave it all up.” Here is an interesting fact I see often. I am almost jealous of heart disease. Patients will stop smoking on the spot, no patches and vape or little crutches to get off the cigarettes. Heart attack? Boom, done! Cancer? not always. Cancer seems to not make a big movement in the needle. Maybe patients feel fatalistic about it- although we have a ton of algorithms to follow to get patients to stop. It’s not judgmental. Fact is that the radiation is not as effective if a patient smokes. I like Billy. He is no nonsense and tough. He will manage this well.

In room 2 is Natalie. She is wearing the fashion-required grandmotherly Halloween sweater and has her two grandchildren in tow, decked out as a princess and transformer. The attention goes directly to them and she beams, leaving the breast cancer a non-issue. When I pass the chemo room with its barco-loungers lined up, I glance to see Gretchen, treating for a very unusual gall bladder cancer, climb into the chair. Her black and orange pumpkin socks peak out. She is weary but I admire that she took that effort.

Again and again, the center will buzz this week with spirits of all kinds. But by far, the costume I adore is the most ubiquitous and powerful. Every patient will enter, their shoulders back, head high, with determination and a smile. Their “spirits’ will haunt and inspire each other. They will fight evil and they will be our super heroes as they battle for their lives. Making the world a better place.

Happy Halloween.