Author: Joanne Dragun, M.D.

When the Artemis II astronauts returned from the far side of the moon, words fail us in describing their immense bravery, as well as the spectacular feat of science and group coordination. Their accomplishments capture our imagination. We are in awe. We wonder if there is any part of us that could begin to demonstrate that degree of bravery and grit. Yes, they are trained. They are prepared, but the unknown was still ahead of them on the journey.

Does this dynamic sound familiar to you? Did you find yourself or your loved one on their own extraordinary journey when life is threatened by an unexpected force? When a diagnosis of cancer is made, it can be shocking, life altering, inspiring fear, confusion and anxiety. Frankly, it can be terrible and terrifying. Do we have within each of us the grit and determination required? Can we face this with fearlessness?

Millie tells me “no“. She sits timidly on the edge of the exam table as we review the films on the screen next to her. She cannot comprehend. Her eyes are wide and tear filled. “Doc, I have never been brave“. That Millie wants to give up without a fight is actually palpable. She is not alone. Over the years, some patients have expressed a fatalistic approach to the diagnosis. I am never surprised when people are overwhelmed. Regardless the gentle touch of guidance and support, everyone comes to this journey from their own personal perspective, history and experience.

George on the other hand, is just pissed off. The terrible diagnosis of pancreatic cancer is blindsiding him at the age of 53. He has teenagers to get through college, a job to work for his health insurance, a mother to care for in her elderly years. George is willing to tap into every single new and exciting advancement in pancreatic cancer treatment his “bring it on“ mentality is meant to demand our attention and support with a no holds barred plan of attack. The fact that it is for others adds urgency and power.

Between these two scenarios, Jason presents with a devastating brain tumor related to his time at Camp Lejeune. The toxicity overwhelming his body at a young age of 30. He has not even started to have a family or children or career. His 60-year-old mother offers the support, holding them both up, and he is willing to do whatever he can to soothe her aching heart.

What the amazing astronauts have taught us, and even expressed, is humility and the fact that so many others were involved with their success. You as well, are not alone. Science, technology, immunotherapies, new drugs and deliveries to help us cure cancer or at least live better with it, are all conspiring. The entire staff at the Cancer center has one focus. They are supporting you and they are on your side. Family and friends surround you and their heart and soul is with you. Your own extraordinary journey will bring you as well to a place of peace and extraordinary gratitude, which will boost your immune system and give you fortitude. You actually cannot travel this alone. The brave astronauts did not rely on science alone. They frequently brought God into the “space”. You can too. When you are overwhelmed, push the pressure off your shoulders and into your prayers. Believe that you can move from your own extraordinary journey to being extraordinary.

The tiny woodpecker must be doing major renovations. I fully expect when I open the door to find that his nonstop drilling will construct an entire new roof! The only result, however, is to awaken the sleepy neighborhood. He is comically committed while his little redhead does not even make a dent in the tile roofs. But he continues undeterred.

We have to admire his joyful noise. Why not? When do we permit ourselves to fully express our own excitement? Too often with life challenges, we retreat, overwhelmed, and sometimes defeated. But the world is eager for your own personal expressions. When the women run or walk the breast cancer marathon, they raise their arms with victory. They shout, they hug and they express themselves with such exuberance . When Doug arrived daily for his prostate treatment he was outfitted head to toe from ball cap, t shirt, shorts and clogs in Florida gator gear. It was his way to strike up conversations with other men in the waiting room about his grandson attending University of Florida. He was completely unapologetic in his bright orange and blue. As a former exotic dancer, Cheryl’s flamboyant personality was “revealed“ in shocking pink from hair, to lipstick to tiny clothes. She brought her own brand of excitement. We noticed the men congregating in the lobby.

Your own passions are revealed as you engage with others. You may be prideful with Pickleball wins or delight in sharing pictures of darling grandchildren. Your own exuberance, even during a trying time will surely inspire others. You are so much more than your diagnosis. Be assured that others will benefit when they witness your personal joy. As you lift everyone around you, your immune system will help battle the cancer with its boost of energy.

Giggling Cheryl returned a few years later holding hands with a smiling man undergoing prostate cancer treatment. They had actually met in the waiting room when he was bringing his mother for treatment during Cheryl’s therapy. The joy on their faces was evidence that no diagnosis was going to define them.

See how even the smallest event can leave a legacy? The tiny redhead woodpecker will not be ignored. He is now in our story about exuberance. Be assured that you are really making a difference and touching others when you live with expression and refuse to allow cancer to lessen your life or your enjoyment. Thank goodness, no head banging is required.

We did not take the massive achievements of Artemis II for granted. I well recall my own fascination with Neil Armstrong ‘s first steps on the moon. Today we are spoiled, the brave astronauts interacted, and spoke directly to us during their entire adventure. We were captivated. TVs across the nation, took a break from The Masters to tune into real time video of dangerous reentry, and successful splashdown.

As the astronauts hobbled on their “space legs” they still appeared happy, healthy and hearty. There was exuberance replacing exhaustion. Thank goodness pioneers continue to fulfill the need and devotion to exploration with profound courage.

Even healthcare benefited as one of the hundreds of experiments examined the astronauts own cells to investigate radiation impact. Science never stops. Knowledge continues to grow exponentially. The good news for us in cancer care is that the desire for exploration to the tiniest minutia of nano particles and Epigenetics is bringing new life to treatments to extend life.

Just as we were able to watch the astronauts in real time with minimal transmission delay, these massive numbers of experiments and cancer treatments are also happening very very rapidly, in minutes instead of years. Treatments are moving from laboratory to rapid use. Physicians are hungry for the knowledge and the newest trials. The most deadly cancers are finally receiving their due instead of acceptance.

What I witnessed daily is that patients also have renewal. Many of us have friends, family, new acquaintances, who have taken the cancer journey and succeeded. I am most impressed how these brave individuals decide with faith and courage, their own personal reentry. They mention their experiences in an offhanded way. They have already lived the drama and intend with ferocity, to move forward. Beth casually mentions, “Oh, years ago I had catheters put in my breast for brachytherapy, and I was done with treatment in five days instead of six weeks”. I tell her how far we’ve come that we are using a ball like device to deliver the radiation in the lumpectomy cavity right in the OR now with the patient leaving the operating room and requiring no further treatments. A luncheon conversation regarding children and grandchildren on spring breaks, leads to Carly casually mentioning her child now moving into her own career after suffering osteosarcoma years ago. Gavin does not cancel, but instead just changes his golf reservation to make time for a focal prostate cancer treatment. Sharon casually mentions how a “bout of colon cancer“ changed her appetite as she peruses the menu. None of these conversations is placing the cancer at the center of attention. It is an aside, it is an event that happened and there has been acceptance and a determined desire to move forward with dignity and renewal. You will begin to see the shift as more and more leave cancer behind and view it as a life challenge, surely life-changing, but also life affirming. Every survivor, even those continuing treatment, develop their own magnificent reentry. These “former“ patients have determination to engage and enjoy, never forgetting or diminishing. They place cancer in the context of a full, rewarding, adventurous, and loving life. This is not to ignore or dismiss the tremendous chaos that cancer can bring into our own lives and homes, but to have faith that the struggle will eventually have less power.

We also humbly recognize that success is not guaranteed. For our loved ones whom we miss, we will find our own reentry as families and friends. We will honor their memory and develop greater awareness, empathy, forgiveness, and kindness.

May God continue to bless and inspire the amazing scientists who are impacting our lives, even from the farthest in space, and may we each know the peace to power our own re-entry.

Youth and vitality is reviving senior spaces this week. Different from college spring break (!) because the children arrive to spend time with aging parents for Passover and Easter. As retirement communities flourish, especially in Florida, the collective energy slows and so, resurgence of this delightful vigor changes the landscape more than the flourishing flowers and warm breezes. The spirited high kick jogging (usually in northern logo college t shirts), the toddlers joining grandmom’s dog walks, the noisy thrills at the pools and the glow on parent and grandparents faces introducing loved ones to neighbors, is all contributing to a renaissance. Forgotten are the pains, heartaches of loss, fear of illness and disabilities. Everything is converted to refreshingly new, improved and joy filled.

A week unfolded with Passover and Easter blessings strengthening faith. Bushes burst with fragrance as a long winter wains. A lovely pastel pink moon enhances the miracle of our brave astronauts exploring the far side for the first time, fascinating imaginations. As if these blessings were not enough, the bonds of families and generations of anticipation are evident everywhere.

Grandfathers hold the tiny hands of offspring, arriving for a golf clinic with miniature pink and blue club sets. They are prouder to show them off than their own low handicap. The children arrive with joyful anticipation. The Easter egg hunts are on as well and excitement sparkles the air. Grandmothers, who frequently hobble on morning walks, now push a baby carriage spritely, joyfully. There is a renewal in spirit and it is palpable.

The seniors during this celebration time are foreseeing the future for their families. It is delightful that patients, friends and family have this time to soothe and refocus with joy and expectation. Burdens are lifted by the spirits of these young people. Two men chat amiably as the son slows his pace to the father‘s gate, while together they pull a little wagon holding a toddler and puppy. What an adorable vision. The golf course is alive with high school and college students proud to display their youthful prowess. For the older generations, drama is diminished. The fears are quieter. The resurrection of generations to come is assured and the vibrancy is palpable.

Once again God provides. Spring, and the miracle of Easter, remind us that rebirth will and always occurs. We can all appreciate a resurrection of spirit. What matters most is using well the time available. Tapping into the energy. Having faith and experiencing hope. The children and grandchildren have no idea that they changed the immune system of their parents and grandparents dramatically just by their energetic presence. Easter blessings abound, and they are deeper and more impactful when shared.

It is my hope that you will also witness the power of renewing energy this spiritual season. God bless you and your family on this beautiful Easter day and may the Risen Spirit continue to live in our hearts.

Cancer is work. It’s not a goal, something you study or train for. It’s not enjoyable or an aspiration. There is a whole lot that this stinkin’ disease is not. For all of its impact on you and your family, you would think that there should be benefit or a payday. We can’t even view it as a hobby – something to practice and get better at. We have a lot of experience developing, moving, engaging, honing skills, and enjoying benefits of success. We overcome challenges. Frankly, we have no frame of reference for this new dynamic. You read, search, get opinions, ask friends, maybe travel for care, but it’s very discombobulating.

Patsy is p….d. She is now ready to enjoy a well earned retirement. “Doc, I’ve worked since I was 14!!! I cared for my husband before he passed, raised children, helped with grandchildren. I am ready to relax, travel, and make new friends. This is derailing my plans“. I understand the disappointment and even anger.

“Patsy, you will manage this just as well as you did everything else in your life. You will succeed because you did screenings and found it early. You will do the work because you are diligent and you will now be an inspiration. Cancer will open doors. You will embrace your new dynamic, spreading your unique cheer and optimism in the center to the staff and other patients. You will be a hero to your family. You will gain strength, knowledge and wisdom.”

No, disease is never invited or enjoyable, but there are so many aspects of this development that will stretch and grow you. You didn’t even know what part of your spirit you could tap into. For Patsy, and others, there will be fear and concern, but there will also be a renewed purpose – not just to manage and heal herself. When the person, now patient faces the challenge of a deadly disease, even if it’s treatable or “curable“, the opportunities for self discovery are tremendous. No, it’s not something to which we aspire, but every effort in life and experience has led you to this point. Be curious and open to the adventure. Trust that you have a vast fortitude and resiliency. No, you did not sign up for this, but my own experience with patients bears witness, you are really good at it and a diagnosis is not an identity – it can however, actually enrich your life.

Is it possible that developing breast in Northeast Florida could bestow super powers? Three high profile women in our area from Jacksonville to Ponte Vedra have revealed their diagnosis, two just last week, and will inspire us all. This is a perfect topic as we celebrate Women’s History Month.

Donna Deegan is Mayor of Jacksonville. I met Donna when I first arrived here 18 years ago. She developed metastatic breast cancer and is a three time survivor. She started the nation’s first breast cancer marathon “The Donna” which draws many thousands every February. It raises funds with researchers at Mayo clinic here. Donna was a news anchor, but her new title is Mayor of the largest land city in the US. The beach run lifts everyone, family, friends and patients from across the US. The joy and exuberance is infectious.

Last week another famous news anchor and Health watch reporter with twelve Emmys, a Peabody and two Edward R. Murrow Awards, Jeannie Blaylock revealed her own diagnosis. Jeannie started “Buddy Check” over 30 years ago to increase awareness for women to do self exams. We raised money for screening at our cancer center over the years. She started the program when a friend was diagnosed in her 20’s. Still going strong decades later, Jeannie will tackle her own diagnosis head on and with tremendous grace.

Susie Wiles, from Ponte Vedra, and now one of the most powerful women in the US as Chief of Staff, revealed her diagnosis last week, reminding us that no one is immune as one in eight women will face this demon and can do it with determination and grit.

All shapes, sizes, ages, genetics, careers and responsibilities. Women don’t allow these perky appendages to hinder them. Instead they are fierce in the face of drama as if they strap into those comical conical breast plates from sci fi movies. They put hands on hips like wonder woman and inspire. The thousands of women I have cared for (I prefer to “treated”) bear witness to the strength and power of adversity. As if to say, ” Breast Cancer?, oh please, I’ve got this!…… “.

Think even the nasty forms can intimidate us? Triple negative breast cancer is taking center stage recently due to many new therapies, battling the most aggressive form. BRCA positive patients ( 15%) may respond to PARP inhibitors, Keytruda (immunotherapy) helps us to increase immune system instead of just killing the cancers. Antibody drug conjugates deliver therapy right to the tumor.* All new in the past decade…. Donna was right its all about the research.

You don’t need to be famous. You don’t need to lead the charge. You will inspire, guide, grow, aid and comfort many women in your own family and circle by your courage if you are confronted with this insulting disease. You are not alone. In 2025 there were 4.3 million breast cancer survivors- and what a fiesty bunch they are! Didn’t this disease get the memo? Don’t mess with a woman! Good news is, 5 years survival for early stage is 95-99%, 86% for regional spread ( nodes), 77% for triple negative, but 30% for distant spread. (source Moffitt).

You or someone you know will, has or is in the process of the tackle. There is super power in numbers. There is a massive collective voice for improvements. There is resilience and recovery. There is joy and comfort knowing that a band of sisters (and a few good men each year) will be undeterred in their life missions. Go Girls! Make more History!

• Find more at BCRF.org

A lifetime of chasing dreams : School, career, relationships, marriage, hobbies and activities, committees and organizations, moving and travel, generational family growth, even rest and retirement, the constantly shifting and expanding components of life have trajectory. The growing, development, searching and explorations define our lives. There is little if any room for drama, sickness or tragedy. Suddenly, we are faced with a shift, sometimes subtle, but often profound. Caring for people at one of the most critical times in their lives has presented me with thousands of opportunities to bear witness, engage and guide.

Even among your friends and family, each of you is independent in your responses. I have seen the range from busy, frenzied, information gathering, multiple opinions, to almost catatonic. I will offer that, as you and loved ones navigate, please also respect each other other’s path. Recognizing that support and love is far greater at a difficult time then demands and direction, which can be intimidating.

As a cancer physician, I want you to be engaged. I want you to now chase the best treatments for your best outcomes. Honestly, not everyone is up for that and respecting their point of view is critical, not just for success, but also for comfort and acceptance.

The family gathered in the exam room, one holding their mother‘s hand while her husband is on the exam table. He had been receiving spinal injections for back pain for almost a year before the jaundice led to a very different diagnosis. A presenting symptom for pancreatic cancer is often back pain. Schedules were made. The chase was on: surgery, chemo, radiation, immunotherapy, a plan was set quickly in motion. Paul is defeated and exhausted. The pain taking its toll, the jaundice and ascites contributing to the weight loss and frailty. At 62 he had not even had a chance to retire. Two children are still in college. The shock is evident in all of their faces. Everyone wants to fight. We will be there for Paul if he wishes to as well, but with this devastating diagnosis, nothing is guaranteed.

We’ve talked here often about how inflammation influences cancer. The development of the disease, the effect or ineffectiveness of treatments, the trajectory, the outcome. It has been found that within a matter of days in pancreatic cancer, elevated inflammation, can spread the disease rapidly cause increasing ascites (fluid) and make successful treatment essentially impossible.. It’s as if the cancer has conspired against us all. New research is looking at attacking inflammation and allow the body’s immune system to battle disease rather than just trying to treat the tumor.

Many patients, and now even friends, are dealing with this difficult new reality and questions arise. Could more have been done? Could the disease be found sooner and curable? Why did the chase for treatment get so derailed? Once again, we are reminded how truly humbling this disease can be. Take heart that research is advancing at very microscopic, nano particle levels for every disease even the toughest to treat. Frankly, this may not benefit all of us now, but therapy for the next generation will be dramatically different. The chase is on to make cancers that do develop, even the worst of the worst, a chronic disease, one that is survivable..

The best hope for Paul now is not to manage the disease, not to chase treatment. It is instead for loved ones to gather and know that it is not a new immunotherapy that will hold his hand, relieve his mind or comfort his heart. It is his knowing that his life well lived will now bring him support and devotion. There will be grieving, but there will be acceptance and memories to honor. Love may not cure but it always heals.

The title is misleading because this post is about the bowel and very rarely is there any pain associated with colo-rectal cancer. Since there is information in the news lately, especially surrounding younger people, I thought we would explore a bit. You may brush this blog aside as not pertinent to you. But data says otherwise and you may want to gain knowledge as to encourage your adult children to not miss the signs. This is the number one cancer in men and women combined (prostate number one for men, breast number one for women, but together it is colo-rectal, and second leading cause of death after lung cancer).

March is colo-rectal awareness month so pay attention, there may be a test at the end of this. Good news about cancer is that overall it is on the decline. Bad news is that colo-rectal cancer seems to be increasing in the younger population with a 1 to 3% increase in people in their 40s. The fact that we have screening recommendations for those over the age of 50 (and then finally we moved it to age 45) still will not catch all of those at the earliest stages. Because there is rarely pain involved, it will take real attention to find these cases early and curable.

Since the bowel has the capacity to expand, people can get large tumors before they know they have a problem. It is not unusual to find very elderly people, often in nursing homes, with large bowel cancer and requiring surgery. For younger people, especially those who are fit, they often believe that they’re change in bowel habits could be related to lack of hydration from exercise, nervousness around events, lack of fiber, etc. For James Van der Beek, it was a change in habits that he did not realize was related to an actual obstruction in the bowel. I am not a fan of the kits used to detect colo-rectal cancer and here is why: a colonoscopy can go in and actually remove polyps. If those polyps continue to grow they could form cancers so it is actually a diagnostic and therapeutic test. Researchers are also investigating possible vaccines.

Finally (Oh thank God Joanne! ) Awareness is key, especially in these cancers found at early stages by screening. Family history of colon cancer? Get checked early before 40 by GI. There are genetic testings available to see if you have Lynch and other syndromes that make you susceptible to disease.

Everyone will not have their diagnosis found early. Everyone will not have curable disease. What patients often regret, as witnessed by several folks giving interviews now, is lack of attention and awareness earlier. You have insurance. Go to the doctor and bring your list of concern. They are not mind readers and the 9 pages of symptoms you fill out in the waiting room, can still miss the “money shot”. No one regrets paying attention, only dismissing until a multitude of symptoms can no longer be ignored- true for every disease.

The early age onset is contributed to unhealthy diet and microbiome, obesity, chemicals in environment, alcohol, antibiotic use and sedentary lifestyle. To reduce risk, cut down on red meat, a processed and bbq meats, increase fruits and vegetables, whole grains, fish. Don’t ignore rectal bleeding it is the early sign and not always hemorrhoids, so get checked out. Change in stool, chronic constipation, even loose stools, rectal pressure (tenesmus) need attention.

So, please be your own attentive advocate. You know you best, so always be responsible for yourself. Your body will thank you.

Resources: American Institute for cancer research is a good online place to find diet information. ACS (American cancer society has recommendations for screening and for each specific cancer. AACR.org for updates on research for detection and treatment.

What I love about the Olympics is the profound joy captured. Sometimes we forget in the throws of drama that we ever felt that. Alysa Liu’s fantastic personality, generous spirit and pure joy and excitement for the figure skating gold made us all smile.

I happened to be in Miami airport when US hockey won in overtime and the thousands stranded with cancelled flights and blizzard drama forgot their distress for a few moments. The cheers flooded the airport as if each of us scored the winning goal. A moment to enjoy regardless other issues.

These times of national pride and so many more, even those who trained, battled but did not win hardware, are a gift as we extend our good will to others with pride in our hearts and admiration. I really love the interviews with parents saying they didn’t necessarily hope for the wins, they hoped their children are happy.

Youth does not have the exclusivity for exuberance. When Harvey rang the bell after prostate treatment, he beamed and we all felt his relief and excitement. It was his own gold medal moment. Then he surprised us, saying that it’s the second time. How so? He smiled even broader and said that he rang the bell at the shelter when he adopted his now beloved abandoned senior dog.

Moments like these remind us that you will rejoice, laughter will lighten, and you will heal your heart, often.

Cancer cannot steal your exuberance. There is opportunity for more moments ahead and you are well prepared to recognize and celebrate them. For those and their families facing comfort care and leaving active treatments, know that even at this time, you have control. Patients still hear long after they cannot respond. Pain control is paramount and well managed in hospice care. Holding a hand and kissing a forehead gives strength to the person for their next journey.

Be strong my friends. Celebrate with exuberance. Recognize and honor your own strengths, make good decisions to help another move on. During and after treatment regain control through PT to enhance your own abilities. Never be a victim. Power is always yours.

Note: As national cancer screening month of February come to a close, take the reminder to screen and prevent cancers. The most common cancers can be screened for so don’t blow them off: breast, prostate, colorectal, skin, and now lung… at least X-ray even for non-smokers. Treatment is in the doctor’s hands, prevention is in yours.

With another blizzard due to hit the Northeast this weekend, looks like Punxsutawney Phil was right adding six more weeks of winter. But many in the northern regions, just brush the snow off their shoulders and shrug. I found after many years, you could actually get used to temperatures in the teens and shoveling daily. We never closed the centers and when the morning radio would announce 13 inches, the school buses still ran. We all learned to manage and even thrive. The weather provides another lesson for people with all sorts of challenged lives now. I encourage you to have faith that you are resilient.
Have you noticed a shift in conversations lately? Yes you’re not imagining, at a certain age in life, you can’t meet up with friends and family without hearing someone describe their new cancer journey. It seems ubiquitous.

When Mark and Jane came to the center, their faces showed the dismay since they both have been diagnosed this past month. We triage what is most urgent, since family is far and they will try to care for each other. We tag team scans for efficiency and send both for bloodwork and discussed managing the cancers in tumor boards. .After a few weeks, the shock is over and the work begins. They hold hands as one heads to the chemo unit and the other to radiation. I overhear their discussions of running errands and picking up at the end of treatment. What we witness is developing acceptance, strength, and confidence. Their devotion to each other and focus to the tasks at hand is beautiful to witness. At one point, while Mark is perched on the exam table, Jane surprises me by saying “I am glad we are going through this together”.

Mark and Jane teach us that we are stronger than we know. Healthcare and diagnoses don’t scare us. We are more powerful because we are prepared for every storm. We can dig in and be part of solutions instead of fearing and fighting. This week, a new friend at an event, knowing my career, whispered that she is having whole body scans this week because of new abnormal blood work. Her demeanor of concern changed with my comment, “ Good. Then you will have knowledge and a plan. Don’t fear the scans. Be grateful for them. It’s the first step in healing“.
Life changes in many forms are going to happen, trust that you are well armed for them. You got this. Once again, stay safe my friends.