Author: Joanne Dragun, M.D.

Are you “guilty” of habit-forming online scrolling? These “dopamine” hits can become addictive. We know well to attempt to limit kid’s screen time, but may be developing our own short attention spans. It is actually tough to keep up with all the info flying and that is true in medicine as well. I will therefore give a tiny synopsis of amazing updates in cancer in just the past few weeks. Thank goodness researchers are not scrolling but instead are passionate in their deep work. A few examples:

MD Anderson: developing a novel antibody-toxin conjugate (ATC) to stimulate eradication of tumors. Combining immunotherapy and antibody-drug conjugates, will trigger the body’s natural immune system to attack.(Published in Nature, 2025)

UMass Chan Medical School is investigating how a tiny break in DNA can kill drug resistant breast cancers, and Moffitt Cancer Center published in Cancer Immunology Research a study showing that immune cells can stop dormant breast cancers from growing new tumors.

Memorial Sloan Kettering is researching mRNA -based therapeutic vaccine for pancreatic cancer, finding that it can last up to four years after vaccination in this most deadly cancer.

Glioblastoma is the most aggressive and lethal brain cancer and yet researchers will not be intimidated. Dana Farber scientists are combining a novel agent, navtemadin with chemotherapy with positive result in early work.

As a Radiation Oncologist, we recognize the damage this treatment can cause to normal tissue surround tumors. MIT, Brigham and Iowa are teaming to find a protein in tardigrades (tiny creatures that survive extreme conditions). The protein can bind to DNA shielding it from radiation.

These are just a few examples from the top research cancer hospitals in the US in 2025. This week I am attending, as Chair of the Board, the American College of Radiation Oncology annual meeting. The depth and breadth of new and exciting and actionable treatments will be breathtaking. I am so proud of my fellow physicians in their quest to extend and improve lives.

Today’s message is to encourage you. No matter the trial, sickness or the fear, nothing is static. There is “deep work” occurring everyday and there is real benefit to all of us. The world is conspiring to cure disease, including cancer. As these top researchers continue to dig in and work diligently and even feverishly for this purpose, then I recommend that you do not give up. Continue to work with focus and attention toward your own wellness, so that when an amazing discovery presents, you will be the perfect specimen for a trial, because you are both wise and brave.

It is almost an oxymoron because the tool is used to give you control for end of life care. Circumstances can swing dramatically from what you anticipated calmly filling out a form at your doctor’s office, to the chaos and drama of the real event. A study in “Cancer” from Rutgers, 2024 found dramatically different management of end of life between oncologists who are “high” prescribers with chemo up until last days and those with less aggressive approaches. It found that patient wishes were NOT the true directive.

Some real advice may be helpful here for you and your family as we all strive for comfort and peace. Do fill out the living will since it is a legal document and must be abided. I have been in the middle of chest compressions when they were stopped when the directive was located. If you don’t have one, the hospital and EMS will do everything, when what you really need is a hand to hold and soft words to be spoken.

Thank goodness more is being written about doing less chest compressions. I am in favor for drowning or witnessed heart attack, but in cancer care especially advanced disease and frail and elderly, palliation and comfort is best. Oxygen and IV fluids can be given, but aggressively attacking the body should be chosen carefully. No one wants to pass in the glaring harsh lights of a hospital. Even the Pope is trying to get to the Vatican if he can be stabilized, even for just a short time. Patients are more comfortable in hospice or at home with loved ones present. Families can not always handle the situation which makes bringing in hospice care a perfect solution to give support and medications.

Just because there is always a new drug, therapy, device touted doesn’t mean it will turn things around. Hail Mary is meant to be a devotion not an end of life last ditch effort. The real miracle will be crafting peaceful and loving moments at the end. Be engaged. Show up. Get medical power of attorney so you can be an advocate with legal strength and do it early, not at the end. You want to avoid the default of hospital staff “doing everything” because without clear direction, legally that is what they will do, unless the hospital medial ethics board is brought in.

When we are diagnosed with a life threatening disease, we search for Docs who will fight for us, but should this be the directive at the end? Ask for a hospice or palliative care service to take over. It is my best recommendation for comfort. As a former Hospice Medical Director, I will affirm that the nurses’ skill set is perfect for softly and peacefully guiding the body and mind to find rest.

Finally, please do not speak in front of the patient. Hearing is the last sense to go, so even in the unconscious, they hear you. Speak loving, calming words and hold their hand. What a blessing if we all have loved ones and comfort when our time comes. Your involvement, instead of leaving to the Doctor or hospital’s management will be a great source of peace for you as well. God Bless.

Sorry to use a boxing phrase, but no doubt those of you suffering from recent viruses feel the knock out. It is so ubiquitous and these “bugs” do not discriminate. Already being treated for cancer? Here is some more drama to handle! What’s an achy body to do?

Get a flu shot if you didn’t already. It works in 2 weeks and we believe that this flu season won’t be over in March but may extend to May. As Docs we are required to have the shot in the Fall to prepare for the season, but if you put it off, don’t now- it may keep you from becoming very ill. Many are immune compromised from illnesses and age so you want to avoid a hospitalization if possible. Jump into your nearest supermarket or pharmacy, no appointment needed. Chills, headache, fever, bronchitis cough… often severe and constant, runny nose, sore throat, aches, all signs-not just a common cold. CDC has labeled the 24-25 flu season as “high severity”, the first since 17-18, so no joke.

Boost your immune system. Take vitamin C and Zinc, take probiotics and use immune boosting nasal sprays. Stay home if you can and avoid crowds- it all spreads by air. Wear a mask into the center, carry sanitizer and wash hands often.

For symptoms: Decongestants, antihistamines, ibuprophen, (tylenol for fever and body aches if you cannot take), hydrate. I usually tell patients to try to knock themselves out with benadryl, stay in bed and sleep through it- you will be better in a few days. I am still a fan of Tamiflu (now generic). You have to take it early in the course of the symptoms and it isn’t a cure all, but when you feel this lousy, there is really no down side. If you become more ill, call your Doc, a pneumonia can set in and become a secondary infection requiring antibiotics. Sometimes steroids are used to decrease the symptoms.

You will recover. Don’t push yourself. If you are due for chemo, tell your Doc before you go to the center, they will likely postpone therapy. I know, it’s insult added to injury and misery. I recommend a COVID test (tamiflu doesn’t work for that) because it is still active in all communities. It is exhausting trying to stay well. Eventually, get out for fresh air and a walk, your spirits, breathing and immune system will improve.

Take care, friends, you are not alone and this too shall pass.

No, this is not a message about packing for a three week trip through the Amazon with just a back pack. I’ll leave that to other bloggers. This is how to prepare when you are on a trip-of any length, for your health and wellness. I am motivated from recent experiences to share some advice.

In the Fall a well planned cruise with excursions all went bust when luxurious accommodations provided a softer bedding. I know from experience that could be a problem and so on morning one, the spine did not align, so much so that I lost days of excursions and had to visit the ship ER. They do not take insurance so $400 for the visit and $100 for ten flexaril and 10 high dose ibuprophen. Later, I considered sleeping on the floor- no joke. Difficulty navigating required all the well planned trips of hiking and exploring to convert to bus riding. Next came a recent Caribbean trip where viruses abound. Even someone like me, who takes out the extra shoes and cute dress to accommodate the meds, did not have a full enough pharmacy.

Suggestions: Ibuprophen (200 mg tabs can increase to 4 tabs for severe pain if not on blood thinners). Tylenol. Decongestant like flonase nasal spray. Antihistamine benadryl for allergic reaction, sleep and to shut down cold symptoms, 12 hr mucinex for cough. Saline nasal spray, use it often to avoid catching a virus. Hand sanitizers (don’t work for norovirus, hand washing does). Along those lines, anti -nausea, meclizine for motion sickness, Imodium AD because you had the ice cubes or drank the water, Pepcid AC tabs since most chest pain isn’t a heart attack, lidocaine patches, cold and hot packs, bug spray, hydrocortisone and anti fungal creams.

I’ve come off 2 trips in past years with covid. For a longer trip I take a covid test with me and box of paxlovid. So now I am into the doctor- prescribed suggestions.Be sure you have had the flu shot. Antibiotic (suggestions: bactrim, cipro, amoxicillin, etc.) Bring one of them along in case you are sick and running a fever or have a UTI. It may be viral (tamiflu) but also lead to bacterial. If you have joint issues, flexaril and celebrex help. Your Doc can hook you up with these just- in- case meds- there is no reason not to. If you are taking pain meds you MUST carry them in their prescription bottle and definitely leave the medical marijuana at home. Drug sniffing dogs find it and it’s not worth the legal issues abroad, or states that do not allow it. No defense works (as Mark Fogel from PA found out in Russia, released last week after almost 4 years of a 14 year sentence!)

If you are being treated for cancer, you must bring all of your meds and these prophlactic ones as well. Most issues if severe, will require IV fluids, so I recommend the electrolyte and hydration packets to add to bottled water.

Last comment is about injuries. Everyone lined up with their jaunty hats, backpacks and sunscreen to get off the ship. The return was zombiland. One woman had a broken wrist, a man had a walking cast on his foot, another woman looked beaten as she had bruises around her eye and down her face…. etc! These were all due to falls. So wear sturdy shoes or sneaks always. Use a walking stick for stability or grab a sturdy limb. Paths and “sidewalks” are always rocky, broken and the slightest turn of the ankle makes a mess. Today I see tourists navigate the oldest city in the US, St. Augustine in flip flops. Trips are not meant to trip you up, but nonsense happens. OK enough, so Doctor’s orders: have fun but be safe and prepared.

What other post could there possibly be this Super Bowl weekend than to cheer for my hometown Philadelphia Eagles?! Green runs in our veins and this infrequent and amazing circumstance is uniting Fanatical Philly fans all across the globe. Philly is a very parochial town and takes their sports teams seriously. Old Northern football with original franchises have deep roots and so the hats, T shirts,flags, and boisterous camaraderie are blazing!

“Yo, Doc, I got cancer ova here and you talkin’ football? Have some respect!” With the frenzy in Philly, I am sure my peeps there are not looking for a cancer blog today. But there is absolutely a correlation to be made, so cut me some slack.

Knowing deep in your heart what matters is absolutely necessary to wellness. I am not suggesting that we are living for the game ( tho some are!), but that awareness of connection, joy, family, friends, and purpose must be part of the plan for strength and recovery.

So, yea, it’s about Football today because there will be excitement, memes flying on texts, shouting, exuberance and hopefully for “our side” relief , celebration and thanksgiving. It will all serve to boost the immune system and Football and therapy will converge to remind us that everyday, not just Super Bowl Sunday, we need fun and connection. So…. Fly Eagles Fly on the road to victory.….

E-A-G-L-E-S, EAGLES!!!

Josh now has the unfotunately too common squamous cell and melanoma skin cancers following a bone marrow transplant for a different cancer years ago. He tells me its a “sh.. sh..”now with several Moh’s surgeries and radiation treatments. The new melanoma requires more specialty care with lymph node dissection and scans. “Doc, after almost 20 years being cancer free, I feel as if it’s caught up with me”. Josh is a victim of survival success. He rightfully doesn’t like the pile – on. The patient is only now researching this phenomenon but he knows that regardless of the informed consent fine print, his options at the time were limited. Trading off long term survival for skin cancer risk was still a win.

Docs hone their skills and knowledge quickly and offer cutting edge therapies… what matters is NOW! Rescue the patient! We may too often be guilty of downplaying the side effects and risks to move the patient into life saving care. Practicing for thirty years, gives me the benefit of witnessing the disease, mutations, changes in therapies and very often the chronic problems that living with cancer causes. At least I can offer confidence and support as well as a reality check. When Tracey complains of triceps numbness years after breast surgery, she is relieved to know this is normal. When Frank has to use Oxygen from lung scarring after radiation, as long as the scans are still clear, he breathes a sigh of relief. When Arlene needed to move in with her daughter because memory loss from treating a brain tumor became a problem living alone, she happily describes the joy of living with her grandchildren.

The great news about cancer treatments are their increased effectiveness so that cancer is now a chronic disease. It is wonderful to see that patients who have been on the journey, are well equipped for whatever comes next. I embrace their fearlessness but recognize that there will be disappointments and frustrations.

Perhaps informed consents should be more complete. Missing from the fine print, I see several really amazing “side effects”. How about adding these?: You will be surprisingly tough. You will appreciate your days more. You will value your relationships. You will even love more deeply. You will be touched by other’s kindnesses toward and sacrifices for you. Your children will admire you. You will wear your challenges with great pride. You will tell your story with humility. You will inspire others the rest of your days. And…. you will be cherished.

No. Not dry January. Today’s post is validating the sober reminder of tragedy. The loss of life and property, businesses, occupations, jobs, cherished mementos from the LA fires is of such enormous magnitude and pain. My own awareness is of doctors in the hospitals in California, treating patients for respiratory problems before realizing this cataclysmic event was unfolding, even for their own homes and neighborhoods.

Today is to remember what matters. It is never ever the stuff. Comedian George Carlin was right. We don’t need bigger houses to store more stuff. (If you need a chuckle see his utube from Cappy NJ on “stuff” ). When the light is dimming, the days are becoming shortened, the efforts too much to bear, no one is looking for more. We are, however, searching for the connections that extend our love and our hearts to each other. Nothing else matters. The tragedy of the past weeks helps us focus, but how do we emerge? If I have one comment, it is to have faith in resilience. It’s often said that we have nothing without our health. Ask a patient. At the moment that a diagnosis is confirmed, they are not reaching for material valuables, but toward family and friends. They are grateful for the kind text, an offer of help in any small way. Eventually they often return the favor (as I see among friends this week).

People start to put faith in each other and lean hard into relationships. They do not look back but forward into healing. When recovery comes, they reassess perspective which is a blessing to witness. The fires will be over for a time, but the lessons should smolder with renewal, refocus, re-purpose. If you need inspiration, trust that the examples abound every day in the cancer center.

To donate go to http://www.redcross.org

Ha! You think I am going to talk about the losing Jags? How about my winning EAGLES? No. But prior to games last week, I overheard the pre-game chatter. Can’t believe I am going to quote Coach Jimmy Johnson on this blog… He dogmatically said (twice) “It’s not about the X’s and O’s. It’s about instilling confidence!”

As a mentor to younger physicians in the field and to staff, I believe this applies to healthcare as well. I try to keep the business, paper pushing, and busy schedule of running the office in the background. For me, it’s never about any of that. “Getting through the day” is not grinding out work. Even buzzing from patient to patient, if I don’t take a breath, look at the chart and know what is ahead before I enter that room, the visit itself and all the effort leading up to it won’t matter and the added drama, concern and confusion will have a negative impact.

“That’s fine,Doc, but I can’t influence the staff or physician.” Ah, but I think that you can. Fill out paperwork ahead, get there on time, bring another set of ears (not toddlers you are babysitting). Get off of your phone the second that door opens and shut it off. (Too frequently, phones are on or patients are talking as if I am a second thought and have to wait.) Nope- I hung a sign years ago “no phones” but today it’s even worse, no playing games on the phone. This is cancer, pay attention!

So, now you are attentive, maybe have someone with a note pad and ready to fully engage. When the Doc asks, “How are you?”, don’ t go into a side bar list of complaints. You are there to get results, to get a plan of care. You want to make the most of the visit so don’t distract. Ask for results. Ask for a plan. Ask about side effects. They will be setting you up for more testing, appointments perhaps with surgery, radiation and or medical oncologist. Ask questions pertinent to the specialty you are seeing- patients ask me all the time about chemo- I defer. When they ask the medical oncologist about radiation, it upsets me if they have said, “Oh its just a few days”, when it may be 30 treatments so now the patient is confused and confidence is out the window. Let the specialist handle your teaching based on what they do. Don’t ask primary care about surgery. There are a million ways these visits go sideways, but I am very direct, firm but gentle and informative. I have to move patients past the fear into action so I am determined to make it a success.

It also helps if you come in with some level of information. It’s ok to look up your diagnosis and American Cancer Society can help as well as NCCN guidelines for patients, if you know your disease. I never assume the patient knows anything. That way even if they hear something for a second time, it reinforces knowledge and confidence.

If you don’t understand something, say, “Wait, can you explain that?” You can always ask what other options there are for care. “Doctor” means “teacher” so most physicians do like to explain- especially if the patient is attentive. Be respectful. You only have a limited time with them so make the most of it.

You should leave every visit with confidence that every measure is being taken for your benefit. By the way…. when a relieved patient smiles and adds an X and O, I am ok with that too.

GO BIRDS!

While we are about health and wellness and learn from experiences discussed here, today let’s explore something at the very heart of our well being: control. Our lives unfold with consequences of our actions from education to jobs and careers to families, homes and environments. We attempt to control situations that can improve our lives and our families… constantly. Even your own health while personal, impacts them all. Do they have to move you into their home, pay for care? afford your bills? suffer your pain with you? Those events out of our control like illness and trauma can devastate our planning. None of us wants to accept victim-hood. This concept is top of mind coming off the events New Years Eve and the randomness of the impact. As a joyful new year unfolded, we are reminded to hold our loved ones close and to have gratitude for our health and safety.

Resilience is important to navigate life, but there is no reason we cannot work toward taking responsibility and control. Today lets consider a few reminders. For safety, situational awareness is mandatory. I recall almost forty years ago, navigating a sketchy part of Philly on the way to med school. I would park a distance away due to cost, carry my wallet inside my coat with a satchel draped over my shoulder (a weapon in itself). When I would be approached, I’d look in the distance and wave as if someone was watching me and run or quicken my step- it worked every time to make the threatening party think twice. I was damned if someone bent on evil would derail my mission. I still do this today.

I learned to carry personal alarms and even bought them for female staff going into a dark parking lot at end of day (see amazon to buy in batch). I always kept the alarm app up on my phone when I went jogging, especially in the morning hours.

As we age, we all look like likely victims coming and going to market, getting into cars, too often with our cell phones distracting us. “Read the room” or space and be vigilant. Be in control so someone else doesn’t take control.

Control your own environment. With illness and aging come devastating falls in the home. Get rid of throw rugs and obstacles. If you feel better with a shower chair get one, put up grab bars. A Doctor friend ended his career with a shower fall and head injury in his 50’s. Another Doctor fell with rib fractures and lung collapse.

Control your own healthcare. I am reminded of this as Miriam comes into the center this week. We line up a plan of care for her disease, and at 83 years old, she is having none of it. Since she is alone, I have no one to plead to on her behalf. I eventually ask why. After the deep sigh and furrowed brow, she tells me. She is caregiver for her invalid husband, raising, with full custody, teenage great!-grandchildren and even works a few days a week. She has lived most of her life in the US but has no friends for support. We change plans and come up with a good solution. She agrees because not getting treatment will shorten her time for caring for those relying on her.

Miriam reminds us that control is often a part of every action and decision. Be aware, make demands, never be timid. Whether it is navigating your daily life, or facing down an ailment, even cancer, after you tell yourself to have a “good morning” (last week’s post) act on that directive all day and do it on your terms. Stay safe friends.