Category: control cancer

person riding on horse under cloudy sky during daytime

Lucky Strike

Joanne Dragun, M.D.

Did you also chuckle as Rich Strike was led into the starting gate last Saturday? At first odds of 99 to 1 then “improved” to 80 to 1, we had to assume he was un-yoked and dragged off the farm that morning. I said, “Oh, that’s so sad, he will be humiliated, poor baby”. Hilariously, he proved us wrong, perhaps because he didn’t know any better. He wasn’t intimidated, or shy or even outpaced. He just showed up and ran his little heart out. When the Kentucky Derby gate sprung open I checked to see if he even knew which way to go. In the back of the field, I could just hear his thinking, “Oh, we are running? Where are we going? Oh, this is a race? I love races. Wait let me get around them! What, its over? I was just getting started!!” The drone footage is remarkable as this pony is seen maneuvering past while the others are in a stride, he obviously didn’t now his place. He just ran. Afterward, his exuberance was barely containable since the escort rider had to punch him in the nose to stop his excited biting- a way for him to express his joy.

Rich Strike striking a Derby win is a perfect example of what can happen if no expectations are set. No one told him he was out of his league. He didn’t know his statistics; he just ran his race. This young exuberant three year old is the teacher today.

In the clinic, patients will ask, “What are my chances, my odds of beating this; what’s the prognosis?” You can explore your own disease stats on line…. what they won’t tell you is that each cancer is completely different for each body, every immune system, all confluence of strength and adaptation in every person, and every year there are exciting new developments for treatment. My own pattern of practice is to treat as if everyone can survive everything long term.

And so, when I evaluate the patient I look for all the signs that they too can be a winner. They may be faced with the biggest obstacle, but if we tap into their strengths, manage them for success, they may also surprise us. Long term experience has taught me just how very unique each person is. So I tell patients, “Someone in every trial and study is a winner. Even if it is a small percentage who survive long term, for every single disease someone does. Let’s treat you to be the outlier. You dig into the battle, your team of doctors will provide every possible known therapy and only then we will know if you are in that small percentage of those who thrive. Why would we dare treat you for anything less than full blown success?” We will help guide, but you will make decisions. I will promise you, if your treatment is not going well, I will always be honest. If hospice is appropriate, I will advise.” However, while we all appreciate honesty, optimism can impact outcome.

When you are in the race, keep the blinders on and push for power. You will also feel the excitement of a battle if not won, then at least fought. Don’t let anyone convince you that 20,30,50 or even 70% is good enough for you. Somebody is going to come from behind and against the odds have their disease controlled, if not cured, why not you?

Let’s let this lucky, spunky pony inspire us today. He just didn’t know any better than to expect success. His surprising acceleration may encourage and propel each of us to achieve against the odds.

Note: I mentioned this once in a thousand year phenomenon a few weeks ago..the planets’ alignment continues so check out Venus, Jupiter red Mars and Saturn before dawn this week and take a breath of fresh renewed spirit.

Pain in the Neck

Joanne Dragun, M.D.

On a scale of one to ten rate your pain. What a ridiculous evaluation yet we ask it every single time a patient presents. If you have pain anywhere from anything it is all consuming. You don’t think,”well its just a five”. You want it gone and now! Even a toothache is worse than some post op or cancer pain.

In radiation we treat patients often for palliation, hopeful that as the tumor shrinks, it releases the nerve and clears the sensation- doesn’t always. For years I have prescribed opioids and now with the epidemic of abuse, cancer patients are made to suffer and find alternatives. I have never been a fan of the use of morphine, oxycodone, fentinyl, oxycontin etc. because they work centrally on the brain’s perception of pain. I believe managing it locally at the source is less toxic and addictive.

The pain clinic (not pill mills) are a good place to find experienced anesthesiologists who can inject a site for relief. Medical marijuana is legal in Florida if you can jump thru the hoops and can spare the cost.

Bessie came with her son. He is desperate to find her relief for the spinal fractures from multiple myeloma. She is now a full 2 inches shorter and bravely uses a walker. “Doc, my son wants me to smoke dope!” says the eighty year old. I advise, “That won’t be necessary. Lets get you set up with a Doc who can help”. A month later, Bessie returns. She is using the medical marijuana oil drops under the tongue and the pain is manageable. The relief on her son’s face is evident as well. She has less confusion, sleepiness and constipation as the narcotics are weaned down. “Doc, who knew at my age I would be on marijuana!”

It doesn’t work for everyone. There are regulations still strangling and since the federal government has it listed as illegal you cannot visit your grandchildren across state lines with it. I expect changes are on horizon as a bill recently passed the house. The poor grandmother arrested pre-pandemic in Disney for carrying her legal medical “stash” is one reason the law needs to change.

Local injectables, kyphoplasty (rebuilding collapsed vertebrae) nerve calming meds like gabapentin and lyrica, antidepressants are all alternatives to narcotics. Most pain specialists are anesthesiologists and will explore multiple options. Perhaps even medical marijuana. You do not need to suffer. If you or a loved one is in chronic pain for any reason, see a pain specialist. It is high time to breathe a sigh of relief.

Set an Intention

Joanne Dragun, M.D.

We need a break. Help re-focusing. If you watch news, you may feel your head exploding. Let us find a way to a new refreshed personal path.

Prior to every yoga practice the instructor invites us to “Set an intention” or to “Dedicate our practice to someone”. Often my intention is to avoid falling over, but that’s not the idea. Let’s borrow this practice for ourselves and make a new life affirming action. Your morning has opportunity to be a true awakening not just to the day but to your life. Let the first idea become your intention- no pressure. Eventually this will become a habit that will return to bless you everyday.

If you start to do this daily, you may have 365 different intentions in a year or one that enters your consciousness daily. Its a simple way to send love out into the universe at no cost or effort to you. Maybe your daily intention can be to see beauty, or remember to take a cleansing breath or to practice kindness, to have more abundance, or to be grateful or to be a blessing or to put a problem or someone you love into God’s hands.

Every intention is as unique as the person thinking the thought. If this is too esoteric for you then begin by sending love to someone today. Starting your day with a selfless, outwardly directed thought will begin to open your heart and help you to visualize your life in a more deliberately positive way. Be generous with your thoughts. Believe that you are impacting the energy of the world with your mind because you are.

I have found in my practice that most families impacted by a cancer or life threatening diagnosis pray. I believe in the power of prayers but not every request is granted. We are not privy to all the plans and sometimes can feel disappointed. Setting an intention brings the power into you. It allows you to decide, then act on a focus today. Not just hope, but to be engaged with the thought enough to have an impact on the outcome.

Simple works. Instead of listing everything and everyone you care about, you get to think of just one action, person or blessing, knowing that you have another chance tomorrow. Everyone needs a reason to get up in the morning. Include in your reasons a special intention making this a wonderful and worthwhile day. Namaste.

Kaleidoscope

Joanne Dragun, M.D.

Turn the dial, just a few millimeters. Change the direction: a green tree, a blue sky. Marvel at the prisms, colors, dimensions and complexity.

The simple toy is able to capture our imagination reminding us how each point of view is influenced by minor movements. In medicine as in life, each of us have unique perspectives and they change daily. It is helpful to recognize how a slight change in thought, knowledge, or circumstance will influence our choices. Since “the only thing certain in life is change” we should be open to all possibilities.

Just a few aging and healthcare examples: Many seniors have said, “I am never going into a home”. But now three cooked meals, socialization, care and attentiveness look better then loneliness and rigidly holding onto an outlived house. Patients often present with cancer and say, “never chemo!” But when the grandchild climbs onto their lap and holds their face in their chubby hands, their heart melts and they nod, “Do everything possible”. A newly diagnosed patient enters the center, looks around and sees others getting on with life not terrified or broken and now their spirit lifts with hope.

Doctors are taught to view every decision through a patient’s point of view but we bring our own prejudices and need for rescuing into the mix. This week Dolly is so frightened of side effects she almost says no to any treatment and her family are adding their own concerns to her fear. She doesn’t see a way out, but we implore Dolly to to trust in her own courage and a new prism of hope takes hold.

Even more complicated is recognizing that within your own circle of friends and relatives, even spouses, their viewpoint will not coincide with yours. I have had to tap into this awareness often in my career. Every single time I sit across from the person scared or suffering or questioning and open my own mind to their viewpoint. It takes practice and patience and we don’t always get it right. What I think I understood today will change for them tomorrow.

I offer to you this week just that wisdom. Realize the frame of reference for yourself and others regarding any situation is almost fleeting. Don’t get stuck. Know that you can change a view swiftly and without any effort. It is always available to you. Nothing is firm or fixed and options are everywhere. You are the one holding the viewer. Turn the dial and prepare to experience a new and wondrous change in life. Allow the magic to unfold for you.

Big

Joanne Dragun, M.D.

We all recall the wonder-filled upbeat movie “Big” with Tom Hanks. The title reflected transforming into his grown-up body while still a child. The concept of living big with a child-like wonder can inspire us all. Dancing on the keyboard, falling for the pretty girl, though shy, making bold and wild ideas come to life in toys… living big! Lately, we’ve been doing the opposite. I listened to a meditation recently. The guide had many suggestions to keep things simple and contemplate small, taking time instead of just barreling through life. I am not having any of it. We are done living a scared, tight, small existence. We only get one life and while a virus has upended our peace, we can still be bold.

When Norman came to see me this week, the tattooed motorcycle rider was used to living in a big, gregarious way. The new diagnosis of cancer at only 45 years knocked him over. His whole perspective on life changed with one scan. There is a disconnect between his activities, travels, work, family, and friends, and this new threat. “Shoot me now, Doc! I guess I am dying. How’d you like that for a kick in the head??” This lifestyle change is more than he bargained for so early in life.

 I remind Norman that he didn’t ride his Harley cross country until he practiced around the block. Ramping up to “big” takes effort. “Norman I want that life for you as well. You can still live large, unafraid, fearless. Right now we need to manage the confusion and terror. You can’t get out of the rain until you build a roof, so let’s get started on therapy to protect you”. No one, regardless how tough is not afraid of cancer- double negatives for emphasis. During therapy, Norman needs hope for the future. Eventually, he will improve and there will come changes but he will have time to acclimate to them.

Lives have changed everywhere this year. Every one is not getting back to normal with covid either- there are jobs, businesses, and health changes for many- even psychological stress. Our child-like wonder has vanished. So its time to think of new normals and give ourselves the chance to be fierce and excited about our futures again. We are not here to live small, mousy insignificant lives. No matter the stressors- you are in this life to make a difference, love your family and friends, engage with passion and deliberateness.

The next day Norman came for the simulation to start the planning for radiation. He rode his Harley, walked in the door as if he owned the place. Gone was the downward cast eyes and quiet frightened demeanor. He was big, bold and brash and I loved it. “Bring it on,” his attitude said. That power will give him strength for the battle and surely impact his immune system. If he succeeds it will be all him and he will go on to live and love a big life.

Thanks Norman. You were just the shot in the arm we all need now. You will inspire others and we will all embrace a full future without timidness or fear. It’s important for us to live big lives in honor of those who miss having those years. Let’s all make the most of rejuvenation after the recent months of fear, and engage big and expect bigger.

See No Evil

Joanne Dragun, M.D.

The great thing about murder hornets (oh come on Joanne) is that we know what they are and we know what they do. There is even video of them ripping off the heads of bees- not good. However, I respect them. They are not hiding in plain sight, waiting to wreak havoc by the careless rub of the eye or scratch of the nose. (Yes, keep washing hands).

Florida is lifting restrictions quickly and as ‘stay at home’ is over this week, many are having to find their shoes and squeeze into something other than sweats. Release from captivity comes with responsibility. Respect that someone you encounter could be immunocompromised or lives with someone who is. Just because we cannot see this virus doesn’t mean we can be complacent. All along I have been in favor of living strong and brave but wise.

The virus is a lot like cancer in its surreptitious way. Skin cancer we can see, but the million of other cancers per year hide under that beautiful exterior, wreaking their own havoc on unsuspecting organs. Patients are always fascinated, if not horrified, when we review scans and can actually see inside the body. It helps them to arm for the battle.

This week’s literature tells us people are avoiding hospitals, procedures and screenings. Physicians are concerned people will miss the chance to get care early in disease stages when curable. Healthcare centers are safe and have every protection so have no fear. What isn’t safe is this cancer risk because of covid, 30-50% of cancer will go undiagnosed this year. Survive the pandemic to have an uncontrolled cancer? Don’t do it- be smart.

Pandemics end in 2 ways- they kill everything and then have no hosts or they mutate, become less lethal and highly infective (like this one) and we learn to live with them. Don’t wait for a vaccine- it may never come. So please take control of your life and get the care that you need. 99.97% will not be impacted by this virus but 2 million will be diagnosed with cancer in 2020 (better news- there are 18 million cancer survivors). Lets focus on what needs attention.  Let the murder hornets and virus go- it is time to take care of yourself. Continue to be smart when you go out and now maybe even add some non-toxic bug spray.

Source http://www.cdc.gov/cancer

Red Light -Green Light

Joanne Dragun, M.D.

We’ve tired of  the “Simon Says”  game I recalled a few weeks ago. Next up: Red Light Green Light: Go- don’t go. Stay- go with care. Go now because you may not go next fall or winter. Or ever. Our heads are spinning. Some scientists are holding onto the directives as if those alone will cure us. They resist giving us permission because they do not have all the data. The parochial nature of investigations has paralyzed us but they are unwilling to give into loosening or lose credibility. The scientists working on a cure, control, studying data, and researchers on every front are all feeding their families. They have the luxury of holding everyone hostage until their tracing, testing and insatiable need for data is satisfied.  Many news reporters “tut-tut-tut” about states opening (again they all are working).  We gave the scientists our devotion and attention.  They, not us were reckless. They were erroneously telling us in January “the US had nothing to be concerned about,” and they had to revise broken CDC tests, then these same scientists required a double check while the cases were exploding limiting contact tracing.

In the mean time, the world took control and managed the care needed by the thousands of critically ill. The virus will not change. The response is what changed – the armamentarium of management and care to the rescue. Working on therapy and vaccines is critical but as long as we can rescue or manage the majority (99.97%) we should be about living while they research.

Every doctor’s background is science. I cannot turn the radiation beam on without documented evidence of safety and efficacy for every type and stage of cancer. We do not put patients on the table and deliver light therapy. We respect that all science leads treatment. But we are seeing millions of people forced to give up livelihoods by the government until the scientists advise otherwise. Control of the masses. Some from  the ivory towers are now cautiously whispering that the testing and tracing won’t work and the vaccine may never be found. The deaths are tragic. Lives are changed forever, families broken, loved ones lost and as a world there is grieving. The inertia must however end.

I am already seeing the patients who bravely waited at home- tumor growing right in front of them and perhaps now not curable. Who is liable for this? The greater good is served by freedom and taking responsibility not by letting criminals go free and arresting mothers on the beach. Where is our common sense? We are not invincible, but we are smart and usually cautious. Covid is not the plague, cholera or Ebola. It is not wiping out everything in its path. Yes the toll is tragic as with other diseases and infections. Surely it will continue to infect millions. Cancer patients are at higher risk and must be guarded. The elderly and nursing homes must be protected. I am among many physicians saying that whatever path we are on now for children and the masses cannot be sustained- and even more so maybe it isn’t necessary.

I wrote weeks ago about opening the house to air. I am now saying open the doors and we will accept the outcome.

Addendum: Thank you Gov. DeSantis my patients can now have testing and procedures starting Monday. Remember, even when the stay at home expires, if you are at risk, use judgment and protect yourself. The government doesn’t need to do it for you.

 

Stop the World

Joanne Dragun, M.D.1 Comment

My father loved to sing and some favorite tunes came from a Broadway play,” Stop the World- I Want to Get Off” (1966) with Anthony Newley. I wonder what he would make of this pandemic which has actually stopped the entire world. But we cannot jump off; we have to find a way to be right here and now. Clarity is lacking.  The overarching directive is: everybody stay at home until we figure this out.

Sure we hope there will be a vaccine eventually and a treatment that rescues those at risk. Perhaps we’ve already blown past the testing and contact tracing that may have been helpful early. We are finding just this week that the virus was here and contagious long before expected and millions are probably already exposed. Can we really expect the luxury of studying thoroughly before engaging? No.

We are impatient now- we did the work of stopping our lives for the 6 weeks needed to ramp up requirements to care for the critically ill. Hospitals were built, the military involved, the all hands on deck efforts have succeeded. Hospitals and ICU’s are waiting for the surge. Nursing homes are under more scrutiny.  Taking the first baby steps back into the world is becoming necessary.

Unfortunately, this selfish virus and the impact of devotion to it, will have unintended consequences.  We are ignoring the health and wellbeing of our patients while waiting for control of this virus. Well, life cannot wait for a cure or vaccine. After forty years, there never was a vaccine or cure for HIV-Aids. There is no cure for the common cold either (a coronavirus) so we need to be realistic. These discussions are happening in all specialties. We can no longer ignore and stand by. Collectively all healthcare is ready to get back to caring for you.

If you have an issue, concern, lump, bump, a need to be seen and your physician’s office is closed, then call a cancer center. They are open and ready to help. If we use safety measures, we can get back to the business of saving lives. That’s living. We cannot stay distracted with inertia. We must help you to stay well. We are here for you and ready to be champions for your care.

We all are ready to step out into this new world. Paralysis is no longer a healthy option. Some habits remain: washing hands, avoiding crowds and elderly at risk, wearing masks, wiping high touch surfaces at home and car, getting sunshine and fresh air. As we look around like hibernating bears, we hardly recognize ourselves- I’m not talking about the crazy hair or sweats. Getting back into the world finds us more thoughtful. We can see more clearly what we always knew, what is really important- the love of family and friends. As we re-engage we will all be more loving and devoted. That’s the clarity that will cure us.  The world may have stopped but you and I believe, as well as my physician colleagues around the globe, that we have the power to give it a push to start turning again.

Cancer and covid

Joanne Dragun, M.D.

After 9/11 we witnessed the disruption in travel and the loss of innocence. We gave in and believed if we line up at the airport, put security and barriers around everything we would be safe. There are many similarities this week with the new threat. If we allow, it will be all-consuming and steal our money, entertainment, family and friends interactions even toilet paper. For cancer patients, it may even steal their cure.

Jeanine starts her therapy this week. “Doc, shouldn’t I just wait until this all blows over? I don’t want to get sick” I express to this frightened patient that as long as she is careful (you know the drill: hand washing, no touching the face, avoid others, stay home) we should treat the disease she has, not the one causing fear. The common flu is ubiquitous and deadly* but we don’t stop our lives. We live, we manage, we are brave and not giving into this. Not to be brazen and unwise, just to maintain control. Being anxious, fearful and paralyzed does nothing to contribute to our wellness.

This virus is not seeking us out. It isn’t tracking us down and attacking us in our beds. It’s all in the way the information is approached. We never ever had this level of tracking with other non-curable viruses that caused tens of thousands of deaths. You probably barely recall the bird flu, the swine flu, H1N1. You still worked and lived your life and although many people did succumb to the infection, the world and your own life didn’t stop unless you were directly affected.

In oncology, I actually do have a recommended answer for Jeanine. Medicare (CMS) has come up with suggestions for treatment. Low-risk cancer can wait a few months, medium risk are at the doctor’s and patient’s discretion and high risk should move into care. Cancer centers are well equipped with the ability to sanitize and care for very ill patients. What arrogance this virus has to make us postpone our own well being. In some cancer cases, months are short- should we just abdicate the time we have?

So what are my recommendations after hundreds of hours researching and reading, seeking counsel and advising? If you are well, do not seek healthcare at all. No followup routine visits, no testing, keep yourself away from the ill and frail for your sake and theirs. If you have started therapy or are of moderate or high risk (check with your oncologist) go full steam ahead. If you are newly diagnosed and low risk consider waiting a few months.

This virus isn’t going away but over 90% of us will survive it and even the elderly frail at risk survive 85%. If you venture out you won’t know until up to two weeks after if that was a mistake. But do go out for a walk in nature- the runs to the supermarket or home depot are over for now. A new dynamic has been birthed making communing with nature more precious. Taking a break from our busy lives is something we rarely do so enjoy the peace and solitude. Then be ready to jump back in, hopefully soon. We cannot wait 18 months until there is a vaccine to live. We should be determined to survive and thrive in spite of this virus.

I am going to be strong with you. I am not going to be still hoping a cure will rescue me or a drug will treat me. If that happens fine, but the news would have you believe it is the only way. Make your own way. Don’t be careless but don’t be frightened. Fear didn’t keep cancer away so there really isn’t any therapeutic value in it. You have the power to handle anything that comes your way.

For up to date information: http://www.cdc.gov                                                                                                     *note (hopkinsmedicine.org): flu, 1 billion cases worldwide, up to 646,000 deaths. Up to 60,000 deaths US.

Addendum: The $2 Trillion rescue plan was passed by a self-centered congress yesterday. They laughed and patted each other on the back (hubris ignores social distancing.) While we the people take out an enormous loan for politicians’ special interests, let us pray that my colleagues on the front line will receive the equipment they need and not find it necessary to wear trash bags and bandanas. Doctors, nurses, EMTs are naive- we don’t catch diseases like cancer, heart attacks, strokes, and so they jump in and rescue no matter the thought for their own safety- always. They believe they are invincible even in the face of this invisible pathogen. May God bless their bravery and provide.

 

Powerful forces

Joanne Dragun, M.D.

What passes as “news” can only leave us with one conclusion: no matter your wealth, power, business acumen or intelligence, no one is immune to outside forces. President, CEO, prince, icon, there is only so much we can control. Its a fallacy that’s life long: if we get an education we can control our career. If we exercise and eat well we can control our health and perhaps longevity. If we avoid toxins we can avoid cancer and heart disease. If we pay bills we can keep our house. If we don’t drive under the influence we can avoid jail. While there are positive effects of these behaviors, real control a fantasy.

Why the fatalist attitude doc? You are depressing us. My hope is to have you see that the real power is coming from within, not outside forces. Were you in control when you met your spouse, discovered a career you love, met a close friend, raised a husband, I mean child, came upon a place you love to visit, found that you have a hidden talent? No, most of this was serendipity. We read articles and search the web hoping we find just the right cure, a new discovery of magic that erases all woes (or wrinkles). Lets not be ridiculous.Its impossible.

So what’s the message? We only have control over our reactions- to the insult, the pain, the illness, the fun event, the loving gift- all of it. This is actually a great place to be. Instead of ping-ponging around and living a life confused, damaged, fearful or messy, get in the habit of watching your life like a bystander and decide for yourself if you will engage. It’s the reason we started the year with meditation. This practice, even a few minutes per day, helps us with that awareness.

There are decisions we get to make- will I accept treatment, where will I live during therapy, should my husband be in hospice, but decisions are not control. Relieve yourself of the burden and some days just control your breathing while the world tumbles around you. It can be very freeing. We should stop trying to control everyone and everything. Just go ahead and experience the relief of that concept even for just a few minutes. The outcome isn’t ours to decide. Our reaction is.