Category: Life after cancer, cancer support, cancer therapy, finding purpose

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.

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.

Age

Joanne Dragun, M.D.1 Comment

What word should we use? Middle age, senior, super senior, old, older, young, youth? Often I hear people say, “Oh I am getting old” if they have an ache or pain. Everyone is horrified when the AARP invite comes, how did that happen? Medicare “wellness screening” starts at 65 and in the medical record they have to ask all sorts of probing questions such as, “Are you forgetful, do you fall, how is your memory” etc.etc. The checklist is all so insulting.

The very first doctor’s visit after 65 definitely causes us to take pause- oh I guess I am now a senior citizen! Ha! I don’t buy it. “It all goes down hill after 70 doc”. Well Abe shouldn’t tell that to the 112 year old youngster from Japan. He made the news this week as the oldest known man. Photos of Mr. Watanabe and his wife are adorable. The oldest living woman is also from Japan at 117! So Abe at 70 is only 2/3rds there and when he beats this cancer needs to make plans for a future. That is if he follows Mr. Watanabe’s recommendation and smiles everyday!

How to approach this creep to geriatrics? Perhaps we should choose to ignore it. There are many freedoms that come with ahem..aging. You can exercise today when you didn’t have time for it while raising kids. You bring wisdom into your life not available in middle age. You can learn to enjoy the simple, leaving behind the frenzy of overdoing everything. You become more aware that positive words should be spoken in every situation and avoid piling on the crazy (which will dissipate quickly if left alone). You can choose when to engage and have less ego about it.

Consider a new mind set- not “I am getting old” but “I choose to live full blast as long as possible.” Blow through the midlife and charge into aging not letting aches and pains define you. If you have a major illness, don’t allow it to steal your time. The next day, years, career, golf game, book in the queue isn’t promised.

So live that life at full speed. Don’t give into that misleading review of symptoms docs inflict on their questionnaire. Prepare but don’t abdicate. When the finish line is in sight that is soon enough to finally say, “Okay I am ready to break thru the ribbon. I didn’t slow down because of some concept of aging.” God didn’t put us here to rest- there is ample time for that. There are many in our families, our friends, and young veterans whose lives are cut short. They would be disappointed if we didn’t appreciate or we gave into a lesser life.

I strongly disagree with Dr. Zeke Emmanuel from Penn who helped craft Obama care and wants to stop all healthcare after 75. He says he wants to only live ’til then because you are “slower, less of a contributor” etc. What nonsense. We dishonor all those who didn’t get the chance to age or age well. Be strong everyday. Be fierce. Do not go gently. If you are lucky to hear the two minute whistle, then decide how those last hours are spent, but do not do less, be less, or give in, because a number defines you. You are are not old. You are lucky. And just maybe, you can also reach that 112 number with a smile on your face.

The Greatest

Joanne Dragun, M.D.1 Comment

If you’ve visited a doctor’s office or ER, you may have been asked: “Why are you here today? What’s wrong with you?” (??)!! What a way to start a conversation!

Regardless the ailment, when you are seen in any medical office, you are handed paperwork to fill out listing all of your afflictions. This week I read through an orthopedic surgeon’s consult that, due to electronic medical records, was 13 pages long. It detailed everything about this patient, Mr. Pratt, from birth to present. Three small words near the end said, “No surgery needed”. What I found amazing is that in the report no where did it list anything that was right and good with this patient who unfortunately was diagnosed with prostate cancer in his bones.

The consult carefully crafted, didn’t say that up until this new pain, Mr. Pratt played golf, ran a business, was a terrific grandfather, married 50 years, volunteered at his church, looked after his also aging neighbors, had coached his son’s soccer team, taught his daughter to drive a stick shift, boogie boarded in the ocean with his grandson and thousands of other personal history items not found written anywhere in Mr. Pratt’s detailed report. But aren’t those the aspects of life that are really important? In the cancer center we analyze every minutia in records and films that is abnormal. Always looking for the dis-ease. Sure we are there to fix the abnormality but we can forget the good in the history, the real reasons Mr. Pratt is seeking care.

I recall the shock when Mohammad Ali described himself- such conceit, and pride. He made it his identity. Now so many years later, if you say “the greatest” the champ still comes to mind. There is nothing wrong with acknowledging our own strengths. Unfortunately, if you or a loved one are ill, all the focus shifts to the sickness. Everything else is forgotten until this one abnormal thing (such as cancer) is fixed.

May I suggest that you take a few minutes to define yourself? You have strength, wisdom and life experiences. Give yourself your own pat on the back everyday. Don’t let illness or injury define you. If you care for someone who is ill, then help to give them the dialogue. Remind them of how special and talented they are. Not just “I love you” but the why. That is the heart of the support. Don’t forget yourself. Look in the mirror everyday and remind yourself who you really are.

“Doc, I thought I was going to die. I was so scared”. Fear made the situation worse. Now with treatment, Mr. Pratt can get back to all that he loves and truly makes him great. Stronger in mind, body and spirit. He is able to face more challenges to come, not letting his identity be lost in the struggle.

This is what you deserve. Really seeing strengths behind the affliction. Then reaching out and helping you to reach within and gain control. Cancer physicians work feverishly to deliver the knockout punch to cancer. When we offer the hand to help our patients up from the mat- that is where the real healing resides.

Tell yourself everyday that you are the greatest. You deserve that identity too….because you are.

Just say “No thank you”

Joanne Dragun, M.D.6 Comments

First off, ‘no’ is not a four letter word. I recall the grades in Catholic elementary school. One was for obedience. There were many parents incredulous when their errant child came home with an ‘A” as they double checked the name on the report card. They’re often obstinate child seemed perfectly capable of following orders- just not at home! Anyone over fifty recalls when obedience to authority was valued and we feel guilty not complying with the norm. So, let me give you new permission. Saying ‘no’ is not defiant or selfish. In healthcare, decisions must conform with your own values, needs and vision for your life.

As a doc we say “treat” or “get tested” or often we just set you up for this craziness without asking. It’s a “trust me we know what’s best for you” mentality and you may be tempted to fall in line to get the coveted “A”. But treating cancer and all disease should come with life options, not just treatment options. Sure therapies have changed but more remarkably the decisions have too. Patients in the ’90’s would sometimes say, “Whatever you think, Doc”. Now they come with reams of web information. But here is what I find interesting: People are taking control of their therapy, not just with information but by bringing into the plan their own unique perspective and needs.

“Doc if I cannot be cured, I will not use our retirement savings for treatment. My wife has longevity in her family and could live another twenty years. I cannot leave her broke.” Mr. James has a point about consuming resources. Carlos has a great life here in the states and regularly sends money home to Honduras. “I can still work so if you could just help me survive as long as possible, it’s not for me but it’s good for my family”.

Even small issues are on the table: Sandra will not agree to a chemo that causes hair loss before her grandson’s wedding. “Its going to be the last time many of them see me so I have to look spectacular!” Elaine is a quilter and refuses the chemo that causes peripheral neuropathy with numbness in her fingers- she’ll accept the hormone therapy but that’s all. For the many patients I care for, it is not about whether they can survive and “do everything”. Often the decisions are about other aspects of life.

My best advice is very simple: If you or a loved one are diagnosed with an illness, listen to the “gold standard of care” from your physicians, do some research and then weigh the pros and cons of going all in vs no or less therapy.

A Doctor’s dictum is to “Do no harm”. I believe this includes encouraging the patients’ decisions, and avoid forcing our own skill and value system on them. Just because I can treat doesn’t mean that I should. Back up a pace, evaluate what is right for you.

If you have a doctor who is dogmatic “my way or the highway”, find someone who really sees you and accepts your role in the process. We don’t pay for your treatment. We don’t go home and care for your children, or help your parent, or spoon feed you grandmother. We don’t work your job and support your family. We are not attending your events when you want to feel well rather than sick with treatment. There is always risk to letting cancer grow, spread and take over your life. BUT there also is risk to saying ‘yes’ to everything.

Always speak up. Never be afraid. Find therapy that matches your own path and physicians who respect your part in the plan. When you are brave, find those who fight- fight- fight for you. When you are tired express that you are done. Live your own life always. Never be bullied even by well meaning doctors or relatives. You have the right to say ‘no’. Its not selfish its self-care. You will never ever be sorry when you are in control. We are all here for you, but only by choosing your own path can you have peace and your own unique wellness. Obedience to your own internal guide always deserves the “A”.

Hope for sale

Joanne Dragun, M.D.

Following Black Friday and Cyber Monday the next shopping enticement is the after Christmas sale. This subject came up as I visited with Beth last week and we discussed the festivities of the holidays. Its been a challenging six months with a diagnosis of pancreatic cancer for this lovely 62 year old. She had great joy visiting with family including several grandchildren- fully aware that next Christmas may be quite different.

“Doc, listen to this: I found a way to express faith that this year will go well for me. I went after- Christmas shopping and bought beautiful cards and ornaments. I especially like the ones with this year’s date because it’s a time I will never forget”. Beth is doing well and her last scan was stable if not improved. “Doc, my sale shopping gave me something tangible. Each time I look into the closet, I will see a sign of my faith”. I ask if I can share her unique idea with others. She said that when she didn’t have strength, she believed there was a mission for her to complete, even if just to inspire others. “I made a decision to write out my cards now for next year. I can enjoy crafting a note of love to my family and friends and if I am unable, then I will ask my husband to mail them next Christmas. Won’t everyone be surprised?!” I thought, what courage!

“After all Doc, what’s the sense of buying something on sale then not using it? That would be throwing money away and I’ve always been thrifty. I often look through my box of treasures and mementos. I like sending something tangible- people aren’t going to store emails for years. As I go through boxes of pictures and reminisce, I pull out pics to tuck into the cards too. What do you think?”

“Beth, every card you send will be a gift to your loved ones, so I agree the idea is wonderful.” Writing good wishes and sending love to others is a clever way for Beth to boost her immune system, perhaps enough for her to mail them herself next year. Never doubt the value of faith and hope. We cannot buy them; we cannot invest in them; and we cannot gift them to someone. We can only feel and believe. Faith and hope are never on sale but always priceless.

2020 Vision

Joanne Dragun, M.D.

“Future is fantasy“, Yogi Caryn softly reminds us to pay attention and be mindful, a requirement to avoid falling over in the balancing poses. Her words resonate and have everything to do with life off the mat. But many of us resist the idea that projecting into the future is fantasy. Isn’t this refreshing new year and decade all about expectations? Are all resolutions flights of fancy? Is it conceit to think we can conjure a future based in desires? 2020 vision is perfection, so it’s exciting to anticipate “seeing” the best in our lives this year.

The lesson from Caryn is that living mindfully now influences the future. Moving toward a vision with passion adds excitement and commitment to our lives. But over investing in tomorrow, steals the present moment.

This 20’s decade provides us with a new starting point. As with any goal, preparation is key to success. While we focus on the year ahead, may we consider the concept that centering our minds prepares us for a better future with clarity? Caryn is encouraging us to be here right now and the benefits will follow. It really is not hard, we can re-train our thinking with meditation. It is a way to control thoughts and help us cultivate a habit of mindfulness.

“Oh Doc, I barely have time to make a meal or do the laundry; you expect me to sit still?” Yes I do. My sister Marie (who is a bundle of energy) thoughtfully gifted me a meditation app and I am taking time to sit quietly everyday, so lets do this together. There are several meditation apps that can guide you toward enhancing your well being far beyond what making a list of wishes can do. It only takes 5 minutes per day.

This new year’s commitment can benefit us the entire year. All those years of making and breaking of resolutions just led to frustration anyway. Let mindfulness be your new steady state and expect greatness to enter your life.

If you need convincing, meditation benefits you because it reduces inflammation in the body which is the root cause of cancer, heart disease, diabetes, arthritis, autoimmune disease, hypertension, dementia and memory loss and so much more. So, doctor’s orders: close your eyes, follow the breath and enjoy a new vision for 2020. You deserve this.

Happy 2020. My vision sees a perfectly wonder-filled year ahead for you.

Angels and Elves

Joanne Dragun, M.D.3 Comments

A brick row home in Philadelphia set the stage for brilliant excitement of the season. Large bulb colorful lights framed a doorway as a beacon of warmth and love. The chubby Douglas Fir tree was tucked into a corner of the living room as space magically appeared to accommodate. A Lionel train chugged thru the carefully and lovingly placed tiny colorful houses lit from within. “Merry Christmas Happy New Year” banner was anchored over the arch into the dining room announcing a welcome to all and a cardboard fireplace in another corner with stockings attached. Relatives arrived regardless the weather, filling the home with love and cheer Christmas Eve and later in the evening an open house began. Mom passed her homemade pizza and Christmas cookies to joyful neighbors and friends who, in this mostly Jewish neighborhood adopted the holiday for the evening.

Twenty years later while working at Fox Chase Cancer Center in Philly, I witnessed a similar phenomenon. The hospital was well loved and developed a wonderful tradition. Permitting as many staff as possible to be home with families on Christmas, it opened its doors to the community for help. Barreling in, long before ugly Christmas sweaters were a thing, the excited Jewish community arrived in festive attire and joyfilled hearts. There were no HIPPA laws so they could help at the nurses stations, the kitchen was buzzing and no one cared if the orders were correct. Two elderly ladies struggled and giggled to work the industrial bucket wringer until they gave up and swiped the sheet from a gurney for a large spill. Men carved the meat in the busy cafeteria as if they were tailgating, the dessert slices were generous and the festive cafeteria gave the doctors, nurses and staff, who were necessary in a busy hospital, a chance to enjoy the excitement.

I cannot tell you how very grateful I am and I want to personally thank everyone who contributes to helping others treasure their holiday time with family. A colleague from Pakistan routinely covers another physician and I have a wonderful Doc caring for patients so I can visit grandchildren. When I was an intern on call and working 100 hours a week, my request for Christmas day off to be home for my sons and husband was ignored. When the schedule came out, tears sprung to my eyes and I could hardly get thru morning report. I was crushed with one more sacrifice; 36 hours on call. It was all just too much. A fellow intern put a hand on my shoulder as we headed out the door. “Joanne, out of 40 of us, you are the only one with children ( I was 12 years older having started school in my thirties) my girlfriend is out of town for Christmas but wants to celebrate New Year’s Eve. Lets switch!” And just like that my own Christmas was saved by a magical 6’4″ elf.

Christmas isn’t just a religious holiday. It holds excitement as children that evolves as we age, to anticipation of togetherness, gifting our hearts and love to each other. The emotions are fierce.

To those who celebrate and those who make it possible, my heartfelt wishes for every blessing. My thanks for your support, hope for those deployed for safe return, health for those who are ill, comfort for those who suffer, food for those hungry and warmth for those who are cold, memories in our heart for those no longer here to celebrate. Love for us all knowing that we are a community of people faithful to each other and God has given us a season to celebrate the miracle of our sacrifices and love.

Happy Hanukkah, Merry Christmas and Happy Holidays. May your every wish come true.