Category: life change

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.

Gifting

Joanne Dragun, M.D.

A lovely patient has been busy through chemo and radiation sewing beautiful masks. The fabrics are fun and fanciful yet keep toxic inhalations at bay. She even included some college teams. Her gift of love is extended not only to our staff and fellow patients, but she is mailing to Texas, Ohio and other cities in Florida. It is a great way to share the “we’re in this the together” time. Another patient is making meals she shares with an elderly neighbor. He helped her through her drama of diagnosis with his own strength with cancer history. Mrs. Charles gifts a large pack of precious toilet paper to another patient, Mrs. Evans who is in a wheelchair and unable to go anywhere except this therapy. The gifting and kindnesses go on and on (as is usual with cancer patients anyway) but more so now. This lifts everyone’s spirits.”Doc, its never about me- everything I do, even this therapy is for my family” Hank says. Malinda is a substitute teacher, unemployed. She is “manning up” accepting the risk  helping at the church to make food bags for children- her heart is breaking for them more than her need to feel safe.

What is it with these cancer patients? They are such a fierce group. “Doc, you concern yourself with my treatment but let me live how I need to”. Maybe these gifts from the heart are what is keeping them going- being needed, which is a prime motivator for life. So these feisty cancer patients and survivors are changing my own dialogue. I want to say “be safe, stay home until there is a better way to manage this disease, don’t put yourself at risk (there are patients who have lost the battle not from cancer but the virus). But instead they teach me everyday. I now think: Be strong, don’t cower, push back, remain tough as you had to for treatment, don’t be bullied, spread love which boosts the immune system like nothing else can.

So a new message is evolving: Continue to gift your spirit- even  with a phone call. There is so much rescuing to do. The pain will only heal with human kindness- not a vaccine or drug.

There will be a time when our formerly self-centered lives return to a new normal. But the break in our focus is so dramatic, devastating and gut wrenching that we will all be changed. People are waiting hours in line for food (“Doc, I’ve worked everyday since I was 14 now I can’t afford gas to come for treatment”.) There is no way this won’t have a lasting impact.

If you feel compelled and are able to help, I will not direct that you cower to the threat. Of course I want you to stay safe which may mean staying home. But we know that you are fearless and unlikely to listen to caution after these past months of peeking through the blinds.  Instead I encourage you to live that life of sacrifice and strength that helps you to fight this cancer battle and continue to be unafraid. You are needed. (Just wash your hands and wear a mask).

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.

Super Spreaders

Joanne Dragun, M.D.

Hands washed. Check. Wipes in the car. Check. Sanitizer in the small purse. Check. Keys and credits card handy so no routing around. Check. MASK ON. CHECK! Heading out the door today for any endeavor takes some planning that has now become habit. With numbers increasing in Jacksonville, it remains wise to continue precautions. (Even the RNC canceled. The President’s need for adoring fans is like a need for air- just not this air!)

“Blah,blah,blah!!!!” I hear it across the store aisles. A woman is tossing things into a cart while on the phone- no mask. Not even tucked like so many under her chin as if she had a chin lift (you do realize there is no point of entry there). She is shattering my peace. It is smart to get in and out or buy online and when you can’t, then make your trips quick, efficient, and distanced. The reason I was appalled is that she didn’t distance, talking like that spreads,  and she seems insistent on avoiding responsibility. If someone has a medical condition enough to avoid a mask, stay home please. Like a bee you cannot avoid (well, more like a murder hornet)  she kept following me, so eventually I overheard her conversation.

It was a tirade of complaints from one thing to the next. Her “chi” was very disruptive and brought to mind Peanuts’ “Pig Pen”. I wondered who cared enough to let her whine. It dawned on me that she is a super spreader of hot mess. People who complain constantly, or just want to hear their own voices and not listen, are infectious too. It was noxious stimuli for me.

I rushed out to the safety of my calm, peaceful clinic. I thanked God that demoralizing and aggressive chatter does not happen in my sheltered space. Here, people have every right to be disenchanted with their circumstances. They may be too ill to care for themselves and need to move from home, concerned for the children who may lose a parent, fearful of cancer and it’s treatment now adding to COVID job loss and money woes, so many issues surrounding this insult that vary with each individual and family.

Patients are sitting in front of me daily who have every right to cry, kick and scream their shock, fear, and anger. Instead what I do see is a serenity that is ethereal. It’s not all acceptance; they are here to fight or at least learn. At every turn there is hope and always the love and concern for others come through loud and clear. Above their masks, the eyes tell me all I need to know. Wide eyes, a crinkle of smile, a soft tear- all at the same time in this sacred space.

You will encounter thoughtless people like that shopper many times now. I hope we all remember that many many more of us are being brave in the face of challenge, far beyond a capability we thought was within us. Positive, uplifting words are necessary now more than ever. Gentleness, a loving spirit, and show of courage are also contagious. Let us all be super-spreaders of the very best kind.

Telemedicine

Joanne Dragun, M.D.1 Comment

Have you tried this yet? Telehealth has been around for about ten years and a quick service for minor issues.  We have never used this for radiation therapy cancer visits but engaging with patients who do not require an in– person exam reduces their risk during the pandemic. What I am finding is that sometimes it’s a hoot!

“Doctor! You don’t look sick! How come I gotta talk to you on the phone? They say I can’t come because I might catch a virus.”  I am sitting at a computer in an exam room. Dalia is in front of me on her phone with facetime.  At 83 she needs to be protected but doesn’t fully understand how staying away from the doctor is better for her health. Her face is covered with a mask. “Dalia, is anyone with you?” She assures me no one- “Dalia, I am far away from you on the computer so you don’t need to wear a mask. We both giggle. “Doc, this is the craziest thing! I just want to come in and see you- how are you gonna examine me?” We review the reports I have but I agree this is profoundly limited.  We  set a time in a month for a “real visit”.  

Larry was in this week for a check up. At 87 he is having none of it. “Doc, if I am gonna die, you gotta give me a hug. I might not make it next year.” He always brings a smile. “Larry, your mother lived til 101 and your cancer is controlled, so no hug today, stay home and we will see you next year!”

Ginny is newly diagnosed, has several procedures this week and is frankly terrified. “Doc, I just need your comfort and strength.” You don’t get that from a computer. Mickey came in for a followup. “We could have talked over the computer” I say. She shakes her head, “Doc I live with my 96 year old mother, I was dying to get out for the morning!”. Harvey is happy to call it in and escape the prostate exam. Olive tries to stick her foot in the camera so I can see the swelling. We laugh about her being a contortionist. Mike is shy but finally turns around to show me a rash on the buttock that looks like shingles and needs treatment immediately. Understanding that cancer patients are frequently immunocompromised keeping them safe at home is important but limited.

The laying on of hands is a revered part of doctoring. I recall the first time we examined each other as med students, the scientific learning took a real turn. I have always felt that the bond formed when a physician examines a patient is a force. I never take for granted no matter the years, that you have placed your trust in me to use my skill for your benefit. It is always an honor and a sacred trust. It is never haphazard or routine. Touching another person for an exam has healing properties and the impression that telemedicine can replace is a fallacy.

If your doctor’s visit is set up for telehealth, go in prepared before you hit face time or Zoom. Make a list of your concerns and questions. Since you are not physically examined, this visit is unlike most and involves talking with your doc and they can only help if you provide real information. They are there to help in spite of the circumstances- we all know it isn’t thorough but it can be efficient and safe.

 I will see anyone who refuses medical care over a computer. My patients have a fearless spirit. They know that the virus isn’t seeping under their doors, tracking them down. They have learned to avoid risky behavior.

You and the USA have seen tough situations and prevailed. We will again. I will hug my patients again, I will give up telemedicine for the hand to hold and the touch to calm. I will be there for you and you will be there for others. Let’s be unafraid together.

 

Do this – not that

Joanne Dragun, M.D.

Recall the simple child’s game “Simon Says”? Your friends would have you do the craziest things and then everyone would giggle at the silliness. No one is giggling now, and yet we find ourselves in the midst of another crazy game. This COVID creep has crept into our lives with these seemingly random “Simon says do this- not that” directives. For all the independence we espouse, how quickly did we all adjust every aspect of our lives, stay behind the line, follow the rules in the hope of salvation? There is however, a sense of comfort that we are all facing this together. Many of us can recall a time we were challenged by a trial, sickness, cancer, injury, or fear and were forced to manage alone.  This pandemic, while physically pushing us apart, is bringing families, friends and even countries together.

We are eager to get it right and so we are complying with one way aisles in Walmart, washing plastic packaging, singing happy birthday (twice), not wearing a mask, oops now wearing a mask, and so many “Simon says” type actions. We wonder if the slightest mis-step will endanger us or a loved one.

Here is a recap this week of information and info that explains these random directives (Johns Hopkins*):

The virus is not a living organism like bacteria. It is a protein (DNA covered by fat) When it gets into your mucus membranes (eyes, nose, mouth) it mutates and multiplies. It isn’t killed but decays on its own. It is fragile so if you can cut the fat (foam, scrubbing 20 seconds with soap) the protein breaks down.

Other ways to disrupt the molecule: heat over 77 F for washing, clothing, alcohol over 65% dissolves fat (not vodka), 1 part bleach/15 parts water dissolves the protein from the inside. Pure hydrogen peroxide works but burns the skin. Vinegar doesn’t break down fat.

Don’t shake clothing and bedding. The protein will disintegrate on porous surfaces in 3-4 hrs, 24 hrs cardboard, 42 hrs metal, 72 hrs plastic (so wipe down products you receive or bring into the home.) Wash hands after touching everything and keep nails short. The virus likes to hide in cracks.

Dry, warm, bright environments break it down faster (warm, wet are worse) so air out your house and car. The more confined the space-  the more concentrated the virus. Limit time physically together especially in enclosed spaces. Think ‘under 6 feet away keep under 6 seconds’. The likelihood of infection in a quick transaction is very low- always wash hands afterward and don’t touch the face.

So now you know how to protect and why-  social distance, wash hands, don’t put magnets up your nose (unbelievable from an astrophysicist no less), stay home for now. Wear a mask if you must go out (don’t keep readjusting, that’s just touching your face again)  You can do this. You can be safe and well.

This little ball with the fancy red hooks isn’t tracking you- it is just looking for a place to replicate. Don’t give those deceivingly cute projections a place to latch onto. Do go out for a walk (again, Doc you are a pain about this!) Yes, but it keeps your mind and spirit up and improves your well being for every major disease including cancer, and fresh moving air has less virus. Share your funny memes, talk with friends and family, enjoy peaceful meditation every day.

Every brilliant mind and company is working feverishly to find treatments and vaccines. I participated in a conference call today, “Lessons from the front”  for physicians across America with all the major government leaders (Dr. Birx, Dr. Hahn FDA, Seema Verma, CMS and physicians from New York to Washington to Nebraska and Atlanta) all in the heat of the battle. Every question and answer leads to a sharing of ideas and best advice. Even discussions about every type of therapy, what has been learned on the front lines for others to prepare, (like treating patients prone, setting up triage tents to keep people from crushing ER’s and ICU’s, and in NY, having 911 calls directed to telemedicine docs to triage) as well as some of the seemingly smallest to overwhelming issues they have faced. It is a national group think tank. Trust me and them, we will get to the other side.

*For outstanding information go to: https://www.coronavirus.jhu.edu

Addendum on masks: Wear a mask when you are out of your home and especially if you are undergoing treatment for cancer or are immunocompromised.  Barriers do help. We are now told that you can breathe this airborne virus in, hence remember to distance yourself. Oh and send some virtual love to that nerd you were too cool to hang with in high school because they are getting us out of this mess. Be grateful some people didn’t aspire to be influencers. Their brilliance will save us all.

 

 

 

 

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.

Hearts and roses

Joanne Dragun, M.D.

This week forget about the flu and viruses, political theater, climate and economy, even health and wellness. “Doc, what will occupy my attention? You want me to plan for Valentine’s day but I don’t even have a sweetheart”. But you do indeed so don’t disregard this important holiday. Its more critical to you than the super bowl was. By the way, my Grandfather’s name was Valentine so just maybe I inherited some insight.

Embrace the concept that our own special Valentines are everywhere, you just need awareness. In the cancer center, these life enhancers come in all shapes, sizes, relationships and species. Mr. Levin adopted a senior Labrador from the kennel. His wife recently passed from cancer and all his attention was devoted to her. Mr. Levin didn’t expect to get his own ticket here, with his new diagnosis of prostate cancer. Conversations are filled with this new love of his life, “Lady helps me get up in the morning. I think she is saving my life-just like I did hers”. Another patient, Mark has a significant other, his seven-year-old grandson. Mark’s cancer treatment is never center stage and the drama isn’t his illness. It’s making a life for Manuel whose mother is incarcerated. Last week Linda came to see me about her husband who is choosing hospice over more treatment. “Doc, we are believers and I know Tim will be in heaven with our baby son soon” she sobs. Down the hallway comes Amanda escorting her elderly mother whom she cannot leave alone. “Honey, am I sick?” she says. Amanda shakes her head ‘no’ and eyes tear as she keeps her own stage four cancer to herself so her mother won’t be concerned.

Valentines Day occurs every day with these signs of love and devotion. With awareness you will be so gratified to realize how much you are loved too. Wish others a happy valentine’s day, gift a candy heart, a flower, a hug, a phone call, offer a prayer. It doesn’t have to be a grand gesture and your kindness will open hearts to you. Remember those little “kid’s” cards? In my first grade class, we had to write one for all 98 (!) students. I didn’t want to send one to the boys who pulled my hair, yet receiving one from them was precious.

Give love and it will be returned. Be grateful for all the “significant others” in your life. You are a gift to them as well. Cancer and other illnesses are not unique in providing opportunities to demonstrate support, give attention, embrace a friend, restore a friendship, forgive a loved one. Open your heart to appreciate this celebration of love.

Happy Valentines Day. May love, friendship and devotion find you everyday.

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.