Category: life change

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”.

Puppies!

Joanne Dragun, M.D.

The Australian kangaroos and koala bears are capturing our imaginations as the wildfires roar. We feel heartbreak for their helplessness and grateful for the U.S. and international forces rescuing that beloved country.

Elaine arrives for therapy for lung cancer and tells of being moved by the tragedy. “Doc, I was feeling such a strong desire to do something. I wanted to help in some way. Then I realized I still have a power right here. At 78 I thought I was too old to get a new pet, but I got off the sofa, walked out the door. I went to the rescue shelter and adopted a puppy! I felt that he was waiting just for me. Oh my gosh, my husband was shocked when we came into the house, but “Barky” flew into his arms like he was finally home. Oh what joy I cannot tell you!”

Elaine already has her hands full but training a new puppy is a great distraction from her own drama. “I was putting away the Christmas decorations and he just tumbled through the mess and had a gay old time He is so comical we just laugh and laugh”. She tells how the puppy has bonded fiercely with her husband. “Barky doesn’t know that I have cancer, he just expects me to stop everything and pay attention to him. And I do! He doesn’t realize that my husband has Alzheimer’s disease and that sometimes he forgets we have a puppy”.

A new and exciting, fun-filled routine has captured their imaginations and filled their once sad and painful home with renewed life.. I ask to see a picture, but even better her husband is waiting with him in the car. We head to the parking lot and as I peep through the window, both are sound asleep with Barky snoozing on his belly. What a sight. This bundle of joy greets Elaine with wags, licks and adoration and my heart sings with happiness for them.

Elaine was inspired to open her heart and now their lives are changed magically. They are looking for a pet- friendly assisted living since her husband will need more care and she is in her own battle. What joy Barky will bring to others there as well. Who doesn’t fall in love with a furry, wiggly ball of happiness? Barky is a funny name because he is so busy giving attention and cuddles that I haven’t heard him yip once. I am thrilled for Elaine and her bravery in reaching out for renewal instead of giving into the drama of their situation. Both of their immune systems will be boosted by this tiny gift of goodness, and the several daily walks will enrich their togetherness and stamina.

Little puppy, you outshine all the medications, chemo and radiation we can offer. Love does that.

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.

Rudolph

Joanne Dragun, M.D.3 Comments

We all have favorite Christmas carols and hymns, but even if you love the holidays, we can have fatigue for “BuBuBuBlue Christmas” quickly. I was reminded of my least favorite this morning. I stopped in the dark morning run to admire a full bright starry sky and big dipper. Thank goodness I did. A second later two large dear dashed across the path directly in front startling me, then a possum scurried in the opposite direction. My peace was disrupted but at least my heart rate was up.

Radio stations and malls start at Halloween and people feel pressured to decorate, shop and make travel plans two months ahead. This extended season causes many modifications in healthcare as well. People hold off on elective procedures, and often therapy is interrupted for travel. Patients pull out calendars filled with doctors visits interspersed with activities. Many cancel their plans to travel with a new diagnosis. “Doc, I wish I didn’t have the biopsy last month. I could have enjoyed Christmas more. Now I can’t stand hearing “I’ll be home for Christmas”.

Its a trade off- not just modifying the cancer journey but moving from hearth and home to live a warmer life in Florida. We all miss our relatives this time of year and face- time replaces the hugs. For those who can travel they will brave the cold, ice and snow to be close. What I experience with patients is how emotional the season can be. Many realize that time is marked by these holidays. Mary asks, “Doc, do you think I will be here next Christmas?” You know by now how important hope is. “Mary, I can say with absolute certainty that you will be here next Christmas, even if you are the Christmas angel”. She smiles sweetly.

Of course as always I have a recommendation. Cancer really doesn’t grow overnight. Some forms take years. You can postpone breast and prostate biopsies, scans, Mohs surgery, or starting radiation. Holidays are full enough- why invite more drama? Take control. Enjoy friends and family when you can. Too often I see patients dug into the therapy as if its the only thing important in life- it isn’t. There are empty seats at all of our tables this holiday. We won’t recall our loved one’s therapy. We will joyfully remember a time they celebrated with us. Make some memories for yourself and others. As a cancer physician I am giving you permission to celebrate and forget everything related to any illness. Do not forgo interactions because you don’t feel up to it- others will give you the energy you lack.

If you are already well into treatment and cannot get away, deliberately play the carols on the car radio and sing out loud- you know every word. Let them wash over you and smile at the memories. Indulge in corny holiday movies, make some cookies, brew Christmas coffee or sip some eggnog. You can still participate in the warmth and cheer. I love to do my shopping on line but then head to the mall to see the decorations and watch the anticipation the little ones have as they wait their turn for Santa.

Just remember when you hear the holiday music to smile and enjoy, unless of course it’s “Grandma got run over by a reindeer“. It was a close call!

Healing words

Joanne Dragun, M.D.

“Doc, I want your opinion. The medical oncologist told me I had a 50-50 chance of beating this. What do you think? ” I am often faced with these conversations but wondered how to help fearful Gertrude who has metastatic disease and is still doing well with aggressive treatment.

“Do you have a coin in your purse?” She pulls out a quarter. “So Gertrude, the other Doc essentially described your survival as a flip of the coin. Why not try it, OK?” First she is dismayed but timidly hands me the quarter. “Here we go, heads you are a survivor and tails you live a good life. Call it!” I says these words so fast and flip quickly before she processes that I didn’t say live or die. It hits the floor and we both look down. “Tails it is! you live a good life!”

Did I negate Gertrude’s concern and misguide her? She is 80 years old, the disease will take its toll and some side effect from it will shorten her life- how long? I don’t know. She keeps tolerating therapy and does well. She already is a survivor so “heads” is right. She can still live a good life so “tails” is as well. Docs shouldn’t be in the business of scaring people to death.

“Gertrude, everyday we each have a zero or 100% risk or hope for survival. No body lives 50% and so as long as you do well, you are living your best life.” Worry and fear will only ruin what time she has left. Careful to not ignore end of life discussions, I often send patients to hospice who are finishing the fight. What I object to is the vagueness of percentages that have no meaning but to insight fear. And so, our little game today gave Gertrude a lift and I am reminded how words can heal. Speech “therapy” comes in all forms. Physicians may hold the tools for wellness but we do not hold the key for life and so for my practice, I refuse to steal what isn’t mine to give or take away.

It is important to think, read and speak healing words over our drama. My best advice is to give yourself 100% chance everyday.

No Time for Losers

Joanne Dragun, M.D.

‘Cause we are the champions… of the world! (Queen ’77). Stanley Cup, Super Bowl, NBA Finals, March Madness, World Cup, US Open, now World Series… Everyone loves championships! If your favorite person or team is involved, even better. People enjoy the distraction sports provides.

Mr. Martin discussed his time in D.C. when the team was the Washington Senators and moved to Arlington Texas in 1972. Without a team for 33 years, Washington finds themselves this week in the World series (with Huston Astros) for the first time since 1933! “Doc, worse than having a losing team was having no team at all. We were abandoned. I loved taking my kids to the game on family day. To see a team in my lifetime make it to the series is a gift from God!” His eyes sparkle, he puffs out his chest and 700 miles away in Jacksonville, he is rooting for a home team winner.

Mr. Martin didn’t expect to see this day because he has stage four lung cancer and has lived well for three years. Immunotherapy, found to be effective for his type, is keeping it under control and he is thrilled. Mr. Martin believes he was meant to live for these games. He ties his own wellness to their success.

There is only one issue that matters in this story: Mr. Martin has found an event that captures his imagination. This fills him with joy, lifts his spirits, boosts the immune system fighting his lung cancer. It doesn’t take an IV, hours in the chemo chair, beams of radiation, recovery from side effects or cost of healthcare. It is a shot in his arm of pure goodness and life that doctors do not prescribe.

I understand that not everyone will feel this engaged with the Series, but Mr. Martin demonstrates how easy it is to find a happy engagement in life and is available to us all. It may be a grandchild’s graduation, a son’s wedding, a spouse’s good news, the birth of a new baby, so many events in our own life that help us to celebrate with the champions.

Life didn’t throw you a curve ball so that you can strike out. Difficulties happen that give us opportunities to overcome and bring elation into the heart. There really is no time for losers, we can cheer the champions or become one ourselves. Each one of us must have awareness for the brave and proud unfolding of our lives and raise a toast to our spirits.

Discovery

Joanne Dragun, M.D.2 Comments

Whether it’s Columbus, Erickson or Indigenous Day, its a time to say “Yay for new adventures!” What Columbus has to do with not getting mail or the bank closing is a mystery but what matters is the concept of discovery.

Lets take a moment to personalize this idea of discovery. If I asked you to describe yourself in 3 words, could you do it quickly? You will surely not say cancer victim. You may include survivor, but I hazard to guess that you do not even elude to an illness. When did you discover yourself? Was it when you were tested by a life altering threat? Did you find that you are strong? When you went to school and were able to help a classmate who struggles. Did you admit you are smart? You may have worked out, lost weight and become more physical and self assured. Do you see confident? Have you taught, spoken, advised developed a plan and see yourself a leader?

At what time in your life did you enter into discovery of your own uniqueness and strength? Have you ever taken the time to consider how truly amazing you are? In 1492 Christopher Columbus did not discover a new world, he set out with profound bravery to expand the old world and in doing so demonstrated that exploration changes lives.

All the sacrifices, pain and suffering endured led to adventure and honor still recognized over 500 years later. Don’t think for a minute that your own trials and efforts will evaporate. Your strength, discovery and exploration of your legacy will last for generations to come. You will have constructed a life to be revered. Fortitude will be ingrained in your children’s children and they will have wisdom, laughter and love because you sacrificed, learned and grew. This is not to say they will never suffer, but there will be a strength they didn’t know they possessed. You are the blessed result of your own ancestors and their profound life discoveries.

The Nina, the Pinta and the Santa Maria may have been vessels of ambition, but your own personal discovery of faithfulness, hope and love are destined to last forever. Take a moment now to think of three words that describe you and in doing so discover your own new world.

Power Packs

Joanne Dragun, M.D.

Cell phones, remote controls, drones, even vacuums all battery powered. People use the phrase “energizer bunny” to describe high energy and endurance, but we are going nowhere without batteries. Some day they will be passe but until then we need to charge.

Could you imagine if we had to have a battery pack for each bodily function? We are living miracles and while we can marvel we can also be disappointed. Bodies are not machines. We are not designed for perfection. Diabetes, heart disease, kidney failure, cancer, joint pain so many ways we wish we could reboot.

You hope the more you are disciplined, work out, eat right, that sickness will stay away. “Doc, I gave up smoking thirty years ago! Can’t believe they found this lung cancer when I had a pacemaker!” Jesse says. He is right it doesn’t seem fair.

Amos says, “Doc this cancer plus dialysis treatment is a full time job!.” At 82 he isn’t frightened or disappointed. He is happy to have today. “Hey, well at least I’m still standin’.” I peer over my glasses and we both chuckle. “Oh yeah, except for my wheelchair!” Now that sense of humor will get him through and recharge him.

Martha drags her oxygen tank down the hallway. She is 100 lbs but the emphysema takes the energy she needs to eat a decent meal. “Doc, I can’t breath and eat at the same time so go ahead and stick the feeding tube in, I’ve still got things to do”.

Everyone talks about embracing the natural but look around. We cannot live without being plugged in and there are many reasons patients accept the burden of medical devices. I am reminded that a life worth living and a future worth anticipating is the real power.

Jesse, Amos and Martha aren’t working hard for themselves. The real power player in our lives is hope for the future. Jesse to see a new granddaughter, Amos to attend his grandson’s police academy graduation, Martha to care for her two little dogs. Your mind and body have the real power- don’t abdicate it to any disease.

Think about what gives you power and when you do, I am certain you will appreciate that it is a life with many joys and expectations. Staying fully charged will provide for your best life.

Labor of Love

Joanne Dragun, M.D.1 Comment

Labor Day (125th anniversary) started as a tribute to the contributions workers have made to the strength, prosperity and well-being of America. May I suggest that this holiday gives each of us an opportunity to recognize our own as well as appreciate other’s efforts?

In the cancer center, the concept of labor is strong. I am so proud of my patients who work so very hard for their wellness, but most often they labor not for themselves but out of love for others.

Brandi who is just 48 made it clear to me this week, “Doc, I am not getting treatment for myself. I have children to raise and I have to fight for this.” For Marvin the tough battle may be metastatic lung cancer but his only focus is to be strong for his grandchild just diagnosed this summer with cancer. “Doc, this is such a tough blow. I have to help rescue her”.

These heroes have courage and focus and I marvel everyday at the strength. Labors of love are not always so dramatic, but still very enriching and life altering. Ben holds his wife’s hand and asks all the questions she is too weary to express. Harvey crams his therapy in between visits to the nursing home to help feed his mother after work. Nathan would have stopped treatment but he cares for his wife with Alzheimer’s disease. Patty walks into the lobby with one grandson tucked under her arm like a football and another clambering to get free of the stroller. Her treatment is the least of her issues.

When someone picks up the clothes, prepares a meal, makes the bed, gives a hug or holds a hand, recognize these gestures for what they really represent. Labor isn’t just a job. Fruits of our labors come in all forms. Everyone can love effort that lifts, inspires or brings joy.

Celebrate all the ways that you contributed to your own, your family’s or your country’s prosperity. But please take time this week to really appreciate the many ways that your life is blessed and gifted by labors of love. Then what a lovely environment it will be in which to live and labor.

PS: Stay safe fellow Floridians, Hurricanes never dampen our spirits!