Category: surviving cancer

Kids baseball game

Seeing Red

Joanne Dragun, M.D.

The crack of the bat. The roar of the crowd. It is baseball season and the formerly tiny faces in the big caps and over sized gloves who dreamed of this day await their destiny. The baseball draft will change lives forever and few will be called to greatness. When you are an all star athlete with profound skill, your eyes are on the hopes of a big and glorious future. When you are sidelined from your college team to be treated for cancer, the world tilts. What brings you back on course is a family devoted and your own internal fortitude.

The path of baseball star pitcher Dylan Simmons is close to my heart. While managing juvenile diabetes, Dylan was top in the sport and while recruited from high school, chose to succeed on all levels in life. College came first and so he excelled at a finance degree. During his Florida State journey, the lymphoma diagnosis hit. Hard. Nothing mattered now but getting well. Can you imagine being parents, both with careers in cancer treatment, finding your own child will battle a disease and right at the prime of his college journey? Scott and Tracey his parents sat the bleachers, traveled the journeys, supported the dream for years, then find themselves navigating a familiar terrain, but now for their own beloved son. The star baseball career sidelined with the hushed words and devastating diagnosis.

Dylan made his way successfully through a tough program of treatment and ultimately transferred to University of Pittsburgh where his star continued to shine at every level. The self proclaimed, …“diligent student with a passion for pursuing excellence in everything I do” with aspirations on and off the diamond, saw them come to reality when he was drafted by the Cincinnati Reds.

Dylan’s journey to professional baseball (and sure to follow more greatness, records and success) could be the culmination of this truly inspirational story. His brave and courageous parents and supportive and successful brothers could now see their aspirations for him come to fruition. But I do not believe that this draft, to a wonderful national team, with vision to recruit his talent, is his true life’s work. In his own words, “believing that with hard work and surrounded by good people, nothing is impossible”.

Dylan will inspire every little face of a juvenile diabetic with assurance that a lifelong disease is not limiting. How you stand up to it is what matters. That the children in cancer wards, like the one in home town Jacksonville where Dylan was treated, will envision their own success. That parents will have hope, as Tracey and Scott did, and siblings will converge to lift when another is challenged. Dylan Simmons’ greatness will be legend because he is an outstanding and talented athlete and Cincinnati does not even know yet how fortunate they are. It is his determination, leadership and courage in the face of adversity and power with God’s blessing on him that will reach heights never imagined.

We wish you all the success you so richly deserve. Your journey gives parents the strength to see power and courage in their own children- never victims always victorious. God bless you, Dylan, and your wonderful family. We will follow your career with anticipation and we will celebrate your every achievement, but mostly we will be grateful that you were given the gift to inspire others to reach for their own greatness within.

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.

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

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.

 

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.

To the rescue

Joanne Dragun, M.D.

“Stayin’ alive. Stayin’ alive ah ha ha ha stayin’ alive.” the Bee Gees create a great tempo for the 30 compressions and two rescue breaths timing for the CPR class this week. The EMS instructor is coordinating our movements for success preparing for a challenge in any environment and the staff is gaining skills not just for the cancer clinic but for life. “Another one bites the dust” is another option for pacing but I think she is just kidding. The hands on instruction for this refresher happened to be timely this week in the clinic.

If you’ve never taken CPR or are rusty (2 years), I strongly recommend taking the time to train in basic life support. You have energy and are fearless, so you know if needed, that you would spring to action. We are all life- long learners and take classes for every skill, why not one that could save a life? I thought I’d take this opportunity to provide general guidance on emergency response because in the chaos of a moment, someone needs to keep a cool head and make good decisions. As dramatic as a heart attack or stroke to a sprained ankle, there are many ways we find ourselves accessing the healthcare system in an emergency and I hope this helps.

When to call 911: Examples are: A significant fall, head injury, uncontrolled bleeding, chest pain and shortness of breath, seizure, syncope (unconscious) drug overdose, drowning are appropriate for medical emergencies. The EMTs have medications and electronics to treat in the home quickly then have direct access to the ER upon arrival- no waiting. Always state the problem and your address quickly- that info is immediately sent to your nearest response team while you are giving the dispatcher further information.

Out patient centers (privately or hospital owned) are procedure oriented: minor surgeries, endoscopies, radiology, low risk catheterizations, minor orthopedic procedures, biopsies. Most are accredited with board certified physicians who also serve on hospital staffs. These are never used for emergencies. They are for procedures with appointments. For significant emergencies, hospital is best where all equipment and specialties are readily available.

Urgi-centers: Many of these “doc in the box” units are springing up, often affiliated with a hospital to move less critical care into the community. They serve as a family doc open 24 hrs. Think “I have a problem but don’t need an ER”. These are fine if you need stitches, have a sprain, flu symptoms and are under age 70, or other minor ailments. You may be triaged to a specialist (ortho, cardiac, cancer center) or told to call your family doctor once the issue is assessed or treated. These centers are not designed to provide every level of care and have no specialists other than ER physician on call. Further rescuing requires a fully staffed hospital.

I am pleased that healthcare is moving closer to you, just be aware that these units are not meant to replace more comprehensive care. You always have the right to head to your nearest ER or to call rescue. Again, everyone should take CPR, especially if you are caring for children, have a pool, live near water or live with someone who is at risk. (your local hospital and YMCA often have classes for the public). Be familiar with first aide emergency handbooks. Preparing is the best plan. If you read this blog, you are most likely the person in control in a crisis, so others will look to you. Be ready.

We care about each other and sometimes you have to actually take care of another and “live to see another day”. You can make a huge difference. With knowledge, your bravery can protect a loved one or even save a life.

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.