mementomori | November 5, 2007What do I say to a patient who declines to take chemotherapy, surgery or radiation therapy for his cancer? More specifically, how do I respond when a patient states that he prefers to take "alternative" medications in order to kill his rapidly growing malignant mass?
I've counselled him extensively and clearly explained what the chances are that traditional anti-cancer therapy will kill his tumor and save his life, or in his case, prolong his life since I am suspicious that the disease has already spread. I've explained what the risks and side-effects of chemotherapy consist of. He…
mementomori | November 2, 2007"There will be sleeping enough in the grave."
-Benjamin Franklin
Question: What kills more than 1550 Americans and injures another 71,000 every year?
A. Drowning
B. Accidental discharge of firearms
C. Viral hepatitis
D. Malignant melanoma
(Answer below the fold)
Answer: "None of the above."
Drowning kills 3,529
Firearm accidents kill 649
Viral hepatitis kills 5,382
Malignant melanoma kills 7,952
The correct answer is: falling asleep behind the wheel while driving.
"Drowsy driving is big killer in U.S"
Although studies have found the condition to be nearly impossible to fight off…
mementomori | October 31, 2007Attention All Lovers of the Following:
Hamburgers (also known as "our national pastime")
French Fries (also known as "coronary sticks")
Pastries (apply directly to hips to cut out the middle man)
Sugary Drinks (the answer to this riddle: "What is the slowest known way to commit suicide?")
Beef (sorry, Fred - brontosaurus steaks are gefahrbringend)
Pork (th-th-that's all, folks!)
Lamb (Mary had a little, and look what happened to her)
Bacon (a.k.a. colon cancer fertilizer)
Ham (see "Bacon")
Sausage (see "Ham")
Lunch Meat (see how it is made for the best deterrent)
Alcohol (Hic! Hey, even the…
mementomori | October 29, 2007[Editor's Note: at the request of our readers this will become a recurring feature. The C.O. in his infinite wisdom created a new character, Dr. Noce Saggio, to serve as the protagonist in this series of medical mysteries. And now, if you would please, raise the curtain... ]
"Another espresso, Doctor?" The waiter stood crisply by the table as his customer drained the last of his cup. The cafe swelled with the sounds of early morning conversation.
"I don't think so, Raoul. I've got to be off to my clinic. My secretary will not stand another late start this week." The waiter bowed and…
mementomori | October 25, 2007It seems that health insurance companies in New York are trying to persuade their customers to go to doctors who have excelled at the little game entitled "Popularity Contest." Say, what makes a physician popular with insurers? Is it high intelligence? Untiring diligence? Compassion, empathy and a soothing bedside manner? A really great soap-opera-doc head of hair?
"Some health insurers are abandoning the goal of providing patients with honest physician comparisons based on valid quality criteria," said AMA President Ronald M. Davis. "A growing number of health insurers have unwisely…
mementomori | October 24, 2007As many ScienceBlogs readers know by now, last month Popular Mechanics published a list on their website of "25 Skills Every Man Should Know," which included such esoteric talents as "frame a wall" and "extend your wireless network." How these two made the list over such accomplishments as "find tickets to a Hannah Montana concert," or "pass gas anonymously on an airplane flight" is beyond me, but then again I'm a doctor, not a popular mechanic.
Just for fun I'd like to share my version of this meme, so without further ado here is a list of 25 skills every doctor worth his or her salt should…
mementomori | October 22, 2007Does keeping a positive mental outlook help cancer patients to live longer?
People who are depressed about their cancer are no more likely to die than people who keep a positive outlook, U.S. researchers reported on Monday.
The choice of medical reports that news services choose to disseminate continues to fascinate me, including this latest bit of research involving 1100 patients with locally advanced cancer of the head and neck area. I'm sure they picked this story because of the popular conception that those who keep a positive outlook when fighting cancer will have a better outcome. If…
mementomori | October 19, 2007Lessons learned are like
Bridges burned,
You only need to cross them but once.
-Dan Fogelberg
Last time I checked none of us have been ordered to bend their knee to the Gods of Apathy, Stupidity and Cowardice, yet I see people all the time who are miserable in life because of their unwillingness to walk away from this silly Triumvirate of Mediocrity.
On our fantastic journey from birth to death we all have the opportunity to grow in empathy, knowledge and fortitude, by which we continuously reform ourselves into more loving, more committed individuals. One way to achieve this is by…
mementomori | October 16, 2007"India to host world toilet summit"
The next time you find yourself kvetching about someone misplacing the television remote, or a spot on your collar, or the spaghetti being lukewarm, or $3 a gallon gasoline, or your favorite team playing like a rafter of turkeys, or Junior failing to put the pizza in the fridge whilst you and the spousey were out puttin' on the Ritz, keep this in mind: 2.6 billion of Earth's human inhabitants have to move their bowels without the benefit of a flushable toilet. Now that's something to raise a stink over.
An estimated 2.6 billion people have no access to a…
mementomori | October 15, 2007I recently heard about an amazing case that seems to be filled with lessons for doctors. Not claming to be Homer, my paraphrasing will be modest, but let me tell the tale anyway. Then we'll try to decipher the moral of the story.
Once upon a time a 19 year old man woke up feeling ill. He complained to his mother of nausea, fatigue, loss of appetite and dizziness, and called in sick to work. Within 48 hours his family noticed him to be withdrawn and confused. They brought him to the emergency room where he was examined by the attending physician and found to be nearly obtunded. He…
mementomori | October 13, 2007Here's some food for thought the next time you sit down to shovel in a wheelbarrow or two from the breakfast buffet:
"Obese People Much More Likely To Develop Esophageal Cancer"
I've seen enough esophageal cancer in my career to have developed a profound loathing of this ugly malignancy. Its bite is as deadly as a coral snake's, and the treatments developed to eradicate the disease are, to put it mildly, challenging to take. The five year survival rate for esophageal cancer has risen from 4% in the 1960s to 17% in the modern era.
This, ladies and gentlemen, is what my guru calls progress,…
mementomori | October 10, 2007Des Moines, Iowa, 1961 - Martin Polzhappel, a 25 year-old carpenter, visits his family doctor for yet another bronchial infection. Instead of giving him the usual intramuscular injection of lincomycin, today the doctor decides to try a new oral antibiotic called ampicillin. Mr. Polzhappel is only too happy to avoid subjecting his buttocks to the not-so-tender mercies of the Hermann Göring look-alike masquerading as the good doctor's office nurse.
Our patient takes his prescription to the Katz Drug Store located on Euclid and 2nd Avenue, now considered by historians to be the site of one of…
mementomori | October 7, 2007The story of thalidomide, the notorious teratogenic drug developed in Germany and sold around the world from 1957 to 1961 as a treatment for morning sickness, continues to unfold. By now most are familiar with thalidomide's history, how it caused phocomelia and other severe birth defects in over 10,000 babies, how it was never approved in the United States thanks to the insight and viligance of an FDA employee named Frances Kelsey, M.D., Ph.D., and how it has been approved now to treat certain types of cancer. Will its legacy be one of more than just shame?
Elderly patients with an…
mementomori | October 5, 2007Doctors constantly have to make decisions that reflect their intelligence and judgment, but sometimes they are faced with a decision that tests their personality. Here's an example:
"Should I (a) let this patient continue to ramble on, further delaying the eagerly anticipated close of my frantic day, or (b) cut him off now and risk committing the offense of indecorum?"
This week one of my patients made such an accusation against a specialist I sent her to. "He was rude," she said. "He kept interrupting me every time I asked a quesiton. He didn't seem to be interested in my problem and…
mementomori | October 3, 2007Ridentem dicere verum quid vetat?
-Horace
Here's some hilarious "news" from the FDA, just hot off the press:
Taxotere Gets FDA Approval For Advanced Head And Neck Cancer Before Chemoradiotherapy And Surgery
Heh heh...
The US Food and Drug Administration (FDA) has approved Taxotere Injection Concentrate combined with cisplatin and 5-fluorouracil for induction therapy of locally advanced squamous cell carcinoma of the head and neck before chemoradiotherapy and surgery.
Ha ha ha ha ha!
Clinical investigator, Marshall Posner, MD, Medical Director of the Head and Neck Oncology Program at Dana-…
mementomori | October 1, 2007The next time you're tempted to act like a irresponsible jerk, take a deep breath and ask yourself this:
"Would I find it refreshing to be poseyed in a chair and crapping my pants during the halftime show of Super Bowl LXII?"
"Conscientious people are less prone to Alzheimer's"
According to the World Health Organization, about 18 million people worldwide have Alzheimer's disease, a brain-wasting condition marked by memory loss and confusion that becomes so severe patients lose the ability to care for themselves.
If you are not familiar with the devastating consequences of Alzheimer's you must…
mementomori | October 1, 2007"What is it like to be an oncologist? How long does it usually take to get your specialization? Is there anything I should know from the start that I could learn from your education over the years in and out of school?"
From time to time students interested in the field of medical oncology ask me questions like those above. It is easy to respond to such requests with the platitudes one hears all throughout their school years - "Work hard"; "Study a lot and get good grades"; "Take lots of science classes"; "Shadow a doctor on his rounds." No matter how true they are, instead of focusing on…
mementomori | September 27, 2007New evidence presented today by U.S. researchers suggests that women who drink at least three alcoholic drinks per day have a 30 per cent increase in the risk of developing breast cancer. Why is this important? Could it be because we don't want more women to acquire this disease? ¹ Could it be because there are individuals in this country ² who are keenly interested in getting as many adults as possible into the habit of drinking those same alcoholic beverages now linked to an increase in the incidence of breast cancer? Well, could it? ³
"Studies have consistently linked drinking alcohol…
mementomori | September 25, 2007I recommend you to take care of the minutes, for the hours will take care of themselves.
-Lord Chesterfield (1694-1773)
It was quite busy in the office today; in fact, I'm still here as I type this at 1710 hours CDT, and must go back to the hospital as soon as I'm finished writing. Not to confuse me with a real doctor (read: surgeon), "quite busy" for me usually means one of the following:
1. Had to attend a meeting designed to test my powers of wakefulness.
2. One or more patients presented with a complicated development that required the mental powers of an Einstein to solve.
3. No…
mementomori | September 23, 2007More evidence has just been published showing how reducing the caloric intake of cells influences their survival. Anyone want to take a guess as to what happens when a living organism (eukaryotes only, please) is subjected to noshing only on insultingly small morsels of food? Such asceticism of course is an outrage to those of us who follow the modern method of nutritional ingestion.
Again, the question: What happens when eukaryotic cells are subjected to nutrient restriction?
A. Cell survival is promoted by a reduction in apoptosis.
B. Cell survival is impaired by the genotoxic effects…