Cancer Blows.

Prior to my maternity leave, one of my patients had been diagnosed with pancreatic cancer.  She was set up with specialists, I reassured both her and her husband that they were in excellent hands with my locum and promised to be in touch with them as soon as I could.  My locum has been keeping me up to date on this particular patient as well as a few others.  This patient had major surgery a few weeks ago to remove the tumor and reportedly has been doing well.  I read the operative report today.  She had a procedure known as the Whipple.

The Whipple is a complicated procedure.  I saw one performed once as a medical student and all I remember is holding a retractor for a very, very long time.  Generally speaking, pancreatic cancer is not a good cancer to be diagnosed with – I mean, no cancer is, but this one in particular can kill a patient very quickly if it’s not caught early.  Thankfully, I believe my patient’s tumor was found early and according to the operative report, the Whipple procedure was considered curative.  Curative!! If I believed in God and Angels, I would say she definitely has an Angel looking after her.

Cancer is one of those illnesses that, I believe, touches all of us in one way or another.  My mother had breast cancer, diagnosed 12 years ago while I was still in medical school.  My mom was one of those women who always did self-breast examinations because she was prone to developing cysts.  I remember when I was a lot younger, she went in for day surgery to have a lump removed.  It was benign, but ever since then I always remember her feeling her breasts, always checking for something.  Well, on one of those checks, she felt something different.  Her family doctor couldn’t feel it; the radiologist couldn’t feel it; the breast surgeon couldn’t feel it.  But my mom did and the mammogram proved it. She had a lumpectomy about a month later and it was proven to be contained within the breast with no evidence of spread to the lymph nodes.  She had 5 weeks of radiation therapy, took Tamoxifen for five years and is considered cured.  Her having breast cancer does not necessarily increase my risk as she was post-menopausal at the time of diagnosis, but I still plan on being vigilant and likely will get my first mammogram next year when I turn 40.

Husband’s father was diagnosed with bladder cancer at the age of 62. Like most individuals diagnosed with bladder cancer, he presented to his doctor with gross hematuria (frank blood in the urine).  His tumor was small, localized and initially treated with an immune-stimulating drug called BCG (made of the bacteria that causes Tuberculosis).  It seemed to work at first but several months, maybe a year later, he developed acute renal failure and it was discovered that the tumor had spread outside the bladder wall and was blocking one of the ureters that drains the kidney.  I believe he underwent chemotherapy at that time, as surgery was no longer an option due to local spread.  Sadly, he died about a year and a half after the initial diagnosis. His risk factors were his age (>40) and his sex (male).  He never smoked, but he did work in the pharmaceutical industry as a pharmacist for many years back in Scotland, so it’s possible he was exposed to some chemicals back then.  We’ll never know.   As husband has just turned 40, I remind him periodically that he needs to go for his check up.

I remember a particularly difficult case I worked on during my family medicine training.  I spent two months on the Palliative Care unit. Palliative care is end of life care. More than that, it is medical care and treatment during the process of death and dying, not only for the patient, but for the family as well.  Difficult under any circumstances, but brutally awful in this particular case,which was a 44-year-old mother of two children, dying of colon cancer.

Colon cancer is one of those illnesses you think happens to a man in his sixties.  At least it was for me, as a medical student and resident.  But those two months on the Palliative care ward taught me otherwise.  Almost 10 years later, I don’t remember the details of the case, but what I do remember is that cancer can strike anyone, at any age.  My job as a family physician is to be suspicious and cognizant of that fact.  Anyone with symptoms of anemia, weight loss, change in bowel habit, vague abdominal pain/cramping, night sweats, regardless of their age – these are all red flags that need to be paid attention to.  Sadly for this woman, her physician lacked a certain amount of imagination and her tumor wasn’t discovered until it was too late.

I recently visited the RateMyMD website and looked myself up.  I was pleasantly surprised to see several new comments, and yes, they were all positive. (Giving myself a pat on the back right now!)  One in particular stood out.  This patient was new to my practice, having seen her husband’s physician for many years.  This physician was retiring and she sought out a younger, female doctor.  She got me. Apparently, at her first annual physical exam with me, I asked her about colorectal cancer screening.  She had never had a colonoscopy – it was never brought up by her previous doctor.  She had the “home testing kit” done every few years.  These fecal occult blood tests (FOBT) are designed to detect microscopic blood – blood not visible to the naked eye.  The thing is, not all tumors bleed, so the test might miss one.  Colonoscopy is the gold standard test for detecting colon cancer.  Guidelines for screening state that all patients > 50 years of age should have one every ten years.  However, this usually doesn’t happen because of wait times and cost to the healthcare system. Thus, the FOBT became a test to do in between colonoscopy.  Despite the guidelines, most physician will still recommend for all of their patients to have at least one colonoscopy.  Apparently, I talked about it enough at this woman’s appointment that she agreed to have one.  Turns out, I saved her life.  She had several precancerous polyps which were removed during her colonoscopy.

It’s a no-brainer, folks.  Screening tests work, be it mammography for breast cancer or Pap smears for cervical cancer.  If anyone reading this has a family history of cancer, or is of the age that a screening test is recommended, please get your screening done.  It really might just save your life.

When A Patient Dies.

A while ago, I posted about how it sucked that every time I go on maternity leave, one or more of my patients gets seriously ill right before I go.  I know it’s just part of the job, some of my patients are going to get sick and some are going to die. It just feels worse when it happens and I’m not physically present in the office to get the news.

Well, one of the three patients I was worried about dying while I am off, has died.  I got the news the other day that a lovely woman, a patient of mine for 6 years, has succumbed to her blood cancer. I knew it was coming based on reports I had been receiving from her specialists over the summer.  I just didn’t think it would happen 2 weeks into my leave.  I see most of her family but hadn’t seen them in quite some time.  Either they are relatively healthy, or more likely the case, they were busy with caring for their wife and mother.  In any case, I am now faced with the question:  Do I reach out to the family?

Normally, I wouldn’t hesitate to call the family upon hearing the news that a family member passed away.  But I am not working and I haven’t seen the family in almost a year.  A part of me wants to reach out, but I worry I may be intruding and perhaps it’s best to just let it go and address it when I see the family again.

And I have to ask myself,  am I reaching out for their sake, or my own?

100!

I was saving this, my 100th post, for my 2 year blogging anniversary which is on the 12th of September, but I couldn’t wait.

I am 11 days from my booked delivery date.  I have 6 working days left, and yesterday, I, together with a specialist, mutually agreed that our patient could not travel on her European vacation with an obstructed biliary tract from a probable pancreatic tumor.

This is my 3rd maternity leave and I just wanted to leave my practice with no new ominous diagnoses.  Is that really too much to ask? Right before my first leave, a lovely 50-something woman was diagnosed with a pancreatic tumor.  Right before my 2nd leave, a 50-something man was diagnosed with a particularly aggressive prostate tumor, and now, right before my 3rd leave, a 70-something woman is being worked up for pancreatic cancer.

As I mentioned in previous posts,  I have a wonderful physician who will be covering my practice, but it feels awful leaving these people when they need their family doctor the most.  I especially like this 70-something woman as she reminds me a lot of my own mother.  Her husband is wonderful as well and if his wife does have pancreatic cancer it is going to destroy him – he all but told me that at his most recent visit for an unrelated matter.  My heart broke for him.  He really wanted this trip, but he knows full well how bad it might be if she does have cancer.  I wish I hadn’t been a part of taking that away from him. I wish I could be present for them as they navigate through the health care system.  I hope I see her next spring when I return.