Thursday, January 30, 2014

A Warrior's Battle

What happens when you are given the news you have 3 months to live?  Like the climax of a movie when the group draws straws and the last person picks the short straw.  You never think it's going to be you.  So we shrug it off thinking "wont happen to me".  Then the universe reminds us our time is finite by giving a short straw to a close patient, relative, friend.  It is humbling to see the stages of suffering, it's heartbreaking to experience the visceral feeling of death as it approaches another person.  As a doctor I thought it was "proper" to be stoic to death so as to convey to the grieving family a confidence that the doc can still be a clear headed decision maker in the tornado of emotion that occurs during the last breath.  I have matured to learn that putting a shield up to the emotional suffering of others also blocks you from expressing your own suffering.  If you don't know what its like to hurt, how can you relate to the one that is hurting?   I am not saying we have to have cancer to treat it.....but we should learn compassion.  Not all people are born with this but luckily I think it can be nurtured out of someone.  I believe our cells are hardwired to come to the aid of others.  We feel good when witnessing an act of kindness.  It has been studied that when an act of kindness is performed, the giver develops high levels of the hormone serotonin just like the receiver.  It has also been measured that the observer to this act of kindness has a serotonin release just by watching.  So why is it that some people act so cold in the face of suffering.  And how ironic that some doctors that are sworn to "do no further harm" do just the opposite and harm with poor advise.

Standard Oncologist:     "you don't have to worry about doesn't matter in the long run"
Integrative Oncologist:   "lets teach you to avoid sugars, eat small meals more frequently...can you juice? .. fish is ok if you like it"
Standard Oncologist:   "the statistics on this kind of cancer are poor and you have 3 months to live"
Integrative Oncologist: "I have a patient who came in worse than you and she is alive and well in remission".
Standard Oncologist:   "the experimental protocol medicine says your outcome is not what we want, so sorry but good luck"
Integrative Oncologist:  "I don't want to worry about the cancer right now, lets work on the medical problems that will kill you first, then we can attack the cancer later with a healthier body"

I heard from a doctor that took care of my mother, he didn't want to give her false hope by trying something that didn't have statistics behind it.  Then again, our drug industry calculates in a 30% placebo response when formulating a new drug.  If the observation of and act of kindness gives hope and empowerment then why do we deny it to the most deserving people when they need it most?

Just with the open ears, the acknowledging voice and the comforting words of Dr Keith Block ( The Block Center ), I saw a change in color, posture and facial grimace over the course of 90 minutes with both Kathy and her husband as I came to support them during what was unfortunately her last consult.  Turns out the most powerful treatment over the last 6 months came in the gentle words and hands of a compassionate healer.

We'll miss you Kathy and I will keep my promise.

Saturday, January 11, 2014

"Meat Soup"

The holidays are always festive with opportunity to join family members and share food and laughs.  Some will go from house to house to greet elders and cousins.  In the Filipino tradition, there is usually someone who meets you at the front door with hugs and plates.  "Hello, how are you, go eat".....all before you take jackets off!  Great tradition in my opinion but it also means as a semi-vegetarian, I will be grazing some tables that have a bounty of only beef and pork.  I have to honor the host by not turning down the food offer, but have to honor my stomach to not throw it into spasm the next morning.  The political thing to do is walk around in camouflage-(holding a plate with some essential macro nutrients and "nursing the plate" for the night).  Luckily in the last decade a select few relatives have also decided to join me on the "dark side" and shop at Whole Foods, hike, meditate, and lose weight.  I find it either takes the threat of impending doom (like a surgical procedure's) or the loss of a family member to shock a person into making the switch.  Hearing "you have to lose weight, stop smoking and exercise" from a doctor check up doesn't make lasting enthusiasm to manifest change.  This is why statistics report doing routine things like breast exams or prostate checks doesn't make a difference in mortality for the American population.  believe it or not, the USPSTF suggests against teaching self breast  and prostate exams.  This could make sense to save money for the insurance agencies/government and for the multitude of SBE teaching I gave and the prostate cancer screens I ordered but for the handful of patients I saved with early diagnosis, I feel it was worth it for them there children and children's-children.  The statistics that we apply to the general population have nothing to do with the individual.  (see Ecologic Fallacy).
Another example, dentists at UIC are taught rough spots found on physical exam to the surface of a tooth are labeled as carries (cavities), the insurance industry says there is no reimbursable disease until the rough spot has punctured through the enamel (surface) and deep into the dentin/enamel junction.  Only at this point will the insurance reimburse dentists for the corrective procedure.  The problem is when the cavity has eroded deep into this DEJ, it is days away from a root canal (resulting in killing the tooth and filling it with composite)
A final example is modern day medical insurance does not reimburse the doctor for counseling patients on healthy eating, exercise or ways to lose weight,  You technically don't have disease until your BMI gets to a high number, your sugar and cholesterol reach a high number, or your xray shows a mass in your chest.  When health crests over the test threshold, then you can get treatment and doc can get payment for time spend finding and counseling about the disease.  (Like the root canal case, once the disease is "declared" you will probably be knee deep in an unhealthy lifestyle, making it close to a miracle to reverse without medicine that only treats the effect and not the cause)
Getting back to my holiday story, as I meet with my fellow herbivores at these family functions, there will always be nod and silent understanding that you have to indulge in the feast but not go overboard.  My hard core relatives will be stoic at any event and stay the course of healthy eating - refusing all "door plates".   10 years ago this would have been babysitter suicide in that if you refused cruising the dinner table for seconds and thirds, the elder that prepared the massive layout of culinary meat eater delight would be offended and return the face slap when you asked to watch the kids this week.  I listened to Rick Bayless and Andy Weil speak downtown and remember Andy speaking of the randomized controlled trials and research about food, glycemic load, plant based diets and inflammation (making great sense) and Rick chimed in (no medical degree or university teaching status) and said in human culture you cannot take away "the feast".  It is in our oldest books of man as part of survival/history.  As we develop this disdain for food like it was evil and caused your high cholesterol, high BMI, elevated blood hate relationship starts and we minimize nutrition to scientific elements.  IT ISN'T.  It is a life form placed on earth for humans to prosper.  Eating something prepared really fast from a drive thru window; swallowing it without chewing (like a lion that eats to over gorge in anticipation that the next meal may be a few days away) and trust the food company to use healthy ingredients while trying to make a are bound for early death and disability.  But have no fear, US health care is built to administer "rescue medicine".  In other words, we wait until a disease has manifested and changed DNA, then we intervene with very expensive procedures and medicines.  Note that this style of medicine does nothing for the health of the country and is expensive.
So your choice is make a decision to keep the "meat soup" indulgence to 2-3 times a year   OR   let go of your common sense, eat crap, don't exercise, don't control your reaction to daily stress and live like you only have a year left!