just a little something...

fritz update

The cat drama is settling down a bit here. After one dose of chemotherapy, he's feeling much better. Still skinny as ever, but he's eating again. He's also grooming himself again - a very big plus. 

In the meantime, we could start a kitty pharmacy.

 

Fritz is a real trooper. He's adjusted pretty well to all the poking and prodding. He still doesn't like being held down so we can squirt medicines and tube feeds (!) through his feeding tube. Who can blame him?

We're taking it a day at a time with him. Each day is better than the last, for now. When that changes, we'll rethink things.

On the upside, Mitzi seems very happy now that Fritz is sick. I think she sees her freedom from him coming soon, and she's getting excited. 

our fritz

Fritz used to weigh a healthy twenty pounds. He was the size of a small dog, in fact. Maybe bigger. He was big and sturdy, and not at all fat. Just a big cat.

And then he started losing weight. We noticed it several weeks ago, and we finally took him to our local vet. Routine lab work looked fine, but he had some bad teeth. After a couple of rounds of antibiotics and some dental work by our vet, he wasn't getting any better. Sam decided to take him to the veterinary school last week to see their internal medicine vet and nutritionist. Fritz went back for an appointment two days ago, and he ended up spending two nights there.

Turns out that Fritz had a mass in his stomach and preliminary testing looks like it's lymphoma. 

The irony of the fact that I treat lymphoma is not lost on us. Today, when the veterinary oncologist talked about the CHOP regimen, the role of a bone marrow biopsy, and flow cytometry to better distinguish the immunophenotype of the lymphoma, I was able to follow right along. And I felt totally helpless.

The bottom line is that Fritz has a feeding tube - an E-tube to be exact. It enters his neck directly into his esophagus. Since he can't eat because of the lymphoma (which involves his entire stomach), we have to give him nutrition through the E-tube. He started chemotherapy today. L-asparaginase. Vincristine, cyclophosphamide, and doxorubicin are to come in the upcoming weeks. He's on an injection medication to prevent nausea, steroids as part of the chemotherapy regimen, an antacid (Prilosec), and an antibiotic. We have to feed him at least four times a day through the tube, and we give him his medicines through there also.

It sounds crazy, and it is. But we're just trying to get him to feel better, and maybe eat again. Without chemo, he could die any time. With chemo, there's a 25% chance he'll be here one year from now. But I'm actually not counting on a cure. I'm just hoping to improve his quality of life.

The veterinary oncologist was straightforward with us, and we were straightforward with him. We don't want to extend Fritz's life out of our selfish wish for him to be with us longer. We want him to feel better. And if at any time he has more bad days than good, we're going to stop. And let Fritz go. 

death and dying

I ran across an interesting piece on this site that I wanted to share. A photographer took photos of people just before they died of terminal illnesses, mostly cancer, and then took their photos again after they died. I found it incredibly moving.

If you are interested in seeing these amazing and humbling photos, click on the article here. The direct link to the photos is here. If you're turned off by the whole idea, or if the idea of death is something you find disturbing, do NOT click there.

tuesday

Earlier this week I drove Madeline to her preschool. Sam had taken Oliver to the sitter's house already; Sam had to be at the dental school early that day. When I arrived at the school, all of her teachers were outside and I noticed a couple of parents driving off with their kids still in the car. Uh oh, I thought. This can't be good.

One of the teachers met me at my car with a pen and piece of paper in hand. She informed me that I couldn't drop Madeline off because an alarm was going off inside the school and they couldn't turn it off. No children were allowed inside until they got the alarm fixed. She wrote down my cell phone number and told me she'd call when the school was open. "Could be anywhere from one to four hours," she said.

Great, I thought. I turned around to Madeline in the backseat and said, "Maddie, looks like you're coming to work with me this morning." I'm not sure she was all that excited about it, to tell you the truth. She was looking forward to playing with her friends.

I called Sam to let him know about the crisis, and he agreed to come get Madeline from me as soon as he could. He knew I had patients to see beginning at 8:30, and it's not that easy (at least for me) to see patients with my four-year old in the room. I think it's different if your working in someone's mouth; discussing cancer, death, and dying is just something I'm not thrilled discussing with Madeline in the room.

My first patient of the day was a man whose cancer is getting worse. Mr. D is a patient who I've been seeing for about three years and he's gone through a lot of treatments. I expected an emotionally intense visit with him, because his appointments with me usually are. I didn't want Maddie in the room; I just wasn't comfortable with the idea, but I knew my patient would be more than okay with it.

I realized that I just didn't want to have to discuss CANCER with Madeline. I didn't want her asking me what it means. It's enough that she knows that I'm a doctor. She doesn't have to know more than that yet. Cancer is just one of those things that I want to shield her from as long as I possibly can. Along with the whole concept of SEX. 

As it turned out, Maddie got to meet my first patient. She was very good, perfectly quiet. She sat in the corner and colored. Mr. D was not bothered at all by her being there. In fact, I think he liked getting to meet her. Just before I got into details with Mr. D about his progressing cancer, someone knocked on my door to tell me that Sam was there to pick Madeline up. It was truly perfect timing.

So, for now, Madeline has been spared learning exactly what Mommy does. As far as she is concerned, I take care of sick people. As Maddie told Sam on the way out of the hospital, "Mommy is making people feel better."

Not always, Maddie, but I try.

cancer stinks

One day this week, in a matter of about three hours, I told four people they would die within the next six months of the cancer that was eating up their bodies. I had four separate emotional conversations where I explained that the cancer was winning and there was nothing more that we could do to fight it. We just don't know enough to outsmart it, I told them. Not yet.

These were all older men, and most of them had an idea of what was happening before I broke the news to them. I always worry about the reaction I'll receive when I have The Talk with a patient. I think it's a needless worry, in retrospect, because most everyone I've ever had The Talk with has been grateful that a physician has been honest with them.

My parents lost a good friend to cancer this week. It's hard to watch someone die, and that's essentially what they did. I'm sorry for that. I wish medicine - the field of oncology in particular - could do more.

I'm getting very good at The Talk. Too good, unfortunately.

the controversy over the cervical cancer vaccine

The other day, my sister-in-law asked me about the human papillomavirus vaccine that has been in the news lately. It was interesting that she did, because Sam and I had been talking about it recently.

Certain strains of HPV are known causes of cervical cancer. It's incredibly rare that we can pinpoint a virus that leads to a cancer, so this virus was a natural target for drug companies to focus their research dollars on. The problem with HPV is that it's sexually-transmitted, and it is definitely considered a sexually-transmitted disease. Hence the controversy.

This is an uncomfortable topic for a lot of parents. Thinking about the HPV vaccine means that parents have to think about their daughters having sex. One argument against mandating the HPV vaccine is that promoting the vaccine is encouraging girls to have sex. It's the old condom argument -- you know...handing out condoms encourages sex.

Now, I am the mother of a three-year old daughter. Do I want to think about her having sex? Absolutely not. Never. Ever. Not until she's 35. But I'm not stupid -- I know she will, and probably before I want her to. And, I hope I can do my part to help her NOT get pregnant before she's ready, NOT get a sexually-transmitted disease, and absolutely NOT get cervical cancer.

Cervical cancer stinks. Maybe it's just because I remember the horrible, advanced cases I saw in medical school, but trust me on this. You really don't want your daughter getting cervical cancer.

Imagine if there were a vaccine against lung cancer. Imagine if there were a vaccine against colon cancer. Imagine if there were a vaccine against breast cancer. A vaccine that was 100% effective.

This is a good thing, people. A very good thing.

Just my opinion...medical and personal.

on becoming a cancer doctor

I knew I wanted to be an oncologist before I went to medical school. I worked in an oncologist's office before starting med school, and I realized then that I loved cancer patients. Not cancer, but cancer patients. If you ask any oncologist, most of them will tell you the same thing. There is something special about this patient population. It's hard to describe.

From the beginning of medical school, I was able to eliminate many of the specialties without much thought. My very first rotation of my third year (the year we began seeing patients full-time) was trauma surgery. My very first patient was a middle-aged man who had poured gasoline on himself and set himself on fire in a suicide attempt. He lived for a day or so. My job, while he was alive, was to debride his blackened, charred skin. I have vivid images of that day etched into my mind. I remember crying in the women's locker-room, wondering what I had gotten myself into. I ruled out all surgical specialties based on my experiences during my eight weeks of surgery that year.

I ruled out obstetrics and gynecology, neurology, psychiatry, and pediatrics. I tried to keep an open mind during some of these rotations, but I really loved internal medicine. I think I loved it because I knew it would lead me to the subspecialty of oncology. Even in medical school, my most memorable patients (except for the burned man) were those who had cancer. I loved taking care of them, rounding on them each day in the hospital, talking to them about their experiences.

A lot of non-medical people have asked me how I do it. How can you deal with cancer on a daily basis? I really have no idea. Cancer patients are amazing to take care of. It's a privilege to be able to step into someone's life when they've been slapped in the face by a cancer diagnosis. It is an honor to try to help with whatever medicines or treatments we have available. It is incredibly special to be able to help someone die with dignity when treatments are no longer enough.

Today I saw a young woman who was diagnosed with very advanced stage Hodgkin's disease last year. Chemotherapy nearly killed her, but it was her only option at the time. She fought through it for about five months. Today she is cancer-free and feels great. This is one of the main reasons I do what I do. Because sometimes there are saves.