Wendy Harpham on Healthy Survivorship

A Healthy Survivor's Perspective the News about Breast Implants

My last post drew attention to the media reports of breast implants putting people at increased risk of a rare lymphoma. I'm not suggesting you shouldn't feel anxious, especially if you are considering implants or have implants. Anxiety is natural. My point is to use your anxiety positively. Click here to read complete post on new website.

When Implants Cause Cancer

Journalists often use heartbreaking stories to make a point. Those stories thrill me when they educate and mobilize people to proper action. They worry me when they risk causing undue fear and leading people away from proper action. Click here to read complete post on new website.

Active Surveillance and Cure

In a few clinical situations, patients with a potentially curable  low-risk cancer have the treatment option of active surveillance. What is active surveillance and what are the challenges of pursuing that option?

Dr. Google and Healthy Survivors

Who are your doctors? If you are a Healthy Survivor, so-called Dr. Google is not one of them.

Dr. Tracey Delaplain outlines "10 ways Internet diagnosing interferes with your health care: Dr. Google Will Never Know You or Care as Much As I Do. A few choice lines:

The Problem of Incidentalomas

One unintended consequence of progress in diagnostic technology has been the rise of so-called incidentalomas--findings of potentially serious conditions found while evaluating for unrelated problems.

ED in America

When you saw this post's title, what did you think you'd be reading about? Erectile dysfunction? Emergency Departments?

Rethinking Tumors Through Gene Sequencing

Two patients with the exact same tumor have different outcomes. Why?

Five hundred years ago, a 3-centimeter lump in one patient that looked and felt identical to that of another patient was considered the same tumor. Yet one patient did well and the other died.

With progress in science, doctors determined that tumors that look alike to the naked eye can look different under the microscope. Tumors were lumped together if they looked alike, felt the same, and had the same microscopic appearance. Yet still some patients did well while others died.

With progress in science, doctors determined that tumors that look alike under the microscope can have different surface proteins (antigens). Tumors were lumped together if they looked alike under the microscopic appearance and shared a specific array of surface antigens. Yet still some patients did well while others died. 

This 3-minute video Gene Breakthroughs Spark a Revolution in Cancer Treatment explains how genetic markers are helping researchers separate seemingly identical tumors into those that might respond to a specific treatment and those expected not to respond. 

It's a new way of thinking about cancer. What really matters? Where a cancer began?  Or that it has genetic markers that indicate susceptibility to specific treatments?

If you remember only one thing from this post, may it be this: Well-funded and well-executed research is the only way to uncover truths about treating cancer. 

Redefining Precancerous Conditions

A rose is a rose, but is a cancer a cancer? 

Naked Statistics

You can hate math and not give a whit about statistics. But if you care about your health, you will finish up your summer reading with a fantastic new book: Naked Statistics. Stripping the Dread from the Data.

Compassion and Computers II

What could be wrong with IBM's supercomputer "Watson" helping physicians care for patients?

Knowing You Carry a Cancer Gene -- Part II

In my last post, I responded to an article in the NYTimes Well Blog by Emma Pierson, who shares how learning she carries a cancer gene has transformed her life. 

Faced with "the cruel weight of a paradox: you can never know whether you want to know until you already do," what do Healthy Survivors do?

Knowing You Carry a Cancer Gene

On the NYTimes Well Blog, 21-year-old Emma Pierson eloquently shares the impact of having learned she carries the BRCA1 mutation, a finding associated with a 98% chance of developing cancer in her lifetime. You'll read how...

How We Die: The Problem With Specialists

Most pages of my copy of Nuland's How We Die sport underlinings and check marks. On page 72, though, I drew a big question mark in the margin beside a paragraph that preceded another that earned a "great insight!"

How We Die: Naturally Bad Responses

In Chapter 2 of How We Die, Dr. Nuland illustrates how sometimes the body's natural response to injury or illness is maladaptive, a notion critical to a Healthy Survivor's understanding of treatment.

Obesity Paradox (Part II)

In my last post, I introduced the Obesity Paradox: Overweight patients with certain chronic diseases do better than normal- or underweight patients with the same disease.

I wish we could do this trial:

Dietary Pattern for Health

After a cancer diagnosis, patients ask, "What should I eat? What foods should I avoid?

The answers found in magazines and offered by clinicians and purveyors of alternative therapies often paint a confusing picture of contradictions.

Decreasing The Risk of Delirium

A study designed to determine risks associated with hospitalization and delirium in patients with Alzheimer's Disease (AD) contains important lessons for Healthy Survivors.

New Nutrition and Activity Guidelines for Survivors

Up-to-date, science-driven guidelines on nutrition and exercise after cancer were published in the April 12th issue of Ca - A Journal for Clinicians, a publication of The American Cancer Society. Although addressed to healthcare professionals, the material is accessible to patients (free, online) and includes a section written specifically for lay readers.

Grief and Acceptance - Part V (Promoting Acceptance)

The preceding four posts on grief and acceptance set the stage for a closer look at how patients can be Healthy Survivors at the end-of-life. In other words, how can you both get good care and live as fully as possible after a diagnosis of terminal disease?

Revoking FDA Approval: Conclusion

The FDA revokes approval of Avastin for breast cancer. What's a survivor to do?

Your Medical Mind

My recent posts have discussed some of the difficulties of modern medical decision-making in the context of PSA testing for prostate cancer. A new book by Harvard oncologist Jerome Groopman and Harvard endocrinologist Pamela Hartzband offers help to Healthy Survivors: Your Medical Mind: How to Decide What is Right for You.

Does PSA Testing Save Lives or Not? - Part II

Yesterday's post highlighted the controversy about screening healthy men for prostate cancer using the PSA test. The media does the public a disservice by claiming such testing does not save lives. It does. The issue is: at what price?

My Bad?

My August 6th post shares a report on a new technology for breast cancer screening. I confess: I did not check out the story.

Free CURE

One of the purposes for this blog is to bring attention to high-quality resources to help educate and empower Healthy Survivors.Today I'm shining the spotlight on CURE. Not only is this a superb magazine for cancer survivors and their caregivers, it is also free.

2011 Cancer Resource Guide

Cure in association with the American Cancer Society has published a superb booklet for people with cancer: the 2011 edition of their Cancer Resource Guide.

Healing After A Doctor Visit Gone Awry

Although I didn't have a magic answer for the patient in my last post who emailed me about her doctor visit gone awry, I was able to offer her some thoughts about moving forward as a Healthy Survivor.

Warning Strangers

Walking down the jetway, I hear a woman's voice behind me, "Umm, excuse me. May I ask if you work in the sun?"

The man behind me answers, "Huh? I work inside, but I play outdoor sports."

With a micro-chuckle of embarrassment, the woman says, "Gosh, I hope you don't think I'm crazy or overstepping my bounds, but were you aware of the black spot on your earlobe?

Free Toolbox

We are not born knowing how to become Healthy Survivors. We aren't taught in school how to get good care and live as fully as possible when living with, through and beyond cancer or other serious illness. I wish we were.

Stigma of Illness (Part III)

My last post offered tips for recognizing stigma. My key message was that Healthy Survivors have a right to choose whether or not they advocate to destigmatize the disease that has become part of their life.

Today I'll tackle the challenge of dealing with this stigma.

Tolerating Treatment

Your doctor dictates into your chart, "The patient is tolerating treatment well." Huh? After every treatment you feel nauseated, lightheaded, weak, headachy and, in a word, miserable. What does your doctor mean by "tolerating treatment well"?

Healthy Responses in The Gray Zone

When symptoms or signs are not dramatic, patients often find it stressful to decide whether or not to call the doctor or go straight to the emergency room. As a patient, I found it more stressful when a new problem put me in what I call "the gray zone" than when a sign or symptom was clearly a serious problem demanding immediate attention.

What's a Healthy Survivor to do?

The 5 Rs to Healthy Survivorship

For smokers, snubbing out their last-ever cigarette is a key element of "getting good care" in their pursuit of Healthy Survivorship. But smokers often feel miserable while quitting, enough that most relapse.

When a Healthy Survivor Feels Like Quitting

My 1/14/11 post refers to a post -- Why We Quit -- by a Buddhist physician who believes we quit when we can no longer avoid paying attention to the idea of quitting. He recommends building resilience by "trying again, no matter what the reason you failed before."

The Weed of Cancerous Tumors

When it comes to understanding cancer relapse, what is the significance of a cancer stem cell? According to a recent article by oncologist Siddhartha Mukherjee, maybe everything.

Abigail's Alliance

On my recent post about clinical trials, commenter Steve Walker wrote, "The Phase III trial is being run primarily to satisfy the rigid, formulaic and in many cases scientifically obsolete requirements imposed by the FDA's Office of Oncology Drug Products for most cancer drugs...." 

Is the randomized clinical/controlled trial (RCT) obsolete?

Anguished Debate on Witholding Rx for the Control Arm

My last post introduced a dilemma regarding modern clinical trials: Is it ethical to randomize some patients to the "control arm" of a trial where they will NOT receive the trial drug?

According a NYTimes article, one particular trial of a therapy (called PLX4032) for malignant melanoma "ignited an anguished debate among oncologists about whether a controlled trial that measures a drug's impact on extending life is still the best method for evaluating hundreds of genetically targeted cancer drugs being developed."

Witholding Rx in Clinical Trials

Sunday's NYTimes ran an article tackling a complex ethical dilemma in cancer care: The witholding of treatment in clinical trials. Because I was treated in 3 clinical trials in the 1990s, the topic is close to my heart.

The Treatment Option You May Be Missing

As a scientist, I credit clinical trials with advancing our understanding of cancer and ability to treat it effectively. As a patient, I credit clinical trials with playing an essential role in my survival. 

From both perspectives it troubles me greatly that only ~3% of adult cancer patients participate in clinical trials.

Open Notes and Compassionate Care

For me, the crux of the problem is this: Do Open Notes conflict with the ideal of compassionate care? 

Open Notes: "Our" Chart

My recent posts set the stage for asking: Does the opportunity for patients to read their medical charts help or hurt patients' ability to become Healthy Survivors?

The OpenNotes Project - Why Do We Need It?

In my August 9th post, I introduced you to the OpenNotes project. If you are wondering why we need the study, here is a two-word answer: informational technology (IT).

The OpenNotes Project - Introduction

Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?

For the next few posts, we'll explore the OpenNotes project in the context of Healthy Survivorship.

Costs and Benefits of Counseling

In Razing and Rising, I mention that Healthy Survivors "seek guidance and support." What if you've never needed professional counseling before?

HON

Patients wanting to learn about their illness used to search high and low for a few drops of patient-centered information. The dilemma for modern patients has become how to sort through the flood of information available on the Internet.

HON certification can help.

Mesotheli-what?

A friend from my early survivorship days -- another physician and lymphoma survivor -- is dealing with a new problem: mesothelioma. Mesotheli-what?

A friend from my early survivorship days -- another physician and lymphoma survivor -- is dealing with a new problem: mesothelioma. Mesotheli-what?

Mesothelioma

The post entitled "Mesothelioma" was under construction. The final post was published as "Mesothelio-what?"

Caveat Emptor re: Genetic Testing

Great progress has been made in linking disease to mutations in certain genes. So why the sudden brouhaha at the FDA about companies selling gene-testing kits directly to consumers?

Emotions After Cancer

When I was first diagnosed, my medical background made me more prepared than most for the physical and emotional challenges of cancer treatment. What blindsided me were the medical and emotional issues that arose after completion of treatment.

A Problem with the Electronic Health Record (EHR)

In the newsletter of the Texas Chapter of the American College of Physicians, Dr. Steve Urban shares an important concern about Electronic Health Records (EHR).

Not Waiting for Answers

How can Healthy Survivors get good care -- the first criterion of Healthy Survivorship -- if the data needed to make sound choices in their particular situation is not yet available?