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Medical Forum / General / Alternative / May 2008Another death due to Cancer
Well its not a big issue unless you are involved at a personal level with a family member. What I can report is that my Brother in law after having what was termed a successful bowel operation also had cancer appear in the Liver and then the Lung and then the Brain and then the Spine. In all of this we watched the treatments of continuos Chemo and finally radio therapy but nothing helped with the patient progressively succumbing to the cancers advances. It took around 16 months for the final result and despite trying every possible medical approach death was the final insult. I say insult as during the 16 months there were many highs and lows of seeing improvements in removing the cancer from the bowel and then reducing the cancer spots in the liver, but then they appear in the lung and then the brain and finally in the spine. Of course this can be a normal maturation of cancer within the bowel buy no one wanted to discuss this until it was final in its destruction of life. It hurt me to watch these events and to witness the patient try alternatives as a last resort with the blessings of the Oncologist. I wondered what the outcome would have been if the alternative approach had been tried prior to or along with the chemo assault. The Chemo assault was low dose over a 12 month period which during this time only saw the cancer spread. It was a case of the readings are good and then the readings are bad but at all times getting progressively worse. From lung to brain took about a month and then from brain to spine another month. At that stage the patient was totally incapacitated. I am having trouble accepting this medical approach as clearly the evidence points to failure. The patient was warned of this from the outset but not having any alternative put forward by his Oncologist I guess he viewed it as the only choice. Chemo therapy until the end. It really is a poor situation for cancer patients to have to undergo destructive treatments that yield no result other than disease advancement. Whilst I appreciate the alternative approaches available (in some cases) I do note that these are not readily available for cancer patients and then seem to be suggested or ordained in the final stages of the disease. Can we not at least try other approaches simultaneously? Cancer patients have little options in treatment in the early stages and that does not seem a fair go when people are dealing with other peoples lives. I believe that the Oncologist knew fully the path of the disease and all he could or would offer is the standard treatments as prescribed by the makers of Chemo and endorsed by the medical profession. I hope he sleeps well in the choice of his profession. Please correct me if I am incorrect with my views. Sincerely, Rod > I am having trouble accepting this medical approach as clearly the evidence > points to failure. The patient was warned of this from the outset but not > having any alternative put forward by his Oncologist I guess he viewed it as > the only choice. Chemo therapy until the end. > It really is a poor situation for cancer patients to have to undergo > destructive treatments that yield no result other than disease advancement. You've hit on one of my pet gripes about medicine (and in this I don't distinguish between "conventional" and "alternative"): they are all oriented towards saving life at all costs no matter the odds of success. Sorry, I don't buy it. Read my .signature I've seen the toll that "heroic measures" take on both family and caregivers and think that there's something fundamentally wrong here, in that we're culturally in major denial. Death happens. Someday it will happen to all of us. Before then, a lot of other things will happen that we won't like -- but trying to pretend otherwise, either as regards death or as regards the smaller mishaps of life, is INSANE. Functionally, it's nuts. I have my own opinion on the relationship of this phenomenon and other forms of reality rejection, but that's another matter. In the proximate case, I don't see an upside for anyone in the picture. > Whilst I appreciate the alternative approaches available (in some cases) I > do note that these are not readily available for cancer patients and then > seem to be suggested or ordained in the final stages of the disease. > Can we not at least try other approaches simultaneously? Sorry, this reminds me too much of Susan Gurney's account of the last days of a friend under the Gonzales regimen. I don't see that making\ your illness the 24/7 center of your remaining time for you and those close to you, complete with demanding and agonizing demands of the "therapy" itself, is any improvement. If the procedure in question doesn't have a reasonable track record of at least double-digit favorable prognosis, forget it. I'll take palliative care and make the most of the time I have left. I'm old enough that "the time I have left" is less than the time I've already wasted no matter what, so why fool myself? > Cancer patients have little options in treatment in the early stages and > that does not seem a fair go when people are dealing with other peoples > lives. I believe that the Oncologist knew fully the path of the disease and > all he could or would offer is the standard treatments as prescribed by the > makers of Chemo and endorsed by the medical profession. Actually, many forms of bowel cancer (you haven't been specific) have a good prognosis from surger alone or surgery with secondary chemotherapy. Once the metastases turned up, though, I would have thought a rethink would have been in order. > Please correct me if I am incorrect with my views. I can't fault your indictment. Where to go from there is something else. NB: A few years ago I lost my oldest childhood friend to a relatively rare form of intestinal cancer; it was detected rather late and the prognosis was not rosy even from the beginning. He and his family made reasonable efforts to restore his health (including some experimental treatments) but their primary focus was on making the most of life. He lived a bit less than a year after diagnosis, but left behind a lot of people who remember that year fondly (and, interestingly, a body of appellate-court rulings that are considered by those who know such things to be models of judicial practice.) | sh.t happens. Sometimes it happens to you. | +--- D. C. Sessions <dcs@lumbercartel.com> ---+ > Well its not a big issue unless you are involved at a personal level with > a family member. > What I can report is that my Brother in law after having what was termed a > successful bowel operation also had cancer appear in the Liver and then > the Lung and then the Brain and then the Spine. Rod so sorry to hear of your bil and family's sorrow... however..you asked for opinions so I will state mine..and I agree wholeheartedly with DC that "quality vs quantity of life" is the issue your BIL had metastatic disease ..the colon cancer had already begun its spread..evidenced by the short 16 months he lived after surgery..once cancer has spread its tentacles so far..liver,,brain lung and spine...his days were numbered.. I also agree with DC that if this had been me or mine..I would have said no treatment other than the original surgery...and palliation to make the end a bit less painful I also speak from experience...my hubby age 67 was found to have a malignant colon polyp during a routine colonoscopy... Prior to surgery to remove the sigmoid colon he had a battery of scans and tests...which determined that the cancer had NOT invaded the colon wall...thus unlikely to have begun its insidious spread to other organs...he had his sigmoid colon removed..it has been two years...two colos have revealed NO more cancer in the colon...and scans still negative for metastatic disease... We talked about the "what ifs"...we both agreed to surgery and palliation ONLY if significant metastastes was detected (which is why they check prior to surgery...some folks are doomed from the get go)...neither of us wants to live our last days in chemo and radiation,,if those days are numbered > In all of this we watched the treatments of continuos Chemo and finally > radio therapy but nothing helped with the patient progressively succumbing [quoted text clipped - 4 lines] > reducing the cancer spots in the liver, but then they appear in the lung > and then the brain and finally in the spine. again...this is called metastatic disease...once colon cancer is found in the liver..the prognosis is grim... > Of course this can be a normal maturation of cancer within the bowel buy > no one wanted to discuss this until it was final in its destruction of [quoted text clipped - 3 lines] > wondered what the outcome would have been if the alternative approach had > been tried prior to or along with the chemo assault. once cancer has metastatisized...the outcome is grim regardless of the approach The Chemo assault was low dose over a 12 > month period which during this time only saw the cancer spread. > It was a case of the readings are good and then the readings are bad but [quoted text clipped - 8 lines] > destructive treatments that yield no result other than disease > advancement. this is the key...no one HAS to undergo treatments that "yield no results"...tho docs may think they make the decisions..they do not..the patient and family do..getting oneself educated makes it easier to guide one's own treatment...you are in charge..not the doc.. > Whilst I appreciate the alternative approaches available (in some cases) I > do note that these are not readily available for cancer patients and then [quoted text clipped - 4 lines] > that does not seem a fair go when people are dealing with other peoples > lives. from what you describe...your bil was not in the "early stages" of colon cancer...he likely was stage 3 or stage 4 which an experienced team could easily determine...again..once cancer has spread esp to the liver,,brains and bone..the prognosis is grim.. early stage colon cancer does not progress to death in 16 months..he already had metastatic disease which greatly limited his chances of survival for long...regardless of WHAT was done I believe that the Oncologist knew fully the path of the disease and > all he could or would offer is the standard treatments as prescribed by > the makers of Chemo and endorsed by the medical profession. [quoted text clipped - 4 lines] > > Sincerely, Rod again Rod..my sympathies to you and your family...as a health care professional for over 40 years my personal feelings are that death is NOT always bad...in many cases it is preferable to prolonging suffering..WHEN significant prolongation of a productive life is not likely my last statement to you and all....if placed in such a situation...get all the facts..get scans etc to check for metastatic disease...THEN discuss with surgeon etc what avenue to take....YOU are the boss....YOU (or family) can at any time say "no more"...call in hospice for excellent palliative care (relief of pain etc)..and spend your remaining days..however few..with loved ones...sharing the good days and good life that hopefully you have had.. peace > this is the key...no one HAS to undergo treatments that "yield no > results"...tho docs may think they make the decisions..they do not..the > patient and family do..getting oneself educated makes it easier to guide > one's own treatment...you are in charge..not the doc.. Keep in mind that the doc is in a bit of a bind. The standard of care is "spare no effort to keep them alive." Barring specific instructions to the contrary, they are liable if they do anything else. Arguably (and I'm of two minds on this) that's a Good Thing because "alive" is objective -- "alive and well" is not, and the difference is far too individual to allow someone else's (notably the caregiver's) values to dictate. Bottom line: we hire organic mechanics. They have expertise that we haven't the time to acquire for ourselves (assuming we were so inclined and able.) Well and good -- like any other tradesmen. However, we don't let the electrician plan the dining room lighting, we don't let the painters choose the colors, etc. Those are "quality of life" decisions that nobody can make for us; if we leave the decisions to others by default the blame starts in the mirror. Unfortunately, too many people don't know that the value decisions in medicine are uniquely theirs. Thus you get horror stories like Rod's and Terry Schiavo's, where the caregivers are left to some pretty crude default instructions for want of more personal guidance. | sh.t happens. Sometimes it happens to you. | +--- D. C. Sessions <dcs@lumbercartel.com> ---+ >> this is the key...no one HAS to undergo treatments that "yield no >> results"...tho docs may think they make the decisions..they do not..the [quoted text clipped - 5 lines] > instructions to the contrary, they are liable if they do anything > else. this is only partially true...perhaps what you are referring to is "end of life..cardiac arrest situation"...then your statement is true..and most docs will cpr even a 98 year old...who lacks advance directives my comment referred to cancer and what to do...chemo..etc is indeed a situation where death is usually not emminent..thus a doc is not "required" to insist on say...chemo... Arguably (and I'm of two minds on this) that's a Good Thing > because "alive" is objective -- "alive and well" is not, and the > difference is far too individual to allow someone else's (notably > the caregiver's) values to dictate. agreed.....but near death say from a cardiac arrest or "vegatative state...ie Terry Schiavo"....and how to plan the care following a cancer diagnosis are two entirely different situations... but I agree that families MUST talk about these plans ahead of time...and each member of the family must be on the same page...any disagreement..and the doc wil cpr a 98 year old... we both have advance directives..our children and sibs know the limits to which we would care to go... > Bottom line: we hire organic mechanics. They have expertise that > we haven't the time to acquire for ourselves (assuming we were so [quoted text clipped - 6 lines] > Unfortunately, too many people don't know that the value decisions > in medicine are uniquely theirs. agree...hopefully not because the "doctors" have not given enuf info to allow informed decision making again..this is best done BEFORE one ends up in a grave situation...one can be 25 and have an accident..end up in ICU on a respirator..with no brain activity...and NO one in the family may know what this person would have wanted for themselves... it is never too young or healthy or write your own advance directive... also..please carry a donor card Thus you get horror stories > like Rod's and Terry Schiavo's, where the caregivers are left to > some pretty crude default instructions for want of more personal > guidance. > > | sh.t happens. Sometimes it happens to you. | > +--- D. C. Sessions <dcs@lumbercartel.com> ---+ > Well its not a big issue unless you are involved at a personal level with > a family member. [quoted text clipped - 19 lines] > low dose over a 12 month period which during this time only saw the cancer > spread. Sorry about your loss. Be assured nothing more could have been done to alter the outcome. Remissions in such cases with "alternative" measures are almost impoassible to find, and so rare as to raise doubts as to what produced it. I wonder why the "low dose" of chemo. Was that at the patient's request? Chemo is normally given in doses near the maximum tolerable, because that is the way it works best, and most side effects are temporary. If I were similarly affected by bowel cancer (not usually very chemotherapy responsive) I would try full dosages for a few cycles with the intention of stopping it altogether if there was no clear response within 2-3 months. The chances of prolonged remission are not high, but probably worth such a trial, and very, very rarely a patient may even be cured by it. PM > It was a case of the readings are good and then the readings are bad but > at all times getting progressively worse. From lung to brain took about a [quoted text clipped - 24 lines] > > Sincerely, Rod > Well its not a big issue unless you are involved at a personal level with > a family member. [quoted text clipped - 47 lines] > > Sincerely, Rod Sorry to hear of your loss. I agree with Hawki, everyone should have a living will and carry a donor card. Perhaps a colon cleansing early on could have stopped the cancer from spreading. My condolences to the entire family, especially your sister and the children, if any. You and all the family will be remembered in prayer. Jan >> Well its not a big issue unless you are involved at a personal level with >> a family member. [quoted text clipped - 53 lines] > Perhaps a colon cleansing early on could have stopped the cancer from > spreading. my advice was not for "colon cleansing"...but for colonoscopy....once a malignancy is found in the colon, cleansing cannot do anything...but early detection...as in mammograms....can find cancer at stages early enuf to extend one's life .....perhaps to die of another ailment if lucky as to living wills and advanced directives...I know Jan meant well...but in all states these are not the same thing...so one must find out what your state's "advanced directive" involves...I am not a lawyer...but the first is usually not as specific as the second...my state provides blank forms either with anyone hospitalization...or online ....I like our forms as they are very very specific..and yes..I realize this specificity also protects the medical community...but personally and professionally I like very specific vs very broad launguage... ours need to be witnessed and notarized...several copies are suggested....one in your hospital chart..one with your main doc...one with your spouse and another at least with an adult child....once it is written and notarized,,there is usually no need to change it.... donor cards are for the living...in addition to a donor card with your driver's license..you MUST discusss your wishes re organ and tissue donation with your family....spouse PLUS at least one adult child,,sibling etc...a donor card found in the ER sparks approach to the family...but next of kin also MUST give consent... thanks Jan for adding your thoughts... we all feel for Rod and his family... > My condolences to the entire family, especially your sister and the > children, if any. > > You and all the family will be remembered in prayer. > > Jan >>> Well its not a big issue unless you are involved at a personal level >>> with a family member. [quoted text clipped - 60 lines] > detection...as in mammograms....can find cancer at stages early enuf to > extend one's life .....perhaps to die of another ailment if lucky Yes, I know. > as to living wills and advanced directives...I know Jan meant well...but > in all states these are not the same thing...so one must find out what [quoted text clipped - 15 lines] > etc...a donor card found in the ER sparks approach to the family...but > next of kin also MUST give consent... Good point, but I will check out to see that the donor wishes can be put in your appointment of health care respresentative and have he/she sign it. Knowing full well of the donor's wishes. > thanks Jan for adding your thoughts... Your're welcome. > we all feel for Rod and his family... > [quoted text clipped - 4 lines] >> >> Jan >>>> Well its not a big issue unless you are involved at a personal level >>>> with a family member. [quoted text clipped - 87 lines] > health care respresentative and have he/she sign it. Knowing full well of > the donor's wishes. yes it can be...but remember you or whoever may NOT be at a location where your records are easily accessible..you could always carry both your advancedirectives with you...as well as the donor designation on your license.... my point was that it is in the ER that most often organ donation situations arise...and time is of the essence...YOUR wishes are indeed the most important...but if one of your next of kin refuses...your wishes may not becarried out... >> thanks Jan for adding your thoughts... > [quoted text clipped - 8 lines] >>> >>> Jan |
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