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A blog by lung cancer survivor Tom Galli

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Chemo Doesn't Work and Oncologists Get Rich

Chances are you pay attention to new treatment developments. I was aimlessly scrolling through a social media app when I happened on a dramatic interview.  Everything was staged to look legit.  The interviewer looked like a TV reporter, the background scene looked like a doctor’s office, and the set up question “doctor, let me talk about cancer a little bit” got my attention.  The camera changes views to the doctor as the reporter says, “what are some of the things you’ve seen in terms of your patients?”  Then we see the doctor.  He looks like a doctor, well dressed with a confident assuring voice.  He changes the subject saying “a better thing to talk about“ and his name and titles flash and disappear on the screen: Peter Glidden, BS, ND (note not MD). He cited an unnamed study published in the Journal of Clinical Oncology in 1994, a 12-year program that looked at adults who had developed cancer, further clarifying adult cancer as “the main type of cancer we get here in the United States.” He described the study as a “meta analysis of people all around the world for 12 years who were treated with chemo…and the result?” “Ninety-seven percent of the time chemotherapy does not work.”  Dramatically and shaking his head for emphasis, he repeats the same statement, then he asks “so why is it still used?”  “Money”, he answers. “Chemotherapeutic drugs are the only classification of drugs that the prescribing doctor gets a direct cut of…the only reason chemotherapy is used is because doctors make money from it…period…it doesn’t work…97-percent of the time.” Continuing, he says: “We have lost the war on cancer in the United States…why…when you try to bring a reductionistic phenomena like drugs and surgery to bear on a holistic phenomena, you will completely miss the boat each and every time.”  Further he emphatically states, “if every girl in this country took 200-micrograms of Selenium, in one generation, we’d eliminate breast cancer by 82%; now why aren’t we doing that?” So, let’s take a deep dive into Peter Glidden’s claims and supporting data.  First, consider his probability predictions: 97-percent of the time chemo doesn’t work and 200-micrograms of Selenium eliminates breast cancer by 82% in one generation. These predictions sound authentic, like there was a test to determine outcomes.  But, no scientist, doctor, or engineer would ever describe a statistically based probability outcome using just a naked percentage.  There is always uncertainty and professionals bound uncertainty with a confidence level.  An engineer might say that concrete will achieve a 6,000 psi end strength but will disclose the testing sample size, mean, standard deviation and confidence level that justify the end strength statement. Test results never exactly replicate. The end strength will vary between some acceptable range.  But Glidden’s claim is precisely 97-percent.  It is unsupported.  Moreover, it is debunked in the literature.  Here is a good on-line summary about the unsupported claim . But, to even make a 97-percent statement, one would need to know, with certainty, the cause of death of each of the thousands of people who had chemotherapy.  Were autopsies performed? Might some have died of natural causes, traffic accidents or other illnesses?  A statistically significant record of “meta data of people all around the world treated for 12 years” does not exist.  Do they have data in the Fiji Islands, Kenya, Somalia, Bangladesh or North Korea? How about his 200-microgram Selenium cure for breast cancer?  He says it would eliminate breast cancer by 82% in one generation.  I’m not even sure I know what eliminate by 82-percent means. Think about how imprecise this claim is.  How long is one generation? How did you determine it was 82%? How sure are you it is 82%? I could drive a main battle tank through the gates of this claim’s imprecision! Now to his claim that cancer is not a reductionistic phenomena, suggesting that drugs or surgery misses the boat “each and every time.”  I’m one of those “each and every time” and my survival from drugs and surgery proves him wrong.  Does naturopathic treatment actually cure cancer?  I don’t know but neither does Gladden.  Here is some interesting reading about Naturopathic Doctors.  Peter Glidden’s video extolling a simple nutritional supplement as a cancer cure is compelling. He is dramatic, confident and to a diagnosed lung cancer patient facing an arduous regime of chemotherapy, persuasive.  Why bother with the chemotherapy if I can take Selenium and cure my cancer? If you are reading this, you or someone you care about has lung cancer.  Time is of the essence.  You have but three choices: do nothing, conventional medicine, and holistic medicine or some derivative of the same.  Do nothing is the least expensive alternative.  You pay nothing and might live.  Miracles happen.  Conventional medicine and holistic medicine will cost your money.  How do I make the choice?  I put my money on science-based conventional medicine treatment because treatment outcomes are repeatable.  Mark Twain said it best: “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”  Gladden is trying really hard to convince us he’s 97-percent sure chemo doesn’t work.  It just ain’t so. Stay the course.  

Tom Galli

Tom Galli

 

Thirteen Years; Thirteen Toes!

Today we celebrate 13 years of surviving NSCLC.  I'm borrowing three toes from Martha, my wife and caregiver extraordinaire, who deserves most of the credit for my continued life.  Martha did the heavy lifting during treatment, asking the right questions at the right time, and prodding my medical team with just the right touch.  By comparison, I was at wit's end during my nearly 4 years of continuous treatment.  Doctors McK (GP), H (Oncologist) and C (Thoracic Surgeon) also deserve a lion's share of credit.  Collectively, they share a trait that distinguishes them from the rest of medical community -- they treat people, not patients. The red toenail painting tradition was started by a Dr. Phillip Berman, radiologist and never smoker, who was diagnosed with Stage IV NSCLC.  In an early Internet cancer website he founded, RedToeNail.org, he vowed to paint a toenail red for each year he survived what he called "this nastiness."  He painted 5 before passing but taught me a great deal about living with lung cancer.  During treatment, he was playing with his children, exercising, interacting with friends, and finding something to enjoy every day.  In other words, he embraced the life he had and lived every day reveling in the joy he discovered. His lesson -- those who choose treatment choose life and the important thing is to do something with the life you have.  I pass his powerfully evocative message to you.  If you suffer with lung cancer then resolve to live every day and find something to enjoy.  Realize that if I can live, so can you.  Paint your toenails red! Stay the course. Tom 

Tom Galli

Tom Galli

 

Scanziety

Amazon Kindle Royalties Donated to LUNGevity.org During November:"I am not a doctor; indeed, I possess little medical knowledge.  I am, however, a very experienced and long-tenured lung cancer patient.  That gives me a unique perspective on the disease that kills more people­­—many times more—than any other type of cancer.  I do not intend to fill this story with statistics.  They are readily available from any number of reputable resources.  I have a firm belief, however, that lung cancer research is poorly funded because lung cancer is considered a self-induced disease.  We speak of those who suffer from or succumb to cancer as having engaged in battle; but in battle, one can choose to retreat.  When diagnosed with cancer, the only choices are treatment or death.  Statistically for lung cancer patients, the battle for life through treatment more often than not is lost. Treatment borders on barbaric torture that is endured repetitively, with uncertain outcomes and with death looming closely.  I claim no medals for bravery.  I was, and still am to some degree, overwhelmed by fear.  While in active chemotherapy, the time between a diagnostic scan and results was a nightmare to endure; thus, my name for this experience: Scanziety.  Several times, my treatment nearly killed me.  I survived, not knowing how or why.  My survival provides hope for those who suffer, particularly for the 230,000 Americans who will receive a lung cancer diagnosis this year.  If I can survive, so can you." Stay the course. Get your copy of Scanziety here https://www.amazon.com/Scanziety-Retrospection-Lung-Cancer-Survivor-ebook/dp/B01JMTX0LU 

Tom Galli

Tom Galli

 

10 Steps to Surviving Lung Cancer from a Survivor

MY STEPS TO SURVIVING A LUNG CANCER DIAGNOSIS Step 1 – Invest in sophisticated diagnosics before diagnosis If you smoke, were a long-term smoker, or are in an occupation that exposes you to carcinogenic toxins (asbestos removal, auto mechanic, painter, etc.), I suggest getting a computed tomography (CT) scan, often called a CAT scan, of the chest once a year. Insurance now covers it and CT will detect tumors far earlier than a chest x-ray. Early detection of small tumors dramatically enhances your survival chances. I had a chest x-ray in January 2004 and was diagnosed with inoperable stage 3b, non-small cell lung cancer the following month. The tumor hadn’t shown on the x-ray; but at diagnosis, it was almost 3 inches long and ½ inch in diameter. The only symptom I had was coughing up blood the day before diagnosis. Learn more about early CT screening. Step 2 – Choose a good general practitioner  Your general practitioner may be the manager of your lung cancer treatment. The GP likely will pick your cancer team and may need to do a little arm-twisting to get things moving. Therefore, there can be great benefits to having a GP who is seasoned and well known in the medical community. I prefer doctors of osteopathic medicine to medical doctors. I’ve found that in my experience the former treat people, not patients. I believe a good physician shows kindness, consideration, and compassion toward those in his or her care. These characteristics are essential. Be sure you know your GP and your GP knows you. Such knowledge and trust will give you a survival edge. There are great health care professionals out there. Step 3 – Ensure your oncologist is a physician A doctor has a degree in medicine and a license to practice. A physician is devoted to restoring, maintaining, and promoting your good health. My physician oncologist does a complete examination (looks in eyes, nose, and throat, checks pulse in the extremities, checks reflexes, listens to breathing and heart rate) every visit. He reviews and explains all test results and asks how I feel. He looks at me as I speak, and he listens and makes notes on what I say. He carefully explains medical treatment alternatives that may arrest the disease, and together we choose each next step. He never rushes consultations and, consequently, often is late to scheduled appointments. Because his tardiness results from spending time with those he treats, I know he cares about me and every other patient. These are some characteristics your physician oncologist should possess. Step 4 – Learn about your disease At diagnosis, I had no idea what lung cancer was. Moreover, I didn’t know what an oncologist did, nor could I spell the word! After diagnosis, I read everything I could find about the disease; a good resource is the www.LUNGevity.org website. Then I read medical journals, government reports, research papers, and studies. I made notes about things I didn’t understand and asked questions at my oncology consultations. My wife attended every consultation, procedure, and test to ensure every question was asked and answered, and that we understood the answers. You need to know about type, stage, statistics, radiation, diagnostics, chemotherapy, side effects, surgical options, and so much more. Your chances of survival are improved if you are informed enough to ask highly perceptive questions. Step 5 – Acquire a sanguine attitude quickly Cancer is a disease of death; lung cancer kills more than all other cancers. Your attitude toward treatment is, I believe, essential to survival. When you acquire a sanguine attitude, your treatment team will notice your optimism. They will enjoy interacting with you; they will care about you. I strongly suggest you read Stephen Jay Gould’s essay “The Median Isn’t the Message” to help you understand survival statistics and find optimism about what appear to be bleak probability of survival projections. Join a cancer blog or messageboard. I am a member of several where I can broadcast my complaints and protestations to people who understand and have useful advice for coping. Find cancer support groups and join one. Most people who treat you have no idea how you are feeling. But survivors in cancer support groups understand; they know how you feel—you’ll fit right in! Step 6 – Any port in a storm There is no such thing as “a little stick!” During procedures and treatment, almost everyone will attempt to gain access to your veins with an intravenous device of some type. All such intrusions are uncomfortable, and unless the practitioner is good and lucky he or she will miss more often than not. If your treatment involves intravenously administered chemotherapy, you likely will get stuck at least once a week. A good way to avoid discomfort and frustration is to ask for a port. Installation involves simple, low-risk surgery. Once in place, you need to keep the area clean and exercise precautions when bathing—but access to your veins is no longer a storm but a port in a storm! Step 7 – Don’t believe the miracle cure The consequences of a lung cancer diagnosis are frightening. For most, it will be your first serious encounter with the prospect of death. When you type “lung cancer” into Google, you will be bombarded by advertisement that promises miracle cure at considerable expense. There is no such thing as a miracle cure! Before you invest time (now precious) investigating one of these “too good to be true” remedies, check it out onwww.quackwatch.org and discuss it with your physician. Oncology is a medical science. Procedures, drugs, and protocols are tested using scientific methods that are published and reviewed by peers and regulating organizations. When science-based breakthroughs are discovered, they are broadcast very quickly throughout the practitioner community.Read about Steve Jobs—one of the smartest technologists and businessmen the world has ever known—who delayed his cancer treatment. Step 8 – Don’t try to tough it out I am a retired soldier and believed I was man enough to handle almost anything. Cancer proved to be the “anything” I could not handle! I suffered a long time trying to tough it out before I admitted I was depressed. My physician’s response: “Of course you are depressed—how could you not be?” He prescribed appropriate medication, arranged consultations with a physiologist, and suggested I attend support groups. Unless you are tougher than I, you will experience depression. Admit it and accept help. Here are some other things you might try. Ask for the “freeze spray” before an IV is used. If claustrophobic, get a script for Xanax and take it shortly before scans. Even in summer, wear warm clothing to diagnostic and infusion sessions. Some areas where these take place are kept very cold. Many treatment centers have volunteers—engage one in conversation. Many are survivors or caregivers and have a wealth of helpful information. During consultations, I was so frightened I couldn’t rationally ask questions about results or next steps, and I certainly couldn’t remember what was said. Consequently, I never go alone to a consultation. I suggest if you can, always have someone with you too. Step 9 – Become a calendar maniac If you have a smartphone with a calendar application, become an expert in its use. If not, keep a paper “cancer calendar” to record information. Your life after diagnosis will likely become filled with scheduled appointments, and given the nature of the disease and intensity of the battle, these are appointments you don’t want to miss. For example, my chemotherapy cycle required an infusion every third Friday. I had to record three rounds of steroid medication taken every six hours before each infusion. I had a scheduled blood test every Monday following infusion. Nausea started Sunday morning and lasted until Tuesday. Joint pain started Wednesday and lasted until Saturday. If I took the nausea medication about an hour before onset, symptoms often were minimal. Furthermore, if I started pain medication a couple of hours before onset, my pain was manageable. I used the alarm feature on my phone to warn me in advance. Plus, there was life to live, and the calendar helped me avoid conflicts between my cancer treatment schedule and my life events schedule. Step 10 – Choose to live When asked about my cancer experience, I often tell those in treatment that cancer is a disease of life or death. I believe if you choose treatment, you are choosing life. And if you choose to live, do something with the life you are given. The “something” will be different for each of us, but doing whatever you enjoy or find fulfilling is so important. If you enjoyed an activity before diagnosis, do it afterward. Look at yourself in the mirror every morning. If you don’t see an expiration date stamped on your forehead, then enjoy the day and look forward to the next! Oh, by the way, your hair will grow back! Baldness is a beautiful badge of courage. Stay the course.

Tom Galli

Tom Galli

 

Uncertain Treatment Outcomes: A Baseball Model

Baseball is a game that requires patient players and fans. Like lung cancer treatment, there is a lot of waiting for something to happen. Also like lung cancer, the game is unpredictable. A single pitch can change the outcome of a game like a single cell can change the outcome of treatment. And like lung cancer, baseball has many uncertainties and these are defined by odds. The best hitters succeed a little better than one in three times; the best teams winning about six in ten games. Baseball players need to persevere against low odds of success to achieve victory. So do lung cancer patients. A lung cancer diagnosis is devastating. Recurrence after treatment is common and traumatizing. We ought to prepare for the distress of recurrence. Treatment, even for those diagnosed at early stage, is not likely to be a walk-off home run. I was not prepared for treatment failure. How common is recurrence? A National Cancer Institute study suggests about 33 percent of stage IA and IB patients experience a reoccurrence. Up to 66 percent of stage IIA, IIB, or IIIA experience a reoccurrence. Interestingly, these percentages are virtually identical for both adenocarcinoma and squamous cell lung cancers. What about stage IIIB or IV disease? The study reports recurrence about half that of lower stages but suggests this is due to competing risk of mortality. Including surgery, my treatment success average was a dismal 1 for 5. That translates to a baseball batting average of .200, yielding a quick trip to the minor leagues. I had four recurrences after no evidence of disease (NED) treatments. We didn’t know perseverance was a requirement and we were not prepared. How should we prepare? Here is what I didn’t do. Have a frank conversation with my oncologist seeking information on recurrence likelihood. Share this information with my family to ensure they were prepared for bad news. Finally, celebrate my NED state by fully engaging in life. NED is that extra life treatment buys and we did not take maximum advantage of it.  A sidebar benefit of surviving is accumulating lessons learned. I now completely understand that lung cancer is a persistent malady that is difficult to eradicate with unpredictable treatment outcomes. Like the best baseball players, we need to take our turn at each new treatment with a fresh perspective, forgetting our last experience and striving only to put the ball in play and arrest our disease.  Stay the course.

Tom Galli

Tom Galli

 

Lung Cancer's Painful Quadratic Equation

Early on, we learn Algebraic equations with only one solution. Then we encounter equations with two solutions -- Quadratic Equations. Consider: x2 + 3x – 4 = 0. This has two solutions:  x = -4 or x = 1. Both are correct; one is negative and one is positive. Algebra students get very comfortable with solutions having a positive and negative outcome -- lung cancer survivors are less comfortable! The positive outcome for lung cancer is extended life. But like quadratic equations, there can be negative outcomes that are less desirable.  Mine is chronic pain.  So to the question, how does one fit a negative outcome into the positive?  No, Algebra does not help.  But, for those in treatment or surviving after treatment, preparing for life with negative outcomes is helpful. My chronic pain has two primary and many secondary causes.  I have peripheral neuropathy -- numbness in fingers and toes including a burning sensation in toes and pain in the foot joints.  It is a common Taxol side effect, and we informally call it “taxol toes.”  Also, I have nerve damage caused by quite a few surgeries to my right chest that is chronically painful. How do I fit these negative outcomes into life? My strategy is to tolerate chronic pain until bedtime.  Then something must be done or I won’t sleep.  I’ve cycled through over-the-counter, then prescribed sleep medications.  Both worked for a while.  Doc found a study suggesting a therapeutic effect for Xanax on chronic pain.  He prescribed a 0.5mg dose at bedtime, allowing an increase to a total of 1.5mg.  This relaxes me and makes me drowsy.  It works about 6-in-10 nights.  A secondary cause sometimes drives pain above chronic levels. These are: chemotherapy induced joint pain; muscle cramps; stress, anger and excitement; sneezing and coughing; and flying on aircraft.  The joint pain, an in-treatment side effect, required narcotic medication in every case to relieve.  Reliance on narcotics has two downsides: an inability to think and function normally the next day and constipation. However, other secondary causes occasionally require narcotic medication to achieve relief.  Because of the downside to narcotics, we’ve developed a couple of unique pain abatement procedures that may be of interest. Our first strategy is to apply prescribed lidocaine transdermal patches to incision scars and or feet in combination with Xanax.  Since lidocaine dosage is limited to 2 patches, my wife cuts them into strips and fits them along my incision scars, and applies them to my feet.  A pair of tight fitting socks are stretched over my feet to keep them in place. When the offending pain spike is either in my chest or feet, a full 2-patch application is used.  The patches are applied in time to allow the Xanax to work and I sleep, hopefully. The next works only for feet and is a back-up strategy if lidocaine fails.  My wife uses an ace bandage to wrap reusable frozen Blue Ice packs to the bottom of each foot.  The cold is very uncomfortable for a couple of minutes, but in a short time my feet are numb and if I’m lucky, I sleep. Muscle cramping is a long term side effect from chemotherapy. It stems from low Magnesium blood levels.  I take at least 500 mg of Magnesium supplement per day.  My oncologist would rather I take 1000 mg, but I suffer digestive system revolt. I learned that almonds provide 75 mg of Magnesium per ounce so I snack in lieu of a second pill.  Regardless, I still experience one to two cramping events per day.  When they occur anywhere near my feet or chest, chronic pain soars.   There is however, no remedy for cramps.  The worst occur in the middle of the night and wake me up. Archimedes, the ancient Greek hydrologist, provided an explanation for why immersing up to my neck in a swimming pool eases incision pain.  The upward buoyant force of the water offsets the gravitational pull on chest incisions thus minimizing pain.  Almost every day our community pool is open, I spend hours in the water.  This does not eliminate pain but reduces it noticeably. On leaving the pool, the normal level returns but it is very therapeutic.  Lying in a bathroom tub, unfortunately, does not work because there is not enough water for complete submersion.  A hot tub works fine, but there is no difference in pain relief from water temperature.  Flying in a commercial airliner also spurs chronic incision pain.  Most airlines pressurize their cabin between 6,000 and 8,000 feet pressure altitude.  This lower-than-sea-level pressure expands my chest cavity increasing incision pain.  All commercial flights hurt but long flights are very painful often requiring a dose of narcotic medication in flight.  Not flying is the only remedy.  Those having thoracic surgery have long complained of incision pain after commercial air flights and cabin pressure is the cause. Another secondary cause is extensive coughing and sneezing.  Sneezing is particularly bad when it is a “surprise sneeze”.  During the worst pollen events, I stay indoors and I try and avoid school age children to keep the chest colds in check, especially when school is in session.  The last secondary cause I have the most control over: stress, anger and excitement.  Admittedly, excitement is the easiest to control except when the Dallas Cowboys are playing my beloved Philadelphia Eagles.  These two games a year are indeed stressful and since I live among cowboys, someone is going to be angry over the outcome. My wife reminds me when I complain too much that I am lucky to be alive.  What’s a little pain given the alternative.  She’s right.  Doc reminds me to avoid scheduling things in the morning so I can sleep-in late if pain interferes.  He’s right.  Football season is right around the corner and it is a good thing games are scheduled in the afternoon and evening.   Now if the Eagles start winning, everything will be fine! Stay the course.

Tom Galli

Tom Galli

 

Hope Is A Good Thing

Red, in white shirt and loose thin-black tie and sweating in Maine’s summer heat, is leaning on a rock-wall fence.  He’s just opened Andy’s letter found under the black obsidian rock.  In the background we hear Andy reading his evocative description of hope: “Remember Red, hope is a good thing, maybe the best of things and no good thing ever dies.” The movie Shawshank Redemption is a powerful story about hope and life with a message that should resonate with every lung cancer survivor. I watched the movie the other day and made the connection.  Andy was imprisoned for two life sentences with no possibility of parole.  He was wrongly convicted of murder and throughout the story of his day-to-day life in prison, everyone tells him “hope is a dangerous thing.”  On escaping, Andy proclaims that hope is “maybe the best of things.”  The movie story line is exactly parallel to the plight of the late-stage diagnosed lung cancer patient ⎯- an unforgiving disease with hope as the most effective means of avoiding consequences. For lung cancer, hope is not a medical remedy.  While new lung cancer treatments are emerging more frequently now, basic research funding to diagnose and treat lung cancer lags other cancers.  Perhaps the pace may pick up, one hopes.  Perhaps a treatment may emerge just in time to save a life, one hopes.  Perhaps a miracle remission occurs, one hopes.  Hope may not be a medical remedy but, for many of us, it is our only effective medicament.  And, in my case, hope is “maybe the best of things.”  Recall the story line of Shawshank.  Andy’s future is confinement in a mind numbing institution, but he makes a choice to live in a different reality and works diligently, every day, on a novel escape plan. He makes a conscious decision to live.  He embraces the hope of escape against all odds.  Andy’s poignant characterization about life reveals his reasoning: “I guess it comes down to a simple choice, really.  Get busy living or get busy dying.”  Exactly! Sometimes in the heat of lung cancer treatment, we forget its purpose ⎯- extended life.  No one knows how long but life for most is extended. So what do we do with the extension?  Re-read Andy’s characterization. We long for a period of life extending into satisfying old age.  But most without lung cancer do not dwell on the amount remaining on account.  Lung cancer patients take careful measure of the balance.  But, measure for what end?  I believe, if one chooses treatment, then one chooses life.  Rather than dwell on the remaining balance, focus on doing something you enjoy everyday.  I suggest a survivor forget the past, declare the future irrelevant, and live in the day. “Get busy living or get busy dying.” Stay the course.

Tom Galli

Tom Galli

 

Predicting Doom

I am not a statistics wizard; an engineer, I value the predictive power of statistics.  Indeed, if one can precisely control variables, a statistics-based prediction of the future is remarkably accurate.  The joy of predicting end strength for a new carbon-nanotube concrete mix design melts the heart of this engineer.  But, concrete is a thing with but 4 variables to control.  Human beings have perhaps millions of variables, thus predictions about people are vastly more complicated and inaccurate. Statistically-based predictive power has a foreboding downside.  The methodology is used by the medical profession to forecast life after diagnosis with late-stage lung cancer.  Unfortunately, I have first-hand experience once predicted with but 6 months of remaining life nearly 13 years ago!  My doom was forecasted with high statistical confidence and for a while, I believed it. In the dwell time between treatments, I searched for methods used to generate my projection of demise.  Each patient’s type, stage, age, ethnicity, race, and date of diagnosis are reported to the National Cancer Institute on diagnosis.  Deaths are also reported but not the cause of death.  Nothing is captured on complicating health problems like cardio-pulmonary disease, diabetes, or other life-threatening maladies.  The predictive data set appeared slim and uncontrolled.  My doom and resulting gloom waned while mindlessly searching web pages for statistical good news.  Ammunition in the form of a powerful essay by the noted Harvard biologist Stephen Jay Gould – “The Median Isn’t The Message” – contained: “…leads us to view statistical measures of central tendency [median or mean] wrongly, indeed opposite to the appropriate interpretation in our actual world of variation, shadings, and continua.” This meant the statistician seeks to combine data and express it as a median or mean to predict or explain. I’d forgotten that I was one inaccurate variable in a “world of variation.” One data point used to calculate a central tendency of survival for about 1.4 million Americans diagnosed in 2004.  I might be the one holding the right-shifted curve from intersection with the axis of doom.  Gould survived 20-years beyond his late-stage, nearly always fatal, abdominal mesothelioma cancer diagnosis.  Ironically, he passed after contracting another form of unrelated cancer.  A distinguished scientist, Gould eloquently described the limits of science and statistics by suggesting that “a sanguine personality” might be the best prescription for success against cancer.  There is always hope, with high confidence. Listen to his essay here. Stay the course. ____________ Get your copy of Scanziety here https://www.amazon.com/Scanziety-Retrospection-Lung-Cancer-Survivor-ebook/dp/B01JMTX0LU 

Tom Galli

Tom Galli

 

Targeting My Type With Chemicals

“Squamous cell cancer offers distinct therapeutic challenges by virtue of presentation in older patients, its physical location in the chest, pattern of metastasis and association with comorbidities that can compromise treatment delivery and exacerbate toxicity.” This quote is from the article Targeted Therapy for Advanced Squamous Cell Lung Cancer. When diagnosed, almost 13 years ago, I didn’t realize lung cancer had types. Pathologists visually classify lung cancer cells seen under a microscope as small cell and non-small cell. From this simple delineation, further classification gets complicated introducing sub-type terms of adenocarcinoma, squamous cell and large cell. Large cell as a type of non-small cell? I recall dwelling on the large cell moniker and finally concluding a non-small cell can be a large cell. I remember the emergency room physician telling me I was lucky; my form of lung cancer was treatable compared to the other type. He didn’t say small cell, but I think that is what he meant. Indeed about 15-percent of us suffer from this nasty presentation that metastasizes rapidly. Adenocarcinoma sub-subtypes have morphed into an alphanumeric soup as research at the genetic level identifies biomarker profiles, mutations in an individual’s lung cancer that can serve as attack portals into the cancer cell by targeted therapy. Now adenocarcinoma survivors use terms like ALK, KRAS, EGFR and PIK3CA to further classify their disease and new targeted treatment drugs emerge to attack, like mutant Ninja Turtles! Some of these are so effective, they’ve moved to first-line therapy. Adenocarcinoma describes a type of cancer that occurs in the mucus-secreting glands throughout the body. Lungs naturally have an abundance of these glands but so do the prostrate, pancreas, and intestines. Squamous cells derive their name from the Latin squama meaning scale like those present on a fish. We have a lot of squamous cells including skin, the lining of hollow organs, and passages of digestive and respiratory tracts. The right main stem bronchus contained my squamous cell tumor. The location is what tipped-off the emergency room physician; he didn’t realize how lucky I was given the nature of my treatment and extent of survival. Speaking of treatment, the cited article reports: “therapeutic progress in squamous cell lung cancer has been relatively slow, with relative stagnation of survival numbers….Treatment for SqCC [squamous cell cancer] of the lung remains an unmet need, and novel strategies are needed including specific targeted therapies….” That’s not good. First-line therapy for many continues to be the dual recipe of some variation of taxol and carboplatin, the same drugs I was administered from 2004 through 2007. And, survival rates have not significantly changed despite chemistry changes in platinum and taxol based agents. Thankfully, these have lowered the incidence of peripheral neuropathy and this is helpful. Second and subsequent line therapies for squamous cell have benefited somewhat from research. Immunotherapy research has yielded some success in developing drugs that enhance our immune system’s ability to recognize and attack cancer cells. The alphanumeric monikers PD-1 and PD-L1 are starting to resonate with squamous cell survivors. I do like the names of these approaches ⎯ PD meaning programmed death! The idea of programming cancer cells to die is satisfying although that is not the means of attack. Nevertheless, the scientist that named this approach deserves recognition because a scheduled execution of squamous cancer cells would be well deserved payback. All squamous lung cancer cells are programmed to die tomorrow at high noon! But, progress in the genetic arena for squamous cell cancer has been slow because it is genetically more complex compared to adenocarcinoma and mutates faster. So it is a harder target to hit. When I think of hard cancer targets, I am reminded of Siddhartha Mukherjee’s superb book The Emperor of all Maladies. He aptly describes the challenge of chemotherapy as “finding some agent that will dissolve away the left ear and leave the right ear unharmed.” He also called cancer a “clonally evolving disease.” Cancer cells grow by cloning at a rate far faster than normal cells. Every new cohort creates mutants and some of these survive the assault of chemotherapy. All that need survive is one; it will rapidly grow now immune to the drugs targeted to kill it. Mukherjee said: “the genetic instability, like a perfect madness, only provides more impetus to generate mutant clones. Cancer thus exploits the fundamental logic of evolution unlike any other illness.” Cancer is pure evolutionary nastiness! “Better things for better living through chemistry” was the tagline of the DuPont Corporation. Growing up in southeastern Pennsylvania, many neighbors were chemists commuting to the company research center, just across the Delaware state line. DuPont changed our world evolving from an 1802 gunpowder maker to inventing Nylon, Mylar, Teflon, and Nomex to name a few. Squamous cell lung cancer survivors need better chemistry. The call goes out for a biochemist to step-up and shut down the perfect madness of the clonally evolving squamous cancer cell. Stay the course.

Tom Galli

Tom Galli

 

Thanksgiving

Today, in the United States, we celebrate the holiday of Thanksgiving.  Our first president, George Washington, called for an official “day of public thanksgiving and prayer” in 1789 and although the Congress heartily agreed, the proclamation was lost in the bureaucratic press of politics.  It fell to Abraham Lincoln to rekindle the Thanksgiving Holiday shortly after the pivotal battle of our Civil War—Gettysburg in 1863.  Thus in the mist of warfare and uncertainty, a holiday dedicated to thankfulness was founded.   Today, we gather to celebrate life and thank the Almighty for health and bounty.  Thankfulness for me, a lung cancer survivor, is particularly significant for I have been blessed to witness one of life’s most memorable events: birth of a first grandchild. During my recent visit, while cradling her in my arms, I felt a connection with my infant-offspring.  As the picture captures, Charlett Emilyrose was looking intently into my eyes, unusual for a three-week old baby.  She held my gaze for the longest time as if painting a mental portrait.  Her grandfather was joyous and delighted and thankful.  This touching moment is unfortunately rare for those with lung cancer.  By statistical expression, Thanksgiving 2005 should have been my last celebration.  Yet, nearing my 13th year of surviving a lung cancer diagnosis, I am so thankful to have witnessed the birth of a grandchild. Providence has indeed showered me with gifts. So today I give thanks for survival and in the spirit of George Washington’s original scope of holiday, I pray all who suffer the effects of this horrid disease experience the joy and delight I felt as I held my granddaughter in my arms.  Happy Thanksgiving all. Stay the course.

Tom Galli

Tom Galli

 

Second Opinions

I had an interesting chat with my general practitioner over the Fourth of July holiday.  He’s a gentleman rancher with an abundance of tomatoes so I brokered an invite to his beautiful ranch to relieve him of his abundance. A social cup of coffee segued into a wide ranging conversation about medicine, ranching, politics, engineering and cancer treatment.  Doc has lots of opinions but they are founded on deep study and comparative analysis.  But, unlike most intelligent people, he rarely uses technospeak but rather explains complex topics in easily understood words and concepts. Thus fostering interesting conversation. The topic turned to patients seeking second opinions and physician egos.  His words are worth capturing: “I don’t mind a patient seeking a second opinion…I get paid.” Doctors are important people in our society. Our adulation of their skills causes us to forget that in a pay for service system, customers have a right to express dissatisfaction and seek alternative practitioners.  If you don’t like the medical service you pay for, find someone who provides better service. Stay the course.

Tom Galli

Tom Galli

 

If it Walks Like a Duck

“Terminal stage IV lung cancer patient miraculously cured by cannabis oil.” “Frankincense oil kills cancer cells while boosting immune system.” “The real reason pharma companies hate medical marijuana is because it works.” If you are a lung cancer survivor, you’ve read these pronouncements. Hopefully, you don’t believe them. The purveyors of miracle cures are so persuasive that some people avoid conventional treatment and rely instead on the unconventional. I remember my frantic web search for treatments after diagnosis. I explored conventional methods and learned about lots of downside and little upside. Reading the benefits of aromatherapy, guaranteed to cure my lung cancer by simply breathing a fragrant substance, was so appealing. Then as others learned of my diagnosis, I was bombarded by emails suggesting holistic medicine, Breuss diet, and magnetic therapy, to name a few. All that need be done to cure my lung cancer was move a powerful magnet over my chest for 30 minutes a day! Of course, one needed to spend thousands of dollars to purchase the special magnet but it was a money-back guaranteed cure. There are miracles. These are medically documented instances where cancer stopped growing and spreading without treatment. But those touting magnets, cannabis oil, or a multitude of other treatments, methods, or substances (check Wikipedia’s list of unproven and disproven cancer treatments) are selling miracles. A miracle, in case you are wondering, is an event that defies explanation. No one knows why, including the seller of miracle cures. When stricken by lung cancer, time is of the essence. We are often diagnosed at late stage and effective treatment must be prompt. Consuming time to undergo Miracle Mineral Supplement or Orthomolecular Medicine at great expense eats into this now precious time. Here are three tests one can apply to sniff out a phony cure: (i) drugs and procedures not FDA approved; (ii) drugs and treatments not covered by insurance, and (iii) the patient needs to pay large amounts of cash in advance of receiving treatments. Oh, and check out Quackwatch. Our world is plagued by conspiracy as in: “big pharma has a cure but is withholding it from the market to boost profits.” Sure! Think about it. A publicly traded corporation has a cure for cancer and is not selling it—that would never happen. Recall how quickly we learned of Cuba’s cancer vaccine, and Governor Cuomo’s ex-officio trip to Cuba before restoration of diplomatic relations to negotiate putting the vaccine under accelerated FDA testing. A sure-thing cancer cure would be front page news on every paper around the world! Oncology is a medical discipline founded on science and grounded by rigorous studies that are openly published and reviewed by doctors and scientists around the world. New treatment and diagnostic methods are well vetted to ensure both safety and effectiveness. An oncologist dedicates his or her life to treating people with cancer. When a board-certified oncologist tells me about a miracle lung cancer cure, I’ll believe it.   Till then, it walks like a duck. Stay the course.

Tom Galli

Tom Galli

 

Social Security Disability by Disapproval

Perhaps you’ve heard?  The federal government is a large insurance business with a standing army.  Social Security is insurance — a specific kind of insurance called an annuity.  The insured and employer pay premiums every month to fund a defined benefit at a specified year (normally your federally mandated retirement year).  Everything is peachy-keen till a disability affects work because one has late stage lung cancer.  And, when a lung cancer survivor files for disability, allowed by law and regulation, the federal government almost always disapproves.  So, here are some suggestions for obtaining disability benefits by disapproval. 1. Expect to be Disapproved. I know a lot of folks with lung cancer.  Among this population, only one was approved on initial application.  He passed before he received his first benefit check.  My company provided disability insurance carrier filed my first application.  I had an unresolved bronchopleural fistula after a pneumonectomy that required a second and third surgery and indications of tumors metastasized to my remaining lung.  My claim, filed by a former Social Security claims adjuster, was disapproved. 2. Involve Your Doctors.  The disability application requires you to disclose all your physicians and medical providers.  Then, the administration asks for medical records, reports and observations. Doctors are busy folks; oncologists are bombarded by SSA requests for information, and for good reason.  Late-stage lung cancer (including treatment and side-effects) is often disabling.  Inform your medical providers of your application and ask them to help by responding to the request for information. 3. Complete the Application. The Social Security Administration is a bureaucracy.  Bureaucracies love to find “nits” in applications and return with some very vague description of the problem. This delays a decision and delays payment, and these are typical insurance company behaviors. Read every word of the disability application process (it is all online at www.ssa.gov) and check your application closely to ensure it is complete and error free.  Have several family members check it also after reading the application instructions. Ensure you completely describe your symptoms including those caused by side-effects.  Also, completely describe how these symptoms affect your ability to stand, sit, walk, bend over, think, concentrate, and etc. (Hint - read the criteria that will be used to determine your disability finding and use those words as descriptors). 4. Understand the Fine Print. There is payment delay: six full months after the date of disability (date shown on claim approval letter). Depending on other income sources, payments may be taxable. You are not found to be permanently disabled.  Regulations allow a review of your status after start of disability payments. It is not a good idea to join an adult softball team while receiving disability payments! You are not eligible for Medicare until 24 months after receipt of first disability payment. Your disability payment will be less than your full retirement benefit, and when you reach retirement age, your retirement benefit will not be increased.  5. Lawyering Up. Filing the initial disability application online is a good idea, as long as it is properly completed and supported by doctor reports and observations.  But when denied, it is time to level the playing field and retain a lawyer. Not any lawyer, but a law practice that specializes in Social Security Disability appeals.  By law, they cannot charge you for their services.  They collect fees directly from the Administration if an administrative law judge approves your appeal.  And, most important, they know what they are doing and it is in their financial interest to do a good job on your appeal! The disability process is deliberate, lengthy and frustrating. Like lung cancer, success involves persistence. Insurance companies don’t relish paying claims and every approved disability claim turns a premium into a disbursement.  But, Social Security is insurance with disability payment provisions that you pay for!  If you can’t work, apply, appeal and persist!   Stay the course.

Tom Galli

Tom Galli

 

Having and Eating Cake

I like thinking about choice.  It is an interesting concept and can involve logical, rational thinking and irrational and illogical thought — sometimes concurrently.  Choice is not just a human phenomena.  Animals make choices, some deliberate and some random. But when all is said and done, a choice is a decision that has an outcome (or consequence).  When we make rational choices, we are said to be informed of the consequences. Irrational choices are those where consequences don’t matter. To digress for just a moment, consider the age-old saying involving cake.  It is generally cast as a statement of choice that resolves to a consequence: if you eat your cake, you can’t have it. Think about the statement for a moment.  If I truly want to possess a cake, I can’t eat it.  Both are desirable: having a cake is nice, eating it is better.  But, the consequence of eating involves the loss of cake and, for example, a further consequence if one planned to use the cake to celebrate a child’s birthday. Most would characterize eating this presentation cake as irrational. Disappointment is the consequence and it is known and understood before making the choice to eat.   Let’s extend our thought experiment to a choice between lung cancer treatment and continued smoking. Surgery, radiation and chemotherapy all irritate the lung, and presume the smoker realizes that tobacco smoke (indeed any smoke) is also a lung irritant.  Choosing smoking under these circumstances is irrational. The known consequences range from healing problems, surgical failure, and premature reoccurrence. Yet these don’t seem matter. The impact of consequences will also disappoint the treatment team and family who are praying and hoping for success. There are many choices in lung cancer, all with consequences.  Not choosing treatment because disease is at an advanced stage is rational. Implicit is the forbearance of side effects with little prospect of success but yielding a higher quality of end-time life.  But when one chooses treatment, one is choosing life extension.  Choosing also to continue smoking while undergoing treatment is not rational and puts at risk the opportunity for extended life.  Let’s make rational behavior choices and avoid undesirable and disappointing consequences.  Chose either to have your cake or eat it. Stay the course.

Tom Galli

Tom Galli

 

Royalties Donated to LUNGevity

I will donate all Scanziety Amazon Kindle Store sale royalties for the Month of November to LUNGevity.org to support much needed research. I wrote for the book for three reasons. First among them is “to raise a call to arms for funding lung cancer research.” Help me raise the call to arms! Read a book about surviving lung cancer and donate to sponsor research to find, fix and finish lung cancer. Stay the course. Get your copy of Scanziety here https://www.amazon.com/Scanziety-Retrospection-Lung-Cancer-Survivor-ebook/dp/B01JMTX0LU   

Tom Galli

Tom Galli

 

Fourteen Years, Three Right Feet!

This is my fourteenth anniversary surviving a lung cancer diagnosis.  Granddaughter Charlett's decorated toes join mine to keep our right feet forward! I paint my toes every year as a celebration of the joy life brings. In early treatment, there was no joy.  There was fear, frustration, pain, uncertainty and scanziety. I'd not yet discovered Dr. Phillip Bearman who taught me the reason for lung cancer treatment -- achieving extended life.  Phil decided he would live every moment to the fullest despite the rigors of treatment, and he'd celebrate every year of survival with a painted red toenail.  He couldn't control his lung cancer, but he could control the way he felt about his lung cancer.  I started living when I internalized his message.  My first paint job was at my third anniversary and I'll never miss another. I am a lung cancer survivor. My message for those in treatment is twofold: enjoy the life extension treatment provides and if I can live, so can you. Stay the course.

Tom Galli

Tom Galli

 

KODACHROME

“When I think back” on Kodak Radiographic x-ray film, exposed film was sent out for development.  Then machines were invented to develop film at the clinic.  Today the film is gone.  With a nod to Paul Simon, mama took my Kodachrome away.  But, we still have radiation. There is a lot of press about the harm of low dose CT scans with some asserting a risk of radiation induced cancer from yearly scans.  Let’s take a closer look at radiation with the aim of achieving an unbiased understanding. Meet the sievert (Sv) and his much smaller cousin the millisievert (mSv).  First, understand that 1 Sv is a thousand times larger than 1 mSv.  A sievert (and millisievert) is a derived unit of ionizing radiation dose (warning ambiguous scientific definition).  That means it is a calculated approximation of the health effect of ionizing radiation on the human body.  Why is it an approximation?  Because of uncertainty in type, strength and duration of radiation, differences from human to human, and perhaps most important, the lack of actual test data on deliberate radiation exposure to humans.  So, let’s call it a very good guess of the harm that radiation does to a person. First explore very harmful radiation—say sieverts received during a thermonuclear explosion.  How much is a lot, what’s the harm, and how lethal is it?  The table answers the question. It goes without saying that exposures greater than 30 Sv yield toast, literally and figuratively! Notice the lethality uncertainty. That results from the derived nature of the sievert.  But, 1 Sv is radiation to be avoided.  Who wants a 5-percent probability of dying?  Moreover, literature cites a 5.5-percent chance of developing cancer from exposure to a 1 Sv dose. Now lets compare and contrast the millisieverts (remember, 1,000 times smaller) received from common ionizing radiation for medical purposes.  The table has the details. Pay close attention to the third column of the table.  Single doses of ionizing radiation for all these medical procedures are very small.  Think of it this way, you’d need to have 1,000 x-rays, all at once, to approach the 1 Sv level of concern.  Notice also how small the low dose CT rate is compared to the normal chest CT. The low dose CT screening guideline recommends the test for those 55 to 80 with a 30-pack year smoking history, and current smokers or those quit within the past 15 years. Given these criteria and assuming one receives a low dose CT every year starting at 55 and living to be 100, the total Sv received would amount to 0.07.  Yes there is radiation, but the possibility of it causing radiation induced cancer is very-very-very small.  Late-stage diagnosed lung cancer presents a much higher life-threatening risk. The US Nuclear Regulatory Commission is on record stating “public health data do not absolutely establish the occurrence of cancer following exposure to low doses and dose rates below about 100 mSV.”  Applying this level of safety threshold: “Mama don’t take my Kodachrome" (and low dose CT scans) away.  Stay the course.

Tom Galli

Tom Galli

 

Advocating For Profit

I am a capitalist!  I firmly believe profit is a reward for good performance and indeed it is an expected reward.  Nothing is more important in business than making a profit.  Nothing!  My purpose for writing this is to acquaint you with a new type of business on the lung cancer scene — a for profit advocacy company.  That’s right, companies have been formed to advocate for and sustain those in lung cancer treatment and expect to earn a profit -- off us!  Let that sink in for a moment. Why a for profit seeking venture for lung cancer? Our disease kills three times more than any other type of cancer.  Research into breast cancer is making the “pink ribbon” disease a declining market.  And, perhaps lung cancer is finally getting a research break with the emergence of targeted therapy and advances in immunotherapy for types of non-small cell lung cancer.  Investment capital necessary to start the profit engine sees a growth opportunity -- from us! Let’s get down to business by creating 2 companies: call them Non Profit and For Profit.   Both have a revenue projection of $1,000.  Non Profit gets revenue from donations; For Profit from sales.  For Profit has a 20-percent profit expectation.  Non Profit has none.  Non Profit can spend all of its revenue — $1,000 — advocating for us.  For Profit can only spend $800.  Twenty percent of its revenue must be profit.  From the eye of the lung cancer patient and survivor, which company is more efficient and effective.  If dollars spent advocating and supporting are the measure, clearly Non Profit. That is the business case, but there is a more important case at hand.  For profit companies are establishing a business that makes money from our malady, our pain, our side-effects, our recurrences, our suffering.  They are not selling drugs or providing treatment, they are advocating, for profit -- on us!  You might want do a little checking before establishing a relationship with a new guy on the block.  Rest assured, LUNGevity remains a Non Profit. Private message me for details.  Be careful out there! Stay the course.

Tom Galli

Tom Galli

 

The Smoking Gun

We often hear smoking gun used to describe the “ah ha” moment of a who done it.  I was unsure of the meaning and asked Siri.  My Apple genius defined it as “as piece of incontrovertible incriminating evidence.”  I know two things with high confidence: (i) there is a very strong correlation between smoking and lung cancer, and (ii) implying smoking as a cause adds to the self-induced stigma that smacks down research for my disease. So, how do we address the stigma without pointing the smoking gun? I couldn’t stop because I was addicted to nicotine.  When I was young and fearless, almost everyone smoked and I joined the crowd.  In my 30’s, most quit.  I tried, many times and ways, but couldn’t.  My addiction was stronger than will power.  Addiction is irrational.  Most addicts recognize the harm, but recognition caves in the face of physical craving.  How is addiction to nicotine different from alcohol, heroin, or cocaine? It isn’t but what do the health authorities call it?  The Center for Disease Control (CDC) says smoking caused 480,000 deaths last year in the United States. Note absence of the word addiction.  The CDC also says about 88,000 people die annually from alcohol abuse.  Note abuse is not addiction.  Almost 35,000 people died from heroin overdose in 2015, according to the National Institute of Health.  Note again, overdose is not addiction. It is unreasonable to suggest these deaths resulted from one time or occasional use.   I contend not using addiction to characterize the root cause is part of the problem.  If I smoke, abuse or overdose, I am branded guilty of doing something wrong.  I am causing the problem.  There is no disease or medical abnormality; therefore, there is nothing to research.  This individual guilt becomes a collective stigma.  If our national health authority doesn’t treat use as addictive, it certainly won’t be prone to find new treatments. Nor, will there be interest in treating consequences.  Thus, the paltry research funding for lung cancer. Many people experiment with addictive drugs and are fortunate to stop short of addiction.  But, when one can’t stop, one is addicted and mechanisms must be found to treat the addiction. So, let’s change the nomenclature.  I am addicted to nicotine and my addiction likely caused lung cancer.  Where is the smoking gun pointed now? Stay the course.

Tom Galli

Tom Galli

 

The Lung Cancer Conjecture

Start with any whole positive number. If it is even, divide it by 2; if odd, multiply by 3 and add 1. After a string of calculations applying the even-odd method, regardless of the starting number, the answer will always be 1.  Well maybe because all numbers have not yet been checked. But up to 10 raised to the fourteenth power have been. And that is a very big number! This mathematical oddity is called the Collatz Conjecture.  For example, here is the calculation string applying the even-odd formula starting with 5: 16, 8, 4, 2, 1. (This is a great challenge for children BTW, especially if you require mental calculation.) Try a number. Don't try 33 or you will be up all night calculating till you reach 1, but you'll get there.  Why is it called a conjecture? The word is defined as a hypothesis that has been formed by speculating, usually with little hard evidence. I'm sure Collatz tried thousands of calculations before publishing his conjecture unlike the lady who questioned me about the origins of my lung cancer.  People are inquisitive. When I slip off my tee-shirt to enter the pool, people can't help but notice my "battle-scarred" chest. I've a distinctive banana-shaped scar along my back and missing ribs and a noticeable lack of a right pectoral muscle in addition to many suture scars front and back. I could easily claim a battle wound but tell the truth. When I did, my inquisitor said: "smoker right?"  This is the Lung Cancer Conjecture -- pure speculation. In my case, it is likely true but think of the never smoker encountering the same conjecture, then suffering the disdainful scorn of disapproval normally reserved for a badly misbehaving child.  It is of little value to take these people on. They have small minds that are already made up. It is however required we attack the attitude of deserving to die because we contracted a disease that settled opinion holds as self-inflicted. HIV/AIDS is largely self-induced and the ill are treated as heroes, reaping a bonus-budget of 10-percent of all NIH research dollars. This malicious Lung Cancer Conjecture must be contested if we hope to increase research funding from minuscule to meaningful.  The number 1 is the likely answer to Collatz's Conjecture. One also signifies a single entity, a whole person, a human being who contracted lung cancer. Does the reason really matter?   Stay the course.           

Tom Galli

Tom Galli

 

The Down Low on Low Dose

The other day, in conversation with a newly minted medical school graduate, he told me low-dose computed tomography (LDCT) was dangerous. Dangerous! If LDCT is dangerous, what is late discovery of lung cancer? He nearly fainted when I told him I had perhaps more than 40 CT scans in my treatment history, telling me I was a candidate for radiation induced cancer. It didn’t seem to register that I was a candidate for extinction by lung cancer. We are told the only effective way of treating our disease is early discovery. Few dispute this point. Why then would the Center for Medicare & Medicaid Services (CMS) want to reduce reimbursement for low-dose computed tomography (LDCT) screening by more than 40 percent? The Society of Thoracic Surgeons is concerned calling LDCT a “game changer in the battle against lung cancer.” Then I read: “Family physicians lack sufficient knowledge about recommendations for LDCT." Moreover, Doctors Patz and Chen, professors of radiology at Duke, say: “Not screening patients annually could save millions in health care costs and spare patients the radiation exposure and downstream effects of false positive screenings.” Something is very wrong. We have an effective tool for early discovery of life-threatening disease when not discovered early, and there is a campaign mounted against using it. CMS is a federal government-funded agency. In government programs there is a big difference between savings (cash you can put in the bank) and avoidance (cash spent elsewhere). CMS money is appropriated in broad categories. Once appropriated, fiscal managers move money around to address other needs or requirements. Appropriated federal funds are almost never returned to the Treasury. So the reduced funding for LDCT will be a bill payer for some other CMS program. No money is saved; it is spent on something else. Further, when making a valid cost avoidance argument, one must identify all cost. For example, the professors of radiology predicting savings for reduced screening do not identify the millions of dollars of increased cost for treating late-stage-diagnosed lung cancer. A cost avoided almost always results in cost added somewhere else, and without disclosing added burden, professionals are making very unprofessional arguments. Lastly, and most importantly, no one advocating reducing LDCT is considering the most important impact—suffering. There is a vast amount with late-stage diagnosis. Suffering affects more than the lung cancer survivor; it devastates families. While real and detrimental, suffering defies quantification in dollars. Several hundreds-of-thousands of us in the United States will suffer a late-stage lung cancer diagnosis this year. LDCT can eliminate some of this. In this light, it is hard to understand the assault against using LDCT to find, fix, and finish lung cancer! Stay the course.

Tom Galli

Tom Galli

 

Voyage of Hope

I am writing this from the pool deck of a cruise ship while on a transatlantic sojourn. Our fourth transatlantic and our favorite form of vacation, we cross then pick several countries and explore. This year, after docking at Barcelona, we fly to Ireland and tour the wild and unpopulated western coast, then spend a long weekend in Edinburgh, and fly home. The cruise and the touring after is wonderful. The flight back is a nightmare because my incision scars throb in pain in a pressurized aircraft. We need to make the return flight in two legs (overnighting in Boston) to recover from the pain.  The national hope summit concluded, and missed for the second time because of our annual spring migrations, I tell you about our cruise as two examples of hope. First, we undergo treatment and endure discomfort for a reason -- extended life. It is important to shelve the treatment and uncertainty mantle to do something enjoyable with this life extension. We enjoy these long (and reasonably priced) repositioning journeys on a cruise ship.  We step out of the mundane and into the lap of luxury and enjoy interactions with the international assortment of passengers we sail with.  Second, to the essence of hope, if I can survive to do this, so can you.   I will never go back to my lifestyle before lung cancer. But, I can have an enjoyable and meaningful life after lung cancer. And, my attitude dictates the amount of joy and meaning experienced. It is so important to realize this point. We endure treatments for a reason. Find your reason. Revel in your new normal.  Life indeed is what you make it. Make yours.  Stay the course.  Tom

Tom Galli

Tom Galli

 

Christmas Reflections

I've seen the star of Bethlehem, very early on Christmas morning.  While peacekeeping in Egypt's Sinai Desert, I would run before daybreak as soldiers are prone to do. Although the desert is quite cold in December, dawn running was a habit hard to break.  I ran the camp perimeter to check the defensive positions and greet soldiers enjoying the banter in three different languages.  Starting in the south perimeter and running counterclockwise, the predawn western sky was dark except for the stars that were so clear, they were painted on the black night sky. Passing along the northern perimeter, the sky lightened and my expectation was the sun starting its rise.  But, no, not that day. Right on the distant horizon was a cosmic anomaly, a false dawn, but a bright shining nevertheless.  I was looking at the star in the east seen by the Three Wise Men as they rode in search of Jesus. I would later learn, it was not a star but a rare conjunction of the planets -- Jupiter, Saturn and Mars -- all rising in the east slightly before being washed out by the rising sun.  I am awestruck by that memory. Many years later after surviving a years worth of cancer surgery and while waiting the results of my first post-surgical diagnostic scan, my entire family gathered to celebrate Christmas. Mom, dad, four brothers, daughter, and a posse of nieces who overwhelmed my one nephew comprised the gathering.  Despite my manifest uncertainty, we had a joyous time.  I can count on a single hand the times my family gathered.  With two Galli soldiers, someone was always missing on deployment.  But Christmas in 2004 was an assembly formation, and the clan was all present and accounted for.  We celebrated Christmas and my life.  I am awestruck by that memory. Then started the clammer lung cancer treatment. In my treatment years after the Christmas 2004 assembly, my life hovered in sadness and despair. I allowed myself to become overwhelmed by uncertainty, indeed I could think of little else. I forget there are only two things certain in the human experience: birth and death.  Everything else is uncertain; outcomes are unpredictable. Treatment was working for I was granted extra life.  There were many opportunities for joy but they were frittered away.  I am awestruck by those memories. In common with all lung cancer survivors, having been born, I have only one certain human experience yet to deal with -- death.  Its timing is uncertain with or without lung cancer. In my memories of active treatment, I chose to let life pass me by forever losing opportunities for joy. Today we celebrate a birth, a new beginning.  It was announced by a star. I've seen the star.  Let the joy of this birth be a new beginning for all lung cancer survivors.  Let us live and find joy in the life we have and be awestruck by the memories of life well lived. Stay the course. 

Tom Galli

Tom Galli

 

Few Patients Understand Their Prognosis

Just reported is a Memorial Sloan Kettering Cancer Center and Cornell University study showing but 5% of terminally ill cancer patients understand the gravity of their disease and prognosis. Moreover, only 23 percent of these had a discussion about life expectancy with their doctor. At first pass, I questioned the validity of the percentages.  They were so low they bordered on unbelievable. This had to be mainstream press sensationalism at work! Then I spoke with an expert, and she convinced me I was not a typical lung cancer patient. The fact that I read about my disease after diagnosis was a big tell. Many do not. My education about lung cancer started the first night of my diagnostic hospital stay. The lesson delivered ⎯ a very pragmatic and frank discussion with my general practitioner. His words characterizing my prognosis were "slim odds." He didn't want me to give up but wanted to ensure I knew the enemy. After discharge from my diagnosis hospital admission, I burned up the Google Search Engine reading everything I could about lung cancer. In 2004 there were not a lot of sources, but there were enough to scare the living daylights out of me.  Research revealed a very low probability of living 5 years even with effective treatment. My bravery evaporated. My wife recalls that time. She reminded that my inquisitive nature departed with bravery. Martha asked questions. These explored diagnosis, treatment possibilities, and prognosis. I mostly stared at the clock in the consultation room. Or tried to change the subject. My oncologist was frank. He said even with successful surgery, I had high odds of reoccurrence. When tumors appeared after pneumonectomy, he was down to chemotherapy to combat my lung cancer. Chemotherapy would buy time but it wouldn’t eradicate. Time purchased allowed for CyberKnife technology to emerge that was a surer kill. But treatment opportunities were explored because Martha was persistent. After a year of surgical mayhem and two years of Taxol Carboplatin hardened with Tarceva, I was barely along for the ride. Sure, I knew my prognosis and life expectancy probability but knowledge did not empower me; it empowered Martha. So maybe the study numbers are low because patients understand their dire straits. Maybe we know and are afraid to talk about it. In case you are wondering, lung cancer is deadly. Mostly because it displays few symptoms and is often diagnosed at late stage. The treatment tool kit for late stage lung cancer is largely empty. Why? Now that is a good question; one deserving of academic study. I’ll start. Let’s hypothesize that lung cancer is a self-induced disease ⎯ people give it to themselves. If this is true, why should society invest in new diagnostic or curative means? As a logical extension of the hypothesis, society should never invest in curing maladies that are self-induced. How is taxpayer funded research for HIV/AIDS by the National Institute of Health to the tune of $3 billion a year explained? It is self-induced. Some will assert that a proportion of HIV/AIDS patients get the affliction accidentally. Yes, and some proportion of lung cancer patients are never smokers. But, drug abuse is completely self-induced and it garners just over $1 billion in yearly research. In the same data year, lung cancer was allocated but $225 million. No research for self-induced hypothesis fails. Let’s construct another hypothesis: society funds diagnostic and curative research for diseases that kill the most people. Seems reasonable. Scarce resources ought to flow to afflictions that take the most lives. Let’s examine the data. In 2012, HIV/AIDS claimed 12,963 deaths according to the Center for Disease Control (CDC). In that same year, lung cancer killed 157,425! Drug abuse is now anointed our national pandemic. Indeed prescription opioid overdose is “raging through the country.” CDC drug overdose deaths amounted to 38,538 in 2014 but in that year lung cancer deaths were 158,080. Lung cancer is our pandemic. It has been for a long time. The more-deaths-the-more-funding hypothesis is toast! Frankly, I’m getting tired of the medical research community squandering precious dollars studying what cancer patients think, feel, or understand. What is far more relevant is how to find, fix, and finish lung cancer. Stay the course.

Tom Galli

Tom Galli

 

A Political Test for Physicians?

I’m reading of a Yale University study that advocates we choose primary care physicians by testing their political views. It is political open season and medical reporters want to join in the feeding frenzy.  The danger is some will believe a political test (views on motorcycle helmets, pot smoking and firearms to name a few) is necessary physician competency criteria, especially since the test is aimed at our closest and most important connection to the medical system—the general practitioner. Although medical specialists (surgery and oncology) treat our lung cancer, we often develop illness unrelated to cancer, or just as likely, a side-effect runs wild.  So a general practitioner (GP) is a very important part of our treatment team.  Presuming you just realized you need one, what are factors a lung cancer survivor should consider in selecting a GP?  Here is my list. A Good Listener.  Does your GP listen?  This trait is essential for we have a serious ailment with complex symptoms. During chemotherapy, I didn’t have one symptomatic complaint, I had many and they overlapped and changed day-to-day. A listening GP will hear you out, then asks clarifying questions about symptoms before launching into an exam or grabbing the prescription tablet. Off The Clock.  Does your session seem rushed? Some I know complain their doctor is “on the clock” like a game show contestant during consultation.  That’s not good.  Part of the consultation should be reviewing the reports of specialists involved in your cancer treatment.  And, questions should arise after reports and test results are digested.  A proper review with understanding takes time, not a beat the clock contest. Renew Specialist Prescribed Medications.  Murphy’s Law of medicine is your nausea medication runs out just when your oncologist is booked solid.  Do you have a GP that will come to the prescription rescue?  Some doctors don’t want to intrude on practice privileges of other doctors.  That may be a fine philosophy but when you are suffering and a simple renewal script solves the problem, your GP ought to write the script.  This is a good question to ask when interviewing a prospective GP. Cancer Aware.  In lung cancer treatment, there are medical treatment effects—say radiation burns; medical side effects—nausea, pain, numbness; and related medical problems—depression, chest infections and even common colds.  Your GP should understand the complexity that a simple chest cold might mean to a lung cancer survivor.  Questions and observations to ferret out depression is an important diagnostic role and treatment or referral are essential.  Known and Respected.  My GP was the quarterback of my treatment team.  He selected the players (specialists), monitored their treatment, and intervened to steer the team to a solution that saved my life.  Your GP needs to know practitioners and be able to influence their actions when medical timidity breaks out.  That speaks to a seasoned professional well known in the local medical community. Politics and medicine should be like oil and water—never to mix.  Medical doctors have a higher calling and abide by the Hippocratic Oath.  They swear to share medical knowledge, act always to benefit the sick, and to treat those ill warmly with sympathy and understanding.  In stark contrast, I can name quite a few politicians who forgot taking an oath of office the instant after administration.

Tom Galli

Tom Galli

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