Anyone's death hurts. A young person's death - hurts even more. A young person's death whom you have cared for - hurts like anything.

I recently lost someone who I have cared for the past few years. Lovely person. Always joking around. Surrounded by a caring spouse and children. They were the person's universe.

Diagnosing difficult and rare cancers makes it harder to find good treatment options. We struggled and managed to get access to expensive medications - via a free access program. I have to thank the pharmaceutical company who provided these medications for free.

Once these medications stopped working - the cancer returned with a vengeance and life faded away.

I think about the spouse and the little children. What would they do? What would they think? I think about all the unsaid things. I think about all the things which could not be done.

​Life can be brutal. Life can be tragic.

We grieve. We learn. We keep caring.

One of the possible side-effects of intravenous and tablet based chemotherapy or targeted therapies is diarrhoea. We encourage patients to use Loperamide tablets (Gastro-Stop) to treat and prevent diarrhoea. It works most times, but not always.
Diarrhoea is a adverse effect, which is not managed as well as we should. We have taken huge strides in the areas of vomiting and to some extent nausea, but diarrhoea has still not been tackled well enough.
Some of my patients, who are on chemotherapy, and struggle with diarrhoea (not just the loose bowel motions, but the urgency and uncertainty of the bowel motions) - are scared to go out to public places. Like some of the them tell me - "when you go to go, you got to go now".
I hunted for possible solutions and came across a free App called Flush - Flush app
This has a database of toilet across the city and country towns. I am really not sure how they manage the database and if there is a way to update it in real time, but it surely has helped give some confidence to several of my patients.
Seems like a silly problem?! Ask the person who is struggling with the issue.

Poignant article from the ABC on this serious, yet not discussed about topic.
This is something which affects several people, yet not much information is available about this. Most people will not talk about it, as it is not the main issue. The problem is that this adds up to the rest of the stressors of life. Several relationships break down due to problems during or after cancer diagnosis and treatment.

Worth discussing this in more detail with your cancer specialists.

​Cancer, Sex and Intimacy

Several doctors write very poorly with regard to their handwriting. Some doctors who have a good handwriting seem to have missed their illegible handwriting course!!
I received this picture from a friend and am not sure about the origin of the picture (thus cannot acknowledge the author). Says it all.

ps: I create a bit of a stir in clinic with patients and their families, as they watch me write quite legibly with a real fountain ink pen!

A great indepth article in the BBC about Dr Hadiza Bawa-Garba, who was smashed with work load, responsibility, lack of support and then hung to dry. It worries many of us working in hospitals, because this could happen to any of us. Any time. The result could be the same.
The trainee doctor who took all the blame!!

​Learn to protect yourself. Learn to protect your colleagues and friends.

Work together.

Work safe.

Each week in clinic, patients and their family members will bring me cut-outs from newspapers or magazines or video recorded clips from a TV article – mentioning about the latest and greatest cure for cancer. They bring the article will such hope and expectation. Rightly so.
The problem is that 90% of the times, I have to break their hopes by telling them that most of these reports are experiments are done in a laboratory test-tube or an early phase clinical trial. The chances of most of these drugs reaching a clinic is low or even if they do arrive, it would be at least 4 – 5 years. Most of the patients who need that medication now, will never get to use it.
I understand that journalists have to publish interesting articles, but I really do hope that they would clearly state that this is experimental medication and might take several years to get to the clinic or something like that. Seems like a trivial issue, but it is a pretty big deal for patients and their family members who are struggling for anything new.
The hope lives on.

One of the possible side-effects of intravenous and tablet based chemotherapy or targeted therapies is diarrhoea. We encourage patients to use Loperamide tablets (Gastro-Stop) to treat and prevent diarrhoea. It works most times, but not always.
Diarrhoea is a adverse effect, which is not managed as well as we should. We have taken huge strides in the areas of vomiting and to some extent nausea, but diarrhoea has still not been tackled well enough.
Some of my patients, who are on chemotherapy, and struggle with diarrhoea (not just the loose bowel motions, but the urgency and uncertainty of the bowel motions) - are scared to go out to public places. Like some of the them tell me - "when you go to go, you got to go now".
I hunted for possible solutions and came across a free App called Flush - Flush app
This has a database of toilet across the city and country towns. I am really not sure how they manage the database and if there is a way to update it in real time, but it surely has helped give some confidence to several of my patients.
Seems like a silly problem?! Ask the person who is struggling with the issue.

I think that the best true cancer chemotherapy reference website in the world is http://www.eviq.org.au

It is a free registration for access, and gives you detailed information about chemotherapy regimes, protocols, patient information sheets, supportive care data, etc.
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Brilliant site.

The spectrum of social issues explodes in some patients and their families.

As you get to know the patient better and the family trust you, more details come out. Who is truly supportive, who is the true carer, who matters in the time of trouble, etc etc. Sad. Very sad most times.

​There are others, whom you would love to be a part of your family. They leave everything and are there for their parents or family or friends. Fantastic.

A social worker’s job is quite phenomenal as they must be taking in all this stuff day-in-and-day-out. Wonder how they cope with this. Really. How do they cope with all this?
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Family matters. Stick close.

The best research masterclass sessions in Oncology are:

# ACORD – Asia Pacific
# Vail – USA
# Flims – Europe
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If possible… attend one in a lifetime. Will change your perspective of research and analysis.

How many doctors or nurses pray with their patients? Not many, but there are some who do so. Most doctors either do not think it to be important, are not convinced or are worried about the system. I need to start praying with my patients and their families. There are so many reports of the peace and the calm which is brought in.

Found a great book called ” Gray Matter: A Neurosurgeon Discovers the Power of Prayer… One Patient at a Time” by David Levy and Joel Kilpatrick. Worth a read.

Gray-Matter
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If I do not pray with the patient and their families, at least I should at least pray for them.

In the setting of incurable cancer… over time most of us learn about the more important things versus the not-so-important things. Hugs from grandchildren are more important than the possible risk of infections…. an overseas holiday is more important than completing that last infusion of chemotherapy.
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It is so important to take a proper social history – who is at home with the patient, spouse (lives along or not), who supports the patient. Do children support their parents – or just weekend hellos?
We learn over time that we as humans take social issues to be vital.

Research seems simple to do. We read about it daily… someone has found something somewhere, etc etc etc. Learning to do a proper research in a scientific manner is a completely different ball game.

One of the best learning experiences I had was at the ACORD workshop – Australia and Asia Pacific Clinical Oncology Research Development Workshop. This is held every two years in Queensland, Australia for seven days.

Each of the applicants submit a concept which is evaluated by a panel and 70 participants are selected. The workshop teaches us to take the concept and develop it into a proper protocol, complete with statistics and everything needed to launch a study.
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Absolutely phenomenal. Keep looking out for the future dates.

Where do we stand as far as social media is concerned? How many doctors/nurses have accounts for Facebook, Twitter, Pinterest, MySpace, etc, etc etc? More importantly how many doctors/nurses have been contacted by patients, their friends or relatives to become “friends”.

Where does the line of professionalism and personal info blur? I think this is dangerous. Be very careful.

Most hospitals in Australia would not want staff to have social media accounts giving or discussing information about patients or about the hospital activity.
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Social media is a great source of engagement and information with friends and family. Stick with that 🙂

One of the hardest things for me as a doctor to to tell the patient and family that there is no more active treatment available. The simplest thing is usually to keep giving some treatment or the other. The harder thing is to say NO.

For most patients and their families – ongoing treatment means ongoing hope (however small it may be). When we say no, we are dashing that hope.

There are ways to dilly dally with words and talk about best supportive care and symptom management and stuff like that.

​Hard decisions. Hard implementation.

One of the most frustrating things in the clinic is meeting with patients and their families who refuse standard proven treatment in favour of options which may not have any logical or scientific basis.

It gets worse when the cancer is completely curable with standard treatment.

Most of us can reason with patients to an extent, after which it is their call. Their life. Their responsibility.

Or is it?

Do we as a medical community need to increase awareness about wrong information being dissipated amongst patients and their families? Or do we already have enough work than to spend time on this. This is a relatively small proportion of patients who are so extreme. Should we just leave them to their thoughts and ideas?

Recently I met a lady who had a breast mass but refused all treatment including a biopsy. After lots of chatting, she told me that her spiritual leader had not given her permission for treatment. We negotiated and ultimately she agreed that God has given us common sense. Prayer is vital for everything. We also need to use our brains for decisions. She agreed for treatment in the end.
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“Dr Web-browser” seems to have the answers. Depends on what we are looking for.

Look Good Feel Better – http://www.lgfb.org.au

For patients with cancer who feel dreadful about their appearance, this workshop is great. I personally think that it is not so much for the make-up and cosmetics that help them…. as much as the fellowship of knowing that there are so many other people in the same boat as them.

​Massive boost to their esteem and confidence.

This is an initiative of the Australian cosmetic industry for cancer patients in Australia.
A definite suggestion to patients.

from http://www.lgfb.org.au