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

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.
​
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?
​
Family matters. Stick close.

The best research masterclass sessions in Oncology are:

# ACORD – Asia Pacific
# Vail – USA
# Flims – Europe
​
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
​
If I do not pray with the patient and their families, at least I should at least pray for them.

What is the evidence of low bacterial diet in patients with chemotherapy for solid tumours? I could not really find anything conclusive in the data available.
Can someone help me out here.

Most of the data is anecdotal about a patient getting this illness or that illness, but the majority of the patients get along fine with clean, cooked food. This concept of scaring patients and their families into only eat this or that and avoid this and that…. it a complete overkill.

Now patients undergoing a bone marrow transplant with sustained neutropenia… that is a completely different story. I am talking only about patients with solid tumours undergoing chemotherapy. The period of neutropenia is relatively short and patients bouncy back fairly soon.
​
Eat well. Stay strong and healthy.

I signed up with Twitter. Am trying to figure this whole social media thing out 🙂
My Twitter account is @Med_Oncology
See you on Twitter!!

All pain is not the same in cancer.

Different types of pain requires different medications:
Anti-inflammatory medications – paracetamol, ibuprofen
Opioids – morphine, oxycodone, fentanyl, hydromorphone, methadone
Neuropathic agents – pregabalin, gabapentin, amitryptilline

​Most times it is a combination of these drugs which would help.