Blog

Chemo Brain

All cancer patients treated with chemotherapy swear that the very treatment which helps their cancer ultimately affects brain cells. Friends and family of chemotherapy patients describe neurological side effects like memory loss, dementia, and even seizure.

In an article from Thursday's BBC News, there is now scientific evidence that this is in fact the case. Patients call this syndrome "Chemo Brain." Researchers at the University of Rochester found, in lab tissue samples, that at high chemotherapy treatment doses, not only are cancer cells killed, but also a significant percentage of the normal brain tissue is destroyed.

Lead researcher Dr Mark Noble said: "This is the first study that puts chemo brain on a sound scientific footing, in terms of neurobiology and cellular biology."

The Rochester team carried out tests with three drugs used to treat a wide range of cancers: carmustine, cisplatin and cytosine arabinoside.

All three drugs were toxic to several types of brain cell whose job is to repair other cells in the brain - even at very low concentrations.

So, if you're a cancer patient who has received chemotherapy, how do you react to this news? Some may find solace in the fact that for the first time, there is solid scientific data confirming their suspicion of chemotherapy side effects on the brain. Prior to this, cancer patients had to wonder why their doctor did not believe them when they talked about neurological side effects.

For others who have not started chemotherapy, it may make them think twice about receiving treatment. To be honest, I hope that doesn't happen. Being given the diagnosis of cancer is devastating in itself. Treatment options include surgery, chemotherapy, and/or radiation - possibly a combination of these. All carry side effects. But, the alternative of no treatment (depending on the severity of the cancer), has it's own ramifications.

Hopefully, this newly discovered data will assist oncologist researchers to develop neuro-protective properties in chemotherapy agents. Cancer research has always been furious and technology is always changing. I have hope that more treatment options will be available for patients with cancer.

Childless

I had an interesting conversation with a patient this week. As you may or may not know, I'm the soccer doc for our boys high school soccer team. We got to talking about my experiences with the team when she said, "You know, I don't think I want to have children."

"Really," I said. "Now, doc, don't give me that look that everyone else gives me when I say something like that." We got to talking a little bit more. She's in her mid-30's, married, and she states that she's doing well in her career.

"Don't misunderstand, I like kids," she said. "I could be wrong, but I've never really believed that you could have it all - meaning both family and career - at least for women." She continued, "At least with the people that I know, when you try to go for both, then one suffers, and I never wanted that. I always knew I could be a good mom, but I didn't feel that I had the passion or drive to be a good mom."

Now, I know people out there in blog land are trying to figure out if I'm trying to make some kind of political statement with this post. I'm not. In talking with some of my female staff members at the office after this encounter, I guess this having children thing (or not having children) can be a divisive issue.

I did further research on this and found an article in today's Washington Post called Childless: Some by Chance, Some by Choice. The columnist begins the article by talking about how she had a stillborn baby. Soon after that, she and her husband divorced and the columnist chose to remain childless.

The next part of the article describes her work on a documentary about childless women. The reasons for remaining childless are similar to my patient's reasons.

Just as some women talk of a visceral urge that propels them to have children, others speak of an equally visceral urge that propels them not to. Laurie, a transplanted southerner who teaches history in New York, began to realize at an early age that she didn't want children, as she watched wealthy mothers in Richmond hire other women to care for their children. "These people compelled to have trophy babies in certain socioeconomic echelons don't want to face the realities of raising a child." She is now infuriated by what she calls "that Mother Right" -- the assumption that everyone will make way for a woman with a stroller or a child in tow. She goes on to challenge me: "If we believe that this is the hardest thing that anyone can do, then why should it be assumed we should all be doing it?"

This has been a more painful journey for my friend Lori from Tennessee, who, though quick to find humor in things, was devastated by a miscarriage. Her husband, who had two children from a previous marriage, was reluctant to try again. She's irritated by the signs in parking lots reserving spaces for parents with children: "I park in those spots sometimes just out of sheer defiance -- I'm a peri-menopausal woman under stress -- and I need a sign!" Lori argues that "if you don't have children you've . . . thrown a brick in your path that you're going to spend your entire life trying to crawl over. It would have been a lot easier having had children."

I realize that I'm putting a big target on myself and my blog for bringing an issue like this up. I have found that the "child people" Vs. "childless people" are very passionate about their respective points of view.

Me? I'm not passing judgement on this either way. I will be further exploring both sides of this issue, because I think it will help me better understand a patient's point of view.

Christmas Song Meme


Yes, that's right, boys and girls! It's not even December yet and I'm starting this meme. Can you believe it? Well, I figure that I actually still like Christmas songs right now. Ask me two weeks from now, and I'll be totally sick of them.

This meme is pretty simple: List (at least) five of your favorite Christmas tunes and tag (at least) five of your favorite blog friends to keep the meme going. Simple, huh?

My Fave Christmas Songs (in no particular order):
Christmas Time Is Here from A Charlie Brown Christmas
Christmas (Baby Please Come Home) by U2
Santa Claus is Coming To Town by Bruce Springsteen
Run Rudolph Run by Brian Adams
The Chanukah Song by Adam Sandler (I know, not a Christmas song)
Christmas Eve (Sarajevo 12/24) by Trans-Siberian Orchestra
Please Come Home For Christmas by The Eagles
The Christmas Song by Nat King Cole
(I'd better stop here, or I'll be here all day...)

The lucky people I'm tagging:
Mimi from Mimi Writes (The Meme Queen)
Julie from Flip This Body (It is meme Tuesday, isn't it?)
Kim from Emergiblog (Are there any Notre Dame Christmas songs?)
Fat Doctor (Check out her blog Thursday for the Change of Shift blog carnival!)
Morgen from the Blog Eat Blog World (Gimme the BIG MO song list!)
Skittles from Skittles Place (Just a quickie list would be fine. HA!)
Ipanema from Under the Canopy (Great wreath on your site!)
Irene from Pregnant Pauses (She has the best gift on her site for you!)

If anyone feels left out, then consider yourself tagged as well. Give me your top five Christmas songs and tag five other people for me. (Just place a link back to this post so I know who's in!) This will be fun! Go for it! Gimme your favorite five songs!

What to do with a MeMe: Copy the idea of the MeMe into a new post on your blog. Fill in the answers. Tag people! (Thanks Skittles. I forgot to add this sentence in case people didn't know what a meme was or what tagging people meant)

Grand Rounds

Grand Rounds 3.10 is up and running at Notes from Dr. RW. It is self-described this week as a "running commentary, stream-of-consciousness style, to provide some structure to this incredibly diverse collection of links and perhaps liven things up a bit. I’ll sneak a few opinions in here and there, but you’ll know them when you see them." Thanks to Dr. RW for including my submit this week:

Ectopia what??? Ectopia cordis---a rare developmental anomaly in which the heart is situated outside the chest. Dr. Anonymous writes about a recent case.
For those of you sitemeter watchers out there (I am definitely one of them), it'll be interesting to check out the Dr. RW sitemeter as it goes through the day today.

Next week, Grand Rounds moves to The Antidote: Counterspin for Health Care and Health News. That's funny. Does that mean that Grand Rounds is a poison? Tune in next week to find out. Enjoy Grand Rounds!

Hosting Grand Rounds 3.09 (pt2)

(Look below for part one of this post)

This post will be a little more free-flowing. I thought I would have some steps that you could follow, but it was hard for me to boil down my experience into some simple steps. I encouage you to check out Emergiblog and Tundra Medicine for some other feedback on GR hosting.

I was on call the weekend before my GR posting. So, my schedule was just crazy. As I've said before, my job gets in the way of my blogging. I tried to keep ahead of things by reading submissions as they came in. Sunday was kind of nuts because it was a busy day on call. And, Sunday night after the deadline, there were some people still submitting. That's when I came out with my submission closed posting on Monday which some people remarked as a little moody.

I spent the entire day Monday trying to stay awake and make my final edits on the GR post. I was switching posts from the bottom section to the middle section, from the middle section to the top section, and all combinations in between.

The GR post went live at 6:30am and I waited. To further punish myself, I put up two poll questions to seek feedback on the GR layout and on the quality of GR. I had no idea what the reaction would be to the "link dump" at the end of my post.

At 6:30am, my site meter read 100 total visitors for the day. For the first few hours, it was reading between 20-30 per hour. Then at 9am, it spiked up to 52 visits in an hour. The next few hours, it was between 40-50 visitors per hour. Then at 2pm, the number read 72 visitors the prior hour. A few more hours went by, and then at 5pm, here's what the sitemeter read:

Yes, that's right 183 people saw the GR post in the last hour. Plus, in seeing more data, there were 85 people on my site at the same time! Thinking about this is just incredible.

Then, I was wondering if I hit 1000 visitors in one day. This occurred just before 8pm. Yay! The final question I had on that Tuesday was how many total visitors? When all was said and done - just over 1,300 visitors!

I had no idea what Wednesday would bring. I thought things would cool off a bit, especially because it was the day before Thanksgiving in the US - usually a huge travel day - and not expecting too much blog traffic. Then, at 10am, I saw this from site meter:

Little did I know that at the end of that day, I would have just below 1,400 visitors - quite a shock to me. Then, reality set in and on Thanksgiving day (Thursday), I only had 600 visitors.

Looking back, this was a memorable experience for me. People have asked me how much time out of my day did it take to put everything together. Hmmmmm. That's a tough one. People have estimated about 20 hours total during GR week, I guess that sounds right. Knowing me, I probably spent more time than that. I hope I get the opportunity to host again - although maybe not very soon. HA!

Finally, here are the poll results:
What did you think of Grand Rounds 3.09?

  • One of the best: 38%
  • Great: 51%
  • Ok: 8%
  • Below Average: 0%
  • Awful: 3%
Did you like the format/layout of Grand Rounds 3.09?
  • Yes: 94%
  • No: 6%

Hosting Grand Rounds 3.09 (pt1)

So, you're thinking about hosting Grand Rounds? I have to be honest by saying that I was totally intimidated by the entire notion. But, when the opportunity presented itself, I took it and then tried to figure out how to make it happen. If I did it, and so can you! Just follow these steps....

Step One: Prepare, prepare, prepare!
The first thing I did was go right to the source which is the Blogborygmi site. I did that because I wanted to see the origin of this idea and the original target audience. GR is not targeted toward the medical blog commmunity. It is targeted toward the general public. I think this is the right idea, because this is the only way that the medical blogosphere will grow. Read about my research in this GR background post.

Everyone has told me that the more work you do up front, the less crazy GR week will be for you. I cannot agree more. However, I did not have that much time to prepare, so my timeline was very much truncated.

About the Grand Rounds interview - Take my advice. Do NOT take this lightly. As of this writing, I've had about 2,500 referrals from the medscape interview site. Plus, I'm still getting referrals six days after the original posting.

The more memorable you make your interview, the more people that will check out your site. How do you make your interview interesting? Well, you have to think a little bit like a PR marketer. What do I mean by that? Well, if you can think of a witty soundbite or "one-liner" that people will remember, then that will make your interview more interesting. The only other thing I would say is just be honest and talk from the heart - people like that.

I did not have a theme, mainly because I'm not that creative with that type of thing. Plus, I put a poll on my site and the majority of people didn't want me to have a theme.

If you do opt for a theme, make sure you have a vision for this before you're awarded Grand Rounds. With all the craziness of GR week, I don't think there'll be a way for you to figure out a theme and read all the posts that week. The only other thing I would say is that it's possible to be TOO cute with the theme and not be able to convey to the reader what the link is about. Be careful of that.

Step Two: Promote, promote, promote!
Your first item of promotion will be asking people for submissions. Usually, the GR host before you will announce your site and get the ball rolling. Now, the ball is in your court. Figure out when your deadline is, because this will be the first question that you'll get as host. For me, I was really paranoid that I would not be done on time, so I made the deadline on Sunday night. Usually, the deadline is sometime on Monday.

Usually, the top section of the GR post is called "Editor's Picks." The next question people want to know after the deadline is how to get into that top section. For me, I know I wanted to highlight well written stories. Also, I knew that I wanted to keep some kind of order to the submissions as they came in. So, in my submissions guidlines, I put the deadline date/time, my vision for the editor's picks and directions on how I wanted the submissions (blogger name, blog name, blog URL, post name, post URL, one line description of post). I also preferred that submissions be sent to my e-mail, so I included that also.

As the posts came in, I put them in one of three sections: top 1/3, bottom 1/3, and the rest. You'll have your own instincts on what's good. Trust those instincts. There will be at least a couple of posts which won't feel right. Again, trust those instincts. The people that know you will send you their submissions first. But, like everyone says, the bulk of the posts come in on the weekend.

I kind of overdid the GR promotions on my blog during my week, but I was really trying to hype things up. In addition to posting your GR submission post a week prior, I would suggest at least one more GR post during that week to help your own promotion. Also, look to your own friends for postings, even if they have never posted to GR before. This can potentially grow the GR audience.

Step Three: Follow up, follow up, follow up!
With each submission, I would send an e-mail thank you back to the blogger. I knew I would be moving posts around on the priority list right up until the last minute. So, I would send a generic thank you to the person, not "promising" where I would put the post, only that I would "consider" their post - which was true.

Also, with each submission that would come in, if I had time, I would take a quick read of other posts on that person's blog. There was a couple of occasions where I thought another post would fit better with my vision of GR. Topher asked people for revisions, and I didn't feel comfortable with that (just my personal decision).

Be firm with your submission deadline. People will try to push you and give you every excuse in the book to try to get into GR. And, some people just ignore your deadline and then will expect to be included in GR. It's your choice how to deal with this. But, always remember, don't try to make everyone happy, because it's not going to happen.

Everyone has said this, but I think it's important. Double and triple check every link before you go live. Don't be too bent out of shape if one or two slip by. And, don't be too bent out of shape if one or two authors e-mail you to clarify their URL - this happens every week.

After you publish your GR post, there will be many people who will announce GR on their site. Make sure you place a comment of "Thank You." This will definitely go a long way. I added a bunch of links the past week also, because I had no idea how wide the reach was.

Oh no! This is running a lot longer than I thought. Re-reading it, it may not be as helpful as I intended it to be. I'm happy to answer any questions. I'll have to work on a part two post....

Interview

In case you didn't have the opportunity to check out my interview from last week, here it is. Also, just to let you know, Patient Anonymous did turn on her RSS feed, so feel free to put her in your bloglines, google reader, or whatever...

The "Anonymous Doctor" Finds a Voice on the Web
Posted 11/21/2006 -- Nicholas Genes, MD, PhD

After discovering political Web-logs a few years ago and medical blogs this year, a young primary care doctor was tempted to start his own site: Doctor Anonymous. Despite his unfamiliarity with the medium, Dr. A's humor, attentiveness, and genuine rapport with his readers quickly earned him a large, faithful audience. I'd guess those same traits would make him a good physician, but I suppose we'll never know for sure...

Corresponding with Dr. A this week, I had the chance to learn a little bit more about the man and what he thinks about his online endeavors.

Dr. Genes: Many blogs come and go, but few start off with -- and maintain -- the exuberant enthusiasm of yours. Is this your first foray onto the Web and having an online presence? Are you like your posts would suggest, or are you more reserved and bookish in person?

Dr. A: Probably like most other people, at first I was intimidated by starting my own blog. There are so many great blogs out there that I really didn't know what else I could contribute or what I could do to set myself apart. It was a good 5 or 6 months of me going back and forth on whether to become a blog writer and not just a blog reader. My first blog was in May (not many people out there know that), but it did not work out at all. I was using my real name at the time. I live in a small Midwestern town in the United States, and I didn't realize that people on the Internet can learn all kinds of information about you. I then became very paranoid about what I was writing, and the blog was just boring. So I scrapped that idea and didn't know if blogging was still for me.

The Doctor Anonymous blog launched on June 19, 2006, with a mere 5-line post. Being anonymous really has let me be free to not worry as much about what I'm going to type. Being a doc in a small town is tricky; I'm constantly worried that anything I say or do may end up in our local newspaper, so I'm constantly filtering what I'm going to say. With blogging, I feel a sense of freedom of expression that I haven't felt in a long time.

People ask me what I'm like in person. I guess that's hard for me to describe. I certainly didn't make up this phrase, but I would describe myself as an "extroverted introvert." For the most part, I'm a pretty laid-back guy, but sometimes when I get around people, I'm a lot more outgoing. I guess that's what happened when I started my blog.

I absolutely had zero experience at producing any kind of Internet content. I have a lot of experience at being an Internet consumer, but not a producer. So those first 2 weeks of blogging, I had no idea what I was doing. The one thing that really fascinated me was the interaction with people in the blogosphere. I talked about my first contact with other bloggers.

Dr. Genes: What are some of your favorite posts? Something that really resonated with readers, or captured something you worked hard to express?

Dr. A: One post that sticks out in my mind is called "Why". I wrote it during a bad night on call. It was definitely a change in the upbeat style I was doing for the previous 4 weeks. I hesitated on posting it, because I didn't quite know what kind of response I would get. But I did anyway, because I wanted my blog to be a reflection of me, and sometimes you have bad days. I was quite surprised by the response I got. For the next couple of days, my frequent readers did a type of reflective post of their own. And I really learned that people outside the United States were reading my blog. To think that my little blog is reaching people around the world blew my mind.

Dr. Genes: Some of your posts point to a soul-searching about what your blog should do for you, where it should go. Has writing frequently become too much of a chore? Will you be going more or less medical? What have you gotten from this community of readers and fellow bloggers?

Dr. A: I try to have a mix of medical and nonmedical topics. In my first posts, I had a lot of blogging questions. So I just put questions out there like, What does it mean to be tagged? Or, Do I have to respond to all the comments in my comment section? Or, What is Grand Rounds? Sometimes, I would ask questions I was just curious about, like, Do you prefer your doctor to wear a lab coat or not? I have very much appreciated the interaction that I've gotten from my readers.

There were times when I talked about blogging feeling like a chore. I have told myself that when I feel like blogging is like work, then that's the time for me to take a blog break, or even consider giving it up altogether. People have even told me that they sense that my energy level is not like it was that first month. But I guess that's normal, right? Whenever you first start a project you really like, there is a natural excitement. But as time goes on, that honeymoon period dissipates, and you ask yourself whether you want to keep blogging.

Even though it's only been 5 months since I've been doing this, I feel a significant change in my blog coming in the near future. My early posts talked a lot about patient encounters, and now I feel like I've shifted a little bit more toward news commentary. What the next change will be, I don't know.

I feel very lucky to have achieved what I have up to this point. And that's the advice I have for anyone considering blogging. Here's what I wrote on June 21, Day 3 of blogging, and I think it still holds true: "Blogging is like being at the podium, and to get people to listen to you, your thoughts have to be pretty well developed, or people will walk away. The good blogs that I've run into make me think a little bit and make me post a comment. The interaction with people (conversation like interactions) takes place in the comment area. The blog is kind of like the lecture and the comments are like the Q&A."

Dr. Genes: The shadowy but genial figure of Dr. Anonymous steps into the spotlight this week to host Grand Rounds, the collection of the best in online medical writing. Check out Dr. A's edition of Grand Rounds on November 21, 2006.

Medscape Med Students. 2006;8(2) ©2006 Medscape

Patient Anonymous

Yup, you read that right. This past Wednesday, I posted something called Opportunity in which I talk about being approached by an insurance company for statements I made in my blog. (BTW, I still haven't decided what I'm doing yet.)

I read this comment by someone calling herself Patient Anonymous...

I just found your blog courtesy of your Medscape interview. I should probably read more of it before just jumping right in and posting but I'm all about immediate gratification and lack of impulse control at the moment.

I would not respond to this. I used to co-moderate a support board/group of fora for mental illnesses, meds etc... and I won't go into the details but we received trolls like this.

Also, it just sort of screamed, "Let us pimp you out!"...and such a cheery (form) letter from an insurance company? Yeah.

If you wish to get published, go for something a little more reputable.

Oh, and I just picked this name in quick, rather unoriginal random fashion so if someone else already has it, apologies--I'll change it.

Thanks and I look forward to reading more here.

There are two thoughts that pop into my head. First, I absolutely do not want to make this person mad. LOL! And, second, this person, whomever she is, really needs to start a blog. So, I responded in my comment section (with the second part only - HA!).

Now, I never believed that this person would take me up on this. So, the very next day, here is the beginning of the first post for the Patient Anonymous blog...

Well, I blame Dr. A for all of this. I posted on his blog and he said I should start one of my own because he thought I'd make a good blogger. Huh. Well, I'm sure this will prove him wrong!...

...Well, if nothing more it will prove to be an interesting "experiment" and I love experiments! It will either be the most pathetic blog in the history of the internet or I may actually get someone (besides Dr. A) to read it.

So, if you could do me a favor, and show some love to the newest person in blogland. Please stop by and say hello. And, don't forget to tell her that Dr. A sent ya! HA!

Ectopia Cordis

This is the name of the congenital birth defect which caused Naseem Hasni's heart to be outside his chest. He was born on October 31, 2006 and has been at a Miami children's hospital ever since. (Miami Herald)

On Wednesday, the first of many corrective surgeries took place to try to correct the defect. Now, a thin film along with a thin membrane of his own skin cover his beating heart. Soon, he will be fitted with a plastic chest to protect the heart. It's optimistic, but Naseem may return home by the end of December in time for the holidays.

This defect is so rare that it occurs in only eight in one million babies. Most are stillborn or do not survive the corrective surgery. One can beat the odds, however. I found the story below about Christopher Wall who was born in 1975. Chris set the record for living the longest with the heart outside the chest. This is from a TV broadcast in 1998 and the piece is about 8 minutes long. Very inspiring story.

Happy Thanksgiving

Rocky and Bullwinkle love Thanksgiving, do you? It's the day to spend with family, eat too much, watch the parade, and watch football. How do you spend the day? All the best to you and your family.