Alternative

This article “What Do Doctors Say To ‘Alternative Therapists’ When a Patient Dies?” by Ranjana Srivastava appeared on my Facebook newsfeed yesterday.  I couldn’t resist reading it.  I think you should read it too.

First of all, it is clear I am a big nerd when this is the most eye catching thing I saw on Facebook.

But, the big reason it is eye catching is because I was curious what it would say.  And it said what I thought it would.  We say nothing.  We don’t talk about it with others.  We talk about it amongst ourselves.

It also echoed a lot of feelings I would describe having around alternative therapies.

I am probably one of the more “loosey-goosey” of the people in my department when it comes to alternative therapies.  I am touchy feely, I inherently trust people and I do believe that there is value in a lot of things we can’t or haven’t necessarily studied.  I’m that kid who did a presentation on medical marijuana in research rounds and concluded that it isn’t all bad and we really need to look into the stuff more because people are using it whether or not we think they are or should.

I ask people what they take over the counter or with supplements.  I explain why I ask.  You see, some products, although “natural” act in ways that counteract the actions of chemotherapies or radiation or other drugs.  Sometimes in terribly harmful ways.  Ways that make cancers not respond to treatments.  Or ways that make side effects worse.  I ask because I care.  Not because I want to judge you or make you feel foolish.

Actually, some of the drugs that we give people are “natural.”  Some chemotherapies are plant derived.  They are natural and very toxic, but when used appropriately can treat cancers.

I see nothing wrong with trying something different when nothing is working.  I see nothing wrong with adding things that have low risks of harms that may help.  I see nothing wrong with doing things that are healthy for you.

I do see something wrong with people who are encouraged to spend their life savings on a “miracle drug.”  When people risk their lives to procure enough cannabis to make the oil they were told online was a “cure.”  When people entrust their health to internet “doctors” and people who make a profit from preying on the sick and the scared.

Many of the “miracle” agents on the internet are anecdotes.  Sure, everything starts as an anecdote.  But, that is why things are tested, because we are often wrong and they are one-off events.

There is some laboratory in anecdotal data about cannabinoids.  I’m not refuting it.  I’ve read it.  But, there is no cold hard evidence for it as a cure for cancer in humans beyond the odd case.  Could it be coming?  Maybe… But that day isn’t today.  And there is cold hard evidence for other treatments in some cancers.

It scares me that some people believe the person that will make a fortune off of them buying their concoctions is more trustworthy than the person who makes the same amount of money whether or not they take the treatment.   It upsets me that people think I am the one brainwashed because I am offering medicine with evidence behind it, with the experience of time, the monitoring of governing bodies and the backup of provincial funding.

It terrifies me to know that supplements and some complementary therapies (not all) are not regulated at all.  In fact, often they aren’t even containing what they claim or have contaminants that can be harmful.    And people die from complications from these therapies.  Just like conventional medicine.  But in a lot of cases we don’t even know some of the risks.

When something claims to work almost all of the time or have no side effects… It probably isn’t for real.  Too good to be true is something I see a lot.  But people want it to be true.  And why not?  Some people have nothing left to lose.  But really, everyone has something to lose.

It also makes me sad that some of my colleagues think all complementary or alternative therapies are bad or dangerous.  It is scary to see people doing things we don’t understand, so I get it.  And it is hard to trust when people you cared for and gave your all for die, sometimes because they gave it all up for the wrong choice.

Miracles happen.  There are things we don’t understand how they work, but they do.  There are things we know do work and they scare some people because of misinformation or lies spread through all kinds of media.

When people forgo conventional treatments or risk counteracting treatments for something advertised on the internet or sold by an alternative provider, it makes me uncomfortable.  I’ll be honest.  When people die doing this, it makes me sad.

Complimentary and alternative therapies can be many things… I send people for massages, acupuncture, reiki and I think chiropractors do good work. I encourage spirituality and  and exercise.  I preach good diets and appropriate vitamin supplementation depending on need.   I think cannabis can be an option for some people for symptom control.  I am okay with you doing something else so long as it isn’t putting you or your treatment at risk.  I can’t stop you from doing something I don’t agree with or trust because you are your own person.  But, I can be honest and tell you why it is concerning.  I can review the evidence.  I can help you interpret it because I have a background in reading that kind of stuff when many people don’t.   I’d rather know than not know in any case because your health is important to me.  And I make no gains or losses by having someone take “my treatments.”

I just want people to be healthy and safe.

Conventional medicine can’t save everyone.  Neither can alternative medicine.

It is scary, but things go wrong.  Alternative therapies (namely the various supplements and drugs and cleanses) can cause a lot of problems.  But, we don’t talk about it when things go right.  We also don’t talk about it when things go wrong.

Talking would be a good start. Regulations would be wonderful.

There will always be people out there trying to make money and preying on the sick and vulnerable. Sadly, these people give everyone a bad reputation and are the source of my distrust and skepticism.  I know there are practitioners out there who think they are doing good and maybe are not.  That is where better regulations and research could make a change.  And I know there are practitioners out there doing amazing work with the best interest of the patient at heart.

An open mind is good.  Educated professionals are better.  But, I think that opening up the lines of communication between professionals but also with patients could make a movement towards making a difference.  At least in some cases.

My new favourite vaccine mock PSA

Anyone who has followed this blog has had to put up with my intermittent vaccine rants.

Here we go again.

Jimmy Kimmel had a little rant on his show this week about vaccines complete with “real doctors” saying why vaccines are important.  I don’t often like Jimmy Kimmel’s humour.  He is sometimes a bit too much for me.  But, this was perfection.

Perfection.

Check it out.  Show your friends.

A Haunting Encounter

Today, I had a class on incorporating the humanities in medical education.  We were asked to write a short piece of prose or poetry on a patient encounter that haunts us.  Hearing what others wrote was way to much for my hormonal psyche.  I didn’t share mine because I was too busy trying not to let anyone see me cry about the ones that were shared.

I am not a poet, but it kind of has a poetic feel, I think… Here it is…

You did your best.  You knew something was wrong.  You were low risk, they said.  But, now, you are sit in clinic and don’t know how bad it really is.

You are angry and scared.  You cry when I review what is happening within your body.  I am gentle, but I am up front.  Medicine is so advanced, but so limited.  

Together, we bring you down off that ledge.  We have a plan.  You know what is likely to happen.  Then, I point out you need to meet my staff.  To keep in mind that a chance for second opinion isn’t gone.  

Gruff and curt, he approaches.  The plan changes and you are confused.  There is no explanation.  Just a closed door.

I try to help you understand.  I feel a sense of loss.  Like I am free falling in a place outside of my control.  It can’t compare to what you feel.

You don’t want another opinion.  You trust him.  Because you trust me.

In that moment, I don’t trust me.

I go home and review the literature.  I think and think.  I talk to another staff person.  I am right.  There may be more.  But, how does that get approached?  Who is willing to speak up?  

Everybody talks, but nobody deals.  That seems to be the way sometimes.  The questions are brought up, but I wonder if they were truly dealt with.  They get swept under rugs that some of us can’t help but look under.

This time, someone did say something.  This time, something did change.  Somehow, the suggestions were accepted.

I was relieved.  I want the best for you.  I want the best for all of you.  But still, the whole thing is unsettling.

In the long run, will it be enough?  Will you continue to get the care you deserve? 

If I hadn’t been there, if you didn’t trust me, would it be different?  Would you have made a different choice?

Maybe it is enough.  But, I wonder if we could do better.  I wonder if it is my fault.  That my being nice, that we “clicked” made you not question, not request that second opinion.

I won’t know.  I can’t help but wonder it is my fault.  And I’m not even sure what “it” is.

Teacher, teacher

I’m doing an education elective this month.

I have almost always wanted to be a teacher (and an author).  Well, after I got over the wanting to be a vet (my parents quashed that dream when I was about 4 when they informed me that if I was a vet, I would have to take a bath every day) and work at KFC (I was a chubby kid who really liked the way it smelled, despite the fact that I was informed I would no longer like KFC if I smelled it every day… I didn’t even have to smell it everyday to develop a dislike for KFC as an adult).  Honestly, medicine came much, much later in life.

I realized as a teenager that I hate kids in mass, so perhaps teaching elementary or middle school was out of the question.  I also realized science was very fun.

Once I hit medicine, though, I came to this crazy realization that maybe, just maybe I could “have it all.”  Who knew doctors teach?

Probably most people.

But, the fact that it could be my reality blew my mind a little.

So, I have always thought teaching was important.  I tutored in med school, mentored new students, all that stuff.  And now, I am doing an education elective and launching some new education related stuff in my department.  It has confirmed that I want to teach more.  I think I might even start working on my masters in the next year or two (depending on how this whole juggling residency and baby thing goes).

The funny thing is about the elective is that, for the first time in a long while, it is like being a student again.  Sure, there is no call and my hours are a bit more set, but I have assigned readings and projects and assignments.  Plus, the studying/prep for my usual program academics.  I forgot a bit what it was like to be a “real” student.  I have a love-hate relationship with being like a “real” student.

My focus is suboptimal.  Lectures from 8-12 and 1-4:30  That is a lot now.  Friday afternoon half-day is like torture and that is just 1-5 one day a week.  Plus, the degree of interaction is much more than I’m used to.  Group work?  Heck, usually my whole program is the size of a group they have me working with.  Non-clinical assigned readings are novelties.  Doing assignments and writing papers are things I do much more rarely now, but they are becoming regular occurrences.  Presentations and teaching practice prep is similar, but different.  And then there is switching focus completely to study for my usual departmental half-day stuff and exams.

That being said, it is neat to learn more about being a better teacher.  And knowing that it is something I can do.  And will do.

Seeing the enthusiasm of the Med 1s in tutorial and how everything is challenging and exciting is super cool.  Learning about what always seemed to be the top secret world of designing OSCE stations and training standardized patients makes me realize how much goes in to our learning.  Finding ways to make things better for newer trainees is encouraging.  Even figuring out how and why I learn the way I do and how to make that work for me is useful.

Most of my friends are teachers.  Heck, I’m married to a teacher.  And I am realizing that in more ways than I originally thought, I am a teacher too.

I know, I’m a huge geek.  But, I’m okay with that.  Just humour me.

My Study Buddy

I’m studying.  Again.

You see, I have another sporadically scheduled treatment planning exam this Tuesday.  I had one last Tuesday (which got cancelled… And has yet to be rescheduled… UGH).  It seems that I have a “get me to do something” sign taped to my face.  This week’s topic is Rectal Cancer.  Last week’s was Small Cell Lung Cancer.  We can’t get much further apart.

I spent my morning picking up a few things at the grocery store and cleaning (ah, I do love a clean house (just don’t look in the guest/to-be-baby room or our room)).  I have mac and cheese in the slow cooker and the oven preheating to make some veggie crisps (looked like a good idea on the internet).  Patrick is playing Wii with his little brother with Big Brothers Big Sisters (great organization, by the way).

I decided to hole up finally and get some studying done.

I can’t study on my own anymore.  I have these two study buddies.  One goes everywhere with me, thanks to a little thing I call the placenta.  The other is the feline that can only travel as far as the confines of the apartment (hypothetically).

Jeter has a strange obsession with sticking nearby.  Today, he passed out on my textbooks.  Including the one I wanted to read. 10325749_10153286555099316_5885870976480320603_n

Silly cat.

Plus, the placenta attached study buddy is having a small dance party in my uterus.

Clearly these folks are not the best study partners.  They did not get the memo.

So, I’m updating my phone and my laptop and writing a blog post.  With a textbook open in front of me.  If it is open, it at least half counts, right?

Positives in the Tunnel

I wish I could say there is a light at the end of my tunnel of insanity.

But alas, there isn’t one.

Sometimes being a resident and a wife and having a life is discouraging.  Sometimes because it is so hard to do it all.

But, on a bright side to my frustrations, I do have a supportive program.  I may have a million expectations and things to do.  But, it is also a place where the staff person I worked with on call this weekend offered (insisted, really) to take my pager overnight for a few hours so baby and I can get some sleep.  And where I get encouraged to go to appointments and eat.

And I have a supportive husband.  Who picks me up late and is okay with a haphazard supper (again).  Who puts up with my hours of studying and pauses the TV when the pager beeps and who lets me take the car when I have a chance to go to a church ladies’ movie night.

Plus, I have outside friends who try to get it.

And a kind of cuddly and entertaining cat (with a bald spot that is finally growing in (that is a story for another time)).

And of course, I have a great Saviour who is the reason I can do and be all of these things and get through the day.

There are lots of things to be thankful for amidst the crazy.

My love-hate relationship with Christmas hospital

The hospital is a funny place at Christmas. I kind of have a love-hate relationship with Christmas hospital.

One part of me loves Christmas hospital. I love that everyone tries so hard to make it festive and that each floor or section have a different décor scheme (or lack thereof). I love that some people really rock the decorations. I get excited for the treats on the nursing units.

I love how people try so hard to make it a welcoming and festive place, even if for many people it is the last place they want to be.

But, I hate that people have to stay in hospital over the holidays. I’m glad we have the option and that these people are well taken care of. But, this weekend, I seem to have spent a good chunk of my on call rounds talking to people about their hopes to get out, their dismay about not getting out and trying to help them see or find the bright sides in the situation. It comes up a lot. And it is important, so it makes sense that it comes up.

I remember when I was about 5 (it was the year I got a Troll watch for Christmas), my Aunt was in hospital over Christmas. And she swore never to be there at that time again. I am too young to remember what was so bad about it, but I do remember her saying repeatedly she would never go to hospital before Christmas.

That is something I won’t forget.

I don’t want that for my patients. Because, unfortunately for a number of them, this probably is their last Christmas…

Our service is pretty good in that if there is any way the person is stable enough to go out even for a few hours, we try to make it work if the person and their family is wanting, willing and able.

I have one person who has the most festive room ever and plans on having their whole family in for Christmas dinner, although the logistics are still being sorted out. They are pretty excited and encouraged about being around for the holidays at all.

I saw another who only just realized home isn’t going to be an option and just wants to not be alone. Another who is going to get someone to bring in decorations. And a third who was working on Christmas cards and gift wrapping with their spouse.

Its not all that sunny, though. Some people say it won’t be Christmas this year, or get upset when talking about not being home.

I can’t make it better. But I want to. We can treat pain or nausea, but treating being in hospital over the holidays isn’t easy.

The nurses on our ward are awesome and make the best of it. We all, for the most part try to. That is what humans do over the holidays. And that makes it kind of a cool display of how people are decent.

Thus my love-hate relationship with Christmas hospital.

25 Faces (reblog)

I stumbled upon this awesome piece on Buzzfeed by Aemun Reza called “25 Faces Everyone Who Went To Medical School Will Remember.”

Check it out.  It is worth the click and the laughs.

My favourites (and most common expressions) are number 9, 15, 22 and 25.  But seriously, I think I have made all of these faces at one point or another.

Turning Tables – Treating Physicians

Today, one of the other residents and I had an interesting conversation.

Somehow, the topic of treating physicians came up.  And it is something that terrifies us both.  And not just for the reasons you might think.

I will confess, treating other health care people is always nerve wracking because you worry even more about saying something wrong or stupid because you always wonder if they are secretly judging your skills.

But the bigger thing is that when we see them, they are being faced with a cancer diagnosis.  And for some reason, most physicians and nurses get the bad ones and all the complications.   And that is horrible for anyone.

The issue is, they know too much.  Sometimes, having some uncertainty is a good thing.  But, when you have cared for people with the same thing.  When you understand the odds and get the treatments, it is a whole other level.  You know the worst case scenarios.  All of them. Sometimes the unknown bits of the known are the worst.  Especially when your whole world gets turned upside down.

That is the hard part.  The anxiety, the sadness, the anger and guilt.  The fact that sometimes, the person who knows too much coming in can’t be easily comforted.  That the numbers that scare everyone have too much meaning.

It also forces us to face our own mortality.

We both agreed that given we work in Oncology and given the odds in the world today, we will both one day have cancer.  And we will probably die from it.   Those are simply real odds.  And the “comedy” that is life.

And we know this and accept it.  In fact, we laugh about it in an uncomfortable kind of way.  Sure, I might have a heart attack or an accident, but it is more likely I get dementia or die of cancer… Or both.

Really, it is something I accept.  But, it is still something that is terrifying. And maybe that won’t happen.  Maybe I’ll just die in my sleep in old age.

Either way the reality of seeing people who dedicate their lives to healing others broken, afraid and unwell is terrifying.  They are “one of us” who became “one of them.  It is just too real sometimes.  Too close to home.

I just want to fix the hurt.  I want to prevent the hurt.  I want to be out of a job (kind of).

But I can’t.  So, we do the best we can.  With every person.  Because one day the tables will turn in one way or another.

Work in the midst of call

This weekend, amidst all of my call-y goodness, I am trying to get some work done on a few upcoming projects/presentations.

I have a journal club a week from Tuesday, so I picked some articles.  Head and neck cancer supportive care.  Look out world.  I’m about to critique the pulp out of an article on prophylactic versus reactive feeding tubes and hemoglobin levels and transfusions in head and neck folks.

And then, I spent a bunch of time looking into stuff for career day.  Every year, I help out with career day.  And every year, I say we will make it better next year.  You see, Rad Onc, much like me in high school, is kind of one of the nerdier, quiet and obscure specialties out there.  As a result, most people walk right past our booth.  Seriously.  You should see them all flock to the surgical simulators and fake airways at Gen Surg or Anesthesia.  And everyone wants to know how much the Radiologists make to sit in a dark room.  But, the Rad Onc folks.  They have creepy masks and a powerpoint.

Image from ebroc.com.

Not this year.  Okay, we will still have creepy masks and a powerpoint running.  That is who we are.  But this year, I am cracking out some YouTube videos of some of the “cooler” aspects (that’s right… big machines and computer animations).

They are cool to me.  And at least they give people something to ask questions about.

Plus, I think I have found an online application that we can use to make ourselves “interactive.”  A try your hand at contouring station, perhaps.

I know, not as cool as intubating a dummy.  But, maybe we’ll get to tell another couple people who we really are.

I just have to get approval from the powers that be (and acquire the technology to make it all happen).

Today I decided to clean out my email inbox instead of starting to actually work on the journal club.  Because that is just too much energy.

I got about 2 minutes in when I realized something.  I have something like 30+ One45 emails.

For those of you in the world who don’t use One45, it is an online evaluation system people in the medicine world love.  And we evaluate every single flipping session we ever attend.  And get evaluated almost as often.

Image from imerrill.umd.edu.

Usually, I’m on top of those things.  I hammer them out once a week or so.

The last two months or so, not so much.

I know what I’m doing this evening.  It involves a likert scale, good music and trying to reach back into the recesses of my memory.