The doctor was referring to the fact that heat can interfere with the patch’s slow-release mechanism, causing it to “dump” a large dose of fentanyl all at once. Some patients wearing the patches have died, and some of those deaths were likely caused by a patient applying a heating pad, or because a patient had a fever.
Thursday, April 30, 2009
Wednesday, April 29, 2009
Tuesday, April 28, 2009
Monday, April 27, 2009
Many of the medical tools we currently use during end of life care were not created for that purpose. For example, a ventilator is a great way to help someone bridge from sickness to health. Does the same tool (which is extremely uncomfortable and requires additional drugs) make sense to extend one’s life for a few days or weeks? Should we sustain life at all cost?
Friday, April 24, 2009
Adderall, a stimulant composed of mixed amphetamine salts, is commonly prescribed for children and adults who have been given a diagnosis of attention-deficit hyperactivity disorder. But in recent years Adderall and Ritalin, another stimulant, have been adopted as cognitive enhancers: drugs that high-functioning, overcommitted people take to become higher-functioning and more overcommitted.
Asked whether it was a “major problem,” “minor problem” or “not a problem” with the U.S. health-care system that too many patients were getting tests and treatments they don’t really need, 49% of respondents chose “major problem” and another 39% called it a “minor problem.”
At the same time, 82% of respondents said that they hadn’t received an unnecessary medical test or treatment over the past two years. And 87% said their doctor during that time hadn’t recommended an expensive test or treatment when a cheaper alternative would work just as well.
I'll come out and say it. I've had unnecessary tests: lots of them. Some soreness around the ankles and a few minutes in bed led to an ultrasound. Layers upon layers of CTs and MRIs. Exotic blood tests and more. Don't get me wrong -- I don't feel like my doctors have been profligate. Dr. S is actually pretty conservative, rejecting the hastily proposed idea of a brain scan, for example, when long-acting morphine starting giving me headaches and making me throw up.
Interestingly, the biggest tester of all my doctors, a glorious radiation oncologist who will still, two years after treatment, seek us out in the halls of the hospital and call as at home to ask if we need any help, is probably the physician that I love and admire the most. It's not because of the tests, but perhaps the aspects of a doctor's temperament that make him or her more likely to be more aggressive about testing are related to the parts of a physician's personality that are good at making a patient feel well-looked-after and cared for. Which is what we all want, really.
The WSJ blog post has a lot of added information and context that I didn't bring in here, so it's worth reading if this topic interests you.
“I am still on that and will be forever until the cancer progresses and I change to other drugs or some new drugs are developed, or I die,” she said.
The hardest part is explaining to friends and family.
“People will say to me, ‘So when is your treatment going to be over?’ ” Ms. Kutt said. “That’s the perception. You get treated. You’re done. You’re cured.”
“I think some of my family members still believe that,” she added. “Even though I told them, they forget. I get cards from my nieces, ‘How are you doing? You’ll be done soon, right?’ ”
From here, the article moves back and unlocks the context for some of this false hope: the technical language used in the testing-and-review process for new drugs. I've touched on this here and there, but Kolata does so in an efficient way:
One reason for the misunderstanding, he said, is the words that cancer researchers and drug companies often use. “Sometimes by accident, sometimes deliberately, sometimes with the best intentions, sometimes not, we may paint a picture that is overly rosy,” he said.
For example, a study may state that a treatment offers a “significant survival advantage” or a “highly significant survival advantage.” Too often, Dr. Saltz says, the word “significant” is mistaken to mean “substantial,” and “improved survival” is often interpreted as “cure.”
Yet in this context, “significant” means “statistically significant,” a technical way of saying there is a difference between two groups of patients that is unlikely to have occurred by chance. But the difference could mean simply surviving for a few more weeks or days.
Then there is “progression-free survival,” which doctors, researchers and companies use to mean the amount of time from the start of treatment until the tumor starts growing again. It does not mean that a patient lives longer, only that the cancer is controlled longer, perhaps for weeks or, at best, months. A better term would be “progression-free interval,” Dr. Saltz said. “You don’t need the word ‘survival’ in there.”
I don't know if I'd dive into this piece when there's sunny gardening time to be spent, but I learned from in it and even (thanks to Ms. Kutt) found a little inspiration.
Thursday, April 23, 2009
Monday, April 20, 2009
TYRONE and I never watched TV together — at least we didn’t until last fall, when his lymphoma came back. We knew then what we were in for, months of waiting for the injections of Campath to knock down the cancer, and fear that it wouldn’t. We knew there would be many homebound evenings, so I put all five seasons of “The Wire” on my online DVD list.
Thursday, April 16, 2009
Ms. Winger allowed as how Mr. Petit had been “a sort of muse” since long before she met him. “The metaphor of a life on the wire,” she began, “the idea of being too busy to be afraid, these are the things that spoke to me.”
“If Philippe would wear a swoosh on his T-shirt, he could walk the [Grand] canyon yesterday,” she said. “If he would do a reality show. But he’s a purist, and that’s tied up in the reason he’s up on the wire. But we need this ‘uselessness.’ I find that the things that are useless in life free us in a way that nothing else can. ...”
Wednesday, April 15, 2009
Tuesday, April 14, 2009
Conversely, the death we speak of and deal with every day, the death that is full of meaning, the non-absurd death, this is a place-marker, a fake, a convenient substitute. It was this sort of death that I was determined to press upon my father, as he did his dying. In my version, Harvey was dying meaningfully, in linear fashion, within a scenario stage-managed and scripted by the people around him. Neatly crafted, like an American sitcom: “The One in Which My Father Dies.” It was to conclude with a real event called Death, which he would experience and for which he would be ready. I did all the usual, banal things. I brought a Dictaphone to his bedside, in order to collect the narrative of his life (this perplexed him—he couldn’t see the through line). I grew furious with overworked nurses. I refused to countenance any morbidity from my father, or any despair. The funniest thing about dying is how much we, the living, ask of the dying; how we beg them to make it easy on us....As it was, I missed the death, I missed the body, I got the dust, and from these facts I tried to extrapolate a story, as writers will, but found myself, instead, in a kind of stasis. A moment in which nothing happened, and keeps not happening, forever. Later, I was informed, by way of comfort, that Harvey had also missed his death: he was in the middle of a sentence, joking with his nurse. “He didn’t even know what hit him!” the head matron said, which was funny, too, because who the hell does?
Friday, April 10, 2009
Thursday, April 9, 2009
Then, stillness. I tried not to move or even think, just listen and feel. Narcotics don’t take effect instantly; 20 minutes to full activity seems a reasonable benchmark to me, though they certainly seem to be doing something after about 10 minutes. But for the first few minutes, the dilaudids were working about as well as jellybeans. Every shift made me cringe. Every ebb and flow of my breathing, every gravitational shift and surge of the body’s fluids: I felt them all as they pressed toward the maw of pain at the core of my body, the pelvis. Sometimes pinpricks, sometimes sharp stabs, sometimes an ache surging into echoing pain. I pressed a hand against my thigh as if to remind myself that another form of sensation was possible.
I imagined that I was carrying a dagger suspended by filaments in my lower belly. The weapon was unadorned; nothing but a thin, sharp blade. Any movement could bring tissues and sinew in contact with it, creating sudden jolts of pain reminiscent of electric shocks. In this hyper-aware state, time crawled and I focused on the body’s unceasing activity: respiration and excretion, the twitch of a calf muscle, a sudden spike in sensitivity in a patch of skin asking for a scratch. All of these seemed to cause chain-reactions that led to something somewhere rubbing up against the dagger. I gritted my teeth without relief. Some red lever in my brain is set to “pain” now. There is nothing but the dagger. I imagine the pocket next to my left hip leaking acid on the nerves that run down my legs and up my back. I worry about the old internal radiation burns, healed we hope, but caked with scaly scar tissue that could begin cracking and weeping strange fluids at any time. Even my ankle, with which absolutely nothing is wrong, cries for attention; I slept on it oddly early in the day.
I wait, I wait, marveling at all the complexity and interdependence, and suddenly the cloud lifts, the pain drops, the dagger shrinks. After twenty minutes or so, the knife is gone. I turn over again, slowly and painfully, gather my pillows, and close my eyes.
Tuesday, April 7, 2009
Untitled [This is what was bequeathed us]by Gregory Orr
An excerpt from How Beautiful the Beloved
This is what was bequeathed us:
This earth the beloved left
Left to us.
No other world
But this one:
Willows and the river
And the factory
With its black smokestacks.
No other shore, only this bank
On which the living gather.
No meaning but what we find here.
No purpose but what we make.
That, and the beloved's clear instructions:
Turn me into song; sing me awake.
Monday, April 6, 2009
None growing here in waaaay upstate yet...but any day now, we think. We hope, too.That said the price will plummet over the next few weeks before they're inedible. I'll still be holding out for something I find a little tastier.
I gotta tell you, they are one thing after being transported six-ten hours by truck to your market; they are a whole different something 20 minutes out of the dirt, dipped in salt crystals and eaten with fresh bread and butter.