Discussing Cancer

The gym goers glance in awe as the personal trainer starts his own work out. He easily swings the large 45# rings onto the bar, then leg presses 450. A blend of intimidation and inspiration. He has a soft spoken guidance with clients, but his own efforts are fearless. What I love about the display is the pure physical reminder that we can all aspire for more.

Dr. Howard Luks is an orthopedic surgeon who described in the NY Post this week a phenomenon called the “narrowing” as we age. We have all witnessed this in family, friends, acquaintances, and patients. People are too willing to use age, illness and cancer as an excuse for a smaller life. Walking less steps. Calling fewer people. Engaging less. Learning less. Giving into aches and pains and allowing them to dictate what we are willing to try or do. No longer stretching in dynamic ways that can make a better life.

The issue with cancer is that logarithmically it can increase the shrinkage. Days are filled with appointments, treatments, rest and symptom management. Doing anything else is overwhelming. Let’s bring this concept to our attention so that perhaps we can consciously avoid the phenomenon.

“Beware the narrowing, it can steal your strength as you age. BUT it is not inevitable” he says and you have a lot more control than you think. Make better choices since disuse turns an active 60 year old into a frail 70 year old. This concept of narrowing is a brilliant way to describe the loss that feels like aging. Penn State study found just 4 min of strength training quadruples fitness in older adults. Ohio State recommends to keep moving, eat well, get sleep and commune with others to combat frailty.

You have a choice. Only a small fraction is inevitable as we adjust to the changes and that is a slippery slope. So make a decision to not “narrow”. Decide that cancer took enough, guard yourself against giving in. There will be between 65 and 82 million seniors. With cancer developing in 1 to 2–3, you will be among many who have battled and succeeded. Patients often ask for a timeline and it is easy for them to look it up and see what survival rates are for their stage of disease. However, I have always advised patients that we cannot buy that time, hence every day …. One day at a time, is here for us. Don’t miss the point of your own dramatic cancer battle. Everyone thinks it’s to buy more time, and yes it allows for that. But what cancer does that enriches us now is to give perspective to today.
The changes in treatments are coming so fast and furiously that these survival numbers will also change rapidly. However! There is no guarantee. Why choose a smaller life and give into the narrowing as we age and have health limitations? You deserve so much more. You didn’t do the work to accept less from yourself. You don’t need to bench press 300#, run a marathon, organize a big event, fly around the world for work. We should, however, expand to get the most from ourselves and our time. Remember there are no limitations on you. So brush off the ones that are starting to creep in and everyday aspire, in your own way, to go big.

The heightened exuberance this week has gifted us with the power of winning. The proudly parading New York Knicks ( thank you Nova team)) and the spectacular soccer win by USA over Australia, sending them into the “knockout” round, have been wonderful distractions, lifting hopes and spirits.

When Charlie rang the bell at the end of treatment on Friday, you would think that he personally won the World Cup. His face was alight, his eyes bright. The man who had entered the center, dejected and scared at 80 years of age, was completely gone, and the champion had risen.

A brief note today to remind us all that every single day there is an opportunity to accomplish, to be our best, to rise above, to have faith and always hope and trust that within each of us there is strength. We will all face challenges. But they will never be more than you can bear. I have witnessed firsthand, tremendous courage again and again. You will inspire others. Friends and family will lift you and carry you across the abyss. But it will be your own internal fortitude that achieves success.

They say as you age, to protect your brain, you should learn something new or do something that you’re not good at. The need for treatments with aging comes the opportunity to work that magic to protect our beautiful brains as we are now required to learn more about medicine and healthcare than we ever wanted to. You don’t need to header a ball, you don’t need to dribble with your feet. You don’t need to make the basket. You just need to have the assurance that you have the wit, wisdom and skills to be a winner in this new and sometimes exciting wellness space.

Today, there is even more cause for cheering winning strength. Just one day to celebrate Dads, because they never ask for much. And so, to our wonderful fathers, family, friends, and patients, Happy Father’s Day. Know that your leadership and guidance are necessary, not only for your children and grandchildren to find their own unique successes, but for you, in turn, to have a meaningful life and legacy. God Bless.

Life naturally and unbidden offers us an abundance of twists and turns. Why would anyone seek out adding more drama? Want to challenge yourself? Try being a cancer patient. I was always fascinated when television programs like “Fear Factor” deliberately presented“victims“ with massively, unpleasant situations and foods. Didn’t folks have enough drama in their lives without inventing it? I suspect that there was entertainment value so that ultimately the show “Survivor“ was launched, placing people at tremendous risk, physically, and even mentally to “show their metal“ and try to survive in the wild. They ultimately segued to having aggressively scripted games of competition to make it more “interesting“.
Dealing on a daily basis with real life issues threatening patients, young and senior, who never had a chance to sign up for it, or get paid to participate, or have a chance at “stardom”, inspired my true respect for the process of survival.

Well, this is your moment! Join 18.6 million ! cancer survivors to celebrate June’s cancer survivor month. * Tell your story. Join a group. Look for local events. Take a day with family and friends to celebrate your rebirth. No need to eat bugs, make fire without matches or climb a waterfall. No risk of being “voted off the island“. You are surviving and should celebrate your bravery and determination. You may have been through surgery, chemo, radiation or could be ongoing now. You may have received immunotherapy or even enrolled in national trials. Whatever you have done, you are the star of the show as you took on the uninvited, life threatening diagnosis. You stared it in the eyes, raised your torch and you worked to conquer. Survivors do not know failure they know success by never claiming victimhood. Bravery become ingrained.

Find a way to join with survivors so that you can manifest power, excitement, and force together. Surviving cancer, as you know, is no joke. It often can go on for years. It affects relationships, family, careers. and threatens every aspect of “normalcy”.

You should be so very proud! You will inspire others who timidly are just initiating their journey. They will look to you for advice, comfort , support, and assurance that within them also, there is ability, drive and determination to do the work. You will heal others. There is no doubt that a cancer survivor is a powerful force. They inspire me daily. Congratulations on managing your journey in a fierce and successful way. Survivors month also celebrates your caregivers and the physicians and staff who champion you. Thank them. Lean on them. And continue to lift them up. Happy Cancer Survivors Month. Celebrate your success and may God continue to bless you on your journey.

• NIH: cancercontrol.cancer.gov. ,
• American Association of Cancer Rearch:aacr.org,
• American Cancer Society: cancer.org.

Cheers erupted with a standing ovation at last week’s ASCO meeting in Chicago. Presented was exciting data that a new drug DARAXONRASIB can double life expectancy in metastatic pancreatic cancer. Once again, we see successful targeting of a specific genetic mutation that appears to drive the majority of pancreatic cancers. I have to tell you after 35 years of meetings, that oncologists as a group very rarely get this exuberant. Harvard oncologist Brian WOLPIN was simply stating the facts. In reality, it is a game changer and as an oncologist stated a “grand slam“. One of the most resistant -to -treatment cancers is starting to have a moving the needle moment. Once again, immunotherapy plays the role rather than attacking the tumor directly as with surgery, chemo and radiation. We are tapping into the patient’s own immune system. It has worked incredibly well in metastatic melanoma cases with another immuno drug essentially changing the entire trajectory of that disease for those who respond.

More great news was discussed at the conferencing including 30% lower breast cancer incidents in patients on GLP-1 drugs. The prolific cancer of the prostate has even seen tremendous gains in treatment with radio immunotherapies and at Hopkins actually injecting an agent into the prostate, combining it with an antiviral oral drug is being studied and found to reduce progression or recurrence of disease. More optimism in the field of oncology described at ASCO is an oral agent studied in cervical, liver, bladder, non-small cell lung, cancer, squamous cell cancer, head and neck and bowel cancer. Physicians at Oxford have found that when it is added to IV immunotherapy it once again helps the body’s immune system fight disease. Researchers are now discovering at NYU Langone Cancer center that making a vaccine from the patient’s own cells combined with an immunotherapy can attack the most deadly skin cancer, melanoma. Once again personalized cancer vaccines are on the cusp of reality. A multicenter trial from MD Anderson is evaluating implanting collagen tiles during brain surgery for metastatic cancer, delivering targeted radiation therapy and dramatically improving tumor control.

The news is dramatic, the changes are swift, the hope is real and alive. Individualized care is here. As you speak with family and friends, you will find a wealth of diversity among all their treatments, even if it is the “same disease“. Thank you to the amazing oncology physicians worldwide and the ASCO conference presenters for improving quality and longevity and reminding us to never give up hope.

Once you are underway with therapy there is almost a sigh of relief. Yes, there’s concern about side effects, what to expect, interruptions in schedules and “real life“ ,but pretty much everyone gets on with it and finds a way to manage. The toughest conversations both for patients and their families is when they rethink the last few months or even years. With full knowledge that cancer found early is much more curable than after it has metastasized, a missed opportunity disheartens everyone. Trust me that doctors feel this way as well. Many patients leave their primary care doctors having a full battery of blood tests and a physical exam with a “clean bill of health“. Too often a matter of weeks or months thereafter, disease is found and occasionally it is overwhelming.

Patients are always surprised that these yearly check ups are so disappointedly unrevealing. They thought that bloodwork would show the cancer. Routine bloodwork does not. They wondered why no scans were ordered, even a chest x-ray. Years ago we did chest x-rays just as a screen during cataract surgery, and many small curable lung cancers were found, and that is long gone. Now, unless you actually have chest symptoms, a chest x-ray is almost never ordered. Only patients with the history of smoking get to be reviewed with CT scans routinely. Lung cancer notoriously is one that if found early could be cured, but generally are found in stage is three and four hence the poor prognosis. You’re intake on all the many forms tries to guide your physician as to whether there could be a sign or symptom to follow up on, but as people age, there are all sorts of confusing tidbits that arise and confuse the picture.

Here is the recommendation: get all of your screenings and don’t let anyone tell you are “too old to have them“. Colonoscopies,gyn exams, mammograms, PSA testing,skin checks for skin cancer are the minimum. A physical exam where a lymph node could be palpated or an abdomen that is distended or an enlarged liver or even a rectal or anal mass could be found, abnormal breath sounds, abnormal ear, nose and throat exam all of these take laying on of eyes and hands by your doctor. or even a rectal or anal mass could be found.The good news today is that the future is very bright for finding cancer early.
A pioneer blood test will detect more than 50 cancers before symptoms appear, saving tens of thousands of lives a year. It is being called the “Holy Grail“ for cancer. It is titled the Galleri test by pharmaceutical firm Grail, which looks for fragments of cancerous DNA that have broken off of a tumor and are circulating in the blood. This signal will allow doctors to pick up traces of cancer when it is most treatable months or even years ahead of symptoms. The blood test alone will transform outcomes for patients. This was presented at the American Society of Clinical Oncology (ASCO) , demonstrating a transformational shift in cancer detection, moving us to more comprehensive and proactive approach. It will also help reduce false positives that current screening programs provide. We expect in the future to see a substantial decrease in stage four cancers with this new detection agent. When you see your doctor, ask about this since it will move quickly into clinic from trial and we are hopeful that insurances will begin to cover. This will make that once a year visit with your doctor so much more valuable and revealing.

It is heartbreaking when one of our patients or a loved one is diagnosed too late to have significant impact on the disease with treatments. I am excited about this new tool in our armamentarium to evaluate patients and be proactive in their care. New treatments are evolving rapidly, but we must know the disease first. Help is on the way for all of us and as always, I am grateful to the researchers and companies providing us with this outstanding and necessary tool. There is good news every week in cancer management. Stay aware, stay strong and prepare for victory. God bless.

This weekend, we will remember those who made the ultimate sacrifice with their lives during service. Memorial Day is sacred, sobering and an opportunity to come together as a grateful nation. For survivors, we must also acknowledge the physical and mental impacts and the risks these brave men and women continue to manage their entire lives. With renewed patriotism, the flags are flying. The wreaths are ceremoniously laid. The speeches, moving. The celebrations necessary, so that we never forget. While we can quickly move past the holiday that the opening day of summer provides, there are thousands of others continuing with lifelong journeys deeply impacted by service. Although they did not lose their lives in the line of duty, their service, even if brief, has changed them forever.

New to the intake forms in the centers is one question: did you serve in the military? Why would this be an important question along with medical history? Is it because we are looking to see if they have VA benefits? No. It is because there is a cloud of uncertainty once a man or woman has been exposed and we are learning more and more about those effects. Veterans are often impacted well beyond their risk of eminent danger during battle. If you have a loved one who has served, you recognize that their healthcare is more complicated. I want to take this opportunity to remind us that it is not just wartime service that impacts these brave men and women.

We stand witness to their sacrifice long after deployments. While there is relief in home coming, the dangers beyond battle persist. We are aware of PTSD, inability to assimilate back into society, depression, severe life limiting physical wounds. They have increased life long risk for specific cancers, including lung cancer, prostate cancer, bladder, and kidney cancer, melanoma and other more rare cancers. Ubiquitous use of deadly Agent Orange herbicide in Vietnam, burn pits, burning waste in open air, asbestos exposure and high risk radiation in pilots, and many chemicals even found in food and drinking water have exposed these men and women to life threatening damage. The forgotten or hidden effects are enormous and life altering for veterans and their families. The ongoing life long injury to those survivors of military service must be acknowledged, honored and managed aggressively. We have our own duty to serve them with honor and wisdom and great care.

The VA PACT ACT is a law passed that expands VA healthcare and there is a portal to file a claim online or review a condition. (Va.org). There is recognition for more than 20 conditions related to these toxins. There are specialized VA oncology programs, including screening initiatives, a national oncology, service and precision oncology program. Additional resources can be found at cancer care and triage care. A good website is always the americancancersociety@ cancer.org.

So this Memorial Day, be sure that the veteran you know and love is tapping into everything they deserve. They do not have to receive services through the VA system, they may be referred to community care or use their own private insurance. Healthcare is complicated, especially oncology, so your interest and help is valuable. Today, thank a veteran, hug a veteran and pray for the families of the veterans who have passed. Encourage every veteran to be screened, receive attention and care, recognizing that the sacrifice of their service is lifelong. It’s the least they deserve, as we also step up to keep our heroes safe.

When hurricane Helene devastated an International Factory in North Carolina in September 2024, a nationwide source of critical life saving IV fluids was gone, cutting our necessary lifeline for hospitals and cancer practices. A tool we rely on was so scarce and the shortage continued a full year! Something so simple that I used often to rejuvenate patients as an Oncologist, I took for granted. Hospitals sent out notices and reserved their reserves for only the most critical use. Many patients were completely unaware of the challenge….. caused by a distant hurricane but affecting their lives. I am certain that patients suffered.

Why bring it up now? Because we need a reminder that medical preparedness starts with you. While it is so much more complicated with cancer treatment, we are all at risk. While we can never completely anticipate our own risks and requirements, I want you to set yourself up for success. No, there may not be another IV fluid shortage in our lifetime. However, resources are stretched. Healthcare is paying for less care. We need to do as much as possible to manage our own situations wisely.

Therefore, as the summer starts, and the heat increases, I have one easy suggestion: hydrate hydrate. 11 glasses of fluids for women, 16 for men is recommended. You don’t want to overload with just water, so potassium, magnesium and sodium are key electrolytes to include. If you are fit and healthy, you will quickly become dehydrated if you are running or exercising in the heat. Preload your fluids so that it can nourish all of your tissues. The brain becomes very challenged with dehydration. Infections increase. Weakness follows, a fall can result. If you are under the care of a physician for cancer and actively receiving treatment, know that your hydration status is more critical than anything else in your well-being. 99% of the time when you need care, the first thing they will do is place an IV. It can be extremely restorative and life-saving.

Fluids are literally life lines. They regulate your body’s temperature, boost your physical and cognitive functions, remove waste and toxic chemo, protect organs, avoid kidney stones and UTIs and sepsis. They help us absorb nutrients, increase energy, decrease joint pain, keep our hearts healthy and detox. Lack of proper hydration can be life threatening and also lead to muscle cramps, dizziness and confusion. Then comes a point when oral intake isn’t enough and IVs may be required to adequately restore.

Therefore, my friends, as we head into the summer season, please pay strict attention to your fluids: carry them in the car, everywhere you go, and drink them. Don’t just walk around with a bottle of water. Add supplements to boost the electrolyte component. Be vigilant. You cannot be rescued if you do not first prepare yourself. You already know to apply the sunscreen, wear a hat and SP 50 clothing, avoid the heat when possible, but by the time you are thirsty, you are already in dehydration. A way to know, is if the urine is dark or you actually stop sweating. Never allow your body to get to that point. Know that nourishing fluids are your lifeline and they will keep you strong and healthy. (No, Alcohol doesn’t count and is actually dehydrating). Be your own life “line” and your gorgeous, robust, healthy, powerful body and brain will thank you.

Caring for (preferred phrase to “treating“) thousands of mothers and grandmothers over 35 years, I have a few observations: when a woman has spent her entire adult life caring for others, she has no frame of reference for this new self -centered dynamic of cancer. Drive me to treatment? Buy my groceries? Help with my appointments? When too weak, help me dress??? You can almost hear her thoughts… Please do not make a fuss! I am not a weakling! But gradually, Mom allows graciously for the attention, fully aware her compliance is another way of teaching family to love and to be unselfish.

Moms let their adult son hold their hand, arm, or even the handbag as they enter the center. They allow children to speak for them (which she knows helps them to cope, and gain some control over the shocking situation). The roles have reversed, and everyone is discombobulated. The spouse may sit in shock, but the children demonstrate their well-trained (by mom) power and rise to the occasion. The businessman son drops everything and travels from Chicago to Florida. The daughter returns from college. Another brings her toddler to “help” grandmom. I love every one of the dynamics I’ve been privileged to witness.

This Mother’s Day, we honor the women who nurtured us and remember with loving hearts those passed. It is the perfect day to praise God’s plan in providing us with the entire concept of motherhood, for all species. There is never a doubt they will step up. So many holidays celebrate, but this is one completely about gratitude for a woman who accepted the role of caretaker unselfishly in our lives.

Honor her, celebrate her, pray to, or for, her and model her strength and fearlessness. While she was important in your life, her greatest hope is that whatever she must endure, her only wish is that you will be OK and she can be proud of your strength and feel that her job was well done. When the diagnosis comes, Mom’s reaction is almost always concern for her family. Her sense of responsibility, too great to allow her to focus on her own needs, only as they relate to her wellness to continue her God-given mission. She also holds the family when it is their Dad on the exam table, smoothing the way as to not interrupt her children’s busy lives. Her assurances and bravery are not naïve. She can lean into friends’ strength. Even when the family dynamic is rough – even when there is less contact or fractures – in a mother‘s heart, and in her prayers are her children, always. She keeps her head up and is laser- focused on her vision for the future. Always hopeful for herself and her family.

A woman may choose to be a mother, but trust me, she had no idea of what it would entail, so even if everything is not perfect, cut her some slack. With cancer, either in herself, her spouse or her own child, her life just got exponentially more complicated. Be there with your support and love. That is all a mother needs.

Happy Mother’s Day, dear friends. May God bless you and your families every day.

What is so wonderful about life is having your own personal independent vision. Case in point: In just two minutes and two seconds an entire world changed for Cherie DeVaux as she became the first female horse trainer to win one of the greatest sports competitions of all time. 152 years in the making, the Kentucky Derby still captures imaginations. But Cherie thought, don’t bet against me! As a premed student in Albany, I am sure that family and friends thought she was crazy to, as they say “walk horses“. But that is what she saw in her vision and for her life. If you watched the Derby this weekend, as we always do, having two grandsons born in Louisville, the pageantry is fantastic, the clothes and hats creative and fun, the exuberance exciting. This year however, I am reminded that having faith in yourself is so critical, not only for success, but outcomes that are beyond imagination.

Making her vision possible was Jockey Jose Ortiz, with his own exceptional plan, winning both the Kentucky Oaks (on Always a Runner) a celebration for breast cancer with the Fillies on Friday, and then again on Sunday, to win the Kentucky Derby on long shot Golden Tempo. His come from behind (flying past 14 others) brave win was a “everyone get out of my way event”. He even passed his brother on Renegade who came in second! It was startling and fun and surprising to witness.

The world converged to allow two people to manifest unheard of dreams and wild expectations. The impossible became possible, and even the doubters had to cheer for their amazing success.

Isn’t it wonderful when a new champion is crowned, whatever the event or sport? It is not someone jaded who has followed that path before. These are people whose lives have changed forever in two minutes. But Cherie and Jose are not alone. We all can manifest our personal successes, even against tough odds. Trust that these feelings are available within all of us. They exist in the scientist, who discovered that they needed to find access inside the tumor cells to kill the cancer with special microbial probes or genetic sequences, as opposed to just cutting or blasting or medicating. If you have not worked in a lab you may not understand that these moments occur everywhere in life and especially in cancer care with the changes that are exponentially coming. The feeling of exuberance also can arrive, my friends within each of you, who have experienced or been touched by an event. It may be when we review a scan and the “Lady Macbeth spot“ is diminishing or gone. People jump and hoot in the exam room. We draw the blood and do the genetic testing to find that the patient is a perfect candidate for a very experimental trials, just like Ben Sasse with his devastating pancreatic cancer, still thriving with new treatments. Again and again life presents us with moments worthy of cheering. These are much more important to our well-being, our immune system, our quality of life for, not just ourselves, but our family, than any cancer or diagnosis is.

You will have many moments like these in your own life. You will not wear the ring of roses, but you will have a halo of hope. Just like the fastest two minutes in horse racing, the feeling may be fleeting, but what will remain in your heart is victory and that is what will carry you to the finish.

Congratulations to a jockey with hope, and trainer Cheri DeVaux. Many were disappointed that she did not complete her career in medicine, but took another path, however she remains a healer. This weekend, she touched millions with her fearlessness, accomplishments, success in the face of obstacles and instead taught us all that the impossible is possible when you have faith. Thanks for the reminder.

When the Artemis II astronauts returned from the far side of the moon, words fail us in describing their immense bravery, as well as the spectacular feat of science and group coordination. Their accomplishments capture our imagination. We are in awe. We wonder if there is any part of us that could begin to demonstrate that degree of bravery and grit. Yes, they are trained. They are prepared, but the unknown was still ahead of them on the journey.

Does this dynamic sound familiar to you? Did you find yourself or your loved one on their own extraordinary journey when life is threatened by an unexpected force? When a diagnosis of cancer is made, it can be shocking, life altering, inspiring fear, confusion and anxiety. Frankly, it can be terrible and terrifying. Do we have within each of us the grit and determination required? Can we face this with fearlessness?

Millie tells me “no“. She sits timidly on the edge of the exam table as we review the films on the screen next to her. She cannot comprehend. Her eyes are wide and tear filled. “Doc, I have never been brave“. That Millie wants to give up without a fight is actually palpable. She is not alone. Over the years, some patients have expressed a fatalistic approach to the diagnosis. I am never surprised when people are overwhelmed. Regardless the gentle touch of guidance and support, everyone comes to this journey from their own personal perspective, history and experience.

George on the other hand, is just pissed off. The terrible diagnosis of pancreatic cancer is blindsiding him at the age of 53. He has teenagers to get through college, a job to work for his health insurance, a mother to care for in her elderly years. George is willing to tap into every single new and exciting advancement in pancreatic cancer treatment his “bring it on“ mentality is meant to demand our attention and support with a no holds barred plan of attack. The fact that it is for others adds urgency and power.

Between these two scenarios, Jason presents with a devastating brain tumor related to his time at Camp Lejeune. The toxicity overwhelming his body at a young age of 30. He has not even started to have a family or children or career. His 60-year-old mother offers the support, holding them both up, and he is willing to do whatever he can to soothe her aching heart.

What the amazing astronauts have taught us, and even expressed, is humility and the fact that so many others were involved with their success. You as well, are not alone. Science, technology, immunotherapies, new drugs and deliveries to help us cure cancer or at least live better with it, are all conspiring. The entire staff at the Cancer center has one focus. They are supporting you and they are on your side. Family and friends surround you and their heart and soul is with you. Your own extraordinary journey will bring you as well to a place of peace and extraordinary gratitude, which will boost your immune system and give you fortitude. You actually cannot travel this alone. The brave astronauts did not rely on science alone. They frequently brought God into the “space”. You can too. When you are overwhelmed, push the pressure off your shoulders and into your prayers. Believe that you can move from your own extraordinary journey to being extraordinary.