Doctordenky's Blog

Couples who get married vow to stay together. “Til death do us part”. But have you heard that some couples have defied this vow? Let me tell you this story:

There was a sixty-something man who was diagnosed with brain cancer. He and his wife were apart because he works abroad while his wife took care of their family. One day, he was brought home because he had been experiencing some symptoms which led to his being diagnosed with brain cancer.

The patient went through a rather turbulent course. His symptoms made him debilitated to the point that he was bedridden. His wife unselfishly and patiently took care of him. Every time I would see the patient, his wife was always at his side feeding him, changing his clothes, adjusting whatever needs to be to make him comfortable. Many many times I had to tell her that she needed to sleep, rest and relax because her body was showing signs of exhaustion. But despite this, she always managed to draw the energy to attend to his needs. I was amazed to see how dedicated she was. I don’t know how to accurately describe it but her love for her husband was so palpable and heartwarming every time I visited them.

One day, I had really terrible news to deliver. It was one of the most difficult breaking of bad news that I had to do because I couldn’t bear how this woman might receive the news. As I told her, she calmly listened and naturally, tears started rolling down her cheeks. She was not hysterical but was quite calm. Later on, she broke down into a sob. She told me that she was an adopted child. Her adoptive parents took really good care of her but it was only with her husband that she truly experienced being loved. At that moment, I could sense all her emotions, sincerity and pain as she spoke those words. She told me that it would be extremely painful but that she will try to accept.

Several weeks after our conversation, her husband succumbed and that was the last time I saw her.

Six months later, while I was at the emergency room, a lady approached me whom I couldn’t remember at first. She introduced herself and told me that she was one of the relatives of the couple above. So I naturally asked her how the wife was doing. Her face changed and she told me that a few months after her husband died, she was diagnosed with a terrible illness and died within a few months of being diagnosed. I froze in shock because despite her exhaustion, she did not manifest any sign of being ill at the time that she was taking care of her husband.

She has defied their vow and joined her husband soon after he left.

I have encountered this phenomenon a few times in my practice. The spouse who was left behind often would follow within a year or two of the other spouse’s death. Same thing happened to Christopher and Dana Reeves. Who would have thought that she will be diagnosed with lung cancer?

Their love have defied all odds.

Consumption of green tea may help lower the risk of lung cancer even for persons who smoke according to a research presented at the American Association for Cancer Research.

The study found that individuals who did not drink green tea had a five-fold higher risk of developing lung cancer. Smokers who did not drink green tea had a 12-fold higher risk of developing lung cancer. Whether smoker or non-smoker, this study shows that there is a benefit to drinking green tea. This, however, does not give us an excuse to continue with the smoking habit. Intake of any form of supplement, maintaining a healthy diet and lifestyle will never eliminate the cancer-causing effects of smoking on the body.

Is your diet anything similar to the following?

Breakfast: 1 cup coffee, 3 pcs pan de sal with hotdog and fried egg
Snack: 1 small bag of chips with tetra pack orange juice
Lunch: ½ cup of rice, bangus sinigang
Snack: pancit bihon
Dinner: 1 cup of soup, ½ cup of rice, chicken adobo with 1 glass of iced tea
This type of diet is very common among Filipinos. It is complete with carbohydrates, proteins and fats but very much devoid of healthy fruits and vegetables.

We have all been exposed to the concept of antioxidants. They have been advertised as anti-cancer but they mostly come in pills or supplements.

Fruits and vegetables are nature’s health gift to man. They are packed with so many vitamins, minerals, antioxidants and other substances that are beneficial to the body. Man has been very good at identifying, isolating and synthesizing these antioxidants and packaging them as supplements.

Unfortunately, these supplements will never work in the same way as when they are derived from their original source. Fruits and vegetables, in their natural form contain different kinds of good substances that we have not yet all identified. Taking these antioxidants as individual substances in the form of supplements will never completely take the place of eating fruits and vegetables in their natural form (not the canned variety which is very high in sugar). Taking these supplements will also not undo very poor dietary habits.

The diet above provides calories, the major components of the basic food groups but it is sorely lacking in healthy nutrients and fiber. It also contains a lot of sugar (in coffee, tetra pack juice, pan de sal, iced tea) and refined carbohydrates (pan de sal, rice, chips, pancit) which can cause blood sugar to suddenly spike.

So how can we makeover this diet?

Breakfast: 1 cup coffee, 3 pcs pan de sal with hotdog and fried egg. Add ½ cup tomato and cucumber
Snack: 1 small bag of chips with tetra pack orange juice. Add 1 piece of fruit
Lunch: ½ cup of rice, bangus sinigang. Add 1 pc banana and 1/2 cup vegetables to sinigang.
Snack: pancit bihon. Add 1/2 cup mixed vegetables
Dinner: 1 cup of soup, ½ cup of rice, chicken adobo with 1 glass of iced tea. Add 1 cup lettuce and 1 piece of fruit

Making the above additions to one’s diet increases the servings of fruits and vegetables from 1 serving in the previous menu to 6 servings.

Many of us are aware that exercise reduces our risk of getting heart disease but a lot of information is surfacing that exercise also lowers our risk of developing cancer.

A study done in Finland showed that men who exercised for at least 30 minutes a day decreased their risk of prematurely dying from cancer. The study is published in the British Journal of Sports Medicine.

The subjects were queried about their leisure-time physical activities over a period of 1 year and were subsequently followed up for the occurrence of cancer over a 16 year period.

The reduction in the risk for premature death from cancer was seen in men who exercised for more than 30 minutes every day, and with an intensity that was moderate to high. Examples of activities that can produce this effect are jogging, swimming, rowing, cycling, brisk walking, hiking, dancing, boxing, etc.

What is important to remember is that these activities should be done consistently and should form part of our lifestyle. Exercising regularly should be as essential as eating our meals and not to be done only “when we have time”.

I have repeatedly said that there are no absolutes in medicine. Treatments and diagnostic tests employed whether mainstream or alternative do not give absolute certainty of efficacy and must all be employed with caution.

I have been asked several times how we can prevent cancer with expectations that I will be able to tell them with all certainty the answer. Because it is part of human nature to expect certainty, it is no different whenever I am asked about cancer prevention.

We have not yet identified definitively how we can PREVENT CANCER. What we have identified are “Risk Factors” or those things that may increase a person’s likelihood of developing cancer. The evolution of cancer is so complex that it entails many many factors that are beyond our control. Our genes/inheritance, age, gender and certain environmental factors are beyond our reach. However, our lifestyle is one of those risk factors that is well within our control and should be the focus of our risk reduction strategies.

By saying that we have not yet identified how to prevent cancer is not the same as saying that we can’t do anything. Nor should we just live as we please because we will all die anyway. There is a lot that we can do but we have to always keep at the back of our minds, that in the end, whatever happens, a good dose of surrender and serenity is very important.

The choice is ours. As a doctor, I have seen what can happen and I’m telling you that it is very unpleasant. The outcome for all of us if we continue in our current ways is very very ugly, very very uncomfortable and can be very emotionally and financially devastating, not only to the patient but the entire family.

Let’s choose wisely.

The number of patients being diagnosed with cancer has been progressively increasing for the past several years. Cancer is found among the top five causes of morbidity and mortality in the Philippines.

There is a stigma attached to patients who are diagnosed with cancer. People automatically think that a diagnosis of cancer is equivalent to being sentenced to die soon even if some patients have better prognoses than patients who have moderate to severe forms of heart disease. People experience fear just by hearing the word cancer.

Cancer is no longer a death sentence. However, the psychological impact of being diagnosed with cancer can still be devastating. Having to go through the long period of treatment can be traumatic and can exert its toll on the physical, social, emotional, psychological, spiritual and financial well-being of the patient and family.

Much of the focus on cancer (and most of the common diseases) now has been on treating the cancer after it is diagnosed. Considerable efforts have also been placed on early detection. However, so much more emphasis should be given to raise awareness about CANCER PREVENTION through changes in lifestyle and we, physicians and patients, should pay very close attention and take the matter more seriously.

Answer the following questions to give you an idea of how detrimental our lifestyles are

1. Do your meals consist mainly of processed carbs (white rice, white bread, white flour) and protein (chicken, fish, beef or pork) without vegetables or only traces of vegetables serving as garnish?

2. Do you lack recommended servings (5 or more) of fruits and vegetables in your diet?

3. Do you consume a lot of cured or smoked meats or fish?

4. Do you consume a lot of sugar on a regular basis?

5. Do you live a sedentary lifestyle without any form of exercise or only very occasionally?

6. Do you smoke?

7. Do you consume more than 1 serving of alcohol per day for women, more than 2 servings for men?

8. Is your diet very high in fat or fried foods?

9. Are you sexually promiscuous especially without protection?

10. Are you always stressed out and harbor a lot of negative emotions?

11. Are you overweight?

12. Do you stay under the sun for long periods without protection?

13. Do you have a family history of cancer?

If you answer yes to any of the above questions then perhaps you need to seriously consider about changing paradigms.

I was talking to a group of patient’s relatives regarding his prognosis. It was very grim. In the group were the patient’s son, patient’s sister and the patient’s daughter holding her two year old son. The patient was dying and I was relaying that information to the family.

Expectedly, the group was distraught but something caught my attention which I found truly amazing.

The patient’s daughter’s face was covered by extreme sadness. Tears were running down her cheeks. She was not sobbing but anybody who passed by our space would know that what we were talking about was not very good.

As I was talking to them, the two year old son was as usual playful initially. However, as our conversation went on, the child started to calm down. He suddenly noticed the sadness on her mother’s face. He started kissing her. He gave her one kiss then backed down a little to see the effect it would have on her mother. Then he gave her another one and another one and another one and every time he kissed her, he would look at her response hoping that his gesture would make his mother’s face light up. When he couldn’t achieve that, he looked around with a face that said “Help me! What can I do to make my mother happy again?”.

Up to this day, I can still clearly see the look on the child’s face. I cannot help but be amazed by what I saw. A truly awesome and unforgettable experience!

A friend called me in a state of confusion. She said that one of her friends was diagnosed with intermediate stage breast cancer despite undergoing regular mammography. “Isn’t mammography supposed to detect breast cancer?” she asked. So why did the doctors miss my friend’s cancer?

I have previously said that none of the interventions we employ in medicine come with absolute guarantee. Similarly, the laboratory tests that we do are also not 100% fail-safe. Not all diagnostic tests are as accurate as we hope them to be. There are many factors affecting the degree of validity and accuracy of these test results such as:

• Inter-laboratory variability – different labs can produce different results.

• Intra-laboratory variability – different results on different days due to factors such as different person performing the test, use of a different brand of chemical to carry out the same test, lack of calibration of machines

• Reader or interpretation variability – interpretation of results often depend on the reader’s experience such as reading of x-rays or CT scans. The same results can be interpreted differently by different persons.

• The quality of machines or reagents used – old machines (x-rays, CT scans, MRIs, ultrasounds) though cheap, can produce substandard results

• The inherent flaws of a test – not all tests, no matter how seemingly accurate, high-tech or done at reputable centers will give 100% correctness and accuracy. Some tests are bound to miss a positive diagnosis while others can detect problems that are not really there.

Tips to Minimize the Flaws and Maximize Laboratory Results

• Make sure that you are going to reputable laboratories instead of fly by night labs which offer lower prices to lure patients

• As much as possible, stick to the same laboratory to allow to minimize inter-laboratory variability.

• When doing specialized tests such as mammography, CT scans, MRIs, etc, better inquire from your doctor whether you can go ahead with a certain diagnostic center of your choice other than where your doctor wants to have it done. Patients often scout for cheaper prices (there is nothing wrong with this but let us take a lot of caution)and find them in small diagnostic centers not knowing that the cheaper cost is because they are using outdated machines which do not provide the same accuracy as the more expensive ones and hospital-based labs do. (I’ve had patients go for cheaper CT scans or MRI’s only to have them repeated at more reputable centers because the results did not give us the information that we needed)

• For tests that are done in series or annually such as xrays, CT scans, ultrasounds, mammography, MRI, request for the same reader to interpret your results.

Isolation, loneliness, feeling of being all alone in the difficult journey are emotions that patients go through upon being diagnosed with cancer. Yet, the patient is not alone in the pain, suffering and sadness. His entire family is afflicted with the disease perhaps not literally but figuratively.

When a patient is stricken with any kind of severe illness, it is never his journey alone. The entire family is afflicted as well. When a family member undergoes surgery, his entire family also feels like they are undergoing the treatment too. When a family member undergoes chemotherapy and experiences its effects, the entire family suffers with him.

Dealing With The Family

I recently delivered a lecture about “Breaking the Bad News” to medical students. I told them that when delivering the bad news, I almost always discuss first with the family before going directly to the patient. I do this not with the intent of hiding the truth from the patient but to educate the family and facilitate their understanding and approval of the necessity of letting the patient know and have him participate in decision-making. It is very comforting for the family to understand and know that they are being considered important too. There are some who might consider this unethical since we are not supposed to discuss the diagnosis with anybody except the patient. They claim that doing so will undermine the patient’s rights.

I am strongly opposed to withholding the diagnosis from the patient. Let that be very clear. However, my experience has taught me that in order to be a good doctor, I have other things to take care of aside from the physical well-being of the patient. I cannot separate that from his emotional, social, psychological and spiritual well-being and a significant part of this well-being is in relation to his family. Part of managing patients is not only dealing with what the patient is going through but also taking care of the well-being of the relatives. The doctor not only facilitates understanding and acceptance by the patient but the family as well. Taking care of the family too makes the patient happy and gives him a sense of peace and security.

As a doctor, I deal with patients. But I must always remind myself that I also need to deal with relatives and need to see everybody as human beings who have raw emotions. Theory is very nice, very interesting, very exciting but being strictly adherent to theory is not what doctors should do. Strictly adhering to theory puts us in danger of being unable to deal with the real world, real people and human emotions. Strictly adhering to theory puts us in danger of being devoid of compassion and makes us no different from machines. We can debate about theory for as long as we want but when it comes to patients, we need to be a little bit more respectful, compassionate and understanding. At the end of the day, the patient and relatives may not necessarily remember how long they survived or whether we were excellent in following the rules but in how they were dealt with as human beings. Expressing their sincere gratitude in the face of terrible loss lets me know that I am doing the right thing.