Wendy Harpham on Healthy Survivorship

How To Convince Your Doctor

In response to the April 18th post on the Choosing Wisely™  campaign, a blogger emailed me about her doctor insisting on repeating blood tests done 5 weeks before her scheduled procedure, because they were outside the 4-week window. She asked, "How does a patient convince the doctor to NOT order a test?"

Exercise During Cancer Treatment

The ACS document, Nutrition and Physical Activity Guidelines for Cancer Survivors, highlighhts the therapeutic value of exercise during primary cancer treatment. "[E]vidence strongly suggests that exercise is not only safe and feasible during cancer treatment, but that it can also improve physical functioning, fatigue, and multiple aspects of quality of life."

"Doctor, I Use Dietary Supplements"

What are Healthy Survivors to do if they want to go against their physicians' medical advice and take dietary supplements? 

Tell My Doctor I'm Taking Supplements?

In my last post I advised people to tell their physicians if they are taking supplements, even if their physicians explicitely advised against doing so. Won't such revelations harm clinician-patient bonds?

Dietary Supplements During Treatment and Recovery

If a little is good for you, a lot is better. Right? Not when it comes to vitamins, minerals and other dietary supplements during cancer treatment.

Nutrition During Treatment and Recovery

"You are what you eat." This can be a useful motto during cancer treatment and recovery.

Dynamic Guidelines

The updated Nutritional and Physical Activity Guidelines for cancer survivors emphasize the dynamic nature of the recommendations. In doing so, they imply two lessons for Healthy Survivors.

New Nutrition and Activity Guidelines for Survivors

Up-to-date, science-driven guidelines on nutrition and exercise after cancer were published in the April 12th issue of Ca - A Journal for Clinicians, a publication of The American Cancer Society. Although addressed to healthcare professionals, the material is accessible to patients (free, online) and includes a section written specifically for lay readers.

Talking to Your Doctor About Info on the 'Net

In an online exclusive for CureToday, journalist Jody Schoger tackles How to Talk to Your Doctor About What You Find on the Internet.  "For cancer patients, the question isn't whether to go online for health information, but how to discuss information they’ve found with their oncologist."

Lab Mistakes; Researchers' Mistakes

A recent Wall Street Journal article by Amy Dockser Marcus reveals that many cancer cell lines used in research labs around the world are contaminated or misidentified.

Dr. Harpham's Opening Comments

Wendy's Eagles soared at the 9th annual Dallas Lymphomathon, bringing in over $11,000 and numbering over 90 walkers (final count pending). Exceeding my usual 250-word limit on blog posts, here's my short speech to the crowd of over 600 people:

choosing wisely - part V

To wrap up this mini-series, here's an excerpt from an NCI interview with breast cancer oncologist Dr. Schnipper, offering one perspective on why the top five in oncology are overused:

Choosing Wisely - Part IV

A commenter on my last post wrote after reading the Top Five list offered by the American Society of Clinical Oncology (ASCO) for the Choosing Wisely™ campaign: "If I ever have an oncologist recommend any of these tests, I will be armed with the knowledge I need to say no."

My reaction (copied here from the comment section) offers another opportunity to reinforce a central theme of Healthy Survivorship:

Choosing Wisely Part III

Let's look at one component of the Choosing Wisely™ Campaign.

Choosing Wisely Campaign - Part II

In my last post, I introduced the Choosing Wisely™ campaign, an effort by clinicians to avoid overuse or inappropriate use of tests and therapies. Obviously, a successful campaign would save lots of money. But the campaign is motivated by a higher goal that reflects the mission of Healthy Survivorship.

Choosing Wisely Campaign

Having received my board certification from the American Board of Internal Medicine (ABIM), I am proud of their "Choosing Wisely Campaign," an effort to address spiraling healthcare costs and overuse of tests and treatments.

You Don't Understand

While attending a conference or event for some cause other than cancer survivorship, I invariably hear insights and stories that clarify and/or reinforce messages about Healthy Survivorship. Yesterday was no different.

Parenting With Cancer: Out in the Open

Lymphoma survivor Jen Singer, journalist and parent, just launched a new website -- parentingwithcancer.com -- to provide guidance and support to moms and dads facing the twin challenges of cancer and kids.

When Illness Strikes a Physician

I came across an old article (2000) about a colleague I befriended years before the interview. The piece opens with an introduction:  

Music Can Heal

Last month, Canadian singer-songwriter Drew Seeley released a new song. What makes it extra special is that he wrote and performed it for a young girl, Brooke, a patient of oncologist David Mark Loeb, MD-PhD.  100% of the proceeds from the sale of this single go to the pediatric cancer research unit at Johns Hopkins.

A Problem with Doctors' Feelings

In an article "Doctors Have Feelings, Too," physician/writer Danielle Ofri explores why it took a team of physicians so long to lay out the truth to a terminally ill young mother.

Doctors Have Feelings, Too

Any good clinician considers his or her patients' emotions as an important element affecting the evaluation of these patients' medical problems, sharing of test results and outlining of recommended plans of action.

But what about the clinician's emotions?

A Doctor's Guide to Joy

With Bill's permission, I'm paraphrasing his comment on my last post to illustrate the value of talking with your doctor about joy. 

Talking with Your Doctors About Joy

The tip I offer clinicians to strengthen clinician-patient bonds can help patients directly, too. At doctor visits, your talking about your medical challenges in terms of lost joys or hoped-for joys may be just the ticket to getting good care.

Relieving Major Depression in Cancer Patients

An Oncology Times article caught my eye: "Relieving Major Depression in Cancer Patients: Specific 'Biopsychosocial' Method Found Useful."  It reviewed a study that addressed the impact of an intervention developed to treat depression, reduce stress and help patients develop coping strategies.

Problems with Generics - Part II

My March 21st post introduced the problem of patients forfeiting the right to sue for damages if they take generic drugs instead of brand names. What are Healthy Survivors to do, if they've been taking generics?

Problems with Generics

Did you know that when you take a generic drug, you essentially forfeit the ability to sue the company making the drug for damages if you experience an adverse event?

To Survive with Cancer

James C. Salwitz, MD doesn't use the term Healthy Survivor. Still, the story he tells offers a name and face to the idea that patients in difficult circumstances can find Happiness in a Storm.

Be a Good Patient; Study Up - Part II

In yesterday's post, I introduced an article/video to clarify some of the points. Today I want to focus on the quote, "Hope cannot be false."

Be a Good Patient; Study Up

Usually I refrain from criticizing human interest stories or online videos, instead staying focused on all that is good and right. But today I'm making an exception because I know what the person interviewed meant, and I want to clarify. 

Jeff Zaslow's Last Lesson

You've read on this blog about Randy Pausch, the Carnegie Mellon professor who delivered his "Last Lecture" after being diagnosed with pancreatic cancer.

Did you know that the journalist who co-authored the best-seller -- The Last Lecture -- had equally powerful lessons to share through his life -- and death?

Honor Someone on May 5, 2012

I have an idea for a beautiful way to honor special people in your life: Silver ribbons inscribed with their names.

What about loved ones you've lost? Keep their memory alive with inscribed Gold ribbons.

Grief and Acceptance - Conclusion

Sometimes I fear saying the wrong things when trying to comfort a bereaved friend. The temptation to say nothing can be strong. So to conclude this series on grief and acceptance, I've decided to share a recent letter to a friend. 

But first, I want to mention that I expect to continue learning, gaining insights that help me find gentler, stronger, more comforting words for future letters.

When I wrote the letter, it was the best I could do with what I knew then and where I was at the moment. Both my writing the letter and my sharing it here reinforce the notion that the best we can do is the best we can do. And the best is good enough.

Dear Friend,

If only we had access to an easier, less painful path through grief that heals. We can escape the pain of an incision if anesthetized while the two sides of the wound knit nicely together. In contrast, loss of a love causes pain, without which healing doesn’t progress.

The "medicines" that ease the pain of grief are facts and hope. May you find help in the knowledge it will not always be like this and that your pain reflects having enjoyed true love. May you find comfort in the hope that you always feel his love and that someday soon you begin to feel more joy than pain when remembering him.

I wrote the essay (below) after the death of a treasured colleague in the prime of life. For me, the message is applicable to the loss of a love of any age. I hope you find it comforting in some small way as you remember your loved one. May his memory be a blessing.

Patent Pending: The Measure of a Life

"So young!" I cry. "Too soon. Cut short, it feels. How could this be?"

The teacher nods sympathetically and then drops a hint, "Your measurement is wrong."

"You're wrong!" I think to myself, trying to hide my anger. "My numbers add up perfectly, every way I count them. I can calculate to the minute. To the second, if you like." I think longingly of all the days that he might have had, the dreams now gone forever. "I'm sure my numbers are accurate," I say, my veneer of calm slipping. "Which is why it's not fair. Not right. Surely, a mistake."

The teacher once again nods, “Your readings are correct, but look at your yardstick.”

"My ruler?" Suddenly I remember an afternoon in my youth when the world was a wonder and I was thirsty. I demanded the tall slender glass, absolutely sure it held more juice. When handed the stubby tumbler, I was furious. I got less, I protested. It's not fair! So my mother poured the contents of each glass into side-by-side identical measuring cups. At first, I thought it was a trick. Or magic. Then I saw I was wrong. Just as the difference in height of the orange menisci had disappeared, so, too, did my anger. I was once again happy, my thirst quenched. And thereafter I knew: My mind can deceive me if I use the wrong measuring tool.

"So how does one measure a life? “ I ask.

"Not by how many, how quickly, how far. Not by how much.”

"Then, how?"

“Yes. How.”

"How?“

"What matters is not what one does, but how. With purpose? With loving kindness?”

"Can I know the heart of someone who is gone? How? “

"By focusing on the imprint in the sand or the ripple in the pond.”

I don't understand.

“When an artist is done, do you measure how much paint is on the canvas or how long it took to put it there? Do you add up the notes on the score or the words in the book? Stop counting the number of nails the carpenter used and stop looking for the price tag on the curtains if you want to see the home in the house.”

I'm beginning to see that mournful measuring can lead me away from truth into anger or despair. "So, please, tell me, I yearn to know, the reproducible irreducible measure of a life. Is there such a thing?"

“You want a unit, like an inch or a pound?”

"I want to know the measure of a life."

“I told you that one way to measure is by looking at what's left behind. There are other ways, but they all require faith.”

"Faith? “

"You must believe—have trust in measures that are unlike inches or pounds. And then you can know.”

"What other measures?“

"A measure that convinces you Michelangelo's meticulously painted Sistine Chapel and Picasso's Dove, created with but one deft brush stroke, are both masterpieces. A measure that assures you an eight-year-old child's Haiku is as complete as Moby Dick. A baby's giggle? As glorious as Beethoven's Ode to Joy.”

"Does this measure count heroism? Quiet acts of fortitude? Generosity? Honor? Duty? Beauty? Does this measure weigh-in love?“

"A single kiss can be eternal. But beware: All that glitters is not gold. Measure wisely and you won't be fooled.”

My desire for a measure reminds me of a time when I was a doctor and needed an exact weight of one of my patients. I can still see my old office scale: the stand-up kind whose big round face had numbers around the edge except at 12 o'clock, where two words marked the spot. I can still picture my patient lumbering onto its platform, his weight far exceeding capacity and forcing me to look elsewhere for my answer.

Yesteryear's exasperation is today's comfort: Were my friend to step on a scale-of-life, he would surely, as did my patient, send the needle spinning wildly—once, twice—before it slowed down to a stop, the tip of the arrow pointing to Patent Pending.

Grief and Acceptance - Part XIII

After illness or injury, dealing with loss in healthy ways is a necessary element of Healthy Survivorship. So while I begin wrapping up this series on grief, rest assured we are not nearly done with grief. For now, let's narrow our focus to grief after the loss of a loved one.

Grief and Acceptance - Part XII

When grieving the loss of a thing (e.g., jewelry, job, limb), exploring how much the lost thing mattered may be healing. Why? 

Grief and Acceptance - Part XI (Mattering)

Thinking about loss and grief, I have three postulates:

Grief and Acceptance - Part X (Love)

Bill commented, "...I grieve because I love." Is this true? If so, can knowing this help us understand grief or get through grief?

Grief and Acceptance - Part IX (Time)

A reader commented on my last post, eloquently sharing his hard-won insights about grief. In doing so, he highlighted an important element of grief: time.

Grief and Acceptance - Part VIII (Struggle)

Since my February 11th post, I've been thinking about the idea that grief reflects the struggle to hold onto what has been -- or soon will be -- lost. For me, it's not that simple.

Grief and Acceptance - Part VII

Since my last post, I've been wrestling with what I believe about the struggle between grief and acceptance.

Needing more time, today I'll share Part 4 of the series "Managing Uncertainty," a topic germane to this discussion and newly available online at Oncology Times.