Monday, August 31, 2009

The Question of Cancer

When I wrote a veterinary blog, the most common question I had was "What IS this tumor on my pet-what is cancer?" With the passing of Ted Kennedy, the Senator and friend to most everyone he ever met, the magazines and periodicals are putting out information relating to brain cancer. Recent studies, showing that Prostate cancer is greatly over-diagnosed, are making rounds in the health columns. Stores sell pink products in support of the efforts made by the Susan G. Komen Foundation against breast cancer. The common tie to all of this is many people just know that "cancer" is the bad thing that kills people, but what cancer really IS seems to be lost in the headlines.

Cancer is a term given to cells in the body that grow and absorb other cells which in turn grow and absorb other cells, and the growth continues until the cells become toxic to the body. Cancer cells become toxic to the body for a few reasons. First, some of the growth happens so quickly that the function of the organs, bone, nerves, or blood vessels stops, and the body cannot work properly. Another way cancer cell growth becomes toxic is when the mass is so large that it ends up carrying its own blood supply-- so much so that other parts of the body lose oxygen, nutrients, and enzymes, and dies little by little, until the body ceases to function. Another way cancer becomes toxic is when the location of the growth interferes with key body functions, and the body cannot heal itself fast enough to battle the cell growth.

Tumors and lesions are not always "cancer". The shape the cells take, and the manner in which they grow are the key differences. Almost every human, at one time or another has a bump, lump, or growth that is certainly not a cancer. Warts, cysts, clogged pores, and nodules are not always cancerous, but sometimes lead doctors to watch for signs of future possible tumors. When a woman has a mammogram and a lump is discovered, it is usually cause for further testing. Some women have fibrous tissue, "dense breasts", and false positives for cancer. But with the proper follow up exams, cancer can be ruled out. Proper care makes the difference.

Cells that trigger to grow at a different rate than neighboring cells change shape, and density. Some of these cells become solid, others become soft. Softer cells are generally benign tumors, or appear as abscesses. Other soft cells end up appearing as lesions, that appear as openings, rather than lumps. When lesions occur, doctors are likely to assume the area is cancerous rather than benign. A benign tumor is likely to stop, lessen, or reduce growth after the correct treatment.

So what treatments stop the growth of cancer cells? Why is it that cancer seems to elude cure? Science reveals the key factors lie in genetics, chemical and biological influences, age, time- the issues that cause cancer in one person may be an entirely different in someone who has the same type of cancer. There are correlations that some women who have a cervical virus can develop cervical cancer later in life. There are some correlations with those who smoke developing lung cancer. Not all women who get cervical viruses, nor all people who smoke, develop cancer. If cancer held a definite cause and effect then it would be far easier for medical professionals to cure or eradicate the disease.

Cancer also seems to carry a clock. For some people, the clock is set to be fast, while others seem to stop. The remission of cancer happens for some but not others. What is remission? For some reason the cells that are eager to grow turn off that growth. Remission is the period of time that the cells stop growth. The period of time can be weeks, months, and for some the growth stops altogether. Most cancer treatments are designed to put those cells into full remission. Remission means there is always a stronger chance that the cancer will return later on, than for those who have no cancer at all.

Some patients have surgery. Areas of the body affected by the growth are removed, along with healthy cells nearby, in order to stimulate the growth of the healthy cells. Medications, or chemical-therapy, (chemo), are blended together to cause cells to stop growing. When chemo is combined with radiation, the 'bad' cells are killed off. Since the body has a weakened immune system during chemo, it doesn't fight against the death of the bad cells, and the body can begin to heal.

But other treatments are starting to come to play, in the advances of bone marrow and stem cell transplants. The concept behind these treatments is healthy cells that have the function of growth and support of healthy cells will replace the bad cells that are attempting to take over the body. The advances in this research over the last decade are vast. Even those with breast cancer and lung cancers are seeing results. It isn't the cure, but for some it means full remission.

There is hope that some day a "cure for cancer" will exist. It will likely have to be a genetic change as well as a chemical or surgical option. Because so many varieties of cancer exist, and so many causes are discovered, scientists are attempting to find a way to turn off the genetic factor that tells cells to start growing in the first place. The biggest struggles come from learning how to turn off the bad cells without stopping the growth of healthy, good cells. Biologists are learning from species which appear to be cancer-free, including sharks, as to what the genetic difference they carry that we could adapt for ourselves. The answer may be just one discovery away.

Life expectancy for those who have cancer is greatly different than it was just twenty years ago. The care for those battling the disease has greatly improved. We aren't killing the patients with the treatments as often as we had in the past. We are learning how, as patients, we can reduce our chance of contracting cancerous cells by eating the right foods, avoiding sun, refraining from smoking, and avoiding chemicals in the workplace. We screen for lumps, polyps, and lesions, and doctors are better trained at finding the cells that will result in cancer. Our awareness is greater, and our doctors are better educated. Until there is a cure, this is something we must rely upon.

This week's questions- Has cancer affected your family or your life? Have you discovered lesions or tumors and had them turn out benign? Do you feel the government should support medical research if it involves stem cells? Do you think private labs will discover the cure for cancer?

Wednesday, August 12, 2009

Public Healthcare in the United States

The issues of Public Health seem to spur more than just passion from people who haven't actually read the latest plan. It seems to be bringing a near "Red Dawn" scare in those who lived through the Cold War, a taste of McCarthy Era panic, from those who don't comprehend socialized medicine. And for others, it's a desperate plea to finally find a way to get care into their lives when they've had none. First of all, I want anyone reading this blog to READ the plan before they assume any positions on the matter.

It's hard to make an informed decision unless you really understand the points being made. The fear is that we will have huge tax increases, that our choices will be limited. The fear is that those who have chronic illnesses and those who have terminal illnesses will be excluded from the plan. The fear is that those who have private care will no longer be allowed to keep the doctors they have. The fears are enormous, and largely fanned by a media pool addicted to dramatic town meetings. The media isn't showing those discussions that are allowing people like you and me to ask questions and get answers. The media isn't showing the number of letters responded to on both the President's websites, nor the letters written by the Senators and Congressmen who try to explain the facts from the drama.

I do see the issues that have taken place in the Veterans Health Care system and with Medicare that have caused people undue hardships. These are both well documented over years, and with my personal experience in both programs I also have found some of the issues are infuriating. Mental Health, especially, seems to be poorly funded and the issues with those who have long-term illness are often mired with red tape long before care is recieved.

But, both programs are run without the sky-rocketing tax increases threatened by fear-mongers who assume that the Canadian and British taxation that pays for those country's health programs are similar to what we'll experience. It's just not going to happen that way. With nearly 50% of the American public on either VA or Medicare, Medicaid, or other governmental programs, we have a long term history of not using our tax dollars on these. Our construction bonds, military spending, and now "bail out" spending has taken a far greater percentage of our tax dollars, and education, once a larger pie slice is now whittled away.

Be educated about the plan, and you'll see there are faults, but there are benefits. There's not a stipulation stating that those who have private care MUST convert to this program, although I've heard both reporters and politicians state this. Several key points seem to rely on the "Once the Program Is Running" solutions to imminent issues. There is just no way to have millions of people under one system without bumps, potholes, and even traffic jams on the road to the change. There hasn't been such a large scale change expected of the American public since the days when we were allowed to go to gas stations only on odd or even days. Be aware there are going to be problems, but don't be afraid that you will be expected to solve them, or that the solutions lie in your paychecks. We'll all be adjusting, even those who are not electing to take part in the program. And, just be aware- being part of a Socialized Health Care System does not make you a Socialist, which also seems to be the war cry of those who haven't read the plan.

The program is expected to change the way we get our care, but it hasn't fully addressed the FDA, and I believe this is a key gap in the idea. We have had a governmental program in place to protect consumers against failures of medical treatments and pharmaceuticals, but the length of time and the manner of the testing doesn't seem to address the failures of drug companies to work towards healing ALL people, rather than those who will provide the largest dollar amount to the trustees. Until that issue is completely, and honestly addressed, we simply don't have any chance of Universal Health Care. A child with Down's Syndrome deserves the same medical breakthrough research as someone who wants to look younger on television. Yet, there isn't anything in the new plan addressing this.

Whether you support Democrats or Republicans, or if like me, you prefer to remain label-free, you don't have to use that label to determine your agreement to the plan. Libertarians will disagree- by the nature of the beast having one more governmental program is completely against all they stand for, but the concept of choice isn't lost on them either. This is still the land of the free, and the home of the brave. We are part of a growing problem. As Los Angeles and other cities have events that bring thousands to the doctors' office for the first time in some lives- the fact is there are millions of people who have had no care. Ever.

As much as we'd like the government to stay out of our personal lives, we've built a long-term relationship of reliance. The war exists between those who work hard and get very little and those who don't work at all, and get everything handed to them. The word "Free" is a four-letter f-word that inspires hate in those who are tired of seeing people abuse the system. But, the fact- another f-word- exists that there are millions of people who are living paycheck to almost-paycheck. Millions are out of work because jobs are sent overseas. Millions are out of work. Period. The biggest population growth in the last five years is in the senior population and jobs for seniors are harder to obtain. Age descrimination exists in the country obsessed with youth.

We can pontificate the issues of birth control. We can claim that illegal aliens are the reason for the full emergency rooms. We can spout on about the failures of corporations in the concept of employee retention. We can disect the issues of the bad financial management. The country is full of thieves, and it's full of poverty. The fact exists that people are struggling. The fact is people are the country. We, The People. If we deny care to one, we have denied care to all. Pointing out flaws doesn't solve the problem- it only states obvious issues. In the ideal of a country based on the dream that anyone can succeed if only given the right tools- the tools may be something as simple as a pair of glasses, or as complex as surgery for spinal bifida. And, the fact remains, an educated person and a healthy person provide more to a society than one lacking both.

Today's Question- Do you feel comfortable discussing the health plan with peers, family, or employers? Have you read anything about the plan before, and if so, do you plan to note your objections or agreements with your political leaders? Where do you see the health care program in 5 years?

Monday, August 3, 2009

Genetic Anomalies

Very few of us get the opportunity to speak with a genetic specialist, yet doing so can help prevent years of pain, and even give us the clarity of vision for our future health. In the last 18 years, genetic medicine has changed lives. Adopted children who have no contact with birth families can get a better idea of the medical history of their family tree. People who have parents with history of cancer can now treat far earlier. People deciding to be parents can determine if their genetic combination will lead to complications in a child's life, and therefore can decide to adopt instead. Prenatal care becomes a matter of less invasive procedures, also includes statistic genetic evidence of possible issues in the fetus. Those who are unsure as to why they are experiencing mental health issues now have a clue with the genetic tests that reveal a serotonin issue.

But, genetic testing isn't part of the normal medical screening done by family practices. For today's blog research, I've found there are no HMO's or PPO's that put "Genetic Testing" as part of the routine care for pregnant women. When people start to show signs of Alzheimer's, joint diseases, or even depression, there isn't an obvious step by physicians to screen for genetic anomalies. The cost is listed as too prohibitive. Yet, the dollars that health care systems can save simply by ruling out genetic illnesses, disorders, or even traits for future generations could mean millions saved in health care costs- per patient.

This week the National Institute of Health released information about a genetic factor found in those who are experiencing major long term depression. Millions of people aren't even treated for depression, and instead get misdiagnosed with other disorders because the symptoms of pain, lethargy, appetite change, sleep loss, and weight change can be traced to other illnesses. And, those who are actually suffering from Cushings Disease, Adrenal disorders, pituitary illnesses, and other disorders are often misdiagnosed with depression and mental health issues. Knowing the genetic marker for depression is a leap in proper diagnoses.

Genetic markers exist for Tay Sachs disease, Huntington's Chorea, Polycystic Kidney disease, Hemophelia, amongst other rare and not-so-rare disorders. Early detection can not only arm medical professionals with the tools needed to treat and heal, but the patient can be forewarned regarding any impending issues based on a genetic probability. And, testing for genetic markers can help to find out if patients have single gene issues, or polygenic disorders.

The single gene issues include Autosomal Dominant which means just one copy of the gene marker can create illness. One parent contributes to the issue. In the Autosomal Dominant marker, there is a 50% chance the child will inherit the problem. In Autosomal Recessive genetic marker, both parents must contribute a malformed genetic marker for a child to have an issue. Cystic Fibrosis is an example of Autosomal Recessive, and Huntington's Chorea is a Autosomal Dominant genetic failure. Knowing if a genetic marker is X and Y linked dominant and recessive in a single gene can help define if a male or a female will have the disorder. Muscular Distrophy and genetic male infertility is discovered via the X and Y linked markers.

Maternal Inheritance, found in Mitochondrial DNA, is a method of measuring issues mothers can pass on to embryos. This form of disorder is much less likely, and only exists in the rarest of genetic disorders. But, Polygenic issues can arise in many instances and can lead to the discovery of heart disease, cancers, diabetes, and other more common illnesses. The screening of polygenic failure can not only save lives, but again, millions of dollars in health care costs.

The Human Genome Project offers insight into thousands of issues that can be treated once found through genetic screening. However, there are not cures for all genetic disorders, and some issues don't even have known treatments. This raises the question of offering screenings to those who cannot be helped. Does the cost of the test include the fear that comes along with it? Do you warn a patient about impending illness if there isn't any way that the patient can help herself? Is there an ethical issue involved in these tests that counter the oath of "First Do No Harm"?

I am a patient of a genetic disorder. My parents showed no obvious signs of the joint condition that leaves me in a wheelchair or in unbearable pain. My grandfather on my mother's side has obvious signs of Marfan's Syndrome when you view his photographs. The clues include a sunken chest, tall lanky frame, and long spindly fingers and toes. He also died of a lung illness, battling the disease from the time he worked as a coal fueler on the railways as a young man. Although I didn't show severe issues until I was well into my 30's, knowing that I could help prevent some of the damage that results in my current condition could have been useful. In fact, years of misdiagnoses could have been averted all together.

With the NIH commenting this week on the discovery of the "depression gene", there is an upcoming event where hundreds of medical professionals will discuss the issue. The European College Of Neuropsychopharmacology meets in September in Turkey, and will discuss treatments options, genetic testing, and other key points in helping not only to treat but to cure mental illness and depression based on the genetic findings. A program at Louisiana State University will study issues with genetics and brain functions, primarily of depression, through a grant received in the last two weeks. There is hope that the knowledge will lead to a cure.

Today's questions- Have you ever undergone genetic testing? What do you feel is the best use of Genetic Testing? Could you see medical organizations adding this as a preventive measure for patients? Do you feel the costs of knowledge outweigh the price of the test?