Chemotherapy related diarrhoea and an App!!

One of the possible side-effects of intravenous and tablet based chemotherapy or targeted therapies is diarrhoea. We encourage patients to use Loperamide tablets (Gastro-Stop) to treat and prevent diarrhoea. It works most times, but not always.

Diarrhoea is a adverse effect, which is not managed as well as we should. We have taken huge strides in the areas of vomiting and to some extent nausea, but diarrhoea has still not been tackled well enough.

Some of my patients, who are on chemotherapy, and struggle with diarrhoea (not just the loose bowel motions, but the urgency and uncertainty of the bowel motions) – are scared to go out to public places. Like some of the them tell me – “when you go to go, you got to go now”.

I hunted for possible solutions and came across a free App called Flush – Flush app

This has a database of toilet across the city and country towns. I am really not sure how they manage the database and if there is a way to update it in real time, but it surely has helped give some confidence to several of my patients.

Seems like a silly problem?! Ask the person who is struggling with the issue.

Cancer and Bucket Lists

What is a bucket list?

Defined as “a list of things a person wants to achieve or experience, as before reaching a certain age or dying”

I see a fair number of patients in the clinic – public and private. Most people, rightly so, want to start treatment and get on with things as soon as possible. One of my jobs is to help people understand the various treatment options available and the rationale of each option. This includes talking about the risk versus benefit, the toxicity of treatment and the improvement in survival.

All this sounds great on paper or when lecturing to students or junior doctors. In the real world, things can get very difficult.

Some people want absolutely everything done to prolong life, even if it means that they are miserable for the entire time. Other people want nothing done with regard to our treatment, as they pursue alternative therapies. Yet others, can’t decide what they want.

As the years go past, many of us learn the value of talking to people and understanding what they want. What are their wishes, their fears, their aims, their goals? What does the family want? What are the plans for vacations? Holidays? Time spent with loved one? Major events planned – weddings, waiting for a grandchild to be born, graduation ceremonies. The list goes on.

I am slowly learning the importance of listening to people. It means a lot to them. And (now) me.

Media and Patient hopes

Each week in clinic, patients and their family members will bring me cut-outs from newspapers or magazines or video recorded clips from a TV article – mentioning about the latest and greatest cure for cancer. They bring the article will such hope and expectation. Rightly so.

The problem is that 90% of the times, I have to break their hopes by telling them that most of these reports are experiments are done in a laboratory test-tube or an early phase clinical trial. The chances of most of these drugs reaching a clinic is low or even if they do arrive, it would be at least 4 – 5 years. Most of the patients who need that medication now, will never get to use it.

I understand that journalists have to publish interesting articles, but I really do hope that they would clearly state that this is experimental medication and might take several years to get to the clinic or something like that. Seems like a trivial issue, but it is a pretty big deal for patients and their family members who are struggling for anything new.

The hope lives on.

Quora and Cancer

I ventured onto a website called Quora. Fascinating site. People ask questions about pretty much any topic in the world. There are people who try and answer the query. Over the past year or two, I started answering cancer related questions. It has been a fascinating journey. At times, it worries me about giving answers to people I have no idea about, their circumstances, their medical background, what their doctor has said to them, etc…. but over time I have learnt to be generic but specific.

It does not seem to be a second opinion, but a generic opinion. There are several doctors on the forum trying to help people from across the world.

The site is nice and simple. Most people can navigate it without too many problems.

My Quora link

The Trainee Doctor who took all the blame!!

A great indepth article in the BBC about Dr Hadiza Bawa-Garba, who was smashed with work load, responsibility, lack of support and then hung to dry. It worries many of us working in hospitals, because this could happen to any of us. Any time. The result could be the same.

The trainee doctor who took all the blame!!

Learn to protect yourself. Learn to protect your colleagues and friends. Work together. Work safe.

Oncologist with Breast Cancer – The Guardian

Great article by Dr Victoria Lavin in The Guardian describing her struggle with breast cancer, while training in Oncology in the UK. She describes the people who truly made a difference during her treatment and the lessons she learnt. Amazing.

Guardian – Oncology doctor and cancer

Royal Flying Doctor Service Donation

I remember watching a TV show about “The Royal Flying Doctors” and used to wonder about the amazing service they provided to people in remote areas in Australia. I wondered why people liked living so far away from cities and crowds. As time gets by, as maturity helps… I learn to appreciate the distance from things. More importantly, people live on farms and cattle stations. They provide the food we eat daily. We need to learn to thank them.

If and when the farmers get unwell, we must support them. The Royal Flying Doctor service is an institution in itself and have grown to help thousands of people in their dire times.

Geoffrey Carrick owned a cattle station in the far-north Queensland outback. His 138-square kilometre property was sold for $9.85 million and the money was donated to the Royal Flying Doctors Service and the Children’s Hospital Foundation. Thank you Sir and your family.

The full article from the ABC – Royal Flying Doctors – Donation

Christmas time

Christmas time is amazing. People try to be nicer. Families get together. Time for a short break and reflection on life.

It gets harder for people who have been diagnosed with cancer and are on treatment. I try my best to give people a break over this time, time to get away from the hospital setting, time to be with family and friends, time to recover from side effects of treatment, time to relook at life.

There are several people who are admitted to hospital and unfortunately cannot be discharged home for a variety of reasons. The idea is to give them a break for a few hours to have Christmas lunch at home.

The saddest thing is when people are just diagnosed with cancer and need more investigations and reviews; and so many services or people are on leave. These patients and families are upset and frustrated. It does not really help them, when I explain that waiting for a few days will not make a huge difference in the bigger scheme of things. They want something done now. I can understand them.

What about people who know that this is their last Christmas on earth? It is important to tell people to enjoy their time with families and loved ones, not just for the patient, but also for the loved ones who will cherish the memories.

I continue to be amazed at the generosity of my patients – who will gift me and the team with cards, chocolates, gifts and so on. There are people who take the time to thank other members of the team (who are forgotten otherwise) – cleaners, support staff, pharmacy, reception staff, etc.

I love this time of the year. It brings a joy to most people. It also helps us understand that Jesus is the reason for the season.