medicine

Happy World Cancer Day!

Today marks the release of the 2014 World Cancer Report and World Cancer Day!

Via CNN:

“[Most striking from the report is the prediction that] new cancer cases will rise from an estimated 14 million annually in 2012 to 22 million within two decades. Over the same period, cancer deaths are predicted to rise from 8.2 million a year to 13 million.

[Attributable factors include greater life expectancy and an increase in the aging population, but also lifestyle choices like smoking and obesity.]

[Per Christopher Wild, director of the International Agency for Research on Cancer]: “We cannot treat our way out of the cancer problem…More commitment to prevention and early detection is desperately needed in order to complement improved treatments and address the alarming rise in cancer burden globally.”

The report said about half of all cancers were preventable and could have been avoided if current medical knowledge was acted upon. The disease could be tackled by addressing lifestyle factors, such as smoking, alcohol consumption, diet and exercise; adopting screening programs; or, in the case of infection-triggered cancers such as cervical and liver cancers, through vaccines.

Lung cancer remained the most commonly diagnosed cancer (1.8 million cases a year, or 13% of total cancer diagnoses) and the deadliest, accounting for about one-fifth (1.6 million) of all cancer deaths worldwide…the next two most common diagnoses were for breast (1.7 million, 11.9%) and large bowel cancer (1.4 million, 9.7%). Liver (800,000 or 9.1%) and stomach cancer (700,000 or 8.8%) were responsible for the most deaths after lung cancer.”

Also, apparently “The International Cancer Genome Consortium (ICGC) today announced that it has made available to the scientific community data from more than 10,000 cancer genomes. The data can be used by cancer researchers around the world to better understand the genomic basis of cancer, accelerate cancer research and aid in the development of more targeted treatments.” <–this is HUGE!!

Exciting times lie ahead for cancer research… 😀

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Updated: Global Burden of Cancer

Because I’m cancer obsessed, here are the Latest world cancer statistics from IARC

Highlights:

According to GLOBOCAN 2012, an estimated 14.1 million new cancer cases and 8.2 million cancer-related deaths occurred in 2012, compared with 12.7 million and 7.6 million, respectively, in 2008.

The most commonly diagnosed cancers worldwide were those of the lung (1.8 million, 13.0% of the total), breast (1.7 million, 11.9%), and colorectum (1.4 million, 9.7%). The most common causes of cancer death were cancers of the lung (1.6 million, 19.4% of the total), liver (0.8 million, 9.1%), and stomach (0.7 million, 8.8%). (same top 3, but liver has surpasses stomach now)

For Cervical cancer:

Almost 70% of the global burden falls in areas with lower levels of development, and more than one fifth of all new cases are diagnosed in India.

In sub-Saharan Africa, 34.8 new cases of cervical cancer are diagnosed per 100 000 women annually, and 22.5 per 100 000 women die from the disease. These figures compare with 6.6 and 2.5 per 100 000 women, respectively, in North America. The drastic differences can be explained by lack of access to effective screening and to services that facilitate early detection and treatment

Also relevant: Obesity is the new cigarette, via Huffington Post. From the article,

An official report published by the American Institute for Cancer Research and the World Cancer Research Fund entitled “Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective” states that there is convincing evidence that body fatness increases the risk of postmenopausal breast, endometrial, esophageal, pancreatic, kidney and colon cancers.

Yikes.

Part of the increasing cancer burden is because of the growing world population, and the growing number of aging people, but the disparities between the rates of death and prevalence for cervical cancer, and cancer in general in developing nations, is a reminder that much work needs to be done in these regions. Also, obesity is definitely on the rise, but to the misfortune of everyone 😦

lessons from Dr. Pizzo

Today’s Great Teacher lecturer: Dr. Philip Pizzo, former Dean of Stanford Medical School

-Tenacity, tenacity, tenacity. If you encounter obstacle after obstacle but truly believe in your cause, KEEP GOING. All you need is passion; the rest will fall into place.

-Find your mission. In every encounter you have, especially as a leader, have a missions statement, continue REMINDING yourself of that, and have that be the thread throughout all your talks. Focus on your mission, and it will be accomplished. One source? Your patients.

-Listen. listen, listen, listen.

-You’ll never revolutionize unless you take risks.

the other side of the coat

“23 yo F, no PMH, victim of high velocity MVC. Was driving on I-95 from Bethesda to Philly when got cut off, lost control of car and swerved into median. Air bags deployed. Sole victim. No LOC; pain scale 9/10. On physical exam, vitals WNL, AAO x3, Full thickness laceration from the upper lip to the nose and a laceration on the R eye between the cornea and sclera; vitreal hemorrhage visible. Extensive hyphema on R; fundus unable to assess. Vision in L eye is 20/20; R eye is hand motion. CT scan shows bilateral nasal fracture. No lens visible in the R eye. No other cervical, spinal, rib or extremity fractures. “

*abbrev: F = female. PMH = past medical history. MVC = motor vehicle collision. LOC = loss of consciousness. WNL = within normal limits. AAO x3 = awake, alert and oriented to person, place and time.

Last summer, I was on trauma call at Christiana Hospital, mind racing through mental checklists as the nurse in charge shouted “MVC, middle-aged male, arriving in Trauma Bay 3.” The doors flew open, it was ABCs, Glasgow coma scale, primary, secondary and tertiary surveys; the paramedics telling history on one end, the police interrogating on the other end, residents and attendings throwing orders overhead. I barely had time to LOOK at the patient when, in a matter of minutes, he was whisked off to CT, admitted to the surgical service, prepped for OR.  I remember being struck by the cacophony of firm, direct voices and the rapid pace at which things were accomplished with machine-like efficiency. Strict adherence to protocol was vital to ensure the chance of recovery was maximized, but at the time, I couldn’t help but imagine the chaos our patient must have felt, going through so many sets of hands, instruments, rooms, and procedures in a half-conscious fog, covered in blood, stripped of clothes and possessions and left only with a tossed-on hospital gown and blanket.

Little did I know, I didn’t have to imagine for long. Just over a year later, I found myself reliving my entire surgical rotation from the other side of the stethoscope. It was very lucky that I rotated in ophthalmology and anesthesia as a 3rd year, because it certainly helped me somewhat keep track of what was going on, regardless of whether or not I was informed (which sadly, was more often not the case). I am also thankful to have been taught during my rotations that:

1) doctors don’t have a lot of time, simply because they have so many responsibilities
2) we as medical professionals tend to forget to tell patients things, for the same reasons as in #1 and
3) patients know their bodies the best, but not speaking up means we (med people) can’t use it in our assessment and plan.

My background was both a blessing (enabling me to stay adequately informed and ensure recovery was maximized) and a curse (plaguing me with questions to EVERYTHING). I am thankful to my physicians for being patient and accommodating to my borderline-OCD and constant questioning. heh ^__^’

They say sometimes life throws you lemons, and I had always understood the importance of optimism when those lemons come, but I really do believe that if an accident were to happen at anytime, this was the best possible accident. I am so thankful that I was doing research this year, and not applying for residency or stressing at an away rotation during this time. I am thankful that my accident happened about 15 minutes away from Hopkins, quite possibly the best hands by which to have been received.  I am thankful that no one else was hurt in the collision, and that though I was alone, my phone still worked. I am thankful that my L eye was completely spared, and I was able to dial 911. I am thankful that beyond facial trauma, the rest of me is fine.

I am thankful that my eye repair surgery went well, without complications. I am thankful that the recovery from nasal surgery was also relatively uncomplicated, and though it was 10x more painful, I had medication. I am thankful that resources were not an issue; also that I was not unknowingly allergic to any medications. I am thankful the prognosis looks promising in my R eye.

I am thankful that two weeks into my medical leave,  the government shut down, so my fear of missing work or lectures was literally eliminated. (confession of my borderline-unhealthy restlessness/fear of being unproductive ^__^’)

Most of all, I am thankful for PEOPLE–for a ridiculously amazing and patient family to take care of me, tolerate me, and relay the message of what happened to others for me. My mom and dad were true heroes for driving me 3 hours back and forth between multiple appointments, and my brother a hero for flying in and helping me restore my phone and everything tech related. I am so thankful for awesome friends, you guys, who have been absolutely incredible with your barrage of texts, facebook posts, voice messages, emails, phone calls, food, flowers, cards, prayers, and visits…you guys who continue checking in, sending words/prayers of encouragement. I was blown away. I still am blown away. An eternity wouldn’t be enough to thank you guys, and special shoutout to those who have been there from the start (you know who you are 🙂 <3) . I seriously wouldn’t be where I am mentally without all your support. Love you all!!

Finally, I am thankful for having this accident occur at a time in my own Christian walk where I can actually confidently say that I have joy in Him, regardless of the circumstance–that I truly have had a peace that passes understanding. I am so thankful that my faith rests completely in a God who is sovereign, has an ultimate will and plan, and never fails to provide–as evidenced above. I am thankful that because of Christ, I can never be NOT thankful. God has been so good during this healing process, and it wouldn’t have been possible without all your prayers!

I decided to share these details about my journey not in want of pity or sympathy, but rather, to share the importance of being thankful in the little things. They say it isn’t until you lose something that you realize its true value; I would also add that it also helps you realize the true value in the things that still exist around you. I would admit I did have some low points during the course of the month, but what kept me going was this quote, that

The true key to happiness is gratitude

It doesn’t take an accident to remind ourselves of things to be thankful for, however small, and I certainly hope no accidents happen. But we cannot predict the future, and regardless of whatever may come, being thankful can make situations more bearable.  This experience has taught me that more than anything that people are the best reminders of encouragement and thankfulness. No matter what, love people, and keep them close : )

As for me, the good news is that I am finally well enough to (almost) fully function normally! Now I just need to wait for my body to heal over time. There is at least one more surgery I will have to undergo, but that won’t be for another couple of months. I am excited to say I return to work tomorrow.

Life, I’m back 🙂

oh, science (and the public)

First off, my nerdy side continues to be in heaven here at the NIH. Second of all, I just posted up this article on fb yesterday with dismal opinions of the food in general, when I attended another talk today that presented this AMAZING article:

and then came across these lovely reviews of the article:
and public report by The Washington Post
 
As the conclusions in the abstract by Schoenfeld and Ioannidis report: 

“Associations with cancer risk or benefits have been claimed for most food ingredients. Many single studies highlight implausibly large effects, even though evidence is weak. Effect sizes shrink in meta-analyses.”

From SBM:

“though…there are lots of studies out there that claim to find a link, either for increased risk or a protective effect, between this food or that ingredient and cancer, [and] very few of them actually provide convincing support for their hypothesis…We must resist the temptation to go too far in the opposite direction and reflexively dismiss even the possibility of such risks as the ACSH is wont to do, most famously with pesticides and other chemicals.” 

Bottom line:

“there are at least a few foods that are reliably linked to cancer. For instance, alcohol consumption is positively linked with several cancers, including pancreatic, esophageal, and head and neck cancers, among others….When you boil it all down, it’s probably far less important what individual foods one eats than that one eats a varied diet that is relatively low in red meat and high in vegetables and fruits and that one is not obese.” 

From Brown et al:

Important steps to improve the fidelity of research reporting include the following: Increased use and improvement of clinical trial and observational study registries; making raw data publicly available; making supporting documentation such as protocols, consent forms, and analytic plans publicly available; and mandating the publication of results from human (or animal) research supported by taxpayer funds...comprehensive approaches to improve reporting of nutrient-disease outcomes could go a long way toward decreasing repeated sensational reports of the effects of foods on health. However, none of these debiasing solutions address the fundamental human need to perceive control over feared events…the public is always the final audience. It is therefore imperative that we spend less time repeating weak correlations and invest the resources to vigorously investigate nutrient-cancer and other disease associations with stronger methodology, so that we give the public lightning rods instead of sending them up the bell tower.”

microbiome!

Probiotics lecture (on this study) Q&A:
Q: One could say mice have shared microbiomes because they eat each other’s poop. Now in reference to humans, do you think there is an application?
A1: Well, I must reference the study on the microbiome of households with dogs that show increased homogeneity within these households vs non-dog households…
A2: There is a proposal that improper hand washing may play a role…heh heh

^__^’ That’s sort of gross. But also sort of fascinating.

For those unfamiliar with the microbiome, which has been BLOWING UP science news:
NYT: Say Hello to the 100 trillion bacteria that make up your microbiome

Nice collection of recent NPR articles

my people

“i heart you”, said heart to the gut 😛

You know that feeling when you meet people that totally just click with you? That you can be yourself around and not be judged, or be judged but still tolerated? That you might not even know that well yet, but you know you have so many things in common already, and totally hit it off?

Or when you just love the people you’re surrounded with?
Reason #howeverhundred I’m so happy I chose medicine: my classmates and peers are some of the most amazing people I’ve ever met, or will ever meet, and though not everyone creates that same feeling felt above, there is a pretty darn high percentage of them that do. It is true that you may just meet some of your best friends in med school.

Absolutely love the people I’m meeting, the people in my life, and the environment I’m in. Trust me, it wasn’t always like this, and won’t always be like this either. But man, does it feel good, and this moment deserves recognition in a post so that if I ever doubt or feel lonely, I am reminded that I really am not. Another reason I think this is possible is because I feel like I’m finally being honest with myself and who I am. Med school taught me the hard way that you can never please people, but hey, the lesson is learned. Also, I’ve been slowly coming out of my introvert shell–opening up a bit more, letting people in a bit more, being confident in who I am and getting away from the ‘pleasing’ mindset that has been in my head too long. It is amazingly liberating how good this feels.
Thanks be to God for always being so amazing and providing 🙂

IPV…a huge issue

Found this in one of my email drafts: I’ve been meaning to post it up, but wanted to write a bit more…but then other things got in the way. I think this alone speaks for itself:

from NEJM —

The U.S. Centers for Disease Control and Prevention (CDC) recently released a comprehensive report on the prevalence of sexual violence, stalking, and intimate-partner violence (IPV) in the United States.1 The report relays the alarming findings that 35.6% of women in this country are raped, assaulted, or stalked by intimate partners at some point during their lives, and approximately 6% experience these events in any given year. Men are also at risk for IPV victimization: 28.5% report having been victimized at some time during their lifetime, and 5% report victimization within the past year. But the forms and consequences of IPV experienced by women and men are not the same. Women are more than twice as likely as men to experience sexual coercion in their intimate relationships (17% vs. 8%) and are twice as likely to experience severe forms of physical assault by an intimate partner, such as being choked, hit with a fist, or kicked (24.3% vs. 13.8%). The most striking differences relate to the consequences: very few men (5.2%) report ever being fearful of their intimate partners, in contrast to 28.8% of women, and women are almost four times as likely as men to be injured by a partner (14.8% vs. 4.0%).

One THIRD of women. Aka, one in THREE. One in three women you will ever meet in your life either will have already experienced, or will experience, intimate partner violence.

if this was your mother, doc….

By HAIDER JAVED WARRAICH, M.D, from the NYT
 
I love this. Essentially:

Quote–

 ““Doc, give it to me straight. If this were your mother, what would you do?”

 While the patient-doctor interaction varies widely across cultures and continents, this question seems to be a universal constant…From a patient or family member’s perspective…. this question helps them make sense of the confusion, desolation and powerlessness that so often defines the hospital experience, which usually involves a full-on assault of numbers, jargon and ‘expert’ opinion… it makes sense that they would defer the choice to those who appear to know what they are doing. And by invoking the physician’s parent, they hope to humanize the physician and have a conversation with real stakes.

Yet I still find this question hard to answer. See…my answer to the question would be very different, as it would be for anyone, depending on which parent you asked me about.
  
So I have come to believe that the right answer to the question, “If this were your mother, doctor…” is: “Tell me more about your mother.” 

This response gives patients’ families the chance to think about their loved ones, about what they would value and what they would consider a good life, what they would think was worth fighting for if they were available to answer the question for themselves…It takes them away from a place where they feel solely responsible for the trajectory of their relative’s life to one where they simply communicate what the patient would want out of her life. We as physicians can then weigh in on whether it is reasonable to expect that to happen.”

YES. Totally using this.