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Clinical Trials

A disturbing sentence jumped out at me in the January 2019 Scientific American. “Most cancer patients never get into lifesaving drug trials because of barriers at community hospitals,” wrote David H. Freedman in Out of Reach. Freedman reports that people who get their medical care away from big-name, big-city academic medical centers are less likely to enroll in clinical trials.

Drugs that are being tested in studies often are the best hope for good results, especially with serious medical conditions, such as cancer. I participated in a hepatitis C clinical trial in 2013. At that point, I had lived with hep C for 25 years, and it was starting to do significant damage to my liver. Two prior treatments had failed to cure me, and even if I could wait for a few more years for a cure, I had lousy insurance with a high-deductible. I didn’t hesitate. It was worth the 6 hour round trip drive.

The top reason why cancer patients said they did not participate in a clinical trial was that they were not aware of any studies. A fairly large but old (2009) study reported that 81 percent of cancer patients didn’t discuss studies with their medical providers.

Not all clinical trials are appropriate, but they shouldn’t be viewed as last ditch options. A good study can be an wonderful experience. How do you figure out what is right for you? I suggest you start with learning some basic facts about studies. Hepmag.com has excellent information about clinical trials.

If you want to look for a study, talk to your doctor, or visit the U.S. National Library of Medicine’s  Clinical Trials website. (https://clinicaltrials.gov/)

Participating in a clinical trial can be incredibly rewarding. First, you may get to try a new drug sooner than you otherwise would. Second, you are taking part of making history and making a difference. It can be a wonderful experience.

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Tricks of the Mind: Meditation

Image by Bianca Mentil from Pixabay

My mind plays tricks on me. Recently, I saw a title of a research article on the relationship between liver cancer and the often prescribed over-the-counter medicines known as proton pump inhibitors (PPIs). Since I was just finishing up a two-week course of PPIs, my mind leapt to the worst possible conclusions. It turns out that researchers found that PPIs don’t increase risk of liver cancer. I was relieved, until I started thinking about why they studied the relationship in the first place. By the time my mind was done weaving a tall tale, I was exhausted. And I was wrong about all my assumptions.

My thinking is unreliable. It’s the number one reason I meditate. Meditation is like a field trip for excavating how untrustworthy and changing my thoughts are.

And then there are the memory issues. Age is no friend of memory. Fortunately, there may be good news on that front. In a recent issue of Nature Neuroscience, Romain Quentin and Leonardo G. Cohen published research on reversing working memory decline in the elderly. When noninvasive high-definition transcranial alternating current stimulation was applied to the brain, older adults showed short-term improvements in memory.

Interestingly, memory improvement was done by stimulating theta-phase synchronization. Meditation is all about increasing theta waves. In light of this research, meditation is looking really appealing to me; I’m sticking with it. Plus. I am seeing changes in my thinking. If nothing else, it’s like being in a playground, having fun learning how to do new things.

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Prescription Costs and Humor

In April, I usually try to write a humorous column in honor of April Fool’s Day.  Humor is vital to my health, and I believe there is a national shortage of levity. Today I’m keeping my blog short. I’ll leave it to you to judge whether this is comedy or tragedy, keeping in mind that humor often follows tragedy.

The following comes from a cartoon by John Carr:

A man is picking up a prescription at his local drugstore. The pharmacist says, “The good news is…at a thousand dollars a pill, it only takes five pills to meet your deductible.”

Unfortunately, this is all too true…However, I can’t tell you how often I’ve seen patients get high quality help and reduction of prescription costs from programs such as NeedyMeds. If you are facing high drug costs, ask for help. In the meantime, apply humor. Laughter may not cure all ills, but it sure makes them more bearable.

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Shingles, Vaccines and Picnics

Some of us are old enough to remember having preventable diseases. I recall measles, mumps, chicken pox and rubella (aka German measles). Each left a distinct memory.

Measles were the worst. I remember hallucinating from the high fever I had. My mother got them and we had to endure my father’s burnt toast and overcooked eggs for a few nights. I wasn’t very sick with German measles, but in the days before reliable contraception, we couldn’t leave the house, lest we infect any pregnant women.

Chicken pox were hideous, and I still have a couple of scars from them. I got mumps the last week of second grade. We had a school picnic and a field trip, so I didn’t tell anyone I was sick. However, my swollen neck betrayed me. I tried to suck in my cheeks and challenge the school nurse’s diagnosis, but she wasn’t having any of it. I was sent home.

These memories play a significant part in my decision to be vaccinated against any preventable disease. I don’t want to miss another picnic or take an unnecessary sick day again. I lived with hepatitis C for 25 years, a disease for which there is no vaccine. Life is short. So when I hear ‘vaccine,’ I’m all in.

On Tuesday, I was vaccinated against shingles. Shingrix is the newest version of this vaccine. I had the older version (Zostavax), a far less effective vaccine. Overall, Zostavax works about half of the time, dropping to about 18 percent in people over 80. I could see my 80-year-old self with shingles missing more than just the school picnic, so I got the Shingrix.  

If you’ve ever known anyone with shingles, you know how painful it is. We are talking pain that can last for months or even years. Approximately 1 in 3 people in the United States will develop shingles in their lifetime. That’s about a million cases a year in this country. Since risk of shingles increases with age, I thought it prudent to be vaccinated as soon as possible.

There is a Shingrix shortage, so it took a bit of patience and diligence to get the vaccine. Yes, I did get some side effects. My arm hurt a bit and is red. I felt tired and achy the day after. This is a normal immune response and tells me my immune system is doing exactly what it is supposed to do. It is NOT because of anything wrong.

The only side effect that I didn’t like was the cost. I paid $165, and since this is a 2-dose vaccine, presumably the second co-pay will be similar. The woman next to me paid only $20 for her vaccine. In other words, the cost depends on your insurance plan. I received the vaccine through my local pharmacy.

Here’s to life without shingles!

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National Donate Life Month

April is National Donate Life Month.  Most of us know that we can donate blood and our organs. Did you know that after you die, your skin can help burn victims? Your corneas can give sight to two people. Upon death, there is the potential to donate your heart, kidneys, lungs, pancreas, spleen, intestines, skin, bone, veins, lymph nodes, the entire eye or just the cornea, and soft tissue, such as ligaments, tendons, and muscle. Instead of the entire liver, sometimes only liver cells are used for transplantation purposes. Bone from two donors has kept my neck stable for decades. Thank you donors!

You don’t have to die to be an organ donor. Living donors made more than 6,000 transplants possible in 2017. Living donation saves two lives: the recipient and the next one on the deceased organ waiting list. Kidney and liver patients who are able to receive a living donor transplant can receive the best quality organ much sooner. It saves a lot of suffering.

From tissue to your entire body, the donation save lives and brings hope and relief to families and friends of recipients. You can also donate money to help keep donation programs solvent.  Click here to become a registered donor and proclaim your intention to help save lives.

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Exercise is not the best tool for weight loss. However, if you want to feel better, sleep better, reduce the risk of various chronic diseases, and feel like you can do everything better, exercise is the best tool in the toolbox. According to the Centers for Disease control and Prevention (CDC), some health benefits start immediately after activity, and even short bouts of physical activity are beneficial.

Studies show there is benefit to ANY physical activity. It can be slow and long or short and intense. It doesn’t matter if you do all your daily exercise at once or do it five minutes at a time. The point is to do something, and do it daily.

However, if you want to aim for precise goals, here are the recommendations from the Physical Activity Guidelines for Americans. “To attain the most health benefits from physical activity, adults need at least 150 to 300 minutes of moderate-intensity aerobic activity, like brisk walking or fast dancing, each week. Adults also need muscle-strengthening activity, like lifting weights or doing push-ups, at least 2 days each week.”

What is moderate to vigorous physical activity?

There are various was to measure intensity. I prefer the concept of relative intensity. Using this method, people pay attention to how physical activity affects their heart rate and breathing. Intensity level is subjective. What may be intense for one person may be less intense for someone else. For instance, I don’t play tennis, but if I were to try, I would probably be huffing and puffing after the first serve. On the other hand, I do aerobic dance, and it takes me a bit of effort to raise my heart rate.

In general, if you are doing moderate-intensity activity you can talk, but not sing, during the activity. If you are engaged in vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath.

According to the CDC, examples of moderate-intensity activity are:

  • Walking briskly (3 miles per hour or faster, but not race-walking)
  • Water aerobics
  • Bicycling slower than 10 miles per hour
  • Tennis (doubles)
  • Ballroom dancing
  • Gardening
  • Examples of vigorous-intensity activity are:
  • Race walking, jogging, or running
  • Swimming laps
  • Tennis (singles)
  • Aerobic dancing
  • Bicycling 10 miles per hour or faster
  • Jumping rope
  • Heavy gardening (continuous digging or hoeing)
  • Hiking uphill or with a heavy backpack

Not ready for this amount of activity? Any exercise is better than none. I don’t care if you are walking once around the table, it is better than sitting all the time. In fact, prolonged sitting is very unhealthy.

If you are new to exercise, be sure to talk to your medical provider before starting. Start slow and only do what feels comfortable. Most of all, do it. Find ways to battle every excuse. Make exercise a non-negotiable part of your life. It may be hard, but it is worth it.

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