He Who Pays Chooses How to Play; Metastatic Cancer; Hurricane Preparedness.

This blog contains information presented in the live broadcast of Let's Talk Medical with Doctor Gigi on June 1, 2012.  Please check out the podcast on www.SkipShow.com if you prefer the audio version.

He Who Pays Chooses How to Play:

The New York mayor has proposed that his city should essentially outlaw large sodas.  So what do you think about government taking away your Big Gulp?  As a physician, I see the beauty of encouraging people to eat & drink sensible serving sizes, especially as we battle our epidemic of obesity, but I really hate the idea that my dietary habits might be dictated by government!  The problem is that as long as government is responsible for our healthcare, they have a vested interest in our health.  Thus, they just might be justified in passing laws that seemingly help to keep us healthy.  Again, I like the idea of healthy habits, but I despise the idea of government-mandated anything!  We as Americans like our freedoms, so how can we think this is a good idea?

Well, the unfortunate truth is that "he who pays chooses how to play."  So if government pays for your healthcarethey will dictate how you live your life... perhaps affecting your diet, your exercise habits, your sleep habits, your sexual habits, etc.  If that sounds frightening, start paying attention to healthcare policy, & start thinking about the control Big Brother already has... & be leery of giving them more control!  This is an aspect of government-provided healthcare which many of us have not considered

When government or insurance pays the doctor, realize that the doctor actually works for them.  When you pay the doctor, he works for you.  Which program do you think provides for an appropriate doctor-patient relationship?  There are many political policies which might seriously affect your health, as well as your freedoms, so if you care, get involved & realize that "free" healthcare is NOT FREE!

Metastatic Cancer:

A "primary cancer" is the initial cancer that develops, & it is named according to the area in which it first begins.  When that primary cancer spreads to a different area, then it is called "metastatic" or "secondary" cancer.  So if cancer begins in the breast, it is called a primary breast cancer.  If that cancer spreads or metastasizes to the brain, it is still called breast cancer (not brain cancer), but it is metastatic breast cancer which has gone to the brain.

Metastatic cancer is obviously not likely to be as treatable as primary cancer, but it is not by definition terminal!  The curability depends on the type of primary cancer as well as the extent of metastatic spread... which is determined by the number of metastases & the organs involved with metastases.  It also depends upon the overall health of the patient, & also to a large degree upon the patient's attitude.  So never decide that there is no hope just based upon the knowledge that a cancer has metastasized... ask for treatment options & perhaps get several opinions.

During the show someone asked questions regarding a cancer which has just been diagnosed & has already metastasized to the bone.  Obviously I cannot say whether this is curable, but certainly the patient should not assume there is no hope!  Oncologists are the specialists who treat cancer patients, & they know treatment protocols, expected outcomes, cancer behavior, etc.  So obviously this person must see an Oncologist soon!  Many cancers like to metastasize to bone, so this could be a primary breast cancer, or perhaps a primary prostate cancer, or even some other cancer.  Depending upon the type of primary cancer, the treatment will vary, so the Oncologist will need to diagnosis the primary cancer. The work-up is chosen by the Oncologist based upon the patient's history & a physical exam, & might include x-ray studies like CT scans or PET scans, biopsy of the bone tumor, mammograms, prostate checks, blood tests, & more.  Treatment will
depend on the type of primary cancer, but generally the bone lesions are treated with radiation, which shrinks the tumors & helps decrease the pain... & yes, bone cancer is VERY painful!  Bone cancer also weakens the bone, thus patients with bone cancer are at risk of breaking those affected bones.  This type of fracture is called a "pathologic fracture" indicating that the bone has broken due to a pathologic process (the cancer), not because of trauma or osteoporosis.  Radiation also helps to decrease the risk of these pathologic fractures.

As a side-thought, there are primary bone cancers, so not all bone cancer is metastatic.  There are
many primary bone cancers, including Multiple Myeloma (which actually is cancer of the bone marrow), Osteosarcoma (which is most common in young people aged 10-25, & saddly is very malignant), Chondrosarcoma (which is cancer of cartilage), & several others.  Each cancer has it's own personality & behavior, so I guess it is easy to see why we need Oncologists!!! 

If you want to check out a great website with patient-friendly yet thorough cancer information, check out www.AboutCancer.com.  It is the website of my friend Dr. Robert Miller who is a Radiation Oncologist in St. Petersburg, FL.  Once in the website, go to "Dr. Miller's Web Site," then click on "Cancer Information."

Hurricane Preparedness:

So June 1 has arrived, & with it comes another hurricane season.  Those of us who live in coastal states must prepare our homes, our property, & ourselves just in case the next 6 months bring threatening storms.

First it is important to know your evacuation zone, so you will know when it is imperative for you to leave.  Have a plan as to where you will go, but pack a road map in case you have to take an alternative route.  If you cannot evacuate independently, register with your city so they can get you the help you need.  It is best to not depend on a shelter, but if you must, be sure you know where those are.  If you require a special-needs shelter to assist with medical issues, be sure to register for that as well.

I am from Louisiana & live in Florida, so I've been through the drill more than a few times.  I also recall a hurricane which hit Louisiana when I was 5 years old.  Though we were 70 miles from the coast, I still remember the frightening wind & sideways rain.  My home was also hit by a tornado which came from Hurricane Andrew as it headed north in the Gulf after having devastated Homestead, FL.  To say the least, I have great respect for hurricanes, & as such, I evacuate.  I can only hope you will do the same!

As a physician I would strongly encourage you to pack the following:

1)  a 2 week supply of your medicines - ask your doctor for samples or a separate prescription which you can purchase on your own if your insurance will not allow an extra or early refill.

2)  a list of your medications including the dose of each pill & how you take them.

3)  a paper with your medical problemspast surgeriesallergies (to meds & to foods), physicians, & immunizations.
          After a bad storm you could be incapacitated & unable to tell rescue personnel this information, & without electricity there might be no access to your medical record if it is electronic.  Also, your physician might not be available or reachable.  If you have a medical app (like My Medical) on your iPhone, iPod, etc., be sure to update it now.

4)  perhaps a copy of your last 1 or 2 office visits from your doctor, as well as your most recent lab tests, including blood tests, x-rays, colonoscopy, mammogram, DEXA, etc.

5)  equipment you'll need such as your CPAP machineoxygenbandagescrutches, bracesglassescontac solution, etc.

6)  water - plan to need 1 gallon per person per day & prepare for 3-7 days... but don't forget the animals!
          If you can, keep the water in plastic jugs, but if you are caught without an adequate storage unit, fill the bathtub with water (after scrubbing it of course).  Also, as water is so heavy, you might not be able to take enough with you if you evacuate.  In this event, you should pack panty hose to act as a strainer, & bleach to purify water.  Bleach should be pure Sodium Hypochlorite 5-6%, & you should mix it as follows:  2 drops of bleach to 1 quart of water, or 8 drops to 1 gallon.  If the water is cloudy you should double the amount of bleach:  4 drops to 1 quart of cloudy water, or 16 drops to 1 gallon of cloudy water.  Mix the bleach with the water & allow it to sit for 30 minutes before you drink it.  Of course, if you have propane or another source of heat, you can boil the water to purify it.  Remember however that flood water not only contains bacterial contamination, but also often contains contaminants such as chemicals (from cars, boats, pipelines, etc.).  Unfortunately neither bleach nor boiling will help with this issue.

7)  NOAA radio which will sound an alarm when a weather emergency happens in your area (such as a change in the hurricane's route or speed, or such as a tornado).

8)  food - remember that you can go days without eating, but you won't last long without water!
          Consider buying MRE's or similar packaged food from an Army store or camping store.  If you pack canned goods, don't forget a hand-held can-opener.

9)  a full tank of gas in a well-tuned car.

10)  petsleashespet food & medicationscrates & bedsshot records, & perhaps towels to dry them off.
          If your pet is fearful of bad weather, ask your Veterinarian for "storm pills" & be sure to pack them with your other supplies!

It is a good idea to pack things in advance, & those that cannot be packed early can be written on a list so you can quickly grab & go!  I like to keep evacuation supplies in the attic, so if I am caught off guard I can just climb up & honker down.  Don't forget, you'll need a ladder to get up there, & you should store an ax or chain-saw in the attic in case you have to cut your way out!

As some last thoughts:

Be sure that you only use a generator in a well-ventillated area; otherwise you might survive the disaster only to die from carbon monoxide poisoning.

Don't walk through storm water.  It possibly has contaminants such as sewage & other chemicals, & it might be deeper than you expect.  Also, you could be electrocuted if there is a downed power line hidden beneath the water.

And so we conclude another blog.  I hope you find the information helpful... & if you do, please consider sharing the blog with your friends & family.  You can do that by hitting the "F" or "T" button at the bottom of the blog to share with your Facebook or Twitter connections.

Also, consider listening to the radio program.  You can do this by tuning to WTAN 1340-AM in Tampa/St. Pete, FL area, or if you are not local, find us on the web via www.SkipShow.com where you can listen live or check out the recorded podcast.  Feel free to call or e-mail questions or concerns:  (727)-441-3000 local, or (866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.

Stay safe, & here's to our health!

Doctor Gigi