The Big C

C is for Cancer.

In my mere four years in practice out of residency, I have diagnosed patients with endometrial cancer, ovarian cancer, fallopian tube cancer, skin cancer, lung cancer, colon cancer, pancreatic cancer, prostate cancer, tonsillar cancer, lymphoma, and more, and I have lost several of those people to their diseases.

As a family practice doctor, I am always encouraging preventative care and sometimes feel like the "pap police," trying to get women to get in to get their regular cervical cancer screening (at one point, our clinic was incentivizing patients with Starbucks gift cards and posting "Get your Pap On!" fliers everywhere). It always amazes me when patients decline, avoid, or postpone their age-appropriate cancer testing including mammograms (yes, I hear that getting your boobs squeezed is uncomfortable) or colon cancer screening (I know no one thinks that cameras up your butt are fun, but at least you are not in Denmark, where my Dad told me they don't use sedation. And I can guarantee that cancer is a whole lot more uncomfortable). 

While certainly some cancers are fast-growing, uncommon, and are not ones for which we have good screening tests, the "big three" of cervical, breast, and colon cancer do have regular and pretty sensitive testing options which follow reasonable guidelines.  When I ask the reasons my patients don't want these screening tests, I hear from them "I forgot to return the stool sample" or "I just didn't get around to calling the hospital radiology department back"  or "I'm not sure I can afford the charge/ I don't have insurance right now" or "I hate getting my breasts squeezed or having a pelvic exam" or "I don't have symptoms, so I don't think I could have something bad like cancer" "I just don't want to know" or "You gotta die of something."

I just read a couple of fantastic books, particularly for readers who have interest in the medical (particular cancer) field. They are especially relevant in light of my daily battles to get people screened and as someone who never wants to lose another patient (or relative) to a possibly preventable (if caught early in the screening process) oncologic illness.

The first was 'The Emperor of All Maladies" by Siddhartha Mukherjee, which is an extremely interesting biography of cancer -- from its earliest (mummified) victims, to the history of new surgical/radiation/chemo treatments and screening modalities (I learned that we have the Pap test now because of the research of George Papanicolaou, who subjected guinea pigs' [and his wife's] cervices (?cervixes) to frequent, sometimes daily, cell scraping at various times in their menstrual cycles!)

Earlier this week, I then finished an incredibly well-written, engaging, and personal book, Pandora's DNA by Lizzie Stark, who was a family friend from church in McLean, Virginia. In her second book (which also references Mukherjee's book above), Lizzie chronicles the history of breast cancer treatments and screening tests, including the now-available BRCA (breast cancer gene) testing which has been her personal family's curse and which brings up many ethical and personal dilemmas about having a family and potentially passing on a lethal gene or even keeping one's own breasts.  Interestingly, one of the first "reviews" listed on Amazon commending Lizzie's book is a quote from the author of the first book above:
"An extraordinary book, written with passion and compassion, Pandora's DNA illuminates a new world of science and medicine." —Siddhartha Mukherjee, oncologist and Pulitzer Prize-winning author of The Emperor of All Maladies: A Biography of Cancer

The Immortal Life of Henrietta Lacks by Rebecca Skloot, which tells the story of the Lacks family and the HeLa cervical cancer cells we all learned about in biology classes and which changed  modern medicine, was another great nonfiction science/ethics/medicine book that comes to mind which I read a few years ago.

I really wish that some (or all) of my patients would read these books so that they may come to appreciate the context for these screening tests, and to hear directly about how devastating and helpless cancer patients (or those who are unlucky enough to carry a genetic predisposition to cancer) feel daily.  I wish that their eyes would be opened to the reality of the painful decline of patients who, due to insurance issues or procrastination or whatever, put off that colonoscopy and ended up with metastatic colon cancer, and wish that it could somehow change their minds about early detection.

Other suggestions for improving our cancer screening rates and taking advantage of the remarkable medical advances and tools at our fingertips are appreciated (book recommendations are always welcome, too!).

(And please schedule that pap appointment!)

Manila Dunes Sand Sculpture Festival

Today, for the first time, we checked out the Manila Dunes Sand Sculpture Festival. It was a lovely sunny and warm (not-on-call!) Humboldt day, and, in our haste to leave after Iver's nap before it got too crowded, I put on extremely inappropriate (Jambu) shoes that filled with sand, which prompted me to walk a lot barefoot on the hot sand (ouch!).

 

The artists started on their creations as early as 8 a.m., (we were there between noon and 1 p.m.) and these sculptures were really amazing!

 

 

 I loved this frog, which was one of the last sculptures we saw.

This "Buffal-Owen" (by Team Owen) won the People's Choice Award (you got to vote for your favorite by placing a flag in the sand)

We ran into a lot of friends at the beach-- first Molly, Eddie, Wes, and Levi (who shares Iver's birthday)...

... then Natalia and Paul with their boys, Max and Nikolai. 

The twins were enamored (and very gentle) with Pepper

Iver had fun in the sand...

... which ended with a pretty good faceplant! :)

We would love to make it back to this (annual) fest next year!

7-month update

 

At 7 months, Iver:

- weighs around 16-16.5 lbs (at his 6-month WCC, he was 15#4 oz and staying in about the 10-15%).

- is still in 6-month (and some 9-month) clothing

- is still on all breastmilk and a good eater. He has tolerated the solids (but has to be distracted with toys while eating and it can be a fight), including (Gerber) oatmeal cereal, and homemade pureed fruits/veggies including sweet potatoes, bananas (a big hit), zucchini (two thumbs down), squash (eh), avocado (a hit), mango, apples, carrots, and watermelon in a mesh feeder.  He will take water in a sippy cup and lets us know when he's done eating.

- Has pretty much outgrown his reflux/spitting up. However, in the past week, he has had two impressive (outfit-change-requiring [mine and his]) vomiting episodes (one waking himself up from sleep), consisting mostly of milk, but which reminded me of the projectile-puking days. Not sure if this was a food reaction, or an overfilled tummy (entirely possible) as he had no other systemic symptoms and a good appetite

- is still a prolific pooper (i.e. at least 4-6 times per day) with frequent blow-outs despite the solids. We have actually started some potty habits since he is so regular (am) on the pooping and peeing (always after a nap), sitting him on the Baby Bjorn potty chair at these times and letting him do his business. I've done some reading on "elimination communication," and I can see how it's pretty possible to (if you have the time and patience) almost completely potty train a child before about age 18 months (which would be awesome for many, particularly environmental, reasons) if you pay attention to their patterns.

- is in cloth diapers during the day (which is definitely more icky now-- we are using flushable liners and a spatula as a scraper) and size 3 Naty or Pampers (usually with one change after the 3 am feeding)

- loves rolling around (and across) the floor and the crib.  He can almost sit independently but still topples over occasionally. He easily gets up on all fours often in his crib and floor, rocks, and I can see that he wants to crawl but can't connect the brain and motor skills yet. He pushes up with his feet, scoots and face plants a lot and sort of army-crawls. He is still very squirmy. He is a very strong grabber--  which hurts our ears, face, and we have to be careful with earrings/glasses/everything within reach in the diaper changing area (which includes a lamp and dreamcatcher, as well as diaper creams). He likes his jumperoo but prefers exploring the floor. He doesn't seem to like the restriction of the bumbo chair.

- sleeps in his crib/own room at night (although one of us [usually Kelvin, for the first shift] is often on the futon next to him at times). He still goes to bed pretty easily between 7:30 and 8 p.m. and wakes 2-3 times at night, usually around 11pm-midnight and 2 or 3 am (and sometimes at 10pm or 5 am). He is "up" for the day usually around 6 am (although the last few days have been met with a 5 am wake-up time... not our favorite). On alternate nights (to preserve some supply and minimize my need to pump extra) or often when I'm post-call, Kelvin has started giving him the first feeding 2-4 oz by bottle so I can sleep which has done wonders for my ability to be functional during the day, and I nurse him the second and third. We are considering some sleep training to try to eliminate this first waking (Kelvin is starting to come around to the idea of graduated extinction/cry-it-out, but not there yet). We are often tired in the days and need naps ourselves, but are managing ok.

- has become pretty regular with the naps in the crib (although these have been a bit off with the earlier wake-up time). He sleeps about an hour-to and hour-and-a-half around 9 a.m. and about another hour or so in the early-to-mid-afternoon, although sometimes only snoozes 30-45 minutes. We often find him cooing on all fours when he's had a good nap. We are bringing back the naptime pacifier and encouraging a security blanket/transitional object.

- is still scratching his head (or my arms) while nursing or at sleep times, which keeps us putting mittens on his hands at these times (and saying "ouch")

- gets bathed about once per week on Sunday nights (sooner prn blowouts), and is not always a fan, as he's often tired/cranky at the time of the bath

- loves walks and runs in the stroller/BOB, and swinging at the neighborhood parks

- is incredibly smiley and vocal, shrieking, laughing, and smiling. He has started to say "ya" and "da," nonspecifically. We have been signing to him (mom, dad, potty, change diaper, milk, more, all done) but have yet to see him sign back. He has a great personality and this is an extremely fun age. 

Morning smiles

 

 Potty time!

 He mostly eats, not reads, books

Loving the swing!

I loove this one!

 

Cool in the stroller

With his favorite person, grandma...

... and his next favorite... dada!

We had some fun (and challenges) taking the 7-month pictures!

Not too into it, initially:

 

 

Now hamming it up a bit...

Thumbs up?

Sitting mostly unsupported

Love this smile!

On the go, as always!