GIST is classically operated upon and thought to be cured by surgery. Unfortunately more and more clinicians are finding that patients have recurrence of disease. Nowadays, there are way to find possible recurrence risk rates, and treat accordingly.
If a patient has a high to moderate risk of recurrence, then they must be offered Imatinib (Glivec or Gleevec). The duration of treatment continues to be a matter of discussion - most people agree for one (1)year of treatment, but there is now data to show that three (3) years of treatment is necessary.
I suspect that treatment would be needed for long term (much longer than three years), as the survival curves at one year and three year of treatment are quite similar, when treatment is stopped.
The important thing is to ask your surgeon to consider Imatinib therapy or refer you to a Medical Oncologist for discussion.
Monday 21 May 2012
Sunday 20 May 2012
Driving and Brain Metastasis
People who have been driving their vehicles for several years (most times decades) are really upset when we tell them that they should not be driving their cars.
In Australia the onus is on the clinicians to get affected patients to stop driving their cars. The treating clinician is meant to tell the patient to stop driving and send a letter to the Driving Authority to withhold/revoke the patient's driver's license.
The number of clinicians who even know about this is minimal!!
If a patient's cancer has spread to their brain, the chances of seizures or altered consciousness are quite high. There is no specific time or place when things can get out of control. Also these patients have had radiotherapy, surgery, are on high dose steroids, narcotics, etc... and thus the mental cognition and reaction time is dramatically altered.
The conversation is a difficult one. But a very important one. It could save the patient's life and others on the road.
In Australia the onus is on the clinicians to get affected patients to stop driving their cars. The treating clinician is meant to tell the patient to stop driving and send a letter to the Driving Authority to withhold/revoke the patient's driver's license.
The number of clinicians who even know about this is minimal!!
If a patient's cancer has spread to their brain, the chances of seizures or altered consciousness are quite high. There is no specific time or place when things can get out of control. Also these patients have had radiotherapy, surgery, are on high dose steroids, narcotics, etc... and thus the mental cognition and reaction time is dramatically altered.
The conversation is a difficult one. But a very important one. It could save the patient's life and others on the road.
Movember
MOooooooovember
I participated last year (2011) and we raised nearly $ 4000 (AUD). Pretty cool. Worth re-doing this year.
I participated last year (2011) and we raised nearly $ 4000 (AUD). Pretty cool. Worth re-doing this year.
Sunday 6 May 2012
Best Oncology Textbooks
Which is the best Oncology Textbooks?
I think:
# DeVita's Cancer: Principles and Practice of Oncology
# Abeloff's Clinical Oncology
are the best ones.
There are tons of other books, but these two seem to cover the maximum amount of information in the best possible manner.
I think:
# DeVita's Cancer: Principles and Practice of Oncology
# Abeloff's Clinical Oncology
are the best ones.
There are tons of other books, but these two seem to cover the maximum amount of information in the best possible manner.
Urine protein and Avastin / Bevacizumab
Avastin (Bevacizumab) is a good medication in metastatic bowel cancer (both colon and rectum). It is used for extended periods of time with chemotherapy to control and reduce the burden of cancer.
It is very important to check the urine for proteins while on this medications, as it does have a potential to damage the functioning of the kidney. In case, the kidneys are secreting proteins, it is then important to check the quantity and then if needed to stop Avastin till the kidneys recover.
We have found that a significant number of doctors forget to check urine protein, while patients are on Avastin.
It is very important to check the urine for proteins while on this medications, as it does have a potential to damage the functioning of the kidney. In case, the kidneys are secreting proteins, it is then important to check the quantity and then if needed to stop Avastin till the kidneys recover.
We have found that a significant number of doctors forget to check urine protein, while patients are on Avastin.
Wednesday 2 May 2012
Infections from doctors
Infections can also be transmitted from doctors and nurses to patients. It is quite well known. Hospitals across the world are trying to convince medical staff to clean their hands - wash with soap and water or use rubbing alcohol.
The other common things which are sources of infections are doctors' white coats (which are not washed very often), neck ties (never washed), stethoscopes (hardly ever cleaned), telephones, and the list goes on.
Think about it.
The other common things which are sources of infections are doctors' white coats (which are not washed very often), neck ties (never washed), stethoscopes (hardly ever cleaned), telephones, and the list goes on.
Think about it.
Doctors as patients
One of the nightmares for medical units across the world is to have a doctor as a patient. Everything is has to be extra-careful in the discussion, tests, planning and implementation. Each thing is checked and double-checked.
I know that I am a terrible patient. I do not quite remember completing a full course of antibiotics or doing the things recommended to me.
The problem is that for some strange reason (?Murphy's law), when we are extra-careful; things go extra wrong. Some people term it the "VIP syndrome".
I know that I am a terrible patient. I do not quite remember completing a full course of antibiotics or doing the things recommended to me.
The problem is that for some strange reason (?Murphy's law), when we are extra-careful; things go extra wrong. Some people term it the "VIP syndrome".
Hospice and Nursing Homes
Today's ward rounds were a bit sad. I have a bunch of patients who are quite unwell, some due to cancer and some due to unrelated issues. One thing is certain that they would not be able to manage alone at home. A couple of these patients, do not have any family or friends to support them at home either.
The alternatives are a nursing home or a hospice. Telling a person that they cannot go back home and need to move to a nursing home for the rest of their life, is NOT an easy task. People who have been fiercely independent all their lives are not happy to be dependent on others.
The other major issue for some patients is the decision to move to a Nursing Home versus a Hospice. They are too well to be transferred to a Hospice and thus are planned for a Nursing Home... but by the time they find a Nursing Home place, they are too sick to move there.
Difficult decisions. Tough on just on the patients, but also their families, friends and the health personnel taking care of them.
Life moves on.
The alternatives are a nursing home or a hospice. Telling a person that they cannot go back home and need to move to a nursing home for the rest of their life, is NOT an easy task. People who have been fiercely independent all their lives are not happy to be dependent on others.
The other major issue for some patients is the decision to move to a Nursing Home versus a Hospice. They are too well to be transferred to a Hospice and thus are planned for a Nursing Home... but by the time they find a Nursing Home place, they are too sick to move there.
Difficult decisions. Tough on just on the patients, but also their families, friends and the health personnel taking care of them.
Life moves on.
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