Welcome to Grand Rounds, Vol. 7, No. 31

Welcome to Grand Rounds! First, a quick shout-out to Nick Genes, an emergency medicine physician who blogs at blogborygmi (possibly the best blog name ever) and is one of the founders of Grand Rounds. I had no plans to host GR a second time until I saw Nick’s APB for April hosts. I had forgotten how much fun this was until the posts started coming in. So thanks, Nick.

The theme this time is what gives your life or work meaning. One of the loveliest, most contemplative posts I’ve seen on this topic is Nourishing Healthy Seeds from Deb Thomas, who blogs at Debbie’s Cancer Blog. Another one I loved comes from psychiatrist Greg Smith. He has become one of my favorite bloggers and The Day The Music Died is one of many reasons why. He captures music’s power to heal and bring us together during times of profound sadness.

Psychiatrists are famous for answering questions with a question, such as “What do you think it means?” But in all seriousness, the good doctors at ShrinkRap want to know what meaning we ascribe to psychiatry. Here’s the survey.

Dr. Val, who blogs at Better Health and coincidentally, is the other founder of Grand Rounds, submitted the wonderful The Hug That May Have Saved A Life, or as she called it, “meaningful use of a hug.” If you ever needed a testimonial about the healing power of touch, this is it.

I triple dog dare you not to be inspired by Diabetes Polar Flight, Take-Off Today! It’s a Diabetes Mine interview with Douglas Cairns. Kicked out of the Royal Air Force when he was diagnosed with Type 1 diabetes, this record-breaking pilot is on a mission to show what you can achieve.

Bongi, a South African surgeon who blogs at Other Things Amanzi, submitted Tongue Twister. Honestly, I have no clue how this fits, other than “it means what it means,” his Zen response when I asked about it. Bongi is one of the best, most vivid storytellers out there, and you are likely to get a laugh if not a vicarious thrill out of this one. Call it the sound of one hand klapping.

Some submissions were love letters from doctors to their chosen profession. ACP Hospitalist submitted Life At Grady: Medicine Nerd by Kimberly Manning, in which she explains why she loves being a doctor. And no, it has nothing to do with the long white coat. Beth Renzulli, who blogs at The Happy Internist, submitted I Love Medicine. And John Mandrola, who blogs at Dr. John M, shared a heartfelt thank you letter in The Most Noble Nobel. It’s the best illustration I’ve ever seen of the intimate connection between research and life.

While doctors love their work, they are less enamored of a system that seems determined to marginalize them. Doug Perednia, who blogs at Road to Hellth (you know what it’s paved with), submitted How to Sabotage A Health Care System. He and many other doctors are questioning the meaning and value of what they do thanks to Kafkaesque experiences like the one he recounts here. After reading it, I can tell you that sabotage is not too strong a term.

Some submissions found meaning in teaching. Christopher Bayne, a urology resident who blogs at hokieMD, submitted The Essence of Medical Education. Chris explained he thinks the open sharing of knowledge has the greatest meaning in medical education, or as he said in his post,”The essence of medicine is sharing our human gains with the rest of society.” 

ACP Internist submitted QD: News Every Day–Physicians Are Peeking Behind Dr. Oz’s Curtain and told me this post was especially meaningful because their physician audience has to contend with patients who get their information from television personalities. I applaud these doctors. It’s bad enough when someone like Oprah values ratings above science. It’s way worse to have an MD go native the way Dr. Oz did. We expect more from doctors.

Social media has become a meaningful way to connect, but it comes with healthcare confidentiality issues. One doctor recently learned this the hard way, as David Harlow explains at HealthBlawg.

Beth Gainer, a breast cancer survivor who blogs at Calling The Shots, submitted Sexualizing Breast Cancer, a topic she said means a lot to her because society needs to change the way it views breast cancer, and because the conversation should be meaningful instead of degrading. Of late, it’s been rather heated as well.

I’m always interested in where posts come from, and the following three came from Canada. Many of us find meaning in sports, and Carolyn Thomas, who blogs at The Ethical Nag, submitted the lighthearted Do It Yourself Psychotherapy for Suffering Hockey Fans. Psychologist Will Meeks took a slightly more serious approach in Emotion Maps. Will explained that being able to sort through and understand our emotions helps us live a healthier life. Finally, a post that really resonated with me came from Susan Biali, MD by way of KevinMD. Its title, Stop and Really Think About What You Want From Life, says it all. Dr. Biali did not let her passion for medicine extinguish her passion for flamenco.

Barbara Kivowitz, who blogs at In Sickness and In Health, submitted the thoughtful Taking A Break, in which she and her partner took a much needed break from illness and caregiving.

I’d like to close with a bit of a counterpoint from Dr. Jessie Gruman at Better Health. It’s called Finding Meaning in Illness: Lemons and the Demand for Lemonade, in which Dr. Gruman contends that her illness is neither blessing nor lesson.

Thanks so much to everyone who submitted, and I hope you have as much fun reading these great stories as I did.

Calling All Doctors, Nurses & Patients for Grand Rounds Submissions

 

I am honored to host Volume 7, No. 31 of Grand Rounds on Tuesday, April 26th. This will be my second time hosting; my first time was last August.

In case you aren’t familiar with Grand Rounds, it’s a weekly round-up of the best medical blogs, and people take turns hosting. It’s one of the oldest (and I would argue best) “blog carnivals” out there. It was started by doctors but nurses and patients are welcome too.

Some hosts ask for themed posts and others simply ask you send a favorite. I’m a theme junkie; last year my theme was the power of listening. My theme this time was prompted by all the discussion of meaningful use around health-care reform. Meaningful use has to do with electronic records  and no, I do not want posts related to that. I want to hear about good old-fashioned meaning. What gives your work and your life meaning? Is it your faith? Your family? A hobby that brings you joy? Has an encounter restored your faith in your profession and/or humanity?

I know how hard it is to keep cranking out content week after week, so if you have a favorite post that meant a lot to you, whether it touches on the above or not, feel free to send it my way. Just let me know why this particular post meant something to you.

Please e-mail links to your posts to fromzero *at* cox.net and put Grand Rounds submission in the subject line. I will send you a confirmation e-mail. Deadline is 4 p.m. Eastern time on Sunday, April 24. I realize that’s Easter Sunday and a busy family time so feel free to send submissions early. Can’t wait to start reading!

4 Ways Breast Cancer is Like Golf

In honor of the Masters taking place this weekend, I’m dusting off this post from last year. I wrote it when I watched Phil Mickelson’s very touching win. -Jackie

Whether you follow golf or not, you’re probably aware that the final round of the Masters took place today.  We couldn’t avoid it if we wanted to, with the media focus on whether Tiger’s fans would forgive his transgressions, would his wife show up, blah blah blah. My frame of reference is a bit different. As I watched on and off between pruning roses and other spring yard cleanup, I was struck by the similarities to breast cancer.

For the record, I’m not a golfer. Motor skills are not my strong suit. But I did try it for a season and even took lessons. It was quite a stretch for me to go from a best ball situation to having to hit my own ball all the way through. I think I made par once. I also nearly beaned a groundskeeper in Phoenix. But I digress. Here’s what I think breast cancer has in common with golf:

Reason No. 1: Obstacles are part of the deal. Mark Twain called golf “a good walk spoiled” and if you look at it that way, it is. Trees and sand traps and water are just waiting to claim your ball. And yet golf courses are some of the most beautiful places on earth. With cancer, your bunkers and water hazards are biopsies and blood draws, surgery and radiation and chemo. But you’ve also got love, humor and loyalty in the face of these obstacles—the things that lend beauty to the adventure.

Reason No. 2: Both are humbling experiences. It doesn’t matter if you’re Tiger Woods or that guy in the cubicle next to yours who dreams of making par. Sometimes your shot will end up in the trees, or the gallery, or the bunker. It’s a leveling experience. So is cancer. Educated or ignorant, health conscious or not; the cancer gods don’t care. We’re all pretty much the same in a hospital gown. But there’s a good side here as well. It can be quite humbling to realize how much people care, as it must be for golfers when they hear the gallery applaud and realize it’s for them.

Reason No. 3: You have to deal with internal noise. As with any sport, golfers have to contend with “choking”—when they’re favored to win but can’t handle the pressure. Golfers can also be prone to the “yips”—when you aren’t steady enough to make a putt. For those of us in the pink ribbon tribe, our version of choking is more like freezing. What was that the doctor just said? How am I supposed to decide what kind of treatment and risk I’m willing to accept? We all need to find a way to quiet that noise in our heads.

Reason No. 4: It’s not your score on the board but your conduct on the green. Sure, you can throw your clubs or curse at the caddie, but what does that really get you? It’s the same in Cancer World. You can throw a tantrum at the surgeon’s receptionist but what good have you done? Does that mean you should never get angry? Of course it doesn’t. No one has the right to tell you how to feel, but that doesn’t give you license to take it out on others.

I mentioned that we couldn’t escape the Masters if we wanted to. And even at the Masters, we can’t escape breast cancer. If you follow golf you know that both Phil Mickelson’s wife Amy and his mom have been battling breast cancer. He wasn’t sure Amy would even be able to attend the Masters, but she was. When they embraced after his win, you could feel how special the moment was. And I can’t think of anyone who deserves the green jacket more.

Where Are Breast Cancer Screenings for Young Women?

First, a disclaimer: I’ve never done regular breast self-exams. I tried it once, twice at most, in the late ’80s or early ’90s. I brought home a little how-to tag and hung it on my bathroom door for about three weeks before I threw it away. I figured I’m more likely to notice something in the shower. (And now that I’m on the cancer watch list for my remaining breast, I get four exams a year, courtesy of twice-yearly visits with my oncologist and family doctor. So I’m good in the exam department.)

The problem with breast self-exams is that by the time you can feel something, breast cancer has gotten a pretty big head start. And if you’re young, it’s even bigger. The American Cancer Society says breast self-exams don’t work as well for young women, since their breast cancer is likely to be dense and more able to hide tumors. They discuss the pros and cons of BSEs in their guidelines for early detection.

Some groups, such as the Feel Your Boobies Foundation, which is geared to young women (and some would argue, young men), advocate BSEs. I’m not sure I can fault them for that, for the simple reason that young women seem to have no screening alternatives. You can get a genetic test for BRCA and/or a mammogram if you have a family history. But, as the American Cancer Society says, only 5 to 10 percent of breast cancer cases are hereditary.

So where does this leave young women? They’re too young for mammograms. Another screening tool coming into wider play is the MRI, but they’re recommended only for women at high risk and therefore not indicated for young women without a family history. And they’re pricey, to boot. Mine cost $4,000.  

The only option young women seem to be left with is finding a lump and treating cancer that has progressed far enough to produce one. By that time, you’re talking heavy artillery like chemo.

I know this is what health experts call anecdotal, meaning it’s based on my own observations and not scientifically sound data, but I’ve never met a woman in her 30s who was diagnosed with stage 0 breast cancer. The only ones I’ve ever met are stage III or IV. It seems to be the women my age (55) and older who are stage 0 and stage 1. And we’re the ones getting mammograms and MRIs.

I think every woman should know what’s normal for her breasts, just as she should know her entire body, and report any changes to her doctor. But BSEs seem a bit too little, too late as a screening tool. I wish I had an answer, but all I have are questions. All I know is there seems to be nothing out there for young women. Please, someone tell me I’m wrong.