Chemo Brain

All cancer patients treated with chemotherapy swear that the very treatment which helps their cancer ultimately affects brain cells. Friends and family of chemotherapy patients describe neurological side effects like memory loss, dementia, and even seizure.

In an article from Thursday's BBC News, there is now scientific evidence that this is in fact the case. Patients call this syndrome "Chemo Brain." Researchers at the University of Rochester found, in lab tissue samples, that at high chemotherapy treatment doses, not only are cancer cells killed, but also a significant percentage of the normal brain tissue is destroyed.

Lead researcher Dr Mark Noble said: "This is the first study that puts chemo brain on a sound scientific footing, in terms of neurobiology and cellular biology."

The Rochester team carried out tests with three drugs used to treat a wide range of cancers: carmustine, cisplatin and cytosine arabinoside.

All three drugs were toxic to several types of brain cell whose job is to repair other cells in the brain - even at very low concentrations.

So, if you're a cancer patient who has received chemotherapy, how do you react to this news? Some may find solace in the fact that for the first time, there is solid scientific data confirming their suspicion of chemotherapy side effects on the brain. Prior to this, cancer patients had to wonder why their doctor did not believe them when they talked about neurological side effects.

For others who have not started chemotherapy, it may make them think twice about receiving treatment. To be honest, I hope that doesn't happen. Being given the diagnosis of cancer is devastating in itself. Treatment options include surgery, chemotherapy, and/or radiation - possibly a combination of these. All carry side effects. But, the alternative of no treatment (depending on the severity of the cancer), has it's own ramifications.

Hopefully, this newly discovered data will assist oncologist researchers to develop neuro-protective properties in chemotherapy agents. Cancer research has always been furious and technology is always changing. I have hope that more treatment options will be available for patients with cancer.

Childless

I had an interesting conversation with a patient this week. As you may or may not know, I'm the soccer doc for our boys high school soccer team. We got to talking about my experiences with the team when she said, "You know, I don't think I want to have children."

"Really," I said. "Now, doc, don't give me that look that everyone else gives me when I say something like that." We got to talking a little bit more. She's in her mid-30's, married, and she states that she's doing well in her career.

"Don't misunderstand, I like kids," she said. "I could be wrong, but I've never really believed that you could have it all - meaning both family and career - at least for women." She continued, "At least with the people that I know, when you try to go for both, then one suffers, and I never wanted that. I always knew I could be a good mom, but I didn't feel that I had the passion or drive to be a good mom."

Now, I know people out there in blog land are trying to figure out if I'm trying to make some kind of political statement with this post. I'm not. In talking with some of my female staff members at the office after this encounter, I guess this having children thing (or not having children) can be a divisive issue.

I did further research on this and found an article in today's Washington Post called Childless: Some by Chance, Some by Choice. The columnist begins the article by talking about how she had a stillborn baby. Soon after that, she and her husband divorced and the columnist chose to remain childless.

The next part of the article describes her work on a documentary about childless women. The reasons for remaining childless are similar to my patient's reasons.

Just as some women talk of a visceral urge that propels them to have children, others speak of an equally visceral urge that propels them not to. Laurie, a transplanted southerner who teaches history in New York, began to realize at an early age that she didn't want children, as she watched wealthy mothers in Richmond hire other women to care for their children. "These people compelled to have trophy babies in certain socioeconomic echelons don't want to face the realities of raising a child." She is now infuriated by what she calls "that Mother Right" -- the assumption that everyone will make way for a woman with a stroller or a child in tow. She goes on to challenge me: "If we believe that this is the hardest thing that anyone can do, then why should it be assumed we should all be doing it?"

This has been a more painful journey for my friend Lori from Tennessee, who, though quick to find humor in things, was devastated by a miscarriage. Her husband, who had two children from a previous marriage, was reluctant to try again. She's irritated by the signs in parking lots reserving spaces for parents with children: "I park in those spots sometimes just out of sheer defiance -- I'm a peri-menopausal woman under stress -- and I need a sign!" Lori argues that "if you don't have children you've . . . thrown a brick in your path that you're going to spend your entire life trying to crawl over. It would have been a lot easier having had children."

I realize that I'm putting a big target on myself and my blog for bringing an issue like this up. I have found that the "child people" Vs. "childless people" are very passionate about their respective points of view.

Me? I'm not passing judgement on this either way. I will be further exploring both sides of this issue, because I think it will help me better understand a patient's point of view.

Christmas Song Meme

Yes, that's right, boys and girls! It's not even December yet and I'm starting this meme. Can you believe it? Well, I figure that I actually still like Christmas songs right now. Ask me two weeks from now, and I'll be totally sick of them.

This meme is pretty simple: List (at least) five of your favorite Christmas tunes and tag (at least) five of your favorite blog friends to keep the meme going. Simple, huh?

My Fave Christmas Songs (in no particular order):
Christmas Time Is Here from A Charlie Brown Christmas
Christmas (Baby Please Come Home) by U2
Santa Claus is Coming To Town by Bruce Springsteen
Run Rudolph Run by Brian Adams
The Chanukah Song by Adam Sandler (I know, not a Christmas song)
Christmas Eve (Sarajevo 12/24) by Trans-Siberian Orchestra
Please Come Home For Christmas by The Eagles
The Christmas Song by Nat King Cole
(I'd better stop here, or I'll be here all day...)

The lucky people I'm tagging:
Mimi from Mimi Writes (The Meme Queen)
Julie from Flip This Body (It is meme Tuesday, isn't it?)
Kim from Emergiblog (Are there any Notre Dame Christmas songs?)
Fat Doctor (Check out her blog Thursday for the Change of Shift blog carnival!)
Morgen from the Blog Eat Blog World (Gimme the BIG MO song list!)
Skittles from Skittles Place (Just a quickie list would be fine. HA!)
Ipanema from Under the Canopy (Great wreath on your site!)
Irene from Pregnant Pauses (She has the best gift on her site for you!)

If anyone feels left out, then consider yourself tagged as well. Give me your top five Christmas songs and tag five other people for me. (Just place a link back to this post so I know who's in!) This will be fun! Go for it! Gimme your favorite five songs!

What to do with a MeMe: Copy the idea of the MeMe into a new post on your blog. Fill in the answers. Tag people! (Thanks Skittles. I forgot to add this sentence in case people didn't know what a meme was or what tagging people meant)

Grand Rounds

Grand Rounds 3.10 is up and running at Notes from Dr. RW. It is self-described this week as a "running commentary, stream-of-consciousness style, to provide some structure to this incredibly diverse collection of links and perhaps liven things up a bit. I’ll sneak a few opinions in here and there, but you’ll know them when you see them." Thanks to Dr. RW for including my submit this week:

Ectopia what??? Ectopia cordis---a rare developmental anomaly in which the heart is situated outside the chest. Dr. Anonymous writes about a recent case.

For those of you sitemeter watchers out there (I am definitely one of them), it'll be interesting to check out the Dr. RW sitemeter as it goes through the day today.

Next week, Grand Rounds moves to The Antidote: Counterspin for Health Care and Health News. That's funny. Does that mean that Grand Rounds is a poison? Tune in next week to find out. Enjoy Grand Rounds!

Hosting Grand Rounds 3.09 (pt2)

(Look below for part one of this post)

This post will be a little more free-flowing. I thought I would have some steps that you could follow, but it was hard for me to boil down my experience into some simple steps. I encouage you to check out Emergiblog and Tundra Medicine for some other feedback on GR hosting.

I was on call the weekend before my GR posting. So, my schedule was just crazy. As I've said before, my job gets in the way of my blogging. I tried to keep ahead of things by reading submissions as they came in. Sunday was kind of nuts because it was a busy day on call. And, Sunday night after the deadline, there were some people still submitting. That's when I came out with my submission closed posting on Monday which some people remarked as a little moody.

I spent the entire day Monday trying to stay awake and make my final edits on the GR post. I was switching posts from the bottom section to the middle section, from the middle section to the top section, and all combinations in between.

The GR post went live at 6:30am and I waited. To further punish myself, I put up two poll questions to seek feedback on the GR layout and on the quality of GR. I had no idea what the reaction would be to the "link dump" at the end of my post.

At 6:30am, my site meter read 100 total visitors for the day. For the first few hours, it was reading between 20-30 per hour. Then at 9am, it spiked up to 52 visits in an hour. The next few hours, it was between 40-50 visitors per hour. Then at 2pm, the number read 72 visitors the prior hour. A few more hours went by, and then at 5pm, here's what the sitemeter read:

Yes, that's right 183 people saw the GR post in the last hour. Plus, in seeing more data, there were 85 people on my site at the same time! Thinking about this is just incredible.

Then, I was wondering if I hit 1000 visitors in one day. This occurred just before 8pm. Yay! The final question I had on that Tuesday was how many total visitors? When all was said and done - just over 1,300 visitors!

I had no idea what Wednesday would bring. I thought things would cool off a bit, especially because it was the day before Thanksgiving in the US - usually a huge travel day - and not expecting too much blog traffic. Then, at 10am, I saw this from site meter:



Little did I know that at the end of that day, I would have just below 1,400 visitors - quite a shock to me. Then, reality set in and on Thanksgiving day (Thursday), I only had 600 visitors.

Looking back, this was a memorable experience for me. People have asked me how much time out of my day did it take to put everything together. Hmmmmm. That's a tough one. People have estimated about 20 hours total during GR week, I guess that sounds right. Knowing me, I probably spent more time than that. I hope I get the opportunity to host again - although maybe not very soon. HA!

Finally, here are the poll results:
What did you think of Grand Rounds 3.09?

• One of the best: 38%
• Great: 51%
• Ok: 8%
• Below Average: 0%
• Awful: 3%

Did you like the format/layout of Grand Rounds 3.09?

• Yes: 94%
• No: 6%

Hosting Grand Rounds 3.09 (pt1)

So, you're thinking about hosting Grand Rounds? I have to be honest by saying that I was totally intimidated by the entire notion. But, when the opportunity presented itself, I took it and then tried to figure out how to make it happen. If I did it, and so can you! Just follow these steps....

Step One: Prepare, prepare, prepare!

The first thing I did was go right to the source which is the Blogborygmi site. I did that because I wanted to see the origin of this idea and the original target audience. GR is not targeted toward the medical blog commmunity. It is targeted toward the general public. I think this is the right idea, because this is the only way that the medical blogosphere will grow. Read about my research in this GR background post.

Everyone has told me that the more work you do up front, the less crazy GR week will be for you. I cannot agree more. However, I did not have that much time to prepare, so my timeline was very much truncated.

About the Grand Rounds interview - Take my advice. Do NOT take this lightly. As of this writing, I've had about 2,500 referrals from the medscape interview site. Plus, I'm still getting referrals six days after the original posting.

The more memorable you make your interview, the more people that will check out your site. How do you make your interview interesting? Well, you have to think a little bit like a PR marketer. What do I mean by that? Well, if you can think of a witty soundbite or "one-liner" that people will remember, then that will make your interview more interesting. The only other thing I would say is just be honest and talk from the heart - people like that.

I did not have a theme, mainly because I'm not that creative with that type of thing. Plus, I put a poll on my site and the majority of people didn't want me to have a theme.

If you do opt for a theme, make sure you have a vision for this before you're awarded Grand Rounds. With all the craziness of GR week, I don't think there'll be a way for you to figure out a theme and read all the posts that week. The only other thing I would say is that it's possible to be TOO cute with the theme and not be able to convey to the reader what the link is about. Be careful of that.

Step Two: Promote, promote, promote!

Your first item of promotion will be asking people for submissions. Usually, the GR host before you will announce your site and get the ball rolling. Now, the ball is in your court. Figure out when your deadline is, because this will be the first question that you'll get as host. For me, I was really paranoid that I would not be done on time, so I made the deadline on Sunday night. Usually, the deadline is sometime on Monday.

Usually, the top section of the GR post is called "Editor's Picks." The next question people want to know after the deadline is how to get into that top section. For me, I know I wanted to highlight well written stories. Also, I knew that I wanted to keep some kind of order to the submissions as they came in. So, in my submissions guidlines, I put the deadline date/time, my vision for the editor's picks and directions on how I wanted the submissions (blogger name, blog name, blog URL, post name, post URL, one line description of post). I also preferred that submissions be sent to my e-mail, so I included that also.

As the posts came in, I put them in one of three sections: top 1/3, bottom 1/3, and the rest. You'll have your own instincts on what's good. Trust those instincts. There will be at least a couple of posts which won't feel right. Again, trust those instincts. The people that know you will send you their submissions first. But, like everyone says, the bulk of the posts come in on the weekend.

I kind of overdid the GR promotions on my blog during my week, but I was really trying to hype things up. In addition to posting your GR submission post a week prior, I would suggest at least one more GR post during that week to help your own promotion. Also, look to your own friends for postings, even if they have never posted to GR before. This can potentially grow the GR audience.

Step Three: Follow up, follow up, follow up!

With each submission, I would send an e-mail thank you back to the blogger. I knew I would be moving posts around on the priority list right up until the last minute. So, I would send a generic thank you to the person, not "promising" where I would put the post, only that I would "consider" their post - which was true.

Also, with each submission that would come in, if I had time, I would take a quick read of other posts on that person's blog. There was a couple of occasions where I thought another post would fit better with my vision of GR. Topher asked people for revisions, and I didn't feel comfortable with that (just my personal decision).

Be firm with your submission deadline. People will try to push you and give you every excuse in the book to try to get into GR. And, some people just ignore your deadline and then will expect to be included in GR. It's your choice how to deal with this. But, always remember, don't try to make everyone happy, because it's not going to happen.

Everyone has said this, but I think it's important. Double and triple check every link before you go live. Don't be too bent out of shape if one or two slip by. And, don't be too bent out of shape if one or two authors e-mail you to clarify their URL - this happens every week.

After you publish your GR post, there will be many people who will announce GR on their site. Make sure you place a comment of "Thank You." This will definitely go a long way. I added a bunch of links the past week also, because I had no idea how wide the reach was.

Oh no! This is running a lot longer than I thought. Re-reading it, it may not be as helpful as I intended it to be. I'm happy to answer any questions. I'll have to work on a part two post....