Cancer advocacy and asking the right questions

It has been just about a month since we have been home. One of our primary reasons of moving back to Orlando was my Mom’s health.  There have been some updates. First, during her surgery a few months ago, the extra infected lymph nodes were actually removed and her chemo that she is undergoing right now is more preventative. I have absolutely no clue why this was never shared with us to begin with. We thought that the lymph nodes were still in her body and they would be removed later after the chemotherapy. Only during a doctors appointment a few weeks back did Mom mention the lymph nodes and her Oncologist said, “oh we removed them during your surgery.” URG. Why were we not automatically given all of the medical notes on discharge so we knew what happened in the operating room Her oncologist here in Orlando, has stated that some of her cancer on her liver has grown. We don’t know how much of the cancer, or how much growth, or what scans they are comparing the growth too. In the past, her doctor here in Orlando and the Drs. at NIH have used different scans and not always had the same results and answers for us. Her oncologist here, Dr. Z, has spoken with her doctors in Maryland at NIH. This discussion was preempted by a talk I had with the NIH doctors. Her oncologist here wanted to stop her chemo for the Colon Cancer and go back to treating her renal cancer in hopes of stopping the growth on her liver. The problem…NEVER have they biopsied her liver growths…so how the heck do they know which type of cancer to treat anyway!? This Thursday she will have a needle biopsy to determine the type of cancer on her liver. She is scared to undergo more medical treatment, but it really is for the best. My biggest problem at this point, is that her oncologist here in Orlando has been treating her almost weekly for the past 5 years. The doctors in Maryland see her once a year. 1) Why has Dr. Z never brought up the idea that her liver has NEVER in 16 years been biopsied? 2) Why is he not being more proactive in advocating for her healing and defeat of this disease? 3) Why are all of the doctors not looking at everything, the whole picture, and just trying to help her beat all of this instead of treating parts at a time? This morning I did a quick simple google search. I typed in Renal Cancer and Colon Cancer. The first article that popped up was of a Mayo clinic study done between 1970-2000 (in which time my Mom was a patient), published in 2006 (6 years ago!!!)
RESULTS Of the patients studied 2,188 (80.4%) had clear cell, 378 (13.9%) had papillary and 128 (4.7%) had chromophobe renal cell carcinoma. Patients with papillary renal cell carcinoma were significantly more likely to have colon cancer (p = 0.041), prostate cancer (p = 0.003), any second malignancy (p <0.001) and multiple malignancies (p <0.001) compared with patients with clear cell renal cell carcinoma. In addition, patients with chromophobe renal cell carcinoma were significantly more likely to have colon cancer than patients with clear cell renal cell carcinoma (p = 0.020). Although patients with papillary renal cell carcinoma were more likely to have bladder cancer, the incidence did not differ significantly compared with that in patients harboring clear cell and chromophobe renal cell carcinoma (p = 0.193). We did not find a significant difference in the incidence of breast cancer, lung cancer, rectal cancer or lymphoma among histological subtypes.
Um…HELLO!!!! And when looking in more detail, none of my mother’s doctors at NIH were even a part of the study. The conclusion of the study:
Our data indicate that patients with papillary renal cell carcinoma are more likely to harbor secondary malignancies, including colon and prostate cancer, than patients with clear cell renal cell carcinoma. These results may have important implications for patient education and followup evaluation, and they should prompt mechanistic investigations.
This was published in 2000, by one of the Mayo Clinic’s cancer research teams, published and easily found in the US National Library of Medicine, National Institutes of Health. My Mom has been a patient at NIH since 1998. So, why were her doctors never on the lookout for this? As a non-medical family member, not educated in Oncology, how on earth do you even know what questions to ask or what to point out to the doctors. Why are so many doctors not looking out for the possibilities of what may for their patients? This all goes back to the idea of if you know what questions to ask, if you direct the doctors in the right direction, then possibly they may find the right solutions. I have asked her doctors questions in the past, but mostly the answers are very short, to the point and I am handed off to a nurse. It seems that many don’t like to be questioned and patronizing. Where is Dr. House when you need him and his very curious team? Why can’t all teams fight like his group of wonderful actors? Where is the list of questions all of us should have on hand when we go to the doctors with loved ones? How do you ask questions if you have no idea what to ask? I guess my next steps are going to be to try to contact these doctors at the Mayo Clinic and see how they treated their patients.
 
How do you build a life around adventure and travel?

Intentionally and incrementally. Most families who live this way did not leap from conventional to adventurous overnight. They built remote work capacity, paid down debt, tested longer trips, and had increasingly honest conversations about what they actually want from their lives. The leap feels bigger from outside than from inside.

What does an adventurous family lifestyle actually look like?

Different for every family. For some it is long-term travel. For others it is weekend adventures close to home. What connects them is intentionality about how time is spent and a preference for experiences over accumulation. The version that fits your family is the right one.

How do you balance adventure with stability for kids?

By finding stability within the adventure rather than treating them as opposites. Routines, rituals, and family rhythms travel with you. Familiar foods, bedtime routines, and predictable family dynamics provide stability even when the location changes. Kids need consistency in relationships more than consistency in geography.

What has travel taught your family?

That people are fundamentally similar across cultures in what they want for their families. That comfort zone is a smaller circle than it feels from inside. That the things worth having in life require effort and discomfort to get. And that time together doing hard interesting things is the most reliable source of family closeness.

How do you handle the pressure to live conventionally when you have chosen differently?

By getting clear on why you made the choices you made and returning to that clarity when the outside noise gets loud. Most families living unconventionally describe an initial period of explaining themselves that gradually gives way to just living the life. The explaining becomes less necessary as the results become visible.


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3 comments

  1. Your Mom is very lucky to have you in her corner. You are thinking outside of the box and sometimes that is what it takes to bring all parties together!

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