BOOK REVIEW: CRITICAL CARE, A NEW NURSE FACES DEATH, LIFE AND EVERYTHING IN BETWEEN

by Yeong Sek Yee & Khadijah Shaari

This memoir by Theresa Brown is a deeply personal book that details the transformation of an English Professor (who has taught at Tufts University, MIT and Harvard) into an oncology nurse. This is indeed a noble career change (at mid-life after giving birth to twin girls) from the cozy world of academia to the challenges of a 12-hour day of caring for the seriously ill. Perhaps, this gives Brown herself a deeper appreciation of what it means to be alive. And perhaps, this may also be the very reason that persuaded a very successful insurance lady friend of ours to sign up for a three and a half months nursing course so that she can tend to the sick in her free time.

After Brown completed a one-year accelerated nursing program at the University of Pittsburgh, she now works at the University of Pittsburgh Medical Centre Shadyside, and this book documents her first year as a nurse on the oncology floor. She gives the reader an idea of the unique role of nurses in health care, giving us a deeply moving portrait of the day-to-day work nurses do: caring for the person who is ill, and not just focusing on the illness itself. Watch Theresa Brown’s video on How Nurses Can Change The Image of Nursing at the following link: https://www.youtube.com/watch?v=JQ6F31mINEw

Being in the oncology ward, Brown had first-hand experience in tending to her cancer patients’ needs, both the physical (the rigors of chemotherapy) and emotional (their late-night fears, etc). Below are some of her comments/findings during her one year stint as an oncology nurse:-

Chemotherapy is a Faustian bargain, a deal with the devil. The luckiest patients, we say, are the ones who are bored, who aren’t dealing with intolerable mouth pain, or nausea or vomiting, or odd rashes, breathing problems, infections, cardiac troubles, nerve pain: the list of side effects is almost endless, and all of the side effects are bad.
Patients love the idea of being treated and cured, but they hate how those treatments can wrack their bodies more horribly than their disease ever did.
…for some chemo regimens, patients need tests prior to getting the drugs to make sure that their heart, or liver, or kidneys can tolerate the medications.
Chemotherapy drugs are toxic, potentially deadly poisons, not just for the GI tract, but for other major organs as well. Some chemo drugs can damage the heart, others the liver, and some the kidneys. The lungs can suffer and the nervous system, too, leaving patients with permanent numbness, tingling, and pain in their arms and legs. Giving patients chemo always involves balancing risks and benefits. The benefit can be saving someone’s life, but for some patients, the risk is death.
As for leukemia…it will take a long time before the world comes to rights again, because the cure for this kind of cancer is almost, but not quite, as bad as the disease. Patients know they will be treated with chemotherapy, but the reality that chemotherapy is, literally, poison, will not sink in until they’re already in the middle of their treatment.
All chemo drugs come wrapped in an outer bag, really just a large Ziplock bag, taped with a caution strip: “Warning: biohazard drug, handle appropriately”.
These drugs are dangerous biohazards. On her floor, pregnant nurses and nurses who are breast-feeding do not administer chemo. Their gowns and gloves, and the empty containers of drugs once they’ve been administered, get thrown away in special yellow trash cans marked “For chemotherapeutic waste only”. If chemo drugs “spilled”, special procedures exist for cleaning up the mess.

Allow us to share with you some additional information why chemotherapy drugs have to be treated as a biohazard:

The pictures on the last page speak a thousand words. Drug companies and hospitals take extraordinary measures to protect their employees. For more information, just click on the following article…HOW DRUG PRODUCERS AND HOSPITALS PROTECT THEIR EMPLOYEES Link: http://www.pharma-cycle.com/chemoeffects.html

Pharmacists and nurses who prepare the chemo drugs before infusion are very prone to various forms of cancer. Visit/Read the following links to find out more:

v Pharmacists give themselves cancer from dispensing toxic chemotherapy chemical Link: http://www.jmbblog.com/2010/07/pharmacists-give-themselves-cancer-from-dispensing-toxic-chemotherapy-chemical/

v Lifesaving Drugs, Deadly Consequences Link: http://www.invw.org/chemo-main

Some cytotoxic chemotherapy drugs remain extremely dangerous even after they are infused into the patient because they are excreted as active, dangerous chemicals during the few days after each infusion. During the danger period, the patient’s urine, feces, vomit, sweat and saliva contain huge quantities of dangerous chemicals. Loved ones will become contaminated by touching bodily waste or touching a surface contaminated by bodily waste. Because the chemicals cross skin, the patient will spread contamination by touching surfaces, kissing family members and eating and drinking from family plates and glasses. Surfaces in bathrooms, sheets and towels will also become contaminated. Read the full article at the following link: http://www.pharma-cycle.com/familydangers.html

If these chemicals are so dangerous to the doctors, nurses and pharmacists dispensing them, how can they be considered “safe enough” to inject into patients who are already suffering from cancer? The whole idea of “safety” in the cancer industry is to find new ways to protect the health care workers from the extremely dangerous chemicals they’re injecting into the bodies of patients. If health care workers need to be protected from this stuff, why not protect the patients from it, too?

For further reading, we recommend the following:

CHEMO SPILLS

1) DANGER! DANGER! TOXIC SPILL

Link: http://www.cancertutor.com/ChemoSpill/chemospill.htm

2) Chemotherapy Spill / Leak Handling Instructions

Link: http://www.nelifecare.org/doc/instructions/ChemoSpillInstructions.pdf

3) A Guide To Safe Handling of Chemotherapy Drugs

Link:http://www.ansellhealthcare.com/temps/america/canada/english/university/riskmanagement/guideshcdrugs.cfm

4) HANDLING LIQUID CHEMOTHERAPY SPILLS

Link: http://stage.smh.com/sections/services-procedures/medlib/nursing/NursPandP/onc09_handling_082109.pdf

SOME YOUTUBE VIDEOS:

5) Cytotoxic Drug Exposure

Link: http://www.youtube.com/watch?v=myU4f9jO83s

6) Chemo Spill

Link: http://www.youtube.com/watch?v=0iEEHqUm_p0

FURTHER RELATED ARTICLES:

1) Safe Handling of Hazardous Drugs

Link:http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HazardousDrugs.html

2) Health workers fear the dangers of secondhand exposure to chemo drugs

Link:http://www.mlive.com/living/kalamazoo/index.ssf/2010/07/health_workers_fear_the_danger.html

3) Chemo Drugs Pose Serious Public Health Risks

Link: http://www.ecori.org/public-safety/2012/11/19/chemo-drugs-pose-serious-public-health-risks.html

4) Nurses Exposed to Toxic Cancer Drugs, Study Finds

Link: http://www.livescience.com/15721-nurses-exposed-toxic-cancer-drugs.html

5) Chemo’s Deadly Risk for Health Care Workers & Patients

Link: http://www.leaflady.org/chemonu.htm

6) Health Care Workers Risk “Secondhand Chemo”

Link: http://www.fairwarning.org/2010/07/health-care-workers-risk-secondhand-chemo/

NB: THIS IS HOW THEY CLEAN UP THE FLOOR IN THE CASE OF A CHEMO SPILL.

NB: THIS IS WHAT WILL HAPPEN TO YOUR HAND IF A DROP OF THE CHEMO DRUG LANDS ON YOUR SKIN. WHAT WOULD IT DO TO YOUR INTERNAL ORGANS?

BOOK REVIEW: FOOD OVER MEDICINE–THE CONVERSATION THAT CAN SAVE YOUR LIFE

by Yeong Sek Yee & Khadijah Shaari

The main author, Dr Pamela A. Popper, PhD, ND, is a naturopath, an internationally recognized expert on nutrition, medicine, and health, and the Executive Director of The Wellness Forum. Dr. Popper serves on the Physician’s Steering Committee and the President’s Board for the Physicians’ Committee for Responsible Medicine in Washington, D.C.

The other author, Glen Merzer is coauthor with Howard Lyman of Mad Cowboy, and with Howard Lyman and Joanna Samorow-Merzer of No More Bull!, and with Chef AJ of Unprocessed. He has been a vegan for the last 20years.

The format of the book is very unusual. In Food Over Medicine, Dr Pamela and Glen Merzer invite the reader into a conversation about the dire state of American health—the result of poor nutrition choices stemming from food politics and medical misinformation. Backed by numerous scientific studies, the book details how dietary choices either build health or destroy it.

The book (released June 2013) imparts a lot of information, but it’s a very easy read, due in large part to the conversation style format in which it’s written. Glen Merzer and Pam Popper discuss everything from health-promoting/destroying foods, to supplements and healthcare. They talk about screening and diagnostic tests such as mammograms and PSA tests, and whether or not they are beneficial, harmful or useless. The subject matter is certainly not light but they manage to create an atmosphere in which you feel at ease, as if you’re sitting at the table listening to these two knowledgeable, witty professionals.

The best part of the book is that nearly everything they say is referenced. While some stories are shared, the recommendations are always supported by the science. That being said, the data is laid out in such a way that the reader is engaged and interested without feeling dazed and confused. Many common myths are debunked and there are even some tasty recipes in the center of the book, courtesy of vegan chef Del Sroufe.

Overmedicated, overfed, and malnourished, most Americans fail to realize the answer to lower disease rates doesn’t lie in more pills but in the foods we eat. With so much misleading nutritional information regarded as common knowledge, from “eat everything in moderation” to “avoid carbs,” the average American is ill-equipped to recognize the deadly force of abundant, cheap, unhealthy food options that not only offer no nutritional benefits but actually bring on disease. (Comment: Malaysians are not very far away).

Chapter 3 is aptly called “Diseases and the Foods that bring them on.” Below are some relevant points explained by the two authors:

A lot of diseases are turned on by diet and lifestyle – e.g. strokes, high blood pressure, cancer, type 2 diabetes, asthma, chronic disease, Alzheimer’s, osteoporosis, multiple sclerosis, acid reflux, Parkinson’s, rheumatoid arthritis, gallstones, kidney stones, irritable bowel syndrome, etc,
You may have genetic predisposition, but those genes are switched on by diet and lifestyle choices,
The environment is often responsible for cancer initiation, but not usually promotion; it is the diet that promotes the cancer.
No other population (besides America) has ever had such unlimited access to so many bad foods. The overall state of health of Americans as a population is very sick and very overweight. A lot of people in this country (US) are overfed, but are still malnourished (same as in Malaysia also).
Most breast cancers are estrogen receptor positive, so elevated blood levels of estrogen increase the risk of breast cancer…all cow’s milk has estrogen metabolites because it comes from lactating cows.
Regarding protein: the protein needs for normal adults may be as low as 2.5 % of calories. We eat way too much protein.
Animal protein consumed in excess of what humans need becomes a powerful cancer promoter (read Dr Colin Campbell’s studies as reported in The China Study).The cancer–promoting effect of proteins has been proven to be limited to animal proteins.
The general medical wisdom about the etiology (cause) of most diseases comes down to genes, bad luck, and we don’t know..!!
Alzheimer’s is rarely present in plant-eating population; it is a disease of the western diet. It’s a vascular disease that is most present in the population that eats the most meat.
In the case of osteoporosis, it isn’t the fracture that killed them; it’s the poor health (from a high fat diet and lack of exercise) and the drugs they were taking that caused the fall in the first place.
Eating animal food causes the body to use calcium drawn from the bones to buffer the acid in order for the body to maintain blood within a very narrow range.
Rheumatoid arthritis is almost always diet and lifestyle related and is particularly related to the consumption of animal foods.
Chicken is just another animal food, and a particularly filthy one at that. Chicken, even white meat chicken is high in fat.
Dairy is the most toxic of all – high fat, high- protein, zero fiber, low-carbohydrate. Dairy proteins have been linked to a string of diseases including asthma, allergies, autoimmune diseases, breast cancer, and prostate cancer. Dairy products increase the hormone called insulin-like growth factor (IGF-1) which is a powerful cancer promoter in humans.
Refined sugary foods elevate triglycerides and triglycerides are blood fats waiting to cause mischief. Not only do sugar do not provide any nutritive value, they are destructive to health in terms of elevating blood sugar and suppressing immune function.
Dried fruit –firstly, it is high in calories. Secondly, there are lots of sulfites, coloring agents, and sugar in many dried fruit products.
Fruit juices are concentrated calories and sugar. Instead of drinking apple juice, eat apple; instead of orange juice, eat oranges.
Coffee – there is no question that caffeine is a drug.

In essence, the authors basically recommend a low-fat (10-15%) and plant-based diet (whole, unprocessed plant foods). For more information on the benefits of a plant-based diet, we recommend the following:

1) THE CHINA STUDY by Dr T. Colin Campbell, Professor of Nutritional Biochemistry at Cornell University. You can view Dr Campbell’s comments on how animal proteins and dairy products affect cancer, just visit the following link: http://www.youtube.com/watch?v=yfsT-qYeqGM

2) FORKS OVER KNIVES…THE PLANT-BASED WAY TO HEALTH…edited by Gene Stone (watch the DVD of the same title)

3) THE PLANT-POWERED DIET by Sharon Palmer, RD

4) THE PROTEIN MYTH by David Gerow Irving

5) PREVENT AND REVERSE HEART DISEASE by Dr Caldwell B. Esseltyn, MD (learn how a plant-based diet can reverse heart diseases).

Dr Popper’s website The Wellness Forum is at http://www.wellnessforum.com/

To know more of Dr Popper’s views on nutrition…..just type in Pamela Popper in YouTube…lots of videos to enlighten you.

BOOK REVIEW: OUTLIVING CANCER

by Yeong Sek Yee & Khadijah Shaari

Dr Robert A. Nagourney, MD is no ordinary medical doctor. He is board certified in internal medicine, medical oncology, and hematology. He earned his BA in Chemistry, from Boston University, and graduated with distinction in Biochemistry. He received his MD at McGill University in Montreal, Canada, where he was a University Scholar. After completing his residency in Internal Medicine at the University of California, Irvine, Dr. Nagourney received fellowship training in Medical Oncology at Georgetown University in Washington, DC. He then completed a second fellowship in Hematology at the Scripps Institute in La Jolla, California.

The book under review spans nearly 30 years and offers insight into how our understanding of cancer and cancer treatment has and, in some cases, has not changed in the more than forty years since the famous “War on Cancer” began. Since then, the death rate from cancer in the U.S. has decreased just 5%, and cancer is poised to claim the lives of more people than heart disease in the near future.

In Outliving Cancer, Dr. Nagourney describes the scientific rationale for his particular approach to cancer medicine, beginning with an interest in cancer as a disease and his good fortune to work with many accomplished researchers along the way. Readers will come to understand that cancer is not what it once appeared to be, that its management has often been ill conceived and ill applied. This informative book also demonstrates that cancer doesn’t grow too much but rather that it dies too little and why that matters.

Many years ago, as an oncology fellow, Nagourney’s lifelong desire to be a healer and a physician had been replaced by his role as what he calls “an administrator of toxic, ineffective chemotherapies.” He said he felt as if he had made a terrible mistake–that his patients weren’t only dying, he was poisoning them. He resolved that the remainder of his career would be dedicated to finding better, innovative ways to treat cancer. By rethinking what cancer is and how it behaves, Nagourney developed what he considers a smarter, more effective way to treat cancer patients, and he established Rational Therapeutics.

Rational Therapeutics is a pioneering cancer research institute that specializes in the “functional profiling” of human tumors through the application of a laboratory platform known as the Ex-Vivo Analysis of Programmed Cell Death (EVA-PCD). Using human tumor micro spheroids isolated directly from surgical specimens, these scientists measure which drugs, combinations and new targeted therapies can induce cell death (programmed cell death, one form of which is apoptosis). This process eliminates the “one size fits all” administration of cancer treatments, enabling physicians to provide personalized cancer care.

In layman terms, this is called “chemosensitivity testing/assay” which can identify which drugs would be effective for that particular cancer or which ones would be ineffective or harmful. Rather than prescribe a standard chemotherapy combination without knowing whether or not it would be effective, some oncologists are choosing to test tumor cells in advance of treatment. A chemosensitivity assay can help determine which drugs will most likely shrink the tumor, kill the cancer cells, and give patients the best outcome.

Is chemosensitivity testing being practiced in Malaysia? Not to our knowledge. Is it widely used in US and Europe? So far, only integrative oncologists like Dr John Forsythe, Dr Keith Block, Dr Robert Zieve, Dr Jurgen Winkler and a few others will only treat patients after the correct type of chemo drug has been determined suitable.

Why conventional oncologists are not interested and still prefer the one-size-fits-all approach to chemo drug selection? The American Cancer Society says the chemosensitivity testing is not scientifically proven and one local (Malaysian) oncologist commented that it is not “reliable.” Is this true? The following comment by Dr Joe Brown, ND (in “Defeat Cancer”) sums up the answer:

In a perfect world, patients would get a chemotherapy sensitivity test when they are first diagnosed with cancer, to determine their cancer’s sensitivity to specific drugs.
In the real world, however, it’s as if doctors are more or less saying to their patients: “You have….cancer. We’re going to give you this drug, because it’s the standard. If it does not work, then we will try another. If that does not work, then we’ll try a third” and so on.

(Comment—by the way, this approach is definitely more lucrative).

Outliving Cancer is full of patient stories, showing that many are not just surviving but are living cancer free and thriving up to 15 years later. By utilizing assay-directed treatment, Dr. Nagourney has taken the guesswork out of treating cancer and improving patient outcomes. Through the study of an individual’s cancer cells in the lab, personalized cancer treatment has come of age.

In an earlier part of the book, Dr Nagourney described his encounters /experience as an oncologist. Here are some notable comments:

…cytotoxic chemotherapy is a double-edged sword with a razor-sharp back edge.
…in the middle of the first year of my oncology fellowship, every single patient under my care died a miserable death. No one got better, not anyone ever.
My lifelong desire to be a physician, healer, and comforter had been replaced by my role as a tormentor. Patients weren’t only dying, I was poisoning them. I hated oncology. I was beginning to hate medicine.
Many (cancer patients) responded and a few cured, but absolutely every one of them suffered toxicities.
With each passing course of radiation, a new area of disease would crop up. Further radiation, more disease.

Elsewhere in the book, Dr Nagourney also made some very blunt comments on conventional chemotherapy/radiation treatments:

Cancer patients aren’t cannon fodder (cannon fodder is an informal, derogatory term for military personnel who are regarded or treated as expendable in the face of enemy fire). It is not their (the cancer patients) duty to be martyred at the altar of drug development.
…most cancer patients don’t respond very well to chemotherapy and we certainly don’t need help finding bad drugs. There are already plenty of those around. What patients need is help finding drugs that work.
The operative term here is “standard”….this means “average patient, average outcome” approach. Average outcomes are what these guidelines are designed to provide and they are exactly what you get.
Cancer medicine, it seems, is subject to the same types of trends that drive women’s fashion. Like fitted suits or short skirts, doxorubicin for breast cancer is in and then it’s out. But it will be back again.
All the while, patients suffer through dose intensity, dose density, bone marrow transplantation, and targeted therapies only to find out that the conceptual underpinnings that led their doctor to treat them accordingly were wrong and everyone’s going back to the drawing board. This happens because there are no absolutes in drug selection. There is only opinion and opinions vary.
…our most advanced therapies today are little more than diet plans.
…the human genome project has provided us the world’s most expensive telephone book.

In concluding, let us share one more quotation by Dr Nagourney which sums up what he is doing:

“You don’t go to a restaurant to find out what they aren’t serving. You don’t go to an airport to find out where they aren’t flying. And you don’t go to your oncologist to find out what treatment not to take. Laboratory assays that measure growth and proliferation can only tell you what not to get. That is why I (Dr Nagourney) departed from that technology two decades ago to use newer, more accurate techniques and will never go back.”

Is your oncologist using the newer techniques or is he still basing his drug selection on the recommendations of the drug supplier?

FURTHER REFERENCES:

1) ARTICLE: WHY I DO CHEMOSENTIVITY TESTING

LINK: http://robertanagourney.wordpress.com/2011/07/13/why-i-do-chemosensitivity-testing/

2) ARTICLE : CHEMOSENSITIVITY TESTING FOR BREAST CANCER TREATMENT

LINK: http://breastcancer.about.com/od/newlydiagnosed/a/chemosensitive.htm

3) WEBSITE OF RATIONAL THERAPEUTICS

LINK: http://www.rationaltherapeutics.com/cancer-testing/index.aspx