Archive | January, 2012

The Employment Doctor

26 Jan

Earlier this month I wrote about “Managing One’s Illness” [15]. I referred to the Employment Doctor as a key player, the man who decides whether you’re fit to work or not. I met the man last spring.

About a year ago I started claiming on my medical insurance policy. I suggested that you have to be on the ball, something that isn’t always easy. But you certainly can’t spring any surprises on an insurance company. They snail-mailed me a good old fashioned letter, no less – that by the anniversary of my claim, I have to submit all my claim forms again. Phew, no sweat for an old hand like myself. You just need the energy and patience. Not something that’s grown on me recently.

This morning I met the Employment Doctor again. Such a helpful young lady. Our early start to Jaffa was rewarded with traffic flowing freely. But I can’t explain why I felt so poorly. I was disconnected from my bi-weekly treatment yesterday which will take me uncomfortably to the weekend. But this morning? Could it psychosomatic?  We get there early, are seen early; the doctor even apologized for the unnecessary bureaucracy – the documentation of your updated case history, she explained, shouldn’t require you to come in – but that’s the way it is.

We walk out and I begin to feel better – so well that we stop in at a cousin in the trendiest part of Tel Aviv for breakfast. She asks how I am and in all honesty I can’t answer. A piece of paper tells you one thing and your body tells you something else. Confusing living with cancer – a complicated challenge. You just have to believe that good can come out of bad.

The illness keeps me moving forward. And I’m glad for that.

15 “Managing One’s illness” was posted on 1st January 2012

Cancer and the Internet: A Word of Warning and Awareness

20 Jan

The internet is an infinite fount of information. I question whether we are as objective as we should be when reading what we are spoon-fed.

Just recently, two articles on pancreatic cancer appeared on the BBC’s website. The first article is so far from my own experience. Written by Rob Hicks[13], here’s the link:

It covers the causes of cancer, its symptoms, diagnosis and treatment. For example:

–          Causes of Cancer: seven reasons are cited as to why people get pancreatic cancer. I can’t identify with any of them except, perhaps, the inherited tendency towards cancer – which accounts for 10% of cases. Both my parents had cancer; I inherited the BRCA2 gene.

–          Symptoms: nine symptoms are listed. I didn’t have any of them!

–          Diagnosis: this paragraph, at least, speaks a little more to me. I had an EUS (endoluminal ulatrasound), blood tests for markers (CA 19.9) and a laparoscopy (is that the same as a laparotomy?).

–          Treatment:  the drug gemcitabine is recommended. This is the standard treatment of our own Ministry of Health. It was my initial treatment until my chance introduction to Dr William Isacoff, the UCLA  pancreatic cancer specialist[14]. He told me to stop gemcitabine immediately – and I started using his cocktail instead.

The second article, written by the BBC’s Health reporter, James Gallagher, claims that processed meat is linked to pancreatic cancer and recommends that people eat less red meat. However, it does acknowledge that “the jury is still out as to whether meat is a definite risk factor for pancreatic cancer, but processed meat may be playing a role.” Here’s the link:

It’s now one year since I’ve been on the Ketogenic diet. I haven’t deviated from it since. As you might know, the diet is carbohydrate free, sugarless and without fruit. But it may be the most fruitful thing I’ve ever done – even life-saving. I eat meat almost every day, sometimes twice a day – but never processed meat – as well as lots of chicken, fish, eggs, cheeses and most vegetables. The problem is how to prove that the diet is indeed effective; even using myself as a case-study. I’m still having chemo, still taking food supplements – and I had radio therapy before I started the diet. I know of no way I can prove which of these elements has helped me most.  And scientific evidence can’t be called on either.

I try to keep abreast of the latest research but there is very little, if anything, on the benefit of diet. Pharmaceutical companies, who spend massive amounts on medical research, have a vested interest in developing new drugs and, as far as I’m aware, have no interest in anyone’s diet.

Then there’s the endless flow of internet articles, like the two above – reader beware!

I’ll go further than that. From the moment anyone you know is diagnosed with cancer, tell that person to stay away from the internet. It’s his first step to keep his sanity. No individual is a statistic yet the statistics he’ll see on the internet will almost certainly set him back dramatically. Take it from me. You see the odds stacked massively against you. Nowhere have I read that you could prove the statistics wrong. They don’t even put you up for the challenge.

I remember, shortly after being diagnosed, how I had a peek at “pancreatic” in the internet…just to give myself a bit of background knowledge. The statistics smacked me in the eye. It was a bit like hearing that the brother of someone at work – a work colleague that you really don’t know that well – well, the brother’s son was killed in a car crash. Too real to deny – but too far to feel personally involved. And what do you do with the information? Confronted with the statistics I felt a physical feeling arouse somewhere in the depths of my stomach. It rolled around for a while, till the vile of bile rushed upward through my oesophagus toward my brain. My brain was struggling with the statistics too. My mental and physical feelings met near my tear glands – and released them. I cried. And cried and cried. Why didn’t someone warn me?

A year on, the internet is the least of my problems – I can even blog about it! And write now what I realised a year ago. Save the innocent from the internet.


[13] Dr Rob Hicks qualified at St Mary’s Hospital,London, and entered general practice in 1992. He’s a part-time GP and a hospital clinical assistant in sexual health medicine. His special interests are men’s, women’s and children’s health, complementary therapies, nutrition and health promotion.

[14] Refer to my blog “Paying it Forward” published 28 November, 2011

Mind Over Matter

17 Jan

I’m in a bit of a muddle at the moment. It’s not that that I’ve lost direction – I’m basically pounding the same treadmill to keep myself in the same place. Only in my case I’m always aware of the possibility of going over the top of the “up” curve and starting the down-side. Last week was difficult. For the first time in a couple of months, I put back the drug oxalyplatin into my bi-monthly chemo cocktail. I had previously stopped taking the oxaly because of its bad side effects. In my case, the side effect is neuropathy – which I wouldn’t recommend to anyone.

I get through the week and we’re fortunate enough to have the whole family over for Friday night supper. A log fire is crackling in the fireplace. Nice. Guests leave and it’s just the five of us left; we start talking. I suppose I should have been happy that we are able to talk openly together – good communication is certainly not a given in many families today. But emotions get high and inner thoughts come to the fore. It’s not easy for me. I was brought up in a home where thoughts were not shared nor were discussions developed.  

Many things came out of the maelstrom. I try and detach myself from the discussion on two accounts. Firstly, I feel uncomfortable when the discussion is about me and secondly, there’s only so much theorizing one can do. After that, I see things as becoming counter-productive. Perhaps I still have to learn the art of debating. The family has certainly moved forward since my illness. Time never stands still in any circumstance and I’m proud of the way they’re dealing with reality.

My thoughts move on to the week ahead – and what I’ll be doing. It should be a better week than last week; it’s a week between treatments. I’ve got lots of peripheral activities on the go – but no core activities to look forward to; no work and no projects to perfect. No garden to potter around for the moment as the weather is wet and wintry. I even consider how long to keep the blog up and running.

Two other issues came up during the week which gave me food for thought. Where am I in my pancreatic fight and why was my office bothering me with an issue that for me is now completely off the radar screen?

Can cancer be a built-in excuse for copping out of everything? I come to no conclusion on this one. For the first time, I feel as though I’ve written this posting for myself. But I’ve decided to share it.

Life goes on – and naturally enough each one of us enveloped with his own problems.  



CAN CANcer be fun?

12 Jan

Sounds like a strange question. But life goes on and where possible having a good laugh must be good for one’s well-being. It works for me. To quote a song from the “Life of Brian”, once again, “Always look on the bright side of life”! So have a look as this little gem.

The gentleman on the left is yours truly, and my dancing partner is none other than the fabulous beautiful soul and most helpful individual, my brother-in-law, Philip.


A Pancreatic Prayer

8 Jan

In the early days of my illness, the most common message I used to get was that people were praying for me. All sorts of people. Since then, I’ve often been asked what the illness has done to my faith.

The last thing I would do is get myself embroiled in a religious debate about faith or belief. But in the context of “religion” in Israel today, I feel I have to say something. Why is religion in inverted commas? Because so many of us have a definition of religion that is far removed from the religious-secular chasm that is, day by day, growing in Israel. For me, religion is something private between me and my God. My relationship with my fellow man has to have a tolerance far beyond what I see around me today.

My take is as follows: there’s 1 land; there’s 1 Jewish people; there’s 1 Jewish religion – but there are more ways than one way to practice the Jewish religion. On two conditions: no religious coercion and a division between State and religion.

So much for my own musing. I’d rather recount a story that started a couple of months before I was diagnosed. It puts religion in a different perspective. After many years, I decided to change banks. I could only have been to the new bank a couple of times at most; filling-in forms and changing credit cards with a helpful clerk. Then, in the middle of the process, I got sick. Finances weren’t foremost in my mind.  More than a few months passed by without me contacting my clerk. Then the sickest days seemed to have passed – I was beginning to get back to “normalcy”.  I needed to get back to the bank.

So I phone the bank clerk, tell him it’s Moshe, and try reminding him who I am … he stops me mid-sentence. “Moshe ben Ester Malka”, he says, reciting my Hebrew name and my mother’s Hebrew name in full, “I pray for you every day”. You could have knocked me over with a feather. How did he know the names? Why would he bother praying for the likes of me? I remembered that he wore one of those small knitted skull caps. But this is not about his skull cap, nor his dress code. The man had faith in what he felt. And he acted accordingly. Modestly, privately – between himself and his God. I bet he never goes around telling people what to do.

When I was really bad, so many of the “all sorts of people” I referred to above, told us that they themselves were praying for me. From those dressed in black – to those whom religion seemed anathema. I was even told that someone had their whole class at school praying for me!

Is this why my condition turned round? Let each one have his own opinion. But I really believe that in matters of faith, it’s better to keep religious opinions to one’s self – or share them with your God.

And as to the opening question of “what has the illness done to my faith”? I can’t point to any dramatic changes in my belief – but even if could, I’m not sure that I’d share them. The change that is obvious is the increased amount of time I spend at home and with Pam. She bears the brunt of my “belief”. She sees me as how I am. For better for worse. And I bless her every day.







Golf gets you going

3 Jan

Sunday was New Year’s Day. I started my year by teeing off early with my golf buddies. Cold weather but warm-hearted friends. I should have blessed every minute. But then something got to me. Either my inability to hit the ball nicely, or the cold itself, or the New Year well-wishers. They may have just tipped me over the brink into thinking “What the hell am I doing here?”

I found myself welling up with tears that I couldn’t hold back. My golf partners of the day, two doctors and a dentist, couldn’t stop me.

In retrospect, I try thinking through what caused the collapse. It happened moments after I scored a very nice par on the 7th. Was I contemplating a few “if only” scenarios – like soon to be emulating Tiger Woods? No. I have no pretensions to any of part of his persona. Was I considering moving up a golfing notch into some Masters competition? No. Life for me is not about a “journey” – or moving in as direct a line as possible from one goal to the next. Life for me is a cycle. Sometimes you’re on the up – and sometimes on the way down. The art is to know exactly where you are on the circle – and in particular whether you’ve started the downward drop. This was going through my mind on the 7th. A thought that keeps recurring when I least expect it. This time I wasn’t prepared.  

My buddies literally picked me up – and suggested we call it a day. I refused. I tried to explain that it’s their care and friendship that keeps me going.

Thank you,Harvey, Karl, Marcus and Robert for being amazing friends.

Let’s hope that next New Year’s Day we’ll all score more pars!

Managing One’s Illness

1 Jan

The gust of wind that was my initial diagnosis swept all of my immediate family into a whirlwind of medical activity.  Even before the dust had settled we realized that we were traveling through a medical maze that was so foreign. But to administer the quagmire there was no time to mess about.

When all’s well, it’s amazing how we can bash the Government and its institutions. Looking back over the year, I’m in awe of how help is available. It’s a pity I had to learn the hard way. May be this blog can help others that have to go down the same road.

Pancreatic cancer is classified in Israel as a “serious” illness. My natural skepticism took its toll until I realized that this classification isn’t discretionary – but you need a myriad of forms for various offices. Many over-lap because of financial implications.

I’ll split the task into two – starting with administration (in alphabetic order); managing the medical aspect will come later. Who said “Divide and conquer”?  

– Employment Doctor

      A key player. In a world of fraudulent insurance claims, he’s the man who decides whether you’re fit to work or not. A decision-maker with a medical committee – a busy man. Long lead times to get an appointment. His list of documentation may seem unreasonable but his authorization is needed almost everywhere. So don’t disappoint him. Come well prepared.

– Enforced Retirement

      My retirement had instant financial impact; my monthly salary being replaced by a small pension. But there were hand-outs. Money was due to me for holidays and sick-leave not taken. My wife had also stopped working so as to be at my side – the temptation was to take the money as soon as possible. Read on to see why this was not in my best interest.

– Family Doctor

      Another key player who must be kept in the picture. He’s less hands-on medically because of specialists and me being treated in hospital – but he’s vital for form-filling and obtaining the omnipotent “Form 17” – the form that means your Health Fund will pick up the tab. You have to build the right relationship with the doctor himself and his secretary in particular. Getting forms by fax is a real time-saver.

– Health Fund

      My Health Fund provides for home-help. Unbeknown to me was the fact that a monthly sum is payable to a spouse, if they provide the home-help – all contingent on the degree of incapacity. We just had to wait patiently for a home visit and inevitable form-filling. But the financial gap showed its first sign of closing.

– Medical Insurance

     I mentioned the importance of insurance in my blog on BRCA 2 [11]. If you’re fortunate to have cover – then you’ve got to keep abreast of the claims. Keep receipts, submit them on time, ensure that they’re paid in full. Not everyone’s cup of tea.

– Ministry of Transport

      This was a surprise. The Ministry of Transport can provide an invalid badge for your car. Another long procedure but the benefits of easy parking are invaluable. And learning where you can park legally is full of pleasant surprises.

– Pension Fund

      I’m sitting at home one day last March, and I receive an annual statement from my pension fund. One of those multi-page documents with too many numbers – even for an accountant. But boredom had to be killed before something happened to me. Then I came across a clause which said “Payment in cases of incapacity”. The financial gap showed signs of closing even further. Pension funds have their medical committees – I’ll leave the detail for a different blog. The end result turned out in my favour – which is why taking my retirement hand-outs would not have been financially beneficial.  

– Social Security

      Social Security is actually there to help. And it does. It may be bureaucratic and means-tested but, they certainly come through with benefits – notwithstanding their medical committee.

– Tax Authority

      Another surprise in our bureaucracy. The tax man recognizes pancreatic cancer as a serious illness and, as a result, gives tax breaks.

Hopefully, you’ve got a better feel of what’s available. I’d be deluding you by giving the impression it’s straightforward. Ask Pam. If it wasn’t for her tenacity, how much would I have accomplished? Perhaps the best I can do – in the context of this blog – is to grant her the stage of another “Pam’s Perspective”[12].

A  happy and healthy New Year to all of you out there.    


[11] See my blog from 14th December: “The BRCA 2 Gene – and other things you may not know”.

[12] Pam’s first perspective was published on this blog on 24th November, 2011