Archive | April, 2012

Is Change As Good As A Rest?

27 Apr

Monday was probably my last monthly meeting at Tel Hashomer with my oncologist, Dr Ido Wolf. The month before he informed us he was leaving for the largest hospital in Tel Aviv, Ichilov. A bombshell for us, possibly not less of a surprise for Tel Hashomer. Either way – a problem.

So when most other Israelis were touring the length and breadth of the country for their Passover holiday outing, our sight-seeing was the oncology department in Tel Aviv. The tenth floor of the new Ted Arison tower block. New building, beautiful interior design and staggering views of the Mediterranean– especially from the “recreation” room.  A well-appointed lounge with library, computer terminals and comfortable couches. They need it. The wait could be worrying. And so to the problems. Is the devil you know better than the devil you don’t? We “grew up” at Tel Hashomer, know the ropes and the nurturing nursing staff. Eighteen months later we’re still hanging in together. Their new Head of Department hasn’t even been named. My natural choice, a wonderful young doctor in the department, announced that she too is departing soon – for a Sabbatical in The States. 

But do we need change at this time of my roller-coaster life? Administrative adjustments, parking permits to purloin, new nursing staff and the tortuous traffic in and out of the never-sleeping city? All to stay with our oncologist. When our local hospital, with a reasonable reputation, is walking distance away. While Dr Bill Isacoff in UCLA and my brother-in-law, Keith are still helping us call the shots. Will we find someone else as accommodating and willing as Wolf? His interest for us to join him was certainly inviting.

Our insight of Ichilov is improved by a chance meeting with the Head Nurse, Bruria. So professional and patient. But she does warn us about waiting. “We work under pressure. Place is at a premium”. Not always a bed available. In fact, unlike Tel Hashomer, they don’t have beds in private cubicles, but comfy couches. Is this difference defining?

Our difficult decisions used to be whether to go to Denmark or Dubrovnik. We’re certainly in a different ball-game now.

 

 

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Independence Day

25 Apr

Tonight will usher in Israel’s 64th Independence Day. Israel will morph movingly from solemnly commemorating its fallen soldiers to celebrating the miracle of the modern State. While so-called “Human Rights” activists around the world have selectively chosen Israel for what they call BDS (Boycott, Disinvestment, Sanctions), any caring person would have to ask: “Why, despite Israel’s many faults, those activists cannot recognize serially worse offending States and campaign for their citizens who have no rights at all? Israel’s defenders would alternatively call that political agenda and anti-Semitic campaign: Blood-libel, Distortion, Slander.

I still see Israel as a land of miracles, flowing with milk and honey. Only my ketogenic diet precludes the milk and honey. I’ll settle for a personal miracle.

This Independence Day has brought The Beatles back to the fore – in particular their song “When I’m 64”. It starts, of course, with those happy lines:

“When I get older, losing my hair, many years from now,

Will I still be sending you a Valentine,

Birthday greetings, bottle of wine”.

I’m looking forward to being 64 in November, and I’m OK with the Valentine surprise, birthday sonnet and even a glass of red wine now and again. But losing my hair, many years from now? Not unless I invoke the words of Nankki-poo from Gilbert and Sullivan’s “Mikado”:

“We’ll call each second a minute – each minute an hour – each hour a day – each day a year. At that rate we’ve about thirty years of married happiness before us”!

Only in my case, if Abraxane is working, let my hair fall out thirty years from now.

To the world I say, be objective, recognize democracy and independence.

Happy Independence Day.. .  .   .

 

But having mentioned The Beatles – I must go down memory lane. To 1964 – when I saw The Beatles live at The Hammersmith Odeon. An unforgettable experience, as alive today as it was live then. I remember recalling that experience at a work convention in Israel- where each participant was asked to present himself and describe one moment of personal greatness. Almost all the other participants recalled heroic war action, which I found both amazing and personally humbling. I continued my presentation by saying that I couldn’t decide which experience was greater – the Beatles concert, or attending the World Cup Final at Wembley in 1966. My stories won first and second prize. But that’s a different story.

 

 

Why the Ketogenic Diet?

23 Apr

Following the positive interest shown in my recipe for cauliflower kugel last week-end – including from “The Ranting Chef”  http://rantingchef.com who described the recipe as “awesome” – I thought I ‘d share with you why the ketogenic diet and food supplements are so important. Let me introduce you to the thoughts of Chris Kresser. For this introduction I must thank my friend, Laurie Bean.

Incidentally, Laurie’s dad is an example we could all follow. How happy I was to see him back at the golf club yesterday. A nonagenarian, just recovering from a shoulder injury. He regularly goes round the course in a score lower than his age – and has recorded seven holes-in-one (so far!).

Chris Kresser, according to his own web site,  is a licensed acupuncturist and practitioner of integrative medicine. He did his undergraduate work at UC Berkeley, where he was introduced to Eastern spirituality and a wide range of health modalities and practices, from nutrition to meditation to tai chi, yoga and massage. While traveling inIndonesia, he contracted a mysterious tropical illness which became a chronic condition. He saw more than twenty doctors around the world in an effort to diagnose and treat the condition and realized he would have to treat himself. Today, he gathers and analyzes medical research to stay abreast of the latest developments.

Here’s a link to a transcript of one of his latest medical interviews. I’ts long and not exactly in “Queen’s English”. If you’ve got the time and patience – go for it. If not, read my summary underneath.

http://chriskresser.com/rhr-chronic-stress-cortisol-resistance-and-modern-disease?utm_sou

He reminds us that there is no one-size-fits-all approach, and something that works for people who are sick may actually cause harm in people who are well. The interview deals with burning fat, boosting energy, and preventing and reversing disease without drugs – probiotics, stress-relief and antioxidants.  He looks at pancreatic cancer treatment at the Integrative Medical Center in New Mexico.

I’m NOT suggesting you follow him blindly – if at all. But he is apparently extremely knowledgeable and well researched. Here’s an extract:

“The Integrative Medical Center in New Mexico is using a protocol that involves two components: intravenous administration of alpha lipoic acid at 300 mg to 600 mg two days a week and 4.5 mg of low-dose naltrexone, which is the standard low dose of naltrexone.  They also were giving 600 mg per day, of oral alpha lipoic acid; 400 mcg per day of selenium and 1,200 mg per day of milk thistle extract, which is another potent antioxidant. 

Chemotherapy can help people to survive cancer, but you would never give chemotherapy to somebody who doesn’t have cancer, right?  And I think that’s a more extreme example than this, but if someone’s just under extreme amounts of oxidative stress, as you find with cancer, something like high doses of all of these antioxidants might be beneficial, but in someone who’s otherwise healthy, it may have undesirable effects.  In the same way, you know, we get questions about diet.  If somebody has no gallbladder and a lot of difficulty digesting fat, they may have trouble with a really high-fat diet, but that doesn’t mean someone who has an intact gallbladder and good digestion is gonna have trouble with a high-fat diet.  So, we always have to consider who we’re talking about, what the goal is, and even what the length of time is that we’re talking about, you know, short-term versus long-term supplementation, or supplementation for therapeutic uses versus supplementation for longer-term, just kind of indiscriminate, indefinite use”.

Beware, the ketogenic diet may be the answer for me and you – but it’s certainly not easy.

 

 

A Ketogenic Kugel (Pie)

20 Apr

My tenacity at sticking to the ketogenic diet is invariably met with marvel rather than “I’ll kick the carb habit too”. So to help those that might find the prospect of diet daunting, here’s a recipe to try – Cauliflower Kugel (Pie).

It’s good as a side dish to meat or fish or can become a meal in itself. The chosen cauliflower could just as easily be changed for courgettes, broccoli, mushrooms or whatever takes your fancy. This is for 4 to 6 servings:

1 large cauliflower (900 gms)

2 large eggs

1 tbl ground almond

2 tbl extra-virgin olive oil

1 large onion, chopped

half tsp tumeric

half tsp cumin

salt and freshly ground pepper to taste

cayenne pepper or paprika to taste (for topping)

Divide cauliflower into medium florets. Slice leaf stems and/or stalks.

Boil/steam for 8 to 10 minutes until tender. Take care not to overcook.

Drain well and when cool mash (or blend) but not too finely. Transfer to bowl.

Heat olive oil in medium-sized pan and sauté onions over a medium heat, stirring occasionally until onions are golden brown. Add tumeric and cumin for a final quick stir.

Add the onions to cauliflower and fold in the eggs and ground almonds.

Oil a shallow 20-cms square baking dish and add in the mixture. Sprinkle another tbl olive oil over the top and your preferred spice to taste.

Bake in upper third of oven pre-heated to 190C until lightly browned on top – about 40 minutes.

Enjoy

 

 

A Puncture When You Least Expect It

18 Apr

Yesterday I had a puncture – well, Pam did. Or the car she was driving. Funny how in the times of sexual equality, some jobs remain in the male domain. But that’s another story. I went to get the tyre fixed.

I’ve been going to the same puncture repair place for years. Although, fortunately, not too often. It’s a family business in which the founding father  could be either side of eighty. God knows whether he knows me or not but I did innocently say to him that he wasn’t there last time I came in. I had a treatment he tells me – chemo for cancer. Like me, I empathized – but he was off. I wasn’t sure that he was in “reception” mode – he seemed to be into his monologue. But I did manage to squeeze in that I was being treated for pancreatic cancer. “They didn’t want to operate on me so I went  privately”, he was proud to say – “I was operated on by Prof. So-and-so. Number one in the world”. Israelis are to medicine a bit like Americans are to baseball. It starts with the World Series – and goes upwards from there. “He took my pancreas out and my colon and this and that,” he added. I wanted to question him on the removal of the pancreas but he continued with “cost me 120 grand (shekel)” he tells me. Apparently his proudest moment. Can you survive without a pancreas? That was news to me.

What did I expect from an octogenarian? He was lucid indeed. I wanted to tell him how awesome it would be to reach his age. But I was reflecting – he was reciting. I then realized that I haven’t actually had a “social” conversation about cancer for a long time. Certainly not with my contemporaries – not that I would wish cancer on anyone. I realized that my blog does give me a medium for expression – but it’s not the same as speaking to a fellow sufferer. Just to get things in perspective. The puncture-man’s message was that you have to keep working. He gets up at the crack of dawn and does his routine, including the rounds at the bakery to buy his workers an early morning bite. “Not that I work as I used to” he tells me – but I won’t bore you.

Our conversation was coming to a conclusion. We went on for almost as long as it took to fix the puncture – somehow they convinced me on the way that the tyre was irreparable and would have to be replaced. Together with the other front tyre – just to even things up. An expensive business.

But it did give me the incentive I needed – not to return to work – but to continue my volunteering. Same place, same satisfaction. And tomorrow at another charity where I help out. Life, fortunately, is going on.. .  .   .         

Hancock’s Half Hour

14 Apr

Every time I think of blood – obviously donations but transfusions as well – I think of Tony Hancock’s unforgettable sketch, “The Blood Donor”[1]. And Hancock was exactly the person I thought of the moment I was told I needed a blood transfusion during my latest Abraxane treatment last Monday.

Funny thing, the brain – and thought transference. Which again reminds me of one of my favourite quotes – this time from Woody Allen: “Amazing thing the brain. For most people, it works from the moment you wake up – till you get to work”. Back to my blog. They tell me I need a blood transfusion. My hemoglobin count was too low. What I didn’t realize was that not all transfusions have the same affect. A healthy person, for example, in some sort of incident requiring blood, would have little problem in receiving multiple portions. In my case, my body is at high risk – apparently at a much greater risk of rejecting the blood.

But my thoughts didn’t immediately rush to the whys and wherefores of the need. I thought of Hancock and his inimitable lines. For those not around in those days back in the Sixties – and who were not lucky enough to have heard the still hysterical show, I have to share a few of his lines, such as “God gave me eight pints – I need eight pints” or “I don’t mind giving a reasonable amount, but a pint! That’s very nearly an armful!” or “Can I have my tea and biscuits” (after his finger was pricked for a blood test). How the world has changed. I wonder if people find that sort of humour funny nowadays – or could even listen to comedy shows on the radio, or watch that sort of entertainment on TV today?

My life has changed as well – as has Pam’s. I didn’t actually imagine that Pam would be charged with the task of running around Tel Hashomer to bring the blood. But that’s what happened – and she didn’t even faint! The learning process goes on. I’m “A” Rhesus positive (“Rhesus? They’re monkeys aren’t they?”). Having donated blood regularly for years, it was only this week that I found out what blood group I am. Does having the Rhesus factor improve my chances of survival?

So I had the transfusion – nice and slowly. Drip by drip just to make sure there was no adverse reaction – or maybe to ensure that it was another interminable day at Tel Hashomer.

But hey, they told me a blood transfusion would put my energy levels up – and it did. ‘Bloody marvellous!   


[1] “The Blood Donor” was an episode from the BBC comedy series featuring British comedian Tony Hancock. First transmitted on 23 June 1961, the show was written by Ray Galton and Alan Simpson.

Surviving Pancreatic Cancer

8 Apr

As the holiday season advances, I realise I have two other reasons to celebrate. Firstly, it’s now almost a year and a half since diagnosis and secondly my blog seems to be growing in momentum – more readers from more exotic places.

It’s exciting to see someone has clicked in from Chile– or from places as improbable as Papua New Guinea or thePhilippines. And that people have shown interest from Indonesia to Italy. So be it. I have no idea who they are, but assuming they are interested in treatment for pancreatic cancer I thought it might just be time to give some sort of interim report.

Chemotherapy:

I’m now on my new chemotherapy regime of Gemcitobene and Abraxane. Tomorrow will be the third treatment, then I get a week’s break. This will hopefully be the pattern for the foreseeable future, especially as the side effects have fortunately been minimal thus far. The threat of hair loss and worsening neuropathy still hang heavily over my head.

This latest regime replaced my short tangle with Tarceva. I survived six weeks of Gemcitobene with a daily dose of one Tarceva pill. Although the treatment seemed to be working, I simply couldn’t stand the side effects.

The change to Tarceva followed almost a year on “5FU” – a cocktail of Folfirinox, Oxalyplatine and Irinotecan. How user-friendly it now seems to have been on a regime that my treatment was every other week – interspersed with a week’s break here and there.

Diet:

I’m still clinging religiously to my ketogenic diet. To remind you, it’s a diet of no carbohydrates (pasta, potato, rice, etc for the uninitiated), no fruit, nothing containing sugar – nor cakes or biscuits! If you’re having trouble not eating bread this week, bread is something that hasn’t passed my lips since January last year!  (For the reader who enquired about courgettes – yes! They’re allowed.) 

Daily Medication & Food Supplements:

Everything listed I take daily with meals – with the exception of Ompradex, which I take an hour before breakfast and dinner:

Omepradex Caplets (Omeprazole 1 x 20mg before breakfast & dinner) 

–  Manufacturer: Dexcel Pharma Ltd, OrAkiva,Israel

–  Purpose: Inhibiting acid secretion in the gastrointestinal tract.

Metformin Hydrochloride (Glucomin 2 x 850mg; 1 morning/1 evening)

 – Manufacturer: Dexcel Pharma Ltd, OrAkiva,Israel

 – Purpose: Antidiabetic to reduce sugar levels

Pankreoflat (Pancreatin [Amylase, Lipase, Proteases & Simethicone] 3 x daily

– Manufacturer: Solvay-Faes Farma SA,Spain

 – Purpose: Relief of abdominal distension due to cumulative gas & foam.

Curcumin (3 x 500mg with every meal)

– Manufacturer: VRP Brand, LLC,Carson City,NV89706,USA

Omega 3 (1 x 300mg with every meal)

– Manufacturer: Ocean Nutrition,Bedford,Nova Scotia,Canada

Pro-biotic (1 x 450mg with every meal)

– Manufacturer: Supherb, UpperNazereth,Israel

Calcium & Magnesium – ratio 2:1(1 x 300mg at breakfast and dinner)

– Manufacturer: Solgar,Leonia,NJ07605,USA

Multi-vitamin (1 x 150mg at breakfast and dinner)

– Manufacturer:Contrex Pharmaceutical,New York,USA

 

Hopefully I’m still helpful to fellow sufferers out there…