Archive | May, 2012

Triumph or Trivia

28 May

You may remember that when I was in Canada I trivialized over writing a best selling book “Guide to Inter-continental Cancer Centres” – based on personal experience (see my posting “The Impossible Dream” dated 15th February 2012).

Today, I had my first treatment at Ichilov Hospital. I now feel suitably “experienced” – based on that unacceptable statistical sample of one – to share my findings. Today was, of course, the first working day after a long holiday weekend, so the results maybe even less representative. Hopefully the table of comparisons will help. I realize that it is more relevant for those in the Tel Aviv area but I’d be interested to know the experience of cancer patients wherever you are:

 

 

Subject

Tel Hashomer

Ichilov

1

Arrival Time

Never less than 45 minutes

Half an hour

2

Parking

Free parking right next to oncology dept

Free parking, 4 escalators, 5 mins walk & lift to department

3

Registration

Maximum 7 minutes

Over 1 hour wait

4

Blood Tests

Results within 45 minutes

Results took an hour an half

5

Vital Signs

Not taken

Blood pressure, temperature & weight

6

Pharmacy

Drugs arrive within an hour

Drugs arrive after an hour and half

7

Chemo Management

 1. Sterilisation kit                       2. Mechanical drip counter

 1. Manual hand scrub            2. Electronic speed control

8

Nursing Care

Excellent

Excellent

9

Catering

Free tea, coffee & soup

Free tea and lunch

10

Physical Conditions

 1. In need of restoration (British   under-tement)                           2. No view                                3. Possibility of private bed

  1. Brand new tower block         2. Sea view                             3. Comfy-chair in cubicle 

11

Treatment Time in Total

About 6 hours

About 9 hours

12

Getting Home

About 40 minutes

About 40 minutes

 

At the end of the day you look up to see whether the Sword of Damocles is still hovering in the same place or inching slowly downwards.

If it’s the latter, the travail turns from triumph to trivia. Time will tell.

In the meantime I’m more than aware of both options.

 

Ketogenic Breakfast Special – Shakshouka

23 May

I thought it’s time to share with you one of my favourite ketogenic recipes – something really special: Shakshouka

Shakshouka is a staple of Tunisian, Libyan, Algerian and Moroccan cuisines traditionally served up in a cast iron pan with bread to mop up the sauce. It is also popular in Israel, where it was introduced by Tunisian Jews. Like in Libya, Shakshouka is a traditional breakfast meal in Israel. In Hebrew Shakshouka (actually a word derived from a North African dialect) means “all mixed up”.

The dish has been said to challenge hummus and felafel as a national favourite, especially in the winter. According to some food historians, the dish was invented in the Ottoman Empire, spreading throughout the Middle East and Spain, where it is often served with spicy sausage. Another belief is that it hails from Yemen, where it is served with zhug, a hot green paste.

Shakshouka is normally made from tomatoes. My version is a spinach variety (with thanks to my eldest daughter). Here goes – for 4 servings:

1 medium sized onion, diced

4 gloves of garlic, peeled and sliced

4 eggs

500 gms fresh spinach

50 gms butter

1/4 cup full fat cream

1/4 cup goats milk

50 gms grated cheese (chedder or whatever)

handful of wallnuts –broken into smallish pieces (“the secret ingredient”)

Heat butter in medium-sized frying pan – or wok – and sauté onions over a medium heat, stirring occasionally until onions are golden brown. Add the garlic and spinach and steam for about 3 minutes (to steam I simply cover the mixture with a lid).

Add the cream and goat’s milk and keep stirring for about another 5 minutes.

Drop in the eggs – I try not to break the yolks – and cover with the grated cheese and walnuts. Let the whole dish cook for another 2 minutes on a low light. Take care not to overcook.

Enjoy – needless to say without bread – unless it’s ketogenic (see my recipe from 5th March 2012)

A Real Dilemma

20 May

This time last week I wrote about my so-called dilemma of following my oncologist from Tel Hashomer to Ichilov (from a spralling hosiptal in a Tel Aviv suburb to a tower-block hospital in the city centre). Well, my week went past without much to report. A “break” week which, unfortunately, was interrupted by the need to have our first meeting with Dr Wolf in his new rooms. The meeting itself was pleasant enough, but we did encounter the all too-foreseeable administrative hiccoughs. I perceive that today’s lack of working norms is responsible; something that would “never” have happened in the good-old days/old country. But that’s not the story of the week.

I mentioned to Dr Wolf that I’d heard of a new treatment being administered by a Dr Sela at Assaf Harofeh Medical Centre in Tzrifin, near Rishon Lezion. The treatment is a new a Phase 2 clinical trial of an anti-angiogenic product called TL-118.

TL-118 was previously tested in a mouse model of pancreatic cancer. In pre-clinical trials, TL-118 monotherapy has been shown to inhibit tumour growth significantly, compared to the standard-of-care chemotherapy.

TL-118 inhibits new blood vessel formations in tumours and thus inhibits their blood supply and growth. TL-118 is an oral solution administered once daily and comprises a combination of agents that target different, non-overlapping aspects of the angiogenic process.

Here’s a link to a recent press release:

http://tiltanpharma.com/apress%20releases/310804.php

Sounds simple. But how does one know whether one trial is better than any other? I’ve been waiting for the Parp Inhibitors – and up pops Tiltan. Is this another option? Dr Wolf tells me that there is no conclusive evidence yet that allows him to form an opinion – other than the trial is moving the new product forward.

Joining any trial is a real dilemma – I’m not there yet.

Thank You, Tel Hashomer

12 May

Last Monday may have been my last treatment at Tel Hashomer. We’ve decided to follow my oncologist, Dr Ido Wolf, to his new post at Ichilov Hospital in Tel Aviv. One learns to be wary of using absolutes. The concept of “never going back to Tel hashomer” may prove so wrong. Especially as word has it that Stage II trials of the Parp Inhibitor, under the auspices of Memorial Sloan Kettering, are supposedly coming toIsrael; specifically to Sha’arei Zedek, Belinson and Tel Hashomer Hospitals. Criteria have yet to be disclosed but the hope is that the next alternative is not too far away.  In keeping with how we’ve managed my illness upto now, we’re examining every possibility to ensure that I can get into the trial somewhere – as and when necessary.

Meanwhile, Monday came and went with an unfair amount of emotion.  The treatment starts with blood tests.  Two nurses have been taking my blood at least 2 or 3 times a month for the last year and a half.  How fortunate that they never had to struggle to find my veins – a problem so common for so many.  I thought of telling the nurses that this would be my “last time”.  The words stuck in my throat.  They never see the results but they must be so familiar with patients who really do have their last blood test – and not for the delicate dilemma of hospital preference. 

Then came the “farewell” from our tireless head nurse, Margalit – polite, practical and pleasant as ever.

It was only when I got home that the folly of agonising over the change of hospital issue fell into place.  An email from Agi Hirshberg was waiting.  It announced, in words that have only one meaning, that the Hirshberg Foundation would not be honouring a mother-daughter relationship for Mother’s Day next week.  The beautiful mother had succumbed to her pancreatic cancer. 

Can one ever forget the real writing on the wall – or can hope cloud the writing into timelessness?  Today, and more than ever as a Jew, in whatever field, we have to believe that hope cannot be taken away.

The Passion to Survive Pancreatic Cancer

4 May

Recently I’ve found myself being criticised for being too “passionate”. I’m not referring to any lurid lechery but more mundane matters. For example, when I let out one of my expletives on the golf course. My golf partners can hear me calling myself “twit” or “you silly boy” – strong stuff indeed. Then I’m told to calm down – it’s only a game. Or letting my emotions get the better of me when West Ham concedes yet another goal. “They don’t care about you – why should you care about them”, I’ve been reprimanded. Or little idiosyncrasies of people in the service industry that tend to irritate me. Being told “Why do you take things so seriously? Don’t take them to heart” – is not exactly heartening.

I look at these minor infractions and ask myself whether they have any meaning. My outbursts on the golf course are only aimed at myself, and last no more than the moment. I demand a high standard of myself and if I can’t hit that little stationary b… ball, why can’t I be irritated with myself? And wishing West Ham win? It’s only a game – and for its duration, why can’t my team win?

The question is whether my attitude today is any different from before I was diagnosed, and whether it makes any difference? The answer to the first question is a definite “no” but to the second question a definite “yes”.

To those who know me, it’ll come as no surprise that I can often be ignited from a very short fuse. I may go “bang” but then it’s all behind me. The bashing is basically at myself – and I’d be sorry if anyone felt slighted.

As to whether it makes any difference?  Cancer hasn’t changed my character. I’ve always been passionate about causes that concern me. I see my passion as a spark that is able to ignite my continuing fight.

This week I went to the funeral of a work colleague. A “Yekke”  born in Berlin in the 20s who came to Palestine as a twelve year old and became a legend in his own life-time defending the country. There were a number of old-timers there, many of whom I hadn’t seen for a while, who looked at me as if to say “What, you’re still here? You really must be amazing”. I don’t see it as such. Deeds of daring deserve their due, while I struggle to find the answer as to how I’m hanging in.

Perhaps passion is part of the plan. In the meantime, West Ham are surviving in the play-offs and I want to see them play in the Premiership next year. Maybe it’s not only a game.

 

      

 

Keith’s Perspective

1 May

Other than Pam’s two perspectives, the only other contribution so far, not written in my own hand, was from my brother-in-law Pip “Can Cancer be Fun”. Now, it’s my brother-in-law Keith’s turn to give his professional perspective. I have no words to thank these two incredible human beings:

 

Shortly after Martin’s diagnosis of pancreatic cancer, Sheila and I flew to Israel, painfully aware of the dire situation and the grim prognosis. The initial ultrasound assessment had showed a possibly benign cyst in the pancreas, but the MRI scan was far more sinister – highly suggestive of an invasive pancreatic cancer.  A diagnostic laparoscopy confirmed the worst–adenocarcinoma of the pancreas with multiple metastatic deposits in the peritoneum.  Aggressive treatment with radiotherapy and gemcitabine chemotherapy was started the day following his laparotomy. Within days Martin was gravely ill, primarily as a result of side effects of his treatment regime.  We arrived to this awful scene, finding Martin severely weakened and exhausted.

I needed to spend time with Martin and Pam at the hospital during his treatments. Sheila took to spending hours researching conventional and alternative treatments for pancreatic cancer.  Just prior to flying out, we had become interested in the growing movement showing various health benefits to a low carbohydrate/ gluten free diet. Surprisingly, some of the research Sheila was investigating showed this approach might influence tumor progression and growth.  Unfortunately no well- researched studies have ever been done in this area, so we had to be guided by the basic science and our instincts. There certainly was evidence that individuals with metabolic syndrome, elevated blood glucose and diabetes were more likely to develop pancreatic cancer.  Martin’s blood testing had revealed glucose intolerance.  The basic science also made sense – pancreatic cancer cells lose the ability to switch to metabolize ketones instead of glucose – an ability normal, healthy cells retain. The theory was simple and compelling – decreasing the amount of glucose available to tumor cells would choke their growth and lead to cancer cell death. This is the metabolic approach to tumor genesis, known as the Warburg hypothesis (proposed by Nobel Laureate Otto Warburg).

Could a simple dietary intervention be effective in treating such an aggressive cancer? What other safe interventions looked promising?  The research showed Curcumin (an extract of tumeric) effective as a synergistic agent with standard chemotherapy, resveratrol as a powerful antioxidant with activity against tumor cells, and metformin (a glucose lowering drug used for diabetes) to be the prime candidates. How though to convince Martin to embark on this restrictive diet and multiple supplement regime, with a dearth of scientific evidence to back it up? Well-intentioned oncologists and nutritionists were treating him with intravenous glucose infusions and encouraging him to eat ice cream and sugar in order to “gain weight”!

Somehow Martin found the strength to live up to the challenge, and became the most compliant and faithful “patient” I have ever seen! Since hearing the theory and explanation, he made his decision to embrace the diet and supplements and has stuck 100% to a ketogenic lifestyle subsequently.  His blog attests to the remarkable progress he has made. At the time of writing, his disease remains in a stable remission, he has done numerous overseas trips (including a fantastic visit to us in Canada!), plays golf regularly and for the most part has good energy and no pain.  There have been various changes in his chemotherapy regime, which can be read in his blog.

There is no way of telling what factors have led to such a remarkable outcome. Perhaps it is a combination of medical therapy, diet and genome.  It is highly unlikely that a good double-blinded study will be done soon on the ketogenic diet effect on cancer. Rather than wait for that day, Martin has made a lifestyle switch, which seems to have had a very positive effect on his condition. He has by chance or fate become part of the “paleo” movement, which sees the modern Western diet as the source of many chronic diseases and he has shown that eating a more “ancestral” diet can be a healthy and possibly therapeutic choice.

We pray that our “experiment” will go on for many, many years!