Breast cancer and Angelina Jolie
I am sure everyone in the modern world will have read about
Angelina Jolie’s double ‘prophylactic’ mastectomy after finding she carried the
hereditary breast cancer gene. Her mother died from the effects of breast
cancer, so there is some degree of justification, but personally I think she has
over-reacted somewhat. Having the breast cancer gene is not a 100 percent
predictor of getting breast cancer.
However, “Cancer” is still a word which induces fear. And in some cases, rightly
so. Cancer can be a killer, but not always. There are many people who have had
cancer and lived to tell the tale. My dear old Mum had cancer of the womb and
ended up having a hysterectomy before she was 50 years of age. She was 94 when
she died of pneumonia, so I think we can safely say the operation was a success!
The treatment for cancer is classically surgery, chemotherapy and radiotherapy.
Much depends upon the type of cancer, and how long it has been growing, and how
far it has spread. This can be a single modality, or combined. There is also
much work being done with the immune system and cancers, with a vaccine for some
types of cancer on the horizon.
However, I came across an article the other day referring to advanced breast
cancer survival rates and compared two similar kinds of cytotoxic drugs. The end
result of the study was that Drug A was more effective than Drug B, but had
significantly more side effects as well. Reading further, it was reported that
Drug B extended life by 13 point something months, while Drug A had the sufferer
living 15 point something months; however, the downside to these two extra
months included mouth ulcers, infections and low blood counts. However, the
researchers had come to the conclusion that Drug A was best.
I ask you, best for whom? In my book, it wasn’t the patient! Yes, it’s my old
hobby horse - the Quality of Life. What is the point of saying you can have Drug
A to give you two extra months of life when that is a life of misery? One thing
is for sure, I will put my last baht on the fact that none of the research team
took either drug! At least the famous medico John Hunter gave himself syphilis
to try to find the cure. And it wasn’t the ‘fun’ way, but self administered
syphilitic pus. You won’t find that kind of dedication today, even though some
people would call it foolishness.
We must never forget that in all our research we are not dealing here with body
cancers - we are dealing with patients that have cancer! We, the medical
profession, must treat the whole person, not the disease.
Now I mentioned breast cancer at the start of this item for a couple of reasons.
One is the fact that screening tests can be done, and I would suggest that all
you ladies over the age of 40 (or over the age of 30 if your mother or a
maternal aunt died of breast cancer) should consider annual mammograms in
addition to your monthly Breast Self Examination.
The second reason I mentioned breast cancer is that it is not, as many western
women think, the greatest killer of women. For many 10 year groups of women,
heart disease is the greatest killer. Yes, heart disease, the greatest killer of
men is now firmly entrenched in women’s medicine.
So what can you do about this? The simple answer is to take a leaf out of the
Eastern ladies’ handbooks on living. An Asian diet, which is high in vegetable
content and low in animal fats is a good start. More of a Thai ‘jai yen yen’
approach to life’s problems also helps. Use the ‘family’ network to get problems
solved, and in fact the family approach to living, with each member helping when
necessary, is another good example from the Asian book of life. And finally, the
Buddhist practice of moderation, the middle way, applies to the women folk as
well the men.
And if you haven’t done it already - give up smoking.
Is there a medical place for the “F” word?
Somber and staid are descriptions used
for doctor’s surgeries. They are not thought of as places for humor.
However, it has been shown to the satisfaction of the medical world, that
humor and a good laugh really is good medicine. Some hospitals even employ
clowns to brighten up the days of the inpatients. And no, I am not the
However, one of my favorite jokes involves a parrot that was prone to ‘bad’
language, and consistently used the “F” word. After threatening the
talkative bird with dire consequences, its owner put it in the freezer chest
for five minutes. After being retrieved from the freezer, the parrot was
asked if it would now behave. “Yes,” said the shivering parrot, “I won’t say
the ‘F’ word again, but please tell me what did the effing chicken say?”
Now, the F word in medicine. Inappropriate use of the F word (there are some
appropriate situations, in my mind at least) is part of an interesting
condition known as Tourette’s Syndrome. These are involuntary movements (and
sounds) and can be related to the magic “F” word, and is usually seen in
children (not parrots) around the age of 5-7 years. Boys outnumber girls
three to one!
So is this just a case of little Johnny parroting off (sorry about that,
couldn’t help myself) dirty words he has heard at home? Actually no. This is
a developmental problem that comes under the general heading of ‘Tics’ (as
opposed to ‘ticks’ that are parasitic problems).
Tic disorders can affect up to almost 20 percent of children at some stage
of their development. At one end of the spectrum are children with brief
episodes of single tics, whereas at the other are children with chronic
multiple tics, including our friend Tourette’s syndrome.
Tics are abrupt and recurrent involuntary motor or vocal actions. Motor tics
include eye blinking, grimacing, nose twitching, lip pouting, shoulder
shrugging, arm jerking, head jerking, kicking, finger movements, jaw
snapping, tooth clicking, frowning, tensing parts of the body, and rapid
jerking of any part of the body are simple tics. More complex ones include
hopping, clapping, touching, throwing, arranging, gyrating, bending, biting
the mouth, the lip, or the arm, head-banging, picking scabs, writhing
movements, rolling eyes upwards or side-to-side, making funny expressions,
sticking out the tongue, kissing, pinching, writing the same letter or word
over and over, and tearing paper or books.
However the tic can also be vocal, with simple ones being coughing,
spitting, screeching, barking, grunting, gurgling, clacking, whistling,
hissing, sucking sounds, and syllable sounds such as “uh, uh,” “eee,” and
“bu.” The complex vocal tics can involve complete phrases such as, “Oh boy,”
“you know,” “shut up,” “you’re fat,” “all right,” and “what’s that.” Take
that a little further and you get repetitive bad language (which we call
Coprolalia, because we love big words) and that is the best known example of
Children who have these tics can be looked upon as fools by their peers, and
there is a no more predatory group than other children. Parents also can
feel helpless in these situations. Form the medical point of view, one has
to treat the entire family, not just little Johnny with the foul mouth!
Most children with tics can lead normal lives, and the tics themselves
usually slow down in teenage years. Parents should be encouraged to get
support for themselves from various organizations such as the Tourette
Syndrome Association ([email protected]). With a good understanding of
tics and related problems, including acceptance from teachers and education
of the child’s peers, most children with tics do not need regular medical
Parents and children need to understand that, although all these symptoms
relate to an underlying brain disorder, breaking the cycle may be extremely
simple - for example, just allowing the child to have a short “tic break” in
a long school lesson may be enough.
Drug treatment can be used, though there are differences in opinion on the
efficacy, with some researchers claiming only 30 percent can be helped.
However, tic severity and frequency can be reduced. Studies of Risperidone
in Tourette’s syndrome have shown that it is efficacious too.