Comments on: Anna Donald: Confessions of a chemo-veteran

By: Elaine

Elaine — Mon, 13 Oct 2008 22:00:53 +0000

Hello, A question for Martin Ashdown. I am undergoing a chemo treatment 4 weekly called F & M. Mitozantron and Fludarabine. I live in New Zealand and our medical care is not great due to lack of funding and a brain drain of medical seeking the bigger pay packet. My question is the same as Anna’s. They can’t get the nausea under control. I have tried Metoclopramide (Maxalon),Ondansetron (Zofran),cyclizine, Domperidone (Motilium). all have proven completely useless. I vomit and remain nauseated for a further 10 days after treatment. Can you offer any suggestions. Anna You are amazing. Good Luck Girl

By: Martin Ashdown

Martin Ashdown — Sun, 17 Aug 2008 02:10:18 +0000

Hi Anna,
i’m a clinical cancer researcher collaborating with the Mayo, Royal Women’s Hospital Melbourne, Peter MacCallum Cancer Melbourne and others. We have discovered that in the late stage cancer patient, the patient’s immune system is persistently and repeatedly oscillating on and off against the tumor burden in a process of endogenous vaccination / autoregulation over an approximate 7 day cycle. The “off switch” autoregulation lymphocytes are synchronously clonally active over a narrow 12hr window every ~7 days…..within this narrow window these cells are exquisitley sensitive to being ablated by standard cytotoxic agents. Once these cells are killed off the unregulated immune system can dispatch the tumor burden relatively quickly. We know this from the mouse experiments. We have good evidence that when chemoRx is spectacularly succesful in a late stage patient, it is due to fortuitous ablation of these regulatory cells and not direct cytotoxicity against the cancer. Consequently the patient must be treated at the correct point in their idiosyncratic cycle for best therapeutic outcome - a complete response ……so its a bit like the menstrual cycle and fertilization/conception….as my wife says…..”if you want the baby, you got to get the timing right. Last year I was an invited speaker by the NCI/NIH Dept. of Surgery at the cancer immunotherapeutics conference in Banff, also by the TGA in Canberra and this year (May2008) by Ian Frazer to address his oncology collaborative group at Princess Alexandra re our clinical work at the Mayo Clinic and with Michael Quinn director of oncology at RWH here in Melbourne. I would like to discuss this with you….as I think you would understand it, as this cycle explains the heterogeneity of responses to chemoRx and why chemoRc doesn’t work most of the time.
Prof Martin Tattersall is also aware of this work.
best regards
Martin

By: David Anthony

David Anthony — Wed, 28 May 2008 09:27:41 +0000

Dear Anna,

A late comer to your blog, but you have been in our thoughts. Such clarity. Why would I expect less. I smile through tears imagining you exploring this frontier within yourself.

Sending all our hope and love.

David

By: Alan Lovell

Alan Lovell — Tue, 27 May 2008 15:58:02 +0000

Hey Anna,

I loved your metaphors about chemo… it’s already been pointed out so many times but you really do have a wonderful turn of phrase (I’m sure you’ve already read some Wodehouse at some point in your life, but if not give him a go - you’ll appreciate him as one wordsmith to another). And you should get a book deal, as your writing is too good to be wasted on the blogsphere.

As for Tom and Mai’s idea of Drs being obliged to under chemo - yes, quite, absolutely! Oh, and imagine what we could do to dentists!

By: Urmila

Urmila — Tue, 27 May 2008 10:19:40 +0000

Dear Anna

You are always in my thoughts and prayers, Anna. I hope you continue writing your blogs, which have touched and inspired so many. You write beautifully and explicitly about your experience, which I hope will make a difference to cancer patients. I miss you and can’t wait to see you. With very best wishes and tons of love.

By: Neelima

Neelima — Mon, 26 May 2008 12:25:44 +0000

I look forward to reading your blog.I must admit, there are certain words and phrases which I cannot understand.However it is coming from your heart which makes it such a beautiful reading.Keep writing.

By: Rick Niederman

Rick Niederman — Sat, 24 May 2008 02:41:40 +0000

Anna:

I am just catching up with you after a too-long delay. Your blogs are simultaneously heart-breaking, uplifting, and funny - although I didn’t get the right hand / left hand humor on the previous blog.

Your description of the epirubicin so reminds me of Asha’s first encounter - with the drug and the toilet bowl - it brought me to tears, again.

In an odd twist Asha currently plays an electric violin with an Aussie rock and roll group in Los Angeles, Porcelain, who are all from Wollengong (did I spell that right?).

I dearly miss seeing you, and hope the cough is a short-term setback.

My very best wishes and love,

Rick

By: Andrew Herxheimer

Andrew Herxheimer — Thu, 22 May 2008 13:32:21 +0000

Dear Anna,
It took me a while to get to your blog - it’s wonderful, I can hear you saying it all. So much important truth from the heart & mind. I’d like it to reach everybody, & shall try to get DIPEx to link to it. Delighted to be in touch with you again!
Love, Andrew

By: Diana

Diana — Thu, 22 May 2008 11:56:44 +0000

Reading your blog makes me feel like I’m sitting in the living room with you, looking at the glorious view. Hope things went OK today.

By: Richard Smith

Richard Smith — Wed, 21 May 2008 15:32:41 +0000

Dear Anna,

You’ve taught me more about chemotherapy in these few paragraphs than I ever learnt in my medical training–and the last proper medicine I did was a spell in oncology.

I’m walking the Dalesway, which is “heavenly,” an entirely appropriate word. Everything is simultaneously ancient and reborn, the fields are full of blubells, lambs, and the freshest, greenest grass. But I had to snatch a moment in Sedbergh Library to catch up with your blogs.

Lots of love

Richard
XXXXXXXXXXXXX

By: Tom

Tom — Wed, 21 May 2008 10:46:40 +0000

I agree with Mai Luen (hey Mai!) and thought similar when reading: Cancer doctors should do one round of chemo to experience it so they can truly empathise with their patients.

Thinking of you all the time Anna, and hope (like Sam) that the elephants stay away as long as possible. But if they come, remember they like peanuts, and Ganesh is widely revered as the Remover of Obstacles.
Much love, Tom.

By: Fraser Macfarlane

Fraser Macfarlane — Wed, 21 May 2008 07:40:48 +0000

Hi Anna

Good luck for tomorrow. Trish and I are thinking of you (and Michael). You make us feel incredibly humble. Send our love to all in Sydney

Fraser

By: Tom C

Tom C — Wed, 21 May 2008 02:59:59 +0000

Dear Anna,
You are in my thoughts often. I am enjoying reading your blogs - good luck this week, whatever that means. Hope to speak soon, love to you and M. Tom

By: Sam

Sam — Tue, 20 May 2008 23:11:10 +0000

Dear Anna

Good on you for raising the question about insufficient
anti-emesis - and for your thoughts behind the reasons
for this. Fascinating.

Best of luck on Thursday -and hopefully may you avoid the elephants a little longer

Sam

By: Mai Luen

Mai Luen — Tue, 20 May 2008 19:02:00 +0000

I have pondered whether as doctors we ought to have to try some of the treatments we prescribe or procedures/investigations we order…now, I am going to just take your word…fingers crossed for Thursday…take care and say hi to M & J.

By: Isabella

Isabella — Tue, 20 May 2008 16:12:41 +0000

Anna, thank you so much for this blog. You write like an angel and face the hard stuff with clarity.
Isabella

By: Jeremy Wyatt

Jeremy Wyatt — Tue, 20 May 2008 05:08:07 +0000

Dear Anna, thanks again for these profound and generous new insights about your experience of illness. I’m wondering if you can perhaps bring all these together in some more accessible format than your blog, to help many more doctors improve their approach to the people they see and treat. A summary of your insights would also help balance the conventional flow of information from doctor to patient, inspiring and empowering our patients to continue your brave questioning and reporting back to us about the nature of disease and its effects on them. This seems so much more important than replying to our fleeting comments ! Good luck on Thursday… Jeremy

By: austin leach

austin leach — Mon, 19 May 2008 15:52:35 +0000

Dear Anna
Thanks for your honest and forthright writing.
I am a consultant in pain medicine and have dealings with oncologists from time to time. I, too, have noticed an occasional distancing of the doctor from the reality of symptoms, and a failure to acknowledge the impact unpleasant side effects can have. I don’t honestly think it’s a deliberate attempt to get chemo imbibers to pull themselves together. It may be that to be a career oncologist it becomes necessary to thicken the skin a little - getting ‘too real’ with their patients may be emotionally extremely demanding.
This is in no way an apology for those attitudes - I find unsympathetic (or rather, unempathic) doctors an anathema - merely an observation.
Symptom control is as, if not more, important than the treatment itself in terms of QoL impact.
Austin Leach