Category Archives: awareness

Time to change direction and focus

awareness, Goals, Marketing NETs
I restarted this ivy heart shortly after Jane's death. The original plant died while Jane was in the hospital. It sprouted a bit that spring. The change since then is remarkable.
I restarted this ivy heart shortly after Jane’s death. The original plant died while Jane was in the hospital. It sprouted a bit that spring. The change since then is remarkable.

A year of change

My friend John died July 1. August 8, I had minor surgery to remove a basal cell skin cancer from my nose. I fought off a cold in September, another in October, the flu in early November and an intestinal issue last week. This weekend marks the seventh anniversary of Jane’s death. My mind, my body, and my soul are tired. Something needs to change.

I need a real break…

Change has very much been in my mind much of the last year. Too much of what I am doing seems pointless. Much of what isn’t pointless, others do far better than I can do. I’ve always believed one should let other people take over when they’ve proven they can do the job better. In those areas, it’s time I did that.

Change over seven years

We have literally dozens of online and offline support groups for NET cancer. Those groups spread the latest NET cancer treatment information to patients and their lay caregivers quickly and efficiently. Ronny Allen and others have taken on the task of putting the latest knowledge into lay terms. Ronny’s site dwarfs this one in every way that matters. It’s time for me to move on from that piece.

Something needs to change.

The Carcinoid Cancer Foundation has set up a place for patients to tell their stories on its website. Increasingly, patient stories make the local print and broadcast media across the US–and across the world. There is more to do there, but the job is getting done better than I can do it. It’s time for me to move on from that, too, except where patient experiences with specific treatments are concerned.

The change grief creates

When I began this, Jane’s story needed to be told. I’ve told it. I’ve told it from every meaningful angle–likely in more intimate detail than anyone needed or wanted to hear. I have also told the story of my grief to the NET cancer community in far greater detail than most would want to hear.

It’s time for me to move on from that piece.

That grief has driven me to a kind of madness. I live too much in a form of solitary confinement. I spend too many days and nights alone with little more than a keyboard and disembodied voices for company. Even when I go out, I am too aware of being alone in a crowd–even when I am out with friends.

Where Walking with Jane began

When I began this work seven years ago, I saw three things that needed addressing: funding, medical awareness, and public awareness. While we have seen improvement over the last seven years, those remain the three intractable problems that stymy our efforts. We can’t fund research without money. We can’t get better diagnostics without greater medical awareness. We can’t get money in the quantities we need without greater public awareness.

That grief has driven me to a kind of madness.

At some point, I lost track of those three things. When patients asked questions, I got caught up in answering those questions. When patients needed emotional support, I did what I could to answer that need. When caregivers needed an understanding ear to listen to them, I tried to do that.

Unexpected change

I forgot I am one human being. In trying to be all things to all people I could forget the burdens I carried for a time. And I could ignore the larger issues I set out to find answers to that seemed beyond my powers to achieve. At least I could feel I was doing some immediate good.

…funding, medical awareness, and public awareness.

My ego got involved, too. I wrote, day-after-day, for years, for an audience of 25-30 regular readers. They were all people I already knew. I needed to attract a general audience that had not heard of NET cancer before who would be moved to do something by Jane’s story. And I couldn’t do it–I couldn’t create that audience.

Change in audience

Without the patient and caregiver audience, I’m not sure what I would have done. One can only write in a relative vacuum for so long before doubt climbs on board. I have no doubt telling Jane’s story has helped many patients. I have no doubt those stories will continue to prove helpful. But telling that story has done little to reach the outside world with the NET cancer story.

My ego got involved, too.

This website has largely lain dormant over the last year. Some of that had to do with helping care for my friend John. Some of it has had to do with my own health issues–both physical and mental. But a big chunk also has had to do with my own frustration. It seems, sometimes, that everything I put my hand to fails–but the moment someone else picks up that same task, they succeed.

Moments of doubt

And I can’t convince myself that somehow I’ve inspired them. People say that to me with some frequency but I don’t see it. They see a role that needs filling and they fill it. Sometimes, after they are well started, they see something I did or am doing. But the thing that started them had nothing to do with me–just with the need I failed to fill effectively enough to make the difference they make.

This website has largely lain dormant…

The last 7.5 years have been the most difficult of my life. They began with Jane’s NET cancer diagnosis and her doctor’s confession that he knew nothing about the disease. They’ve included rising and dashed hopes, multiple deaths, dozens of projects started but never finished, and more mental and spiritual anguish than I can describe. We’ve seen much change in the NET cancer universe over that time–but not nearly enough. We still have no cure.

The battle continues

I don’t walk away from a fight just because the opponent refuses to go down easily. I don’t give up over my own failures–or anyone else’s–either. But sometimes one needs to consider a change in tactics.

…the need I failed to fill…

The focus of Walking with Jane will remain NET cancer. But a return to first principles–and first goals–seems in order. We need to raise public awareness of the disease for two reasons.

Public awareness focus

First, we know there remain many people out there who have NET cancer and don’t know they have it. They suffer the various vague symptoms and travel from doctor to doctor looking for answers–answers the doctors don’t have because they can’t suspect what they’ve never heard of.

I don’t walk away from a fight…

Second, only by broadening public awareness can we generate the funds we need for the basic research that will open the door to real progress on treatments and potential cures. We can’t continue to rely almost exclusively on funding from donations from wealthier patients and their families for the research we must have. A broader donor base that includes both patients and non-patients will generate more funding than either group alone.

Physician awareness must change

But public awareness is not enough. We also need far better physician awareness than we have. The NET cancer landscape has changed substantially in recent years–but primary care doctors remain largely unaware of the existence of the disease, let alone the changes in diagnostics and treatments.

A broader donor base…

Virtually every day a NET cancer forum patient reports conversations too similar to what Jane heard on the day of her diagnosis. Worse, many doctors who do have knowledge of the disease work from a knowledge-base that is a decade old or more.  That, too, needs to change.

Revamping our approach

Starting almost immediately, then, Walking with Jane will begin reinventing itself. We’ll focus on general physician and public awareness in the coming year, as well as fundraising. We’ll continue trying to support patients with first-person experiences with new treatments. But I’ll write far less about Jane and spend significantly less time monitoring patient support groups–or writing things aimed at those groups, myself.

…public awareness is not enough.

In mid-January, we’ll undertake the first major redesign of this website since its creation in 2011. We’ll create separate tracks for patients, primary care doctors, and the general public. We’ll do more to link patients to other sites that do a better job of addressing their concerns than we can do here. We’ll use our Facebook page in different ways than we do now.

And, in the year ahead, we’ll do more general information leafletting in public spaces, as well as other awareness focussed events for both the general public and physicians.

My own needs

But I’m tired. John’s last days took a lot out of me. Memories of Jane’s last days are tearing me up inside. I hurt physically, mentally, emotionally, and spiritually. I need a real break–or at least to slow down. I have a craft fair I’m committed to and a Facebook Awareness Campaign that runs through the end of December. The awareness campaign is largely already designed–most of that is simple posting and sharing.

Starting almost immediately…

So after December 17, I’m taking some time off. For about a month, with one exception, I’m going to try not to think about NET cancer. I may take a trip, do some writing, take some pictures…or I may just work on some house projects I keep thinking about doing but never get to. A few weeks without structure might make a good change for a man who plans just about everything.

Thankful? Perhaps. Terrified? Absolutely

awareness, Caregiving, Death, Grief, Holidays, Jane
I am thankful for the many former students and friends who have worked with Walking with Jane two raise money for NET cancer research.
I am thankful for the many former students and friends who have worked with Walking with Jane two raise money for NET cancer research.

Thankful for what is

I have much to be thankful for: I have cupboards stocked with food, I have a roof over my head—a heated home with comfortable chairs and a warm bed to sleep in. I have clothes to wear at every season of the year. I have friends who would walk to the Gates of Hell with me if I asked them to.

It’s painful to lose your wings…

Most importantly, I have my health. Yes, I have the aches and pains anyone my age experiences. Yes, I’m still recovering from the summer’s surgery. And yes, I’m still grieving the loss of my wife seven years after her death. But my mind still works and I can still walk a goodly distance at a pace that would leave many a younger person gasping at the roadside.

Thankful but pained

One night, when Jane was in the hospital and unconscious but still with weeks to live, I stood alone in the waiting area outside the ICU. I was looking out the window at the city beyond. But the city did not register. The cars in the streets below did not register.  My mind was in the room with Jane.

I have much to be thankful for…

I was always in the room with Jane. If I went to dinner in the cafeteria, my mind stayed with her. If I drove home to pick up clean clothes and pay the bills, my mind stayed with her. When the nurses sent me out to take an afternoon’s walk, my mind stayed with her. Truth be told, part of my mind has never left that room.

Memories and weights

I still see the early morning view of Binney Street from her window—the cancer patients pulling up to the door of the Dana-Farber clinic and walking in. I still see Jane sleeping in her bed, still see her not sleeping when the bouts of insomnia came on, still see the madness and anger in her eyes. But I still see the smiles, still feel her hand in mine, still feel the tears and the final brush of her lips as she died.

My mind was in the room with Jane.

But that night, standing alone, looking out over the city, the enormity of what I was doing came down on me like the world settling onto Atlas’s shoulders. I had two decades of conversations to rely on—and they were too slender to do more than be crushed beneath the knowledge that I really was at the point of the spear—and thoroughly alone. I had friends and doctors behind me, but the weight was mine—the decisions were mine.

Living with decisions and consequences

On good days, I know I made the best decisions I could, given the information I had to work with. On bad days, the guilt is overwhelming. Most days fall between those two extremes. I console myself that Jane’s death—like her life—made a difference in the lives of others.

…the decisions were mine.

Seven years ago today, Jane was in a coma. I talked with her doctor. I talked with a friend who had come up to visit. Jane had come through one coma already. Part of me said,”Enough. Let her go.” But there was hope, I believed, with the right approach and a bit of luck, that Jane’s desire to be the first person to beat NET cancer might yet be realized. I let them convince me the chance was good enough.

Thankful, but…

And for 13 days, it looked like the right decision. And then, suddenly, it wasn’t. If you’ve been in my position, you know what that feels like. If you haven’t, I hope you never do.

Jane was in a coma.

This is what it is to be a caregiver and lose the person you love at the end. You can have food, shelter, clothing and friends. You can know how thankful you should be for each of those things—and you are. You can have your health and know how valuable that is, and be thankful for that, as well.

The terror of the void

But there is this void you can’t fill—that you are afraid to even try to fill. At first, you give yourself altruistic reasons not to. “I would never want to put someone else through this,” you tell yourself. “I don’t want anyone to feel they have to live up to my image of the one I’ve lost—that they’d constantly be compared to an idealized memory.”

You can know how thankful you should be…

The truth is, you’re terrified. You don’t want to go through watching someone else you love that much die again. You don’t want to hurt like this again. You don’t want the responsibility or the guilt or the pain. You come to prefer the real pain of solitude to the potential pain of that level of loss.

The end of the world

The Mulla Nasrudin, a Sufi teaching master, put it best when he said there are two ends of the world. “The lesser end of the world is when I die. The greater end of the world is when my wife dies.” Truly, the death of one’s other half truly is the end of the world. I’ve experienced nothing more painful.

But there is this void you can’t fill…

Truth be told, I’ve had momentary crushes—feelings I’ve squashed nearly as quickly as they appeared. When I have thought women have shown potential romantic interest in me, I’ve been quick to drive those interests away–or into safer channels. I’ve never been particularly quick at picking those things up, so perhaps those moments were imaginary. But I’m terrified to think any of it might be real—and both my conscious and subconscious minds have proven quick to put a stop to any potential relationship beyond friendship. Even that, sometimes, frightens them.

Of wings and hearts

It’s not that I can’t imagine falling in love again. I hear Jane’s voice in my ear constantly, reminding me that part of that final Saturday conversation before she went into the hospital was about her desire for me to find someone else if she died—to fall in love again. But my wings were singed long before I met Jane. She healed them, made them strong again. But her death charred them back to cinders.

Even that, sometimes, frightens them.

It’s painful to lose your wings that way. It hurts like Hell to have half your heart carved out of you without benefit of anesthesia. That’s what grief is like when the love is strong enough. But I can’t live with half a heart—don’t want to live without my wings. Still, I remain terrified of what happens if they fully recover. And equally terrified of what happens if they don’t.

Money remains a central NET cancer problem

awareness, Fundraising, Goals, NET Cancer Awareness Day/Month
We raised just over $5000 last month with a dinner fundraiser. That's not a lot of money compared to what we ultimately need--but with the slim funding we have, every dollar counts.
We raised just over $5000 last month with a dinner fundraiser. That’s not a lot of money compared to what we ultimately need–but with the slim funding we have, every dollar counts.

Money remains too scarce in 2017

Money was a problem in 2010. The amount researchers had to spend amounted to less than we spent on Jane’s treatment in the four months from her diagnosis to her death. Jane telling her doctors to study her the best they could, in some ways, doubled the research money for the year.

Grants run out and have to be replaced.

Money remains a central problem for NET cancer seven years later. Yes, we have 10 times as much research money now as we did then. Yes, we’ve seen significant increases in money for clinical trials from pharmaceutical companies and other sources. But we need to find more.

Funding for research

We still spend far less on NET cancer than we need to. The disease is complicated in ways no one saw coming. Just growing tumors in test tubes has proven insanely difficult. Mouse models have proven largely pointless. The tumors often grow so slowly the mouse dies before we can get useful information from it. The DNA shows no major attackable weaknesses.

Money remains a central problem…

Our efforts seemingly remain largely limited to finding ways to slow the disease and ease patient symptoms. Yes, we’ve found better scanning techniques. Yes, we have a trial of one variety of immunotherapy going on at this moment and another variety in the works. But much of the last seven years has remained devoid of curative ideas. This is not to belittle the substantial efforts to find ways to alleviate patients’ symptoms. Quality of life very much matters–especially in the absence of a cure. But we should not have to choose between one or the other.

Funding for awareness

The lack of money has also hampered our efforts to educate primary care physicians about the NET cancer. Our first priority has been finding ways to help patients who know they have the disease. But we have no real idea how many additional cases we are missing because of simple ignorance. As I’ve written before, not only can we not detect what we don’t suspect, but doctors can’t suspect what they have not heard about.

The disease is complicated…

And too many primary care doctors have not heard of NET cancer. NET cancer patients outnumber brain cancer patients in the US by a significant number. Every doctor in America knows what a brain cancer is. Too many don’t know what NET cancer is. And too many who do know so little about the disease that they say things like, “You have a good cancer too have.”

The next round

We can’t deny that NET cancer research is much better funded today than it was even seven years ago. But we still have less funding than what amounts to a rounding error on many other forms of cancer. We need sufficient funding to mount and maintain a more serious basic research effort than we have today. We need sufficient funds to continue to find and test new treatments and new diagnostic tools. And we need sufficient funds to ensure that every primary care doctor comes to know NET cancer for the menace it is.

…doctors can’t suspect what they have not heard about.

So for all the improvements in funding we have seen in recent years, we have to do more. Grants run out and have to be replaced. Much research that we need to do goes unfunded because we can’t afford to fund everything that needs funding. And awareness campaigns for both doctors and the general public need not just planning, but the resources to carry them forward. For all the problems we have solved in the NET cancer community, this one remains very much on my mind.

 

 

Birthday takes me back seven years

awareness, Death, Grief, Jane, NET Cancer Awareness Day/Month, Uncategorized
Today would have been Jane's 63rd birthday. Seven years ago, she was recovering from heart surgery.
Today would have been Jane’s 63rd birthday. Seven years ago, she was recovering from heart surgery.

Jane’s birthday present

“I got a new heart for my birthday.” Jane said that cheerfully seven years ago today. She had gotten out of bed, briefly, for a short walk down the hall. She’d begun doing other pieces of physical therapy. We were preparing to move her to the step-down unit as soon as they had a bed for her. They’d taken off the monitors as part of that preparation. It was truly a happy birthday for both of us.

…especially on her birthday.

Then the shift changed and the new nurse started doing her review of Jane’s condition. Jane’s blood-oxygen level had dropped into the upper 80s. Jane went back on oxygen, but the numbers refused to budge. Then they fell into the low 80s. They took Jane to another building for a scan in the wee hours of the next morning. I never got back to my hotel room that night.

Birthday night drama

None of us realized until weeks later this may have been the first of the carcinoid crises that would eventually kill her. We thought the problem came from a lung that hadn’t fully re-inflated after the surgery. Jane would spend many hours strapped into a CPAP mask over the next couple of days. She hated the mask. She was claustrophobic to begin with. Life in that mask was a hateful struggle.

I got a new heart for my birthday.

This was not the first complication in the replacement of the valves in the right side of Jane’s heart. Two days before a 4-6 hour operation had turned into 10 hours. First, they’d had difficulty placing the central line because Jane was so dehydrated her veins just didn’t take well to the needles. Then, in mid-operation, they’d discovered the damage to her heart was much more extensive than anyone had imagined. The surgeon had to build a new seat for one of the valves.

Two days before Jane’s birthday

I’d sat in the heart surgery waiting area as doctor after doctor came in to speak to other patients’ loved ones. At one point, I went for a walk down Tremont Street to Mission Hill Church. Senator Ted Kennedy had made a similar trek every day when his son was in the hospital fighting his cancer. Kennedy’s own funeral was held there years later–and Jane and I had watched it on television.

Life in that mask was a hateful struggle.

In college, I’d lived in that neighborhood. I’d watched the sun rise from a small park next two the church on many mornings. That afternoon, I sat in that same space for a time. Then I went inside and sat in a pew at the back of the church. Someone walked the Stations of the Cross as I sat there. I’m not Catholic–not even traditionally Christian. But the arches and the stained glass and the silence eased me marginally.

Into darkness

I walked back to the hospital, hoping for some news. There was none to speak of–just that the surgery continued. The people at the desk were supportive. They’d seen this all before–knew and understood my anxiety. Slowly, the room emptied out until I was the only person besides the person on the desk still there. At 8 p.m., they closed that area. I went to the lobby outside the ICU and let the nurses know I was there. Periodically, they gave me what bits of news they had.

In college, I’d lived in that neighborhood.

I tried to watch some television. It was just noise. Most of the time I stood at the window, looking out over the area I had once called home–and pacing back and forth, trying to burn off the nervous energy. I did that a lot in the weeks that followed when I couldn’t be with Jane for one reason or another.

Home by Christmas

Eventually, they told me Jane was in a recovery room and would be upstairs in a couple of hours. I called her father and sister to let them know, then settled in to wait for the surgeon. The surgeon came up about 11:30. He told me about the damage to her heart, the problems with her dehydration. But the surgery had gone well, despite that. He expected her recovery would go as planned–slow, but ultimately, she’d be home by Christmas.

I walked back to the hospital…

They let me see her about an hour later. They try to prepare you for what you will see. People sometimes pass out when they see someone like that. The paleness alone is difficult. There are lines and wires everywhere and you can’t touch the person you most love in all the world despite knowing how much you need to hug them–to let them know you are physically there and not just a disembodied voice in their dreams.

Back to the present

Wednesday, I had meetings with people at Dana-Farber, Jane’s oncologist, Jen Chan, among them. I had a meeting with people from the Jimmy Fund Walk in the morning. Then I went into Kenmore Square for lunch. I walked back to DFCI afterward for my meeting with the 3-in-3 committee. I was early, so I walked out to Mission Hill Church. They were in the middle of a service, so I didn’t go in.

…she’d be home by Christmas.

I walked back, going down the long main corridor at Brigham and Women’s Hospital, as I had during every day of Jane’s time there. It dawned on me only then I was retracing my steps on that day seven years before. My conscious mind was focused on meetings and the work in front of me. My subconscious was busy reliving the events that started me on this path.

Birthday memories

After the afternoon meeting, I walked back to the heart clinic building. I took the elevator to the sixth floor ICU. I stood, once again, in front of those windows. I looked out at the lights on Mission Hill. And I remembered the young man who once lived there. I remembered the older man waiting for news about his wife. I saw the face of the person I’ve become–and saw the work that remains for me to do.

…I walked out to Mission Hill Church.

Jane could have died that day seven years ago. She could have died from that first crisis the night of her birthday. I could have let her die when the second crisis took her down the following Monday. Sometimes, I think I should have. Sometimes, I think she would have liked any of those options better. The thought still haunts my sleep.

Contemplating different paths

I would be different today. I might be doing other things. Perhaps I would sleep better. Perhaps not. The events that followed shaped more than my life, though. They helped shape the lives of others as well–doctors, nurses, caregivers, patients. New knowledge emerged from those events–new alliances, new friendships, new ideas, new focuses, new procedures, as well.

The thought still haunts my sleep.

Jane’s death and the manner of it made a difference in the lives of others, just as her life had. But I miss her–and the loss still hurts–especially on her birthday.

 

 

 

 

 

Public awareness key to increased funding

awareness, Fundraising, NET Cancer Awareness Day/Month
Most people on our Jimmy Fund Walk teams rely on small donors to reach their minimum $300 goal. Finding those donors helps increase public awareness of the disease.
Most people on our Jimmy Fund Walk teams rely on small donors to reach their minimum $300 goal. Finding those donors helps increase public awareness of the disease.

Public awareness strategies key

I spent yesterday in Boston in a variety of meetings about NET cancer fundraising and awareness. My morning meeting involved discussions about a potential NET cancer awareness event in the city sometime this spring. We talked about both an awareness walk and doing a series of “table” events in various locations in various cities with an eye toward reaching out the general public about the disease.

We need to do a better job…

While we’ve made too little progress on educating primary care doctors about NET cancer, we’ve done an even poorer job of reaching the general public. Some would argue that awareness doesn’t matter very much. I have to disagree, for two reasons.

Not as rare as we thought

First, NET cancer is not the insanely rare disease we thought it was even ten years ago. It has not yet achieved the level of a public health crisis–and likely won’t. But we’ve seen explosive growth in diagnoses over the last six years–an increase of about 2000 cases very year from 2010 to 2016–the last year for which we have statistics.

…reaching out the general public about the disease.

In 2010, we diagnosed about 10,000 cases in the US. By 2016 that number had swollen to 21-22,000 cases a year. In 2010, we had about 105,000 people living with a NET cancer diagnosis in the US. Today, that number tops 171,000. The number of people with the disease who have not had a NET cancer diagnosis yet is a matter of debate. Some doctors, privately, talk about 250,000 additional cases. Others, again privately, put the number far higher than that.

Implications of larger numbers

What we do know is even the small improvements in PCP awareness combined with the arrival of the Gallium-68 scan have unveiled a substantial number of new cases. We are closing in on the kinds of numbers that will end NET cancer’s legal status as a rare disease–as a true zebra. Much NET cancer funding is tied to that status.

…not the insanely rare disease we thought…

If NET cancer is, as appears increasingly likely, a significantly more widespread form of cancer than previously believed, people in the general population need to be made more aware of that fact. To do otherwise would be immoral. People in general need to know the symptoms the way they know what to look for to catch breast cancer at an early stage. Early diagnosis is critically important with any cancer. Public knowledge and awareness increases the chance of early diagnosis.

Solving the funding riddle

The second reason we need greater public awareness has to do with funding. We are currently too reliant on major private donors–those who give over $20,000 a year. One-third of the funding for basic research over the last two years has come from a single grant. When that grant ends in 2018, my understanding is that money is gone. There is no renewal option beyond that. We’ll need to find a way to replace that money or watch research funding–and research–shrink.

People in general need to know the symptoms…

About 20 percent of the money raised by 3-in-3: The Campaign to Cure NET Cancer, the funding campaign I chair for the Dana-Farber Cancer Institute’s NET cancer program, comes from small donors. We know we can count on that money year-in-and-year-out. The other 80 percent comes from major donors. The loss of a single smaller donor is generally fairly easy to replace. The loss of a single major donor can mean an entire line of research dies for lack of funds. The addition of a major donor can open an entirely new line of research.

Every donor matters

We need to keep major donors in the mix–honestly, we need to keep adding them. But we need to do more to cultivate the small and medium size donors more than we currently do. People don’t–can’t–donate to causes and diseases they have never heard of. They don’t donate to things they don’t feel a connection to. Nor do they encourage government and institutional spending on those things.

We’ll need to find a way to replace that money…

We need to do a better job of reaching out to the public at large about NET cancer. We need to do so for the sake of their health. But we also need to do so for the research funding they can help supply.

 

Landscape has not changed enough

awareness, Goals, NET Cancer Awareness Day/Month
Changing the landscape of NET cancer awareness among the general public is one reason I do craft fairs. Reaching out to primary care doctors has proven a more difficult task. Wow need to reach them.
Changing the landscape of NET cancer awareness among the general public is one reason I do craft fairs. Reaching out to primary care doctors has proven a more difficult task. We need to reach them.

Brighter landscape in many areas

The NET cancer landscape has changed dramatically since 2010, as I wrote earlier this month. Patients who came to this disease before that year no doubt have seen even larger changes. But newer patients may well look back seven years from now and see today as just as bleak as we saw the date of our own or our loved ones diagnosis.

That still needs to change…

To a large extent, even the name of the disease has undergone significant change in recent years. When Jane was diagnosed, everyone seemed to talk about it as carcinoid cancer. Carcinoid meant “cancer-like” and many doctors took that literally. They called it a good cancer too have. They did not mean that cruelly. They’d never really seen it. They didn’t understand it.

PCP landscape still dark

Too many primary care doctors still see it that way. Too few doctors remember it from medical school. Many did not hear of it even in passing then. And even those who have heard of it too often think of it as a form of cancer so rare there is no point to testing for it. Worse, the idea of it as a “good” form of cancer to have persists.

They did not mean that cruelly.

People say basal cell skin cancer is a good cancer to get. I used to think so, too. My dermatologist freezes some off my face every six months. A decade ago, I had Mohs Surgery to remove a more troublesome spot. I went back to work the next day. Basal cell skin cancer isn’t generally life-threatening. It’s easy to cure. But in early August I had another round of Mohs Surgery. It’s mid-November and I’m still recovering.

A patient’s daily landscape

There is no “good” form of cancer. Not all cancers end in death, but every cancer changes life as we know it. My skin cancer forced me to face a variety of issues–gave me a small taste of a future I don’t like. For weeks, everything I did was a struggle. The fog of mourning deepened in enforced inactivity. I’ll be months regaining the endurance and strength I’ve lost.

Too many primary care doctors still see it that way.

And this is a picnic compared to what Jane went through–to what every NET cancer patient goes through. Diarrhea, insomnia, flushing, sudden mood shifts form the daily routine of NET cancer patients. The constant diarrhea alone strips patients of protein, vitamins, minerals–every nutrient the body needs–and leaves them in an endless state of at least marginal–and often serious–dehydration. It annihilates quality of life on its journey to destroying life.

Not that rare in the total landscape

Nor is this the rare disease many doctors think. We diagnose 5-7 times more NET cancer patients a year than we do MS or Cystic Fibrosis, two of the better-known “rare” diseases. More patients diagnosed with NET cancer live in the US than those diagnosed with all forms of malignant brain cancer combined. Among all the forms of gastrointestinal cancer, NET cancer patients outnumber every other individual form but colon cancer.

There is no ‘good’ form of cancer.

Brain cancer, pancreatic cancer and those other gastrointestinal cancer kill more quickly than the average NET cancer. The comparative longevity of NET cancer patients builds up the number of those living with NET cancer beyond those of the cancers that kill more quickly. But mere longevity means nothing without good quality of life. When even a trip to grocery store requires knowing exactly where the bathroom in every store is, there is nothing good to be said for the quality of that life.

Changing the landscape

We have significantly more research funding than we did seven years ago. The support system for patients has changed with the creation of more than 20 online support groups. Those groups cover everything from what to eat to surgery, from emotional to informational support. There are even groups that support specific types of NET cancer. We have new drugs, new treatments, new diagnostic tools, and more new ideas in the pipeline than at any point in the history of the disease.

…mere longevity means nothing…

But the general medical awareness and understanding  piece of the NET cancer landscape has not changed enough over the last seven years. No patient should ever hear any variation of the words, “You have a good form of cancer.” They should never hear, “You don’t really have cancer.” And they should never hear, “I’ve never heard of this type of cancer before.” That still needs to change if we are going to change the NET cancer reality.

Walk idea needs volunteers to work

awareness, Boston Marathon Jimmy Fund Walk, Fundraising, Goals, NET Cancer Awareness Day/Month

 

Raising awareness--or money--requires effort from everyone affected by carcinoid/NETs. We all have to take the lead in our local areas. An awareness walk in Boston seems a good next step.
Raising awareness–or money–requires an effort from everyone affected by carcinoid/NETs. We all have to take the lead in our local areas. An awareness walk in Boston seems a good next step.

A simple idea

Gordy Klatt had a simple idea in 1985. He was a doctor who’d seen one too many cancer deaths to sit on the sidelines. So he went to a track in Tacoma, Washington and started to run. He ran and walked for 24 hours. Friends and family supported him from the sidelines as he garnered pledges to the tune of $27,000.

…it is a puzzle we need to put together.

Somewhere in that 24 hours, the germ of the idea for Relay for Life was born: teams walking a track and raising money and awareness for the cancer cause. The American Cancer Society built a fundraising powerhouse from that idea–and arguably spawned hundreds, if not thousands, of team-based fundraising walks.

The walks we take

My friends and I participate in many walks over the course of the year. We do the local Relay, the Greater Boston Walk for Hunger, local walks for MS, Cystic Fibrosis, and scholarships, and, of course, the Boston Marathon Jimmy Fund Walk, the capstone of our year. This year, we tried to add the Pan Mass Challenge biking event–with limited success.

Gordy Klatt had a simple idea…

For most of those walks, we walk as Walking with Jane. But we do the Jimmy Fund Walk as the NETwalkers Alliance. That team is part of the second most successful Jimmy Fund Walk Group, #cureNETcancernow. Our bike team this year called itself the NETriders Alliance. Whether that name stays remains to be seen.

The walk we don’t have

What we don’t have is a NET cancer specific walk. Such walks–and even runs–do exist, but they are hardly as ubiquitous as walks for MS or Cystic Fibrosis, let alone Relay for Life. The closest such walk I know of is in New York. That’s a bit longer drive than I want to undertake for a 5k walk.

My friends and I participate in many walks…

The idea for a NET cancer awareness walk in Boston has kicked around the inside of my brain for a couple of years. Wednesday morning, if all goes as planned, I’ll pitch that idea to some of the people who run the Jimmy Fund Walk. I’ll seek their guidance and support for the project.

We need help

I know one of the first things they’ll ask is how many local volunteers we can get for the project. We’ll need people to help plan the route, figure out where to put support stations, and deal with local government to get permits and police. We’ll need day-of volunteers as well as people to work on the steering committee.

I know some day this spring or summer, I’m going for a walk in Boston to raise NET cancer awareness. I don’t want to plan that walk alone. And I don’t want to walk it alone. If you are in the Boston area, we need your help. Consider your markers called in.

Raising the stakes

This represents just one of many steps in putting NET cancer in the national consciousness. We need the average person to know NET cancer exists at the same level they know that brain cancer or ovarian cancer or cervical cancer exists. We need people to know it exists the same way they know MS or ALS exists.

There are many pieces to that puzzle–and this is just one of those pieces. But it is a puzzle we need to put together. Recent advances show this cancer affects many more people than we imagined just seven years ago. Without broader awareness in the general population we will never have the resources to help change the lives even of current patients.

 

I hate one day in every month

awareness, Caregiving, Goals, Grief, Jane, NET Cancer Awareness Day/Month
I hate the reason this memorial garden exists. But it gives me a place to sit and remember my wife and who she was.
I hate the reason this memorial garden exists. But it gives me a place to sit and remember my wife and who she was.

Days that hurt

I hate the tenth day of the month–any month. But I especially hate November 10 and December 10. I hate the fact November 10 is Worldwide NET Cancer Awareness Day. I don’t want to, but it falls on the tenth of the month and that day has a double sacredness to me in November.

…I love the possibility NET Cancer Day helps create.

Today is the monthly anniversary of Jane’ death. It also marks the seventh anniversary of the last even remotely normal day of my life. Worse, this year, it stands one month away from the seven-year anniversary of Jane’s death for a man whose life runs in sevens, not decades.

The last sane day

Seven years ago today, Jane and I went to bed early. The next morning, we faced the difficult rush-hour drive into Boston to Dana-Farber. We’d see Jen Chan, Jane’s oncologist, get another round of blood tests, wait for the monthly Sandostatin shot to thaw out, get that injection done, see a dietician. It was supposed to be a routine day. It wasn’t.

…that day has a double sacredness to me…

There was trouble with the blood draw because they couldn’t find a vein that would work. Jen was concerned about the build-up of fluids in the abdomen. The meeting with the dietician went well, but then we discovered Jane was leaking a clear fluid from the injection site. When we got home, for the first time, I had to carry Jane up the stairs. That had never happened before.

The beginning of the end

The next morning, Jane’s heart surgeon called. He wanted to move the surgery to replace the valves in the right side of her heart to Monday. They’d been damaged by the cancer. We’d planned to do that surgery after the holidays. Now…

It was supposed to be a routine day.

Saturday, we had that long conversation everyone needs to have. We did it once a year in January. This was an extra one–a more difficult one–the real one no one really wants to have. But we both stayed optimistic. This was a precaution–not a good-bye.

Sudden decline

Sunday, I had to help her off the toilet. That had never happened before. We arrived at Brigham and Women’s Hospital that afternoon. She didn’t have it in her to walk to admitting. I pushed her wheelchair to the desk on her floor and to her room. I can’t describe how that felt–how it feels, even now. She had always refused a wheelchair before.

But we both stayed optimistic.

Monday, they took her into surgery about noon. Part of me wishes she’d died on the table. She could have. The heart was more damaged than they expected. The brilliance of her surgeon saved her. But six hours of surgery became 11. I got to see her after midnight–unconscious and with tubes and wires flowing everywhere.

Aftermath

I loved her and I fought for her. And then I let her die. I planned the funeral she refused to believe she’d need. I buried her and settled her affairs. I stayed strong for her family and our students. Two months later, I started to cry. I haven’t really stopped since.

Sunday, I had to help her off the toilet.

But everyone else had moved on. They thought I had, too. No one saw the tears. No one saw me walk into the grocery store and start shaking. No one saw me walk out the door. I worked as I always had–though not as efficiently. I wandered the house aimlessly. I didn’t sleep. But slowly, I learned to cope, if not to heal.

Seven years in solitary

I understand solitary confinement. Every widow and widower does. You go from constant human contact to almost none in an instant. You join support groups, have coffee and meals with friends and children. But at the end of the day, you come home to an empty house filled with silence and memory. For all that you fill your life with other people and other things, a part of you no longer exists.

No one saw the tears.

Something has changed in you and you can never go back. You can only live with it and keep moving forward. So you change grocery stores, go to different restaurants. You paint rooms and redecorate. Sometimes, you move. You find work that has meaning for you. You cope–but sometimes–even years later–you just cry for no better reason than it hurts too much not to.

A day of hate–a day of love

November 10 marks the last sane day of my life. It marks, too, the last day I could–if even for a minute–pretend  NET cancer wouldn’t prove the end of our life together. I wish NET Cancer Day fell on any other day of the year–and I’m glad that it doesn’t. In a very real sense, for me, it falls on the perfect day–a day of remembrance that lets me fight back.

…a part of you no longer exists.

I hate that other people face what Jane faced. I hate that we don’t have a cure. And I hate the idea that too many other spouses face the same solitary life I live if nothing changes. But I love the possibility NET Cancer Day helps create. It helps me deal with the second worst day in my year.

 

Chemistry between patient and doctor matters

awareness, Caregiving, Jane, NET Cancer Awareness Day/Month
Jane taught chemistry, physics and biology at the end off her career. Seeing the meeting of Jane and Jen was watching a confluence of all three disciplines in a single second.
Jane taught chemistry, physics and biology at the end of her career. Seeing the meeting of Jane and Jen was watching a confluence of all three disciplines in a single second.

Matters of taste

My friend John and I had very different taste in doctors. Two years before I met my dermatologist, John had an appointment with him. After the appointment, John called him a cold fish with no personality. He knew his stuff, he said, but there was no chemistry between them.

It took Jane three tries…

My primary care doctor sent me to see the same dermatologist for a spot on my face. I went to that appointment with an open mind–knowing John and I were different people. The doctor and I hit it off immediately. We’d both been serious runners in our youth and still ran recreationally. Our appointments always end with us catching up a little.

Individual judgements

Jane went into the hospital for a blood clot that may have been related to her cancer the same day we learned about her NET cancer. An oncologist met with us while she was there. When he left, Jane’s reaction was, “Not him.” The man was as knowledgeable about NET as most oncologists were at the time–which is to say he didn’t know very much beyond what he’d read. But Jane found his tone offensive and his manner abrasive. I’ve since known other patients who liked him just fine.

The doctor and I hit it off immediately.

A week later, we met with another oncologist from the same office. She, too, had very little knowledge of NET cancer beyond what she’d read. But she and Jane hit it off well. She referred us to Dana-Farber for a consult that turned into Jane being treated there. But if that hadn’t happened, Jane really liked that second local doctor a great deal. The chemistry worked.

Powerful chemistry

Matt Kulke, the head of the NET cancer program at DFCI, was out of the country at the time. We went to see Jen Chan instead. I watched two long-lost sisters meeting for the first time when Jen walked through the door. That encounter was a confluence of chemistry, biology, and physics in a single second.

The chemistry worked.

I’ve heard wonderful things about Matt as a doctor and a person from his patients over the years. I’ve worked with him on committees, gone on walks with him, had dinner with him. I’d take him as my doctor in a heartbeat–as I would Jen. But given the instantaneous chemistry between them, for Jane, Jen was the better choice.

Why the relationship matters

Especially with a disease like NET cancer, having a knowledgeable doctor is not really enough. The personal relationship matters. Patients need a doctor they are comfortable talking with about diarrhea episodes and other uncomfortably intimate matters. Sometimes, the only way a doctor can know what is really going on with a patient comes out of those kinds of conversations. It informs treatment just as much as knowledge of the treatments does.

…a confluence of chemistry, biology, and physics in a single second.

But the chemistry that exists between any particular doctor and any particular patient does not provide an indicator  of the chemistry between that doctor and any other patient. Nor does it help describe the chemistry between that patient and some other doctor. Each case is different. The doctor I like, you may hate; and the doctor I can’t stand, you may love.

Each relationship is different

I’ve met a significant number of NET cancer specialists over the last seven years. Some, I’ve immediately hit it off with. Others, not so much. But they’ve all had two things in common. First, they all were really knowledgeable about NET cancer, though all have more expertise in some forms of the disease than they do in others.  Second, they all have patients who love and respect them who say they have the best doctor they could ask for.

The personal relationship matters.

And they do. Knowledge matters. So does being comfortable with your doctor. But just because a particular doctor is right for you, doesn’t mean that doctor is perfect for everyone. And just because you don’t get along well with a particular doctor, doesn’t mean they are wrong for everyone else.

Are you comfortable?

It took me four tries to find the right cardiologist for me. I like him so much, I made him my primary care doctor, as well. Those other doctors were just as knowledgeable, but I never felt quite comfortable talking to them. I have friends who like them fine. It took Jane three tries to find the perfect oncologist for her. The others were fine doctors, just not the right people for Jane.

…they have the best doctor they could ask for.

Like the elements in the Periodic Table, we are all different–and we all react to each other in very different ways. We all need to keep that in mind while we search for the right doctor for us–as well as after we’ve found them.

Specialist shortage issue for NET patients

awareness, Goals, NET Cancer Awareness Day/Month
Becoming a NET cancer specialist who meets the Carcinoid Cancer Foundation's criteria is tough. Kim Perez works with NET cancer patients at DFCI. She isn't listed at CCF, yet. But she will be.
Becoming a NET cancer specialist who meets the Carcinoid Cancer Foundation’s criteria is tough. Kim Perez works with NET cancer patients at DFCI. She isn’t listed at CCF, yet. We need more young doctors like her to choose NET.

See a specialist

Veteran NET cancer patients and advocates in support groups constantly tell new NET cancer patients they need to see a NET cancer specialist. We also frequently tell them going to an NCI cancer center with a formal NET cancer program that offers a team approach should be a priority as well. Advanced NET cancer treatments can involve not only an oncologist, but a surgeon, a liver specialist, and a radiologist, as well as other doctors in a variety of specialties.

…there is a very real elephant in the room…

Finding a NET cancer specialist requires one click on the computer. The Carcinoid Cancer Foundation (CCF)  maintains a list of recognized specialists on its site. That list also includes non-specialists with a strong interest in NET cancer who work well with specialists, as well as cancer centers that meet their very strong criteria.

We have few specialists

That’s the good news. The bad news: the list of doctors, including the non-specialists in the US, has only about 100 names on it. Fifty-eight of those people meet the criteria CCF sets for specialists. They list only six NCI cancer centers with a NET cancer specialty.

…see a NET cancer specialist.

The criteria for being listed as a specialist are pretty stiff: 10-20+ years treating NET cancer patients; 10 NET cancer papers, authored or co-authored; a minimum of 100 patients treated. Some very good NET cancer doctors may not have the years or the papers or the patients yet to make the list of specialists. Some may even be among the 40+ other US doctors on the list with some NET cancer interest or experience. The list also includes overseas doctors by country.

What the numbers mean

But even if we include everyone on the US list as a specialist, those doctors would have to handle a caseload of more than 1700 patients a year. Cut the number back to the list of CCF recognized specialists and that number jumps to over 2900 patients for each doctor.

That’s the good news.

Simple truth: We don’t have anywhere near enough NET cancer doctors for the number of patients we have. In the best, insane, semi-workable scenario I could come up with–worst case, for doctors–a NET cancer doctor could handle a caseload of about 600. This assumes seeing patients five days a week, and an average of one visit per patient per month. It includes no time for research or detailed review of patient records. Nor does it include time to review research done by others or visits to patients in hospitals. I didn’t give them vacation time either. Even so two-thirds of patients would not get to see a NET specialist regularly–or at all.

Research reality

Reality is significantly different. Recommendations based on actual research argue for a patient load for oncologists of 250-350 patients per doctor per year. Given the nature of NET cancer, I’d argue the 250 is likely more reasonable than 350.

…over 2900 patients for each doctor.

Frankly then, we need at least six times as many NET cancer specialists as we currently have just to service current patient levels. Given the rapid growth of NET cancer cases since 2010, that situation will only likely get worse. I don’t know where to begin to look for the doctors we need to fill the current gap. I have even less idea how we fill the potential gap if doctors are right about the possibility of 250,000 undiagnosed cases currently in the US. I don’t want to think about my own private worst case scenario.

NET cancer centers?

The situation for NET cancer centers may be even worse. If every NET cancer patient went to one of those six listed NCI cancer centers to seek treatment, they’d face a sea of more than 28,000 individual patients. Each center would require 100 or more NET cancer specialists or specialists-in-training, depending on what we decide is a reasonable caseload. And never mind the number of other specialists we’d need to support a team approach.

…we need at least six times as many NET cancer specialists…

The number of specialists required to staff a NET cancer department for one of those six centers would require nearly four times the total number of doctors in the Dana-Farber Cancer Institute’s entire gastrointestinal cancer department. I know there are other NCI centers with NET cancer programs that are not included on the CCF list. But even doubling their list–or tripling it–still makes for an unmanageable situation.

Problems for patients

Nor do I want to think about the travel hardships many patients would–and do–face to get there. Commutes of 800 miles or more are not uncommon among patients seeking cancer centers now. When urgent diarrhea comes in the middle of such a trip… Jane and I only traveled the 60 miles to Boston and back and frequently had this issue.

…a sea of more than 28,000 individual patients.

Patients need less distance to travel. We need to create many more NET cancer programs at NCI cancer centers within convenient driving distance for patients. But we don’t have the specialists to do that any more than we have the numbers to fully staff the number we have.

What do we do with this elephant?

Many of us are rightly focused on doing the basic scientific research and finding and testing treatments. Others, also rightly, concentrate their efforts on educating doctors, patients and caregivers. Still others work diligently to find the money to fund those things, also a real necessity.

Patients need less distance to travel.

But there is a very real elephant in the room we need to consider as well. Knowledgeable NET cancer doctors, nurses and medical centers are in critically short supply. Given the rapid growth in the patient population, it is a problem we must address–and quickly.