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Archive for November, 2013

I Give a Crap…..

November 27, 2013 7 comments

BBC_logo_small

Beat Bowel Cancer Aotearoa (BBCA) is an organisation dedicated to raising the awareness of bowel cancer. A few years ago I was asked to be an ambassador for them to help them raise the profile of bowel cancer in NZ  as it is one of our biggest killers. Breast and prostate are the fashionable cancers that celebrities get (although no cancer is actually fashionable) and people like to wear ribbons or grow moustaches to raise awareness for. Bowel cancer is a bigger killer than both of them combined and slides under the radar forgotten.

Leading up to Christmas this year, BBCA has launched the ‘I give a crap’ campaign that they hope will get spread via social media and the likes to help raise awareness of bowel cancer. The idea is to help people realise that if you actually catch it early by knowing what symptoms to look for, you can beat this disease. As part of this campaign, BBCA has put two videos together, which you can see here. See if you can spot me in one of them. 🙂

Help raise awareness of this cancer in NZ which only has a 55% survival rate (at 5 years) when compared to 75% in the OECD. Its easy to talk about bowel habits if you give a crap.

I give a crap this Christmas*….

*I probably recorded that line about 20 times till I had it nailed… ahh showbiz..

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The Next Phase

November 25, 2013 15 comments

Yesterday I sent an email to some of my work colleagues that have made significant contributions to my career over the past three years. The email is as follows:

I have addressed this email to those who have been instrumental in my medical care over the past few years, and those who have been instrumental in supporting me professionally as I have navigated the first three years of juggling my work as a Junior Doctor juxtaposed against my role as a patient.  

Most of you have probably read in the media about the latest developments in my health and my expectant fatherhood in January, but I wanted to personally inform you about where things are at, as well as extending my heartfelt gratitude for your contribution to my short lived career. 
 
Two weeks ago I made the incredibly difficult decision to take indefinite leave from my job. As you will likely be aware, I have had aggressive recurrence of disease in my liver between my two most recent CT scans (between which I had 25 fractions of 45 gray radiation to retroperitoneal disease). This has necessitated starting a new regime consisting of agents I have had previously (FOLFOX), and the not-publicly-available monoclonal antibody Bevacizumab. I have completed two rounds of this, and it has resulted in the almost inverse of my well:non-well time ratio. 
 
Previously on FOLFIRI, for which I completed 66 rounds, I usually found I had 5 days of downtime and 9 days of up time each fortnight. This has enabled me over the years to continue with my medical studies and graduate, and then to complete 3 years as a house officer. I now find that on this new regime my unwell time has extended to close to 8 days, with only 5-6 days of being well each fortnight. I have also found that during my well time, I do not have the same level of energy I once had. After much reflection, I realised that it wasn’t fair on my colleagues and my patients for me to keep working when my attendance was so infrequent, and I wasn’t able to give the 150% that the job deserves and that I want to give. It was a heart breaking decision as I had also been offered a General Surgical Registrar position starting this December, and this for me was the job I was born to do. I now feel that I have entered the next phase of my illness and only time and the next CT scan will reveal its exact course. 
 
I wanted to send this email because there have been many many people to whom I am so incredibly grateful for their contribution to either my medical care or my professional career. These people consist of surgeons who have operated on me, and those I have operated alongside; those who have treated me clinically; colleagues I have worked alongside; and referees that have helped enable me to be offered the job that ultimately I will never start. The journey over the past 5 years since my initial diagnosis has been difficult, but to be able to continue to study and then work in an area I am so passionate about has, I am certain, enabled me to survive longer that anyone could have predicted. 
 
There is no doubt I am a statistical outlier, and perhaps we will never know why, but my hope is that I might continue to be one. The decision to take indefinite leave rather than resigning was with the faint hope that maybe one day I might step back into the role of the Doctor, but all things being equal, I feel that I have likely treated my last patient. 
 
We are all dealt different cards in our lives, and I want to thank you all from the bottom of my heart as you have helped me play my hand the best way I know how. 
 
Humbly grateful, 
 
Jared. 

The decision to stop working has been one of the hardest decisions of my life. For me my medical career wasn’t just a passion, it was a choice of vocation that goes to the core of who I am. It was a God-inspired decision to go to medical school, and I believe, a God-given strength to be able to finish, qualify and work whilst being treated with chemotherapy. What tipped the scale to stepping down was the realisation that as a patient, I would want a Doctor that could give more than I can currently give with my new treatment.

That realisation led me to tears….

This feels like the beginning of the end, the down hill slide to the bottom.

I will still persevere though, I will maintain my practicing certificate and I will reconsider this decision should the circumstance allow it. For now though, I need to focus on the next phase of my life. The next CT scan will help determine what that next phase will look like, but the one certainty that remains is chemotherapy and a probable slow deterioration in health.

The key thing for me is to do this well. All of us are eventually heading to the grave, and whilst I will be there sooner than most, I have the chance to make that journey the best it can be.  

Until next time…

Categories: Blog

FOLFOX + Avastin 1.0

November 5, 2013 16 comments

As I settle into the aftermath of the whirlwind of generosity expressed a few weeks ago, I still am at a loss to express my gratitude at both the number of people who donated and the amount that was given. It has facilitated the next step in my treatment, which has paradoxically left me feeling pretty miserable in amongst a real sense that other people, both those we know and don’t, are journeying with us and supporting us.

I always remembered my treatment from the first line therapy with oxaliplatin 5 years ago with disdain. It is a chemotherapy agent that takes sometime to recover from and I am still feeling the effects of it now one week on. On the day of the infusion, I actually felt really good. There was a sense that maybe this treatment wasn’t as bad as I remember it. On the second day I got hit with hiccups. A benign common occurrence can become a tormentor when you endure 8 hours of unrelenting hiccuping. You cannot sleep, your muscles and chest become sore, and you just exhaust yourself. Hiccups are largely a manifestation of nausea, and can result from irritation from the diaphragm as well. These hiccups won’t succumb to any remedy that I know of, and I have tried a lot, you just have to wait them out. When finally they relented, I was able to sleep.

My sleep was then interrupted by what seems to be the next of the side effects, this time from Avastin. Supposedly it can cause tumour pain, although I’m not entirely clear on the mechanism, and this was what would wake me at three in the morning. Fortunately it was able to be relieved with some potent pain relief, but the paroxysms did persist for a few days.

Finally, the biggest of the side effects I have had to battle with over the past week has been extreme fatigue. Its a sense where no matter how much sleep you get, you just don’t feel refreshed. This has been what has stopped me from getting back to work on Monday as I had planned, but hopefully tomorrow, two days later, I will be able to do so.

So all in all it has been a rough 7 days. I guess it was to be expected but that doesn’t make living through it any more pleasant. Fortunately I move on to the well phase now between cycles and resume normality as much as I can. I suspect the next few weeks of life will involve some significant decisions on my behalf with regards to work and planning exactly how Hannah and I want the next few months of our lives to play out.

Until next time…