“Fierce, empowered… and less alone”: A 32-year-old cancer patient reflects on her new film

Posted January 11, 2018 by Jennifer Huber
Categories: Health

Tags: ,

Photo by Kerith Lemon Productions of writer Becky Hall, left, and director Kerith Lemon.

As someone who battled against Hodgkin’s lymphoma when I was in my 20s, I can relate to Becky Hall, a young breast cancer patient at Stanford. I recently spoke with Hall about her cancer experiences and her short film, bare, which describes the night her friends shaved her head before starting chemotherapy.

When were you diagnosed with cancer?

“I was a 25-year-old graduate student in a veterinary program at UC Davis. I wanted to work with horses. I was a Stanford graduate and was all about school. Then I went for a run one Saturday and laid down on my chest to stretch — a stretch that I’ve done every day for years — and it felt like I was laying on a golf ball. The nurse at the health center said I was too young for breast cancer and didn’t have a family history so I didn’t need to worry, but she sent me to get a mammogram just to be 100 percent sure. I completely panicked, because that’s what I do. The mammogram showed lumps in my breast and lymph nodes, so they biopsied right then and everything spiraled. A week after I found the lump, I was a stage 3 breast cancer patient.

I couldn’t do such a demanding academic program during chemotherapy. So I dropped out of school and moved back in with my parents in Santa Cruz — really losing all my independence, privacy and social interactions for a year as I went through chemotherapy, surgery, radiation and biotherapies. I went into remission for about two years and then I found out my cancer had metastasized three weeks after my wedding. So I’m now a terminal, stage 4 patient. Since August 2014, I’ve been in continual treatment to keep up with and out smart my cancer.”

What was that like?

“Having cancer is always going to be traumatic and challenging, but there are additional challenges when you’re young. My 25-year-old friends were busy going out drinking, so we couldn’t relate to each other’s interests any more. And they didn’t have enough life experience and skills to cope with being a friend to someone with a major illness. So many of my friends just disappeared, because they didn’t know how to handle it. It was very isolating.

There was also the whole element of being single, because dating was terrifying after I’d been through breast cancer. I had a reconstructed breast. I had scars all over my body. I knew there was a chance that it was going to metastasize. And I had to explain all of this to someone.

And finally there was the fertility issue. I had cancer, and suddenly they ripped away this huge element of my life that I’d always envisioned for myself. When I was stage 3, I was hopeful and a little delusional, thinking that I’d still be able to have kids after chemo. When I was diagnosed stage 4, I was married to an amazing teacher who loves kids. On our honeymoon, we’d talked about how many kids we wanted and even about names. And then we got home and were told we could not have kids. And it just destroyed me. I would never be able to carry a child. Adoption is exceedingly difficult for someone with stage 4 disease, and surrogacy is pretty cost prohibitive. It’s just a whole other layer of heartbreak that cancer throws at a young woman.”

What motivated you to capture the experience of shaving your head in a short film?

“The idea of watching my hair fall out slowly was absolutely terrifying. And I was facing so many changes physically that I had no control over, but I could control when and how I lost my hair. It turned out shaving my head before chemo really helped me process some of my emotions and biggest fears — potentially dying, being unattractive, and losing a big part of my identity.

I wanted other women to feel what I felt when I looked in the mirror after shaving my head — fierce, empowered and like I could take on anything. I also wanted to help people feel less alone. In mainstream media, so many of the stories told about cancer are very rosy and falsely upbeat. I wanted to show a more honest slice of what it’s like — that you can be in the darkness, but you can emerge from it if friends are willing to just sit in the darkness with you. I also wanted to shed some light on metastatic disease and the disparities in research between early stage and late stage breast cancer.

Before the project, I felt like all I did was go to doctor appointments. The film reminded me that I’m still capable of creating and contributing. I co-wrote the script with my childhood friend Kerith Lemon and helped with the project while recovering from brain surgery and brain radiation — I’m really proud of that.”

Do you have any advice on living with cancer?

“When living with cancer, you’re constantly dealing with treatments and side effects. Everything is always up and down — one scan is good and the next is bad. It’s really, really draining. In an effort to help, people often encourage you to stay positive and upbeat. But my advice is to feel whatever you feel: sad, angry, scared or whatever.

It’s also important to find other metastatic cancer patients who understand on a deep level what you’re going through because they are going through it too. Find people to reach out to on those dark days, who can help you process and get through it when you’re ready.”

What are you doing now?

“I’m living in Santa Cruz with my husband and dog. In addition to being a full time cancer patient, I’m writing and getting involved in metastatic advocacy. My advocacy work started a couple of months ago after I participated in a panel during a screening of the film. I really enjoyed public speaking and talking about the needs of metastatic patients to a room full of people that can actually effect change. It felt like I found my purpose beyond just surviving cancer. And I give credit for this to the film.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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Living with cancer: A Q&A with comedian Fred Reiss

Posted January 4, 2018 by Jennifer Huber
Categories: Health

Tags: , ,

Photo by Ben Moon

Cancer isn’t what comes to mind when I think of stand-up comedy, but Fred Reiss may change that. A three-time cancer survivor, Reiss shares at Comedy Day 37 what it’s like to go for a follow-up PET scan to find out if your cancer is back, also joking that they found a computer chip in his neck and returned him to his original owner. I recently spoke with Reiss, who is also an inspirational wellness speaker and novelist, to learn more. 

When were you diagnosed and treated with cancer?

“I was diagnosed with testicular cancer when I was 28 in 1982. Then about 4 years ago, I was diagnosed again with testicular cancer and treated at Stanford — I should have gone for the 2-for-1 deal on testicular removal and saved myself some money. And then a year ago when going for a routine endoscope, I found out I had esophageal cancer. Fortunately Stanford caught it early, and it’s gone now with treatment. So I’ve had cancer three times. I guess I’ll keep on doing this until I get it right.

I started wearing boxing gloves to chemo during my second bout of testicular cancer. I thought of the scene in “Rocky” when he throws the first punch and knocks Apollo down in the first round. I kept thinking: I need to be in shape to throw that punch. I need to fight for my life. So I decided to wear boxing gloves. Why should I be self-conscious? And the first day, I had someone take a photo in a fighting stance with the gloves. The nurses loved that.”

Why do you do stand-up comedy?

“The genesis was when I was 28 with testicular cancer. I was lying there with an IV in my soft blue vein and I thought: If I’m here again, who will I be? Who will be lying in this bed? And I decided to move from the East Coast to California, go do stand-up comedy and write books.

Later, after I had cancer again, no one wanted to hire a two-time cancer survivor in his 50s to do comedy, radio, journalism, public relations or administration. I had to become Fred 2.0. So I thought, what do I have to say about going through all of this? And I headed back to the stage.

I started going to open mics to use the gravitas of my own mortality to help other people and explore myself. People in the audience wondered why I was there, because I’ve been on national TV, but you have to develop material at smaller clubs — the only way to find out if something works is by saying it. I’ve been on a billboard on Times Square to promote the film, “This is Living with Cancer.” That was the result of two to three years of going to open mics and working on material. I know I’m betraying myself if I don’t go out and perform. I’m betraying the person that I vowed to be.”

How did you become a cancer advocate?

“My cancer advocacy grew out of my suffering and watching other people suffering — it alters you. When I first had cancer, I went through self-actualization to figure out what I wanted to do. The second time, I thought about what I was going to do and what I’d done. And the third time, my ego was completely gone and I thought about other people.

So I decided to travel two tracks — comedy and cancer patient advocacy. I started doing “Fred talks” (my brand of motivational Ted-style talks) and speaking to hospital groups, offering myself to people. In comedy, the audience wants jokes. But if I’m speaking to groups, the audience wants to know how I feel; it’s enormously satisfying. If they can help me out financially when I speak, that’s great. But if they can’t afford it, I don’t mind speaking for free.

During my talks, I use jokes, personal anecdotes and photographs to tell my story of being diagnosed and at the end overcoming cancer. I stress how to draw on your personality, passion, humor and the character of your life to overcome it. I also give practical tips on how to reduce your suffering. My main message is that you can’t let cancer define you; you have to let the spirit that enabled you to overcome it be given to others to help them prevail over the disease too.

In that spirit, I still visit Stanford when I can, giving out my books, CDs and food. I can’t do it every day, but it’s a temple that I have to respect. It’s a way to pay homage and show that I haven’t forgotten the oncologists, nurses and all the people that made a difference. It’s not out of a sense of duty. These people did great things for me, so I’m trying to propel that toward the other people around me.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

New course highlights how surgeons can serve their communities

Posted December 29, 2017 by Jennifer Huber
Categories: Health, Science Education

Tags: , ,

Photo courtesy of Jecca Steinberg

Stanford medical students Jecca Steinberg and Paloma Marin-Nevarez want to spread the word that service-minded medical students can care for underserved communities by specializing in surgery. With the help of their mentor James Lau, MD, they have created an upcoming seminar series for medical students called “Service Through Surgery,” which showcases how surgeons can address health inequities.

Beginning in January, the new 10-week course will expose Stanford medical students to a diverse group of surgical leaders who are passionate about improving health equity through surgery. I connected with Steinberg, shown on the left in the photo, and Marin-Nevarez to learn more.

What inspired you to create the Service through Surgery seminar course?

Marin-Nevarez: “I emigrated from Mexico when I was 10 and settled in a low-income community in south Los Angeles. I never really considered myself disadvantaged until I went to college and experienced firsthand the shortcomings of my education system. Ever since, I knew I would make my life’s work to serve the underserved in communities like my own.

In my second year of medical school, I fell in love with surgery. However, when I thought about being a ‘community physician,’ I didn’t see how surgery would fit into that picture. The speakers in this course will show students with the same internal struggle as mine that they don’t need to compromise their values in order to pursue their dreams.”

What role can diversity play in overcoming health inequities?

Steinberg: “Low-income, minority communities continue to receive inadequate surgical services and bear unconscionable health burdens. Research has demonstrated that increasing diversity among physicians improves healthcare access and outcomes for traditionally disenfranchised communities, but surgery continues to trail behind other medical specialties in racial, socioeconomic and gender diversity. So the surgical workforce represents an underutilized resource for decreasing health inequities and improving the health of our communities.”

Marin-Nevarez: “A more diverse workforce leads to better outcomes for the underserved because minority patients are more likely to seek care from and be more comfortable with physicians from diverse backgrounds. And physicians from diverse backgrounds are more likely to treat patients of color in underserved communities.”

What causes surgery to be less diverse than other medical specialties?

Marin-Nevarez: “Because of unequal opportunities — especially for communities of color — surgeons are not as diverse as they should be. Because of this lack of diversity, there is a lack of mentorship that then perpetuates the cycle.

Mentorship can make a huge difference in recruiting people into a field. For example, James Lau, MD, is an amazing mentor — he was the first person to make me believe that being the first surgeon in my family may be an attainable goal. Those who ‘make it’ without mentorship most likely had access to extra resources or had to work much harder than their counterparts, or both.”

How will your seminar course inspire change?

Steinberg: “Our seminar course will create an opportunity for Stanford medical students to meet and form relationships with accomplished physicians who have combined their passions for diminishing inequities and surgery. It will show the incredible impact surgeons can make on their community. For example, Matias Bruzoni, MD, will talk about a Spanish clinic he created from scratch to improve the surgical experiences and outcomes of Spanish speaking patients. And Sherry Wren, MD, will provide her perspective on serving veterans domestically and populations around the world, exploring the adversity she faced in dedicating her career to social service.

When students connect with role models like these with a similar background and passions, they are more likely to follow in the trajectory of that role model and consider careers that might have previously seemed unattainable. We hope this seminar will provide that initial connection.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Nicotine patches and medications aren’t enough to quit smoking, a study finds

Posted December 26, 2017 by Jennifer Huber
Categories: Health

Tags: , ,

I’ve watched family members and friends struggle to quit smoking, using nicotine patches and prescription medications. For many, it continues to be an ongoing battle.

This struggle is common, according to a new study from the University of California, San Diego that shows using smoking cessation drugs alone may not improve your chances of successfully quitting. The researchers studied two patient groups — comparing patients who used medication aids to ones that did not — to evaluate the effectiveness of three frontline smoking cessation drugs. To learn more, I spoke with the lead author Eric Leas, PhD, who conducted the research as a graduate student at UC San Diego and is now a postdoc at Stanford School of Medicine.

What inspired you to study the effectiveness of smoking cessation drugs?

“There is a major public health need for smoking cessation aids. Tobacco use remains the primary cause of cancer and cancer mortality in the United States and quitting smoking is so difficult for many smokers. I have several close family members and friends who have had debilitating disease caused by smoking and who struggled for many years to quit.

Several randomized trials have shown that some pharmaceutical smoking cessation aids can double quit rates. However, in the early 2000s, post-market surveillance studies of these cessation aids suggested that the population effectiveness did not match the randomized trial results. This was a major surprise to the medical field and met with some opposition. A criticism of these surveillance studies was that the same individual factors that make quitting difficult are also related to self-selected use of pharmaceutical aids when trying to quit. For instance, heavier smokers are more likely to use a cessation aid and also less likely to successfully quit. In social science and medicine this bias is known as ‘confounding.’”

Why did you study two “matched” patient groups?

“In our analysis, we attempted to address confounding variables using a method known as ‘matching.’ The goal of matching is to make study comparison groups similar with respect to potential confounders. In addition to cigarette consumption, we matched sociodemographics such as age, sex, race-ethnicity and education; smoking characteristics such as previous quit history and nicotine dependence; self-efficacy in quitting and having a smoke-free home.”

What did your study find?

“Even after matching, we found no evidence that the pharmaceutical aids improved the likelihood of successful quitting. While understandable, this finding is disappointing considering the need for successful cessation aids.

One possible explanation is that in many of the cessation randomized trials, smokers received the drugs in combination with intensive behavioral support. This support is not typically provided in the population. Prescribing behavioral support along with these drugs may be needed — as our results suggest that administering the drugs on their own is not working.”

What are you working on now?

“In collaboration with other professors at the School of Medicine and Stanford Business School, I am currently extending this work by studying how different groups of smokers respond to smoking cessation treatments, with the goal of developing tailored treatment plans.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Kidney stones most likely affect residents of warm, wet regions

Posted December 20, 2017 by Jennifer Huber
Categories: Health

Tags: , ,

Photo by harryson

If you’ve ever had a kidney or bladder stone, you know how excruciating and debilitating it can be. The pain — typically felt in the abdomen, groin or back — is often severe enough to cause nausea and vomiting.

These stones are solid clumps of minerals and salts that form in the kidney or bladder when the urine becomes very concentrated, which allows minerals to crystalize and stick together. Factors that are known to increase the disease risk include genetic predisposition, dehydration, a high-salt diets and obesity.

A landmark study published in 1994 determined that where you live also affects your risk for stone disease. U.S. residents in the south and east have more stones than those in the west and north. What causes this geographic distribution? The answer is still unknown: weird, right?

One theory is that higher temperature is a risk factor, but Stanford urology resident Kai Dallas, MD, told me that temperature doesn’t fully explain the phenomena.

“If higher temperature alone was the primary driving factor, then the American Southwest should have an equally high prevalence rate to the Southeast. The fact that it does not suggests that there are additional factors at play,” explained Dallas.

So his research team explored a correlation between weather patterns and urinary stone prevalence in regions throughout California, by analyzing data on urinary stone operations from the California Office of Statewide Health Planning and Development and climate data from the National Oceanic and Atmospheric Administration.

Their study found that more urinary stone surgeries occurred in regions with more rain and higher temperatures. These results intrigued Dallas because they “explained an unanswered trend in the larger national trend.”

Further studies are needed to explore why exactly this association exists, but Dallas said the and his colleagues have a theory: “We hypothesize that the increased rate of stone burden in hot climates with higher precipitation could be related to the increased inefficiency of human body thermoregulation in wet heat verses dry heat. In other words sweating is less efficient in very humid hot conditions, causing further sweating and fluid loss. And dehydration has been shown to cause kidney stones.”

Dallas hopes their study results will lead to a greater understanding of the causes of stone disease and better appropriation of resources to areas where the population faces a higher risk. He also explained that their findings are particularly important in light of climate change:

“The Environmental Protection Agency predicts that global warming will increase global precipitation. In fact, in the contiguous 48 states, total annual precipitation has steadily increased 0.17 inches per decade since 1901. This means the whole United States climate will become hotter and wetter, which is exactly the climate patterns we found that places patients most at risk for kidney stone disease.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Few California pharmacists prescribe birth control, a study finds

Posted December 15, 2017 by Jennifer Huber
Categories: Health

Tags: , , ,

Photo by Anqa

It takes time and money to visit the doctor’s office to get birth control. This is particularly an issue for low-income women, those who live in rural areas and teenagers who feel uncomfortable seeing their family doctor.

So four states — California, Oregon, Colorado and New Mexico — are trying to make contraception cheaper and more readily available by allowing trained pharmacists to prescribe and dispense birth control pills, patches, injections and vaginal rings. However, pharmacists aren’t required to participate and few do, according to a new study.

University of California, Berkeley researchers investigated the availability and cost of pharmacist-prescribed contraception in California using a telephone audit survey of approximately 1000 community-based, retail pharmacies. Although randomly selected, most of the pharmacies were in urban areas and affiliated with retail chains, like CVS.

Posing as patients, they called the pharmacies and said, “I heard that you can get birth control from a pharmacy without a prescription from your doctor. Can I do that at your pharmacy?” If the answer was yes, then the researcher asked follow-up questions to identify the types of birth control available and the service fee.

The study found that pharmacy-prescribed birth control was available in only 11 percent of the surveyed pharmacies, with no availability differences between the rural or urban stores. They also determined that most participating pharmacies charged a service fee between $40 and $45.

“Our findings strongly suggest that more pharmacies need to offer this service to live up to the promise of widespread, easier access to birth control,” said lead author Anu Manchikanti Gómez, PhD, an assistant professor of social welfare at UC Berkeley, in a recent news release.

The authors noted that the current service fees may make birth control too expensive for some low-income women. They are hopeful this will improve once California’s Medicaid program starts reimbursing pharmacists for these services, which is required by July 2021.

They conclude the paper with a call for more research to identify the barriers to birth control accessibility.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Drug blocks Zika and other deadly viruses in cells cultures, Stanford study finds

Posted December 12, 2017 by Jennifer Huber
Categories: biology, Health

Tags: , ,

Photo of Jan Carette by Paul Sakuma

A team of Stanford researchers is developing approaches to thwart a family of deadly viruses, called flaviviruses, by targeting the human cells that host these invading pathogens.

Flaviviruses include the dengue-fever, yellow-fever, West Nile and Zika viruses transmitted to humans by mosquitoes, as well as encephalitis transmitted by ticks. Unfortunately, approved antiviral drugs for these diseases aren’t currently available.

So, instead of the traditional approach of attacking an individual virus directly, the researchers focused on the cellular factors of their human hosts that are essential to many viral infections.

“Generally, when you develop a drug against a specific protein in dengue virus, for instance, it won’t work for yellow fever or Zika, and you have to develop new antivirals for each,” said Stanford virologist Jan Carette, PhD, in a recent Stanford news release. “Here, by targeting the host rather than a specific virus, we’ve been able to take out multiple viruses at once.”

Earlier, the team genetically profiled human cells to identity the host factors necessary for the viruses to replicate inside the cells — revealing new candidate targets for antiviral drug development. Specifically, they demonstrated the importance of the oligosaccharyltransferase (OST) complex that attaches sugar molecules to proteins. They found flaviviruses did not infect their genetically engineered cells without OST.

In the new study, recently published in Cell Reports, the Stanford researchers collaborated with scientists at Yale University to test the effectiveness of a drug called NGI-1, which inhibits the activity of the OST complex.

They showed that low concentrations of NGI-1 could be used to block the viruses from replicating without harming the host cells — successfully reducing the infection by 99 percent when treating cells immediately after they were infected by Zika or dengue virus, and by 80 percent when administered 24 hours after infection.

Their study also indicated that the viruses are unlikely to become resistant to NGI-1. “When you target a host function rather than a viral protein, it’s usually much more difficult for a virus to develop resistance,” Carette said in the release.

The researchers are now busy with follow-up studies to test NGI-1 in small animal models of dengue fever and are also developing similar drugs with improved specificity.

This is a reposing of my Scope blog story, courtesy of Stanford School of Medicine.


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