Re: I'm pretty fucking depressed

On Nov 22, 3:01 pm, Alan S <loralgtweightandca...@xxxxxxxxx> wrote:
On Thu, 22 Nov 2007 09:28:55 -0800 (PST), "Michelle C."





<bookbug2...@xxxxxxxxx> wrote:

While I would never give advice about what a person should or should
not do in regards to health, here's my perspective, both as a patient
and a medical lab tech. Doctors get the issue of quality of life
mixed up with quantity of life--they tend to think they are same
thing. (Patients, and families of patients often mix these issues up
as well.) Doctors also tend to look for problems because it's their
job to cure them--but sometimes the problems and cures really aren't
that important to quality of life. Here's an example: I worked for
an internist, a smart, compassionate guy, but also very thorough,
sometimes too thorough. We had a 90 year old lady who was amazing--
sharp, no major physical infirmities, lived by herself. The only
issue that was developing in regard to her health was the onset of
lymphocytic leukemia. Her white count was 20,000+ and the greatest
percentage of cell types were lymphocytes. The thing about this type
of leukemia is that it develops very slowly. Anyway, the internist
wanted to do a bone marrow on her and she wouldn't allow it. It
perturbed him to no end. I asked him if he had the bone marrow test
if he could begin treating her. He told me that no, he couldn't treat
her until her white count reached 50,000. So I followed up with the
question about why the bone marrow test was so important. He replied,
"Well, I just want to know!" Okay, this internist was a good guy and
he helped a lot of people, but obviously he forgot that quality of
this patient's life was more important than his need to know. (I
later talked to another physician I'd worked for before--an old guy
with a more "country doctor" attitude--about the incident. He told me
the internist was being ridiculous, that at her age, the patient was
more likely to die of something else before her leukemia became bad
enough to require treatment.) My point is that one needs to be very
careful to sort all of this out. So while I wouldn't give advice
about what to do in regards to health, I will offer this: Try to
determine what the doctor's motivation is in the advice they give
because sometimes they really don't know themselves--even the good
ones.

<snip>

Hi Michelle

I understand your point and I would certainly agree with
your view that a 90yo in her position should not have the
BMA. An initial BMA can be very important in correct
diagnosis and assessing correct treatment regardless of the
white count, although other less intrusive methods may also
be possible these days. But I certainly wouldn't support it
in geriatric circumstances.

However, for others of a different age be aware that while
some CLL patients do move very slowly, some don't.

One reason I am taking a sabbatical from the management team
of the ACOR CLL list next year is that, while I am one of
those lucky ones "more likely to die of something else
before my leukemia became bad enough to require treatment",
I have said goodbye to too many on that list lately. Some
were only diagnosed a year or two ago.

While I'm on the subject, I'll put in a plug for any cancer
patients who are not aware of the ACOR lists:http://www.acor.org/

And, just in case there are other CLLers reading here, a
great blog by a British haemotologist for CLL patients:http://mutated-unmuated.blogspot.com/


Hi Alan,

I'm sorry you're losing friends to the cursed CLL. You bring up some
very important points.

I think what we're both saying is that each case is unique, and all
factors must be taken into consideration--age, aggressiveness of the
disease, and the patient's personal philosophy about what constitutes
quality of life. Doctors, even terrific ones, are human and they tend
to form "policies/philosophies" in order to make their jobs easier,
which are sometimes in conflict with what is important to the
patient. In the case of the internist I mentioned above, he was
always very thorough. This was a "policy" that served him and his
patients well overall. However, it prevented him from seeing that in
this 90 year old lady's case, it wasn't appropriate. And that's where
we as patients need to be on the ball.

From way up here in the US, you've always impressed me as being very
informed, able to get to the crux of the matter, and well in tune with
what you personally believe is important. I know you are always going
to be your own best advocate. Unfortunately, many people do not even
know where to begin. I imagine most of us here on ASD can remember
when we were confused and bombarded by too much information too fast.
We learned to research, sort data, network, etc. Some people never
get to that point.

In Jackie's case, where she has several issues going on all at once,
it's really tricky, although I know she's going to do well at getting
the information she needs to make informed decisions. She has a
particularly remarkable knack.

Alan, I certainly wish you a long and comfortable life. ASD needs
your wisdom.

Best regards,
Michelle C., T2
diet & exercise


Cheers, Alan, T2, Australia.
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--http://loraldiabetes.blogspot.com
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