Re: Betty's oncology visit

In article <l6jgh1hc6kaoauapiffemcpp5le4u6drf9@xxxxxxx>, Wayne Mitchell
<gwmitchell104@xxxxxxxxx> wrote:

> "Howard C. Berkowitz" <hcb@xxxxxxxxxxxx> wrote:
>
> >In article <df8asb0m3e@xxxxxxxxxxxxxxxxx>, evgmsop@xxxxxxxxxxxxx wrote:
>
> >
> >?However, we're all different, and
> >> for some of us the mere fact of "life" is more important
> >> than the quality of that life.
> >
> >Translation: you have a fixation on quality of life, and you fixate on
> >other than euthanasia for cancere as poor quality. I suggest you learn a
> >bit more about oncology.
> >
> >>Purrs and prayers for you
> >> and Betty, whatever you ultimately do.
> >>
> >
> >I suppose this formality absolves you from second-guessing Takayuki?
> >Yes, I am angry with you.
>
> In fairness, Howard, I don't think Evelyn's message was
> particularly second-guessing or accusatory in tone. She was
> just expressing her own viewpoint, and presented it as a
> *question* for Tak.

I'm sorry, I have to disagree. Tak clearly had made a decision.

Now, if Evelyn had described, with knowledge, the potential effects of
radiation, that would be useful information.

The use of NSAIDs demonstrated to have a chance of causing tumor
regression is hardly radical, and, far beyond the chances of regression,
will control pain. I offered a basic suggestion about them, and I offer
to do a literature search on whether COX-2 inhibitors are superior to
nonselective cyclooxygenase inhibitors.
>
> If I use the test she proposes -- what would I want done to *me*
> -- I would agree with her. I've long decided that I have no
> interest in difficult procedures to extend my life.

I don't disagree with this, and, indeed, my own advanced directives are
very, very specific about the conditions under which I want nothing but
comfort measures, the exception conditions such as I am a viable organ
donor candidate, and the perfectly legal things that are effectively
euthanasia. As an example of the latter, I specify that if I have a
confirmed organic dementia, and am unable to discuss choices, with no
reasonable medical chance of recovery functions, I absolutely forbid the
use of antibiotics, although authorize specific comfort measures. That
effectively means I am likely to die, comfortably, of pneumonia.

But I keep returning to the point that Evelyn was assuming everything
was radical, when not everything being proposed was radical. Potentially
with some other drugs to strengthen bone and further reduce
inflammation, I know of humans with bone metastases that have had a
meaningful extension of life of decent quality.

> For humans,
> who can envision the future, the choice of euthanasia at an
> early stage can be the best one. (Would that it were as readily
> available for us as for our pets.)
>
> Cat's, however, are different. They don't anticipate, so that
> isn't part of the equation for them. They have no fear of pain
> or suffering in the future, and no fear of becoming useless and
> dependent. Their quality of life doesn't suffer much until
> their physical condition prevents them from being themselves --
> from looking out on their environment with interest or getting
> comfortable enough to rest.

Exactly. The NSAID therapy is a comfort measure that may induce
regression. Radiation can be used in different ways, and one technique,
particularly appropriate to bone cancer, is "palliative" rather than
curative: it is a lower level, with lesser side effects, that helps
control the physical size of tumors. The tumor doesn't disappear, but
doesn't spread such that it presses on nerves.

>
> Tak, I like the way you went about making this very difficult
> decision, looking at Betty as an individual. You'll probably
> second guess yourself, at times, but if Betty isn't too
> terrified of the treatments themselves, then why not take the
> gamble that her time of being "happy and full of wonder" can be
> prolonged?

I agree completely with that, and, speaking from knowledge of the
treatments mentioned, do not find them especially radical. If they do
not reduce pain, then, indeed, the difficult choice of euthanasia may be
appropriate. I've dealt with humans at that stage, where euthanasia was
not an option, but the rational and humane thing was to induce
barbiturate coma, essentially a state of anesthesia from which the
patient will not wake up.

Now, what I'm about to say is extremely rare, but there are cases where
induced coma can, in rare circumstances, help the body heal. There is
some neurochemical and immunologic reasoning to this, although it's
something you can't count upon.

My objection is that if someone wants to advise against "radical" care,
they have enough knowledge of the proposed treatments to explain why
they might be inappropriate.

Hopefully as a bit of tension release, if a bone-strengthening drug is
prescribed, I'd sort of like it to be calcitonin. Most forms of
calcitonin are prepared from salmon, so perhaps it would be a cat treat.

> She just wants to be Betty. You'll know when that's
> not possible any more (and because you're human, you'll
> anticipate that time and suffer far longer than she will.)
>
> For your suffering, my sympathy; for your courage and
> competence, my respect.
.

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