Monday, April 9, 2018
Hamlet: Forgiveness
The Cockroach Catcher
Chapter 26 Forgiveness
KING CLAUDIUS
….My fault is past. But, O, what form of prayer
Can serve my turn? 'Forgive me my foul murder'?...
Can serve my turn? 'Forgive me my foul murder'?...
Now might I do it pat, now he is praying;
And now I'll do't. And so he goes to heaven;
And now I'll do't. And so he goes to heaven;
Hamlet Act 3, Scene 3.
William Shakespeare
S
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ometimes we are reminded of our patients in the most unusual way. One summer we had the opportunity to go on a Baltic Cruise which started and finished in Copenhagen. It is unavoidable on such tours to come across tragic stories in history. The different Baltic countries had their fair share of wars, sieges, slaughters and some of the most macabre murders in the history of mankind.
Our last stop was outside Elsinore and those of us who were interested were tendered to visit Kronborg Castle, the setting for Shakespeare’s Hamlet.
Hamlet reminded me of Anita.
She refused to attend school because of Hamlet. In my work I have come across many unusual patients but it has never occurred to me that someone would refuse school because of Hamlet.
She refused to attend school because of Hamlet. In my work I have come across many unusual patients but it has never occurred to me that someone would refuse school because of Hamlet.
I can still remember being called to see her on a Domiciliary Visit as she had refused to come to the clinic. The parents were not very forthcoming and felt that at seventeen, she should be able to talk to me herself.
She reluctantly agreed. We then had a most interesting discussion about Hamlet. She was upset because her English teacher did not like what she wrote about Hamlet. The essay was about Hamlet and forgiveness. She felt that Hamlet indeed should have been more “forgiving” and killed his uncle when he was praying.
“So what if the uncle goes to Heaven? Big deal!”
“Instead,” she added, “he got himself killed as well.”
Our sweet prince was no hero to her and that upset her teacher. He really wanted the class to write about Hamlet and Laertes exchanging forgiveness.
LAERTES
Exchange forgiveness with me, noble Hamlet:
Mine and my father's death come not upon thee,
Nor thine on me.
Exchange forgiveness with me, noble Hamlet:
Mine and my father's death come not upon thee,
Nor thine on me.
Hamlet, Act 5, Scene 2
She then refused to return to school. At least that was what appeared to be the problem.
I eventually got her back to school and persuaded her to see me at the clinic regularly for the next eight months or so. She wrote a good deal and told me that she kept a diary that was kept under lock and key. She said whatever happened she would never let anyone see it, not even her psychiatrist, as she would probably have to kill that person afterwards. I did not ask to see it and told her that I had no intention of asking to see it in future.
Teenagers have their secrets and I certainly want to respect that, I thought. She did show me some other writings and she had some very interesting and unusual things to say.
Looking back, I often wondered about the challenges we faced, having to base our diagnosis and treatment on some of the most subjective things related to us by our often very disturbed patients. We could hardly expect to get any “truth” from them, and yet various psychiatric professional bodies seem to accept psychiatric diagnosis made in this way as infallible. She probably did give me a clue but unfortunately I missed it.
One day she was very distressed, saying she thought she might have caught something from a Spanish Waiter that she slept with. I was a bit puzzled as she did not appear to be the promiscuous type and certainly not the type who would sleep with someone she hardly knew.
She never turned up again despite several reminders.
Then she came to the notice of the adult psychiatric department following a serious overdose. This was on the day of her father’s death. She saw a lady psychiatrist and disclosed to her that her father had been abusing her since she was eleven. She never kept any follow-up appointments though and there had not been any further episodes of self harm.
Nearly a quarter of a century later we had four boys referred because of serious sleep disturbance. One of my colleagues at the clinic made an initial home visit and afterwards asked to see me in a distressed state.
She said it was one of the worst cases she had ever come across and asked me to see the mother, who happened to be my patient twenty some years prior.
It was Anita.
She, who should be in her early 40s then, appeared worn and exhausted, and looked much older than her age.
When her father died it was all too much for her. She said she was very confused by what happened to her. She admitted that there never was a Spanish Waiter but she was hoping that I would inquire further. She was desperate to understand what was going on then.
“The overdose woke me up,” she recalled, “I felt I had to forgive what my father did to me.”
She decided to go into journalism. One of her assignments was to do an article on a notorious murderer. For that, she had to interview that murderer in prison.
“That was the start of all my troubles.”
Fascinated by her first case experience, she became a voluntary prison visitor for those prisoners who did not have any visitor of their own.
“We live in a very forgiving society.”
Then she met this man that was to become her husband. He was serving time for murder.
“He killed his father who abused him for as long as he knew,” Anita recalled, “I could identify with him and I felt so sorry for him.”
Was it the process of reparation? I too struggled to understand her.
She found herself falling in love with him.
Prisons allowed conjugal visits and before long she had two boys by him. Because of her and the children the parole board soon granted him day release passes.
A murderer granted day release! Not long after he was out on license.
We indeed do have a rather forgiving penal system.
“But he never even knew his father, let alone killed him!”
By age nineteen he was doing time in a borstal and soon after his release he killed the landlord who took pity on him and gave him board and lodging. The landlord was unfortunate enough to catch him trying to steal from him.
“I did not know until the trial.”
It is amazing how protective we are of convicted criminals. I could never understand why the probation service did not warn her.
No wonder the public has little faith in our rather liberal judicial and parole system. People sitting on parole boards seem to continue to fail to see into the darker side of the human psyche. Often those trained to understand the human mind also appear not to understand, or are they so driven by performance targets and results that they just want another successful treatment to add to their credit?
This man had “anger management” therapy when he was doing time. The truth is a psychopathic personality is capable of adapting to suit his ulterior motive. We do have too many psychiatric casualties from such unfortunate releases from maximum security mental hospitals and I am not even referring to psychotic patients.
He could not hold his job as a security guard and started to do break-ins. He was open to his wife and she said she did not understand why she never informed his probation officer.
“Perhaps I was afraid of him but he convinced me that these people would get their money back from insurance and he was never going to hurt anyone as he loved her and the children and did not want to be locked up again.”
One cannot help wondering how much the wives of “famous” serial killers actually knew and to what extent they were convinced by the arguments put forward by their spouses.
She had two more boys.
One day he decided that they could make more money if he set her up as a prostitute. He would stop the house break-ins as it was getting more dangerous with the alarms set up by people.
Surprisingly she went along.
“I had to do something to stop his burglary activities. I did not want to lose him.”
“I was sick over the first client. As it reminded me so much of what my father did, I told him I could not do it.”
The next day he said he was resuming his break-in business.
“The rest is in the papers.”
He came home when the children were having tea. He was covered in blood.
“The idiots tried to stop me!” he told her.
The children were screaming. Suddenly she felt a strong repulsion and called the police.
Even the most forgiving philanthropist had her limits.
“I was thinking more of my children. I was not going to be like my mother. I was sure she knew all along.”
I had to agree.
How could this ever have been allowed to happen? What did her forgiveness do to her? Could I have done anything?
He was tried for murder and sentenced to life imprisonment without parole. What he did was much worse than what he told her on the day he came home covered in blood, but that was by and by. Hopefully no one will think it unkind to lock him away forever. You never know.
Anita had to pick up the pieces of her life again, having had her long held belief in good human nature and forgiveness totally demolished.
It was probably destroyed a long time ago by someone she should have been able to trust.
Read more:
NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
Sadness & Abuse: As You Like It.
Abuse Abuse Abuse
All is not well in this beautiful part of the OLD WORLD that is Austria.
Josef Fritzl, an engineer in his seventies was found to have kept his 42-year-old daughter locked in his cellar since she was 19. The woman, who bore her father seven children during her captivity, was discovered only after one of the children she had with her father fell into a coma in hospital.
I can only quote from Chapter 27 in The Cockroach Catcher:
And your experience makes you sad:
I had rather have a fool to make me merry
than experience to make me sad…..
(from: As You Like It - Act II, Scene 7)
Salzburg, Austria ©2008 Am Ang Zhang
Josef Fritzl, an engineer in his seventies was found to have kept his 42-year-old daughter locked in his cellar since she was 19. The woman, who bore her father seven children during her captivity, was discovered only after one of the children she had with her father fell into a coma in hospital.
Austria does not have the monopoly of family abuse.
And your experience makes you sad:
I had rather have a fool to make me merry
than experience to make me sad…..
(from: As You Like It - Act II, Scene 7)
With so many quotable quotes from As You Like It you may wonder why I would chose to pick this one.
Perhaps it is a warning to young doctors to enjoy the blessings of inexperience. Luckily for me sadness brought about by experience from my clinical work is mercifully little but I would be either dishonest or heartless to say that there has been none.
As You Like It happens to be one of the few popular plays of Shakespeare that are often performed in schools, maybe apart from Dreams, and for most it is basically a comedy with a happy ending.
My wife and I went to a recent production at BAM (Brooklyn Academy of Music) by none other than Peter Hall with his daughter playing Rosalind – their New York Brooklyn for his debut but in the end it was a great experience. The New York Times said that it was more reviving than spending a week in the Caribbean . Having been an accidental resident in the Caribbean for two years I would dispute the comparison but totally agreed with the sentiments expressed.
At the BAM, it was like walking into a renovation site and in many ways I hope they leave it that way as it was rather charming. It was a most fitting setting for Shakespeare. I accept that they have to make sure it is safe.
It was at the start of my psychiatric training in England
My ideal Shakespeare is indeed one that can be performed on a bed sheet with a few broomsticks for prop and without wanting to sound derogatory, I would say that this was exactly the approach adopted by this production.
Much was left to the imagination and it worked.
Mrs Coleman
Now and again in our work we get an indescribably sad case. Sometimes what started out as a rather straightforward case might begin to roll downhill so fast that we would be forever taking deep breaths thinking: can it get any worse? We would question if what we were doing was making any difference at all to what seemed like a predetermined course where no intervention would be able to make any impact on the final outcome.
One thing is for sure, real life is not like a play – you have only one chance to perform it and often not everything is clear.
Mrs Coleman came to see me about her daughter within months of my appointment as a consultant. With my new job came advantages and disadvantages. I used to be able to ask my seniors about cases, especially the difficult ones. Suddenly I was supposed to know it all. I used to have a big team working on a case, to the point that when the patient came to me there was hardly anything left for me to discover. Single-handed consultants are “on their own”. They are lucky to have a social worker and perhaps a psychologist. I had both but the psychologist was not really part of our team – she happened to be sharing the same building. She belonged to the old school, which meant she knew her field and she did not try to be a social worker. For a while it became fashionable to blame everything on background and upbringing. Any disturbed child not performing well at school had nothing to do with teaching methods or intelligence but everything to do with social background. What were the implications for the social background of bright high achieving children?
There was some excitement in the clinic when it was known that a shepherd’s family had been referred.
Shepherds? "As You Like It" sprang into my mind.
We have lambs so we must have shepherds – so I thought. It is true that we seldom had referrals from the farming community. I can only remember one other case and that was when I was a trainee. Shepherds also conjure up scenes of nativity and there is a sort of biblical romantic feel to it.
What we did have was something quite different. As it was unfortunately the lambing season, the shepherd Mr Coleman, though making a valiant appearance, was as good as asleep during most of the session. Mrs Coleman talked through the session with her rather charming old Sussex
Mrs Coleman at the time had two children but it was the older daughter Laura of nine with whom she was having trouble. Tom, some eighteen months younger, was a happy-go-lucky sort of boy. Laura had a whole range of behavioural problems. She had recently taken to soiling in her pants.
It was often our practice for the social worker to do a preliminary home visit, and my social worker told me that she was most impressed with their home when she visited. They lived in a tied cottage on the farm. The children’s grandfather was a shepherd and he had two sons, the older one working on the dairy side. There was also a daughter, the children’s aunt, and her husband was the local milkman. The aunt had children similar in age to Laura and Tom. She worked part time in the local greengrocer’s and between her and Laura’s mother they split the fetching from school and childcare. The aunt unfortunately was recently diagnosed with breast cancer and was having different kinds of treatment at the local hospital. Luckily her husband was a milkman and could take over the afternoon part of the childcare arrangement whenever necessary. Mrs Coleman took the children to school on the days when the aunt had to go to hospital.
The aunt was a strong lady, Mrs Coleman told me, and she was sure she would outlive her.
It was an old cottage they lived in and my social worker told me that Mrs Coleman kept the place clean and tidy. It was therefore most upsetting to her when her nine year old daughter started soiling herself.
It was mostly in the afternoon but not everyday.
As my social worker had just started her training at the Tavistock Clinic on child therapy it was a good chance for her to take the girl on for some individual therapy sessions. Like my old consultant did when I was in training, it was now my turn to see mother.
This seemed to be a simple enough family and I did wonder at the beginning if there was much to unfold.
I was proved wrong.
Within two to three weeks of Laura starting therapy, Tom the younger brother refused to go to school. It was natural for everybody to think that there was some jealousy involved. So I arranged for mother to bring him to see me. It was rather obvious from the start that he was not very bright and that his not going to school had little or nothing to do with Laura but more to do with the fact that he could not keep up with the work and was being teased at school very badly. He tried to hit back at one particular boy and was told off by one of the teachers on duty at play-time. He did not want to go back. I arranged for the psychologist to assess him.
Yes, he was functioning at a much younger age and yes, he needed to go to a special school. In those days it was called an ESN school – school for the Educationally Subnormal. The SSN school was for the Severely Subnormal. In the 90s, it was deemed more polite to call the subnormal children “special”.
Both schools were local and extremely well run. Tom was transferred and seemed to have settled down well there.
Not bad. I congratulated myself.
Laura was getting on well with her new therapist. She was attending without any problem and was doing nice drawings, according to my social worker.
Mrs Coleman was grateful that I sorted out her son. Tom, who had always been a Daddy’s boy, had upset father very much with his escapade but as he had now settled in his new school father was rather pleased. He in fact went to the same school so he made it a point to turn up to thank me once everything settled.
Mmmm, perhaps we are not escaping the genetics theory.
As a precaution, we also tested Laura but she turned out to be rather bright.
Genetics, you are wrong.
Not so, Mrs Colman must have thought. She was rather perturbed when I told her. She started crying and pleaded with me to keep the secret she was about to tell me.
Her husband was not Laura’s father.
Mrs Coleman had worked at the local butcher’s since she left school and he was always all over her. Before long he was having intercourse with her at the back of the shop. He always gave her extra for that part of the service and she was happy with the extra bit of money. The butcher’s wife had a stroke a few years back and had been bed ridden.
“It was not the money,” Mrs Coleman assured me. She did not want me to think of her as a slut.
None of the mothers I saw wanted me to think badly of them and it often took a while before they would reveal their secrets.
Mrs Coleman had also been seeing the shepherd but never gave him much thought as she felt he was rather stupid. The butcher was much brighter.
Then one day some accident happened and she found herself pregnant. But the butcher was not going to divorce his wife. She was the one with the money.
She decided that the next best thing was to let the shepherd sleep with her as long as he married her. He was so pleased with himself and they had a big white wedding in the local church.
So Laura was the butcher’s daughter and not her husband’s. Now that I had proved Laura was clever, she was afraid I might ask awkward questions although she doubted if her husband would ever really work it out for himself.
Once a parent realised that you had ways to get to the truth, they often started revealing things that you wished they never did.
The butcher had some idea that Laura was his and had been slipping even more extra money for mother to buy her things. He never had any other children.
I never broke my promise and to this day I do not think that her husband ever knew.
What was to unfold was what caused most sadness.
I attended some special seminar on sexual abuse and at the time some rather ugly looking anatomical dolls were produced for the sole purpose of diagnosing Sexual Abuse. They were anatomical in that a whole family set including parents and grandparents, children and adolescent all had what was described as anatomically correct parts - females with breasts, nipples, vagina and anus; and males with penis and anus; and all the orifices were so to speak fully functional. These dolls all had proper clothes on and yet all the clothes could come off.
The idea was that normal children played with them as normal dolls but abused children would perform with the anatomical parts.
I had a full set ordered, having spent sometime persuading the managers that others had labs and X-rays and so on, but these were the only tools we required for the specific job.
Laura was the first to discover them and before my social worker’s eyes one of the male figure’s penis was in the girl’s mouth. She told my social worker that was what Uncle Tom liked.
What followed were special “disclosure” interviews conducted under camera. Uncle Tom was the milkman. It happened to both girls. When the boys were in the kitchen playing computer games on the TV, slowly the girls were made to suck him. That was when Laura started soiling.
Mrs Coleman went berserk. Arrangements had to be made for alternative child care which really meant she had to cut short her hours at the butcher’s. Uncle Tom moved to his mother’s as a temporary measure pending Social Service investigation and Police enquiry.
Mrs Coleman could not sleep at night and called her GP. He asked her to pray with him as she had to be forgiving. She was so angry and when she was cleaning around the house she managed to get some caustic liquid all over herself and had to be admitted to hospital. She was also referred to the adult psychiatric department.
She started attending an anger management group at the hospital. It was thought to be the best way to help her deal with recent events.
One day when I went in to work, my social worker was already there and in tears. Mrs Coleman had just taken a massive overdose of Paracetamol and her liver was thought to be too far gone to survive. She died a rather painful death and we were all deeply saddened.
Could we have done any better? Was the truth too much for Mrs Coleman to bear? Would she still be alive if we had not discovered the sex abuse? We would never know. We might have rescued Laura from sex abuse but now she had lost her mother. Mrs Coleman was right about one thing though, her sister-in-law did outlive her.
As Shakespeare said, “…….And your experience makes you sad…..”
I wanted to hide the dolls.
Sunday, April 8, 2018
Save the NHS: Control Health Insurers!
Spring is here!
©2014 Am Ang Zhang
It must be very obvious that all the talk about medical cover for visitors to England
Could this be because insurers have managed not to cover for everything. One need to ask the question on how one ever travel to the US
It may well be prudent for government to insist that non EU visitors to this country must have mandatory Health Insurance as part of the admission requirement. This should apply to students and tourists alike. After all nobody in their right mind would dream of going to the US
We have managed to get people to insure their cars, why not their bodies.
There is of course the need to fully control Health Insurers for those that live in England
Let people opt out of the NHS if it is so bad! But Insurers need to cover every thing.
Citizens could be given a tax break and yet have the insurance policy incorporated into their NI/NHS number so that those with the tax break, the insurer will be charged for every kind of medical care they receive if they were within the NHS.
©2014 Am Ang Zhang
If we are not careful Private Insurance will creep into England without a single bit of control as it is singularly important to stop Insurers to reject those with pre-existing conditions or dump them once they have a chronic illness such as Type 1 Diabetes.
Patients could have to start to pay charges to use basic NHS services such as GPs because the health service’s finances have become so dire, the leader of Britain
It must be very obvious that all the talk about medical cover for visitors to England
Could this be because insurers have managed not to cover for everything. One need to ask the question on how one ever travel to the US
It may well be prudent for government to insist that non EU visitors to this country must have mandatory Health Insurance as part of the admission requirement. This should apply to students and tourists alike. After all nobody in their right mind would dream of going to the US
We have managed to get people to insure their cars, why not their bodies.
There is of course the need to fully control Health Insurers for those that live in England
Let people opt out of the NHS if it is so bad! But Insurers need to cover every thing.
Citizens could be given a tax break and yet have the insurance policy incorporated into their NI/NHS number so that those with the tax break, the insurer will be charged for every kind of medical care they receive if they were within the NHS.
©2014 Am Ang Zhang
If we are not careful Private Insurance will creep into England without a single bit of control as it is singularly important to stop Insurers to reject those with pre-existing conditions or dump them once they have a chronic illness such as Type 1 Diabetes.
Here are some things the law will do:
· It will prohibit insurance companies from refusing to sell coverage to people simply because they have one or more pre-existing conditions.
· It will also prohibit them from cancelling our coverage when we get sick just to avoid paying for our care.
· It will prohibit insurers from charging women more than men for comparable coverage and will not allow them to charge older folks more than three times as much as younger folks.
· It will require them to spend at least 80 percent of what we pay in premiums actually paying claims and improving care.
· It will allow young adults—who comprise the largest segment of the uninsured—to stay on their parents’ policies until age 26.
Summary of a popular post:
· Ends discrimination against people with pre-existing conditions.
· Limits premium spread to normal, high risk and healthy risk to say under 20% either way of normal.
· Limits premium discrimination based on gender and age.
· Prevents insurance companies from dropping coverage when people are sick and need it most.
· Caps out-of-pocket expenses so people don’t go broke when they get sick.
· Eliminates extra charges for preventive care.
· Contribute to an ABTA style cover in case Insurance Companies go bust and many might.
We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.
Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital
This will eliminate problems like PIP breast implants.
It will indeed encourage those that could afford it to buy insurance and in any case most firms offer insurance for their employees including the GMC.
To prevent gaming of Insurers by individual patients (I look after their interest too), the medical fee should be paid up front by the patient and then deduction taken from premiums. Corporate clients like those with the GMC should not be gaming Insurers.
Imagine the situation where those with “individual personalised budget” being able to “buy” their own insurance!
In fact, to save money, government can buy insurance for the mental patients and the chronically ill.
This way there will be real choice and insurers will be competing with each other to provide the worst deal.
Why?
What Health Insurer will want the business?
Spring is here indeed!
©2014 Am Ang Zhang
Perhaps they will go back to the US
Saturday, April 7, 2018
Brain Tumour: Pork and Unusual Treatment.
© Am Ang Zhang 2015
A short while back I blogged about GBM and how an innovative treatment may have helped. Being a doctor Dr Anderson noted this:
My wife, Carmen Alicia, called a local friend, also a cardiologist, who sent us to a nearby hospital; there, an MRI exam revealed a small spot on my brain. The neurologist felt it needed to be biopsied to obtain a tissue diagnosis. I immediately returned to Virginia and went to several specialists, who suggested further testing before I decided to have an invasive brain biopsy. I also had a blood test for cysticercosis, an infection that results from eating undercooked pork contaminated with Tenia solium. This common parasite produces cysts all over the body, including the brain. It is the most common reason for seizures in many countries, particularly in India, where children with seizures are first treated for this disease even before other studies are done. My blood test was strongly positive. I started a course of oral medicine to treat it. The test reassured me.
My later research showed that there may indeed be some association of Tenia and GBM.
Neurocysticercosis (NC) is the most frequent and widespread human parasitic infection of the central nervous system (CNS). Glioblastoma multiforme (GBM) is a neoplasm of CNS in elderly population and may have a similar clinical and radiologic presentation as of NC. The coexistence of NC and neoplastic intracranial lesion in an individual is a very rare entity. The incidence of NC among intracranial space occupying lesions is reported to be 1.2-2.5%.[1–4] Though cerebral cysticercosis may be associated with glioma,[5] but this rare coexistence of NC and brain tumors puts into question a causal relationship between the 2 diseases. Here we report a case in which glioma and cysticercosis appeared concomitantly, with continuing progression of low grade Glioma to high grade Glioma (GBM, WHO grade IV).
So some religious dogma might actually be good for ones health.
But watch out, even if you do not eat pork:
Neurocysticercosis in an Orthodox Jewish Community in New York City
All the patients and their families adhered to Orthodox Jewish dietary laws, which forbid the eating of pork. Moreover, T. solium taeniasis due to the ingestion of contaminated pork is extremely unlikely in the United States. Cysticerci were detected in only 3 of more than 83 million hogs examined after slaughter under federal inspection in 1990.
The most likely sources of infection in the patients described in this report were women living and working in the patients' homes who had recently emigrated from Latin American countries where T. solium infection is endemic.
In 2003 the world was in the grip of a new plague that challenged our knowledge of medicine to its limit.
For the first time, doctors and nurses who were normally in the forefront of the fight against diseases were fighting for survival from SARS (Severe Acute Respiratory Syndrome), a new and dangerously contagious disease. The alarm was first raised by its first victim, Carlo Urbani. He was an Italian physician employed by the World Health Organisation (WHO) and based in Hanoi , Vietnam
Doctors often thought that they would be immune, a God given right I suppose. Not so this time! The virus obviously knew what it was doing.
A doctor friend had just been diagnosed with GBM (glioblastoma multiforme) grade IV. My hospital librarian had the same tumour and told me that the hospital neurosurgeon got it too. Another close friend who is an ENT surgeon has just been diagnosed with NPC (Nasopharyngeal Carcinoma).
Looks like doctors are no longer as immune as we like to believe and that goes for those that worked closely with doctors like our beloved librarian. .
More about the DOCTOR I mentioned earlier:
He is a cardiologist for thirty five years, (so not a neurosurgeon then) but with the diagnosis his research unravelled one of the possible reasons for "catching" GBM.
Why?
Why did this tumor happen to me? I never smoked and had had no brain injuries, and there is no history of such tumors in my family. As a cardiologist, I had implanted close to 400 pacemakers in my life and during the procedure was exposed to ionizing radiation (X-rays). In the early days we used portable X-ray machines and gave ourselves some protection by using thin lead gowns. Nowadays, heavy lead gowns are worn, and doctors and technicians protect their thyroid and eyes with shields and glasses. We also use heavy sheets of radiation-protective glass that hang from the ceiling.
At some point in my research, I was surprised by an article by a Johns Hopkins-trained cardiologist who now practices in Israel
GBM
" I had a glioblastoma multiforme (commonly called a GBM) grade IV. This is the most malignant brain tumor; no grade II or III exist. A glioblastoma is what killed Sen. Edward M. Kennedy (D-Mass.) in 2009. While rare, it is the most common of the brain tumors. The prognosis is dismal; on average, patients survive only 14 months after diagnosis even with chemotherapy and radiation. After five years, only 5 percent of patients are still alive."
So depressing.
But wait: The Zapping!
" The Preston Robert Tisch Brain Cancer Center at Duke University
As doctors there examined me, it was obvious that my tumor had already grown again; in fact, it had quadrupled in size since my initial chemo and radiation. I was offered several treatments and experimental protocols, one of which involved implanting a modified polio virus into my brain. (This had been very successful in treating GBMs in mice.) Duke researchers had been working on this for 10 years and had just received permission from the FDA to treat 10 patients, but for only one a month."
The procedure:
"I was given the Salk polio vaccine to prevent a systemic polio infection.
At Duke, my skull was opened under local anesthesia and I had the viral infusion dripped through a small catheter directly into the tumor in my brain for six hours."
The result:
"I returned to Duke a month after the infusion, and though an MRI showed some expected swelling, the more significant fact was that the tumor had stopped growing. I have gone back to Duke every two months since then, and the tumor, initially the size of a grape, is now a scar, the size of a small pea. It’s been two years since the initial biopsy and radiation, and one year since the experimental polio viral treatment, and I have no evidence of recurrence nor tumor regrowth.
According to a presentation about the research that the Duke doctors gave last May, the results so far are promising: “The first patient enrolled in our study (treated in May 2012) had her symptoms improve rapidly upon virus infusion (she is now symptom-free), had a response in MRI scans, is in excellent health, and continues in school 9 months after the return of her brain tumor was diagnosed. Four patients enrolled in our trial remain alive, and we have observed similarly encouraging responses in other patients. One patient died six months following . . . infusion, due to tumor regrowth.” They added: “Remarkably, there have been no toxic side effects . . . whatsoever, even at the highest possible dose.”
That has been true for me. I feel as fit as I was three years ago, before the first symptoms of the glioblastoma made their appearance. I remain only on an anti-seizure medication."
Laoshan China
© Am Ang Zhang 2011
Thirty years ago, I saw mountains as mountains, and waters as waters.
When I arrived at a more intimate knowledge, I came to the point
where I saw that mountains are not mountains,
and waters are not waters.
Thirty years on,
I see mountains once again as mountains, and waters once again as waters.
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