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January 2012 Archives

Livingwell2.jpgEditor's Note: A new report today from the Institute of Medicine of the National Academies addresses improving the health of people with chronic illnesses. Karen Basen-Engquist, Ph.D., professor in MD Anderson's Department of Behavioral Science, is one of 17 experts nationally who co-authored the report.

By Karen Basen-Engquist


In fighting the war on cancer, emphasis has been placed on detecting disease early and, hopefully, curing it. Many battles have been won, and because of this we have more than 12 million Americans living today who have had a previous diagnosis of cancer. 

While those gains are to be celebrated, many cancer survivors suffer from after effects of treatment, or undergo extended treatment over a period of years to keep their disease in check.

In essence, cancer is becoming a more chronic condition, a fact acknowledged by the ground-breaking 2005 Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition, which documented the experiences of cancer survivors after treatment, and the gaps in the health care system which often resulted in a failure to properly address survivors' problems and concerns.

Since then, MD Anderson and other centers have worked to address the needs of cancer survivors in health care settings. 

A new IOM report released today, Living Well with Chronic Illness: A Call for Public Health Action, draws attention to the need to help cancer survivors and others with chronic illnesses manage their disease effectively, reduce complications, prevent additional health problems, and optimize their health.

By John Chattaway, MD Anderson Staff Writer

Tessfinal.jpgPart II of Monday's post- Short Circuit: MD Anderson Robots Provide Safety in the 21st Century

"Autobots, roll out!"... and into the next lab


"I am a robot."

If you've traveled Floor 4 of the Main Building, you may have heard those words spoken by "Tess," the Swisslog SpeciMinder used by Laboratory Medicine to transport specimen batches between labs.

The robot is on loan from Swisslog while Pathology and Laboratory Medicine determines if it's a technology we want to invest in.

Laboratory Medicine technicians have a button or "bell" they push to call Tess. The robot has a pre-programmed map of our facility that it uses, along with external sensors, to find its way to the technician. Once Tess arrives, the technician loads specimen batches into it and tells it where to go.

Once Tess delivers the specimens to the required destination, if that destination has nothing to send, Tess returns to a docking station in the central specimen processing area.

"Tess minimizes the need for manual transport of specimen batches between labs. This enables our lab employees to stay focused on high value and patient-oriented work," says Lila Pulido, director, Pathology/Laboratory Medicine Operations. "It's also fun because you can program what Tess can say. I once heard it say, 'Sorry, I haven't had my morning coffee,' when it bumped into a wall."

Don't be fooled by Tess's simple, R2-D2-like appearance. The robot can hold up to 150 tubes of blood and a bag of microbiology specimens, or up to 50 pounds of cargo.

dexter copy.jpgBy John Chattaway, MD Anderson Staff Writer

Robots. The word conjures images of science fiction characters from movies such as The Terminator, Star Wars or Transformers.

But those characters actually are androids, forms of human-like artificial intelligence. Robots are machines that, when programmed or operated by a person, can perform specific tasks.

At MD Anderson, we're using them to improve the safety and efficiency of our care.

"I'll be back"... with your medication
Pharmacy has been taking advantage of robot technology since 1998.

The first outpatient robot was installed in the outpatient pharmacy on Floor 2 of the Main Building. Now, all three outpatient pharmacies use the ScriptPro SP 200 prescription dispensing system.

Our outpatient pharmacies dispense approximately 1,300 prescriptions a day. According to Lori Bertrand, manager, Pharmacy Operations, the robots account for almost 55% of our prescription volume. The SP 200 robot can fill and label 150 prescriptions an hour. "It would be closer to 95% except that chemotherapy, narcotics and investigational drugs can't go into the ScriptPro robot," Bertrand says.

organizing medical files FB pic reshare.JPGBy Andrew Griffith

Andrew Griffith has mantle cell lymphoma and has had an auto (November 2009) and an allo (August 2011) stem cell transplant. He lives in Canada and is married with two young adult children. He blogs at www.lymphomajourney.wordpress.com and can be followed on Twitter @lymphomajourney.

Most of us find it challenging to make sense of the wave of information when we enter our cancer journey. This is foreign territory, with its own language, culture and routines. It takes time to absorb and understand.

We're not oncologists or hematologists. However, we can learn to improve our discussion with our medical team.

Tips to help
Build your knowledge: By the time you start your treatment, you'll likely have searched the web and read brochures on your cancer. Ask your medical team which sites have reliable and up-to-date information to avoid old and possibly discouraging information on treatment outcomes.

While blogs and support forums help give a real-world view of the range of experiences, you're an individual, and too much thinking about what happens to others, good or bad, increases worry further. Moderation!

To save time, set up Google Reader for news sites, blogs and forums, and use the search function (general terms like cancer or lymphoma) to narrow down articles of interest.

Strength in Weakness

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By Isaac Van Sligtenhorst

strengthinweaknessfinal.jpgIsaac van Sligtenhorst is a physician-in-training in the Texas Medical Center. He blogs about his training, as well as battling cancer from the perspective of a caregiver. Read more about his approach to grief, hope and life in general at heartofalonelyhunter.blogspot.com

Fifteenth floor, leukemia and lymphoma ward. My dad was admitted here twice, the second time the same day my brother died.

I knew the floor well.

I had just finished with my patient and was waiting for the elevator. A phenomenal case. History of four different cancers, pulmonary embolism, triple coronary bypass, a stroke 80 years young, still alive and kicking.

Truly a touching experience.

Connecting with compassion

While waiting for the elevator, a young guy walks up slowly with his IV pole. He's big and broad shouldered. I'm not exactly slight of frame, but he towers over me. Probably in his early 20s, he sports a baldness that could easily be fashionable. But his absence of eyebrows says the lack of hair is due to far more grim reasons.

Below his eyebrows, his eyes catch me. There is a yearning in them. Something so elementally human, which desired contact.

tipsfornewcomerstomda.jpgBy Holly Easley

I began my journey about five years ago when I had some temporary blindness. I went to the doctor and my blood counts were low, so I was sent to a hematologist oncologist.

After a bone marrow biopsy, I was diagnosed with myelodysplastic syndrome (MDS). Once I got my diagnosis, I went straight to MD Anderson.

My doctor at MD Anderson was Guillermo Garcia-Manero, M.D., in the Department of Leukemia. I can't say enough good things about this man. From my first appointment with him, I knew he was the best doctor in the world. It turns out he's considered the leading authority in the world on my disease.

I never doubted him, did everything he told me to do and constantly sought his advice.

When my MDS became more vicious and progressive last spring, I became transfusion dependent and my quality of life was deteriorating, he decided it was transplant time. It was now riskier not to have the transplant than to wait. He also told me that after the transplant and when I no longer had MDS, he would no longer be my doctor.

I cried. 

I had a stem cell transplant on May 24, 2011. Chitra Hosing, M.D., is my stem cell transplant doctor and I love her. She has a great team. She has helped bring me out of some tough times. Just as I had with Dr. Garcia-Manero, I have extreme confidence in her.

Happy to Say Ta-Ta to 2011

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By Val Marshall

Val Marshall's cancer journey began in May 2009, when her son Addison was diagnosed with acute lymphocytic leukemia. A visit to the family doctor for what they thought was a simple high school football injury turned out to be much more.

Inspired by her son's strength and hope, Val strives to be a voice that connects other parents on this journey. Her series shares insight into her life as a mom of a typical teenager who just happens to be fighting leukemia.

Addison Marshall Crush Cancer


I have to say that I was happy to ring in the New Year and say "hasta la vista, baby" to 2011. Last year was a huge mountain for Addison to climb. But he scaled it with a heavy load, while refusing to yield to leukemia's wrath.

I remember when I saw the protocol with 104 weeks of chemotherapy at the time of his relapse. I never thought the end of treatment would occur. He's now looking down at 81 weeks -- "run Forrest, run!" We're crossing our fingers and hearts that he will finish chemo in June, in time to ship off to Texas A&M this fall.

Addie started the year like he lives each day. He fell on jump boxes while working out and split open his shin. I didn't flinch but realized that his platelets must have been decent, even though it took a while to stop the bleeding. Boy, I am getting lax.  

By Sarah Cook, Department of Social Work

An acute leukemia diagnosis can make you feel as if the world has stopped -- for you, the patient, and for your loved ones.  

Before diagnosis there was grocery shopping, work, coffee dates and laundry. Now, suddenly, life is lab work, test results and an endless stream of medical professionals --many of whom you can't identify by name.  

The information comes fast and furious: "you have leukemia," "we're running tests," "you're being admitted" and "we're placing a PICC line."

A PICC line? What's a PICC line? Will my insurance pay for this? Will I lose my job? What the heck is a stem cell transplant? Is that the same as a bone marrow transplant?  


To say that a new leukemia diagnosis can be overwhelming would be putting it mildly.  

If this has been your experience, please know that you're not alone. Also, know that there's support to help you and your loved ones cope with your diagnosis and treatment. MD Anderson social work counselors are available to offer emotional support and to help link you with helpful resources.  

If you or your loved one has recently been diagnosed with leukemia, there are a few things you need to remember as you begin to cope with this new situation.

Three things to remember:

Treating Uveal Melanoma

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By Sapna Patel, M.D., assistant professor, Department of Melanoma Medical Oncology

treatinguvealmelanoma.jpgWhen a patient is diagnosed with uveal melanoma, he or she should be evaluated by an ocular oncologist, an ophthalmologist who specializes in treating cancer of the eye.

The objective of this examination is to find out whether the uveal (or intraocular) cancer has spread to the optic nerve or nearby tissues of the eye socket, or has moved through the blood to other parts of the body.

Depends on diagnosis
When uveal melanoma is diagnosed, the treatment depends on whether the disease has metastasized to other organs. Most patients whose disease has not metastasized are treated with surgery known as enucleation or some form of radiation therapy.

A commonly used radiation treatment for uveal melanoma is plaque brachytherapy, in which a tiny radioactive disk is placed on the affected part of the eye for a few days, minimizing exposure to surrounding tissue.

Dan Gombos, M.D., associate professor and chief of the Section of Ophthalmology, is an ocular oncologist who specializes in the treatment of uveal melanoma, in addition to other intraocular malignancies. He works in coordination with Beth Beadle, M.D., and William Morrison, M.D., in the Department of Radiation Oncology, to manage these patients.

The latest diagnostic techniques and treatments for eye cancer are available at MD Anderson, where cutting-edge translational research is conducted, continually driving laboratory discoveries forward to application in the clinical realm.

Letting People Know

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talkingaboutcancer.jpgBy Andrew Griffith

Andrew Griffith has mantle cell lymphoma and has had an auto (November 2009) and an allo (August 2011) stem cell transplant. He lives in Canada and is married with two young adult children. He blogs at www.lymphomajourney.wordpress.com and can be followed on Twitter @lymphomajourney.


One of the hardest things after a cancer diagnosis is telling others: family, friends and colleagues. I preferred a more open approach for a number of reasons:

  • Keeping everything inside was harder; talking and writing was a form of release.
  • People close to you need to know to support you.
  • Letting people know avoids awkward questions and provides an invitation for support.
  • Experience with others who didn't share made it harder on others and me.
Looking back over the past three years, a number of steps helped me talk to people:

Identify your circles: Who needs to know, after the obvious close family and friends? Do you have natural support groups (religious or other organizations)? What about colleagues at work -- how wide should the net be?

Write out your script and be direct: I think better by writing out things. Particularly at work, a script allowed me to get out what I wanted to say and ensure that I didn't forget anything important.

Look at the Strings

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strings.jpgWith so many transformations in health care, it sometimes seems that the world is spinning faster. To organize each hectic day, I think about it like it's a string. 

My strategy for dividing the string into various fragments is important. You need string of a certain quality and length to do things that require deep thought, like writing a paper or making major strategic or personal decisions. 

Other things, like signing routine documents or filing things, can be accomplished using the lower quality portion of the string (i.e., the fragmented string toward the end of a long day).

This idea of strings -- what one faculty colleague called my "string theory" -- triggered a memory of a patient who told me an inspiring story. Inspirations are a gift shared by so many patients and part of the huge privilege of being a physician.

Here is the story that I recalled: "Look at the Strings."

Mr. Z. was a liberal arts professor with widespread cancer, in the midst of chemotherapy. A subspecialist colleague called to ask if I'd see this patient who seemed to have a distinctly profound problem with fatigue.

By Laura Nathan-Garner, MD Anderson Staff Writer

woman talking to doctor.jpgYour pap test isn't the only reason to see your gynecologist.

Your doctor also can address unusual symptoms that could be cancer. And, he or she can help you decide what do about body changes that may affect your cancer risk at different stages of life.

Here are some topics you may need to discuss with your gynecologist at your next appointment.

1. Gynecologic Cancer: Symptoms Besides Pelvic Pain

Unfortunately, gynecologic cancers -- including cervical, ovarian and endometrial cancers -- have vague symptoms. And, many women often overlook or mistake them for less serious conditions.

Talk to your doctor if you have any of these symptoms for more than two weeks:

You Want Me to Do What?

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Dr.shannon copy.jpgExercise Benefits Lung Cancer Patients, Study Shows

A typical patient of Vickie Shannon, M.D., is on oxygen and confined to a wheelchair. Often a family member is there, too, to offer information.

"'Mom can't walk from here to the bathroom. She struggles to get out of bed,'" is a common theme of these family members, according to Shannon.

"'She doesn't go to the store anymore. She's not cooking. She's not doing any kind of cleaning,' they say."

Shannon, a professor in the Department of Pulmonary Medicine, listens carefully and takes notes. When she suggests putting the patient in rehab -- which includes some exercise -- she gets startled looks.

"You want her to do what? Have you listened to a word I've said?"

According to Shannon, much is now known about the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease (COPD).

Still in question is whether patients with COPD and cancer, or cancer patients who may have lung disease due to other causes, benefit from pulmonary rehabilitation during their treatments.

By Stephen Collazo, Department of Social Work

Whether you're the doctor or the patient, having conversations about future care should be an integral part of the overall treatment planning process at every stage -- beginning at the time of diagnosis. It's a team effort and a partnership that ensures patient choices are given the utmost respect.

Steps for planning

The following steps are by no means an exhaustive list for fully implementing the advance care planning process in one's specific medical situation, but it serves as a good starting point for the patient and health care provider.

1. Evaluate quality of life
For the patient -- Begin to think about what living with quality of life means to you. Discuss your thoughts with the people who would be involved in making decisions for you if you aren't able to make them yourself. This will ensure that care choices are made to support your quality of life in the way you'd like.

For the provider -- Ask patients what quality of life means to them. Explain their current treatment plan and the side effects involved in terms of these ideas. Also, talk about how possible life-prolonging treatments relate to the patient's concept of quality of life. Remember, often the patient is waiting for you as the professional to broach the subject of what they should do in end-of-life situations.

By June Stokes

genetictestingpic.jpgJune Stokes was diagnosed with stage IV ovarian cancer in April 2000. She was told she had 12-18 months to live. June has been cancer free for 11 years, and hopes her experience will offer comfort and peace to those who are beginning their journey with (or after) a diagnosis of cancer.

In June 2001, 14 months after my ovarian diagnosis, my daughter, Lisa, told me that she found a lump in her right breast. She called the same day and got an appointment with Dr. David McCoy, an oncology surgeon. 

Dr. McCoy did a needle biopsy. The following day, I anxiously awaited Lisa's pathology report. She called around mid-morning and said it was benign. Dr. McCoy would do a lumpectomy the following week.

The lumpectomy was performed and the report would be back the following day. 

As I drove into my driveway the next evening, I noticed that Lisa's car was parked in front of my home. I walked in and asked, "How bad is it?" 

She started crying and I grabbed the paper and started reading the pathology report, which stated, "duct carcinoma" and "differentiated carcinoma." Unable to control my emotions I ran through the house, room to room, crying hysterically while clutching the report.

Grace Saves a Life

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By Jennifer Texada, MD Anderson Staff Writer

gracesavesalife.jpgAbout a month before my baby was due, my obstetrician asked me, "So, have you thought about what you want to do with the cord blood?" 

Without hesitation, I said I wanted to donate it to the Cord Blood Bank at MD Anderson. She scribbled a note on my chart and we went on with the appointment.

Because I work at MD Anderson, I'm aware of the cord blood donation program. But if you've never heard about it, it's easy to miss.

Cord blood remains in the placenta and umbilical cord after a baby is born. It's a source of stem cells that can be used as an alternative to bone marrow to treat patients with many diseases, including cancer.

By Judy Overton, MD Anderson Staff Writer

Dr  Raad with patient.jpgFelipe Corrales has blown out the candles on 103 birthday cakes so far. He's also survived a prostate cancer diagnosis. However, the greatest challenge for the 17-year cancer survivor has been recurrent bouts of urinary tract infections.

The infections have been managed by Issam Raad, M.D., professor and chair of Infectious Diseases, Infection Control and Employee Health, through various antibiotics. Yet, Raad states, "The best care to prevent these infections is to place one of the antimicrobial urinary catheters being developed by our team."

The antibiotic coated central venous catheter (CVC), invented by Raad and his team of researchers in 1994, was first introduced through a randomized, double-blinded study in 1997 (published in Annals of Internal Medicine).

Now 14 years later, the Center for Disease Control is recommending it for all high-risk patients who continue to have infections after all the best practices fail.

According to Raad, "The CDC Guidelines that came out in May 2011 highlight our invention and placed it in the highest category, Category IA. The antimicrobial catheters are in practice now in Europe, as well as in the United States."

Dr.jpgMesothelioma is a rare cancer that starts in the cells lining certain parts of the body, especially the chest and abdomen. Primary risk factors include workplace exposure to asbestos.

Anne Tsao, M.D., associate professor in MD Anderson's Department of Thoracic/Head and Neck Medical Oncology and director of its Mesothelioma Program, answers questions about mesothelioma. (See related story on mesothelioma patient Sherry Moore.)  

What is mesothelioma?
Mesothelioma is a cancer that arises from mesothelial cells, which normally make up the lining around our organs. Mesothelioma can originate from the:

  • Pleura (lining around the lungs)
  • Peritoneum (lining around the abdominal cavity)
  • Pericardium (lining around the heart)
  • Testes
Is mesothelioma rare?
In the United States about 3,000 cases of mesothelioma are diagnosed each year, and in Western Europe approximately 5,000. There is some speculation that the 9/11 event that destroyed the Twin Towers in New York City may lead to increased incidence of mesothelioma and other cancers in the first responders who worked in the affected site.

By Lauren Schoenemann, MD Anderson Staff Writer

Sherrieandhusband.jpgBefore mesothelioma, Sherrie Moore dreaded the idea of getting older. Now, three years after being diagnosed with the challenging illness, she celebrates each birthday with joy.

"I used to not want to grow old, but now I want to have a major celebration each year," says Moore, who celebrated turning 55 at her home in Carl Junction, Mo., on Nov. 30.

In early 2008, Moore was supporting her husband, Ed, in his battle with prostate cancer. When she began to feel fatigued and noted an elevated heart rate, she called her general physician. He referred her to a cardiologist, whom she had seen in the past for high cholesterol.

When her blood work revealed a low hemoglobin count, Moore received a blood transfusion. She also was instructed to visit a gastrointestinal doctor for an endoscopy and colonoscopy. Those yielded normal results.

Results inconclusive

She followed up with her cardiologist three months later and learned that her hemoglobin levels had returned to almost normal. By that time, she was feeling better.

In July 2008, Moore returned to her physician with a pain in her right side that extended into her back. She associated the aches with the stress and physical exertion of taking care of her husband.

The doctor ordered a CT scan of her liver and pancreas. While he found no abnormalities in these organs, he recommended she find a pulmonary specialist. Something didn't look right with her lungs.

Diet and Cancer

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dietandcancer.jpgBy Lauren Schoenemann

A growing body of research has revealed that diet is thought to account for about 30% of cancers in Western countries.

Clare McKindley, clinical dietician in MD Anderson's Department of Clinical Nutrition, says choosing the right foods comes down to knowing one's physiological needs and practicing self-respect.

"Knowing what your food behaviors are is the first step in determining the most healthful feeding frequency for a person's nutritional and health goals."

Balancing your plate
The American Institute for Cancer Research (AICR) recommends that two-thirds of one's plate include vegetables, fruits, whole grains and beans. Foods and beverages that may support a reduced risk for cancer include:

  • Beans
  • Berries
  • Cruciferous vegetables
  • Dark green leafy vegetables 
  • Flaxseed
  • Garlic
  • Grapes and grape juice 
  • Green tea 
  • Soy 
  • Tomatoes 
  • Whole grains

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