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flavio cord blood post.JPGBy Judy Overton

The psalmist wrote, "From the mouth of infants and nursing babes, Thou hast established strength." For more than 20 years, from the cord blood of babes, cancer patients have gotten a second chance at life.

Flavio Lopes Ferraz is one of them.

Bone marrow provides the standard of care transplant, but the Brazilian attorney found himself without a viable family marrow donor when he was diagnosed with leukemia seven years ago. His only option: cord blood.

"Our first choice is always to find a donor in the family," says Elizabeth Shpall, M.D., professor in the Department of Stem Cell Transplantation and medical director of MD Anderson's Cord Blood Bank.

"However, usually only one in four patients has a member in the family who can donate marrow, because of the gene pool and how the genes combine," Shpall says.

Lifeline to a cure
With the first cord blood transplant performed in France in 1988, physicians found cord blood -- rich in blood-forming cells -- provided another option toward a cure for patients with leukemia, lymphoma and other life-threatening cancers and blood diseases.

Jeanette and andy sebesta.JPGJeanette Sebesta has tackled many roles during a celebrated career as a regional actress in Houston. But recent real-life experience has been the most challenging.

Sebesta's son, Father Andy Sebesta, was diagnosed with an anaplastic astrocytoma  in 2004. The cancer was partially removed during surgery to prevent seizures.

After several rounds of radiation, Andy, a Holy Cross priest at The University of Notre Dame, was in remission for six years until he was diagnosed with glioblastoma  in 2010.

After a second surgery, Andy received low-dose chemotherapy due to platelet problems. His oncologist, W.K. Yung, M.D., professor and chair in the Department of Neuro-Oncology, said radiation wasn't an option since he'd had so much after the first surgery.

"Physically, he was fine," Sebesta says. "Even though he had a brain tumor, he never had any problems with his mental capacity. Although he had cancer, he was never handicapped by it."

120723picnik.JPGAfter a long and successful career in broadcast journalism in Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in 2008 as a senior communications specialist. Her husband, Tom, was treated at MD Anderson for renal cancer. He died in April 2007. Judy's occasional posts will cover aspects of the cancer experience from the caregiver's perspective. Read more posts in this series

I didn't think much about being a caregiver until I wasn't one anymore. It isn't something in which you test the waters. You are simply thrust into the situation as I was almost eight years ago.

Family and support groups can ease the abrupt transition, says Djuana Fomby, a social work counselor at MD Anderson. Fomby facilitates a caregivers' only support group every Tuesday, 12:30-1:30 p.m., at the Rotary House in the patient guest relations room on the MD Anderson campus.

Care4Caregivers is an opportunity for those supporting cancer patients to speak openly and honestly about their experiences. Fomby says the needs of a caregiver differ based on the stage of their loved one's cancer experience.

Master the system

In the first six months of diagnosis, the caregiver is in a state of shock.

"While they want information, they're overwhelmed," Fomby says. "Their feelings are fragile and their anxiety level is high-pitched. They don't have an understanding of what being a caregiver is going to mean. They're thinking strictly, 'Save my loved one's life.'"

Once someone has been a caregiver for three or more years, Fomby says, "They're calmer. They come to the realization the cancer will be there, the financial challenges will be there. They settle in to a new normal."

Keep it to Yourself

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judysflowersfinal1.jpgAfter a long and successful career in broadcast journalism in Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in 2008 as a senior communications specialist. Her husband, Tom, was treated at MD Anderson for renal cancer. He died in April 2007. Judy's occasional posts will cover aspects of the cancer experience from the caregiver's perspective. Read more posts in this series

I wish people who have never experienced the loss of a loved one would keep things to themselves.

An acquaintance said to me she felt people could recover from a debilitating illness if they had a strong faith. I immediately gave her my two cents. I have first-hand knowledge that is not the case.

Letting him go
Tom's last day on earth was a beautiful, sunny April day. The annuals were at their height of bloom. A palette of colors decorates our lawn every spring.

Almost two weeks had passed since Tom left MD Anderson and was under hospice care in our home. Family and close friends came to see him for the last time. Every day was a mini-party, of sorts, because he was still alert enough to "hold court."

So, this particular day didn't have any mark of the end, at least not the way it started. My sister, Joanie, and the hospice nurse raised Tom on the lift to give him a bath. Not long afterward, Tom, sitting up in bed and looking very boyish, received the Viaticum from our parish deacon.

But then, the hospice nurse pulled me aside, "You have got to let him go," she said. I thought to myself, "But I have!"


M_Davila3.jpgMarta Davila, M.D., continues to see the benefits of colorectal cancer screening.

A physician in MD Anderson's Endoscopy Center, Davila recently treated a presumably healthy 52-year-old man who responded to his wife's encouragement to get a colonoscopy.

"The patient kept postponing his colonoscopy appointment because he felt well. He was diagnosed with early stage colon cancer, underwent surgery and is now cured," says Davila, professor in the Department of Gastroenterology, Hepatology and Nutrition. "He was one of the lucky ones."  

According to Davila, preventive colorectal cancer screening is particularly important, especially since patients rarely experience symptoms until the cancer is at an advanced stage.

"The reality is we need to encourage our patients to get a screening test. It's the right thing to do," she says.

Research shows screening saves lives
A recent article published in the New England Journal of Medicine underscored the effectiveness of colonoscopy and colon polyp removal in saving lives. Researchers learned the death rate from colorectal cancer was cut by 53% in patients whose doctors had removed precancerous polyps.

polypmanscope2012.jpgKimberly Tripp was 12 years old when her grandmother died of gastrointestinal cancer. The loss of the person she most admired led her to a career in health care and, eventually, to MD Anderson.

"My first position here was as a post-op surgical nurse on the GI floor," says Tripp, currently administrative director of Acute Care Services. "I ended up taking care of these very same patients."

She eventually became a research nurse in the Department of Gastrointestinal Medical Oncology, where she worked with colorectal and pancreatic cancer patients. About the same time (in 2002), Cathy Eng, M.D., associate professor, joined GI Medical Oncology, and Tripp began working on a number of her colorectal cancer trials.

A stroll through a "colon"
According to the American Cancer Society, colorectal cancer is the third most common cause of cancer in men and women and the second leading cause of cancer death. However, colorectal cancer, relative to other malignancies, is a preventable cancer.

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 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."

Caregivers17.jpgAfter a long and successful career in broadcast journalism in Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in 2008 as a senior communications specialist. Her husband, Tom, was treated at MD Anderson for renal cancer. He died in April 2007. Judy's occasional posts will cover aspects of the cancer experience from the caregiver's perspective. Read more posts in this series

I haven't been myself lately.

I haven't felt like doing much beyond getting up and going to work.

Four-and-a-half years have passed since Tom died. His 58th birthday would have been Nov. 2.

Sometimes I can't believe he's gone. I don't think I'm depressed, but maybe I am. It's all catching up with me.

I've held the fort for so long, and now it feels like my psychological and emotional walls are caving in.

Manzullofatigue.jpgJerry Wilson claimed a front row seat. Wilson, diagnosed with stage IV colorectal cancer in 2009, has beaten the disease so far. What he can't shake is the fatigue he's experienced during his cancer journey.

"If you ever had a severe case of flu that totally drains you both physically and mentally, this is what I felt like all the time after starting a multiple chemo treatment," Wilson says.

Wilson has regained some of his energy now that he's taking a lower dose of chemotherapy and has learned to pace himself. He attended the recent Anderson Network Cancer Survivorship Conference to hear about other options.

He is among more than 100 cancer survivors and caregivers who heard Ellen Manzullo, M.D., professor in the Department of General Internal Medicine at MD Anderson, offer management strategies for cancer-related fatigue.

Manzullo, deputy division head in Internal Medicine, is one of two specialists who regularly evaluate patients in the MD Anderson Cancer-Related Fatigue Clinic.

According to Manzullo, fatigue is a common symptom. In fact, 30% of cancer survivors experience fatigue years after receiving treatment.

Todd_Emergency Medicine.jpgIt was Father's Day weekend, and photographs of my brother were sprinkled among the tables at the reception. Raymond wasn't physically present at the wedding of his oldest daughter, Amy, but his memory lives on among those of us who loved him.

"Hard"-felt message
"Mrs. Barton, your son is dying." The harsh words of reality were delivered to my mother by Raymond's oncologist more than 21 years ago.

Could they have been revealed a little more gently like a slow, boiling pot of water rather than as a quick deep fry? When do you finally cave in to reality, especially when miracles do happen?

Raymond was only 36 years old when he was diagnosed with non-Hodgkin's lymphoma. Always the life of the party, he died a year after diagnosis, leaving his widow, Sandy, to raise their three children on her own: Jason was 12, Amy was 5 and Shelli, the youngest, was 3.

The message revealed

When should the end of life be discussed and who is responsible for initiating the discussion?

Knox Todd, M.D., chair of the Department of Emergency Medicine at MD Anderson, says there's a lack of understanding about palliative care and hospice, both among the general public and the medical staff who treat them.

He says the end-of-life conversation should begin much earlier, right along with discussion about the diagnosis and treatment.

"It's important not only to assist our patients in living well," Todd says. "It's just as important to assist them in dying well."

judy tom wedding.jpgAfter a long and successful career in broadcast journalism in Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in 2008 as a senior communications specialist. Her husband, Tom, was treated at MD Anderson for renal cancer. He died in April 2007. Judy's occasional posts will cover aspects of the cancer experience from the caregiver's perspective. Read more posts in this series

Today, Aug. 22, is Judy and Tom's 30th wedding anniversary.


August also marks the first anniversary of Caregivers Chronicles.

I'm grateful to several colleagues in the Communications Office for suggesting I share my journey with you, and to MD Anderson for allowing me to post the stories on Cancerwise.

I hope it's been reassuring to know that, although you don't forget your loved one, life goes on. You do get better.

What makes the experience more bearable is the establishment of special friendships with people who also have lost loved ones. One of my friends is Bev Warner, who was widowed 14 years ago.


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