Saturday, October 22, 2016

HPV Vaccination Update

My cancer is one of the very few types that have a known, direct cause: Human Papillomavirus or HPV. Most people are infected with HPV at least once in their lifetime. Most infections clear on their own. Some infections don't, and uncleared infections with certain strains of the virus turn into cancer. It's the primary cause of cervical cancer. It's also becoming the leading cause of oral cancers like mine.

Since 2006, we have had a vaccine for HPV. It is the only preventive cancer vaccine we have. The CDC recommends that all children aged 11-12 be vaccinated. Vaccinations are recommended for women up to age 29 and men up to age 21.

Vaccination rates are still way too low. Here are the latest stats from the CDC:

In 2015, among males, coverage with ≥1 HPV vaccine dose was 49.8% and with ≥3 doses was 28.1%; among females coverage with ≥1 dose was 62.8% and with ≥3 doses was 41.9%

Even at those disappointing vaccination rates, the vaccine is already having an impact:

HPV vaccine is having a big impact, study shows (CBS News, February 22, 2016)
More evidence that the HPV vaccine works (Incidental Economist, October 11, 2016)

Ultimately, if every teen were vaccinated, almost all cervical cancers and many oral cancers would disappear. Pap smears would become either unnecessary or at least recommended at longer intervals. That's already starting to happen.

Cervical cancer screening could be less frequent, start later (Harvard Gazette, October 17, 2016)

In studies investigating why vaccination rates are low, the number one reason given by parents is "my pediatrician didn't recommend it." The number one reason pediatricians give for not recommending the vaccination is discomfort discussing sexuality with parents. There are now efforts emerging to boost pediatrician recommendations by shifting the focus from sex to cancer.

Cancer doctors leading campaign to boost use of HPV vaccine (Washington Post, June 19, 2016)

Another obstacle to vaccination is the original requirement for three doses spaced over six months. This required three trips to the pediatrician, and many kids were not completing the series. But that also provided populations of partially-vaccinated kids for research on whether fewer doses were sufficient. Based on that research, the CDC this week changed the recommendation to just two doses spaced six to twelve months apart if the vaccinations are given before age 15. This is expected to help increase vaccination rates.

CDC now recommends just two HPV vaccine doses for preteens (Washington Post, October 19, 2016)

Finally, Merck, the maker of Guardasil (the HPV vaccine) has just started running a commercial to guilt-trip parents into getting their kids vaccinated.

Do the new Merck HPV ads guilt-trip parents or tell hard truths? Both. (Washington Post, August 11, 2016)

If you are a parent of a child or adolescent, it is also my purpose here to guilt trip you. With a very simple action on your part, you can, with almost 100% certainty, prevent your child from ever developing cervical or HPV-related oral cancer.

My 12-year-old received her three-dose series earlier this year. My 10-year-old will get vaccinated next year.

What possible legitimate reason could you have for not providing your children with this protection?

Thursday, October 20, 2016

Returning the Favor

I have a bit of news.

At the beginning of September I changed jobs, leaving behind 10 years working to enable genomics research in pharmaceutical & biotech drug discovery to join the new Informatics department at the Dana-Farber Cancer Institute. Dana-Farber is ranked as the fourth best cancer center in the US by US News and World Report (for my Seattle friends, the Seattle Cancer Care Alliance, which includes the Fred Hutchinson Cancer Research Center, is #7). I'm proud to have the opportunity to work at such a distinguished institution.

Those who followed my treatment story on this blog know that I was treated at Dana-Farber in 2013. You also know that I received excellent care and that I am very grateful to "the Fahbah" (as Bostonians call it). I joke that I'm returning to the scene of the crime, but really I'm there to return the favor: to do what I can to improve outcomes for future cancer patients.

I consider it quite an honor.

It's a very exciting time in cancer research. Normally progress in cancer treatment is slow and painfully incremental, with new treatments for difficult forms of the disease perhaps providing a few months of life beyond the previous best treatment. But in the past 15-20 years science has learned a great deal about the unbelievably complex human immune system; enough that in the past five years breakthroughs in "immuno-oncology" (using the immune system to fight cancer) have provided startling improvements in prognosis for some formerly deadly forms of the disease such as metastatic melanoma.

One of these breakthrough drugs put Jimmy Carter's cancer into complete remission.

So far these new treatments are only working in a few cancer types, and only in a fraction of patients with those forms. But the field is energized and hopeful that these gains can be expanded.

I was not looking for a new job - this one came and found me. The man who was my boss' boss for about seven years back in pharma was recruited to Dana-Farber to build a new department from a collection of existing groups plus new growth. This is a person I respect greatly for his intelligence, creativity and most of all his demonstrated leadership abilities. For him to reach out to me to come and join him was the biggest professional compliment I have ever received. So not only am I motivated to help patients; I'm also motivated to live up to that trust.

I'm finishing my seventh week tomorrow. At least once per week I have texted Wonderful Wife sometime in the middle of my busy day to tell her,

"I love my job. I made the right move."

Thursday, May 5, 2016

Excuse Me

Hi there!

Yup, I'm still here.

As a friend said the other day, "I assume that since you aren't posting much on Cancer Fun Time! you are enjoying Wellness Fun Time!"

Indeed I am.

But here's a funny post-cancer thing.

Long time readers know that among the permanent side effects of my treatment is a dry mouth due to radiation damage to my saliva glands. I'd estimate I have maybe 30-40% of normal saliva amount.

That has several downstream effects, including the need for extra liquid when I eat and probably bad breath that no one tells me about.

It also means that I usually have a plug of mucous in my throat because it isn't being constantly rinsed by saliva. So I cough more often than normal (which fellow subway riders don't appreciate), and I also clear my throat a lot.

I clear my throat so often that I do it unconsciously. Several times now I've done it while walking behind one or more people on the sidewalk, and they have interpreted my throat clearing as a request to pass them and they've stepped aside.

The first time I sort of tried to tell them as I passed that I wasn't signalling them.

But now I just chuckle a little to myself and go on my way.

Saturday, March 5, 2016

HPV vaccination works. Vaccinate your tweens!

Let me start by saying that if you are an anti-vaxxer, turn around right now and go somewhere else. I don't really want to waste my breath on you. In the words of Daniel Patrick Moynihan:

"Everyone is entitled to his own opinion, but not to his own facts."

And the fact is that vaccines are safe. Period. There is no real scientific debate on this topic.

OK, got that out of the way.

One vaccine that you know is close to my heart is the HPV vaccine (Human papillomavirus). Had the HPV vaccine existed when I was an adolescent, and had I received it, my cancer would have been prevented.

The CDC has recommended since 2006 that all girls aged 11 and 12 receive the HPV vaccine, and has recommended the same for boys since 2011. Teens and young adults who did not receive the vaccine still should: the current guidelines specify vaccinations of males up to age 21 and females up to age 26.

Since the initial recommendation is now 10 years old, we have some pretty good history available to see how the vaccine is working in the population. The graph above shows the rate of HPV infection in young women in the United States before and after the vaccine was introduced. Note the huge decrease in infection in the age groups that were covered by the recommendation. Among girls who were vaccinated, only 2% were infected as opposed to 17% of unvaccinated girls.

This will prevent hundreds of thousands of cancers in both sexes in the decades to come. If all kids were vaccinated, cervical and other HPV-related cancers would disappear. Eventually, Pap smears would disappear, too.

But vaccination rates are far too low: only about 40% of girls and 20% of boys are being vaccinated.

As I've urged many times before: if you are the parent of an adolescent, please vaccinate him or her!

The argument that vaccinating your child to protect them from a sexually-transmitted virus will encourage them to have sex earlier is, first of all, absurd. And secondly, it's selfish. That's putting your own puritanical beliefs before the life of your child.

Sex won't kill them.

Cancer might.

Coincidentally, Progeny the Elder just turned 12. She received her first dose of the vaccine this week.

Tuesday, October 6, 2015

Cheeseburger, Cheeseburger

Way, way back when I was first starting to eat again after treatment, my strongest desire was for a cheeseburger.

Not just any cheeseburger, but a cheeseburger from Tasty Burger.

It's a small chain in Boston. I used to eat lunch there when I worked near the original location a few years ago.

In the fall of 2013 when I was craving that cheeseburger I was a long way from eating it. It took months to get back to eating most normal foods.

Plus, ground meat has been one of the most hit-or-miss foods. It must be the fat content or something else that varies with the particular meat: sometimes the texture of ground beef is fine and sometimes it is disgusting. Ground turkey has been really bad each of the few times I've tried it.

Today was my routine surveillance check-up at Dana-Farber, with Dr. Chemo.

All was well, of course.

It's now past two years since the end of treatment. Dr. Chemo said I'm now "on cruise control".

Nine months until my next appointment with her.

It so happened that my appointment ended at lunch time and Wonderful Wife and I were hungry. Tasty Burger is right down the street.

The result?

It was delicious!

How's that for a long range milestone?

Thursday, July 23, 2015

My Turn

Wonderful Wife has had recurrent annoying health issues related to her throat and jaw for a couple of years. She has seen an ENT for these issues several times and they eventually came to the conclusion that removing her tonsils was likely to provide relief.

One issue she has had is tonsil stones, formally called tonsilloliths (if you want to gross yourself out, do an image search for that). They felt constantly irritating to her. She described it as feeling like someone was constantly poking her tonsil with a sharp pencil.

In May she decided to go for it. She scheduled the surgery for July.

Then, as is her way, she started researching.

She discovered that a tonsillectomy is a pretty serious operation for an adult. The post-op nurse told me that they are roughly the size of golf balls in an adult. Those are a couple pretty big hunks of tissues to cut out of one's throat!

She also read about ways to prepare foods she'd be able to eat: lots of frozen fluids like broth, Ensure, Jello, etc.

Most adults do not like to eat a lot of ice cream post-tonsillectomy: the injury already causes increased mucous production and dairy exacerbates that for some people.


Wonderful Wife was going to need some TLC for at least a week. She would be in fairly serious pain.

It was time for me to pay back a tiny portion of all that loving care she gave me two years ago.

The ENT called me immediately after the surgery to tell me everything went fine. He commented that he thought Wonderful Wife's tonsils had more stones than any he could ever remember.

Also, almost under his breath, he mentioned that he was sending the larger one for lymphoma screening. Uhhh. I wasn't sure if his delivery indicated that it was completely routine, or that he was concerned but didn't want to give that away. He happens to be a practice partner of my ENT, Doctor B. So he knows my history.

I arrived at the hospital a short time later, with Progeny the Younger, and found Wonderful Wife in the recovery room. She had a huge smile on her face and seemed very happy. Probably a mixture of residual anesthetic and relief. She was still pretty woozy, but we got her dressed and wheeled out to the car and shortly thereafter I had her resting in bed.

We were told to take the opioids on schedule to stay ahead of the pain. So we set alarms for the middle of the night to keep her dosed up. I tried to help keep her fed and hydrated.

Recovery went pretty much as her research indicated it would. Surgery was two weeks ago tomorrow and she is almost back to normal.

During the middle part of recovery she became a fan of my favorite post-cancer food: Cream of Wheat. I've eaten it almost every morning ever since I resumed eating. Sometimes I have it for dinner, too, if I'm tired and don't feel like working my way through "normal" food.

The past week I've been making enough for two.

I don't feel like it was much, but I liked being to give Wonderful Wife back a little bit of the care she gave me.

Tuesday, June 16, 2015

Oh, Hello Fear. I Didn't See You Standing There!

So, yesterday was an interesting day. Since one purpose of this blog is to document the emotional journey of cancer I'll tell you all about it.

For a little more than a week I've had a persistent "side ache". It feels just like the stitch one gets from running. It comes and goes, sometimes almost disappearing and never getting worse than a 5 on a 1 to 10 pain scale.

The internet told me I had kidney stones.

That would suck. My friend has written that kidney stones produced the worst pain he has ever experienced. So I thought I had that to look forward to.

I gave it a week to resolve. I have arthritis that mostly affects my sacroiliac joints (the base of my spine and pelvis). I've had it since I was 14 years old. Mine is episodic and doesn't impact my life much (I'm lucky!). Arthritis pain can sometimes radiate strangely, so I figured that might be the source. But my normal arthritis treatment didn't alleviate it so I made an appointment with my doctor.

My doctor called in sick. I guess that's a thing? Doctors get sick, too?

They fit me in to see the nurse practitioner. She examined me and asked me lots of questions. We discussed my recent cancer.

Then she took on a look of concern, and what I heard next was, "blah blah blah WITH YOUR HISTORY blah blah blah CAT SCAN blah blah..."

My brain hadn't even gone there.

Well, it had. The internet search that told me kidney stones were a common cause of my symptom also mentioned kidney cancer, but way down the list. I had suppressed that idea.

It became unsuppressed.

I left the doctor's office to drive home to await a CT scan appointment. In the car I immediately started crying.

"I do NOT want to go through that again!"
"I do NOT want to leave Wonderful Wife and The Progeny!"

The fear of cancer's return was suddenly very present. And huge.

I went home and crawled into Wonderful Wife's arms on the sofa. She was reassuring, as always.

The CT scan took place in the early afternoon and I went home again. Shortly thereafter I got a call from my doctor's office.

"Your wet read indicates possible early acute appendicitis. Our advice is that you go to the ER immediately."

Well, that wasn't what I was expecting!

Funny that being told I might need emergency surgery could constitute relief!

The rest of the story is not so germane to cancer so I'll speed through it. I went to the ER, got an IV and a bunch of blood drawn and waited for a consultation with a staff surgeon. After about 45 minutes (an amazingly short ER wait in my experience!) the surgeon appeared. He said I didn't look very much like someone experiencing appendicitis. The CT report was actually ambiguous, with a mention of the appendix but no clear problem there. And I had no fever, no vomiting, a low level of pain and my white blood cell counts were normal. He was pretty sure my appendix was not the problem.

The CT scan also mentioned evidence of inflammation in the terminal ileum - the very end of the small intestine where it transitions to the colon. I had a similar report from my first colonoscopy five years ago.

Remember that arthritis I've had for forty years? Anti-inflammatory drugs, specifically NSAIDs, cause damage to the GI tract. That's the likely source of my recent pain.

So the surgeon recommended "we put the knives away for tonight" and sent me home.

I was exhausted.

I was surprised by how ready my fear of cancer recurrence was to rear its head. For a few hours I was terrified.

Thus wags the long tail of cancer.

I'll finish with some advice: don't do an image search for "terror".