Sunshine

Today started off being sunny and warm, but by 11 the skies clouded over and rain poured down.  It rained off and on for the afternoon, but it was a lovely day.  It’s one of those where we’d say that we carried our sunshine with us!  I talked to my boys as usual this morning; today the building had a planned water outage, and I’d reminded Don several times to be prepared.  He got everything sorted, ready for the 8-hour period without water, and thankfully the water was restored after only 3 hours.  Jerry’s walker called to cancel as her partner was injured at work and needed to be at the hospital for treatment (he was cut badly on his left hand, the artery was severed, he needed stitches and had lost a lot of blood.  He’s going to be fine.)  So the boys went for a drive, and Jerry got to run around in a new park for a while.  The picture showed a happy little puppy busily exploring on his own.  Good little monster!  I’m also happy that Don felt well enough to go out for a bit and do stuff, and the weather cooperated too, which was wonderful all around!

You may (or not) be able to see that I made it to the beach!  My goddaughter came and collected me and we headed off, first stopping to take care of an important issue.  As we were driving into Santa Cruz, the rain started bucketing down and there was some flooding on the road — the rivers were also high, reaching the bottom of the bridges so we were getting nervous that the roads might be impassable if the rain continued much longer.  We opted to continue up the mountains to get to the beach, hoping that the rain would have cleared on the other side of the range.  There were a few nerve-wracking turns where the road had partly collapsed in earlier landslides, and the inevitable tailgaters/bad drivers and other such on the road, but it was dry and overcast when we arrived at Maracas.  I’d realized that swimming there would be a challenge for me — the waves are always powerful and high, and my balance is not great.  So we bought the requisite bake-and-fish (shrimp for me in an alloo pie) and then walked in the sand along the water’s edge for a bit.  Kris went into the water and had a marvellous swim — I was quite envious!  Then she came out and hugged me, so I was also dripping wet!  😂 After the beach, we went to the mall to shop for some clothes for me that hide “thing” and the curve in my back, and found the most darling, gorgeous pants!!  Disappointingly, the salespeople tried to talk me into a blouse that was neither my colour, nor style by saying how perfect it was, and how I just needed to trust them!  I left the blouse, bought the pants, and I swear that I’ll get at least 2 uses out of it before I leave for Canada!!  I also arranged the catering for tomorrow evening, so that’s sorted without me having to cook so I can spend my energy enjoying the time with our guests.  I can be sensible, see? 😘  Then I got to spend time with my youngest godson, who’s just been named Mr. Trinidad & Tobago for Mr. World Tourism (pageant will be in the Philippines at the end of January 2023)  My cup runneth over, having had so much lovely kid time in the last few days!

We are going to offer a memorial Mass for Auntie Ming on Saturday evening, 6:30pm at Our Lady of Fatima RC in Curepe.  It’s the parish where she worshipped from the time the church was built in the 1960s (she’d helped raise funds to build it) so it’s only fitting that this first Mass after her funeral is there.  There will be others, in different parishes and countries, but this one needed to be there.  I hope to see some of our relatives there, and friends from the church that evening.  I think sometimes that I can hear her moving in the house; it’s just so strange to be here and not see her!  I know the feeling will eventually fade, but it’s still new.

Tonight I need to do some work on the cancer research submissions — the deadline is a week away, and I’d thought that I had loads more time!  Ah… tempus fugit and all that.  Before I sign off, though, I’m going to reproduce a series of tweets from my oncologist that he’d sent out this morning.  The tweet is here in full, but I’ve copied the text:

Over time I’ve tweeted a lot about evidence-based medicine. But oncologists are often in situations with little or no evidence to guide them.  In these situations we go to “first principles”.  But what are the first principles? Here’s a thread outlining those I think are key.

Principle #1 – First Do No Harm 

This is a classic that has stood the test of time. There are all kinds of asterisks and caveats.  But if your proposed course of action has known harms and unknown benefits, then maybe it’s time to stop and think if you’re on the right path.

Principle #2– Palliative vs. Curative 

It’s essential to to be clear in your head whether you are proposing treatments with palliative or curative intent. All management decisions (toxicity, dose reductions) flow from this, and being unclear leads to muddled decisions.

Principle #3 – Tell your patient whether it’s palliative or curative

Having settled this in your mind, you have to explain it to your patient. Treatment decisions are made in partnership, and your partner can't be ignorant of fundamental facts impacting their decisions and lives

Principle #4 – Adjuvant therapy requires RCTs

Adjuvant therapy exposes patients who are already cured to toxicity and morbidity. This can't be justified on a case-by-case basis.  You only know you're doing more good than harm if there’s an RCT that says so.

No RCT?  Don’t do it

#5 – Be wary of palliative therapy without symptoms to palliate 

Entirely well palliative patients will likely be that way for a short time. Why fill that time with toxicity? If  no symptoms, seriously consider observation. 

No symptoms & no measurable disease? Observe.

#6 – You’re not so clever as you think

Molecular tests make us think we understand tumors

Bioplausibility makes us attach tests to treatments

Despite good rationale, most cancer treatments fail

If “thinking outside the box”, consider that you might just be flattering yourself

Principle #7 – You're not failing if you don’t treat 

Your job isn’t to treat people. It’s to help people make good decisions. Reasonable people can choose not to be treated. If all of your patients choose treatment then you’re not explaining it completely.

I can’t stress how much I love that tweet, especially #7.  Definitely gives me reassurance that I’m not just a test subject, and I think it just underscores why I trust him.  As you all know, I usually oppose vehemently the “cancer cure BigPharma doesn’t want you to know about” rubbish that people like to circulate, but this message can’t be shared enough!  On that encouraging note, Good night!