Hippocrates in 400 or so BC wrote about a study of patients who had what he called karkinos or crab.  The present day word is Κάβουρας pronounced Kávouras.  What he described in these patients was advanced cancer.  No one knows why he called it Crab, but that doesn’t limit the imagination of medical historians. 

It could be the pain often felt in cancer patients being severe and persistent like the pain felt on the pinch of a crab’s claw inspired the name.  It could be because cancers are often hard like the shell of a crab.  My own theory is that like crabs which slowly nibble away at dead animals, gradually rendering it unrecognizable and eventually only a skeleton, cancer eats away at the host until the patient looks cadaverous.

Celsus, in the first century AD wrote a medical encyclopedia which he termed Cancer, the Latin equivalent of Karkinos.  Cancer became the English term for malignant tumors, and karkinos survived in the term for malignant tumors arising from the ectoderm; carcinomas.

For thirty years I worked primarily as what is termed a surgical pathologist.  That doesn’t mean I did surgery.  It means that I looked at tissues and organs removed from patients, documenting all sorts of things like size, color, texture and shape, confirming what clinicians already suspected, documenting what had been removed, and expanding the knowledge of the nature of a patient’s disease process and its expected behavior.  We made what we termed a pathological diagnosis.  A clinical suspicion of tuberculosis can be confirmed and antibiotic sensitivities performed by culture, but that may take a month because the tubercle bacillus grows very slowly.  A biopsy with appropriate stains can confirm tuberculosis in a couple of days, and the clinician can put the patient on medications that will probably work with a change in medications when the sensitivities are done, if that is necessary.

The type of residency that I did, took five years.  I’m sure that many things in the process have changed since the 1970s, but I spent a year doing autopsies.  I performed or assisted on over 400 during my training, most of them done during the first year.  I have no idea how many surgical specimens I looked at.  I sat at a microscope looking at cases at the same time the staff pathologist did, listening to him (they were all men) discuss what he saw, and identifying those changes and cataloguing them in my mind. 

The last two years were spent in the laboratory learning the methodology of all of the tests done, looking at other methods, the equipment used, equipment required for other methods of doing the analyses, and discussing everything with the two pathologists mainly involved in the laboratory.

Make no mistake; all of the tests were done by technicians and technologists.  Our job was to understand the process well enough that when quality control drifted, or a test just stopped working we could troubleshoot the process and help fix it.

Our relationship with technologists was testy at times.  Most were very bright, knew they knew more about actually doing the test than we did, and many resented the fact that we made more money, and saw us as a hindrance to their own advancement.  Over the years I worked closely with some, particularly as the pathologist responsible for the transfusion service, and very little with others.  Careful observation showed some to be perfectly capable of solo flight, and I only got involved in their business when there was a need.  Other techs and supervisors wanted a co-pilot.

So, I started off talking about crabs.  What has all of this got to do with cancer?

Perhaps the most critical diagnoses I made were diagnoses of cancer.  Over a thirty year career I missed a few – that I know about – and I remember all of them…acutely….painfully.

One was a tiny biopsy of skin received in 1979 or ‘80 that proved to be Merkel Cell Carcinoma.  There was no excuse.  I was the only pathologist reading microscopic slides that day and I had a full load.  I called the process Basal Cell Carcinoma.  A year later I got a call from an academic institution where the patient was being seen asking me to review the slides.  I had that sick, sinking feeling as soon as I stuck the slide under the microscope.

In the spring of 2015 I developed a small, soft nodule on my lower leg.  It grew over the next several months and I asked my primary care doctor to look at it.  He thought it was nothing.  A couple of months later I asked the dermatologist to look at it.  His remark was, “Whatever it is it’s benign.”  It was soft, not fixed to surrounding tissues, tender, and except for the rate of growth it showed no signs usually associated with malignancy.

Finally, in September I decided to get the thing taken off because it was becoming unsightly.  Everybody was shocked when the diagnosis of Merkel Cell Carcinoma came back.

My first thought was, “I’m going to die of this and I deserve it.”

Merkel Cell Carcinoma is rare.  It is usually seen in fair skinned people (check), in highly sun-exposed areas (no check), has a bluish hue of the overlying skin (check), is frequently missed (check), and has a fifty-four percent five year survival rate provided it has not already spread at the time of diagnosis, in which case the survival rate becomes about 34%.

In recent years it has come to light that 80% of people with the tumor have a polyoma virus called the Merkel Cell virus that is involved in the process of becoming malignant.  The mode of transmission of the virus is obscure.  I probably have the virus considering the fact that the other inciting factor is UV light exposure.  Older individuals and those who are immunosuppressed are more prone to develop the tumor.

In October of 2015 I had the biopsy.  In December I had the site widely excised with a skin graft.  I did well, but it was still mid-January before I was fully active.  In September of 2016 the tumor recurred near my previous surgical site.

I’ve been examined with multiple CT scans, MRIs and a PET scan and at present there is no evidence of spread beyond the area on my leg.  Consultation with my surgeon and a Radiation Oncologist at Duke has led me to choose radiation therapy to my leg.  The other option is amputation which I’m not keen on.  Radiation therapy is not innocuous.  There are short and long term side effects, one of which is developing another malignancy in the irradiated area.  However, if I don’t have radiation I won’t have to worry about a future malignancy.

I'm also taking Turkey Tail mushroom.  Four studies of patients with different kinds of cancer have shown that adding Turkey Tail to radiation, surgery or chemotherapy improves survival.  It's pretty cheap and painless.  It has also been a part of Chinese traditional medicine for about a thousand years.

i tried Essiac Tea.  It tastes like a swamp smells, and an attempt to study its effect on cancer was stopped when it became clear that the manufacturer was not cooperating with the study.  So, that looks like all down side to me.  I would never abandon proven treatment for alternative therapy, but I'm OK with combining traditional medicine with scientific medicine. 

I’ll be staying in Caring House, a low-cost residence for cancer patients with access to a shuttle to take me back and forth for daily treatments.  I should come out on the other side of this sometime just before Christmas.

The treatments only take a couple of hours a day – mostly setup time – and The Caring House is a nice place with wifi, so you may still hear from me while I’m there.

I’m always realistic but optimistic.  I won’t bother you with more details unless you ask for them.

In less than a week this awful presidential campaign will be over.  I’m optimistic.

Live long and prosper.

 

 

 

Views: 213

Comment by Rodney Roe on November 3, 2016 at 7:37am

Terry, I've been thinking about how to respond to your comment. From an
insurer's standpoint misdiagnosis is baked into the cake. From a physician's standpoint, though, it represents human failing if there is sufficient information to either make a diagnosis or consider it as a possibility and pursue the diagnosis as a possibility.
There is a corollary in an experience I had when my daughter was in daycare. She swallowed a nickel and it got stuck at the beginning of her esophagus so that she couldn't swallow. She was taken to surgery, put to sleep, and the coin was removed without incident.
When I got the hospital bill it included a charge for four units of blood transfused 2 days after she was discharged. I went to the hospital CEO to point out the error. His response was, "We overcharge some people and undercharge others." He was looking at the issue solely from his own standpoint and as a matter of balancing the books. The patient, on the other hand, sees the issue solely from his/her standpoint, not as an entry on a ledger sheet.
Physicians are supposed to be advocates for the patient, and as such act solely in their interest. A failure to do so is a failure.

Comment by Rodney Roe on November 3, 2016 at 12:36pm

...web log... not wen log....

Comment by marilyn sands on November 3, 2016 at 2:56pm

Good luck & the best to you!  And, hope (for all our sakes) that the news on Nov 8th will give you the desire to want to come home at all!

Comment by Rodney Roe on November 3, 2016 at 6:16pm

Thanks, Marilyn. I'm just ready for it to be over; treatments, election, all of it.

Comment by Dharmabummer on November 3, 2016 at 7:24pm

Good luck and blessings to you, Rodney! Melanoma runs in my family, too. All of us have had malignancies removed before 40...I used to joke that because we are of Scotch/German stock 'we don't get tan, we just get cancer' but it's not funny anymore. 

So, the crab is hard on the outside but it has sweet meat on the inside. I hope you find the sweet side of this, soon. Much love to you:) (And please keep us updated)

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