Farewell

Ladies and gentlemen, it is my sad duty to inform you that your dedicated blogger and my devoted husband died in September from the awful disease which had ravaged him for over a year.  Thank you for reading his posts. He was a wise man whose last advice is "wear a hat."  Marcia O. Kaplan

THE AFTERMATH

A succession of highly competent nurses, physicians and technicians during the five days following my hospital admission for a massive, cancer-related pulmonary embolus, coupled with appropriate care and medication led to my discharge and return home on the fifth day for a slow recovery. Notwithstanding my grim prognosis, I am very slowly getting better, though shortness of breath, a distinct lack of strength and energy, and continuing unmistakeable stigmata of cardiopulmonary insult and aggressive malignant melanoma are clear indicators that all is not yet well and is unlikely to be.

Once again,  I must emphasize the importance of my supportive family, and friends throughout this  illness. Without their support I could not have made it.  To my family, friends, community and the kind and generous rabbis who  have visited and buttressed me, I offer a sincere "thank you."  It would have been impossible to have survived without your help, understanding and support.

FRIDAY NIGHT I DIED
It was a Friday night family "Shabbat" dinner, not initially notably different from Sabbath dinners and accompanying prayers we  enjoyed each week throughout our marriage. This night, I felt a call to the restroom, responded, and soon found myself unable to stand, as the room spun and the floor became unstable.  Recognizing that I was in serious difficulty, I used my hands to protect my head from hitting the cabinetwork and fell. I must have made enough noise because one of my sons recognized that something was wrong and with his brother entered the bathroom where they found me crumpled, not breathing, unresponsive, cold, clammy and without a  pulse. I recall sensing my two sons' strong arms enfolding me, followed shortly by the sounds of the competent paramedics who came to  my aid. Rapid emergency evaluation and transportation to El Camino Hospital's Emergency Department followed. There,  expert evaluation and care led to a confirmed diagnosis of a massive pulmonary embolism and a recommendation by the ER physician that family members be warned of my precarious situation.

This event occurred a little more than 48 hours ago. Luck, genetics, excellent medical and hospital care, modern technology, and advances in medicine have allowed me to survive this feared complication of malignant melanoma.

Stay well.

LET'S TALK ABOUT YOUR MONEY AND FAMILY

IF  AMERICA’S  AFFORDABLE CARE ACT IS GUTTED BY ONE POLITICAL PARTY,  AND YOUR YOUNG ADULT SON OR DAUGHTER BECOMES  SERIOUSLY ILL, WILL YOU HAVE TO CHOOSE BETWEEN SAVING YOUR CHILD’S LIFE AND  BANKRUPTCY?

Read this report, decide what's right for you and your family, and vote accordingly.

 TAILORING DIAGNOSIS AND TREATMENT OF DISEASE TO THE PATIENT GENETICS  - WHO WILL PAY?

"CONCLUSION. . . .
We have provided this information for CMS’s use in setting Medicare coverage and payment policies for genetic tests. Because State Medicaid programs and private health insurance plans closely monitor Medicare’s coverage and reimbursement decisions, CMS’s formulation of reimbursement rates for genetic tests may be useful to them. As one official from a State Medicaid program remarked, “Additional guidance from CMS on genetic testing would be very helpful. We have struggled with payment of such tests for the last couple of years ...."

HOUSTON DAYS

My Houston days have been busy, filled with appointments, consultations, radiographic procedures technical simulations for complex procedures, chemotherapy and a host of other activities which measure the scope and extent of my metastatic malignant melanoma and determines whether the disease has spread, notwithstanding vigorous efforts  to establish systemic control. From my perspective as a physician who, earlier in his career, worked with other "specialist" physicians to treat metastatic cancer of various types and stages, the team work and coordination that I observe here at MD Anderson Cancer Center, is highly reassuring.  Knowledge of, and adherence  to established professional standards is evident in each physician patient (or physician health care provider) contact,communication and discussion.


So far, I have been unable  to obtain access to one of the newest drugs which  stimulates the immune system to kill melanoma cells.  It is not clear when - and if - that access will be available. I will inform my readers of developments in this area.

MD ANDERSON
Last week, I went to Houston, Texas where I was seen by highly skilled, involved, competent physicians associated with MD Anderson's Cancer Center. Neither my time, resources or energy were wasted as I (with my spouse and a son)  saw thoughtful knowledgeable consultant after consultant, visited the laboratory for highly refined tests not generally available elsewhere and the radiologic service for a scan which had not been done before but which was important for the consultant's planning of future health care treatment and procedures for me.

MD Anderson is incorporated in a health care neighborhood, hospital next to hospital, clinic next to clinic and facilities readily accessible to patients and their families.  Patients' and their families' needs are carefully considered as clinics, labs, imaging centers, food services, and even transportation and social services are made accessible and appropriate.  Although the building are on a large scale, it seems as if every effort has been made to consider the patient  - and patients' families -  in the focus.  The environment feels large, but the patient remains the attention point of the physicians, house staff trainees, nurses and staff who provide the important human element of care.

Not everything could be concluded during my actual presence at MD Anderson in Houston.  But I felt satisfied that major steps towards understanding the complex issues I present as a patient were made, that attention had been paid by skilled physicians and staff, and that I would receive an appropriate set of recommendations when they had discussed and considered my medical issues.  Was I  guaranteed a cure? No.  Did I feel that I received proper medical care and consideration in this early stage of my MD Anderson experience? Yes.  Based on my experience would I recommend the MD Anderson Melanoma Center? Yes.