Posted by: Duke Raleigh Hospital | June 18, 2013

My Second Battle with Cancer

by Kip Baker

Most things are easier the second time around. Having had cancer twice, though, I can tell you the second time is no better than the first. In my case, it was harder.

And yet there were blessings that were part of it, too.

After having prostate cancer two years ago, I had made a commitment to living a healthier lifestyle. I lost 50 pounds and decided to mark the occasion by shaving the facial hair I’d had most of my adult life. After getting rid of the beard, I discovered a lump in my neck I never would have seen had the beard been intact. My GP referred me for a CAT scan, which led to a biopsy, which led to the discovery that I had cancer.

In fact, I had the one lump that was visible to me and a second one on the other side of my neck. The cancer had gone to my lymph nodes.

Since I had such a great experience at Duke Raleigh when I was treated for prostate cancer, I decided to return there for treatment. (Raleigh was home for 25 years, but my wife and I moved to Emerald Isle when our kids were out of college and off our payroll.)  Part of the benefit of being treated by doctors who are part of a teaching hospital system  is that they continue to do research and collaborate with others physicians in their field.  Dr. Hahn is my radiologist-oncologist, and  I was originally scheduled for  both radiation and chemo, but the latest research indicated that this rare form of cancer I had – squamous large cell carcinoma – responded as well to radiation alone as it did to the radiation/chemo combination. I was spared chemo, but 35 radiation treatments in seven weeks is harsh.

I kept a journal during that time. Here’s part of it:

“If you remember going to the dentist or doctor for the very first time, then your first experience with radiation would not be much different, except for the fact that you would be going every day for seven weeks.  Even with this not being my first ‘rodeo.’ the first day this time was similar to what I had experienced before, with my heart pounding in my throat and my breathing rapid and shallow. By the second day, I was much calmer and now I find myself fighting the urge to doze off during the twenty minutes of treatments. It is amazing how much we generally dislike change, but how readily adaptable we can become.”

“To make sure that each time you are aligned properly, there are lasers in the ceiling and walls that create a set of crosshairs on the treatment table that are lined up perfectly with the machine. Since there was no support mechanism with the prostate cancer, they simply made three small reference tattoos (one on each hip bone and one on the pubic bone) with which to guide the technician setting up the treatment. With the head and neck being the targeted area this time, I was fortunate that they made all of the reference marks with a Sharpie on the mask, so no facial tattoos! The technology with this process is absolutely amazing, once you get past the ‘Man in the Iron (Mesh) Mask’ aspect. How they can ‘shape’ the beam of radiation to try and spare very sensitive organs only millimeters apart from the cancer is absolutely incredible.”

“Since the source of the original cancer could not be found and the resulting cancer in my lymph nodes is not lymphoma, they are having to irradiate everything from my lower jaw to the top of my esophagus. All of my throat, the tonsil bed, the base of my tongue and the lymph nodes are all targeted with a much wider approach than if the original site could have been identified, which would have resulted with much more refined approach.”

“… Radiation is a progressive process. While the amount of radiation you receive each day is about the same, it has a cumulative effect on the body, and those effects increase over the course of treatment and beyond for several weeks. Even though the effects will continually worsen, my resolve is to stay positive and to continue focusing on the big picture of getting past this small speed bump on my path of living well.”

The treatment made me temporarily lose my sense of taste (and another 20 pounds), but my taste is coming back. I allow myself one beer a week – on Friday afternoons after a week of teaching all my elementary students.  Fortunately, that beer still tastes good.

During my prostate cancer treatment, I had a good friend going through the same thing just a few months ahead of me. He was able to tell me everything he was going through and help me anticipate what was coming next. I didn’t have a guide this time, so I asked my Duke Raleigh dietitian, Lindsay Kovacic, if she could find someone for me to talk to. She did, and that made a huge difference.

I was back at work three weeks after my last radiation treatment, and I feel good. I think it helped that I was in the best physical shape of my life when I discovered the cancer. I eat right, I exercise – biking up to 150 miles a week – and I “indulge” in just one craft beer a week.

Life isn’t back to normal, but it’s a “new normal,” and that feels good.

Posted by: Duke Raleigh Hospital | June 14, 2013

Code Ninja

Duke Raleigh athletes challenge themselves on a 5K obstacle course

Dr. O'Malley

Donald F. O’Malley, Jr, MD

by Donald O’ Malley, MD

We may look like ordinary doctors and nurses to you, but a few of us are secret ninjas. Drs. Keith Michael, Michael Comstock and I – along with others – proved our mettle in the recent Ninja Challenge.

Dr. Debbie Bradley, an oncologist with Duke Hematology/Oncology, was one of our teammates. She proved an invaluable addition, since she used to be a competitive figure skater and is now involved in mountain biking and kick boxing. As we saw in the run, such balance and fight skills are useful to a ninja.

The staff at our office in Raleigh embraced the challenge and became a part of the adventure. Our two X-Ray technologists, Mallory Goodnight and Jenny Moore, along with Jenny’s husband, Chris, joined the team. They were a dominant force on the course, especially when we had to run across the water and throw ninja stars. (If you don’t know what ninja stars are, come out to the Ninja Challenge next year to find out.)

Our team also included the powerhouse Abby Bentley RN (operating room), who filled in for her husband, Dr. Greg Bentley, one of our nonoperative spine partners, because he had recently undergone wrist surgery. Fran Horcher, RN (operating room) was a volunteer and acted as the team cheerleader, as she always had encouraging words.

The Duke Raleigh Hospital team was fortunate, in that most of us already live relatively active lifestyles. So the Ninja Challenge was not some far-off goal of epic proportions that required us to put down our XL sodas and get off the couch. It did act as a reminder, though, any time we may have wanted to drift into a comfy, vegetable state, to continue to stay active.

A cousin told me about the Ninja Challenge and that it began in honor of one of his friends who had passed away at a young age and the proceeds went to charity. The Ninja Challenge website tells the story: “This project is in memory of Karl Andrei Besas, a friend, brother, classmate … adventure seeker and a true ninja. We created this race to remind you to live like Karl and always seek out adventure, push your limits and enjoy every moment.” Knowing that the race was for such an admirable cause – and that it offered new challenges for me – led me to try it out.

The Ninja Challenge is all about overcoming adversities, both physical and mental. However, the hardest part of the race, for me, was the rough terrain. Because I am so used to running on paved roads, moving through the trees, rocks, ditches and hills that I faced during the race became my greatest struggle and left me exhausted by the end.

Though most of us were sore and walked a bit slower in the days following the race, we had no injuries. While the extent of our wounds was brush burns and sore calves, we have seen several patients come in due to injuries from races like these. Before the race, we made sure that Dr. Andre Grant, who wasn’t racing because he was on call, was ready in case any of us got bent out of shape.

One of the most important pieces of advice I can give on preventing injury is to spend an adequate amount of time training before any race. Be sure not to overwhelm your body by doing too much too quickly. Though there is no sure way to prevent an injury while racing, you can lessen your chances of an accident by training properly and at a steady rate.

The Ninja challenge was a fantastic experience and one that I would most definitely do again. Our team had a great time, and the support we were given was even greater. Big thanks to all the volunteers at the race, the family and friends who came out to see and support us, and the Duke Raleigh Hospital Orthopaedic Center for donating the shirts we wore on race day.

To us, this race was purely for the experience of working together and having fun. And such a goal was completely fulfilled, for we ran, sweat, struggled and laughed through this race as one. It was great to see all these people who I know well work together in a different environment than we are used to working in, and it was nice to see each team member helping one another and offering words of encouragement along the way. The unbelievable teamwork paid off, too, because even though we had no aspirations of placing in the top, we ended up finishing in the top 20 of almost 100 teams.

We plan to participate again next year. Maybe we’ll go for the gold!

Posted by: Duke Raleigh Hospital | June 7, 2013

NCHA Hospital Advocacy Day

Rick Gannotta, president of Duke Raleigh HospitalEarlier this week, I joined hospital leaders from across the state for North Carolina’s second Hospital Advocacy Day at the North Carolina Legislative Building.  Each of us met with our local legislators to share challenges that hospitals are facing, specifically, the impact of current state legislative proposals on our hospitals.

Current proposals could affect hospital tax exemptions which enable many of us to provide continued community benefits.  Many of our hospitals, including Duke Raleigh, earn our tax-exemptions daily through charity care and other community programs.  We treat anyone who comes to our hospital regardless of their ability to pay.  Because of the state’s decision not to expand Medicaid, many of the uninsured will continue to rely on our hospitals and emergency departments for care – and we will continue to incur losses from these patients.

We also discussed the importance of preserving hospital payment rates to minimize hospital losses on Medicaid and to preserve the hospital assessment program which offsets a portion of hospital losses from caring for Medicaid patients.  Medicaid is currently paying hospitals less than they spend caring for Medicaid patients. In fact, hospitals are currently spending more on care for hospital services for Medicaid patients than the State does.

I was impressed and encouraged with the candid dialogue that I had with House Speaker Thom Tillis and Senate President Pro Tem Berger.

The Speaker’s willingness to engage in a thoughtful and extremely informed discussion on the very tough issues facing hospitals was a display of real leadership.

At Duke Raleigh Hospital, we are proud to be able to offer the latest advancements in care and treatment options to patients.  Our government’s decisions will profoundly affect the way our hospital and others will be able to deliver care to our communities.  We are committed to fulfilling our promise to deliver the very best care to our community.

If you are interested in learning more about these issues and the impact they have on our state’s hospitals, visit www.healthyhospitalsnc.org.

 Healthy Communities and Healthy Hospitals

References:  www.healthyhosptialsnc.org, www.ncha.org

Patrick Larkin thought it “unfair” that he got cancer. But only because the Dublin native and Statesville resident has the loveliest Irish lilt and a bent for storytelling, and the throat cancer made talking a little tough.

Other than getting hoarse, cancer wasn’t a bother for him. In fact, he says, “It was a fun experience for me. I’m not all gloom and doom, so I never took it very seriously, if you want to know the truth of it.”

Larkin brought Irish good cheer to Duke Raleigh’s cancer center. During the time he spent there, the place felt more like a friendly Irish pub than a cancer center. “I didn’t really think of myself as a patient, you know,” he jokes. “I thought they worked for me. They needed to ask me for permission to take a few days off.”

Dori Trone, RN, BSN, OCN, and Lindsay Kovacic, RD, CSO, LDN, with Patrick Larkin

Dori Trone, RN, BSN, OCN, and Lindsay Kovacic, RD, CSO, LDN, with Patrick Larkin

As for Larkin, a hotel manager, he never missed a day of work during his treatment – something the Duke Raleigh staff says is unusual for people undergoing radiation.

The love was mutual. Dori Trone, RN, BSN, OCN, Larkin’s patient navigator, says, “He is the best! I absolutely do believe that the positive attitude Patrick had throughout his treatment made a huge difference.”

Larkin won’t acknowledge his radiation treatment was anything but a party, but Trone says she believes otherwise. “I know there were some hard days, but he pushed through and did everything he needed to do to take care of himself and stay on track for treatment,” she says. “I feel very fortunate to have gotten to know such a wonderful person. He is thought of so often, and we have the pleasure of seeing him whenever he is over this way. He pops in and checks in on us from time to time to make sure we are staying on top of things.”

Larkin enjoyed the experience so much that he can’t stay away – even though he’s finished with radiation treatments. He claims to have gone through “withdrawals” because he missed the staff so much. The staff misses him, too. “Patrick actually stopped by this afternoon because he needed a cup of coffee,” laughs Lindsay Kovacic, RD, CSO, LDN,  his outpatient dietitian. “Everyone has become a huge fan.”

Larkin and the staff spent plenty of time together. He received treatment daily for “eight or nine weeks.” (He can’t recall exactly. Cancer just wasn’t a big deal for him.)

Larkin’s wife, Linda, remembers the treatment quite clearly, though. “It began in June with the teeth removal,” she recalls. Having his teeth removed was a medical necessity since the radiation was so close to the jaw. It was a potential hazard to the integrity and structure of the jaw bone, Linda Larkin explains. Then, she says, radiation included “35 treatments from July to early September. Chemo was in July and August. The only time Patrick had any anxiety was when there was the possibility of a third chemotherapy session in September, which never occurred.”

Through it all, Larkin remained in good spirits. “Dori and I worked closely with Patrick,” Kovacic notes. “His positive attitude has often reminded me to take a greater outlook on life and look at the way we really react to situations. [Cancer] was what Patrick called a ‘hiccup’ in his life. It wasn’t a setback. He often calls 2012 the ‘best year of his life.’”

“He jokes with us often that he was put in this situation for our benefit,” Kovacic says.  “Nonetheless, through the jokes there was some seriousness. During the hard days he barreled through, and I am 100 percent sure he didn’t miss work one day simply because of his positive attitude. I remind patients often that a positive outlook does make a difference.”

“Dori and I have put Patrick in contact with some patients going through the same regimen simply because we know just talking to him can lift one’s spirits,” Kovacic says.

Indeed he can. He and Linda found themselves not just keeping relatives in Ireland updated on the progress, but entertaining them, too, via the private Facebook page the Larkins set up. One of Linda’s first posts read: “This will NOT be a down/depressing/sad group! It’s to be an uplifting, fun, happy, sharing environment! Feel free to share with others who might benefit from the experience! Post COMMENTS to AND ABOUT Patrick; post thoughts, suggestions, advice or just about anything you want to say. INSPIRE!”

Typical humor from Larkin on Facebook is the post from Aug. 28, 2012: “I met with Dr. Fesko today and I asked him if I will be getting a mention in any medical journals. He said he would work on it!” And when he finished his final treatment, he asked on Facebook: “Now what do I do at 8 a.m. Monday to Friday? Or, to put it another way, what are all the people at Duke going to do?” (They went through withdrawals after Larkin was no longer in their midst each day.)

Larkin and Cleo

Larkin and Cleo

And there’s more trademark Larkin humor. He says his story really can’t be told without “giving a shout-out to Cleo.” Cleopatrick (her full name) is Larkin’s Beagle, and he says, “Cancer turned her whole life upside-down, yet she never complained.” She’s a lot like her master that way.

Post-treatment, Larkin has gotten his lovely voice back – and he has no shortage of stories to share with anyone lucky enough to hear them. You might call him an Irish blessing.

Duke Raleigh Cancer Center is celebrating all cancer survivors on June 4 for our National Cancer Survivors Day Celebration. Join us for refreshments, music, art, and more!

Posted by: Duke Raleigh Hospital | May 24, 2013

My Journey with Breast Cancer; One patient’s story

My Journey with Breast Cancer

pink-breast-cancer-ribbonBy Pamela Wilson

When I went for my annual physical last January, the physician’s assistant noticed a lump during my breast exam. She said it felt like a cyst and referred me to get a mammogram.  Both the mammogram and an ultrasound confirmed it was nothing to worry about.

I was referred to a breast specialist, Dr. Gayle DiLalla at Tolnitch Surgical Associates, who drained fluid from the cyst and told me it was normal for women to have cysts and that as long as the fluid was clear (and it was), it was fine. She instructed me to come back in six weeks.

About four weeks later, the cyst was back and larger than before. I returned to Dr. DiLalla, and this time, she sent the fluid she drained to be tested. The results again came back negative. This was on a Friday, and by the time Dr. DiLalla called me back – less than a week later – the cyst had returned. She performed a procedure in her office to remove the cyst walls so that it would not come back. During this procedure, she mentioned that some tissue looked abnormal. The following Monday, she called to tell me the test came back positive.

I had cancer – invasive triple negative breast cancer (right side). Apparently, the cancerous tumor was behind the cyst and not visible during the mammogram or ultrasound. Fortunately, the tumor was aggravating the cyst, which caused it to recur. Dr. DiLalla suggested a mastectomy followed by chemotherapy and radiation. She referred me to an oncologist, Dr. Spiritos of Duke Raleigh Cancer Center, and I met him later that day. He suggested eight rounds of chemo every other Friday, which I started last March and completed last June.

I originally thought I’d have my right breast removed and just wear a breast prosthetic. However once my BRCA results [genetic testing] showed I had a genetic mutation – increasing the chances of recurrence – I decided to have both breasts removed and get tissue expanders for silicone implants. Talking to survivors in my support group helped me confirm this decision. I also had my ovaries and fallopian tubes removed due to increased risk of ovarian cancer.

There is no history of breast cancer in my family; however my mother did the BRCA testing as well, and she also has the genetic mutation. My treatment was pretty aggressive. Every other Friday for 15 weeks, I had chemo, and on Saturdays, I would go for a shot to help increase my white blood cell count. By, Sunday I was pretty sore. Mondays were usually my bad days, and I would come around by Tuesday and be back to work by Wednesday.

I could not stand the smell of food cooking and didn’t eat a lot of meat. Grilled cheese sandwiches were my food of choice, along with lots of fruits. I made sure not to eat any of my favorite foods for fear they would taste horrible. It got to a point I was eating food only because I knew I needed to eat, but I could barely taste anything. My nails turned dark, I lost my hair, and I had tingling fingers and toes and decreased energy – the typical side effects.  I didn’t have much nausea, thankfully.

I couldn’t have asked for a better support system than my family, friends and Red Hat coworkers. I never had to drive myself to my chemo treatments. My mom, Ruby, stayed with me from Friday evening through Monday evenings on my chemo weeks. She did my laundry, changed my sheets, cleaned my bathroom, swept, mopped and dusted. I joke with her that I sure do miss that now.

My sister, Kesharra, and niece, Aleah (6) live with me in Knightdale. They made sure I ate and took my meds. Aleah was my little nurse. Whenever I felt really bad, she had a way of knowing and doing something extra special for me. My cousin, Emerald, who is like my daughter, kept my nails and toes done since I couldn’t get them done at the nail shop.

My manager, Dorothy, her manager, Paul, and his manager, Charlie donated paid time off so I wouldn’t have to go without pay.

The hardest part of the chemo was the uncertainty of how it would affect me. I must say, I was given good information and was not really taking by surprise. The nurses were excellent and let me know what to expect.

If you get a diagnosis of breast cancer, realize that no two women will have the same journey. You have to deal with it in your way. As women, we often take on so much, but this is one time you have to take care of yourself first. Allow others to help you. Take time to rest and let your body react to all that it is going through. Find a support group. Love hard, play hard and enjoy life.

I am still trying to figure out how to live life as a survivor. Right now, I think about it every day, but I’m sure one day I will wake up and just be Pam and not think about the cancer. I pray one day there is a cure.

Duke Raleigh Cancer Center is celebrating all cancer survivors on June 4 for our National Cancer Survivors Day Celebration. Join us for refreshments, music, art, and more!

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