>> TWO GUESTS FROM THE MAYO CLINIC TO DISCUSS PANCREATIC
CANCER AND INTERNAL MEDICINE ISSUES.
THE MAYO CLINIC: A HISTORY OF EXCELLENCE TONIGHT "ON CALL WITH THE PRAIRIE DOC."
>> STARTING THIS SEASON, WE ARE OFFERING A FACEBOOK LIVE
OPTION FOR OUR VIEWERS TO STILL BE ABLE TO WATCH THE
SHOW DURING THE REGULAR BROADCAST TIME ON THURSDAY NIGHT AND ASK QUESTIONS.
ALL YOU NEED IS EITHER YOUR LAPTOP, TABLET, OR A MOBILE
DEVICE, SUCH AS YOUR SMARTPHONE, TO VIEW THE SHOW.
HERE'S HOW TO DO THAT.
FIRST, LOG INTO YOUR FACEBOOK ACCOUNT.
IF YOU DON'T HAVE A FACEBOOK ACCOUNT, GO TO FACEBOOK.COM
AND COMPLETE THE INFORMATION TO CREATE AN ACCOUNT.
IN THE SEARCH BAR, TYPE IN PRAIRIE DOC.
MAKE SURE TO CLICK "LIKE" ON OUR FACEBOOK PAGE SO YOU CAN
GET UPDATES AND NOTIFIED WHEN WE'RE GOING LIVE.
EACH THURSDAY ON THE PRAIRIE DOC'S PAGE, YOU WILL BE ABLE
TO SEE A LIVE BROADCAST OF THE NEWEST EPISODE.
YOU CAN ALSO ASK DR. HOLM QUESTIONS VIA FACEBOOK LIVE.
ALL YOU HAVE TO DO IS ASK A QUESTION IN THE COMMENT BAR AND AWAIT A RESPONSE.
IF YOU MISS A SHOW LIVE ON FACEBOOK, IT WILL BE AVAILABLE
LATER, BOTH ON THE PRAIRIE DOC FACEBOOK SITE OR AT PRAIRIEDOC.ORG.
>> GOOD EVENING AND WELCOME TO "ON CALL WITH THE PRAIRIE DOC."
ABOUT A YEAR AGO, I WAS DIAGNOSED WITH PANCREATIC CANCER.
SINCE THAT TIME I HAVE SEEN MANY DOCS AND BEEN THROUGH A VARIETY OF TREATMENTS.
AT SOME POINT IT WAS RECOMMENDED THAT I GO TO THE
MAYO CLINIC IN ROCHESTER, MINNESOTA.
I'M STILL HERE WITH YOU. AS IT TURNS OUT, THAT WAS THE RIGHT DECISION.
FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
A PRIMARY CARE DOCTOR REFERS TO A SUBSPECIALIST OFTEN TO
HELP DEFINE THE DIAGNOSIS SO AS TO BETTER TREAT A CONDITION.
A MAYO CLINIC STUDY FOUND THAT THE PERCENTAGE OF THE TIME THE
FINAL DIAGNOSIS WAS ENTIRELY DIFFERENT FROM THAT OF THE REFERRAL DIAGNOSIS WAS:
A, 12%? B, 21%? C, 99%?
DIAGNOSIS WAS DIFFERENT THAN THE REASON IT WAS REFERRED.
12%? 29%? 99%?
VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED
INTO A DRAWING TO WIN A SIGNED COPY OF OUR BOOK, "THE PICTURE OF HEALTH."
EACH OF MY ESSAYS, ORIGINALLY WRITTEN FOR THIS SHOW, COMES
WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON.
WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW.
REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN!
WE ANSWER YOUR MEDICAL QUESTIONS ABOUT THE MAYO
CLINIC AND PANCREATIC CANCER AND INTERNAL MEDICINE,
AS THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL.
CALL IN QUESTIONS TO 1-888-376-6225.
OR SEND US AN EMAIL TO THE ADDRESS ON THE SCREEN.
THIS SAYS YOUR SHOW, YOUR QUESTIONS MATTER.
WE WANT TO ANSWER THEM.
JOINING US TONIGHT IS, DR. ROBERT LOHR,
AN INTERNIST AND A CONSULTANT AT THE MAYO.
AND DR. MARK TRUTY, ABDOMINAL SURGEON, PANCREATIC CANCER RESEARCHER.
AND THE GUY WHO CUT OUT MY PANCREATIC CANCER ON MAY 10th.
WE'RE SO GLAD TO HAVE YOU HERE. THANK YOU.
BOB, YOU AND I HAVE KNOWN EACH OTHER FOR FOUR, FIVE, SIX
YEARS, SOMETHING LIKE THAT, THROUGH INTERNAL MEDICINE
ORGANIZATION, THE AMERICAN COLLEGE OF PHYSICIANS.
ARE YOU STILL ON THEIR MAJOR BOARD?
>> YEAH. I'M ON THE BOARD OF REGENTS AND I'M TREASURER OF THE COLLEGE.
>> AND YOU WILL BE THE PRESIDENT, PROBABLY?
>> NO, I DON'T THINK SO. [Laughter]
>> NOT IN THE CARDS.
>> THAT'S A VERY IMPORTANT POSITION AND AS A GENERAL
INTERNIST, YOU'RE AT THE MAYO CLINIC.
NOW, A LOT OF THINGS HAVE HAPPENED GOING INTO SUBSPECIALTY AREAS.
BUT YOU'RE A GENERALIST. >> RIGHT.
>> SO, HOW DOES THAT WORK AT THE MAYO CLINIC? WITH ALL THESE SUBSPECIALISTS.
>> ACTUALLY, THE GENERAL INTERNAL MEDICINE DIVISION IS
THE LARGEST DIVISION WITHIN THE DEPARTMENT OF MEDICINE.
THERE'S OVER 100 PHYSICIANS.
AND THEN THERE'S ANOTHER PRIMARY CARE GROUP OF ANOTHER
50 OR 60 AND HOSPITAL MEDICINE IS 50 OR 60.
SO, THERE'S A COUPLE HUNDRED GENERAL INTERNISTS, YOU'RE
RIGHT, PEOPLE ASK, WHAT ARE THEY DOING THERE?
YOU'VE GOT ALL THE CARDOLOGIST, THE GASTROENTEROLOGIST,
MANY OF THE PATIENTS, I WOULD SAY THE MAJORITY
OF THE PATIENTS THAT WE SEE, WHETHER THEY'RE LOCAL,
REGIONAL, OR COMING FROM ABROAD, HAVE MORE THAN ONE THING WRONG WITH THEM.
AND THEY REALLY WANT A VERY COMPREHENSIVE EVALUATION.
SO, THEY START IN GENERAL INTERNAL MEDICINE.
AND THEN WE HELP SEND THEM OFF TO THE CARDIOLOGIST, TO THE
SURGEON, WHATEVER THEY NEED.
BUT TRY TO HELP COORDINATE THE CARE AND KEEP THINGS TOGETHER.
WHEN THEY'RE DONE, YOU KNOW, AT A FAIRLY TIGHT PACKAGE OF
RECOMMENDATIONS FOR THEM AND FOR THEIR PHYSICIANS AT HOME.
>> RIGHT. YOU'RE ORIGINALLY FROM WHERE, BOB? WHERE'S YOUR HOME?
>> COLUMBUS, NEBRASKA. >> GREW UP IN NEBRASKA.
>> GREW UP IN NEBRASKA. CORNHUSKER.
>> YEAH, CORNHUSKER, KIND OF THOUGHT I KNEW THAT.
AND THEN YOU WENT TO MED SCHOOL?
>> IN CHICAGO AT NORTHWESTERN. AND I TRAINED AT HENNEPIN COUNTY IN MINNEAPOLIS.
>> AND THEN YOU PRACTICE IN MINNEAPOLIS FOR A PERIOD OF TIME.
>> FOR ABOUT TEN YEARS. THEN I'VE BEEN AT MAYO FOR 24 NOW.
>> OKAY. WELL, WELCOME. >> THANK YOU. PLEASURE TO BE HERE.
>> AND DR. TRUTY, YOU'RE A GENERAL SURGEON, NO, AN ABDOMINAL CANCER SURGEON.
EXPLAIN YOUR TRAINING FOR ME, MARK.
>> SO, TRAINING AFTER MEDICAL SCHOOL, I DID MY GENERAL
SURGICAL TRAINING UP IN ROCHESTER.
AFTER THAT, I WENT OUT, DID SOME MORE SUBSPECIALTY
TRAINING IN SURGICAL ONCOLOGY, LIVER, PANCREAS, G.I. CANCERS.
I'VE BEEN BACK AT ROCHESTER NOW FOR GOING ON SIX YEARS.
>> SO, SIX YEARS NOW. >> UM-HUM.
>> THERE ARE HOW MANY SURGEONS THAT DO -- LET'S SEE NOW.
I HAD THE WHIPPLE PROCEDURE. >> YUP.
>> HOW MANY SURGEONS AT THE MAYO THAT DO THE WHIPPLE?
>> IN MAYO, ROCHESTER, THERE'S SIX OF US. >> RIGHT.
COULD YOU EXPLAIN -- I'VE BEEN TOLD THAT THE WHIPPLE
PROCEDURE IS ONE OF THE MORE AGGRESSIVE SURGERIES THAT THERE IS.
IN FACT, I REMEMBER AT MEDICAL SCHOOL, BACK MANY YEARS AGO,
THAT THEY SAID THAT 50% WOULD NOT SURVIVE THAT SURGERY.
THAT'S CHANGED NOW. >> THAT'S CHANGED DRAMATICALLY.
IT IS A VERY COMPLEX OPERATION, THAT INVOLVES THE
PANCREAS, WHICH IS LOCATED DEEP WITHIN THE ABDOMEN, IT'S
SURROUNDED BY A LOT OF CRITICAL STRUCTURES,
PARTICULARLY ARTERIES AND VEINS, INTERSECTION OF YOUR
G.I. TRACT, YOUR LIVER, YOUR BILE DUCT, AND YOUR INTESTINES.
SO OPERATING IN THAT AREA IS TECHNICALLY COMPLEX.
THE OUTCOMES HAVE SIGNIFICANTLY IMPROVED OVER
THE LAST THREE DECADES, WE'VE BECOME VERY GOOD AT WHAT WE DO.
THE KEY THING IS, YOU WANT A SURGEON THAT DOES THIS OFTEN,
YOU KNOW, HIGH VOLUME, AND ALSO BEING DONE AT A CENTER
THAT DOES IT AS A HIGH VOLUME AS WELL BECAUSE COMPLICATIONS
STILL CAN OCCUR AND YOU HAVE TO MANAGE PATIENTS THROUGH THOSE COMPLICATIONS.
>> ALL RIGHT. BUT YOU DO OTHER CANCER SURGERY ON THE BILE DUCT AND THE LIVER?
>> YEAH, DO LIVER OPERATIONS, STOMACH OPERATIONS, SARCOMA
OPERATIONS, THAT'S THE BULK OF OUR WORK.
>> RIGHT. SO, -- AND YOU DO RESEARCH. >> UM-HUM.
>> EXPLAIN SOME OF THAT RESEARCH. >> YEAH.
SO SOME OF THE RESEARCH THAT WE DO, DIFFERENT TYPES OF
RESEARCH, COULD BE BASIC SCIENCE AT THE BENCH, IT COULD
BE CLINICAL RESEARCH, SPECIFICALLY OF PATIENTS AND
TRIALS, AND THEN ONE OF THE THINGS I HAVE, I DO IN A LAB,
IT'S A TRANSLATIONAL LAB WHERE WE TAKE PATIENTS'S CANCERS
THAT WE TAKE OUT OF SURGERY, WE GROW THEM IN SPECIAL BREEDS
OF MICE, WHERE WE CAN GROW THAT PATIENT'S TUMOR AND WE
CAN TEST DIFFERENT DRUGS AND LOOK FOR DIFFERENT TUMOR
MARKERS, ET CETERA, TO HELP EITHER DIAGNOSE, TREAT
PATIENTS AFFECTED IN A MORE INDIVIDUALIZED BASIS.
>> COULD YOU EXPLAIN A LITTLE BIT OF MY CANCER IN A WAY THAT PEOPLE WOULD --
>> YOU BET. >> I THINK IT'S INTERESTING.
>> THERE'S DIFFERENT TYPES OF TUMOR IN THE PANCREAS.
WHAT YOU OFTEN HEAR IS PANCREAS CANCER, A GENERAL
TERM, IT'S AN ADENOCARCINOMA, 90% OF ALL PANCREAS CANCERS ARE OF THAT SUBTYPE.
YOUR PARTICULAR TYPE OF TUMOR IS A RARE SUBTYPE, A MIXED
TUMOR BETWEEN ENDOCRINE CARCINOMA.
SO A BIT UNUSUAL BUT STILL FIT THE PANCREAS CANCER.
>> I'VE BEEN CALLED UNUSUAL MY WHOLE LIFE. [Laughter]
SO, WE HAVE SOME QUESTIONS.
WE MIGHT AS WELL JUST KIND OF DIVE INTO SOME OF THESE. >> YEAH, YOU BET.
>> A MAN FROM SIOUX FALLS WONDERS, WHAT IS THE NEWEST
PROCEDURE FOR TREATING PANCREATIC DUCTILE CARCINOMA?
OKAY. NEWEST PROCEDURE?
>> SO, IN TERMS OF PROCEDURES, TECHNICALLY PROCEDURES ARE
DOING A LOT MORE MINIMALLY INVASIVE OPERATIONS.
SO, TRADITIONALLY JUST LIKE REMOVING A GALLBLADDER USED TO
BE A BIG INCISION, NOW WE CAN DO THEM THROUGH SMALLER INSIGNIFICANCE.
>> ROBOTIC. >> YEAH, ROBOTIC, YOU BET.
SO ANYTHING DONE TO HELP PEOPLE RECOVER FROM THEIR OPERATION FASTER.
THE KEY THING IS, YOU STILL HAVE TO BE ABLE TO DO THE
APPROPRIATE CANCER OPERATION, THAT'S FIRST AND FOREMOST.
IF YOU GET THEM TO HEAL FASTER, GET OUT OF THE
HOSPITAL SOONER, RECOVER FASTER, THAT'S OBVIOUSLY BEST FOR THE PATIENT.
>> BUT I DIDN'T GET THE ROBOTIC PROCEDURE.
I HAD THE BIG, HUGE -- [Laughter]
SO, WHY DID I NOT HAVE THE ROBOTIC?
>> SO, SOME OF IT, THAT'S STILL RELATIVELY NEW.
SO WHIPPLE, LAPAROSCOPIC WHIPPLE, WE DO HAVE A SURGEON
THAT'S LEADING THE WORLD DOING THAT. THERE ARE STILL SOME LIMITATIONS.
YOUR PARTICULAR CANCER THAT WE OPERATED ON WAS INVOLVING ONE
OF THE SIGNIFICANT ARTERY, SO WE INITIALLY PLANNED ON DOING
A PROCEDURE THAT'S NOT PERFORMED VERY OFTEN ANYWHERE IN THE UNITED STATES.
WE HAPPEN TO PERFORM MORE OF THESE UNBLOCKED ARTERIAL
OPERATIONS MORE THAN ANY OTHER CENTER.
BUT THE RISKS OF THAT OPERATION IS HIGHER.
>> BOB, TAKING CARE OF SOMEBODY FOLLOWING PANCREATIC
SURGERY OR ABDOMINAL SURGERY, THERE'S A LOT OF MEDICAL COMPLICATIONS.
COULD YOU DESCRIBE?
>> YEAH, OFTEN THERE ARE, BECAUSE PATIENTS ARE OLD AND
FRAIL OR THEY CAN BE YOUNG AND FRAIL.
BUT THEY HAVE OTHER THINGS GOING ON.
ONE OF THE MOST COMMON PROBLEMS THAT WE HAVE,
PARTICULARLY IN THE FRAIL ELDERLY IS THEY GET A LOT OF
DELIRIUM POST OPERATIVELY.
YOU HAVE TO USE SOME OPIOIDS, SOME NARCOTICS, THE FIRST FEW DAYS.
BUT THEY'RE NOT THAT WELL TOLERATED AND WE GET A LOT OF
CONFUSION, WE HAVE TO DEAL WITH THAT.
THERE'S A LOT OF KIDNEY PROBLEMS AFTER A LONG SURGERY.
BLOOD PRESSURE TENDS TO DROP IN THE OPERATING ROOM.
THE KIDNEYS DON'T GET QUITE THE BLOOD SUPPLY THAT THEY WOULD.
SO THERE'S SOME KIDNEY ISSUES, SOMETIMES, AFTERWARDS.
AND THEN IF SOMEONE COMES IN WITH KIND OF A WEAK HEART,
THAT CAN BE AGGRAVATED, TOO.
SO THERE'S A LOT OF THINGS THAT GO ON.
AND WE TRY AND WORK WITH OUR SURGICAL COLLEAGUES TO, YOU
KNOW, GET THE PATIENTS THROUGH THESE.
IT'S IMPORTANT THAT WE UNDERSTAND WHAT THE SURGERY
ENTAILS AND WHAT THE LIMITATIONS THAT WHAT WE MIGHT
RECOMMEND ARE IN TERMS OF SOMEONE BEING POST OPERATIVELY.
FOR EXAMPLE, YOU DON'T WANT TO COMPLETELY ANTICOAGULATOR THIN
SOMEONE'S BLOOD RIGHT AWAY AFTER THE OPERATION BECAUSE
THEY JUST HAD THE SURGERY. [OVERLAPPING CONVERSATION]
YET, THERE ARE TIMES WHEN WE HAVE DO THAT, THEY HAVE AN
ARTIFICIAL HEART VALVE, THINGS LIKE THAT.
SO IT GETS VERY COMPLICATED.
ONE THING I WANTED TO GO BACK TO IS WHAT MARK SAID A FEW
MINUTES AGO, THAT IS, WHEN YOU'RE HAVING A PROCEDURE OF
ANY KIND THAT IS REALLY IMPORTANT TO MAKE SURE THAT
YOU'RE AT SOMEPLACE WHERE IT'S DONE A LOT.
AND, YOU KNOW, PATIENTS ASK ME IN THE OFFICE, YOU KNOW,
IS THE SURGEON GOOD, THEY'VE DONE THIS BEFORE,
THEY SHOULD ASK THE SURGEON THAT. THEY DON'T ALWAYS.
AND I SAY, YOU KNOW, THEY ARE. THE SURGEON'S VERY SKILLED.
AND THEY DO THIS ALL THE TIME.
AND THAT'S REALLY WHAT YOU WANT, YOU WANT TO GO TO A
PLACE WHERE WHATEVER THE PROCEDURE IS, IT'S THE USUAL
MONDAY MORNING, THIS IS NOTHING SPECIAL, WE DO THEM
SEVERAL TIMES A WEEK. NOT SEVERAL TIMES A YEAR.
AND WE HAVE ALL THE BACKUP, THE PERSONNEL, THE SUPPORT TO
HELP IF SOMETHING DOES GO AWRY OR IF WE NEED TO GO
A LITTLE DIFFERENT DIRECTION. THAT'S REALLY REALLY IMPORTANT.
>> YEAH. AND THAT'S BEEN DEMONSTRATED WITH SIGNIFICANT AMOUNT OF EVIDENCE.
PATIENTS DO BETTER WHEN THEY'RE OPERATED ON BY
SURGEONS WHO DO A HIGH VOLUME, AS WELL AS AT A HOSPITAL THAT
ALSO TREATS THOSE CONDITIONS AND THOSE PROCEDURES AT A HIGH VOLUME.
ONE ASPECT OF THE OPERATION, ARE THEY GETTING
THE APPROPRIATE CANCER OPERATION?
IS IT TECHNICALLY DONE AS BEST AS POSSIBLE?
AND THEN, HOW ARE THEY TAKING CARE OF AFTERWARDS?
CAN THEY RECOGNIZE A PROBLEM? CAN THEY ACT ON IT?
DO THEY HAVE ALL THE SUPPORTIVE STAFF TO GET THOSE PATIENTS THROUGH IT?
IT'S A TWO-FOLD ISSUE.
>> RIGHT, RIGHT, EXACTLY.
>> ONE OTHER, WHAT IS THE HEREDITARY FACTOR OF PANCREATIC CANCER?
MY UNCLE DIED AT 58, AND MY MOM AND HER SIBLINGS ARE CONCERNED.
OKAY. SO, WHAT IS THE HEREDITARY FACTOR WITH PANCREATIC CANCER OR ANY CANCER?
>> SO, IN GENERAL, IN THE GENERAL POPULATION, THERE'S
ABOUT A 1 TO 2% RISK OF A PATIENT AT ANY POINT IN LIFE
BEING DIAGNOSED WITH PANCREATIC CANCER.
>> ANYONE OFF THE STREET, 1 OR 2% CANCER?
>> IT'S NOT A VERY HIGH-INCIDENT CANCER.
HOWEVER, IT IS A HIGH MORTALITY CANCER. CANCER DEATHS.
MOST PANCREAS CANCERS ARE SPORADIC, MEANING THEY JUST HAPPEN.
LIKE ANY CANCER, CANCER IS BASICALLY ALL OUR CELLS HAVE BRAKES AND GAS PEDALS.
WHAT HAPPENS WHEN A CANCER DEVELOPS, IS, THE GENE THAT
NORMALLY KEEPS THINGS FROM GROWING GETS TURNED OFF AND
GENES THAT ALLOW THINGS TO GROW GETS TURNED ON AND THAT DEFINES THE CANCER.
THAT'S A SUBTYPE. MOST PANCREAS CANCERS ARE SPORADIC,
THERE'S A VERY SMALL PERCENTAGE OF WHAT WE CALL HEREDITARY.
WE CAN SEE THOSE IN PATIENTS -- >> BREAST CANCER.
>> YOU BET, BREAST, OVARIAN CANCER, THERE'S A VARIETY OF LYMPH SYNDROME.
THERE'S SOME PATIENTS WITH MELANOMA BUT THOSE ARE IN THE MINORITY.
SO, TYPICALLY WHEN WE WORRY ABOUT A FAMILIAL COMPONENT,
WE'RE LOOKING AT TWO DIRECT FAMILY MEMBERS WITH PANCREATIC
CANCER, THAT'S WHEN THE RISK RISES AND WE DO SOME MORE
SCREENING IN THOSE FAMILIES.
>> IN THIS CASE, THERE'S NOT A LOT OF INCREASED RISK WITH ONE RELATIVE.
>> NOT A LOT OF INCREASED RISK, UNLESS THE PATIENT WAS
YOUNG AND HAD OTHER RISK FACTORS.
>> WHAT ABOUT CANCER IN GENERAL, I DO THINK THAT
THAT'S SOMETHING THAT I SEE, WHEN I'M CARING FOR AN ELDERLY
PERSON OR A MIDDLE-AGE PERSON, AND THEY'VE GOT A LOT OF
FAMILY HISTORY OF CANCER, IT'S NOT THE BRCA, BREAST CANCER
THING, IT'S JUST A LOT OF CANCER.
I OFTEN THINK THAT THERE'S A HIGHER RISK OF CANCER IN THAT.
>> IT DEPENDS ON THE TYPE OF CANCER, BREAST CANCER, YES,
THERE ARE CERTAINLY HEREDITARY FACTORS.
COLON CANCER, THERE ARE HEREDITARY FACTORS,
PARTICULARLY IF THE RELATIVES ARE FIRST-DEGREE RELATIVES, PARENTS, SIBLINGS.
NOT AUNT TILLIE FROM TEN YEARS AGO OR 50 YEARS AGO.
BUT FIRST-DEGREE RELATIVES.
AND THEN THERE IS LYMPH SYNDROME, WHICH IS A HEREDITARY PROBLEM.
SO THOSE ARE THE MAIN ONES IN TERMS OF FAMILY HISTORY.
THE REST OF IT IS MORE SPORADIC, FRANKLY. >> OKAY.
>> KNOWLEDGE IS POWER WHEN YOU ARE DEALING WITH LIFE-THREATENING DISEASE.
SUPPORT COMES FROM THE MEDICAL STAFF, DOCTORS AND, OF COURSE,
YOUR FRIENDS AND FAMILY.
>> I WOKE UP ONE MORNING AT THE END OF OUR BED WE HAVE A
VERY LIGHTED BEDROOM, MY WIFE SAID, WHAT IS WRONG WITH YOU?
AND I SAID, WHAT DO YOU MEAN?
AND I HAD TURNED COMPLETELY YELLOW.
SO, OF COURSE, WE WENT TO THE FORT MEADE HOSPITAL IN STURGIS.
AT FIRST, IT WAS HEPATITIS.
AND THEN FOUND OUT LATER IN A COUPLE OF DAYS THAT I HAD PANCREATIC CANCER.
A DOCTOR THERE HAD READ AN ARTICLE ABOUT A DOCTOR IN MAYO
CLINIC IN ROCHESTER THAT WAS HELPING PATIENTS WITH PANCREATIC CANCER.
PUT ME THROUGH A PROGRAM OF CHEMO, RADIATION, AND THEN
FINALLY SURGERY IN SEPTEMBER OF 2014.
AND IT WAS A WHIPPLE SURGERY, YOU KNOW, BASICALLY OPEN YOU
UP, GO INSIDE, AND -- UNTIL THEY CAN FIND THE TUMOR.
AND IN MY CASE, I DID ALL THE PROCEDURES FIRST.
MOST CASES ARE DONE WHERE THEY DO THE WHIPPLE FIRST, THEN
THEY DO THE CHEMO AND RADIATION AFTERWARDS.
BUT IN DOING SO, THEY HAD TO REPLACE A ARTERY SUPPLYING
BLOOD TO MY LIVER BECAUSE IT HAD BEEN DAMAGED AND BECAUSE
OF THE PANCREAS AND THAT.
AND THEY HAD TO REPLACE IT WITH A HOG ARTERY.
I GOT OUT OF SURGERY. EVERYTHING WAS FINE.
SO I WAS IN THE HOSPITAL FOR QUITE A LENGTHY TIME.
ALMOST THREE WEEKS. AND AFTER THAT, MORE RADIATION. MORE CHEMO.
AND THEN I GOT TO GO BACK. AND THINGS GOT IMPROVING.
THEY DID HAVE TO PUT A STENT IN. I AM STILL CANCER-FREE.
I GO BACK EVERY FOUR MONTHS, IT WAS THREE IN THE BEGINNING,
NOW IT'S EVERY FOUR. YOU DON'T GIVE UP.
HAVE SOMEBODY THAT, OH, I'M SO GLAD, I'M SO FORTUNATE FOR MY
WIFE, SUPPORT IS WHAT YOU NEED.
I THANK ROCHESTER, MINNESOTA, AND DR. TRUTY OVER THERE,
BECAUSE HE'S THE MAN THAT SAVED MY LIFE.
>> THIS IS YOUR SHOW.
YOUR QUESTIONS ARE KEY TO OUR SHOW DISCUSSION.
CALL IN YOUR QUESTIONS ABOUT THE MAYO CLINIC, ABOUT
INTERNAL MEDICINE ISSUES, ANY ISSUES.
AND ABDOMINAL SURGERY AND PANCREATIC CANCER, TO
1-888-376-6225 OR SEND US AN E-MAIL TO PRAIRIEDOC.ORG.
WE APPRECIATE THAT.
SO, THAT WAS AN INTERESTING GENTLEMAN.
AND, OF COURSE, MARK, YOU KNOW HIM. >> YES.
>> SO HE HAD METASTATIC CANCER TO HIS LIVER.
AND IT'S AMAZING TO ME THAT A MAN WHO AT THAT THAN POINT
WOULD HAVE STAGE 4 CANCER AND THEN HE'S NOW THREE AND A HALF
YEARS OUT OR SO.
WE APPRECIATE HIS BEING ON THE TELEPHONE -- TELEVISION AND
SHOWING US AND TALKING TO US ABOUT HIS CANCER.
DO YOU SEE THAT KIND OF RESPONSE IN OTHER PEOPLE?
>> WE ARE SEEING MORE AND MORE OF THOSE RESPONSES.
THIS IS, AGAIN, IT'S REALLY CHANGED, NOT JUST THE
TECHNICAL ASPECTS, WE'VE BECOME REALLY GOOD SURGEONS
OVER THE LAST THREE DECADES.
WE CAN DO VERY COMPLEX CASES.
BUT THE PROBLEM WITH PANCREAS CANCER, YOU KNOW, A KNIFE
CAN'T CONTROL BIOLOGY.
AND THAT'S WHERE WE REALLY NEED TO DEPEND ON OUR MEDICAL
ONCOLOGISTS TO COME UP WITH SOMETHING MORE EFFECTIVE TO
TREAT THE WHOLE BODY.
TALK TO MY PATIENTS, IT'S LIKE A DANDELION, IF YOU MOW OVER A
DANDELION, WHAT DO YOU GET?
YOU GET 100 MORE. YOU NEED A WEED KILLER.
WE HAVE MUCH BETTER WEED KILLER, SO TO SPEAK, FOR PANCREAS CANCER.
THAT'S LITERALLY THE LAST FIVE YEARS.
TWO OR THREE MORE EFFECTIVE THAN TRADITIONAL AGENTS.
AND WE'RE FINDING MORE RESPONSE IN PATIENTS WHO HAVE
RELATIVELY LOCALIZED DISEASE. WE'RE SEEING IMPROVED SURVIVAL IN PATIENTS.
WE'RE SEEING WE'RE ABLE TO APPLY THE MODALITY OF SURGERY,
WHICH IS THE ONLY CURATIVE FORM TO A MUCH LARGER FRACTION
OF PATIENTS AND WE'RE DOING OPERATIONS THAT WE NEVER THOUGHT WOULD BE POSSIBLE.
>> SO I HAD THREE CHEMO AGENTS. COMBINED.
ONE WAS A PLATINUM. FOLFIRINOX. A COMBINATION OF THREE AGENTS.
AND I HAD THREE DOSES WHEN I SAW YOU. YOU SAID, NOT ENOUGH.
YOU WANT TO GO TO SIX BECAUSE YOUR RESEARCH SHOWED LESS THAN
FOUR, TWO AND A HALF YEAR SURVIVAL, MORE THAN FOUR, FIVE
YEAR SURVIVAL, SOMETHING LIKE THAT. AM I CORRECT IN QUOTING YOU?
>> YUP. >> SO THE CHEMO THAT MAKES A DIFFERENCE.
BUT PEOPLE HATE -- I MEAN, THEY DON'T WANT TO HEAR THAT.
PEOPLE HAVE A REACTION TO CHEMO.
>> IT'S NOT FUN. YOU KNOW THAT. >> IT IS NOT FUN.
WHAT IS YOUR COMMENT ABOUT CHEMOTHERAPY?
>> YEAH, WELL, IT CLEARLY PLAYS A ROLE, YOU KNOW, WE
CALL IT ADDUMEN CHEMOTHERAPY.
>> YOU DO THE SURGERY, YOU DO THE CHEMO.
>> YOU DO THE CHEMO, THEN YOU ADD THE SURGERY, THEN YOU MAY
DO SOME MORE AFTERWARDS, AND YOU MAY HAVE SOME RADIATION THROWN IN.
BUT, AS MARK SAID, THE OUTCOMES ARE MUCH MUCH BETTER
THAN JUST THE SURGERY ALONE.
AND THE REASON IS, THE SURGEONS, AS SKILLED AS THEY
ARE, YOU CAN'T SEE CANCER CELLS.
AND THEY CAN SPREAD VIA THE LYMPH GLANDS, THEY CAN SPREAD
VIA THE BLOODSTREAM, DIRECT EXTENSION, THERE'S NUMEROUS WAYS.
AND YOU REMOVE WHAT YOU CAN SEE, BUT YOU CAN'T SEE EVERYTHING.
AND THE CHEMOTHERAPY ADDRESSES THE REST OF THE BODY.
UNFORTUNATELY, MUCH OF IT, NOT SO MUCH THE IMMUNOTHERAPY BUT
THE TRADITIONAL CHEMOTHERAPY HAS LOTS OF SIDE EFFECTS.
AND THAT'S WHY PEOPLE -- AND IT ISN'T FUN.
BUT I THINK THE MEDICAL ONCOLOGISTS ARE MUCH MUCH MORE
SKILLED NOW THAN THEY USED TO BE IN ALLEVIATING OR
MITIGATING THOSE COMPLICATIONS.
>> THE KEY THING IS, AS HE SAID, THE TRADITIONAL METHOD
WAS YOU'D OPERATE, THEN YOU'D APPLY CHEMOTHERAPY.
ONE OF THE FEW THINGS THAT WE HAVE REALLY HIGH-LEVEL DATA
FOR IS GETTING CHEMOTHERAPY AFTER SURGERY DOES PROLONG SURVIVAL.
BUT IN GENERAL, THOSE PATIENTS AS A WHOLE HAVEN'T DONE VERY
WELL FOR THREE DECADES.
SO WE'RE TURNING THINGS, NOW GIVING THEM ALL THEIR CHEMOTHERAPY UP FRONT.
WHAT WE FOUND, THOSE PATIENTS THAT HAD SURGERY, THEN HAD
CHEMOTHERAPY, LESS THAN HALF EVEN STARTED IT.
OF THOSE THAT DID MANY DIDN'T EVEN FINISH IT BECAUSE IT'S
VERY DIFFICULT TO GET CHEMOTHERAPY AFTER RECOVERING
FROM A BIG OPERATION.
THEY'RE FINDING, WE HAVE BETTER CHEMOTHERAPY, A LOT
EASIER TO TOLERATE PRIOR TO AN OPERATION, IF THERE IS AN
ISSUE AFTER SURGERY, WE'RE NOT ALL RINGING OUR HANDS, BECAUSE
IT'S BEEN TREATED AS POSSIBLE.
>> YOU SAID ADJUVANT, AND NEO IS BEFORE. >> NEO IS BEFORE.
>> YOU ALSO HAD ME GET RADIATION. >> YOU BET.
>> SO, THE SCIENCE FOR THAT IS STILL PRETTY WEAK, THOUGH, RIGHT?
I MEAN, IT'S NOT THERE YET, RIGHT? OR IS IT?
>> NO, THE SCIENCE IS THERE.
IT'S ABOUT CHANGING THE MINDSET AND THE PHILOSOPHY.
EACH OF THESE COMPONENTS HAVE A SPECIFIC PURPOSE.
THE PURPOSE OF CHEMOTHERAPY IS TO TREAT THE WHOLE BODY.
IT'S NOT THE TUMOR THAT EVERYONE TALKS ABOUT THAT TAKES PEOPLE'S LIVES.
IT'S THE SEEDS. THAT'S THE PURPOSE OF THE CHEMOTHERAPY.
IF WE HAVE A RESPONSE TO THE MAIN TUMOR THAT'S A SURROGATE
THAT WE'RE ALSO HOPEFULLY KILLING ALL THOSE SEEDS.
ONCE WE'VE HOPEFULLY STERILIZED ALL THESE
MICROMETASTISIS, THE SPREAD OF THE CANCER, WHICH WE KNOW MOST
PEOPLE HAVE AT DIAGNOSIS, WE THEN START FOCUSING ON THE LOCAL AREA.
RADIATION IS LIKE SURGERY, IT'S LOCAL.
I USE RADIATION SPECIFICALLY TO ALLOW ME TO HAVE A NEGATIVE MARGIN.
WHAT'S A NEGATIVE MARGIN?
AS A SURGEON, I HAVE TO REMOVE THE TUMOR WITHOUT LEAVING CANCER CELLS BEHIND.
I DO AN OPERATION, I LEAVE CANCER BEHIND, THERE'S NO BENEFIT TO THAT OPERATION.
THAT'S BEEN PROVEN.
RADIATION ALLOWS ME TO HAVE A MUCH HIGHER PROBABILITY TO
OFFER THE BEST CANCER OPERATION FOR THAT PATIENT.
>> SO, I THINK THE MESSAGE THAT WE'RE HEARING IS THAT THE
BAD RAP THAT PEOPLE HAVE WITH CHEMO AND WITH RADIATION IS
INAPPROPRIATE BECAUSE IT VARIES OUR CHANCE, THAT'S THE KILLER OF THE SEEDS.
>> IT'S A HEALTHY MODALITY APPROACH, I THINK HAS REALLY MADE THE DIFFERENCE.
>> KEY THING, IT'S A LOT EASIER FOR THE PATIENTS TO
TOLERATE SOME OF THE SIDE EFFECTS OF CHEMOTHERAPY IF WE
CAN DEMONSTRATE THAT IT'S ACTUALLY BEING EFFECTIVE,
WHETHER IT'S THE TUMOR MARKER GOING DOWN, WHETHER IT'S THE
TUMOR SHRINKING, WHETHER IT'S THE P.E.T. SCAN CHANGING.
ONCE THE PATIENT SEES THAT, HEY, WHAT I'M TAKING IS
WORKING, IT'S A LOT EASIER PILL TO SWALLOW, NO PUN INTENDED.
>> I HAVE TO SAY, I'VE GONE THROUGH THE CHEMO.
AND IT HITS YOU LIKE A TON OF BRICKS.
BUT YOU'RE GETTING OVER IT, YOU'RE GETTING BETTER.
YOU'RE FEELING BETTER. AND THEN THEY HIT YOU AGAIN.
AND THEN YOU GET OVER IT. AND, SO, I HAD THAT SIX TIMES.
I'M GLAD I DID IT. LOOK, I'M A YEAR OUT NOW, OCTOBER IS A YEAR.
SO OCTOBER, NOVEMBER, DECEMBER. I MEAN, WE'RE OUT 14 MONTHS NOW.
AND THERE IS, LIKE YOU SAY, MUCH SMALLER CHANCE OF SURGERY
BEING SUCCESSFUL, WHAT IS IT, TELL ME THE PERCENTAGE AGAIN.
WHAT PERCENTAGE OF PEOPLE CAN GO TO SURGERY FOR PANCREATIC CANCER?
>> TRADITIONALLY, WE LOOKED AT PEOPLE, WHETHER THEY'RE RESECTABLE.
THERE'S A PROBLEM, THERE'S A BIG DIFFERENCE BETWEEN
RESECTABILITY AND REMOVABILITY.
REMOVABILITY, I CAN SEPARATE THAT PATIENT FROM THAT TUMOR.
CONSTRAINTS, IS THAT ACTUALLY GOING TO BE A BENEFIT TO THEM,
WHAT'S THE CONSEQUENCE OF THAT, IS IT GOING TO BE A GOOD OPERATION?
SO RESECTABILITY MEANS, CAN I TAKE THAT PATIENT TO THE
OPERATING ROOM AND ACTUALLY LOOK THEM IN THE EYE AND, SAY,
THIS IS GOING TO ACCOMPLISH OUR GOALS.
WHAT ARE OUR GOALS?
THE GOAL IS TO EXTEND THAT PATIENT'S LIFE, AND EITHER
MAINTAIN OR IMPROVE THEIR QUALITY OF LIFE.
THAT'S THE GOAL FOR ANYONE WITH CANCER.
AND WE'RE TRYING TO DO THAT WITH SURGERY.
THE TRADITIONAL METHOD, WE'VE JUST FOCUSED ON A VERY SMALL
GROUP OF PATIENTS WHOSE TUMORS WERE JUST LOCALIZED IN THE PANCREAS.
>> RIGHT. >> NO VESSEL INVOLVEMENT.
WE TOOK THEM TO THE OPERATING ROOM. SOME OF THEM MAYBE GOT CHEMOTHERAPY.
AND WHAT ARE THE RESULTS OF THAT? THEY'RE PRETTY POOR.
FOR THREE DECADES THAT HAVEN'T CHANGED. WE'RE CHANGING THINGS NOW.
WE'RE GIVING THEM ALL THE THERAPY UP FRONT PRIOR TO SURGERY.
WE'RE APPLYING THIS TO A LARGER FACTION OF PATIENTS.
DOING BIGGER OPERATIONS THAT PEOPLE THOUGHT WERE NEVER EVEN
TECHNICALLY POSSIBLE. IF WE GET THEM THROUGH THAT, THOSE
PATIENTS, IN GENERAL, DO MUCH BETTER THAN AVERAGE, PERIOD.
>> ALL RIGHT. WOW.
>> AND WHAT WERE YOU GOING TO SAY?
>> I WAS GOING TO SAY IN TERMS OF MANAGING THE CHEMOTHERAPY
AND THE SIDE EFFECTS, IT DOES KNOCK THE WIND OUT OF YOUR SAILS.
YOU KNOW THAT PERSONALLY. BUT IT'S ALSO TEMPORARY.
AND YOU'RE GOING TO GET BETTER. THE APPETITE WILL COME BACK.
THE NAUSEA WILL BE BETTER. YOU MAY HAVE TO HAVE ANOTHER ROUND.
BUT IT IS, YOU KNOW, IT'S SORT OF LIKE YOU BREAK A BONE, IT
WILL HEAL, I'LL BE OKAY. THIS ALSO GETS BETTER.
AND I THINK PEOPLE HAVE TO KEEP REMINDING THEMSELVES OF
THAT AND BE REMINDED OF IT.
>> BE REASSURED.
>> YEAH, THAT'S THE KEY THING.
AS SURGEONS, WE ALWAYS FOCUS ON, CAN I GET THE PATIENT OUT
OF THE HOSPITAL IN 30 DAYS WITHOUT A PROBLEM?
WE'RE GETTING BETTER AT THAT.
LARGER OPERATIONS, PATIENTS ARE GETTING A LOT OF THERAPY.
AGAIN, WHAT'S THE GOAL?
I DON'T CARE ABOUT MY 30, 90-DAY SURVIVAL.
I CARE ABOUT WHAT'S THE FIVE-YEAR SURVIVAL OF THESE PATIENTS.
>> GOSH, MARK. AND, SO, THE KEY THING IS, SOME PATIENTS MAY TAKE
A LARGER UP-FRONT RISK TO GET THAT LONG-TERM GOAL.
THESE ARE CONVERSATIONS THAT WE HAVE WITH THEM.
>> OKAY. WE'LL NEED TO HAVE SOME HELP WITH THE WATER I SPILLED ON MARK.
>> NO WORRIES. >> SORRY. AND I WANTED TO TALK ABOUT THE --
THE SYMPTOMS THAT A PERSON WITH PANCREATIC CANCER MIGHT HAVE.
YOU KNOW, NOW WE'RE TALKING ABOUT TREATMENT.
IT WOULD BE NICE TO BE ABLE TO CATCH IT EARLY. >> YEAH, YEAH.
>> HOW CAN WE DO THAT? WHAT SYMPTOMS DOES A PERSON HAVE THAT MIGHT BE A CLUE?
>> MARK CAN PIPE UP, TOO. YOU KNOW, SOMETIMES THERE REALLY AREN'T VERY MANY
SPECIFIC TYPES OF SYMPTOMS.
IT'S NOT UNCOMMON, YOU EXPERIENCED THIS, YOU HAD SOME
BELLY PAIN, BUT ALL OF A SUDDEN YOU'RE JAUNDICE, YOUR
EYE IS YELLOW AND YOUR SKIN'S TURNING YELLOW AND THAT'S
BECAUSE THE TUMOR IS BLOCKING THE OUTFLOW OF BILE IN THE G.I. TRACT.
SO, THAT HAPPENS.
ABDOMINAL PAIN, LOSS OF APPETITE, WEIGHT LOSS,
SOMETIMES NAUSEA AND VOMITING, SOMETIMES NOT AT ALL.
AND, UNFORTUNATELY, MORE OFTEN THAN NOT, THE PATIENT COMES IN
WHEN SYMPTOMS ARE KIND OF ADVANCED, AND THE TUMOR IS,
UNFORTUNATELY, KIND OF ADVANCED.
EITHER THERE'S A FAIR AMOUNT OF LOCAL SPREAD OR IT'S -- AS
THE GENTLEMAN IN THE TAPE, IT'S IN THEIR LIVER OR SOMEPLACE ELSE.
AND THAT'S -- THAT GOES BACK TO, WELL, WHY CAN'T WE FIND
SOME SORT OF A SCREEN OR A SCREENING TEST FOR PANCREATIC CANCER?
>> YEAH, WHAT KIND OF SCREENING TEST CAN I DO?
>> WELL, YOU HAVE TO ASK, YOU HAVE TO BACK UP AND, SAY,
WELL, WHAT IS A VALID SCREENING TEST?
WHAT DOES THAT MEAN?
AND IT MEANS THAT A PATIENT OF AVERAGE RISK FOR WHATEVER THE
CONDITION IS, AND NO SYMPTOMS THAT WE CAN DO A BLOOD TEST OR
AN X-RAY OR SOMETHING, MAKE A DIAGNOSIS, AND WITH THAT
INFORMATION CURE THE CANCER. >> RIGHT.
>> PANCREATIC CANCER CURRENTLY DOES NOT HAVE THAT.
AND THERE ARE -- YOU KNOW, CERVICAL CANCER DOES WITH PAP
SMEARS AND VIRAL TESTING.
BREAST CANCER DOES WITH MAMMOGRAMS.
COLON CANCER DOES WITH A VARIETY OF THINGS,
COLONOSCOPIES AND FECAL TESTING, DNA TESTING, SO FORTH.
PROSTATE IS A LITTLE MORE CONTROVERSIAL WITH PSAs.
>> YES, IT IS.
>> BUT, NEVERTHELESS, THAT'S ABOUT IT. IN THE CURRENT STATE --
>> SO WE DON'T HAVE A SCREENING TEST? >> WE DO NOT.
>> SCREENING PEOPLE WITH C.A.T. SCAN DOESN'T WORK?
>> IT DOESN'T WORK. WHAT WE SEE IN PANCREAS CANCER,
PATIENTS GOT SCANNED FOR OTHER REASONS.
IT'S NOT LIKE YOU CAN SEE A SMALL TUMOR THAT'S SLOWLY
ENLARGING, PANCREAS CANCER, THERE'S NOTHING THERE, AND
THEN, BOOM, THERE'S SOMETHING THERE.
IT HAS THESE KIND OF STEPS.
AND, UNFORTUNATELY, THE METASTATIC, MEANING WHEN IT
HAS CELLS CAPABLE OF LEAVING, UNFORTUNATELY, THAT HAPPENS
MANY YEARS EVEN BEFORE YOU DEVELOP SYMPTOMS, THAT'S WHAT
MAKES IT MORE DIFFICULT.
>> IT'S A TOUGH TOUGH ISSUE. >> IT IS.
>> QUICK QUESTIONS, QUICK ANSWERS.
MAN FROM BROOKINGS, STOMACH CANCER, DIAGNOSED A YEAR AGO,
HAS NUMB TOES, SWELLING ON THE BOTTOM OF HIS FEET, WHAT CAN
HE DO TO GET RID OF THE PERIPHERAL NEUROPATHY FROM THE CHEMOTHERAPY?
>> THAT'S USUALLY THE PLATIN THAT TYPICALLY LEADS TO THAT.
IT TENDS TO BE CUMULATIVE OVER TIME, THE MORE CHEMOTHERAPY OF
THAT PARTICULAR TYPE THEY GET, IT CAN GET SEVERE.
SOME PATIENTS HAVE NONE OF THOSE SYMPTOMS.
SOME PATIENTS IT'S MILD.
SOME PATIENTS THEY HAVE TO STOP THERAPY.
THERE'S BEEN NO REAL HARD DATA TO SUGGEST WHAT CAN MAKE IT GO AWAY.
THERE'S BEEN SOME STUDIES LOOKING AT ZINC, MAGNESIUM
SUPPLEMENTATION TO HELP WITH THE NERVES BUT THAT HAS NOT
REALLY PROVEN, AT LEAST IN GENERAL.
>> YOU CAN TRY THE GABAPENTINS, THAT SORT OF THING.
>> TO HELP THEM LIVE WITH IT. SYMPTOM CONTROL.
>> IT'S SYMPTOM CONTROL, THAT'S EXACTLY RIGHT.
>> MY POINT IS, I'LL GIVE YOU THIS ANSWER, WHEN I HAVE THE
RINGING IN THE EARS AND THE NUMBNESS OF MY FEET, I GO AND
I'M NOT DEAD FROM CANCER. THANK YOU. AND I'LL LIVE WITH IT.
>> BEING UPRIGHT IS BETTER. >> UPRIGHT IS A GOOD THING.
>> THE AMOUNT OF 'FIGHT' IN A PATIENT CAN HAVE AN EFFECT ON
HOW WELL THEY DEAL WITH THE WEIGHT OF TREATMENT.
IT CAN GIVE THEM A FEELING OF SOME CONTROL OVER THE DISEASE
AND TO FOCUS ON THE LONG-TERM RESULTS.
>> YEAH. >> AND THEY'RE GOING TO GO TO...
>> IN 2014, I WENT IN FOR MY ANNUAL PHYSICAL.
AND I WENT IN THE DOCTOR'S OFFICE.
AND THE DOCTOR LOOKED AT ME AND HE'S ONE OF THE DOCTORS
THAT HAPPENS TO KNOW ME BETTER THAN I KNOW MYSELF, HE SAID,
YOU'RE TOO THIN, WE NEED TO FIND OUT WHY.
I GO, I'M BUSY, I'M A CAREGIVER, I TAKE CARE OF MY
WIFE, I'M TAKING CARE OF THE FARM. YOU KNOW.
I DO THE LAUNDRY, I DO THE DISHES, YOU KNOW, I DO ALL OF THAT STUFF.
AND I GO TO THE GYM FOUR DAYS A WEEK.
AND I'M NOT A DISGUSTING FAT BODY THAT I USED TO BE.
AND HE SAID, NO, WE'RE GOING TO DO A C.A.T. SCAN, YOU'VE
LOST 11 POUNDS IN A YEAR.
AND, SO, I SAID, OKAY.
YOU'RE NOT GOING TO FIND ANYTHING BECAUSE I'M NOT SICK.
I SAID, I FEEL FINE.
23 HOURS LATER, HE PUT HIS ARM AROUND ME AND HE SAID, YOU
NEED TO PUT YOUR WIFE IN A NURSING HOME, YOU'VE GOT PANCREATIC CANCER.
FIRST THING THAT HAPPENED, I WAS SCARED, BECAUSE YOU ALWAYS
HEAR THAT PANCREATIC CANCER IS -- YOU'RE A GONER IN THREE MONTHS.
AND, SO, I MEAN, IT COMPELLED MY WIFE AND I BOTH TO GET OUR
AFFAIRS IN ORDER, OUR WILLS, OUR ESTATE, AND EVERYTHING IN ORDER.
AND THEN I GOT MAD. I WAS PRETTY MAD.
I STARTED GOING BACK TO THE GYM.
AND I REMEMBER THINKING, I GOT A PUNCHING BAG THERE.
AND I REMEMBERED GETTING THE BOXING GLOVES FROM THE FRONT
DESK AND PUTTING THOSE BOXING GLOVES AND GOING UP AND
PUNCHING THAT BAG EVERY DAY. 100 TIMES.
AS HARD AS I COULD, AS FAST AS I COULD GO.
AND JUST IMAGINING IN MY MIND THAT THAT WAS ONE BIG TUMOR.
AND I WASN'T GOING TO LET THIS CANCER COME BACK.
I WENT TO SIOUX FALLS ON THE 27th OF JUNE, 2014.
THEY DID AN ENDOSCOPIC EXAM, BIOPSY OF MY PANCREAS, FOUND A
4.3-CENTIMETER TUMOR ON THE TAIL OF MY PANCREAS, I GUESS
IT'S GOOD NEWS ON THE TAIL OF YOUR PANCREAS, BETTER NEWS.
IN JANUARY OF 2015, I STARTED ON CHEMO RADIATION.
I HAD FIVE F.U. AND RADIATION EVERY DAY, FIVE DAYS A WEEK.
THAT WAS SORT OF UNCOMFORTABLE, BUT THE WAY I
ALWAYS LOOKED AT THIS STUFF, NONE OF THIS WAS MORE
UNCOMFORTABLE THAN BASIC TRAINING IN THE ARMY.
BECAUSE I ALWAYS KNEW THAT THERE WAS GOING TO BE AN END TO IT.
AND JUST LIKE I KNEW THERE WAS GOING TO BE AN END TO BASIC
TRAINING SO I JUST KIND OF TOUGHED IT OUT.
SO, SO FAR, AS OF 2017, I'M STILL WITHOUT A RECURRENCE.
I DON'T USE THE WORD CANCER-FREE.
I DON'T LIKE CANCER-FREE VERY WELL. I DON'T USE THAT.
I TELL PEOPLE THAT I DON'T HAVE CANCER NOW.
I KNOW THIS IS THE MESSAGE THAT WE'RE DOING HERE TODAY
AND THE MESSAGE THAT I TELL PEOPLE ALL THE TIME.
BUILD A RELATIONSHIP WITH YOUR DOCTOR.
GET TO KNOW YOUR DOCTOR AND HAVE YOUR DOCTOR GET TO KNOW YOU.
>> NOW, THAT WAS JOHN MOISON, WHO ORGANIZED THE CAPITOL
SPECIAL EVENT FOR PANCREATIC CANCER, TURN THE CAPITOL PURPLE.
A WONDERFUL MAN, TREMENDOUS FRIEND.
AND I JUST THANK HIM FOR BRINGING THIS TOGETHER AND TO
BEING MY SUPPORT PERSON THROUGH MY HARD TIMES. THANK YOU, JOHN.
AND THANKS FOR SAYING YOUR STORY.
BEING IN THE ARMY, KNOWING THAT THERE'S AN END TO IT IS
AN IMPORTANT THING.
AND I ALSO MENTION THAT, YOU KNOW, WHAT I USUALLY DO FOR
PEOPLE WHO SAVED MY LIFE IS TO THROW WATER ON THEM.
[Laughter] SORRY ABOUT THAT.
WELL, WE'VE GOT GREAT QUESTIONS COMING.
MAN FROM BROOKINGS HAD STOMACH CANCER DIAGNOSED A YEAR AGO.
NOW HAS -- WE ASKED THAT ONE ALREADY.
73-YEAR-OLD CALLER HAD A HEART FAILURE DIAGNOSIS FROM HISTORY
OF HIGH BLOOD PRESSURE BUT DIDN'T HAVE ANY TESTING.
SHOULD THERE BE MORE TESTS?
SO HE HAD HEART FAILURE FOLLOWING LONG-TERM BLOOD PRESSURE PROBLEMS.
>> YES. >> YES, HE SHOULD HAVE MORE TESTS. >> THERE SHOULD BE.
I THINK THERE'S SEVERAL TYPES OF HEART FAILURE.
AND THE WAY YOU DETERMINE THAT IS TO DO AN ECHOCARDIOGRAM, IT
SHOWS HOW THE LEFT SIDE OF THE HEART IS PUMPING OR IF THERE'S
AN ISSUE MORE WITH THE RIGHT SIDE OR WHAT WE CALL DIASTOLIC HEART FAILURE.
SO, YES, AN ECHOCARDIOGRAM WOULD BE IMPORTANT AND THAT CAN GUIDE THERAPY.
>> I THINK THAT'S INTERESTING THAT HIGH BLOOD PRESSURE OVER
LONG PERIOD OF TIME BRINGS ON HEART FAILURE, VALVE DISEASE
WILL BRING ON HEART FAILURE.
>> RHYTHMS CAN. >> RHYTHM ABNORMALITY.
>> THIS IS MOST LIKELY LEFT SIDED, BECAUSE IT'S PUMPING
AGAINST HIGHER PRESSURE AND THAT'S WHERE YOU'RE GOING TO SEE THE PROBLEM.
AND THE ECHO WOULD SORT THAT OUT.
>> CALLER IS TAKING COUMADIN FOR ATRIAL FIB, HOW CAN YOU
GET NUMBERS WITHOUT INCREASING THE DOSE. HEMATOMA FROM A FALL.
HE DOESN'T WANT TO HAVE HIGHER DOSE BECAUSE HE ALREADY HAS A HEMATOMA.
>> WELL, WARFARIN, COUMADIN IS A VITAMIN K ANTAGONIST, SO
ANYTHING THAT YOU EAT HAS SOME VITAMIN K IN IT, SOME THINGS HAVE MORE.
BUT, YOU KNOW, WHAT YOU'RE EATING AFFECTS IT, IF YOU'RE
DRINKING MUCH ALCOHOL IT CAN AFFECT IT.
MANY MEDICATIONS, PARTICULARLY ANTIBIOTICS CAN AFFECT IT.
SO, IT DOES MAKE IT VERY VERY HARD TO MANAGE.
AND THAT'S THE ADVANTAGE OF THE NEWER AGENTS THAT DON'T --
THAT WORK A DIFFERENT WAY.
AND THEY'RE NOT AFFECTED BY DIET.
THEY HAVE SOME DOWNSIDES, TOO, BUT, BY AND LARGE, THEY'RE SIMPLER TO USE.
AND THE MOST RECENT RESEARCH SHOWS THAT THEY'RE ACTUALLY
QUITE SAFE AND PROBABLY SAFER THAN WARFARIN IN TERMS OF BLEEDING COMPLICATIONS.
>> TINY LITTLE DIFFERENCES, THOUGH.
AND MY COMMENT IS THAT THE BLEEDING RISK OF THOSE DRUGS,
WARFARIN AND THE OTHERS, BRINGS US TO BE THE
HIGHEST-RISK DRUG THAT WE PRESCRIBE.
AND THERE'S ONLY ONE DRUG THAT WE CAN MONITOR AND KNOW HOW
EFFECTIVE IT IS, WHETHER THE COMPLIANCE IS GOOD, AND WHERE WE'RE AT WITH IT.
AND, SO, MY SENSE IS WARFARIN IS THE BETTER OPTION.
>> WELL, IT DEPENDS ON THE PATIENT. >> IT'S REVERSIBLE, TOO. >> AND IT'S REVERSIBLE.
>> FROM A SURGICAL POINT OF VIEW, AS YOU SAID, THOSE ARE
VERY DANGEROUS DRUGS, PARTICULARLY IN SURGICAL PATIENTS.
>> THAT'S ABSOLUTELY CORRECT.
THE NEWER AGENTS ARE SOMEWHAT REVERSIBLE AND THERE'S SOME
NEW DRUGS COMING OUT TO REVERSE THEM. BUT YOU'RE CORRECT.
IT DOES DEPEND ON THE PATIENT. >> YES, IT DOES.
>> THEY'RE MORE CONVENIENT, THEY'RE EASIER TO USE, THEY'RE
MORE PROBLEMATIC IF THE PATIENT BREAKS THEIR HIP AND
WE HAVE TO GO TO THE OPERATING ROOM RIGHT AWAY. THAT IS A BIG ISSUE.
AND THERE ARE ADVANTAGES, AND IF THERE'S A SIGNIFICANT
BLEEDING RISK, HEMORRHAGE IN THE HEAD, G.I. BLEEDING,
THEY'RE SAFER THAN WARFARIN AND THAT'S BECAUSE OF EXACTLY
WHAT YOUR CALLER SAID, GOES UP AND DOWN WILLY-NILLY, YOU CAN'T CONTROL IT.
>> ATRIAL FIB, YOU LOOK AT IT, WARFARIN OR ANY OF THE
ANTICOAGULANTS REDUCES THE STROKE RISK FROM -- YOU KNOW,
IT DEPENDS UPON THE COMPLICATION OF THE PERSON,
BUT, YOU KNOW, ANYWHERE FROM -- LET'S SAY 8% DOWN TO 2 OR 4%.
[OVERLAPPING CONVERSATION] BUT IT'S NOT ELIMINATED.
>> IT'S NOT ZERO, THAT'S CORRECT.
>> AND THIS PERSON HAS A HEMATOMA AND THEY'RE FALLING.
MY CONCERN WOULD BE ANY OF THEM MIGHT BE MORE DANGEROUS THAN --
>> TRUE. YOU COULD THEN BACK UP AND SAY, WHAT IS THIS PATIENT'S
STROKE RISK IN TERMS OF THEIR ATRIAL FIBRILLATION?
THERE ARE WAYS TO FIGURE THAT OUT.
IF IT'S NOT THAT HIGH, YOU COULD STOP THE WARFARIN
TEMPORARILY AND THEN GO BACK ON.
>> THAT'S THE ISSUE, AS SOON AS YOU HAVE A BLEEDING
COMPLICATION, YOU HAVE ONE COMPLICATION, THEN YOU HAVE TO
HOLD ANTICOAGULATION, IT INCREASES THE RISK OF THROMBOSIS, ET CETERA.
TOUGH SITUATION TO GUIDE THROUGH.
>> NO MATTER HOW IT TAKES A VERY CAREFUL, HARD-THINKING
PHYSICIAN TO HELP GUIDE YOU THROUGH THOSE THINGS. >> YOU BET.
>> SO WE HAVE A QUESTION. WHAT ARE SOME -- WHY ARE SOME CANCERS HARDER TO TREAT THAN OTHER CANCERS?
>> A LOT OF IT -- [Laughter]
[OVERLAPPING CONVERSATION] >> QUICKLY.
>> IT ALL HAS TO DO WITH THE TUMOR BIOLOGY.
THERE ARE SOME CANCERS, LIKE PANCREAS CANCERS, BILE DUCT
CANCERS THAT ARE VERY AGGRESSIVE, THEY DEVELOP A LOT
OF MUTATIONS AND THESE CANCERS SPREAD.
THERE ARE NOT ONE OR TWO DRIVING MUTATIONS, THERE'S MULTIPLE.
EVERY PATIENT'S PANCREAS CANCER IS VERY UNIQUE.
BLOOD MALIGNANCIES THAT ARE RELATIVELY TREATABLE, LOW
GRADE, SINGLE TO A COUPLE DOSES OF CHEMOTHERAPY, A FEW
DRIVING MUTATIONS, YOU KNOCK OFF THE CELLS AND YOU
ESSENTIALLY GET A CURE.
>> IT DEPENDS ON THE BIOLOGY.
>> I THINK THE POSTER CHILD OF THAT IS PROSTATE CANCER, IT
GOES FROM VERY AGGRESSIVE TO WE CAN WATCH IT AND DO NOTHING.
>> SOMETIMES, MANY TIMES -- >> THEY DO JUST AS WELL.
>> MOST OF US, IF WE LIVE LONG ENOUGH, WILL GET IT. >> YEAH.
>> ACID REFLUX FOR YEARS, WHAT SUGGESTED TREATMENTS?
>> I HAVE IT FOR YEARS, IT HASN'T RESPONDED, I WANT TO
KNOW WHAT'S GOING ON.
PROBABLY NEED A LOOK DOWN IN THE TUMMY, ENDOSCOPY, AND THEN DECIDE.
>> YEAH. PLEASE GIVE US YOUR OPINION ON HOSPITALIST FOLLOWING SERIOUS SURGERY.
THE CALLER STATES, YOU DON'T GET TO SEE YOUR SURGEON AND
HOSPITALLISTS DON'T KNOW YOU.
WHAT DO YOU THINK ABOUT THEM AT THE MAYO CLINIC?
SO, HOSPITALLISTS, THE PROBLEM IS, THEY'RE ROTATING. >> TRUE.
>> YOU DON'T ALWAYS KNOW THAT PERSON THAT'S FOLLOWING YOU.
WHAT ABOUT THE MAYO CLINIC?
>> I CAN'T COMMENT ON OTHER INSTITUTIONS' PRACTICES.
I MEAN, FOR US, IN MY DIVISION, MOST OF THE
SURGEONS, WE SEE OUR PATIENTS, WE HAVE CLOSE RELATIONSHIPS,
WE KEEP THEM AND WE WATCH THEM, WE MANAGE THEM THROUGH
THEIR POST OPERATIVE COURSE.
IF WE NEED ASSISTANCE, PARTICULARLY WITH SOME MORE
DIFFICULT INTERNAL MEDICAL ISSUES, WE CAN FLOAT EXPERTS
TO EXPERTS TO SEE OUR PATIENTS PARTICULARLY.
>> THAT'S WHAT I DO IS SEE PATIENTS IN THE HOSPITAL AFTER
SURGERY, MOST OF THE TIME.
YOU'RE CORRECT, WE ROTATE, I'M ON A WEEK AT A TIME.
AND THEN SOMEONE ELSE COMES ON AND WE DO HAVE TO MAKE A HANDOFF.
BUT WE HAVE, I THINK, GOOD WAYS TO DO THAT.
I THINK THE CRITICAL THING HERE IS THAT THERE NEEDS TO BE
VERY CLOSE AND CONTINUOUS COMMUNICATION BETWEEN ME AND THE SURGEON.
AND, YOU KNOW, I'M SUGGESTING WE DO SOMETHING, I TALK IT
OVER WITH THE SURGEON, YEAH, YOU CAN DO THAT, YOU'VE GOT TO
WAIT ANOTHER DAY, NO, WE CAN'T DO IT AT ALL, WHAT'S THE
ALTERNATIVE, YOU JUST HAVE TO COMMUNICATE.
>> COMMUNICATION. ONE MORE TIME. >> THAT'S RIGHT.
>> THE VALUE OF COMMUNICATION.
NECROTIZING PANCREATITIS, WHAT'S THAT?
>> SEVERE CONDITION, INFLAMMATION OF THE PANCREAS,
COMMON CAUSES IS ALCOHOL OR GALLSTONES, MOST COMMONLY IN THE UNITED STATES.
THERE'S VARIOUS FORMS OF IT, SIMPLY ABDOMINAL PAIN, SLIGHT
ELEVATION OF ENZYMES, THAT'S ABOUT IT.
AND THEN SOME PATIENTS CAN HAVE REALLY SEVERE FORMS,
WHERE THEY ACTUALLY LOSE THE BLOOD SUPPLY TO THE PANCREAS
AND IT NECROSES, HENCE, THE NAME.
THOSE PATIENTS BECOME LIFE THREATENINGLY ILL, MANY HAVE HIGH MORTALITY RATE.
>> OF COURSE, THERE IS A RISK FOR PANCREATITIS FOLLOWING WHIPPLE PROCEDURE.
AND I KNEW THAT GOING IN.
>> PANCREAS LEAK, SO FROM THE CONNECTION, IF WE DO A
CONNECTION, THERE COULD BE A LEAKAGE FROM THAT.
>> BUT GENERALLY NOT --
>> WE RARELY SEE PANCRAETITIS AFTER WHIPPLE.
>> DO ANEURYSMS RUN IN FAMILY? >> YES. YES, THEY DO.
THERE IS SOME FAMILIAL ASPECT FOR ANEURYSM DISEASE.
>> THERE IS A GENTLEMAN, NONSMOKER, 40s, DIED SUDDENLY, ABDOMINAL ANEURYSM.
>> ABDOMINAL ANEURYSMS, WE DO SCREEN FOR.
AND THERE'S A SUBSET OF PATIENTS, MAINLY MALE, AND
PEOPLE WHO HAVE SMOKED, AND OVER A CERTAIN AGE, THE
CURRENT RECOMMENDATIONS ARE TO DO A SINGLE ABDOMINAL ULTRASOUND AT AGE 65.
AND LOOK AT THE DIAMETER OF THE AORTA. >> YEAH.
>> IF YOU'RE NOT IN THE HIGH-RISK CATEGORY, YOU DON'T HAVE TO BE SCREENED.
THERE IS NO SCREENING FOR A CEREBRAL ANEURYSM.
[OVERLAPPING CONVERSATION] >> THERE IS SOME FAMILIAL ASPECTS TO IT.
>> SOME PEOPLE WITH CONNECTIVE TISSUE DISORDERS, THEY MIGHT BE --
[OVERLAPPING CONVERSATION]
>> PERIPHERAL ANEURYSM, THEN YOU MIGHT HAVE TO SCREEN.
>> AND KIDNEY DISEASE IS ANOTHER GROUP -- >> THAT HAVE ANEURYSMS.
I THINK, THOUGH, THE BIG RISK FACTOR IS SMOKING. I MEAN, IT'S JUST HUGE.
>> YEAH. >> YOU KNOW, YOU CAN -- A HEAVY SMOKER COMES IN WITH
ABDOMINAL PAIN, THAT'S THE FIRST THING I THINK OF. >> YEAH.
>> JUST WANTED TO EXPRESS HOW GREAT THE MAYO IS.
AND THANK GOD FOR IT BEING IN THE MIDWEST. LOVE THE COLLABORATION.
WENT THERE FOR MY SARCOMA. THAT'S NICE TO HEAR.
>> WE'LL TAKE MORE OF THAT ANY TIME.
>> QUICK COMMENT ABOUT THE FACT THAT THE MAYO IS REALLY A GREAT INSTITUTION.
AND HAS THE REPUTATION THAT IT DESERVES IN MY MIND.
AND WHEN I STARTED PRACTICING, THE COMPLICATED CASES, WE SENT TO THE MAYO.
NOW WE HAVE EXPERTS IN SIOUX FALLS THAT I SEND TO FOR THE MOST PART.
BUT NOT ALWAYS. THERE'S A TIME WHEN YOU NEED THE GUY WHO REALLY KNOWS --
>> YOU WERE AN EXAMPLE OF THAT. BECAUSE I RECALL THE CALL TO ME.
>> YES. >> WAS, YOU WERE SCHEDULED FOR SURGERY, AND YOUR SURGEON
SAID, YOU KNOW, I'VE LOOKED AT THIS SCAN ONE MORE TIME, AND
THE BLOOD VESSELS AROUND THE TUMOR, I THINK YOU NEED TO GO ON, AND YOU DID.
>> I DID. AND, YOU KNOW, I CAN'T THANK YOU ENOUGH FOR MAKING THIS CONNECTION.
>> WELL, THE SURGEONS THAT YOU SAW, WHAT MAKES A GOOD SURGEON
ISN'T NECESSARILY EVERYTHING THEY DO IN THE OPERATING ROOM
AND MAKING THE DECISION TO GO TO SURGERY, BUT MAKING THE
DECISION, MAYBE SURGEON'S NOT RIGHT AT THIS POINT IN TIME.
>> YEAH, YOU BET. SO THAT TAKES A LOT, A LOT OF SURGEONS GET
BAD REPUTATION AS HAVING A LOT OF EGO, THAT TAKES SOMEONE TO SAY,
YOU KNOW, I THINK I'M GOING TO REFER THIS PATIENT ELSEWHERE.
THAT WAS A VERY THOUGHTFUL PHYSICIAN.
>> YES, IT WAS. AND I WAS THERE. IT WAS GOING TO BE DONE THERE.
AND THEN AT 11:00 THE NIGHT BEFORE THE PROCEDURE, --
>> YOU GOT A CALL. >> -- I GOT A CALL.
HAD A NEUROENDOCRINE TUMOR REMOVED IN 2014.
HAD IT REMOVED IN SIOUX FALLS, LOST 60 POUNDS AFTER THE WHIPPLE.
IT IS -- IS IT NORMAL TO LOSE WEIGHT AND HAVE TO WATCH --
AND HAVE TO WATCH MY DIET, IS THAT NORMAL?
>> YOU CAN ANSWER THAT.
>> I THINK THE ANSWER, I'VE LOOKED AT IT, THE TWO PEOPLE
WHO HAVE SURVIVED WHIPPLE PROCEDURES AT PIERRE THAT
TALKED WITH ME, BOTH OF THEM WERE IN THE MID 200-POUND
RANGE WHEN THEY HAD THEIR SURGERY.
AND THEY'RE NOW IN THE MID 100-POUND RANGE, THEY BOTH
LOST 100 POUNDS AND I LOST 170 DOWN TO 145 AND I'VE REGAINED,
YOU KNOW, PROBABLY SEVEN OR EIGHT POUNDS.
AND ONE THING THAT HAS HELPED ME WAS THE CREON, THE
PANCREATIC ENZYME THAT YOU PRESCRIBED FOR ME WHEN MY
PANCREAS WAS WORKING WELL FOR ENDOCRINE FUNCTION.
>> YOU'RE NOT DIABETIC. >> I'M NOT DIABETIC.
BUT I DON'T MAKE THE ENZYMES TO HELP DISSOLVE THE FOOD.
>> YEAH. >> AND ENZYMES ARE A BIG HELP FOR YOU.
HYSTERECTOMY FOR PRECANCER CELLS.
DO I NEED A PAP SMEAR? >> YES.
IF THERE WAS SOME MALIGNANCY OR PRECANCEROUS, WE DO
CONTINUE VAGINAL PAP SMEARS AFTER THAT AND/OR HPV TESTING.
>> HPV TESTING MEANING? [OVERLAPPING CONVERSATION]
>> YEAH. HUMAN PAPILLOMAVIRUS. AND ANY COMMENTS?
>> PAPILLOMAVIRUS. >> OKAY. AND YOU AGREE? >> YEAH. >> OKAY.
A CALLER FROM BROOKINGS HAS BEEN DIAGNOSED WITH A LEVEL --
LOW-LEVEL PROSTATE CANCER AND I'M BEING OBSERVED WITHOUT MUCH CHANGE.
WHAT ARE TREATMENT OPTIONS AND SIDE EFFECTS TO CONSIDER?
SO THAT'S AN IMPORTANT ISSUE ABOUT PROSTATE CANCER.
EITHER ONE OF YOU WANT TO JUMP IN ON THAT?
>> RECOMMENDATIONS HAVE CHANGED. AS YOU MENTIONED, AGGRESSIVENESS.
>> EXACTLY. YOU KNOW, IF THE HISTOLOGY OF THE TUMOR,
UNDER THE MICROSCOPE, IS PRETTY INNOCENT, PRETTY NONAGGRESSIVE,
THEN OBSERVATION, YOU KNOW, CONTINUING TO CHECK FOR SYMPTOMS,
FOLLOWING THE PSA LEVEL, THAT SORT OF THING, IS PERFECTLY FINE.
>> WATCH AND WAIT. >> WATCH AND WAIT.
IF THE TUMOR TURNS MORE AGGRESSIVE, THE PSA GOES UP,
THEN YOU CAN REIMAGINE AND YOU MAY NEED SOME OTHER TREATMENT.
BUT WATCHFUL WAITING IS PERFECTLY FINE.
THAT'S ONE END OF THE SPECTRUM.
THE OTHER IS THE AGGRESSIVE TUMOR.
THAT WE KNOW IS GOING TO CAUSE PROBLEMS, AND THAT REQUIRES
RADIATION AND SURGERY PROMPTLY. >> VERY GOOD. THANK YOU.
>> AND NOW, FOR THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION.
A PRIMARY CARE DOCTOR REFERS TO A SUBSPECIALIST OFTEN TO
HELP DEFINE THE DIAGNOSIS SO AS TO BETTER TREAT A CONDITION.
A MAYO CLINIC STUDY FOUND THAT THE PERCENTAGE OF THE TIME THE
FINAL DIAGNOSIS WAS ENTIRELY DIFFERENT FROM THAT OF THE
REFERRAL DIAGNOSIS WAS: A, 12%? B, 21%? C, 99%?
THE ANSWER IS B, 21% OF THE FINAL DIAGNOSES WERE DIFFERENT
THAN WHAT THE PATIENT WAS BEING REFERRED.
AND IT DOESN'T SURPRISE ME. IT WAS KATHY SURAMDA OF
WATERTOWN WHO ANSWERED THE QUESTION CORRECTLY.
KATHY, THANK YOU FOR PARTICIPATING.
A BOOK WILL BE IN THE MAIL TO YOU SOON.
WE'LL BE RIGHT BACK AFTER THIS.
>> BECAUSE THEY WANT YOU TO BE THERE FOR THE MANY MILESTONES
YET TO COME BECAUSE YOU DON'T WANT TO MISS OUT ON THE LITTLE THINGS.
THERE ARE MANY REASONS TO GET LIFE-SAVING CANCER SCREENINGS.
ONE IN EIGHT WOMEN WILL BE DIAGNOSED WITH BREAST CANCER
IN HER LIFETIME BUT REGULAR SELF-EXAMS AND MAMMOGRAMS CAN
CATCH IT EARLY WHEN IT'S MOST TREATABLE.
>> PROMISE. >> PROMISE. >> PROMISE. >> PROMISE. >> PROMISE.
>> MAKE THE PROMISE TO GET SCREENED. DO IT FOR THE PEOPLE YOU LOVE.
FOR MORE INFORMATION ABOUT LIFE-SAVING SCREENINGS OR
AVAILABLE FINANCIAL ASSISTANCE, VISIT GETSCREENED.ORG.
>> WILLIAM WORRALL MAYO INFLUENCED THE BEGINNING OF THE MAYO CLINIC.
HE HAD A CURIOUS AND REMARKABLE LIFE.
HE WAS THE DESCENDENT OF FAMOUS ENGLISH CHEMIST JOHN MAYOW,
WHO, IN 1668, FIRST RECOGNIZED AND PROVED THE EXISTENCE OF OXYGEN.
W. W. MAYO WAS BORN IN ENGLAND IN 1819 WHERE HE STUDIED SCIENCE AND CHEMISTRY.
MAYO LEFT FOR NEW YORK CITY TO WORK AS A PHARMACIST BUT SOON
MOVED WEST TO ATTEND MEDICAL SCHOOL.
FIRST HE TRAINED IN INDIANA BUT FINISHED HIS M.D. DEGREE IN MISSOURI.
THERE, IN MISSOURI, HE WAS TROUBLED WITH RECURRENT BOUTS
OF MALARIA, WHICH HE BLAMED ON THE SOUTHERN HEAT.
THIS BROUGHT HIM TO MOVE NORTH TO MINNESOTA FOR A HEALTHIER CLIMATE.
HE LIVED IN SEVERAL MINNESOTA TOWNS, INCLUDING ST. PAUL,
DULUTH, LE SUEUR, BEFORE MOVING TO ROCHESTER.
DURING THOSE TIMES, W. W. SUPPLEMENTED HIS MEDICAL
PRACTICE BY TAILORING, FARMING, OPERATING A FERRY SERVICE,
SERVING AS A JUSTICE OF THE PEACE AND PUBLISHING A NEWSPAPER.
HE WAS CALLED TO SERVE AS A PHYSICIAN DURING THE DEVASTATING
DAKOTA INDIAN WAR OF 1862, WHICH ENDED NEAR NEW ULM,
MINNESOTA AND CONCLUDED WITH THE HANGING OF 38 DAKOTA SIOUX INDIANS.
IN 1864, YOUNG DR. MAYO MOVED TO ROCHESTER, BRINGING HIS
WIFE, LOUISE, THREE DAUGHTERS, AND YOUNG SON, WILLIAM JAMES, WILL.
HE CAME FOR A JOB WITH THE DRAFT BOARD TO PERFORM EXAMINATIONS FOR THE ARMY.
AFTER THE CIVIL WAR, THIS 5'4" MAN, CALLED "THE LITTLE DOCTOR,"
SET UP MEDICAL PRACTICE IN ROCHESTER.
HIS SECOND SON, CHARLES HORACE, CHARLIE, WAS BORN THERE.
WHILE W. W.'S PRACTICE BECAME BUSY, HE SERVED AS ALDERMAN, SCHOOL BOARD MEMBER,
MAYOR OF ROCHESTER, AND MEMBER OF THE MINNESOTA STATE SENATE.
IN 1883, A DESTRUCTIVE TORNADO CAME THROUGH ROCHESTER, AND
MAYO TURNED FOR HELP TO THE SISTERS OF ST. FRANCIS,
A TEACHING ORDER WITH LITTLE MEDICAL EXPERIENCE.
HIS ELDEST SON, WILL, HAD JUST RETURNED TO ROCHESTER AFTER
MEDICAL TRAINING, AND HIS SECOND SON, CHARLIE, STILL IN
MEDICAL SCHOOL, BOTH JOINED W. W. TO CARE FOR TORNADO VICTIMS.
IN RESPONSE TO THIS EXPERIENCE, THE SISTERS LATER
BUILT ST. MARY'S, A 12-BED HOSPITAL WITH THE THREE MAYO
DOCTORS AS SURGEONS AND THE SISTERS OF ST. FRANCES AS NURSES.
THE SUCCESS OF THE MAYO CLINIC IS SAID TO HAVE HAPPENED
BECAUSE OF W. W.'S EARLY CONCEPT OF A GROUP PRACTICE
AND HIS APPRECIATION FOR COLLABORATION.
IT ALL STARTED WITH THE DAD AND TWO SONS WORKING TOGETHER,
ALONG WITH THE SISTER-TEACHERS-TURNED-NURSES
AND THE RESEARCH AND EDUCATION THAT FOLLOWS THE SHARED WORK OF A TEAM.
>> A BIG THANK YOU TO OUR GUESTS, DR. ROBERT LOHR AND
DR. MARK TRUTY, WHO VOLUNTEERED TO TRAVEL TO
BROOKINGS FROM ROCHESTER, FOUR-HOUR DRIVE, THROUGH THAT
CRAPPY WEATHER, TO HELP WITH TONIGHT'S PROGRAM.
>>> ABOUT 4,000 YOUNG PEOPLE NATIONWIDE ARE DIAGNOSED WITH
A RARE DISEASE, WITH NO KNOWN CURE OR TREATMENT, CALLED FRIEDREICH'S ATAXIA.
MOST F.A. PATIENTS WILL REQUIRE A WHEELCHAIR BEFORE
HIGH SCHOOL GRADUATION, SUFFER FROM TEENAGE-ONSET HEART
DISEASE, AND SOME DIE IN THEIR 20'S.
A PROMISING NEW TREATMENT MAY BE ON THE HORIZON FOR F.A. AND
IT COULD SAVE MANY LIVES, INCLUDING THAT OF A 16-YEAR-OLD SIOUX FALLS GIRL.
HER FATHER STARTED A CROWD-FUNDING CAMPAIGN TO FUNDTHIS HOPEFUL RESEARCH.
IF YOU'D LIKE TO LEARN MORE, VISIT THE WEBSITE ON THE SCREEN.
THAT DOES IT FOR TONIGHT.
FROM ALL OF US HERE AT "ON CALL WITH THE PRAIRIE DOC,"
GO GET YOUR FLU SHOT IF YOU HAVEN'T, IT'S AROUND, IT'S HITTING US,
AND, UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE.
>> PHYSICAL THERAPISTS, PHARMACIST, THE LIST GOES ON AND ON.
OPPORTUNITIES FOR WORKING IN THE HEALTH PROFESSION.
NEXT TIME "ON CALL WITH THE PRAIRIE DOC."
>> MAJOR FUNDING FOR "ON CALL WITH THE PRAIRIE DOC" HAS BEEN PROVIDED BY:
>> AVERA IS A PROUD SPONSOR OF "ON CALL" ON SOUTH DAKOTA PUBLIC BROADCASTING.
LARSON MANUFACTURING IS PROUD TO SUPPORT "ON CALL TELEVISION"
AS IT CONTINUES TO OPEN DOORS FOR IMPORTANT MEDICAL INFORMATION.
AND BY THE SOUTH DAKOTA FOUNDATION FOR MEDICAL CARE,
THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR SOUTH DAKOTA.
AND WITH THE ONGOING SUPPORT OF THESE INDIVIDUALS AND INSTITUTIONS:
For more infomation >> Make your own moves.
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