As Sure As I'm Standing Here

(Note: I was asked why I posted this story as a lead-in to the announcement of Barry's fundraiser show on Feb 14 with Stand Up For a Cure. In the days leading up to this post, there was a lot of complaining in various circles about the price of the tickets closest to the stage. It concerned me that those who were dismayed did not realize - or care - that this was a BENEFIT/FUNDRAISER show and bringing in money for this cause is (a) not in Barry's hands and (b) essential to saving lives. So - I spelled it out in a way that can't be misunderstood.)

As sure as I'm standing here
You'll never have to be afraid
As sure as I'm standing here
I'll try and help you find your way

In the early 1950s, my grandmother was diagnosed with breast cancer. Oh, wait, it wasn't cancer. It was "the C-word". The word you never said out loud, especially in front of my high-school-age mother. She was quietly whisked off to the hospital for surgery - with a 2 week postop inpatient stay. Afterwards she had an odd little item strapped to her chest for a few days. It was a chunk of radium. Radiation therapy was in its infancy; a medical machine designed to direct the radioactivity of Cobalt-60 was in development in Houston by the US Atomic Energy Comission, but nothing that avant garde was available in her area. No dosimetry, no tomography, just stick a piece of radioactive material up next to the surgical bed and hope for the best.

The best happened. My grandmother was cured. The "C-word" never returned and she died peacefully of old age in her sleep. She was one of the lucky ones. Most patients of her time recurred and that was worse than the original disease.

Chemotherapy? A pipe dream, at the time. The earliest attempts involved mustard compounds. Leftover chemical warfare agents from World War I. The idea of using these compounds in medicine was so outrageously radical that most of the medical community didn't warm up to the idea for 15 years. So after the radium treatment there was nothing else to do. My mother remembers the doctor saying, "You don't need to worry about that anymore." I don't think the phrase "pretty little head" was involved, but I'll bet it was implied.

Genetic analysis and risk assessment? You're kidding, right? Watson and Crick had just published their paper on the structure of DNA after studying the X-ray crystalographs taken by Linus Pauling and his son, Peter. It would be 30 years before genetics even made the drawing board. My grandmother was one of seven sisters, and the only one in her family to get "the C-word". Based on those odds alone, my family and their respective doctors decided it was not a familial cancer.

Fast-forward 30-odd years. Now it's my aunt (Dad's sister-in-law) with the diagnosis. Lots has happened in that amount of time. Surgery is first thing, again. But now, not only is there chemotherapy, there are various kinds and they can be safely combined. (Safely = your patient won't die from the treatment if you follow the packaging directions.) But it was no picnic. Adriamycin is a known severe cardiotoxin. Sure it can cure the cancer but you'd better be real sure that your dose doesn't go over the lifetime maximum tolerated dose that leads to heart failure. Cisplatin is another winner. Very effective at eliminating leftover cancer after surgery. Unfortunately antiemetics were so primitive they were effectively nonexistent. Count on puking like a frat boy. Except instead of the familiar flavor of butyric acid and last night's dinner, the patient experiences the unmistakeable taste of liquid metal.

On the bright side, at least you had options now. Radiation therapy was more evolved, more effective, less dangerous. Survival rates were going way up compared to the 1950s. What's some puking and hair loss and other changes compared to dying from cancer? Sign me up!

My aunt didn't think so. Whether it was fear, or vanity, or some other motivation, we'll never know. But she flat out refused any treatment besides surgery and couldn't be persuaded otherwise. Within a few months of surgery, my uncle called my dad to tell him the cancer was back. "Where?" he asked. "Everywhere."

Now she thinks chemo may not be so bad. But it was too little, too late. Toward the end, some relatives I never met were scoring drugs on the street to keep her out of pain. Symptom control measures had a long way to go - OxyContin hadn't even been dreamed of yet. I was a junior in college and my cousin - her only daughter - was finishing high school when we buried her.

Fast forward 10 years. I was working in medical research now and a friend asked me to be a buddy to a long-time friend of his who was experiencing her second breast cancer. She'd had her first case about 7 years earlier that was cured with surgery alone, soon after her son was born. After seven years, it's not a relapse - it's a "second primary": a completely different disease than the first.

Even a moderately-sized general hospital with an oncology department looked like mission control. She'd had a state-of-the-art lumpectomy then went in for postop cleanup treatment. The tomography landmarks were tattooed on her chest and a linear accelerator delivered precision doses of radiation in a suite straight out of Star Trek. Her chemo combo was delivered in a time-released cassette; no more bolus dosing with instant barf. I don't think she threw up even once. Worst thing was losing her hair - to this day no one can do anything about that. But she had enough energy to yell at me when I arrived for a visit later than planned due to a delayed flight. "WHERE WERE YOU!! I WAS WORRIED SICK!! NOW GET IN HERE AND HAVE DINNER!! Oh wait, give me a hug first!"

Yes, ma'am!

She did have side effects, including some heart failure due to good ole Adriamycin. But today she's a special ed high school teacher and coaches the girls' tennis team.

That's a long way for oncology to come in less than 50 years. That progress didn't float out of the sky on a magic carpet. You had the doctors who wanted to take better care of their patients and had a vision to make it happen. You had the patients who were willing to take a chance on an unproven treatment that probably wouldn't save them, but would benefit thousands or millions in the future. You had the drug companies who would try to develop agents that the doctors were looking for and most times they lose more capital than they ever make testing one failure after another until they find THAT ONE that keeps patients in remission or cured for years at a time. You had the government agencies who had to balance the scales between taking necessary risks for the benefit of future patients, and not allowing the atrocities of Tuskeegee or Germany to happen again, and doling out funding as it was available. That's a lot of people working together over a very long time. And when you put this effort into one form of cancer, there's a great chance it will benefit patients with other forms of cancer too.

But to make all of this happen, no matter how lofty the goals or committed the personnel, you can't do it without the common denominator. Money. Cash. Dinero. Wampum. Moola.

Whenever I'm about to get tired of people asking me for donations, or to attend a fundraising gala with an inflated ticket price, I think of the three women above and all of the other friends and relatives I've known with some other kind of cancer. Each of them, in their time, had options made available to them because of the progress made by others. I could be the next one to need the resources created by that research, or my family.

How much would all of that be worth to you?
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(From manilow.com)
Spend Valentine’s Day with Barry…and raise money for cancer research! Barry is bringing “ULTIMATE MANILOW: The Hits…and then some” to the Nassau Coliseum on Long Island, NY on February 14, 2009 as part of the STAND UP FOR A CURE concert series.

Not only can you spend Valentine’s Day with Barry, but you will be supporting a great cause at the same time! The proceeds from the concert will be donated by Stand Up for a Cure to the Breast Cancer Research Foundation (http://www.bcrf.org/), founded by Evelyn Lauder in 1993. The foundation is credited for creating the infamous “pink ribbon.”

BMIFC tickets to this special benefit concert are available at 10 AM (Pacific) on Wednesday, November 5. Fan Club members can order online at www.starz.bz/bmifc or by calling 310.957.5788.

Tickets will be available to the public on Monday, November 10, via all Ticketmaster outlets.