Several years ago, I listened in a state of semi-shock as a doctor gave me a classic bad news-good news combination: The autoimmune system disorder I had was incurable and life-threatening, but researchers had recently discovered that a certain package of medications could put it into remission. I remember that conversation well, but I don’t recall the doctor mentioning much, if anything, about the side effects of those medications.

At age 12, Jena Graves of Napa, Calif. faced the same serious situation. She was diagnosed with the autoimmune system disease lupus, and among her essential medications was the same steroid I was given, prednisone. It’s a go-to medication for millions who suffer from conditions including asthma and diabetes; it’s also on a short list of commonly prescribed “obesogenic” drugs whose effect on the body includes rapid weight gain.

Graves, just 5 feet 2 inches tall, shot up from 120 pounds to 272 pounds and developed Type 2 diabetes and other obesity-related health problems.

A colleague recently shared Graves’ story, which was told again in today’s San Francisco Chronicle. In the piece, Stanford’s John Morton, MD, who performed gastric bypass surgery on Graves this summer, raises a flag on behalf of patients like her:

“All these medications are absolutely wonderful when they work in the right patients,” [said Morton]. “But we’ve got to figure out if it’s appropriate or not to blanket America with prednisone and other obesity-generating drugs that are creating problems.”

For those of us who live in climes with no shortage of sunny days, spending hours outdoors is a such given that we may forget - especially in the bliss of summer vacation - that it can be too much of a good thing. But Stanford’s dermatologists, about to host their annual free skin cancer screening on June 2, are quick with facts and figures about the risks of too much unprotected time in the sun.

In the latest issue of Inside Stanford Medicine and in the video above, we tell the story of Kelly Bathgate - a classic example of what doctors are seeing in rising numbers: a young woman with melanoma. In the last 30 years, the rate of melanoma in women under age 40 has risen 150 percent.

So how can these cancers be prevented? Since sun exposure remains the single most predictive risk factor for development of skin cancer, protective steps aren’t extreme. As Stanford physician Sumaira Aasi, MD, told me:

We’re not asking people to get on a treadmill or not eat their favorite foods. We’re just recommending that people treat sunscreen like brushing their teeth or using deodorant don’t leave the house without it no matter what the weather is like.

Previously: Study shows link between indoor tanning and common skin cancer, Working to prevent melanoma, New law: No more tanning beds for California teens and Intense, rapid sun tanning may increase skin cancer risk

Chronic hypersensitivity pneumonitis, like other conditions that attack the lining of the lungs, has no known cure. Patient Jen Julian told me that when she was diagnosed, “I didn’t know if I was going to live or not. You face the reality of death.”

In the video above and in an article published today, we share the story of Julian, who was treated by physicians at Stanford’s recently established Center for Advanced Lung Disease. Julian received a transplant here and has since returned with gusto to all those things she did before - skiing, biking, hiking, golfing and scuba diving. Glenn Rosen, MD, director of the Interstitial Lung Disease program, said of his patient, “Jen has a unique attitude. She looks at the setbacks as challenges, tries new things and lives life to the fullest.”

When Stanford neurosurgeon Gary Steinberg, MD, PhD, injected human stem cells this fall into the damaged spinal cord tissue of specially-selected patients, it was considered a major step forward in moving research discoveries toward clinical application. In November, however, the Menlo Park-based Geron Corp. announced it was ending the trial and its research into stem cells to concentrate on cancer drugs. Steinberg was disappointed, as many were. But, as he explained in a new Q&A on the Stanford Hospital & Clinics website:

We should remember that five of the anticipated eight total patients were successfully transplanted with no adverse effects noted to date. Since this was designed as a safety study, the outcomes are very encouraging. These patients will be followed for 15 years to assess continued safety as well as any signs of neurologic improvement. I don’t believe the early termination of enrollment in this study will significantly set back the stem cell therapy field.

And when asked about his personal motivation to pursue and study embryonic stem cell treatment, he told me:

I was inspired by what I see every day: Patients devastated by neurological disorders and psychiatric disease with no hope or little hope for recovery of function. And it’s been like that for hundreds of years for many neurological diseases or injuries, including stroke, degenerative disorders like Parkinson’s, brain tumors, Alzheimer’s. These patients are disabled and we have no treatment once the injury has occurred to restore or regenerate function. Stem cell therapy offers great hope to change that status for a large number of patients.

Previously: First California patient treated in Geron’s human embryonic stem cell trial and Stanford joins first human embryonic stem cell trial

Gilbert Khalil’s exemplary fitness did not protect him against prostate cancer - after age 60, the risk rises for every man. Khalil, a project manager from Danville, took a very orderly approach to decide how to proceed after his diagnosis. He had watched his mother and brother endure the side effects of their cancer treatments, so he and his wife Stacee read everything they could. “They all had consequences,” he told me. “We decided we wanted to get a second or even a third opinion.” The couple ended up at Stanford, talking with Mark Gonzalgo, MD, PhD, director of robotic-assisted urologic cancer surgery. This video tells their story.

The first few times I played a new, Web-based and Stanford-designed medical game called Septris, all my patients died. After a few rounds, however, I felt my competitive fire ignite. And with a little more help from the game’s Dr. Sepsis, the better I became at treating sepsis (in the game, anyway), despite a lack of a medical degree. That degree of engagement is the whole point of the game, as I wrote in a story today:

Created by [Lisa Shieh, MD,] and a team of Stanford physicians, researchers and education technology experts, the game can be played on a mobile phone, a tablet such as an iPad, or a computer, and it represents a promising new approach to medical education. The idea is to plug knowledge about treating sepsis into the brains of clinicians who might find learning by digital game more appealing than a lecture, especially if they grew up with Nintendo, Playstation and Xbox. The name of this medical training tool is inspired by one of the world’s most popular computer games, Tetris.

The game’s designers wanted to keep the experience fun, despite the seriousness of the issue. Septris is free, unless players want to earn continuing medical education (CME) credits. In that case, there is a standard $20 CME test fee.

Previously: Rap video teaches how to recognize, treat sepsis in hospitals

Someone in my family survived lung cancer six years ago. The treatment didn’t include radiation or chemotherapy, and the tumor was removed neatly by an excellent surgeon. But the surgery scar still interferes with his normal muscle function, and the possibility that the cancer might come back is part of our family’s collective consciousness - and worry.

My family member is just one of the 12 million Americans who have had cancer, and the Centers for Disease Control and Prevention released a survey last week describing some of the issues and health challenges facing these patients. In sum (and as a colleague discussed in a recent Stanford Medicine article), survivors may be cancer-free, but their bodies and minds are forever marked by their encounter with the disease.

With that in mind, the Stanford Cancer Institute this week opened a survivorship clinic in its Clinical Care Center. As I wrote today in a release:

The clinic, which will focus initially on gynecologic cancer survivors, joins a small but growing number of such clinics, where all care is focused on wellness post-cancer treatment. “There’s a whole body of knowledge, and more importantly, a whole collection of needs that cancer survivors have,” said Douglas Blayney, MD, the Cancer Center’s medical director. “Some are common across tumor types and some are unique to various tumor types. We are trying to meet those needs and serve those patients.”

At the clinic, patients will be given access to resources through Stanford’s Cancer Supportive Care Program and will likely be seen by a nurse practitioner who was there during the course of initial treatment. Jonathan Berek, MD, director of the Stanford Women’s Cancer Center, emphasized, though, that being seen at the clinic isn’t in lieu of being followed up by one’s oncologist. The service, he said, is an adjunct to patients’ care and something that offers “someone who can spend more time with them, go over tests, get them involved in support groups they haven’t been involved with and pay more attention to those needs not related to a cancer recurrence.”

“The goal is to return to wellness, as defined by each individual,” clinic manager Kelly Bugos, RN, NP, told me.

Previously: Cancer’s next stage: A report from Stanford Medicine magazine, Unique challenges face young women with breast cancer, A call for rehab services for cancer survivors, Fear of recurrence an issue for some cancer survivors and A look at how best to care for America’s growing population of cancer survivors
Photo by Norbert von der Groeben

One of the first things we learn about bodies is, of course, that women and men are different - that awareness is undoubtedly prehistoric. What remains remarkable is just how far we still have to go in our understanding of those differences, whether it’s pain or heart disease.

This month, the Women’s Heart Health program at Stanford celebrates the fifth anniversary of its pursuit toward a more delineated picture of heart disease in women. Interventional cardiologist Jennifer Tremmel, MD, is its founding clinical director. While she and other researchers in the field have uncovered some notable gender distinctions in heart health, their work hasn’t led to a full understanding among all physicians of the unique symptoms and issues facing women. As Tremmel explained to me in a recent Health Notes story:

For years, the standard medical treatment for women with heart disease was based on what we know about heart disease in men. That’s really confounded things. In the past 30 years, we’ve learned a lot about how women differ from men, but there’s a lot we still don’t know. Just getting physicians to have a broader concept of symptoms, and what constitutes coronary artery disease in women, is a challenge.

In the same article I tell the story of one Stanford patient: a thirtysomething woman with chest pain whose doctors couldn’t find anything wrong with her. “I intuitively knew something wasn’t right,” Reyna Robles said, and she was correct: As you’ll see in the video above, she eventually saw Tremmel and was diagnosed with and treated for a myocardial bridge.

Previously: Understanding and preventing women’s heart disease and Gap exists in women’s knowledge of heart disease

There’s lots of talk these days about teaching medical students how to be compassionate practitioners; Stanford’s School of Medicine has even introduced patient-role players into its admissions process. What some might say is equally important is making sure that doctors and other clinicians have outlets to talk about their feelings. Stanford is doing something about that, too. A story I wrote in this week’s Inside Stanford Medicine shows just how much they have to say, when given the chance, and how important it is to their own health:

“In some ways, feelings have taken second place to the illness and the technology,” said Douglas Blayney, MD, the Ann & John Doerr Medical Director of the cancer institute. “Patients often have a support network. We in the profession don’t often have an opportunity to share with one another, to know what our colleagues are feeling and how they are coping.”

Just like every other woman, I’ve read the statistics about breast cancer. I’m now in that age group where I could be the one in 29 who develop the disease, so I’m paying a lot more attention to what my treatment choices might be.

So when Broderick was herself diagnosed with breast cancer, she thought her treatment would mimic what she’d seen with her family members. But she was pleasantly surprised when her Stanford oncologist, Kate Horst, MD, told her she was a good candidate for a new abbreviated form of radiation therapy that would take just five days instead of five weeks. “The thought of going every day, five days a week for seven weeks was just overwhelming,” Broderick told me for an article in Stanford Hospital Health Notes. ”When I was presented with this shorter option, I just grabbed at it… When Dr. Horst explained it to me, it made a lot of sense.”

As more and more medical treatment moves from large incisions to small and, in some cases, no incision at all, radiation has been moving along the same path. With machines like the CyberKnife, developed by a Stanford physician, radiation is no longer like taking a long soaking bath, but more like a quick dip. As I explain in my story:

One approach, which takes place during surgery, is called intraoperative radiotherapy. Another method uses external radiation therapy after surgery. Both approaches focus radiation beams only on the margins of the lumpectomy cavity, instead of the whole breast.

It’s a technique, Horst said, that’s allows patients “to continue to be physically active, to keep working and to take care of their families.”

Stanford was one of the first medical centers to offer these newer forms of radiation therapy, which have shown great promise but are still in their early days. “Physicians knew it was out there,” Frederick Dirbas, MD, who leads the breast disease management group at the Stanford Women’s Cancer Center. “Most said it’s been tried and didn’t work. We decided we were going to do this in a way that would make it work.”

As for Broderick, except for the week of her radiation, she worked throughout her treatment. Seven years after her treatment, she remains free of cancer.

Previously: Partial breast irradiation could sidestep side effects of traditional radiation therapy
Photo of Broderick by Norbert von der Groben