Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Know your Enemy
I know many heroes in my business. One is Mrs. L., another is
Mrs. C., and then there is Dr. O'Brien. They were involved in
a life and death struggle against another of our sinister
enemies--cancer. Let me tell you first about the enemy, so
that you'll understand their heroism.
Cancer is a disease that can take twenty years to develop.
Cells in the body are always dividing but once they reach a
certain point they stop. This is programmed into the cell. In
cancer, an abnormal cell develops that won't stop
reproducing. These cells can be very similar to normal cells
but they just reproduce aggressively, or they can be cells
that are very abnormal (mutants) that spread without
stopping. The latter are usually more dangerous. Since they
are constantly reproducing, they crush and kill normal cells
and put a great demand on the body to support their voracious
appetites. Some spread via the blood stream and cause havoc
in faraway places in the body. People weaken and become more
susceptible to infections. Many literally waste away.
The cause of cancer isn't always clear. Pollution, many
industrial chemicals, tobacco, and radiation are well-known
causes of cancer. Some cancers are now known to be caused by
viruses. There are some that are caused by heredity.
Overexposure to the sun in light-skinned people can cause
melanoma and other skin cancers. Most cancers have no known
The most common killers of men are lung cancer (almost always
caused by smoking) and colon cancer (it is thought that
higher fat foods and the Western diet may have something to
do with this). In women in the West it is lung cancer
followed by breast cancer (we'll discuss risks for this in a
The key is early detection of all cancers. Many have markers
in the blood. Many can be detected on a yearly physical which
includes a gynecological exam for females, a prostate and
genital exam for men, and testing the stool. Sores that don't
heal, swellings, prolonged weakness, easy bruisability,
unexplained weight loss -- are all danger signs.
Treatments for cancer fall into four categories. Many need to
be taken out with surgery, which must look for all the places
where cancer may spread to once it is detected. Except for
superficial cancers, surgery is rarely enough. Chemotherapy
are drugs given in the blood that are designed to kill cells
that reproduce rapidly. Since hair cells also reproduce
rapidly, hair can often fall out. This can cure Hodgkin's
Disease, a cancer of lymph nodes, but on the other end of the
spectrum it fails terribly in cancer of the esophagus, the
In most other cancers, it can put a cancer in remission but
often the cancers recurs and is then resistant. Chemotherapy
is very caustic, can require a special intravenous device,
and can cause a lot of vomiting. Radiation is very effective
for many cancers but it too has its side effects.
New therapies are the last category. These include killer
cells or radiation directed to the cancer cells by
immunological markers, which sniff out the cancer cells.
There is always something new, as a lot of research is being
done in this field.
Many cancers spread to bone and there can be intense pain.
Adequate pain relief is essential. There is good research
that those who turn to Hashem and those with a positive,
determined attitude do better. Those who put things off or
ignore signs are usually in bigger trouble.
I'll speak about individual cancers in future columns, but I
just wanted to give an overview. And oh yes, I haven't
forgotten my heroes. John O'Brien is a physician who is a few
years younger than me. He was a superb physician, who became
a chozer betshuva (his mother is Jewish) and developed
into a warm and pure Jew. He taught me a lot abut what it is
to respect and feel for his fellow Jew. John slipped into a
coma two weeks ago after four years of battling a vicious
Mrs. C. lives in Israel and is holding on. She has been
fighting cancer that has robbed her of many things, and has
caused her much pain. The war is far from over, but she has
taught me dignity in the face of adversity. She and her whole
family have reinforced in me the value of using every
precious moment for chesed.
Mrs. L. won. She, with Hashem's brocho beat a cancer
that almost always kills, and then survived a more common but
almost as lethal cancer. She has been free of all cancer now
for 14 years. It wasn't always easy but she taught me courage
and inner strength. This column is dedicated to her. I love
you, Mom. Write me in care of the Yated.
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