Dr. Oz

Dr. Oz, TV personality and  cardiothoracic surgeon, had a couple of special guests yesterday -- talk show host Montel Williams, and his daughter Maressa Williams. Unfortunately, Manessa was recently diagnosed with Hodgkin's Lymphoma. She's 24 years old.

Montel and Maressa decided this would be an excellent opportunity to educate people -- especially young women, who are seeing a rise in Hodgkin's Lymphoma diagnoses. "Know your body" is Maressa's excellent advice. She will be blogging about her experience, hoping to educate others about the disease.

And I applaud her for that. As we close out a month dedicated to raising breast cancer awareness, it's nice to remember that the color of our shoelaces and the frosting on our cupcakes doesn't raise awareness nearly as much as the stories that patients tell. I admire anyone who goes forward with their disease like this.


I wish I could say the same about Dr. Oz.

His brief explanation of Hodgkin's Lymphoma is not good -- misleading and misinforming.

He uses some serious hyperbole to explain stage 4: "They [the lymph nodes] get so large that you become one big lymph node, basically." Seriously?
 
He presents staging as a series of downward-traveling node swellings: Stage 1, the nodes in the neck swell. Stage 2, it travels to the chest. Stage 3, to the spleen. Stage 4, the groin. 

Yeah....not quite. Lymphomas, including Hodgkin's, can start anywhere, and staging is not quite so "subway-ish," to use his comparison. Here's the Mayo Clinic's more accurate description:

• Stage I. The cancer is limited to one lymph node region or a single organ.
• Stage II. In this stage, the cancer is in two different lymph nodes or the cancer is in a portion of tissue or an organ and nearby lymph nodes. But the cancer is still limited to a section of the body either above or below the diaphragm.
• Stage III. When the cancer moves to lymph nodes both above and below the diaphragm, it's considered stage III. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen.
• Stage IV. This is the most advanced stage of Hodgkin's lymphoma. Cancer cells are in several portions of one or more organs and tissues. Stage IV Hodgkin's lymphoma affects not only the lymph nodes but also other parts of your body, such as the liver, lungs or bones.

In the end, they are pretty minor inaccuracies (especially compared to some of the other things he gets wrong). But it bugs me when someone who has such a large platform doesn't do his homework. I get the "one big lymph node" exaggeration -- he's on TV, and he needs to make things entertaining, or alarming, or whatever will get people to watch.

But he's also a doctor, and his first responsibility is to present accurate information to people who turn to him for information.

I'm sending all good thoughts to Maressa and her family. I hope things go easily and well for her, and I look forward to reading about her experiences.

Jon Lester

There's at least one more game, and possibly two games, before the World Series is over, and I'm in no way celebrating anything, but I have to say once more a thank you to Red Sox pitcher Jon Lester. He was diagnosed with anaplastic large cell lymphoma, an aggressive type of NHL, when he was a rookie in 2006. He was treated and cured, and came back the next season to pitch well.

In January 2008, I was diagnosed with Follicular Lymphoma, and while that's a very different type of NHL than Lester's, it was close enough to remind my son, 10 years old at the time, that people can come back from lymphoma and do great things. Lester was our model for hope. A few months later, when Lester pitched a no-hitter, there was more cause for celebration in our house than usual, and I'm glad I woke my son up and brought him down to see the 9th inning. He and I got to see the cleats that Lester wore for that game when we visited the Hall of Fame this summer.

He pitched brilliantly last night, and there's lots of talk that he might be traded this winter. So if that was his last time pitching in a Red Sox uniform, that makes me a little sad. But he's given me some great memories, and he will always hold a special place in my heart..



Also, I am a little jealous that he got a hug from David Ortiz last night. Papi is high on my "man crush" list....

Indolent Lymphomas: An Interview & a Lesson

Targeted Oncology has an interview with Dr. Andrew Zelenetz, a lymphoma specialist at Sloan-Kettering in New York. 

It's a short interview on indolent lymphomas (including Follicular Lymphoma), mostly reviewing the general issues associated with indolent NHL (the first question is about the differences between indolent and aggressive lymphomas). There are one or two kind of new of interesting things in there -- it's main point doesn't seem to be to introduce new stuff.

I think, though, that the interview is especially useful as a reminder that we need to read carefully -- very carefully -- or we will drive ourselves crazy.

A had a conversation with a friend recently about another mutual friend with cancer. My friend had gone online, and was feeling very down about our mutual friend's prognosis. The conversation brought me down a little. I had to remind myself of the excellent advice that Dr. C, the lymphoma specialist that I saw soon after I was diagnosed, had given me: "Everything that you read online is already out of date." I won't get specifically into what my friend had found online, but I think it could easily fall into the category of "might very well be out of date." At the very least, he was probably misinterpreting what he had read.

The quest for knowledge can be a dangerous thing sometimes. We have to remember to read past that first entry in the Google results list.

As for the interview, this is what I mean:

Dr. Zelenetz, asked about transformation, says, "In Follicular Lymphoma, about 40 to 50% of patients will undergo transformation in 15 to 18 years."

I think that's kind of a daunting statistic. Chances are 50/50 that you'll transform -- that would be my first, panicky thought.

But it's not really that simple. For one thing, there's still lots of uncertainty over just how often transformation takes place. More recent  studies (like, from a few weeks ago) suggest that the percentage might be a whole lot lower. Plus, while Dr. Zelenetz offers some depressing survival statistics, those might be out of date, too. And we won't get into the genetic-level research being done that's trying to find some kind of marker for transformation being more or less likely. But who, reading this, will go straight for the worst news?

Asked about prognosis, he says, "There are Follicular Lymphoma patients will die of their disease 2 years after diagnosis, and patients who have never received treatment 25 years after diagnosis." Unfortunately true.

There are FL patients who will die of their disease 2 years after diagnosis, and patients who have never received a treatment 25 years after diagnosis. - See more at: http://www.targetedonc.com/publications/special-reports/2013/b-cell-issue1/Q-A-Zelenetz-Addressing-the-Challenges-of-Indolent-Non-Hodgkin-Lymphoma#sthash.l4aLJrKQ.dpuf

In FL, about 40% to 50% of patients will undergo transformation within 15 to 18 years, - See more at: http://www.targetedonc.com/publications/special-reports/2013/b-cell-issue1/Q-A-Zelenetz-Addressing-the-Challenges-of-Indolent-Non-Hodgkin-Lymphoma#sthash.l4aLJrKQ.dpuf

Indolent lymphoma can progress or "transform" to aggressive lymphoma. In FL, about 40% to 50% of patients will undergo transformation within 15 to 18 years - See more at: http://www.targetedonc.com/publications/special-reports/2013/b-cell-issue1/Q-A-Zelenetz-Addressing-the-Challenges-of-Indolent-Non-Hodgkin-Lymphoma#sthash.l4aLJrKQ.dpuf

 But, again, if the article gets seen by a newly diagnosed patient, which of those numbers will they focus on?

One good thing thjat comes out of this: Zelenetz says that the median survival for Follicular Lymphoma patients is 12 to 16 years. Woo hoo! Lots of places online give the old, pre-Rituxan figures of 8 to 10 years. So that's one inconsistency in our favor. But even that doesn't take into account some other studies that say a 40 year old FL patient might have a median survival rate of 20+ years.

You can see for yourself what he has to say about treatment options and about Rituxan maintenance. With these, too, he leaves out a lot.

Now, I'm not saying he doesn't know what he's talking about. Far from it. You don't get to Sloan-Kettering without knowing a little something about your specialty.

But the format of this interview doesn't allow for more than the most basic information in answering a question.

There's so much out there to read. And we too often read at a time when our emotions are running high. The lesson is, slow yourself down, find a trusted source of information (like a support group), ask your doctor when you have questions, and try like heck not to panic.

Revlimid, Rituxan, and Follicular Lymphoma

About to be published in the journal Cancer (as straightforward a journal title as you're ever going to find): "Combined Lenalidomide, Low-Dose Dexamethasone, and Rituximab Achieves Durable Responses in Rituximab-Resistant Indolent and Mantle Cell Lymphomas."

Come to think of it, that article title is pretty straightforward, too: R + R (Rituxan + Revlimid,also known as Lenalidomide, plus a little something extra, helps Follicular Lymphoma patients (and others) who are no longer helped by Rituxan.

It's a pretty small study (phase 2, with 24 patients, when all was said and done), but an important one.

Revlimid/Lenalidomide is a pretty cool treatment. It works in a few different ways, mostly by messing with the processes that cancer cells seem to need in order to survive, inhibiting new blood vessels from growing, and changing the immune system in favorable ways that researchers haven't fully figured out yet (but it works, so who cares).  It seems like, when combined with Rituxan, it could boost Rituxan's effects, especially for patients who have grown resistant to Rituxan (which, unfortunately, does happen).

This study looked at 24 patients, including 18 with Follicular Lymphoma. There were two parts to the study: in part 1, patients were give Revlimid plus a small dose of dexamethasone, a steroid. In part 2, they were given those again, plus some Rituxan.

After part 1, there was about a 29% response rate (either a complete or partial response). But in part 2, when the Rituxan was added, the response was 58%, with 8 of the patients achieving a complete response. As for follow up, the median progression-free survival was just under 2 years. Pretty dang good for patients who were told that Rituxan wasn't going to work for them any more.

The big takeaway is just that -- Revlimid might help resistant patients use Rituxan again.

While there are already a bunch of other fairly low-toxicity treatments other than Rituxan, and a bunch more in development, there's some comfort in knowing that Rituxan works, and so it's good to find a way to have it keep on working. (Plus, there has so far not been much to come down the pipeline that has been a major improvement on Rituxan. I'm biased, of course, given that Rituxan is among my closest friends....)

Nice to see a small pick up in Follicular Lymphoma-related studies in the news in the last few days. I hope there are more to come soon.

Transformed Follicular Lymphoma: Some Good News

Busy as heck lately, with work and (especially) my active children. That's in no way a complaint -- stepping back, I'm happy to be healthy enough to be run ragged. But it sure does cut into my time to read, write, and generally be a cancer nerd.

************************

That said, here's a quickie.

And, trust me, it's a good one.

Article from the British Journal of Haematology from about a month ago: "Transformed Non-Hodgkin Lymphoma in the Rituximab Era: Analysis of the NCCN Outcomes Database."

First of, the NCCN is the National Comprehensive Cancer Network is a group of 23 major cancer research centers (Dana Farber in Boston, Sloan-Kettering in New York, MD Anderson in Houston, Fred Hutchinson in Seattle -- that level of awesomeness), and their Outcomes Database is a large collection of information about treatments and outcomes of patients from those 23 cancer centers. It's been around for about 16 years, and has collected a ton of data that gets analyzed to help decide what is working and what isn't.

Researchers analyzed the data from patients with indolent NHL (like, of course, Follicular Lymphoma) who transformed to a more aggressive lymphoma. they looked at 118 patients and tried to figure out who fared best. Some results:

For all 118 patients, the two year survival rate was 68%.

Patients under 60 who received an auto-SCT (an autologous stem cell transplant), the two year survival rate was 74%.

Patients who didn't receive chemotherapy before transforming had excellent outcomes: all of them hit the two year survival target.

I don't have numbers in front of me to compare, but the outcomes seem much better than I normally read about transformation. In fact, the authors conclude, "In this largest prospective cohort of patients of strictly defined HT in the rituximab era, the natural history of HT appears more favourable than historical studies."

In other words, maybe the picture is brighter for transformed follicular lymphoma than what it has been in the past. That's great news.

I've only seen the very shortened abstract version of this study, not the full article, which I am sure contains more nuggets. Perhaps I'll get a chance to take a look at it sometime soon......

Don't Know Much About...Blood Cancers

Oncology Times published the results of a survey, sponsored by the Leukemia and Lymphoma Society, that show how woefully ignorant the general public is about blood cancers (the various leukemias, lyphomas, and multiple myelomas). The lead statistic in the story is that fewer than half (46%) of those surveyed knew that blood cancers were the third most common cause of cancer death in the U.S. (behind lung/respitory cancer and colon/GI cancers).

Some other stats:

• 82 percent of those surveyed said they were surprised to learn that more than one million U.S. adults are currently living with a blood cancer;
• 87 percent were surprised by the statement that about every four minutes one person in the U.S. is diagnosed with a blood cancer;
• 86 percent were surprised when told that approximately every 10 minutes someone in the U.S. dies from a blood cancer.
• 76 percent said they believe that it's up to the government, private industry, and drug companies to fund research for all cancers, including hematologic cancers.
• 86 percent they hadn't realized that certain promising treatments for some chronic diseases, including rheumatoid arthritis, were initially tested and FDA-approved as treatments for blood cancers; and
• Nearly all those surveyed (97%) said they think it important for all blood cancer patients to have access to potentially life-saving treatments.

Now, naturally, I'm pretty thrilled at anything that publicizes blood cancers, and follicular lymphoma in particular. But that first stat -- 46% of people knew that about blood cancers -- seems a little off. Really? In a survey of 1000 people, half knew the order of the leading causes of cancer deaths, but 82% didn't know (and were surprised by) how many people have blood cancer, or by how often they get it? Even I don't know any of those statistics, and I'm up to my lipoma-riddled armpits in lymphoma knowledge.

I don't mean to be critical of LLS or the survey. I'm just having fun.

LLS is a great organization that does a lot for follicular lymphoma (and other blood cancer) patients. They fund research, provide financial assistance to patients, raise awareness, and serve as advocates. All excellent things.

I haven't linked to LLS in a while, so if you haven't gone to their site recently, this is a good time to go. Click around a little. I think they do OK giving general information about different disease types (lymphomation.com is still the best site online for really detailed info about Follicular Lymphoma, in my opinion), but their strength is really in support and advocacy, particularly if you're looking for local, face-to-face support. They have a national network of local chapters, with lots of opportunities for getting help, and for helping others.

I didn't take the survey, but I'm definitely one of those 97% who "think it important for all blood cancer patients to have access to potentially life-saving treatments."

(But who are those other 3%? What kind of sick bastard says No to a question like that? Weird survey.....)

More on Immunotherapy

Monday's New York Times Health section featured an article on Immunotherapy. There's been a ton of stuff written in popular outlets lately about immunotherapy. This would indicate to me that lots of people are very excited about its possibilities.

And of course, they have good reason to be. The idea that we can break through a cancer cell's defenses by manipulating the body's own immune system is pretty exciting.

Of course, the Times also asks some important questions: "Why do only some patients respond to the new immunotherapies? Can these responses be predicted? Once beaten back by the immune system, how long do cancers remain at bay?"

I'm not a cancer researcher, but I think this is just the first step in a long process. Cancer cells are like dandelions -- they find ways to get around every defense that gets put in front of them.

An aside -- did you know dandelions are programmed to force themselves to live on when they are killed? If you hit them with weed killer, they don't just shrivel up and die -- they automatically create that puff ball that kids blow on, scattering their seeds everywhere. You need to pick them and seal them in plastic, THEN spray the weed killer. They find ways to get around your attempts to kill them.

(And, yes, I am an award-winning gardener.)

Anyway, cancer cells remind me of dandelions. Hard to kill, even when you think you know how. My guess is that whatever immunotherapy gets through the shield, as the article puts it, the cells will put up another defense, and we'll need to find a way to get a round that one, too.

Our best weapon in this is our increasing understanding of the genetic makeup of all cells, not just cancer cells. Maybe we can keep ahead of the cancer as we learn more.

A nice article, one filled with hope, which is always nice.

Redefining Cancer (and Follicular Lymphoma?)

Nice commentary from  Scott Seaman on Examiner.com (it's been a while since I linked to an article by him). Seaman has something to say about the recommendations made this summer by a working group from the National Cancer Institute. His article is here.

First, let me be clear: what the working group suggests is just a suggestion. There is no policy set to be implemented, by anyone, anywhere, based on this recommendation. Let's be clear about that before we go any further.

I remember seeing this report over the summer, and made note of it, but never looked into it enough to write about it. The working group suggested that many cancers that are diagnosed lead to unnecessary treatment; people hear the word "cancer" and lose their minds, demanding further tests and treatments that could have been avoided, and that do more harm than good. Prostate cancer is a fairly well-known example of this: some types are indolent, diagnosed when the patient is of advanced age, and slow-growing enough that it would be years before it would need to be treated. Patients die with the cancer, not because of it. The working group gave other examples of this, focusing on certain types of breast and skin cancer, among others.

The panel called for reserving the word "cancer" for "describing lesions with a reasonable likelihood of lethal progression if left untreated." For other growths that would not likely lead to lethal progression, they suggest the term "Indolent Lesions of Epithelial Origin" (IDLE).

Now, back to Scott Seaman's article: Seaman argues that, in the 42 years since Nixon declared "war on cancer," we've come a long way. Not as long as we'd like, but a long way, thanks, he says, to raising awareness, encouraging screening, and suggesting lifestyle changes that may prevent cancer. Yes, we may over-test. We may be too "aware" sometimes. We may have made "cancer" too scary a word.

But isn't that the whole point of "awareness"? Isn't that why I can't buy a loaf of bread this month that doesn't have a pink wrapper?

Seaman says, obviously, that taking the working group's recommendation would be a step backwards.

More importantly, it has some real implications for Follicular Lymphoma. The working group homes in on the word "indolent." If their suggestions were taken, would Follicular Lymphoma be included? Would we no longer have cancer, but Indolent Lesions of Epithelial Origin?

In some ways, that would be nice. I'd like of like to no longer be a cancer patient. I might even give up Lympho Bob.

But then you think about the implications.

If we don't have cancer, would we still get to see the oncologist? Can we see him quite as often? Do we have to wait until our Indolent Lesions of Epithelial Origin transform? Or would just being diagnosed as grade III (with or without B symptoms) be enough?

I agree with the working group that cancer can take "multiple pathways...not all of which progress to metastases and death, and include indolent disease that causes no harm during the patient's lifetime." But some, and I would include Follicular Lymphoma, take such a potentially messed up pathway that it gets hard to define just what "indolent" is, and when it starts and stops fitting that category.

I will say again that the working group hasn't influenced any kind of policy just yet, and no one is proposing that any changes definitely take place. But I do think it says something about how important it is for us to be advocates for ourselves, and to pay attention to issues like this.

And we need top remember that words matter. They influence how we see the world, and the parts of it. Think carefully about how you define yourself, and about how you want others to define you. Not just in terms of cancer policy, but in your everyday life.

Thanks, Mr. Seaman. Some great food for thought.

Idelalisib / CAL-101 / GS-1101 News

Big news yesterday from Gilead, the maker of Idelalisib (also known as CAL-101 and GS-1101). It's not related to Idelalisib as a treatment for Follicular Lymphoma, but I think it's exciting and significant anyway.

Gilead announced that their phase 3 trial for Idelalisib in Chronic Lymphocytic Leukemia (CLL) patients will be stopped because it's going so well.

CLL is similar in some ways to Follicular Lymphoma, on that it affects B cells, and is generally slow-growing (in fact, while CLL is considered a leukemia, SLL, which is essentially the same disease but shows up differently, is considered an indolent lymphoma. To-may-toe, to-mah-toe.

As for the study, it focused on patients who had previously been treated, but were not good candidates for chemotherapy. Idelalisib, with fewer side effects, can be handled better than traditional chemo.

In the study, half of the patients received Idelalisib, and the other half received Rituxan. The preliminary results were so good, in terms of progression-free survival and safety, that Gilead was advised to stop the study. The advice came from an independent organization, not the FDA. The next step is for Gilead to negotiate with the FDA to see if they can get approval for Idelalisib. Maybe that will happen; maybe the FDA will ask that the study be continued.(I don't know if Gilead is considering that possibility, though they are continuing to treat the patients who are receiving Idelalisib).

From what I know of the FDA process (and I'm no expert), it seems like a slightly risky maneuver. There's no guarantee that they get early FDA approval. on the other hand, it seems like they could get conditional approval, and be asked to continue the study -- not so bad, either. They have a couple of things on their side: an independent agency making the recommendation, and the fact that there really isn't anything else out there for CLL patients who can't do traditional chemo. 

So why am I so excited about this, given that it isn't about Follicular Lymphoma?

Well, I'm excited because Idelalisib seems so promising for us -- it is in trials for Follicular Lymphoma as well, and looking good. Of course, despite the similarities between FL and CLL, they are totally different cancers, and nothing that helps one is guaranteed to help the other. But I feel good knowing that Idelalisib works for other cancers, too. Makes it seem more like the mechanism is really understood.

The other thing that seems exciting to me is that the FDA seems to be loosening up on its process a little. Not that I want them to approve things that aren't proven effective or safe, but I like the idea that they recognize that some results are just so good, and will be so helpful, that they are worth approving early. I like the idea that the FDA could consider something like that in the future for a promising Follicular Lymphoma treatment.

So, we can't pronounce Idelalisib as another arrow in the quiver just yet. But maybe the guy standing next to us at the archery range will get one soon, and we can at least shake his hand and feel good about that.

Immunotherapy

ASCOPost, an online publication from the American Society of Clinical Oncology, featured an interview a few weeks ago with Dr. David Porter, who is doing some interesting work in Immunotherapy, specifically with Leukemia patients. He talks about some of the advances in Immunotherapy that have come about in the last few years, and speculates about advances in the fairly near future.

Immunotherapy, basically, is the use of the body's own immune system to fight off cancer. Probably the best known Immunotherapy for Follicular Lymphoma patients is Rituxan, which works in several ways, all of which work with the immune system to kill off the cells. Cool video alert! 

As Dr. Porter makes clear, immunotherapy works because the treatment finds a target that is unique to the cell. (Rituxan finds CD20, which is present on B cells, the white blood cells that get all cancery.)

The challenge over the next 10 years, says Dr. Porter, will be in finding the targets on those cells.

I think that's less of a problem for Follicular Lymphoma. We've had some pretty great success with CD20. In addition to Rituxan, it is also the target for Zevalin and Bexxar, the RadioImmunoTherapies (I refuse to let Bexxar die, even if the current owner is going to stop manufacturing it), and the monoclonal antibody Ofatumumab. We also know that Follicular Lymphoma cells express CD10, CD19, and CD22. That's a bunch of targets, and already a bunch of treatments available and in the pipeline to go after them.

My guess is, given that we're ahead of a lot of other cancers when it comes to immunotherapy targets, our goals for the next few years will be 1) developing more and better immunotherapy agents. So far, nothing seems to beat out Rituxan enough to make us want to switch over. And with cheaper generic versions of Rituxan on the horizon, we're going to need something big; and 2) we're going to need to find some combinations of immunotherapies or other agents that show improvement over what we have (R + R, Rituxan + Revlimid, comes to mind).

(By the way, don't you love how I say "We," as in "We need to develop better treatments," like I'm in a lab coat looking through a microscope? I think it comes from it being baseball playoff season, as in, "We can't allow the Rays to win in the ninth like that again." Put me in, coach.)

Speaking of combinations, the other interesting comment that Dr. Porter made had to do with chemotherapy. It's not going anywhere, he says. I think he's right.

I've made snarky comments about clinical trials with CVP and Fludarabine, and how out-of-fashion they are, but my point isn't that they shouldn't be used anymore. It's that trials should be focusing precious resources on newer, more promising, focused treatments. (Which is actually the case -- I don't know of any brand new trials for older chemos, other than CHOP and its variants, or Bendamustine.)

Chemo is here to stay for a while, because it works, especially with refractory patients. Finding a good immunotherrap-chemo combo is the trick (R-CHOP and R-B certainly are proving effective). So is using immunotherapy agents to deliver targeted doses of chemo, rather than relying on the scattershot approach that traditional chemo takes.

So, while the interview wasn't focused on Follicular Lymphoma, it still provides some food for thought.

When Cancer Doesn't Matter

I woke up this morning to a video called What if Money Were No Object? My son had posted it online, and there are actually a bunch of different versions of it floating around. It's a voice over by Alan Watts, a writer and speaker who actually died about 40 years ago, but whose ideas are still very popular, particularly among young people.

It was a nice think to wake up to. Watts delivers a simple message: do what you love. Act as if money were no object, and you'll get good enough at what you love that things will take care of themselves.

I think what this probably means is that my son has decided to major in music. He played sax last night with a jazz combo in what he said was probably the best gig he'd ever had.

Will majoring in music, doing what he loves, mean things will take care of themselves?

Who knows. But thinking about the journey is kind of fun, and watching him take those steps is a thrill for me. He has the luxury of discovering what he loves, and of even considering the possibility of doing something as if money were no object.

For the rest of us, maybe the real world gets in the way of fully carrying out Watts' advice.

But there's a lesson for us, anyway.

A couple of days ago, I read about Vivian Campbell, guitarist for the band Def Leppard, who has been going through chemo for Hodgkin's Lymphoma. (I wrote about him after his diagnosis had been announced.) The band has been playing some shows, and he said the playing, as exhausting as it is, has been helping him get through treatments. They've been doing it in a funny way, too --disguising themselves as Ded Flatbird, a fake Def Leppard tribute band. It sounds like they've been having a blast for themselves.

And there's the message: I'm not in a position, at my age, with my health, and with a family, to chuck it all and decide to do what I love and hope it works out. I'm not 16 anymore. Which isn't to say I don't like my job -- I'm lucky enough to be able to say that I do. Would I have loved to play guitar for Def Leppard? Or even Ded Flatbird? Absolutely. But I can't do that.

What I can do, though, is find the joy in what I do everyday. In those few hours, or few minutes, that I find the time and energy to do something I really love, maybe I can act like money is no object.

My son has thew world in front of him, and can decide what he wants to do that will make him happy forever.

We have a world behind us, and sometimes we carry it on our backs. Maybe we can carve out just a little time for ourselves to pretend we're 16 again, and act like money, time, and cancer don't matter.

Cancer and the Shutdown

Well, there's not a whole lot of cancer news out there over the last couple of days. Seems like everything is being dominated by the partial shutdown of the federal government, and its current and potential aftermath.

Of course, the shutdown is affecting cancer patients, directly and indirectly.

Kinds with cancer are being blocked from participating in clinical trials.

The National Cancer Institute has stopped taking new patients in its trials, and has shut down its 24 hour hotline for cancer patients.

The Centers for Disease Control have halted their flu monitoring program. 

There are more, but that's plenty for now.

It's very frustrating, particularly when polls show so many people are against a government shutdown, no matter who initiates it or for what purpose.

We can only hope that the people involved start talking to one another, and come to a reasonable solution.

In the meantime, I was going to link to a Reddit thread titled "What's Your Go-To Song if You Need Cheering Up? The One that Never fails to Put a Smile on Your Face." But some of the choices are, to me, questionable. (Coldplay's "Viva La Vida"? Really? It's a great song, but...actually, it's about a king who is dethroned. Maybe that's the perfect sentiment, no matter which of our leaders you have in mind.....)

No, no. Let's stay positive. I'm going to suggest this one instead.

Hang in there, folks.