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Starting Hospice

jakeseliger.com

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Re: Starting Hospice

#111

Post by melling »

jseliger wrote: post #96
keeptrying wrote: post #73

Earlier quoted context omitted.

Thank you for your writing - its taught me a lot about a lot of things. One concrete highlight is how important patient agency is in the patient-doctor relationship - which you've written about a few times. I'm truly deeply sorry about this whole situation. Thank you for sharing all your knowledge.

I hope too to accomplish at least two concrete ends: 1. Help and educate other people who are suddenly facing the opaque clinical-trial system: https://bessstillman.substack.com/p/please-be-dying-but-not-... 2. Ultimately, reform and speed FDA approval for fatal diseases like recurrent / metastatic head and neck cancers: https://jakeseliger.com/2024/01/29/the-dead-and-dying-at-the... . A drug like petosemtamab (MCLA-…

Have you discussed anything about targeted therapies? For example, how the different genetic makeup of some tumors are used to treat them. Keytruda comes to mind.

https://www.keytruda.com/

Antibody drug conjugates also seem to be discussed often:

https://www.mdanderson.org/cancerwise/antibody-drug-conjugat...

Re: Starting Hospice

#112

Post by adamredwoods »

melling wrote: post #111
jseliger wrote: post #96

Earlier quoted context omitted.

I hope too to accomplish at least two concrete ends: 1. Help and educate other people who are suddenly facing the opaque clinical-trial system: https://bessstillman.substack.com/p/please-be-dying-but-not-... 2. Ultimately, reform and speed FDA approval for fatal diseases like recurrent / metastatic head and neck cancers: https://jakeseliger.com/2024/01/29/the-dead-and-dying-at-the... . A drug like petosemtamab (MCLA-…

Have you discussed anything about targeted therapies? For example, how the different genetic makeup of some tumors are used to treat them. Keytruda comes to mind. https://www.keytruda.com/ Antibody drug conjugates also seem to be discussed often: https://www.mdanderson.org/cancerwise/antibody-drug-conjugat...

In his blog, he discusses Keytruda. https://jakeseliger.com/2023/12/19/what-if-things-go-right-w...

Re: Starting Hospice

#113

Post by timr »

cgijoe wrote: post #80
joevandyk wrote: post #79

I hope this is an appropriate place to ask. Say I am eating well, exercising consistently, getting enough sleep. For a male in his 40s, what are the best bang-for-the-buck ways to detect cancer before it becomes life-threatening?

Talk to your doctor, and ask to be screened for all common cancers. A colonoscopy is in your future (I just had one). Also ask for a Prostate-Specific Antigen (PSA) Test. Also look into the HPV vaccine.

Don't do this. Nearly all cancer tests are overly sensitive, and not great at detecting the cancers you care about (the ones that will progress).

If you run out and get a bunch of random cancer tests, you are basically ensuring that you will get unnecessary and painful treatment for a finding that probably wouldn't have harmed you in the first place.

It's not a satisfying answer, but it's true. The reason most cancers are found late is because there's no effective alternative.

Re: Starting Hospice

#114

Post by nyokodo »

The_Colonel wrote: post #103
simeonf wrote: post #71

Earlier quoted context omitted.

Gandalf says this in the movies, not in the book. However the descriptive language is drawn from Frodo's dream in the barrow downs and his experience sailing into west at the end of LOTR. > And then it seemed to him that as in his dream in the house of Bombadil, the grey rain-curtain turned all to silver glass and was rolled back, and he beheld white shores and beyond them a far green country under a swift sunrise.

But "sailing into the west" is not a metaphor for death, Valinor is not a metaphor for heaven (as it's a real place within LOTR world where e.g. Frodo dies). Gandalf's movie quote does not appear to be based on book material.

> But "sailing into the west" is not a metaphor for death, Valinor is not a metaphor for heaven

Tolkien wasn't a fan of allegory that's for sure and you won't find a 1:1 between his fictional works and his own religious beliefs but a devout Catholic like him was definitely channelling heaven as the new glorified Eden to some degree when describing the "undying lands" that were lifted up into the heavens after the corruption and treachery of Numenor and ruled by the great spiritual powers that rule as stewards for the Creator. The movie did paraphrase, and perhaps I'm wrong but I don't think its something that Tolkien would have been offended by.

Re: Starting Hospice

#115

Post by shrubble »

jseliger wrote: post #2

Hacker News, thank you for all the links and all the great reading. Now I have to say goodbye. I’m with my wife Bess ( https://bessstillman.substack.com/ ) and my brother Sam, and crying, but it is okay. At the end of Lord of the Rings Gandalf says to the hobbits, "Go in peace! I will not say: do not weep; for not all tears are an evil.” And that is how I feel now. Ending prematurely hurts, but all things must end, a…

Jake, I have read your previous posts and am deeply saddened to see this post; if there are LOTR references to be made then perhaps the part in the Appendix where Aragorn tells Arwen that "beyond the circles of the world there is more than memory" can be mentioned.

Re: Starting Hospice

#116

Post by soared »

joevandyk wrote: post #79

I hope this is an appropriate place to ask. Say I am eating well, exercising consistently, getting enough sleep. For a male in his 40s, what are the best bang-for-the-buck ways to detect cancer before it becomes life-threatening?

Find a primary doctor you like and stick with them. Do your check ups, talk with them, communicate anything odd.

Go to a dermatologist and get a mole map. Get your tests done on schedule when you should be.

Don’t smoke cigarettes, or work in a high risk job around carcinogens.

Re: Starting Hospice

#117

Post by borbulon »

jseliger wrote: post #2

Hacker News, thank you for all the links and all the great reading. Now I have to say goodbye. I’m with my wife Bess ( https://bessstillman.substack.com/ ) and my brother Sam, and crying, but it is okay. At the end of Lord of the Rings Gandalf says to the hobbits, "Go in peace! I will not say: do not weep; for not all tears are an evil.” And that is how I feel now. Ending prematurely hurts, but all things must end, a…

I’m sorry for both of you. I thank you for your words. As someone who’s right behind you in line, your words mean more to me (and hit harder, and cut deeper) than I expect they do for many.

Take my love with you both. See you on the other side.

Re: Starting Hospice

#118

Post by melling »

adamredwoods wrote: post #112
melling wrote: post #111

Earlier quoted context omitted.

Have you discussed anything about targeted therapies? For example, how the different genetic makeup of some tumors are used to treat them. Keytruda comes to mind. https://www.keytruda.com/ Antibody drug conjugates also seem to be discussed often: https://www.mdanderson.org/cancerwise/antibody-drug-conjugat...

In his blog, he discusses Keytruda. https://jakeseliger.com/2023/12/19/what-if-things-go-right-w...

I see where he discusses it. He said it only works for a small group and not for him.

He’s mentions trying drugs that target EGFR mutations, which I believe tries to stop the blood supply to the tumor. Targeting specific protein receptors, like HER2 in breast cancer, seems to be promising.

https://my.clevelandclinic.org/health/diseases/25213-her2-po...

RAS is a target for (some) colon and pancreatic cancers:

https://www.cancer.gov/research/key-initiatives/ras#:~:text=....

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