Melanoma (skin cancer)

Question:

. Yes it sucks but in a case where health resources must be rationed, how do you decide? As Curly said, triage is cold-hearted. But somebody has to do it! MIKE – Hide quoted text — Show quoted text – For the same reason that, if you could only offer it to one patient, the 30-year-old with 4 kids would have priority over the 43-year-old with two kids. I guess I’m dense, I don’t get the reasoning. If the 43 year old was your father — or even you, would you see this in the same light? Why should it matter how many, if any, kids someone has? How can you place one person’s life as being more important than another? I just don’t get it. It’s the classic utilitarian argument. And unfortunately it’s not uncommon with scarce health resources (e.g. organs for transplant) to ration them according to age and overall patient health. All things being equal, the average 43-yo is healthier (and therefore theoretically better to tolerate treatment) than the average 80-yo. And since the 80-yo is thought to have lived a full life, some think that the younger person deserves first crack. Neither of which may be true for any individual person of course. Yes it sucks but in a case where health resources must be rationed, how do you decide? As Curly said, triage is cold-hearted. T.

Response:

Note that I was careful to say that the treatment is not known to be of benefit.

Yes, I noticed that. It did say "This procedure is still undergoing clinical trials," so I guess time will tell. . But in BC, at least, we have an absolute policy that treatment decisions cannot be made based on age, or number of children, or anything other than the patient’s need and the suitability of the treatment.

I’m in Quebec, and my Mom lived in Ontario. Both provinces still face shortages in medical care. Mom spent her last years blind because the doctor decided it wasn’t worth doing glaucoma surgery on someone her age. My Mom taught me to love books, as she did. She always had a book nearby, until she couldn’t read any more. She kept pictures of her grandchildren, all around, even when she could barely see them any more. Triage can be heartbreaking, even if you know the reasons why. — Oisin "Curly++" Curtin http://pages.infinit.net/curlypp/ oligo 3, szr 6/1/2k, biopsy 6/19/2k, rad 30 8/24/2k-10/11/2k, stable!

Response:

For the same reason that, if you could only offer it to one patient, the 30-year-old with 4 kids would have priority over the 43-year-old with two kids. I guess I’m dense, I don’t get the reasoning. If the 43 year old was your father — or even you, would you see this in the same light? Why should it matter how many, if any, kids someone has? How can you place one person’s life as being more important than another? I just don’t get it.

It’s the classic utilitarian argument. And unfortunately it’s not uncommon with scarce health resources (e.g. organs for transplant) to ration them according to age and overall patient health. All things being equal, the average 43-yo is healthier (and therefore theoretically better to tolerate treatment) than the average 80-yo. And since the 80-yo is thought to have lived a full life, some think that the younger person deserves first crack. Neither of which may be true for any individual person of course. Yes it sucks but in a case where health resources must be rationed, how do you decide? As Curly said, triage is cold-hearted. T.

Response:

Ditto for babies? As Steph said "treatment decisions cannot be made based on age, or number of children, or anything other than the patient’s need and the suitability of the treatment.". I recently heard that it is expected that we will have possibly 60,000 octenagenarians (sp?) – 100 year olds – (this goes to your "average life expectancy" comment), if they are otherwise fit, why not? J PS I’m glad many of my relatives lived out their lives in BC. This triage, if based on age only, disturbs me. That being said, the public is not stupid. Many of them realize that triage is happening even at lower levels of the health system, and not only based on age. Economics, gender, occupation and a number of other criteria are being used (individual physician biases) to either fast-track people for tests or surgeries (or not). That’s reality! Unfortunately this can reflect later on who gets treated or surgery before it’s too late (with respect to cancer).

Response:

I recently heard that it is expected that we will have possibly 60,000 octenagenarians (sp?) – 100 year olds – (this goes to your "average life

It’s spelled "centenarian". An "octogenarian" is in his or her 80’s. When I was a teenager, all three-digit birthdays were covered by the local paper. PS I’m glad many of my relatives lived out their lives in BC. This triage, if based on age only, disturbs me.

It’s not based on age only. Here in Quebec, when you show up at the ER, the first person you see is the "Triage Nurse" who assesses your need and urgency. If you have a broken leg, you get in line ahead of the dummy with a billard ball stuck in his mouth [1] and behind the person with a heart attack. Economics, gender, occupation and a number of other criteria are being used (individual physician biases) to either fast-track people for tests or surgeries (or not). That’s reality!

That’s not triage, that’s discrimination. Everyone suspects it, but I’m sure it happens less than we think. [1] Usually a kid who "won" the bet that he could get a billard ball in his mouth. You can get it in, you just can’t get it out again. — Oisin "Curly++" Curtin http://pages.infinit.net/curlypp/ oligo 3, szr 6/1/2k, biopsy 6/19/2k, rad 30 8/24/2k-10/11/2k, stable!

Response:

I recently heard that it is expected that we will have possibly 60,000 octenagenarians (sp?) – 100 year olds – (this goes to your "average life It’s spelled "centenarian". An "octogenarian" is in his or her 80’s.

Thanks, I knew that wasn’t right because of octagon, but couldn’t pull the word "centenarian" from my brain database When I was a teenager, all three-digit birthdays were covered by the local paper.

Yes, the point was that the trends are going towards longer, healthier lives, for some. PS I’m glad many of my relatives lived out their lives in BC. This triage, if based on age only, disturbs me. It’s not based on age only. Here in Quebec, when you show up at the ER, the first person you see is the "Triage Nurse" who assesses your need and urgency. If you have a broken leg, you get in line ahead of the dummy with a billard ball stuck in his mouth [1] and behind the person with a heart attack.

Well, they make mistakes. I’ll spare you the very long list of examples. Economics, gender, occupation and a number of other criteria are being used (individual physician biases) to either fast-track people for tests or surgeries (or not). That’s reality! That’s not triage, that’s discrimination. Everyone suspects it, but I’m sure it happens less than we think.

Those it doesn’t happen to, think so. Again, I’ll spare you the very long list of examples. (and no, these are not "news" or ‘net stories). These are happening to people that I know and care about. J

Response:

Well, I think that I earned that right when I decided not to ask anyone to foot the bill for diagnosis and treatment of the things I asked about last week. Are you surrendering?

Oh, no — I just won’t steal from YOU to pay for it.

Response:

Everyone has potential/value and if you can’t see that then I suspect that you are depressed.

1) Not everyone has the SAME potential or value 2) You can’t usually save everyone, there isn’t enough to go around 3) Given 1 and 2, above, then you have to decide who gets what. Depression leads to a condition of not being able to see possibilities and apparently you don’t. Perhaps you have some very good reasons for being fatalistic or depressed, or perhaps you are just feeling sorry for yourself.

I am neither depressed nor fatalistic. I simply don’t believe in the Good Fairy, nor do I believe in stealing. "If" isn’t even a question, when it comes to dying — it is "when" and "how." Even 80 year olds have a wisdom that cannot be bought but can and should be imparted on those who’ve come after, so IMO are just as valuable as any child. So a 43-year-old most certainly has a greater value, by some standards, than a 30-year-old father.

Not to the child. There are even free mental health clinics (I’ve looked them up for certain situations/posts) which might lead to contacts to assist you in getting the skin situation looked at.

I’ll stack up my mental health against anyone’s. And my morals. Here’s another possible http://www.vimi.org/index.html and I ran a ‘net search and there are free clinics in the US, if that’s where you are living. (not everywhere, but there are some) We can’t see what’s on your skin and even if we could, we’re not dermatologists and can’t do skin scapings over the ‘net.

Response:

I think you have to take into account what the average life expectancy is and and keep in mind that at 80 years of age they may not be able to handle the treatment and it potentially can do more damage than good. My mother was in her mid to late 70s when she was diagnosed with colorectal (SP?) cancer. The doctors offered her a fairly aggressive form of treatment. I was against if from the beginning, I voiced my opinion, in the end she decided to go with the treatment and died at the age of 81. Chances are she would have survived this long anyway. However, her last years were spent as a shell of the woman she was prior to diagnosis. – Hide quoted text — Show quoted text – If I was 80 he said that he would not recommend for me the above procedure. But since I am 43 and have children he said that he recommend it for added security. And he scheduled me for surgery on the 18th. I hear this kind of reasoning a lot. However, I can’t see why, if lymphoscintigraphy is good (and nobody really knows for melanoma) why the fact that someone is 43 and has kids makes it more appropriate for them than for a fit 80 year old.

Response:

- Hide quoted text — Show quoted text – For the same reason that, if you could only offer it to one patient, the 30-year-old with 4 kids would have priority over the 43-year-old with two kids. I guess I’m dense, I don’t get the reasoning. If the 43 year old was your father — or even you, would you see this in the same light? Yes. I do. Why should it matter how many, if any, kids someone has? How can you place one person’s life as being more important than another? Well, I think that I earned that right when I decided not to ask anyone to foot the bill for diagnosis and treatment of the things I asked about last week. You see, at 43, having no dependents anymore, I have made my most important contributions. A 30-year-old father is of greater value to society than a 43-year-old. <snip No, people treated as potential. There is no more important job than that of parent — ask any child who has lost one.

Everyone has potential/value and if you can’t see that then I suspect that you are depressed. Depression leads to a condition of not being able to see possibilities and apparently you don’t. Perhaps you have some very good reasons for being fatalistic or depressed, or perhaps you are just feeling sorry for yourself. Even 80 year olds have a wisdom that cannot be bought but can and should be imparted on those who’ve come after, so IMO are just as valuable as any child. So a 43-year-old most certainly has a greater value, by some standards, than a 30-year-old father. There are even free mental health clinics (I’ve looked them up for certain situations/posts) which might lead to contacts to assist you in getting the skin situation looked at. Here’s another possible http://www.vimi.org/index.html and I ran a ‘net search and there are free clinics in the US, if that’s where you are living. (not everywhere, but there are some) We can’t see what’s on your skin and even if we could, we’re not dermatologists and can’t do skin scapings over the ‘net. Please get cracking and get some answers. Then come back and let us know. HTH J

Response:

Glenn, Go to http://www.tustison.com/melfaq.html and scroll down to the Cancer Support Mailing Lists. Subscribe to the MEL-L list and you will find people that you can "talk" to. It is a great support group. – Hide quoted text — Show quoted text – security. And he scheduled me for surgery on the 18th. I am still wondering if I need to get a second opinion but don’t really know where to fine people I can talk to.

Response:

Yes. I do. Why should it matter how many, if any, kids someone has? How can you place one person’s life as being more important than another?

Well, I think that I earned that right when I decided not to ask anyone to foot the bill for diagnosis and treatment of the things I asked about last week. You see, at 43, having no dependents anymore, I have made my most important contributions. A 30-year-old father is of greater value to society than a 43-year-old. It’s hard and it’s cold. I think triage was invented in war. The idea seems to be that when resources are limited, you try to do the most good. It’s more likely that a single mother will be able to raise two kids than raise four kids. It’s more likely a 30 year old wife will want to have more children. But an 80 year old will soon develop other medical problems and probably die in the next decade anyway.

Exactly. More likely… could happen… probably… people treated as numbers.

No, people treated as potential. There is no more important job than that of parent — ask any child who has lost one.

Response:

Well, I think that I earned that right when I decided not to ask anyone to foot the bill for diagnosis and treatment of the things I asked about last week.

Are you surrendering? More likely… could happen… probably… people treated as numbers. No, people treated as potential. There is no more important job than that of parent — ask any child who has lost one.

There are plenty of organizations helping children, even children with a parent missing. They could use an extra pair of hands. Especially a pair of hands with a wise mind attached. Get diagnosed, get treated if necessary. Sam needs you, Uncle. — Oisin "Curly++" Curtin http://pages.infinit.net/curlypp/ oligo 3, szr 6/1/2k, biopsy 6/19/2k, rad 30 8/24/2k-10/11/2k, stable!

Response:

To all who may be reading this, I have always said that we the patients must be our own best doctors. If you have a mark on your skin of any type, insist that it is biopsied even if the doctor tells you they think it is nothing. I and others I know have been down this same road and it is not fun, especially when you think of how easy it is for the doctors to do a small biopsy. Don’t ask, tell you want it removed! – Hide quoted text — Show quoted text -Hello all, The dermatologist last week just cut out what was diagnosed as a melanoma from my shoulder. I had it for maybe a year. I went to the dermatologist 8 months ago to specifically ask about this spot that I saw changing and growing on top of another mole for a few months prior. That doctor sent me home saying that all was fine even though I specifically asked and told the doctor that spot was of my main concern. But after pushing on it under my shirt it started bleeding and my wife said that I better go tomorrow and see the dermatologist, which I did and he cut it out that very next day. But I guess my main concern is the time I had it and the fact that it bled, thinking that the blood could spread the cancer. But hopefully I caught it soon enough. I would like to know if others here are willing to share on this subject with me. Or where to seek knowledge on melanoma and others who are dealing with it. I am going to a specialist in skin cancer here in So.Cal. tomorrow named Dr. Jakowatz http://www.skincancer.org/melanoma/treatment-centers.html for my first meeting since receiving the news from my dermatologist. And will know more about where I stand after this meeting. Thanks, Glenn

Response:

Thanks Ross and Ruth for your reply. Well I went to the oncologist that specializes in melanoma at UC Irvine, Dr. Jakowatz. He said that my chances of recovery are excellent because it was only .55 surface spreading melanoma and did not have the other elements that make it more serious. The only thing that is a red flag is that it bled "ulcerated" when I pushed on it under my shirt and the fabric rubbed it. He said the pathologist is one of the best and had praise for his work. The Doctor advise is another in margin to be remove and tested and also have a Lymphoscintigraphy and the Sentinel Node Here is a description: "A new method, lymphoscintigraphy, has been developed for mapping the lymph system. A small amount of a radioactive substance is injected at the site of the melanoma to trace the flow of lymph fluid draining from it to the nodes. Then, with the help of a scanner, the drainage pattern of the lymph fluid can be determined. Armed with this information, the surgeon can remove only those lymph nodes that receive the fluid preferentially. The procedure is known technically as "lymphoscintigraphy-guided-lymph node dissection." Another diagnostic technique makes use of a blue dye injected into the skin around the tumor. The dye passes into the lymph fluid, tracing its path. The blue color is picked up first by the node that is closest to the tumor, the sentinel node. Once a specific area of lymph drainage has been pinpointed by either method, that node or nodes can be removed surgically and tested in the pathology laboratory. If no cancer cells are found, no further surgery is performed. If there are cancer cells in the sentinel node, the additional nodes will be removed. This procedure is still undergoing clinical trials, and is not a standard part of practice. You may, therefore, wish to discuss it with your physician." If I was 80 he said that he would not recommend for me the above procedure. But since I am 43 and have children he said that he recommend it for added security. And he scheduled me for surgery on the 18th. I am still wondering if I need to get a second opinion but don’t really know where to fine people I can talk to. Thanks again and I will keep you posted if I have the time. Sincerely, Glenn

Response:

I hear this kind of reasoning a lot. However, I can’t see why, if lymphoscintigraphy is good (and nobody really knows for melanoma) why the fact that someone is 43 and has kids makes it more appropriate for them than for a fit 80 year old.

Response:

If I was 80 he said that he would not recommend for me the above procedure. But since I am 43 and have children he said that he recommend it for added security. And he scheduled me for surgery on the 18th. I hear this kind of reasoning a lot. However, I can’t see why, if lymphoscintigraphy is good (and nobody really knows for melanoma) why the fact that someone is 43 and has kids makes it more appropriate for them than for a fit 80 year old.

For the same reason that, if you could only offer it to one patient, the 30-year-old with 4 kids would have priority over the 43-year-old with two kids.

Response:

For the same reason that, if you could only offer it to one patient, the 30-year-old with 4 kids would have priority over the 43-year-old with two kids.

I guess I’m dense, I don’t get the reasoning. If the 43 year old was your father — or even you, would you see this in the same light? Why should it matter how many, if any, kids someone has? How can you place one person’s life as being more important than another? I just don’t get it. …lisa

Response:

It’s hard and it’s cold. I think triage was invented in war. The idea seems to be that when resources are limited, you try to do the most good. It’s more likely that a single mother will be able to raise two kids than raise four kids. It’s more likely a 30 year old wife will want to have more children. But an 80 year old will soon develop other medical problems and probably die in the next decade anyway. More likely… could happen… probably… people treated as numbers. The trouble is, triage principles are being used now to deny treatment to 80 year olds even if there is enough treatment to go around, even if that treatment might make the difference between another 5 years of hard life and another 10 years of good life. Now we sometimes have to go to war with our health providers. — Oisin "Curly++" Curtin http://pages.infinit.net/curlypp/ oligo 3, szr 6/1/2k, biopsy 6/19/2k, rad 30 8/24/2k-10/11/2k, stable!

Response:

Perhaps it would help to know the danger signs: http://matrix.ucdavis.edu/tumors/new/tutorial-intro.html — Oisin "Curly++" Curtin http://pages.infinit.net/curlypp/ oligo 3, szr 6/1/2k, biopsy 6/19/2k, rad 30 8/24/2k-10/11/2k, stable!

Response:

Glenn, I also had a mole that was bleeding, that was back in 1982. In 1984 it hit the lymph nodes. I’ve had many surgeries, underwent chemo and all is well at this time. Feel free to contact me through this group or my e-mail. I’m always glad to help out in any way I can. You can also check out the Melanoma Patients Information Page at www.mpip.org for some good information. – Hide quoted text — Show quoted text -Hello all, The dermatologist last week just cut out what was diagnosed as a melanoma from my shoulder. I had it for maybe a year. I went to the dermatologist 8 months ago to specifically ask about this spot that I saw changing and growing on top of another mole for a few months prior. That doctor sent me home saying that all was fine even though I specifically asked and told the doctor that spot was of my main concern. But after pushing on it under my shirt it started bleeding and my wife said that I better go tomorrow and see the dermatologist, which I did and he cut it out that very next day. But I guess my main concern is the time I had it and the fact that it bled, thinking that the blood could spread the cancer. But hopefully I caught it soon enough. I would like to know if others here are willing to share on this subject with me. Or where to seek knowledge on melanoma and others who are dealing with it. I am going to a specialist in skin cancer here in So.Cal. tomorrow named Dr. Jakowatz http://www.skincancer.org/melanoma/treatment-centers.html for my first meeting since receiving the news from my dermatologist. And will know more about where I stand after this meeting. Thanks, Glenn

Response:

– Hide quoted text — Show quoted text – For the same reason that, if you could only offer it to one patient, the 30-year-old with 4 kids would have priority over the 43-year-old with two kids. I guess I’m dense, I don’t get the reasoning. If the 43 year old was your father — or even you, would you see this in the same light? Why should it matter how many, if any, kids someone has? How can you place one person’s life as being more important than another? It’s hard and it’s cold. I think triage was invented in war. The idea seems to be that when resources are limited, you try to do the most good. It’s more likely that a single mother will be able to raise two kids than raise four kids. It’s more likely a 30 year old wife will want to have more children. But an 80 year old will soon develop other medical problems and probably die in the next decade anyway. More likely… could happen… probably… people treated as numbers. The trouble is, triage principles are being used now to deny treatment to 80 year olds even if there is enough treatment to go around, even if that treatment might make the difference between another 5 years of hard life and another 10 years of good life. Now we sometimes have to go to war with our health providers.

Note that I was careful to say that the treatment is not known to be of benefit. Certainly in our system, it is perfectly acceptable not to give an 80 year old nasty chemo (for instance) if other medical problems get in the way (as they often do in the elderly). But in BC, at least, we have an absolute policy that treatment decisions cannot be made based on age, or number of children, or anything other than the patient’s need and the suitability of the treatment.

Response:

- Hide quoted text — Show quoted text – If I was 80 he said that he would not recommend for me the above procedure. But since I am 43 and have children he said that he recommend it for added security. And he scheduled me for surgery on the 18th. I hear this kind of reasoning a lot. However, I can’t see why, if lymphoscintigraphy is good (and nobody really knows for melanoma) why the fact that someone is 43 and has kids makes it more appropriate for them than for a fit 80 year old.

There actually is some rationality. When Melanoma’s recurr, it is often many years later. If the patient is already 80 years old, what are the odds of recurrence in the remaining life expectancy? It is a little like how many physicians manage type II diabetes. It is done much more aggressively in a 40 years then it is an 80 year old. If you don’t do an especially good job, there are likely to be serious complications 20 years down the pike. There is high probability that your 40 year old will still be around, odds are your 80 year old will have died of something else first. Why subject the patient to further treatment, and procedures that are more likely to have serious consequences in the remaining life expetancy then the disease? It just isn’t a very favorable risk/benefit ratio.

Response:

Hello all, The dermatologist last week just cut out what was diagnosed as a melanoma from my shoulder. I had it for maybe a year. I went to the dermatologist 8 months ago to specifically ask about this spot that I saw changing and growing on top of another mole for a few months prior. That doctor sent me home saying that all was fine even though I specifically asked and told the doctor that spot was of my main concern. But after pushing on it under my shirt it started bleeding and my wife said that I better go tomorrow and see the dermatologist, which I did and he cut it out that very next day. But I guess my main concern is the time I had it and the fact that it bled, thinking that the blood could spread the cancer. But hopefully I caught it soon enough. I would like to know if others here are willing to share on this subject with me. Or where to seek knowledge on melanoma and others who are dealing with it. I am going to a specialist in skin cancer here in So.Cal. tomorrow named Dr. Jakowatz http://www.skincancer.org/melanoma/treatment-centers.html for my first meeting since receiving the news from my dermatologist. And will know more about where I stand after this meeting. Thanks, Glenn

Response:

Hi Glenn, I would wait until your doctor gives you specific feedback. I share your frustration in finding out that something you were suspicious of 12 months ago has now proven to be a melanoma. I was diagnosed in 1993, but it had already spread into my lymph system as secondaries. But almost 8 years later I’m alive and well. melanoma tends to be very individualistic so generalisations are dangerious.Please email me once you get the updated results. Take care, Ross Taylor Author, "Living simply with Cancer" – Hide quoted text — Show quoted text – Hello all, The dermatologist last week just cut out what was diagnosed as a melanoma from my shoulder. I had it for maybe a year. I went to the dermatologist 8 months ago to specifically ask about this spot that I saw changing and growing on top of another mole for a few months prior. That doctor sent me home saying that all was fine even though I specifically asked and told the doctor that spot was of my main concern. But after pushing on it under my shirt it started bleeding and my wife said that I better go tomorrow and see the dermatologist, which I did and he cut it out that very next day. But I guess my main concern is the time I had it and the fact that it bled, thinking that the blood could spread the cancer. But hopefully I caught it soon enough. I would like to know if others here are willing to share on this subject with me. Or where to seek knowledge on melanoma and others who are dealing with it. I am going to a specialist in skin cancer here in So.Cal. tomorrow named Dr. Jakowatz http://www.skincancer.org/melanoma/treatment-centers.html for my first meeting since receiving the news from my dermatologist. And will know more about where I stand after this meeting. Thanks, Glenn

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