Wednesday, December 13, 2017

Medicine in Third World Countries; Pregnancy; Unsuccessful Labor

By Larry Puls @Larrypulsauthor

Medicine in Third World Country; Pregnancy
The Jammu and Kashmir state in India are home to part of the Himalayan mountain range. Five doctors lived there and handled two hundred patient visits a day in this very remote and isolated area. When the story occurred, four of them left for their annual national meeting, leaving one physician behind to tend the flocks. At the same time, an American medical student arrived, enticed by an opportunity to gain an experience. And an experience is what he received. These events occurred before the birth of words like Internet, Google, or cell towers.

Wednesday, December 6, 2017

Choriocarcinoma, Treatment of Molar Pregnancy, Cure of Cancer

By Larry Puls  @larrypulsauthor

Choriocarcinoma; Cancer from Pregnancy
Standing outside the door, I collect my thoughts. Walking into her hospital room, I see the young lady who is struggling to breathe. Oxygen is flowing to her. At her rate of decline, she will be on the ventilator soon. And this will not change unless therapy is started quickly. Time becomes a key element. Her breathing is increasingly labored. Her diet is pure oxygen. It is the relative calm before the storm.

Treatment is defined by the word aggressive. A five-drug regimen going by the acronym EMACO. Etoposide. Methotrexate. Actinomycin-D. Cytoxan. Oncovin. Each of those successive letters standing for the listed drugs. But each represents different side effects. All with the potential to eradicate those rapidly growing cells--the little parasites taking over her body. And although they will all be administered through an IV, one is also given directly into her spine. A needle into the back. A drug that will bathe the nervous system with cancer poison. We have to hit the tumor where it lives and breathes--in her brain.

Wednesday, November 29, 2017

Choriocarcinoma, Cancer From Pregnancy, Hope

By Larry Puls @larrypulsauthor

Choriocarcinoma; Cancer from Pregnancy
It is tough enough to be pregnant, what with the backaches, the nausea, and the getting up and down all night. Guys like me will never really comprehend it, though we appreciate some of it while watching our sweet wives endure it. But I would say to those who have been pregnant, imagine how much tougher those inconveniences would be if the events surrounding that joyful time turned tragically against you. A life full of hope transforming into just hoping for a chance, all in the blink of an eye. Those are the events that shake our very foundations. That is what tests our faith. And interestingly, but not surprisingly, that is what grows us.

Wednesday, November 22, 2017

Hysterectomy; Trauma; The Uterus That Saved a Life

by Larry Puls @larrypulsauthor



Trauma; Hysterectomy
The uterus. Arguably, the most fascinating organ in the human body. No bigger than a tangerine ninety-eight percent of the time, no smaller than a watermelon the other two. Fertile soil, doubling as a temporary home, a safe haven, where the beginnings of life take hold. Where an embryo morphs and divides, transforming into billions of unique cells that make up the intricate pieces of the human body. All woven together and permanently bonded with a soul. The baby incubator that graciously and generously supplies all the nutrients and oxygen a small child will need to thrive. It provides the human race with the most beautiful, precious, amazing, heart-warming gifts we call children, made in the image of God.

Wednesday, November 15, 2017

Family History of Cancer; BRCA mutations; The Second and Third Sisters


By Larry Puls @Larrypulsauthor

Sisters with Ovarian Cancer; Family History of Cancer
A year had passed. I had not forgotten the young woman who lost her battle to ovarian cancer. Her smile was still visible and I could almost recall her laugh. Thirty-two-year-old patients are particularly memorable. So few women die that young due to gynecologic malignancies. Many of the details about her final days were still fresh on my mind. In many ways, the more tragic the scenario, the more you remember. But her death in my career was not in vain, for I learned much about the chronic use of chemotherapy and its long term side effects. Things you don't always learn in training. She changed my style of practice. Her bone marrow death in the midst of treatment has to this day, influenced my use of drugs, their duration and their dosing, well past her life—even now. Her death I believe, has helped me help others.

Wednesday, November 8, 2017

Family History of Ovarian Cancer; A Tale of Three Sisters

By Larry Puls @larrypulsauthor

Family History of Cancer, Ovarian Cancer
By the early 90’s, oncologists had obviously observed for some time that certain families were far more affected by various malignancies than others. They knew intuitively that a gene, or genes, tied these cancers to the families, but that genetic component couldn't be readily identified by testing. Today, advances in the study of genetics is changing all of that, allowing us to frequently identify who might be at an increased risk for cancer, even before they develop one. The rapid discovery of new deleterious (bad) mutations allows us to identify individuals who are at an increased risk and to tell them what that risk is over the norm. Knowing this presents us with an opportunity to screen more effectively, to potentially intervene before the cancer starts, to counsel multiple generations within a family, and often prevent certain at risk members from losing their own lives secondary to a malignancy.

Wednesday, November 1, 2017

Cancer in Pregnancy; The End of Life; A Young Mother's Final Day

By Larry Puls @larrypulsauthor


The Death of a Mother
I walk into the room and cannot even recognize her face anymore. How far we have come over the last two years. Laying there, I see a very thin layer of skin covering her collar bone, painted with an ashen pallor. A physician's heart is crumbling. I conclude the end is very near. My desire is to leave the room. My job is to stay by her side. The smell of death is unforgettable.

I pull back the bandage and stare at her wound. There, gazing back at me is the enemy, the cancer, the "small cells" I could not eradicate—though for two years I tried—in fact, many of us tried. Looking at the wound, I see the pulsating beat of the major artery moving her skin up and down, up and down, surrounded by the advancing malignancy. Her pain meds have rendered her groggy and minimally verbal, but at least she looks comfortable. She wakes up enough to ask about end points, about timing of other treatment, about whether or not I have further plans for her. I don’t honestly want to answer those questions. How do you say "I have run out of plans"? I have no other magic pills, magic bullets, magic cocktails. I can only wait. And wait for what? I just can't verbalize that, since I don't want to think about what is to come. God is totally in control of all things now—and always has been, lest I think differently. But what I do know, from where I stand, is that there is very little time left--and that the life here before me is hanging on the edge.