A page from the 'Book of Life'

By my good friend, Susan Dustin

What a little contrast brings

Yesterday was my first day in 2019 of returning to walk with those in end of life. Standing outside of the hospital I lay my empty hands in front of my deliberately open heart and readied myself to receive and work with whatever would be presented to me. I prayed to offer those I encountered an empathetic grace-filled dignity even though I was feeling below par. 

People often comment to me that my walking with the dying is a laudable sacrificial endeavor. There may be aspects that are extremely emotionally taxing. Some situations also stretch my patience and ability to embrace others without bias. Occasionally there are passages so sacred that my failure to render them through any good account leaves me feeling isolated in the experience. Yet, even within my places of lack, great love and joy resound so profoundly that I am often transported into the divine. I am greatly enriched because I get to care for others in deep and intimate ways. The dying, through what great loss so clearly offers, often impart to me invaluable life perspectives. They, in all their broken frailty, teach me how to live fully! 

***

I suffer from reoccurring leptospirosis. The first year I contracted it, I had innumerable fevers, headaches, nausea, loss of appetite and hair, the threat of sight and organ damage, and deep exhaustion and depression plagued me. Throughout the past four years, it has randomly revisited for a month or two at a time. Because the symptoms are not as physical as the first bout, outside of extreme malaise, erratic thought and depression, I’m slow to realize that I am in the throes of it. Once I become aware, I fight furiously to heal and climb out of the pit in which it has cast me. It’s never easy. I eat well, rest when able and force myself to undertake exercises that produce but do not rob me of energy. I engage in positive, gentle thought as I bravely clear through a lot of emotional tears and frustrations. I do my best to keep humor and gratitude alive. Then usually, somewhere out of the blue, as mysteriously as it appeared and had me believing it would never leave, it disappears. Poof! 

***

Yesterday, several weeks into a Lepto Laze Phase, I was introduced to “Bertha”, a 66-year-old Thai hospital cleaner. Perched in her bed she was hooked up for her last round of a dozen chemo sessions for metastatic cancer. Bald but glowing, she happily greeted me. She informed me that she had intestinal cancer five-years-ago, had been operated on and had chemo, and had been clear until this new invasion showed itself. She chirpily said that the chemo had no side effects and that she’d not missed one day of her six-day-a-week work since she’d been sick save on chemo days. 

“No side effects. Without a tuft of hair on your head and face left and you feel you have no side effects. Wow!” I thought to myself. 

After a bit of chitchat, I ventured as to what she envisioned for her future once her treatments were over. Imagining a rather serious discussion to ensue, I was surprised when she strongly informed me that she was not worrying or even thinking about the future. “It’s a waste of time to worry about such things. I am living for today. Once I am off this bed, I am back to work.” 

Wondering if she was avoiding the harsh realities confronting her, I asked what her life has been like and what makes her happy at present. She merrily told me about her family, her work, and her beliefs. She felt she had a good life and even though suffering from an array of diseases such as diabetes, high blood pressure, and cholesterol she was at peace with her lot. 

She then laughed, “So, with all this illness, what’s one more disease? I may have them, but they do not have me. They may destroy my body, but they cannot destroy my way of thinking. I hate sitting around thinking too much; it’s pointless. I pray at times and guide my heart, but even that I am not too serious about. I have a good family who loves and visits me when they can. My two children have grown up and are successful, so I have no worries. I’ve lived well until now. I’ve had a full life and I am ready to go whenever it’s my time. Who knows when that day that will be? I cannot plan for it, so I live day by day, one hour at a time. I eat good food, love my family, and really enjoy the hard work of cleaning for others.” 

Running her hands over her plump, white pajama-clad body she smiled broadly adding, “I will be happy when I get to vacate this old residence in favor of a better one.” 

“You are amazing, and I really admire your way of accepting death and importantly living wholeheartedly until its time for you to ‘vacate your old residence’. I had a near death experience some years ago. Since then, when I remember to at least, I offer prayers of thanks at the end of the day! I ask forgiveness for the wrongs I have done (and promise to make amends when and where able), I acknowledge what I could have done better in order to clear my slate so that I am ready to go without unfinished business or regrets. Like you, realizing that life is tenuous, I embrace it by thanking the day and others for what they brought to me. I thank myself for the things I did well, and then ask if it is meant to be, that I will be blessed again with other such moments after I wake! I have not done this as well as I should have lately.” I wistfully responded. 

With a look of one who truly knew, Bertha took my hand in hers. I asked if I could give her a hug and a kiss. She nodded affirmatively. As I kissed her and told her that I loved and admired her, she mockingly complained, “That’s not fair! I can’t only receive a kiss, I have to give you one too!” 

Not waiting for my response, the humble cleaner of guru proportions, grabbed me in her big arms, embraced me generously, and added a loud smooch. 

***

Usually, when in a Lepto Laze Phase, I am forced to live on a day-by-day and at times an hour-by-hour basis as this dear soul does. I am in no way comparing my health situation to hers; rather it’s my attitude I am comparing. If we are able to honestly face our mortality, limitations, and vulnerabilities positively, we can appreciate our lives and health in ways we may have never envisioned when whole. Each meaningful, energetic, happy moment, has so much value and becomes great gain having been contrasted by deep loss. 

Bertha, like me, doesn’t possess a sophisticated voice to be able to express deep truths. However, her actions, presence, and way of being in the face of chronic illness and death spoke absolute volumes and gave me a well-needed reminder.

Seems to me that she’s mastered what she was here in this incarnation to learn and impart. She assuredly has a lovely new mansion by the beach with dolphins frolicking in the waves, waiting for her to occupy it. I think my eventual new model will be a small caravan—and I am okay with that. But for now, it’s time to use what little energy I have in the offering of gratitude.

I am, again, by contrast, feeling reasonably well, even when running at low battery. And the fullness of truly embracing life, which Bertha so eloquently modeled to me, begins with attitude.

Protein found more in advanced prostate cancer could be key to preventing drug resistance

A cancer-driving protein is found in the tumours of men with advanced prostate cancer after treatment with hormone drugs but rarely found in early-stage disease, a new study shows.

The findings of the major study, published in the Journal of Clinical Investigation, confirm the importance of a protein called androgen receptor splice variant 7 (AR-V7) in resistance to hormone drugs in prostate cancer.

The research, led by scientists at the ICR in collaboration with researchers in the US led by the University of Washington, also suggests that researchers should look for new treatments that negate its activity.

In the study, the researchers examined biopsy samples from two groups of men treated for early and advanced prostate cancer.

They developed a new antibody to detect AR-V7 in prostate cancer cells, which allowed them to map its levels much more accurately than before.

AR-V7 was found in biopsy samples from three-quarters of men whose cancer progressed after treatment with hormone therapy, and expression increased further in men treated with the advanced hormone therapies abiraterone and enzalutamide.

But the scientists detected it in less than 1 percent of patients with early-stage prostate cancer, before treatment with hormone drugs.

Important role of AR-V7

Prostate cancers use the hormone testosterone to grow and develop. Abiraterone and similar drugs target the androgen receptor, which is found within cells and detects testosterone.

Despite the success of hormone therapies like abiraterone, resistance to treatment often occurs due to mutations and structural alterations which side-step androgen receptor blocking to keep signalling active.

The study highlights the important role of AR-V7 in this process and suggests that drugs developed to reduce its activity could make treatments like abiraterone more effective.

Men without AR-V7 survived nearly three times as long on average compared with men whose tumours tested positive for the protein, when treated with therapies targeting the androgen receptor before chemotherapy, the study showed. 

The researchers also identified a specific 59-gene ‘signature’ in men with high levels of the protein, which could identify drug targets for new treatments in advanced prostate cancer.

Novel therapeutic strategies

Leader of the study in the UK, Professor Johann de Bono said: 

“This is the biggest study to date of AR-V7 protein expression in tissue biopsies from men with early and advanced prostate cancer and shows that the emergence of the AR-V7 protein in cells is an important event in the development of resistance to hormone therapies like abiraterone, which was discovered at the ICR. 

“We saw that AR-V7 expression is rare in the early stages of prostate cancer, but emerges after hormone therapy alongside other mechanisms of resistance – highlighting its importance in the biology of advanced prostate cancer. 

“If novel therapeutic strategies could prevent AR-V7 expression during hormone therapy, it could improve outcomes for men with lethal prostate cancer.”

Source: The Institute of Cancer Research

Promising news from Australia (Prostate Cancer Research)

Australian scientists have found a genetic marker that could identify which men are likely to develop deadly metastatic prostate cancer and may pave the way for effective treatments.

The federal government is investing almost $800,000 into researching how prostate cancers spread and become impervious to conventional treatment.

Roughly 3500 men died of prostate cancer in Australia in 2018, according to national data.

While localised prostate cancer has very good outcomes - the overall five-year prostate cancer survival rate is 95 per cent - patients with metastatic disease do very poorly.

The majority of these metastasised cancers are resistant to conventional treatments - androgen deprivation therapy - and become untreatable.

Just 30 per cent survive more than five years if the cancer spreads to other parts of the body.

Dr Philip Gregory at the University of South Australia will receive $782,078 from the National Health and Medical Research Council (NHMRC) to investigate a novel molecular pathway that could lead to new, effective treatments.

Dr Gregory’s team found the RNA-binding protein 'Quaking’ is switched on in prostate cancer cells that metastasise.

“Surprisingly we found levels of this [molecule with this specific protein] are strongly indicative of cancers becoming more aggressive and resistant to the therapies,” Dr Gregory said.

This finding was the springboard for the grant.

“We are trying to understand how this molecule functions in prostate cancer. It changes the way genes are spliced so we are hoping the molecule or gene splicing signature might be able to diagnose which prostate cancers will become aggressive,” Dr Gregory said.

“We can make better decisions in terms of treating patients if we can see which particular cancers look to have an aggressive phenotype. Maybe we would take out a tumour earlier or give them more aggressive treatment."

He hopes to eventually be able to design new therapies that would make the cancers less aggressive and more susceptible to hormonal treatments.

“One of the unique things about this molecule is that it works not by controlling levels of genes, but how the gene is spliced within cancer cells. It’s a new way of thinking about how cancer spreads,” Dr Gregory said.

Health Minister Greg Hunt said the research had the potential to save and protect lives.

“This critical research project is among NHMRC grants worth more than $526 million,” Mr Hunt said.

“Through the 2018–19 budget we provided a record total of $6 billion to Australia’s health and medical research sector."

Mr Hunt said since 2013 the government has contributed more $70 million towards prostate cancer research. In 2018 the government subsidised MRI scans for prostate cancer checks.

• Twitter

Kate Aubusson of the Sydney Morning  Herald

January 2019