"i'm A Professional Road Racing Cyclist"

"On October 2nd, 1996, at age 25, Lance Armstrong was diagnosed with stage three testicular cancer. On his first visit to a urologist in Austin, Texas, he was coughing up blood and had a large, painful testicular tumour. Immediate surgery and chemotherapy were required to save his life, as the cancer had already metastasised to his lungs, abdomen and brain. After his orchiectomy to remove his diseased testicle, his doctor stated that he had less than a 40% survival chance." When I was in secondary school in 2004 almost everyone had a yellow bracelet with LIVESTRONG embossed on it. Now I may have been one of the ignorant ones, but no one (including myself) seemed to know what they were actually for - just that they were cool and you were uncool if you weren't wearing one! If you were a bit older at the time you probably knew that Lance Armstrong had formed a foundation back in 1997 to help people affected by cancer, after he himself had gone through it. The story everyone knows is of a pretty great cyclist beating cancer, somehow coming back stronger and becoming an amazing cyclist who went on to win the Tour de France a record seven consecutive times. I found something out recently whilst reading about him however that I think more people should be aware of - especially health care professionals. At uni we are taught how to take a history from a patient in a very structured manner, and there is one question in that structure that always seems less important than the rest,

"What do you do for a living?" There are only a few cases where this actually seems to make a difference to the diagnosis, for example: .Working in the production of asbestos, presenting with shortness of breath = asbestosis .Coal miner with shortness of breath and chronic couch = coal workers' pneumoconiosis (black lung disease) .Working with sick parrots, presenting with signs of a pneumonia = psittacosis and just for our exams. .Young basketball player, presenting with chest pain and shortness of breath = pneumothorax For every other patient they could be a builder, a nurse, an accountant, a politician and it wouldn't really matter. I never thought of a patients job contributing to more than the diagnosis, but the reason why I'm going into this is due to the realisation that it can also affect all manner of things, one of those being the treatment. In Lance Armstrong's case (going back to the point of this blog post) his career of being a cyclist played a massive part in the treatment of his cancer. After having the surgery to remove the offending testicle, he went on an adjuvant chemotherapy regiment to try treat the lung, abdomen and brain mets and stop the cancer returning. The usual cocktail used to treat testicular cancer includes three different chemotherapeutic drugs: 1.Bleomycin 2.Etoposide 3.Cisplatin The only problem with these drugs is that bleomycin can cause pulmonary fibrosis and impaired lung function. This, for an aspiring world champion road cyclist, is a bit of a problem. The doctor treating Armstrong, because of these side effects, offered him an alternate option: 1.Ifosfamide 2.Etoposide 3.Cisplatin Ifosfamide works in a different way to bleomycin - not quite as effective, yet without all the nasty side effects on the lungs. Armstrong chose to be treated with this regimen instead, and, along with surgical removal of his brain mets, went into complete remission by the end of 1996. He then went on to win his first Tour de France three years later in 1999. I see a lot of doctors whilst I'm on my placements in hospital treating patients just as patients, forgetting that they are people that have to go home and live their life afterward. That's not to say that they don't try and get their patients home as soon as possible, but the only reason I've heard for this is because of the amount of money it costs the NHS to keep them another night in a bed. In the end they must be patients, and the relationship you end up having with them can't be such that it interferes with the objective treatment of their problems. It's a fine line though.