My trip to National Institutes of Health

We drove down on Tuesday and drove back again last night (Thursday); the appointment was on Wednesday. They've taken me off the chemotherapy that I was on because it isn't effectual on the mets in my brain. They're looking at switching me over to a new, more targeted chemotherapy. They're going to try to obtain some more tissue samples so they can do some genetic sequencing to see if my tumor has any genetic markers that respond to certain therapies. And in the event that they don't find any, or it's taking too long, they're going to put me on one medication that is targeted toward something for which I already tested positive - it's a receptor called "HER2" which responds to herceptin and lapatanib. Also, a broad spectrum cytotoxic agent (more traditional chemotherapy)... Dr. Fine suggested "Taxol" or something in that family, based on Fine's instinct.

Anyway, Dr. Fine (head of neurooncology at NIH) told me that the sizes and locations of the brain mets are not likely to be causing me any kind of neurological effects. He thinks my balance issues are due to the weakness in my legs caused by the steroids. He doesn't think I have any neurological symptoms right now from the brain mets. Also, apparently the voice issues (I've been vocally impaired for about six months now) are very common with the use of Avastin, so if I discontinue that I may get my voice back. So right now we're going to wait on them to get the tissue samples sent to NIH and do the sequencing and see if there are any targeted agents they can use, and I'm going to start weaning down my dose of steroids very slowly. If it takes too long, they will probably start me on the above-mentioned combination of herceptin/lapatanib and taxol or something similar.

So that's what we found out at NIH. Radiation is back on the table as a possibility for the future if the brain mets get to be a problem. I feel a lot better knowing that there are options - not just options for treating the cancer but options for treating the side effects of the cancer treatment, too. I'm frustrated with being so weak and not having a voice.

Suicides among Veterans

MSNBC gives me the following statistic, published in the New York Times: every 80 minutes, a veteran commits suicide. Nicholas D. Kristof, author of the article, writes:

More than 6,500 veteran suicides are logged every year — more than the total number of soldiers killed in Afghanistan and Iraq combined since those wars began.

That figure is outlandish. We have watched these figures climb month after month for years now. We are happy to create services to find housing and employment for our veterans, as well as care to physical wounds (such as Project Facade - a service to help reconstruct severe facial injuries to veterans - website down due do bandwidth issues as of 11:06 EDT on April 16).

We're so afraid to think that these men, whom society tells us are supposed to be the strongest, most fierce men in the country, might have some kind of weakness. Does it reflect on some sort of deep psychological American weakness? I say yes.

In this country we fear our mentally ill, because those who do not suffer mental illness often don't understand it. There's a major hole in our national understanding of mental illness - of post traumatic stress and traumatic brain injury. Their injuries are invisible, but very, very real nonetheless. And the deep psychological weakness of Americans to which I refer is this widely held, even subconscious belief that somehow being so emotionally affected by these experience makes them weak. It diminishes their hero status.

Furthermore, there are many, many scientifically rigorous studies that demonstrate that men are less effective communicators than women. This is no sexism: this can be shown plainly using functional Magnetic Resonance Imaging (fMRI).

Other causes include the limited amount of resources that mental health practitioners have to treat our young men. For example, it is not an uncommon practice for a practitioner to prescribe an SSRI - a type of anti-depressant known to occasionally cause suicidal behavior. This can be largely mitigated by sufficient follow-up appointments to monitor for this behavior, but the practitioners simply do not have the time. Another statistic from the New York Times article:

Patrick Bellon, head of Veterans for Common Sense, which filed the suit in that case, says the V.A. has genuinely improved but is still struggling. “There are going to be one million new veterans in the next five years,” he said. “They’re already having trouble coping with the population they have now, so I don’t know what they’re going to do.”

Mental illness requires more than a week or two of treatment - and often times it can never be cured. We simply do not have the human resources to fill these needs. We need more resources. Treatment for PTSD or TBI requires months or even years.

However, there is at least one thing for which the US Court of Appeals and the group Veterans for Common Sense has done for which it deserves credit: "Last year, the United States Court of Appeals in San Francisco excoriated the V.A. for “unchecked incompetence” in dealing with veterans’ mental health." If there is anything more damaging than not receiving any treatment at all, it is receiving treatment from incompetent practitioners. Rooting out these people and removing them from treatment programs is definitely a crucial step to improving our programs.

The ingredients are here:

• Closer follow-ups and longer-lasting treatment programs
• Closer monitoring of patients receiving SSRI anti-depressants
• Re-education of the American public regarding mental health in general
• More psychologists, psychiatrists, therapists, psychiatric nurse practitioners, and other mental health professionals being employed specifically for the benefits of veterans

We need to make this a more central issue when we discuss veterans' issues. After all, without one's mental health, it is nearly impossible to achieve other vital aims, such as securing housing and employment. We owe it to them to restructure the funding of the veterans' program, to put a greater focus on their mental health care, which will restore them to confidence and competence in dealing with their own lives. Our brave young men, our heroes, men who put their lives on the line in the name of democracy: they deserve far better than what they are receiving.