Comment by marincounty | Hacker News Reader

Comment by marincounty | Hacker News Reader

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These stories hit me hard. Liver cancer is one of the worst cancers--strike worst cancer; they are all bad. My father died 10 years ago from liver cancer.

My father had a tumor for 10 plus years, and his new General Practitioner attributed the bulge to a old umbilical hernia scar. Today's doctors vary rarely palpate their patients. I don't know if the latest research shows it doesn't pick up tumors, or doctors are just too busy? But, for ten years no doctor touched his stomach(not one quadrant?). Never?

His previous doctor who saw him from a young man to around 55, always palpated all his patients--including myself. We all used Dr. Shepard as the family doctor. In every physical I had from Dr. Shepard he made sure to feel that liver, and feel for unusual masses. I just figured all doctors palpated their patients? I truely think if Dr. Shepard didn't retire, and my father had him as a GP; my father would still be alive? He lived 10 years with a benign tumor, and it eventually turned cancerous?

I don't blame anyone. I do know this, the pain my father went through was beyond Hell--especially the last week. The nonprofit who took care of his palliative care; under medicated him. They didn't give him enough opiates! Along with enough benzodiazepines. I don't know why--they are overfunded?

My point is not to make this about me, but dying from liver cancer is horrid. I have thought about the pain he went through every day since his death 10 years ago. I know a cure for liver cancer is a way off, but pain relief shouldn't even be an issue? Give the patient all the medication they want? I can't tell you how many times we needed to get the doctor to o.k. new prescription, and then drive down to the pharmacy. My father literally thought the doctor's thought he was abusing his meds? Who cares if he was liked the effect of the opiates? He had a football in his stomach? If I could do it over again, I would have hit the streets and bought him heroin!(yes, I would have risked it. I was to young to know what to do, or even where to get the drugs?)

My point us we need a better way of managing terminal illnesses? Just thus week, another "Death with dignity" bill died--I believe in a California court?

Good night people--

I'm sorry to hear about your father and I empathise deeply with what you and your family must have gone through.

Despite the solemn nature of your post, I feel the need to correct a few points: (I am a doctor - a radiologist)

- Palpating the abdomen is not a very reliable way of assessing an individual's liver. Most liver lesions are not palpable and are normally diagnosed (following blood tests) with ultrasound, CT or MRI scans.

- There are several types of what you refer to as "liver cancer". the most common, as in Oliver Sacks'case is metastatic liver disease (ie. the cancer starts somewhere else and spreads to the liver, rather than being from the liver itself - that is a true liver cancer (hepatocellular carcinoma).

- There are several treatments for both primary liver cancer (hepatocellualr carcinoma) and metastatic liver disease. Whether these treatments can result in a "cure" or a prolongation of the patients life, or mearly an improvement in their quality of life depends on the overall progression of the disease.

- Some possible therapies include surgery, chemotherapy, radiotherapy(of various kinds), ablative therapies(cryoablation, radiofrequency ablation, focused ultrasound), embolisation(bland, chemo-embolisation etc.) as well as systemic treatments and pain therapies.

- I'm sorry that your dad went through what he did. He may not have gotten the best possible care (I can't say, I don't know the details).

- There are certainly problems with the healthcare system overall but its not accurate to say that pain relief isn't something physicians and caregivers don't think about or have potential options for.

This comment is an excellent example of how you can gently correct someone while still showing empathy. What a difference compared to most internet discussions! Thank you.

With you on this, we treat animals better. My dad was diagnosed with Alzheimer's at 62 and with liver cancer at 63 - in his case we noticed he was off his food and the GP did palpitate his liver and this led to a scan and diagnosis. He died just over 6 months later, like your dad, in a lot of pain. Liver and pancreatic cancer need more focus for sure and all the pain relief that can be thrown at them.

I was going to post a comment about the worth of Oliver Sacks' post, but instead I will thank you for your candidness, send you the best of my will (serving no practical purpose, but I can do no more), and bid you good night as well.

It's only a matter of a few more decades before someone who's 82 will be diagnosed with "what was previously terminally ill" liver cancer, and given an extra 20 years of life.

Why don't we put a moonshot effort into medical research? The Baby Boomers are about to retire. Cancer(s), alzheimer's, heart disease, etc can all be turned into treatable diseases with the proper amount of research. There are 76 million baby boomers. In the end it might be cheaper to find cures than to treat all the conditions.

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