Diagnosis Cancer…Deciding on Treatment Options

By Dan Labriola ND

Now that you’ve chosen your cancer doctor(s) you need to decide on treatment. Options come with differing effectiveness, side effects, duration of treatment and, frequently, a recommendation. You can simply accept the first recommendation from your doctor, which may well be the best, but, since you are unique and know yourself best, I suggest you participate in the decision process. There can be points about one treatment versus another that are more important to you than the doctor realizes. At this point you are probably ready to just move on but you don’t want to look back later with regret for a decision made in haste.

The treatment decision process comes down to evaluating the benefits versus risks for each option. Your cancer doctor can walk you through the details keeping in mind that you will not experience every possible side effect. The most effective treatment with the least side effects wins although there may be some tradeoffs. For example, with breast cancer, under some circumstances a woman can choose between lumpectomy, removal of just the tumor and some surrounding tissue with radiation or mastectomy without radiation. Both procedures have very similar effectiveness.

Fortunately there is a lot of credible evidence for evaluating benefits based on well done research. In most cases you will be presented with relapse and overall survival statistics for a time period after treatment such as 5 or 10 years depending on the particulars of your diagnosis. These numbers help you choose the treatment that is statistically best but keep in mind that these are still just statistics and you are not a statistic. Don’t let the numbers bring you down.

In addition to FDA approved therapies there are clinical trials that are worth considering. Enrolling in a clinical trial not only moves us closer to finding an answer to cancer but may also offer an opportunity to benefit from a new therapy. Some clinical trials also present risks so it’s important to weigh the benefits and risks for you before signing up. Cancer clinical trials are separated into 5 phases.

Phase 0 trials represent the first step in using a new treatment on humans. Small numbers of patients are given minimal doses of the treatment to see how it acts chemically in the body. These trials do not usually collect information about effectiveness or side effects and are generally only for patients for whom there is no known, effective treatment.

Phase 1 trials determine the safety of a new, experimental treatment by evaluating the maximum tolerated dose. Side effects are evaluated carefully but effectiveness data may or may not be evaluated.

Phase 2 trials are the first step to evaluate how effective a new treatment is once safety considerations are understood.

Phase 3 trials also evaluate treatment effectiveness but in much greater detail with larger cohorts of patients than phase 2. These investigations are frequently randomized where some patients receive placebo. They also frequently evaluate how the new treatment compares to existing treatments.

Phase 4 trials are usually conducted after the new treatment has received FDA approval to collect more data. They are called Post Marketing Surveillance Trials and may be funded by pharmaceutical companies.

If you are invited to participate in a clinical trial you will be given information including an FDA approved Informed Consent Form. Every trial is different and your oncologist will help you understand the benefits and risks. You can find a list of all the current FDA approved clinical trials in the U.S at www.clinicaltrials.gov.

Once you have chosen a treatment you have the option of getting a second opinion, a valuable service that is underutilized because patients feel that seeking one would offend their doctor. The fact is that no one will be offended. Second opinions are a normal part of cancer care and they provide you with an opportunity to have another pair of eyes look at your diagnosis and treatment to see if there is something better or different that should be considered. The process is simple, can happen quickly and is usually covered by insurance.

You start the second opinion process by getting referrals as you did when looking for your cancer care team. There may be a doctor you already know about. It is best to choose a provider from an unaffiliated institution. Different cancer programs sometimes have different, possibly interesting protocols for the same diagnosis and it also minimizes the possibility for a rubber stamp if the reviewing doctor works too close to your doctor. The reviewing doctor’s office will help you get a copy of your records sent.

The second opinion can have 3 possible results. First and easiest is agreement with the planned treatment. If you’re satisfied you can move forward with the plan. The second, not uncommon, response is a recommended plan that is different but equivalent effectiveness. Unless the differences are significant you will likely go forward with the original plan.

If, however, the reviewing doctor recommends much more, much less or something very different you now need resolution. This doesn’t happen often and is most frequently settled by the 2 doctors speaking with each other. If that doesn’t work or isn’t possible then you need a tie breaker, a rare occurrence but when it happens you need to get to the bottom of it before starting treatment. You can find your 3rd opinion using the same strategy you used finding the second opinion. You may want to consider a larger cancer center even if it means traveling. If travel is not an option, some record reviews can be done without the patient present.

One final note on choosing therapies. The FDA does not allow claims to be made about a treatment without first substantiating them with human trials. Unfortunately, there are individuals and clinics in the US and elsewhere claiming cancer cures without the human evidence to back them up. Be aware that while test tube and animal studies are useful in science they only rarely translate into treatments that work on people. We were curing cancer in laboratory animals using just vitamin E 50 years ago but when the same protocol was tried in humans it didn’t work.

Posted in Cancer Plan | 1 Comment

Diagnosis Cancer…What do I do now?

Dan Labriola ND


No one is prepared for a cancer diagnosis. The words “you have cancer” are a life changing moment you never forget. You must now make decisions for which no one is prepared; choosing doctors, selecting treatments and managing life issues that are suddenly front and center such as financial survival, personal responsibilities, relationships, quality of life, your dreams and plans for the future and, in some cases, survival. And if that wasn’t enough, you must do this while navigating medical and insurance systems that are less than user-friendly.

When you receive the diagnosis you will likely be referred to a conventional oncology physician who will outline a course of treatments or treatment options but it is not uncommon for daunting questions to remain: Is this the best treatment? Is this the right doctor? Where do I look to learn more about the diagnosis and treatments? How do I pay the rent, get transportation to doctor appointments or deal with side effects? If you consult the internet, chances are you will be even more confused.

What you need is a plan that enables you to answer these questions and guide you through the cancer experience with the confidence that you’ve made the best decisions. Such a plan will also restore control of your life.

You don’t want to go this alone. Taking advantage of the training and experience of knowledgeable cancer treatment and support providers will result in the best plan so we begin with a strategy for choosing your cancer team including doctors, other providers and institutions. These are the experts you will rely on to provide the information necessary to make treatment decisions and, in most cases, deliver the treatment. We will start with choosing your team.

Depending on your particular circumstances, the treatment selection process can involve multiple choices that may also include clinical trials, complementary and alternative medicine, other supportive therapies or doing nothing. In the second part of this series we will look at ways to evaluate these choices and tailor your treatment to meet your unique needs.

The third and final installment will address the services and resources that can be critically important in addition to killing cancer cells such as reducing side effects, maintaining quality of life, finances, psychological issues, diet, prevention and much more. These services have a name, cancer survivorship, and can remarkably improve your life and outcome.

 Choosing your care team

Cancer is not a single disease but actually many diseases with a few characteristics in common. Each kind of cancer acts differently, has different treatments and in many cases different kinds of treating doctors.

At this moment in science conventional medical oncology programs have the best diagnostic tools and treatment effectiveness and are the place to start. Even if you are considering using alternative medicine, you can take advantage of the very credible evidence and experience available from the conventional cancer world and then apply the same criteria for evaluating benefits and risks that I have listed below for all of the treatments you are considering. Knowledge brings clarity.

The first step I recommend is to identify the specific kinds of medical specialists that treat your cancer. Referrals are especially valuable from someone you trust such as your family doctor or the provider who delivered the diagnosis. Top Doctor surveys are useful as well but there are many excellent docs that don’t make it into Top Docs. Be cautious of blogs and sites that may be influenced by just a few opinions. If it’s colon, lung or breast cancer, for example, you will likely start with a surgeon or medical oncologist but may need a radiation oncologist (not to be confused with radiologists who read diagnostic studies such as x-rays). For prostate cancer you will probably start with a urologist or radiation oncologist. Medical oncologists, the doctors who administer chemotherapy, also frequently act as quarterback even if you’re not receiving chemo.

Once you have narrowed your choices down to a few, the easiest next step is to schedule an appointment and evaluate your experience with the help of the guidelines below. You can also request a meet and greet to see if a prospective doctor is a good fit but the experience will not be as complete as a formal visit. If the first doctor is a home run you’re set. If not, then seek out more referrals and try again. There are many excellent cancer docs and institutions who would be honored to be your provider. You will be working with this person for some time so it’s worth the effort now to get the doctor that meets your needs.

 Here is a checklist you can use to evaluate prospective doctors:

1. Familiarity and experience treating your diagnosis.
Board certification is a must. Doctors increasingly sub-specialize in specific cancers and specific patient cohorts such as pediatric, adolescent and young adult and others.

2. Covered by your insurance.
Insurance can be tricky. There are different levels of coverage depending on whether the doctor is in network, out of network, preferred etc. The right doctor may be worth a difference in cost but ask the question at the beginning to avoid a nasty surprise later.

3. Has an acceptable disciplinary record.
Log on to your state department of health website to see the doctor’s history, www.doh.wa.gov for Washington State.

4. Practices at a hospital that is highly rated for safety and has all of the other services you may need.
Check reputable hospital ratings such as Leapfrog Group, www.leapfroggroup.org. If you have heart disease, for example, you will want an organization that can also care for your heart issues especially in an emergency.

5. Communicates effectively.
You want a doctor whose communication style and demeanor are consistent with yours, who is approachable, provides clear information and works well with your decision-making process. Be clear about your preferences to give the doctor a chance to meet them.

6. Office staff that is friendly and cooperative.
Front desk, nursing and other support staff are there to meet your needs. They should be approachable, responsive and make you feel like a priority, not an interruption. Today’s healthcare world is pretty lean so keep your expectations reasonable.

7. Is in the same healthcare delivery system as your other medical specialists and hopefully your primary care doctor.
Modern communication has made care coordination much easier but having doctors who are all in the same electronic medical record or otherwise connected will make your care coordination more seamless.

8. The doctor’s gender is not as important as the other items.
We all tend to be modest but doctors have seen thousands of whatever it is you are modest about. The other criteria above will have a greater effect on your satisfaction.

If you belong to an HMO or other restricted plan your choices are different but you can still interview doctors in the oncology group and, in some cases, be treated at affiliated cancer centers.

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Food, Mood & You

Did you know the foods you eat can make you angry, sad, tired, anxious…even hostile?

While Americans increasingly turn to antidepressant, anti-anxiety and other psychoactive drugs for mood issues, the fact is no one was born with a Prozac deficiency. There are many possible causes for these symptoms, but the relationship between food and mood is often ignored, and may not be obvious since the offending food may not affect you until hours or days after ingesting.

So how do you know if foods are affecting your mood or behavior?  Here are some clues.

If you feel moody or fatigued the same time each day, crave sweets, use alcohol daily, have trouble maintaining your ideal weight or wake up tired and grouchy, then you may be experiencing low blood sugar, hypoglycemia. Once treated as an imaginary diagnosis, it is now recognized as a source of mood and behavior change. Our brains and body systems require a steady level of blood sugar to function normally. Low blood sugar can cause mood changes and causes a release of stress hormones, which can cause anxiety.

Some people are more likely to have low blood sugar events than others, but anyone who starts their day with a breakfast that is mostly simple carbohydrates or sugar (scones, doughnuts, muffins) may experience low blood sugar a few hours later.

To prevent these episodes, start by planning three meals per day to provide a steady source of blood sugar.


  • Long-acting lean protein like fish and fowl
  • Medium-acting good fats, such as fish and vegetable oils
  • Shorter-acting complex carbohydrates—for example: whole grain cereals, bread, starchy vegetables and legumes

The second step is to avoid or minimize simple carbohydrates like sweets and alcohol, because they create a rapid increase in blood sugar that can rebound to low blood sugar.

Food allergies and food sensitivities—they are different—can affect mood and behavior. If allergy tests fail to identify the offender, there are other ways to find the answer, including food-challenge and elimination diets. Once identified, the problem food can be removed and often reintroduced later without incident.

Stimulants and suppressants in your diet can also be a problem. Ironically the remedies you rely on to address fatigue, anxiety, stress and depression, such as caffeine from coffee, tea, soda pop or chocolate, ginger, alcohol (a stimulant and depressant) may be making things worse. The double mocha that brightens your morning may be the reason your afternoon, evening or even the next day are darker, unless, of course, you take another jolt.

Many food additives and residues also affect mood and behavior. Certified organic produce and free-range, organically-fed animal products will limit these exposures. Read labels and don’t let industry and government agencies exclude this information from labels.

The food-mood connection is real and can have a dramatic impact on your quality of life. If you suspect you have food issues, and these simple strategies don’t provide a solution, there are other reasonable avenues to pursue with your doctor.  Good references include the book “Sugar Blues” by William Duffy and free classes at nwnaturalhealth.com/classes.html.

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Underappreciated Magnesium

Are you getting enough?

Ask most people about the importance of dietary magnesium and they’ll give you a blank stare.  Yet magnesium is the 4th most abundant mineral in the body and is needed for a number of critical functions.

It’s used in maintaining normal nerve and muscle function, keeping bones strong, maintaining a steady heartbeat and is good for immune health.  It also helps with blood sugar regulation and promotes normal blood pressure.  Unfortunately, the standard American diet is low in magnesium, and many of us have sub-optimal magnesium levels, leading to long-term health consequences.

Magnesium deficiency

Symptoms of magnesium deficiency include:

  • Fatigue
  • Depression
  • Anxiety
  • Irritability
  • Insomnia
  • Muscle spasms
  • Chest tightness
  • Confusion
  • Memory loss

Some medical conditions, like diabetes, increase the likelihood of magnesium deficiency, and some medicines induce magnesium deficiency ­– certain chemotherapies, cyclosporine, diuretics, laxatives, and some antibiotics.

Benefits of Magnesium

Numerous studies indicate that magnesium is useful in treating heart disease, including MI (“heart attack”), heart rhythm disturbances, angina and congestive heart failure.  Additionally, magnesium helps to maintain normal blood pressure and in some cases lowers blood pressure. Magnesium may also be useful in the treatment and prevention of asthma, migraines, insomnia and restless leg syndrome.

Magnesium also plays an important role in carbohydrate metabolism, so when magnesium deficiency is corrected in people with diabetes, they may see improved insulin response and action.

Food sources for magnesium

The recommended daily intake of magnesium is 320 mg for adult women and 420 mg for adult men. Magnesium is found in whole grains, nuts and seeds, legumes, dark green veggies, fish and meat.

Top foods for magnesium are:

  • Spinach
  • Almonds
  • Wheat bran
  • Cashews
  • Soy beans
  • Whole grain cereals like bran flakes
  • Other beans and lentils

Unfortunately, when grains are processed, most of the magnesium is lost.  Which means that soft white bread kids love has very little magnesium, while whole wheat bread is a good source.

If you are considering taking a magnesium supplement, check with your doctor or other health professional first.

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Inflammation of the prostate? Get relief, naturally.

Men…ever experience moderate to severe pain in the pelvis, lower back or genitalia, combined with urination problems – things like burning, irritation or difficulty while urinating, frequent or urgent urination, getting up in the night to urinate?  You’re not alone!  You may be suffering from prostatitis, or inflammation of the prostate gland – the most common urological disorder diagnosed in males over 50, and the third most common in younger males.

There are four types of prostatitis and a variety of conventional treatment options.

  • Type I – acute bacterial prostatitis
  • Type II – chronic bacterial prostatitis
  • Type III – chronic abacterial prostatitis
  • Type IV – asymptomatic inflammatory prostatitis

Depending on the type and severity of symptoms, conventional treatment may include prostate massage, surgery, physical therapy, psychiatric counseling and/or medications such as antibiotics, alpha adrenergic blockers to help urine flow, and muscle relaxants.  Type III, also known as chronic pelvic pain syndrome (CPPS), is especially challenging to treat medically.

Thankfully there are natural treatments that may provide relief and can increase the effectiveness of conventional treatment.  Let’s take a look…

Quercetin & Other Supplements

Quercetin, a flavonoid found in apples and onions, and commonly used in natural seasonal allergy supplements, has been shown to reduce symptoms of Type III prostatitis in clinical studies.  In another study, 89.6% of patients with chronic bacterial prostatitis (Type II) who took an antibiotic along with additional supplements of saw palmetto, stinging nettle, quercetin, and curcumin had no symptoms compared to 27% of those who only took the antibiotic.  What’s more, patients in the first group had no recurrence of symptoms even six months after treatment, compared to two patients who had recurrence in the second group.


Acupuncture is another effective alternative.  Prostatitis sufferers treated with ten weeks of acupuncture were almost twice as likely to have reduced symptoms compared to those who had a sham (dummy) treatment, and were also more likely to experience long-term benefits.  Electroacupuncture, with advice and exercise, also proved to be more effective than either sham acupuncture with advice and exercise, or advice and exercise alone in reducing symptoms.

Prostatitis can be challenging to treat, but there are options to explore – both medical and alternative.  Please note, however, that while natural treatments may be effective, they can also interfere with other medications and may have side effects, such as thinning your blood.  These issues are very manageable, but it’s important to contact a licensed practitioner for proper diagnosis, treatment and guidance.

To your health!

Posted in Men's Health, Natural Health, Natural Supplements, Naturopathic Medicine | Tagged , , , , , , , , , , , , , , , , , , , | 1 Comment