LemonMD

Test 123

2009-10-01T05:19:00.001-07:00

Conversations for the Cure, Thursday, September 24, 6:30 pm, Methodist Estabrook Cancer Center Auditorium

2009-09-21T19:40:00.000-07:00

Join me for "Conversations for the Cure", sponsored by Susan G. Komen for the Cure Nebraska Affiliate, on Thursday, September 24, 2009 at the Methodist Estabrook Cancer Center Auditorium. I will be speaking on Breast Cancer Genetics. We will review the clinical signs of hereditary breast cancer, and indications for genetic testing. We will also discuss breast MRI screening, and PARP inhibitor cancer treatment.

I look forward to seeing you there!

RSVP http://bit.ly/Blq6B

Dr. Lemon

From the CDC, September 21, 2009

2009-09-21T19:16:00.001-07:00

H1N1 Clinicians Questions and Answers

Who is recommended to receive the 2009 H1N1 flu vaccine?

When vaccine is first available, the CDC Advisory Committee on Immunization Practices (ACIP) has recommended the 2009 H1N1 vaccine for the following 5 target groups (approximately 159 million persons nationally):

Pregnant women
Household and caregiver contacts of children younger than 6 months of age (e.g. parents, siblings, and daycare providers)
Health care and emergency medical services personnel
Persons from 6 months through 24 years of age
Persons aged 25 through 64 years who have medical conditions associated with a higher risk of influenza complications

Once providers meet the demand for vaccine among persons in these initial target groups, vaccination is recommended for all persons 25 through 64 years of age. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

Can seasonal influenza vaccine and 2009 H1N1 vaccine be given at the same visit?

Both seasonal and 2009 H1N1 vaccines are available as inactivated and live attenuated (LAIV) formulations. The simultaneous and sequential administration of seasonal and 2009 H1N1 inactivated vaccines is currently being studied. However, existing recommendations are that two inactivated vaccines can be administered at any time before, after, or at the same visit as each other (General Recommendations on Immunization, MMWR 2006;55[RR-15]). Existing recommendations also state that an inactivated and live vaccine may be administered at any time before, after or at the same visit as each other.

Consequently, providers can administer seasonal and 2009 H1N1 inactivated vaccines, seasonal inactivated vaccine and 2009 H1N1 LAIV, or seasonal LAIV and inactivated 2009 H1N1 at the same visit, or at any time before or after each other. Live attenuated seasonal and live 2009 H1N1 vaccines should NOT be administered at the same visit until further studies are done. If a person is eligible and prefers the LAIV formulation of seasonal and 2009 H1N1 vaccine, these vaccines should be separated by a minimum of four weeks.

Can 2009 H1N1 vaccine be administered at the same visit as other vaccines?

Inactivated 2009 H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live 2009 H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.

Douglas County Health Department Influenza Update, September 21, 2009

2009-09-21T11:10:00.000-07:00

Douglas County Health Department Influenza Update

The rate of Influenza-like illness and number of reported positive tests for influenza A continue to be high in Douglas County. Influenza A, 2009 H1N1 continues to be the only circulating strain of influenza.

Some schools continued to report higher absenteeism for a short period, but the overall rate for Douglas County schools remained similar to the past two weeks (~3%).

In the coming weeks, Douglas County Health Dept. will begin receiving shipments of vaccine. The amount of vaccine may be small in the beginning. Douglas County Health Dept. will be trying to ensure that health care providers begin receiving vaccine as soon as possible. Distribution will also depend on the type of vaccine we receive at any given time (i.e. LAIV or inactivated vaccine in multidose vials or prefilled syringes) and who will likely be able to use it.

If you have any questions, feel free to call us at (402)444-4639.

2009 H1N1 Influenza Update, Douglas County Health Department, Omaha, Nebraska

2009-09-04T15:32:00.000-07:00

Latest 2009 H1N1 influenza update from the Douglas County Health Dept., Omaha, Nebraska

Influenza-like illness and positive tests for influenza A have markedly increased in the last two weeks in Douglas County. Many schools across the county are reporting high numbers of children absent due to illness. Influenza A, 2009 H1N1 is currently the dominant circulating strain.

Intensive planning for distribution of H1N1 vaccine has been taking place. Douglas County Health Dept. has been working with many community partners, with the goal of providing multiple and varied venues for vaccination, including hospitals, health care providers, community vaccine providers (i.e.
pharmacies, grocery stores), large businesses, colleges, public clinics located at schools, and possibly other locations.

All information points to enough vaccine for everyone who wants it, but it will not come all at once. The first shipments, which will probably number less than 100,000 doses, are expected in mid October and will be initially recommended for target groups. Once the target groups have had an opportunity to get vaccinated, vaccination will be opened up to other groups. Shipments will continue as vaccine manufacturers are able to produce it, probably on a weekly basis.

Some key points of information

* Patients with flu-like illness who are otherwise healthy probably
don't need to be seen nor given antivirals. They need to stay home until
they are afebrile for 24 hours without the use of antipyretics.

* Persons who have had influenza-like illness without a confirmatory
test will likely be advised that they still need to get vaccinated for
H1N1. We do not recommend testing for this purpose.

* CDC continues to recommend that healthcare workers with flu-like
illness stay home 7 days after onset of symptoms.

Please see http://www.cdc.gov/h1n1flu/ for the most up-to-date
information from CDC. The Douglas County Health Department website
http://www.douglascountyhealth.com/ also has information.
http://flu.gov/ also has many resources for planning and patient education.

Surviving Holly, Holly Rochelle's Colon Cancer Story

2009-08-21T07:00:00.000-07:00

Surviving Holly
Not your typical colon cancer patient – not your typical girl

By Wayne Brekke

It was in mid 2003 when Holly Rochelle was recovering from surgery in her room at Methodist Hospital in Omaha, Nebraska after having 60-percent of her colon removed along with 30-percent of her liver. She lay in bed, weak and struggling to focus through the mind-numbing effects of a morphine drip. She remembers feeling no pain, but was shocked when her doctor informed her that her diagnosis would be stage IV colon cancer with metastasis to the liver. As the surgeon left the room, he scratched a note on her medical chart. It read, "Prognosis is poor, very poor."

The nausea thing again.

Holly's story starts in the Fall of 2001. The very active, vivacious and physically attractive girl that had loved to play basketball as a kid, was experiencing symptoms of vomiting, fatigue, and chronic pain. Doctors ran various tests that yielded no concrete results. This frustrating cycle continued for months as Holly suffered through constant pain, nausea, dehydration, weight loss and a large palpable mass in her abdomen. Her doctors were at a loss. In one instance a certain doctor with somewhat questionable values even wrote, "Holly is here with that nausea thing again," in her medical record. Her symptoms persisted without relief.

By late 2003 Holly was working as a laboratory consultant for a medical clinic. Scheduled for an early morning shift, she vomited on herself en-route to the office and again as she walked into work. A physician found her on her hands and knees as she looked up at him pleading, "Please help me!"

Out of the frying pan – into the fire

Holly drove herself to the ER at Clarkston West in Omaha and explained her symptoms. It was not long after that a flurry of activity including medication for the pain, a CT scan, full lab workup and an eventual transfer to Methodist. It was there Holly was informed that as a result of a colonoscopy and various other testing, emergency surgery was necessary. It was the surgeon's opinion that Holly may have colon cancer. In one way, this explained a lot. She was not your typical colon cancer patient. Holly was young, beautiful, active and female. Far from the older male stereotype she thought of when considering colon cancer.

After surgery, Holly conferred with the doctor who told her that the surgery went fine, but wanted to wait to discuss the prognosis until after she recovered from the effects of the anesthesia. She knew by the look in his eyes what the prognosis was.
"We made this little pact before I went in that he would talk about everything, good, bad, or indifferent and I trusted him," Holly said. "He said technically the procedure went well, but wanted to talk about it after I had rest. At that point he knew I had colon cancer, but I guess he didn't think I was up for a chit chat at the time, because my body had been manhandled."
After a couple hours of rest, Holly awoke to a nurse taking vitals and surprisingly -- a member of the hospital clergy. "The clergy told me that she was sorry that I had stage IV colon cancer and that I was going to die," Holly said. "My mother told the woman to get the hell out of my room and demanded to see a hospital administrator immediately."

It was after that shocking situation that the doctor confirmed the prognosis. He had removed 60% of her colon and 30% of her liver.
"My liver? What?" Holly thought.

The long road to recovery

Her recovery was long and arduous. Months passed where she felt that each step forward was rewarded with two steps back. She couldn't tolerate food by mouth, so it had to be given intravenously. She endured weeks of chemo treatments, weakness, fevers, nausea and intense pain. A home morphine pump was only one of several drugs prescribed for pain management.
"Sometimes I think doctors shouldn’t be allowed to prescribe drugs unless they have tried it themselves. I questioned my doctor about him prescribing me Marinol for my nausea and lack of appetite, which is the capsule equivalent of marijuana. I asked him if he ever smoked weed before. All he said was ' Yeah, I went to college!' I trusted him enough then to take his prescription!" Holly said laughing. "But as it turned out, I took it three times and it really had no effect."

In December of 2003 she was readmitted to the hospital and eventually told that her condition was the result of an infected port and surgery was needed to replace it. Post surgery, Holly was extremely weak and only after she agreed to a transfusion of packed red cells did her body respond. She was eventually discharged, but after considering her situation, Holly decided to leave Nebraska and seek a second opinion. Her medical team helped her travel from Omaha to Knoxville where she would work with a medical team for a more successful recovery. But after weeks of struggling in Tennessee, nothing changed.
"When I arrived in Knoxville I was sick as bloody hell. It wasn't getting better. By the end of January I had given some serious thought to stopping the team in Knoxville and transferring to someplace else," Holly said. "
After a recommendation from her doctor, Holly decided to travel to Texas to seek further help at MD Anderson, a highly respected cancer treatment center in Houston. It was there that she underwent more tests, biopsies and treatments. The conclusion was that no surgery was needed at the time, but a change in chemotherapy treatment was in order. After transitioning to a regimen known as FOLFOX4, her chemo ended in mid August 2004. Holly is now considered without evidence of metastatic disease.

Back in the game

Talking to Holly today, one would never suspect that just a few years ago she was practically knocking on Death's door. Her energetic spirit, sharp wit and genuine personality belie her traumatic surgeries and 13 colonoscopies. Her body seems overflowing with a contagious lust for life that drives her ambitious dedication to raising awareness about cancer and healthy living. In the Fall of 2005 she started a campaign respectfully requesting that each of the fifty state governors proclaim March 2006 as colon Cancer Awareness Month. She continues this campaign through 2007 and beyond. She also organizes an annual cycling event called "Rollin' to Colon." Holly is also involved with several other organizations and committees to raise awareness and uses her experience to help others in similar situations. Her charming laughter makes it hard to believe she ever endured her struggle with cancer and it's only now that she can actually laugh at certain circumstances in her past.

"When other people talk to me about their condition they need encouragement. I sometimes will tell a funny story to help them. There was a time I was on the table in surgery where I was supposed to be completely out. Somehow, I hear my surgeon whisper "Shit," and I sat straight up and told him he couldn't say that when I'm on the table! He said it so quietly that no one else in the operating room heard it. Who's going to believe that?"

She is also featured as Miss March in a calendar called the "Colondar" which was put together to raise awareness of colon cancer. Holly's picture features her in a bandanna, jeans and pose meant to emulate "Rosie the Riveter" from the WWII era campaign honoring women's labor.
Holly continues to help others while attending school in Indiana and raising her eight-year-old daughter. Her life isn’t always easy, but she is simply glad to have it for a little while longer.

"It's difficult sometimes, I'm 34 and people don’t always look at me as a serious voice for colon cancer because I don’t fall into the norm. I want to help people realize that the earth is a really big place and when someone closes their eyes and exhales long enough they can appreciate there's more to the world than simply themselves."

Susan Donahue, breast cancer survivor, undergoes neoadjuvant chemotherapy, surgery, and radiation

2009-07-14T14:02:00.000-07:00

My name is Susan Donahue, and this is my breast cancer story.

Chemo First????????

I was diagnosed with breast cancer on December 22, 2008. In a lot of ways I feel this was an early Christmas gift and definitely a wake up call, not to mention the shock of my life.

Dr. James Reilly was the surgeon who performed the biopsy. He was so good at trying to explain what was happening to my body and what was going to happen to my body; however, after the words “the biopsy is cancerous,” I sort of zoned out. Kathryn Simone, APRN, tried to help me process the information they were giving me at that time and she tried to explain what was going to happen to me over the next several months. She was so supportive and always made me feel like all questions are important. She is very good at what she does.

After learning the diagnosis, my mind wanted to go immediately to surgery and have both breasts removed!!! I had so many questions for them: When would the surgery take place? What would be involved? How would the recovery go? What would happen as far as additional treatments after surgery? GUESS WHAT? I was wrong----turns out there was another way to approach fighting my cancer!!!! Chemo first.

Dr. Reilly immediately sent me to Oncology Associates, Dr. Lemon, for chemotherapy. I had multiple tumors and they were initially too large for surgery. This was the most difficult concept for me to process. I thought you were supposed to have surgery first, then chemo, then radiation. Not in my case.

Next stop, Dr. Lemon. At our first meeting, the same thing happened as with Dr. Reilly. Dr. Lemon started talking and I zoned out after “you will start chemotherapy on Friday.” It was a Wednesday (New Year’s Eve) and I remember saying, “You mean a week from Friday?” Oh no, he meant THAT Friday. I just started thinking about how I wasn’t ready; this was going too fast, I had to make plans in my life for what was going to happen. I remember he asked me if I had any questions, but since I wasn’t even sure what was happening to me, and I was still in shock, I replied “I don’t even know what to ask right now.” I did ask if my hair would fall out and if I should get a wig. He told me to take care of that right away. Sure enough, two weeks after treatment my hair was gone.

Once again, I was in really good care. Dr Lemon and his staff were so good to me at each visit. When I was brave enough to ask what stage I was diagnosed, the answer was stage IIIb. I was so surprised because for the past 5 years I had faithfully been having annual mammograms. In fact, the last 2 years the mammograms were every 6 months. I found the lump under my left arm myself five months after my last mammogram. How could this happen????? There is so much technology available and I was doing what I was supposed to do. How can I be diagnosed with stage IIIb?

Chemo was really rough but they got me through it. The tumor under my arm completely disappeared.

My last chemo treatment was April 28th and surgery was then scheduled for May 13, 2009. I was so excited to finally have surgery. Dr. Reilly performed the surgery (a bilateral mastectomy). It went really well. There was a lot of swelling, but I never needed any pain medications. Dr. Reilly removed several lymph nodes from the cancer side to be further tested and the path report came back with no sign of cancer!!!!!

This is where Dr. Lemon should be extremely proud of himself and I am so thankful to have him as my oncologist. He knew exactly what treatments to use to shrink the tumors and kill any other cancer cells. I now have five weeks of radiation to make sure all cancer cells are destroyed.

If I can help anyone else confused about cancer stages and treatment, then this was worth sharing. I guess after all is said and done, it doesn’t matter what order the treatments are given, or even how far your cancer has progressed, all you can do is hold on to your faith and trust in the medical professionals who are helping you fight the battle of your life.

Something like this really opened my eyes as to how many special people there are in my life. Family, friends, coworkers, and all the many medical professionals involved in my treatments. This was one of the most difficult journeys I’ve taken in my lifetime, but it has taught me so much and given me a greater appreciation for how I spend every day.

I am cancer free thanks to Dr. Lemon and his staff and Dr. Reilly and his staff. The good Lord guided me to the people he knew could take on the challenge and I am so grateful, this was my best Christmas gift ever!!!!!!

Susan Donahue

Today's Chemotherapy Socks!

2009-07-14T07:57:00.000-07:00

Thanks to Donna

Relay for Life, Douglas County, Nebraska, June 2009. Oncology Associates, PC. ---------- "Caring Cabana Crew"

2009-06-15T21:05:00.000-07:00

Hope shines bright

Thanks to all our Cancer Survivors, Families, Friends, Doctors, Nurses, and Staff of Oncology Associates, PC, "Caring Cabana Crew" for a wonderful American Cancer Society Relay for Life fund raising event! The Caring Cabana Crew raised $8,492 for cancer research, education, advocacy and services for cancer patients and their families.

Nurses Tina, Patti, and Amber

Dr. Lemon

Survivors and families

Oncology Associates tent

Walking for life

Flamingos for hope

Family

It's hot!

Luminary

Dr. Lemon and breast cancer survivor Mary with breast cancer survivor bra

Survivors walking for life

Step right up! Only 25 cents! For a great cause!

Survivor bracelets

Journal Watch

2009-04-25T07:36:00.000-07:00

Metastatic Breast Cancer, Her2 Positive
Journal of Clinical Oncology, April 20, 2009

What are treatment options for a patient with Her2 positive metastatic breast cancer that is no longer responding to Herceptin (trastuzumab)?

One option is to continue the Herceptin treatment. This works if a second chemotherapy drug is added to the Herceptin. If the patient is already on a chemotherapy drug with the Herceptin, then changing to a new chemotherapy drug is also effective. This approach can result in improved cancer response and improved disease free survival.

Von Minckwitz et al. report their study "Trastuzumab beyond progression in human epidermal growth factor receptor 2-positive advanced breast cancer: a German Breast Group 26/Breast International Group 03-05 study" in the Journal of Clinical Oncology April 20, 2009. www.jco.org

They found that it was beneficial to keep using Herceptin and add the chemotherapy drug Xeloda (capecitabine). This resulted in a better cancer response and longer disease free survival than stopping Herceptin and using Xeloda alone. Overall survival was not changed.

Continuing Herceptin and using a second chemotherapy drug is a good treatment option. I have successfully used this strategy in my practice.

The future of cancer treatment is bright!

Dr. L