Science
Column: A cancer survivor's advice: research, persistence and second opinions
In the fall of 2022, Robin Clough and Dr. Gene Dorio were going about their lives as they had for many years, serving older adults in the Santa Clarita Valley. Clough was busy with her work as an administrator at the local senior center while Dorio, a house-call geriatrician, crisscrossed the valley visiting his patients.
In November of that year, Clough saw a lump on her neck and had it checked out. The early indication was that she had papillary thyroid cancer.
“I was somewhat worried,” said Clough, but not overly so, because she knew that type of cancer was treatable and highly survivable. “So in the back of my mind it was like, ‘Oh, I’m so lucky. … It’s the easiest type of cancer to take care of.’”
California is about to be hit by an aging population wave, and Steve Lopez is riding it. His column focuses on the blessings and burdens of advancing age — and how some folks are challenging the stigma associated with older adults.
Then things took a sharp turn for the worse. “I noticed it growing a lot,” Clough, 70, said of the lump. “I was having trouble speaking.”
Surgery was scheduled. Dorio, 72, said it was expected to take about three hours to remove the tumor and half of Clough’s thyroid gland. But the procedure dragged on. When the surgeon updated Dorio nine hours later, the news was grim. The tumor had spread through the thyroid gland, onto the carotid artery and into the tracheal rings.
“He told me it was all over the place,” Dorio said.
Tests revealed that Clough had anaplastic thyroid cancer, a far more aggressive form than papillary.
We all know our fortunes can turn without much warning, especially as we age and the odds stack against us, raising the threat of our bodies gradually failing and our minds fading. But in just a couple of weeks, Clough and Dorio had gone from cruising through life to confronting death.
With her type of cancer, life expectancy is often measured in months rather than years. “It was so hard to process, and I think my mind stopped me from processing it because it’s just too overwhelming,” Clough said.
They’d fallen for each other about 20 years ago after each had been married and divorced. Dorio has a daughter named Janene. Clough has two daughters, Catie and Amy. The Dorio-Clough courtship and blending of the two families began with him giving her a flu shot at her senior center; then he had her on his local radio show, “The Senior Hour.”
They never married, and still don’t see the need.
“We’re compatible and we love each other … and have the same interests — fighting for people’s rights,” said Dorio, who, along with Clough, pushed for legislation — signed by Gov. Gavin Newsom — giving families more authority to determine medical decisions for loved ones even in the absence of an advance directive. Dorio had also served on the L.A. County Commission for Older Adults.
Facing her grim diagnosis, Clough and Dorio leaned on each other and on Janene, Catie and Amy. There were weekly Zoom meetings to bolster spirits and share information about emerging therapies.
I’d gotten to know Dorio a little bit over the years, having tagged along on his house calls, so I was copied on the periodic updates on Clough’s status that he mailed to friends and family. She beat the three-to-six-month prediction, and in July of 2023 Dorio wrote to say she was better, “but still has a ways to go.”
By then, she’d undergone seven consecutive weeks of chemotherapy and radiation, suffering skin burns on her neck from the latter. A metastatic lesion was surgically removed from her leg. Dorio took Clough to MD Anderson Cancer Center in Houston on a recommendation from Cedars-Sinai.
“To all our friends and family,” Dorio wrote in that July update, “seeking a second opinion and being persistent in researching and asking questions of your doctor team is very important, no matter what the diagnosis might be. It is physically and emotionally a roller coaster. But we have been given wonderful support from our family and many of you in the community. We will provide help and guidance in the future should you need it.”
In Houston, medical staff queried Clough about her family history. “This cancer is mostly caused by radiation exposure,” Clough said, “and one of the first things they asked me … was where did you grow up?”
Her answer was Arizona, downwind from nuclear weapons testing in nearby Nevada in the 1940s and ’50s that contaminated water, soil and food sources for years.
I asked Clough if she had seen the Oscar-winning movie “Oppenheimer,” about the creation of the first nuclear weapons.
“I won’t watch it,” she said firmly.
It’s impossible to directly link Clough’s cancer to weapons testing, but the federal Centers for Disease Control and Prevention reports that people exposed to radiation fallout, “especially during childhood, may have an increased risk of thyroid disease, including thyroid cancer many years later.”
Oncologists Alain Mita at Cedars-Sinai and Maria Cabanillas at MD Anderson, who had collaborated previously on patients with anaplastic thyroid cancer, determined that Clough’s form of cancer warranted treatment with Keytruda, a drug that stimulates the immune system.
But after a few months of treatment that had showed some promise, the cancer was growing again. In late December, Clough’s doctors switched to a drug called Retevmo, a targeted therapy that blocks the driver of tumor growth.
A hopeful Dorio recalled that in a 2017 blog post, he had written that “genetic engineering research is on the verge of finding the DNA ‘stop button’ ” for cancer cell growth. He added, “Hopefully one day our great-grandkids will ask … ‘What was cancer?’”
One month into Retevmo medication, Clough had to stop because of adverse side effects to her liver. But a new scan revealed what seemed to her like a miracle.
The cancer was gone.
Two months later, she had another test.
No cancer.
“Her cancer is, at this moment, undetectable and in remission. For anaplastic cancer that’s very unusual,” Dr. Mita told me.
That doesn’t mean the cancer won’t return, he said. But for the time being, there’s cause for optimism.
Mita said that 10 years ago he could not have predicted this measure of success against such an aggressive cancer, and he’s hopeful medical science will see more advances in the coming years. With some cancers, he said, doctors are now able to skip chemotherapy and radiation in favor of meds like those used to treat Clough.
Cabanillas shared his optimism, saying survival rates at MD Anderson have improved with some forms of anaplastic thyroid cancer by using “immunotherapy in combination with targeted therapy.”
In her kitchen a few days ago, with the girls’ college diplomas and family photos hanging on the walls, Clough said it’s all been overwhelming at times, and Dorio chimed in on his own worries and determination to remain strong for her sake. Clough’s life has been consumed by doctor visits, surgical procedures, continued unpleasant side effects from treatment and the constant anxiety of awaiting the next test results.
“I never felt like it was too much,” Clough said. “There are times when I think, I’m so tired of this. But it’s never been too much, and I think that’s because of my loved ones.”
Dorio, meanwhile, put his practice on hold to focus on the house-call patient who lives in his own home. He’s been putting off hip replacement surgery, too, and uses a cane.
It’s more than a little helpful, Clough said, when, in the midst of a life-threatening medical crisis, the person you live with is a doctor. She said she never felt that she could beat cancer entirely, “but that I could keep it under control. And I still have that hope.” Each day, she said, is a bonus.
Clough shed a few tears as she told her story, but also flashed a radiant smile.
“I was supposed to be gone, but I’m not. So every day is ‘Wow,’ you know? I get to see my daughters, and in the process of this I had my first grandchild.”
The baby boy is now 11 months old.
His name is Robin.
steve.lopez@latimes.com
Science
Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County
A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.
The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.
The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.
Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.
The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.
After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.
As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.
Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.
The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.
Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.
Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.
The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.
Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.
While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.
Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.
Science
Political stress: Can you stay engaged without sacrificing your mental health?
It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.
“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”
Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.
Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.
The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.
That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.
In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.
“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”
Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).
The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.
For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.
Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.
“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.
Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.
There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.
“Politics is many forms of stress all rolled into one,” Ford said.
Weinschenk observed this firsthand the day after the election.
“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”
That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.
Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.
“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”
Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.
“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”
On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”
“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.
Genessa Krasnow has been seeing a lot of that since the election.
The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.
“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.
“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”
That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.
“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.
Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.
“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”
Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.
“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.
The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”
“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”
Science
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