Death Was Not an Option!

By Tim Layman

On December 18, 2009, Marcy Layman woke up to excruciating abdominal pain, and I rushed her to Swedish Emergency in Issaquah, Washington. After an hour of blood tests and ultrasound treatments, I was instructed to take her to a Swedish hospital in downtown Seattle. Three hours of testing later, we were given the news that Marcy had contracted stage IV inoperable pancreatic cancer and had three to six months to live.

This journal will take you on a two-year spiritual, medical, nutritional, emotional, and, in some cases, humorous journey while we were finding stronger love and friendship between ourselves and the search for a cure for this insidious disease. Marcys courageous fight against this apocalyptic disease and casting away the Grim Reapers shadow that crossed our doorstep on seven different occasions have inspired a plethora of people.

Some people walk through the world and never see it. Marcy was not one of those people. She was interesting and always curious to learn new things. She was funny, loving, and truly creativethe most cherished and giving friend that God, for some reason, saw fit to bless us with. We always question why we were so lucky, and she was absolutely devoted to her family. Marcy didnt just talk her religionshe lived it.

For the next twenty-five months, there were fifty chemo treatments; different drugs, both pharmaceutical and naturopathic; and natural remedies from the Middle East, including teas, mushroom, and spices. No rock was left unturned; no treatment or drug was not explored as an option; we educated ourselves about the disease and all the cures and contacted the top cancer institutes in the country, exploring any and all options possible.

In the two-plus years that I was Marcys caregiver, there were a lot of rhetorical questions that I asked and had in my mind as I found out there were answerssome of which I liked and some I didnt like. I immediately started to look for answers for what this disease was and why it contracted my lovely bride. I looked for cures over and beyond what the doctors told us and tried to explore every option possible. There is a multitude of questions about cancer, and in this book, you will find many answers. We knew one thing, thoughdeath was not an option!

• Language: English
• Publisher: Xlibris US
• Release date: May 15, 2012
• ISBN: 9781477103357

Tim Layman

As a salesman for most of my adult life, I have always been able to tell a good story. When I was thrust into being a caregiver for my lovely bride, I had to learn what care giving was all about. After the second “Marcy Update,” several people encouraged me to continue to send out reports and even write a book. Writing a book was the last thing on my mind, as I was more interested in doing the research to find a cure of this insidious disease and prolong my love’s life. Along the way of research and dedication to my duties as a caregiver, we both found some great humor and enjoyed the time we had together to the fullest.

Book preview

Death

Was Not an Option!

Tim Layman

Copyright © 2012 by Tim Layman.

Library of Congress Control Number:       2012907584

ISBN:         Hardcover                               978-1-4771-0334-0

                   Softcover                                 978-1-4771-0333-3

                   Ebook                                      978-1-4771-0335-7

All rights reserved. No part of this book may be reproduced or transmitted

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without permission in writing from the copyright owner.

This book was printed in the United States of America.

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Contents

About the Author

Author’s Biography

Book Summary

Book Description

In The Beginning

Chapter 1   Emotional Stage

Chapter 2   Learn How to Communicate With Your Loved One

Nutrition

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

Chapter 25

Chapter 26

Chapter 27

Chapter 28

Chapter 29

Chapter 30

Chapter 31

Chapter 32

Chapter 33

Chapter 34

Chapter 35

Chapter 36

Chapter 37

Chapter 38

Chapter 39

Chapter 40

Chapter 41

Chapter 42

Chapter 43

Chapter 44

Chapter 45

Dedication

I would like to dedicate this book to Marcy’s daughter Chris and her husband James and her son Steve for all their love and support for their mother.

To my two sons, Scott and Michael: Thank you for your total support and caring about me and your hero Marcy.

To Marcy’s sister Pauly and her husband Jim, whose love and support for her sister went far beyond just the love for her sister.

Finally, to Dr. Henry Kaplan, for without him, we would not have had these two wonderful years to share with my lovely bride Marcy.

About the Author

As a salesman for most of my adult life, I have always been able to tell a good story. When I was thrust into being a caregiver for my lovely bride, I had to learn what caregiving was all about. After the second Marcy Update, several people encouraged me to continue to send out reports and even write a book. Writing a book was the last thing on my mind, as I was more interested in doing the research to find a cure of this insidious disease and prolong my love’s life. Along the way of research and dedication to my duties as a caregiver, we both found some great humor and enjoyed the time we had together to the fullest.

Author’s Biography

Born in Santa Monica, California, in 1940 and abandoned by his natural mother at the age of four and raised by the babysitter and her husband (Josephine and Ray Duff) as if he were their own child until Ray died of cancer in 1955. Tim went to work for a local grocery store and helped his mom pay some of the bills while finishing high school. As a child he had dyslexia in a time when elementary school teachers didn’t have the tools or the knowledge to diagnose the symptoms. Teachers thought he was lazy or just slow; he had problems with reading and spelling, although he did excel in math.

He worked full-time and attended college with aspirations of becoming a professional baseball player. After one year, neither college nor baseball worked out. He married his college sweetheart and went back to the grocery industry. Divorced fourteen years later, he got custody of his two sons and raised them while doing various jobs in the grocery industry, from delivering tortillas to selling food products to various grocery chains.

Moving to Seattle in January 1983, Tim met the love of his life (Marcy) and chased her for sixteen years before she asked him to marry her. He first came to Seattle and became the foodservice sales manager for a large tortilla manufacturer and then went to work for the largest producer of large, soft pretzels in the nation and worked his way up to director of sales for the United States and Canada. After an unceremonious departure, he went to work for an espresso machine dealer and learned how to design and sell kiosks. Later, he became the vice president of a competitive company designing cafés and selling cabinetry and display cases.

In December 2009, Marcy was diagnosed with stage IV pancreatic cancer and was given three months to live. Deciding that death was not an option, she fought for over two years to defeat this insidious disease. For over two years, Tim was her caregiver, and their bond grew stronger than ever. We looked for every possible cure and remedy and contacted every major medical university and cancer research instruction in the United States to find answers.

I love listening to and telling a good story. This journal is one of those stories that are truly inspiring about the most courageous women who fought this insidious disease to the bitter end. Given only three months to live, she put up a tremendous battle for over two years.

Book Summary

This journal will take you on a two-year inspiring, spiritual, medical, nutritional, and emotional journey while we were finding stronger love and friendship between ourselves and the search for a cure for this insidious disease. Marcy’s courageous fight against this apocalyptic disease that cast away the Grim Reaper’s shadow that crossed our doorstep on seven different occasions has inspired a plethora of people. With this courage, she was still able to find a great deal of levity and humor in her battle. We found that laughter was a great medicine for the soul and spirit.

For the next twenty-five months, there were fifty chemo treatments; different drugs, both pharmaceutical and naturopathic; and natural remedies from the Middle East, including teas, mushroom, and spices. No rock was left unturned, and no treatment or drug was not explored as an option; we educated ourselves about the disease and all the cures and contacted the top cancer institutes in the country, exploring any and all options.

Book Description

On December 18, 2009, Marcy Layman woke up to excruciating abdominal pain, and I rushed her to Swedish Emergency in Issaquah, Washington. After an hour of blood tests and ultrasound treatments, I was instructed to take her to a Swedish hospital in downtown Seattle. Three hours of testing later, we were given the news that Marcy had contracted stage IV inoperable pancreatic cancer and had three to six months to live.

This journal will take you on a two-year spiritual, medical, nutritional, emotional, and, in some cases, humorous journey while we were finding stronger love and friendship between ourselves and the search for a cure for this insidious disease. Marcy’s courageous fight against this apocalyptic disease and casting away the Grim Reaper’s shadow that crossed our doorstep on seven different occasions have inspired a plethora of people.

Some people walk through the world and never see it. Marcy was not one of those people. She was interesting and always curious to learn new things. She was funny, loving, and truly creative—the most cherished and giving friend that God, for some reason, saw fit to bless us with. We always question why we were so lucky, and she was absolutely devoted to her family. Marcy didn’t just talk her religion—she lived it.

For the next twenty-five months, there were fifty chemo treatments; different drugs, both pharmaceutical and naturopathic; and natural remedies from the Middle East, including teas, mushroom, and spices. No rock was left unturned; no treatment or drug was not explored as an option; we educated ourselves about the disease and all the cures and contacted the top cancer institutes in the country, exploring any and all options possible.

In the two-plus years that I was Marcy’s caregiver, there were a lot of rhetorical questions that I asked and had in my mind as I found out there were answers—some of which I liked and some I didn’t like. I immediately started to look for answers for what this disease was and why it contracted my lovely bride. I looked for cures over and beyond what the doctors told us and tried to explore every option possible. There is a multitude of questions about cancer, and in this book, you will find many answers. We knew one thing, though—death was not an option!

Death Was Not an Option

Cancer is an insidious, apocalyptic disease that spreads it wrath of famine across all lands; it knows no boarders, no countries, no ginger, and no culture and discriminates against none or age from the very youth to the elderly and every thing in between. As the four horsemen of the apocalypse spread war, famine, conquest and then death this hideous disease will stop at nothing. There is no fore warning it just appears and one day you know something is wrong and by the time it’s discovered in many cases it’s too late.

—Layman 2010

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My Lovely Bride Marcy

In The Beginning

I never intended to write a book; nor did, or do, I have aspirations of being a great novelist. My intention for this attempt is to give an account of what a caregiver has to learn and go through. There really are no college courses or classes on what to do as a caregiver for the ordinary person. For the most part, we are thrown into the situation and have to learn on our own. Under normal circumstances, there is no training, and the need for a caregiver is instant. It started off with a couple of e-mail updates to family and some close friends. As I did more research, I would include some of that in the updates and for the most part got a little too technical. Before long, it turned more into a journal, and after about a year, my lovely bride started to insist on editing the reports. She felt that I was giving out too much information to my friends and didn’t want everyone to know some of the side effects of the chemo and how sick she really got.

Well, too many people thanked me for the updates and encouraged me to write a book. As I said, I had never had any aspirations of being the next literary genius or Mark Twine of the twenty-first century. The Marcy updates eventually turned into the Z Lemon Reports. My loveliness has called us The Lemon’s as a little joke between us. Z Lemon Reports have caught on for some reason and is here to say or at least until my lovely bride changes her mind.

Unlike long-term illnesses such as Alzheimer’s disease, you can prepare for the support and need you will have to give to your loved ones. Even with that preparation, there are things and moments that you just can’t prepare for. But when there is sudden health issue such as an accident or cancer, there is no warning. You get that message, and all at once you are in the middle of something that you have not prepared or even planned for. The learning curve is enormous.

Over and above, the obvious of giving comfort, feeding, and changing the dressing and whatnot, there is no preparation for the emotional side and the learning curve of understanding what the patient is going through or what their needs are. Life changes in a minute, and you have just been thrown into a pit full of wolves. In many cases, the patient just does not communicate, and you just don’t know what the problem is. All of a sudden, they are grumpy, quiet, aloof, or, in some cases, very argumentative. You wonder, What is going on here? What in the hell have I done? You have not done anything wrong; it’s just that the patient sometimes is embarrassed or just does not want to talk about what is ailing them.

In the case of my lovely bride, she had diarrhea for a couple of months and started to lose weight before I had to take her to the hospital with sever pains in her abdomen at four in the morning. No one likes to talk about the fact that they have been to the bathroom four times today and oppose have to go again. Can you imagine sitting around the dinner table and having the following conversation? Me asking, How was your day today, my love? She replying, After going three times in the morning, I went grocery shopping, only to cut the trip short because there was that sudden urge once again, and I just made it home in time.

Once we found out that Marcy had cancer, we learned that even though we were pretty good communicators, there was still a lot to learn and had to trust that we could talk to each other. No one wants to talk about diarrhea, constipation, cramps, and nausea and explain exactly where and how sever the pain is.

It’s been a year, and I’m still learning how to read her emotions and knowing when she is tired or something is bothering her. It’s a job—a full-time job, and there is no on-the-job training. If I had to put it into proper context, I would say that the two of you have to trust each other and talk about everything without embarrassment. It’s a fact of life, so let’s get it out in the open and discuss it so the other person knows what is going on with the other person. When my lovely bride tells me that she will need my help today, it’s not the normal wife’s honey-do list; it’s the fact that she does not feel well and can’t do her portion of the work around the house. I, on the other hand, have to understand that she does need help and to take it personally. It is a very easy trap for the caregiver to feel that they are being taken advantage of. Nothing could be farther from the truth, so just get past it and do what has to be done.

Think about this: Your wife wakes you up at 4:00 a.m. and tells you that she is in pain and that you have to take her to the emergency hospital right now! You jump up, get dressed, and take her to the emergency room. Tests are run, blood is taken, she is probed and poked, X-rays are taken, and ultra sound is performed, and you are sitting in the cubical and the doctor whom you have never seen or know anything about comes in and says that it is a problem with her pancreatic and that she needs to go to the hospital right now. The doctor rambles off some information about her count being high and that this is not right and that all indications are that she has pancreatitis. Arrangements are made to admit her to the hospital, and you are off and running. Now this has taken about one hour—that’s it, just one hour’s notice that something really is wrong.

I took my wife to the hospital in Seattle about thirty minutes from where we live. When we arrived at admitting, everything was in order, and we went straight to her room. The nurse came in, gave her a gown, and started plugging an assortment of probes and needles in and on her. The local on-call doctor came in to get some information and told us that she would be taken downstairs for some test and that that would take awhile. I told Marcy that I would go home, shower, and change and let the office know what is going on and be back with something for her to wear. This entire process had taken about two and half hours, from beginning to now.

When I arrived back at the hospital, there was a doctor talking to Marcy and then left right after I entered the room. I could tell that something really was wrong when I looked into her eyes, and then she said, Worst news possible. I have cancer. No one wants to hear those words—I have CANCER. She went on to tell me that it was in the pancreas and the mortality rate was 93 percent and that she had between three to six months to live. It was now about 9:00 a.m., just five hours from when I was awoken and asked to take my lovely bride to the hospital. There was no warning and time to prepare or get ready, and I couldn’t go to Barns and Noble and get a book. Hell, I didn’t even know what the pancreas was, let alone what it was for. Oh holy shit! Now I am a caregiver and don’t even know it and/or what I am expected to do!

I had no idea where the pancreas is. You could have said, You know, Afghanistan, right over near Pakistan, Iran, and Turkmenistan. Yeah, just like next to the liver, under the stomach, to the right of the gallbladder and sits on top of the small intestine. I did know that all that is inside is the abdominal cavity but exactly where and what all that did I had no idea. I know what the stomach does but not the liver, other than that if you drink too much, you got a problem, and what the hell is the gallbladder for and what does it do and how does all this fit together? Well, I found out that it is the digestive system and that if one has a problem, they all have a problem. Unlike a car, where you can just go into the engine and replace a fuel pump or a piston with a couple of peripheral parts, and the engine would run perfectly. The body is just a little different; if the liver goes, you can’t just go down to the local liver shop and pick one up and replace what you have in there.

It happened this quickly and in some cases even faster . . . We have a good friend that got the phone call from her husband telling her that he just fell off the ladder and needed her help. Problem was that he was in Seattle and she was in San Francisco on business. She told him to call 911, which he did. After the fact, we still cannot figure out how Craig fell and then went into the house to call his wife with eleven broken ribs, bruised lung, a nick on the aorta blood vessel, not to mention he broke his clavicle, humorous, and scapula and punctured his lung. When the medics showed up, the neighbor came over to assist in any way that he could. We still don’t know how the accident happened and may never know. For over two months, Craig had been on a respirator and had a tracheotomy tube down his throat to help him breathe for over a month and in all six months in intensive care. Once again, no warning—you are just thrown into the position of a caregiver. Imagine getting a phone call in the middle of the morning, telling you your loved one has just had an accident and you have to drop everything, make plane reservations, contact your account in the market letting them know that you have to cancel, and see you next trip then get to the hotel, check out, get to the airport, wait for that damn plane then fly home not knowing what is happening . . . Once you finally get home, you go straight to the hospital just to find out that your loved one has eleven broken ribs along with other issues. Once again, no warning, no time to prepare to be a caregiver, but here you are.

Chapter 1

Emotional Stage

You are going to go through every stage of emotions that there are. I was under the impression that there were about seven stages of emotions but could not remember since I studied this in physiology in my first year of college. That was so long ago that Sigmund Froid was still in dipper. So I went on the Internet to look up emotional stages, and much to my surprise, I saw that there are five stages of emotions just for living and then there are seven stages for the stockbroker and eleven if you are going through a divorce. In any event, you are going to go through an emotional roller coaster. Here is something that I found and think you might be able to relate to:

Living in a civilized society as we do, we often pass judgment on our modes of reacting. We think that we are being too upset, too angry, too hurt, too sad, too serious . . . in short, too emotional. However, it is often more dangerous to be civilized, than to do what comes naturally. I’ll explain . . .

• Ignoring our feelings causes Emotional Indigestion. When bad things happen to us, all of our alarms go off. We become tense, we become stressed, we become ready for fight or flight. Our blood pressure rises, our breathing changes, our pupils dilate, we begin to perspire. Our bodies ready themselves to respond to emergencies.

Once the crisis is over, there is the need to let down and allow our bodies to return to their resting states, and also, to release the feelings which have built up as a result of the experience. When we ignore these feelings, it causes emotional indigestion, which can sour a variety of areas of our lives.

•   Emotions run in cycles and need to run their course. The author described five stages of the grieving process: denial, anger, bargaining, depression and acceptance. These five stages have been applied to a wide range of losses, including the loss of a marriage, job, home, family members, illness, etc. Although, we may not experience all stages of this grieving process, many do apply and we need to recognize that during a loss of any kind, there is a cycle which will run its course until we reach some point of acceptance.

To deny our feelings means that we are still in the stage of denial. To mask our feelings means that we are still in the angry stage. When we find ourselves depressed, it means that we are getting closer to acceptance, and thereby, recovery.

•   Unexpressed emotions build up and prevent our seeing clearly. When we deny our feelings or are not allowed to express them openly, we hold them in and repress them. This is a costly process which can result in physical, as well as psychological illness. Like the windshield of a car that catches mud and debris but is never cleaned, it soon becomes difficult if not impossible to see the road ahead of us clearly. When this happens, our perception becomes distorted and we may make some errors in our judgment calls.

•   Take time for yourself. Like any illness, it is important to get rest in order to recuperate. When we acknowledge that we need time to heal, the healing process begins. It is important to face the crisis head-on, either with the help of others who are supportive, or on our own.

Sometimes it helps to write down our feelings, expressing them on paper. Sometimes it helps to cry. When we have lost someone we love, we may need to say good-bye. Even if it has been a very long time since the actual loss occurred, the process may still be incomplete. Old business may still be unfinished business, and may require the assistance of a counselor or psychotherapist in order to be completed.

• Emotions are an asset . . . the barometer of our experience. Our emotions are largely the function of our unconscious mind, which has recorded every experience during our lifetime. Our unconscious minds help us to sense danger, react quickly, detect lies, and make decisions. In each of us, there is a force working in our own best interest to protect us. When we trust our own instincts, they provide loyal guidance for us.

Sometime ago, I received some shocking news which would decidedly have an effect on my life. I remember going through the day as though it really didn’t happen (denial). When I was again faced with the news, I became angry (anger), and began thinking of ways that I could have prevented the situation (bargaining). After several days of trying unsuccessfully to change things, I became very sad (depression). I stayed depressed for 48 hours, taking small bits of comfort from the kind words of friends, but mostly just allowed myself to feel my emotions. Only then was I able to begin my healing process (acceptance). The next phase of my life was about to begin.

It is often scary to pass through a tunnel . . . but it is also the quickest way to get to the other side of the mountain.

Due Diligence

When it comes to due diligence, that is exactly what you have to do, and the other thing is that as a caregiver, you cannot allow your loved one to become a prisoner to his or her illness. It is important that you become the coach, cheerleader, gofer, listener, communicator, researcher, and good friend. You will have to make appointments and take time off work to take them to the doctor, hospital, or clinic. Do the research on doctors, what the illness actually is, what are the latest treatments and drugs, and a multitude of things you never thought of. They will need someone to rely on, and that is you. When our family got together after I brought my love home, we as a team started to put together a list of things that needed to be done, and they are as follows:

Find a doctor

Get second opinions

Insurance

Learn everything you can about the disease

What lifestyle changes do we have to make

Learn about nutrition

Learn about holistic medicine

Learn how to communicate with your loved one

Build a support group

Plan for the future

OK, here you are thrown into being a caregiver without any warning, training, preparation, or advice. What do you do now? My lovely bride and I were sitting on her bed in the hospital minutes after the doctor left, and we were in shock. For several minutes we didn’t speak, both trying to hold the tears back and not knowing what to do. Finally, one of us spoke (I don’t remember who, not that it matters), and we said, What do we do now? We need a doctor, have to tell the kids, make arrangements, but what kind of arrangements? We don’t have any answers, let alone know what questions to ask. We just don’t know what we don’t know. This is very frustrating. I knew I had to say something to comfort her, but what do I do? Go into my bag of bad jokes or stupid comments . . . ? No! What I did say was You are not going to die. I won’t let you and death was not an option. I then told her that she would live to see her granddaughters get married and see her great grandchildren. Finally, after spurting out thought after thought, we decided to put them in order.

How to find a doctor

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How to Find a Doctor or Treatment Facility If You Have Cancer

Key points

• Resources are available to help you find a doctor who specializes in cancer care (see section on Finding a Doctor).

• Once you receive your doctor’s opinion about the diagnosis and treatment plan, you may want to get another doctor’s advice before you begin treatment. This is known as getting a second opinion (see section on Getting a Second Opinion).

• Resources are available to help you choose a treatment facility for scheduled and ongoing care (see section on Finding a Treatment Facility for Patients Living in the United States).

• If you live outside the United States, resources are available to help you locate a facility in or near your country (see section on Finding a Treatment Facility for Patients Living Outside the United States).

• Citizens of other countries who are planning to travel to the United States for cancer treatment generally must first obtain a nonimmigrant visa for medical treatment from the U.S. Embassy or Consulate in their home country (see section on Finding a Treatment Facility for Patients Living Outside the United States).

If you have been diagnosed with cancer, finding a doctor and treatment facility for your cancer care is an important step in getting the best treatment possible. Although the health care system is complex, resources are available to guide you in finding a doctor, getting a second opinion, and choosing a treatment facility. Below are suggestions and information resources to help you with these important decisions:

Physician Training and Credentials

When choosing a doctor for your cancer care, you may find it helpful to know some of the terms used to describe a doctor’s training and credentials. Most physicians who treat people with cancer are medical doctors (they have an MD degree) or osteopathic doctors (they have a DO degree). The basic training for both types of physicians includes four years of premedical education at a college or university, four years of medical school to earn an MD or DO degree, and postgraduate medical education through internships and residences. This training usually lasts three to seven years. Physicians must pass an exam to become licensed (legally permitted) to practice medicine in their state. Each state or territory has its own procedures and general standards for licensing physicians.

Specialists are physicians who have completed their residency training in a specific area, such as internal medicine. Independent specialty boards certify physicians after they have fulfilled certain requirements. These requirements include meeting specific education and training criteria, being licensed to practice medicine, and passing an examination given by the specialty board. Doctors who have met all the requirements are given the status of Diplomat and are board-certified as specialists. Doctors who are board-eligible have obtained the required education and training but have not completed the specialty board examination.

After being trained and certified as a specialist, a physician may choose to become a subspecialist. A subspecialist has at least one additional year of full-time education in a particular area of a specialty. This training is designed to increase the physician’s expertise in a specific field. Specialists can be board-certified in their subspecialty as well.

The following are some specialties and subspecialties that pertain to cancer treatment:

• Medical Oncology is a subspecialty of internal medicine. Doctors who specialize in internal medicine treat a wide range of medical problems. Medical oncologists treat cancer and manage the patient’s course of treatment. A medical oncologist may also consult with other physicians about the patient’s care or refer the patient to other specialists.

• Hematology is a subspecialty of internal medicine. Hematologists focus on diseases of the blood and related tissues, including the bone marrow, spleen, and lymph nodes.

• Radiation Oncology is a subspecialty of radiology. Radiology is the use of x-rays and other forms of radiation to diagnose and treat disease. Radiation oncologists specialize in the use of radiation to treat cancer.

• Surgery is a specialty that pertains to the treatment of disease by surgical operation. General surgeons perform operations on almost any area of the body. Physicians can also choose to specialize in a certain type of surgery; for example, thoracic surgeons are specialists who perform operations specifically in the chest area, including the lungs and the esophagus.

The American Board of Medical Specialties® (ABMS) is a not-for-profit organization that assists medical specialty boards with the development and use of standards for evaluation and certification of physicians. Information about other specialties that treat cancer is available from the ABMS web site, which can be accessed at http://www.abms.org/ on the Internet.

Almost all board-certified specialists are members of their medical specialty society. Physicians can attain Fellowship status in a specialty society, such as the American College of Surgeons (ACS), if they demonstrate outstanding achievement in their profession. Criteria for Fellowship status may include the number of years of membership in the specialty society, years practicing in the specialty, and professional recognition by peers.

Finding a Doctor

One way to find a doctor who specializes in cancer care is to ask for a referral from your primary care physician. You may know a specialist yourself or through the experience of a family member, coworker, or friend.

The following resources may also be able to provide you with names of doctors who specialize in treating specific diseases or conditions. However, these resources may not have information about the quality of care that the doctors provide.

• Your local hospital or its patient referral service may be able to provide you with a list of specialists who practice at that hospital.

• Your nearest National Cancer Institute (NCI)-designated cancer center can provide information about doctors who practice at that center. The NCI is a component of the National Institutes of Health (NIH). The NCI-Designated Cancer Centers database provides contact information for NCI-designated cancer centers located throughout the United States. It is available at http://www.cancer.gov/cancertopics/factsheet/NCI/cancer-centers on the Internet. Users can select all cancer centers or search by location, type of cancer center, or cancer center name.

• The ABMS has a list of doctors who have met certain education and training requirements and have passed specialty examinations. Is Your Doctor Certified? lists doctors’ names along with their specialty and their educational background. The directory is available in most libraries and online at https://www.abms.org/WC/login.aspx on the Internet. Users must register to use this online self-serve resource, which allows users to conduct searches by a physician’s name or area of certification and a state name.

• The American Medical Association (AMA) DoctorFinder database at http://webapps.ama-assn.org/doctorfinder/home.jsp provides basic information on licensed physicians in the United States. Users can search for physicians by name or by medical specialty.

• The American Society of Clinical Oncology (ASCO) provides an online list of doctors who are members of ASCO. The member database has the names and affiliations of over 27,000 oncologists worldwide. It can be searched by doctor’s name, institution, location, oncology specialty, and/or type of board certification. This service is available at http://www.cancer.net/portal/site/patient (click on Find an Oncologist).

• The American College of Surgeons (ACS) membership database is an online list of surgeons who are members of the ACS. The list can be searched by doctor’s name, geographic location, or medical specialty. This service is located at http://web3.facs.org/acsdir/default_public.cfm on the Internet. The ACS can be contacted by telephone at 1-800-621-4111.

• The American Osteopathic Association (AOA) Find a D.O. database provides an online list of practicing osteopathic physicians who are AOA members. The information can be searched by doctor’s name, geographic location, or medical specialty. The database is available at http://www.osteopathic.org/directory.cfm on the Internet. The AOA can be contacted by telephone at 1-800-621-1773.

• Local medical societies may maintain lists of doctors in each specialty.

• Public and medical libraries may have print directories of doctors’ names listed geographically by specialty.

• Your local Yellow Pages or Yellow Book may have doctors listed by specialty under Physicians.

The Agency for Healthcare Research and Quality (AHRQ) offers Your Guide to Choosing Quality Health Care, which has information for consumers on choosing a health plan, a doctor, a hospital, or a long-term care provider. The guide includes suggestions and checklists that you can use to determine which doctor or hospital is best for you. This resource is available at http://www.ahrq.gov/consumer/qntool.htm on the Internet. You can also order the guide by calling the AHRQ Publications Clearinghouse at 1-800-358-9295 or 703-437-2078 if outside the United States.

If you are a member of a health insurance plan, your choice may be limited to doctors who participate in your plan. Your insurance company can provide you with a list of participating primary care doctors and specialists. It is important to ask your insurance company if the doctor you choose is accepting new patients through your health plan. You also have the option of seeing a doctor outside your health plan and paying the costs yourself. If you have a choice of health insurance plans, you may first wish to consider which doctor or doctors you would like to use, and then choose a plan that includes your chosen physician(s).

If you are using a federal or state health insurance program such as Medicare or Medicaid, you may want to ask the doctor about accepting patients who use these programs.

You will have many factors to consider when choosing a doctor. To make an informed decision, you may wish to speak with several doctors before choosing one. When you meet with each doctor, you might want to consider the following:

• Does the doctor have the education and training to meet my needs?

• Does the doctor use the hospital that I have chosen?

• Does the doctor listen to me and treat me with respect?

• Does the doctor explain things clearly and encourage me to ask questions?

• What are the doctor’s office hours?

• Who covers for the doctor when he or she is unavailable? Will that person have access to my medical records?

• How long does it take to get an appointment with the doctor?

If you are choosing a surgeon, you may wish to ask additional questions about the surgeon’s background and experience with specific procedures. These questions may include:

• Is the surgeon board-certified?

• Has the surgeon been evaluated by a national professional association of surgeons, such as the American College of Surgeons (ACS)?

• At which treatment facility or facilities does the surgeon practice?

• How often does the surgeon perform the type of surgery I need?

• How many of these procedures has the surgeon performed? What was the success rate?

It is important for you to feel comfortable with the specialist that you choose because you will be working closely with that person to make decisions about your cancer treatment. Trust your own observations and feelings when deciding on a doctor for your medical care.

Getting a Second Opinion

Once you receive your doctor’s opinion about the diagnosis and treatment plan, you may want to get another doctor’s advice before you begin treatment. This is known as getting a second opinion. You can do this by asking another specialist to review all the materials related to your case. A second opinion can confirm or suggest modifications to your doctor’s proposed treatment plan, provide reassurance that you have explored all your options, and answer any questions you may have.

Getting a second opinion is done frequently, and most physicians welcome another doctor’s views. In fact, your doctor may be able to recommend a specialist for this consultation. However, some people find it uncomfortable to request a second opinion. When discussing this issue with your doctor, it may be helpful to express satisfaction with your doctor’s decision and care and to mention that you want your decision about treatment to be as thoroughly informed as possible. You may also wish to bring a family member along for support when asking for a second opinion. It is best to involve your doctor in the process of getting a second opinion, because your doctor will need to make your medical records (such as your test results and X-rays) available to the specialist.

Some health care plans require a second opinion, particularly if a doctor recommends surgery. Other health care plans will pay for a second opinion if the patient requests it. If your plan does not cover a second opinion, you can still obtain one if you are willing to cover the cost.

If your doctor is unable to recommend a specialist for a second opinion, or if you prefer to choose one on your own, the following resources can help:

• Many of the resources listed above for finding a doctor can also help you find a specialist for a consultation.

• The NIH Clinical Center in Bethesda, Maryland, is the research hospital for the NIH, including NCI. Several branches of the NCI provide second opinion services. The NCI fact sheet Cancer Clinical Trials at the National Institutes of Health Clinical Center: Questions and Answers describes these NCI branches and their services and is available at http://www.cancer.gov/cancertopics/factsheet/NCI/clinical-center on the Internet.

• The R. A. Bloch Cancer Foundation, Inc. can refer cancer patients to institutions that are willing to provide multidisciplinary second opinions. A list of these institutions is available at http://blochcancer.org/2009/03/multidisciplinary-second-opinion-centers/ on the Internet. You can also contact the R. A. Bloch Cancer Foundation, Inc. by telephone at 816-854-5050 or 1-800-433-0464.

Finding a Treatment Facility for Patients Living in the United States

Choosing a treatment facility is another important consideration for getting the best medical care possible. Although you may not be able to choose which hospital treats you in an emergency, you can choose a facility for scheduled and ongoing care. If you have already found a doctor for your cancer treatment, you may need to choose a facility based on where your doctor practices. Your doctor may be able to recommend a facility that provides quality care to meet your needs. You may wish to ask the following questions when considering a treatment facility:

• Has the facility had experience and success in treating my condition?

• Has the facility been rated by state, consumer, or other groups for its quality of care?

• How does the facility check on and work to improve its quality of care?

• Has the facility been approved by a nationally recognized accrediting body, such as the American College of Surgeons (ACS) Commission on Cancer and/or The Joint Commission?

• Does the facility explain patients’ rights and responsibilities? Are copies of this information available to patients?

• Does the treatment facility offer support services, such as social workers and resources, to help me find financial assistance if I need it?

• Is the facility conveniently located?

If you are a member of a health insurance plan, your choice of treatment facilities may be limited to those that participate in your plan. Your insurance company can provide you with a list of approved facilities. Although the costs of cancer treatment can be very high, you have the option of paying out-of-pocket if you want to use a treatment facility that is not covered by your insurance plan. If you are considering paying for treatment yourself, you may wish to discuss the possible costs with your doctor beforehand. You may also want to speak with the person who does the billing for the treatment facility. In some instances, nurses and social workers can provide you with more information about coverage, eligibility, and insurance issues.

The following resources may help you find a hospital or treatment facility for your care:

• The NCI-Designated Cancer Centers database (described above in the section Finding a Doctor) provides contact information for NCI-designated cancer centers around the country.

• The ACS’s Commission on Cancer (CoC) accredits cancer programs at hospitals and other treatment facilities. More than 1,433 programs in the United States have been designated by the CoC as Approved Cancer Programs. The ACS Web site offers a searchable database of these programs at http://web.facs.org/cpm/CPMApprovedHospitals_Search.htm on the Internet. The CoC can be contacted by telephone at 312-202-5085.

• The Joint Commission is an independent, not-for-profit organization that evaluates and accredits health care organizations and programs in the United States. It also offers information for the general public about choosing a treatment facility. The Joint Commission’s Web site can be found at http://www.jointcommission.org/ on the Internet. The Joint Commission can be contacted by telephone at 630-792-5000.

The Joint Commission offers an online Quality Check™ service that patients can use to determine whether a specific facility has been accredited by the Joint Commission and to view the organization’s performance reports. This service is located at http://www.qualitycheck.org/ on the Internet.

• The AHRQ publication Your Guide to Choosing Quality Health Care (described above in the section Finding a Doctor) has suggestions and checklists for choosing the treatment facility that is right for you.

Finding a Treatment Facility for Patients Living Outside the United States

If you live outside the United States, facilities that offer cancer treatment may be located in or near your country. Cancer information services are available in many countries to provide information and answer questions about cancer; they may also be able to help you find a cancer treatment facility close to where you live. A list of these cancer information services is available on the International Cancer Information Service Group’s (ICISG) web site at http://www.icisg.org/meet_memberslist.htm on the Internet. A list may also be requested by writing to the NCI Public Inquiries Office at the following address:

The ICISG is an independent international organization composed of cancer information services. Their mission is to provide high-quality cancer information services and resources to those concerned about, or affected by, cancer throughout the world.

The International Union Against Cancer (UICC) is another resource for people living outside the United States who want to find a cancer treatment facility. The UICC consists of international cancer-related organizations devoted to the worldwide fight against cancer. UICC membership includes research facilities and treatment centers and, in some countries, ministries of health. Other members include volunteer cancer leagues, associations, and societies. These organizations serve as resources for the public and may have helpful information about cancer and treatment facilities. To find a resource in or near your country, contact the UICC at:

Some people living outside the United States may wish to obtain a second opinion or have their cancer treatment in this country. Many facilities in the United States offer these services to international cancer patients. These facilities may also provide support services, such as language interpretation, assistance with travel, and guidance in finding accommodations near the treatment facility for