September 2008

Q. Our daughter, Claire, age 48, recently had laparoscopic surgery for removal of the gall bladder at Pottstown hospital. She was advised that a carcinoma had breached the gall bladder wall and further surgery has been recommended, to be followed by chemotherapy. She has had a CT scan and is to have a colonoscopy shortly.

From all we have read, it is advisable to seek a second opinion in such circumstances and we are hoping to persuade her to do so. However, we do not know the specialists in carcinoma of the gall bladder and surrounding tissue in Philadelphia and wonder whether you are able to offer us guidance in the form of some names and/or hospitals which we could offer her.

We are not suggesting any doubts concerning her existing medical team but as this can be an extremely serious situation, we would very much like her to have a second opinion before further surgery takes place. We do not wish to place you in an ethical dilemma but would appreciate any help you can offer.

A. I am so sorry to hear this - and I guess so unexpected. I can't agree more strongly with your reaction. Although her care may be perfect, this is an unusual cancer and one that I would want to have more opinions than one. Philadelphia is rich with oncologists that are world class. I personally would have her physician refer her to Fox Chase Cancer Center and/or University of Pennsylvania. She should be treated by a group that has the most experience with this unusual circumstance. My best hope is that it was found early enough as I assume she had few if any symptoms and that treatment really can make a huge difference.

Ideally her physicians should be comfortable and willing to make the referral for a second opinion. Perhaps her treating doctors already have connections or colleagues at one of the local universities.

Q. I was watching GMA this morning about your medical patient with Hodgkin's Disease. My husband has recently had a total thyroidemptmy. He had a large mass around his throat. It was the size of a softball and the growth was very aggressive but there was no cancer found. Before and after the surgery he has consent itching on his lower legs & back. He seems to almost break out in hives with the itching. He has gone to several primary and dermatologists to have this diagnose, each doctor we see says they don't know the cause and the itching has not stopped, even with the cream. At this point, we don't know what type of doctor to see. I was hoping that you could help me find the right kind of Doctor for him to see. We live in Holland, PA. We are very close to Philly, Thomas Jefferson Hospital. I know that you may not be able to recommend at particle doctor, but if you could give me the type of doctor who could maybe help . I would be most grateful.

My husband is actually getting close to some diagnois. They did a bone marrow test which came back with extremely high levels of eosinophil( which has been elevated for over 6 months at 44%) and showed an unusual, almost malignant appearance. The doctors are looking at idiopathic hypereosinhlic syndome. He is also seeing an Allergist to rule out any allergy per his doctor at Thomas Jefferson Hospital.

A. It sounds like he is in the best of hands already at Jefferson which is a fabulous medical center. His extremely elevated eosionophil counts on bone marrow tell me he is seeing the best experts/a hematologist oncologist and allergist. I wish you both the best in finding a treatment and solution.

Q. I just wanted to thank you for bring all kinds of medical awareness to GMA and other platforms. By watching that episode, it at least got me to look further into my husband condition. Thank you again

Q. What’s your opinion of giving young girls the Gardisil vaccine? My daughter is 13 years old after MUCH discussion, she received the first round. At her appointment a few weeks ago, we had a discussion with my daughter's favorite (and ours too) pediatrician about continuing with the booster shot….we decided to wait.

A. The short answer is that if I had a daughter I would give her the series. (I have three older sons and suspect someday boys too may be getting the vaccine). This is a topic that I have a great interest in. Let me summarize my thoughts.

Benefits: it appears to be 100% effective against the most virulent form of HPV - the HPV 16 type that causes most cervical, anal and even tonsillar cancer (which you will being hearing much more about - as it is on the rise). And although there are only 11,000 or so cases of cervical cancer in the US/year, there are half a million abnormal Paps from high risk strains of HPV such as HPV 16 that lead to surgery, cone biopsy, etc. all of which have side effects and potential negative impact on a woman's future pregnancy.

Safety: Australians just reported on over 250,000 vaccine doses - and found slightly higher number of anaphylaxis episodes compared to meningitis vaccine (hives primarily but nothing life-threatening) in about 2/100,000 cases however nothing else serious/worrisome was reported. Although there is reasonably lots of concerns about anything new, the adjuvant in the vaccine is similar to what is in Hepatitis B which we give our newborns...and is a much simpler protein vaccine than many other older vaccines.

Unknowns: there are many unknowns, how well will it work on the population, is the cost worth lives saved, could resources be better used elsewhere, isn't Pap already good enough although far from perfect, do you need a booster sometime, etc. etc. Is there any long term concerns with the vaccine unsuspected?

Even after one dose, your daughter has some protection...and I presume (and hope for your sake) she won't be sexually active for many more years so you have lots of time to give her number 2 and 3. There is no reason to start all over or even rush to make a decision. Just ask yourself what you fear most (sex is inevitable, acquiring HPV is very likely as most of us do, and knowing who will get rid of the virus and who won't is not easy to predict) - the uncertainty abut this vaccine or losing the window of opportunity you have to give your daughter this protection (and once she becomes sexually active, still worth giving but guarantee of protection no longer 100% )

In the end however, I am truly biased in favor - yet I hope it is because I have had the chance to see the face of HPV disease worldwide and am reassured by researchers/immunologists who know so much about the likely safety of the vaccine.