Cancer is probably the most feared of all of diseases. This is in part because the approach using only chemotherapy, surgery and radiation have failed to guarantee a successful outcome. One of the common misconceptions of choosing a therapy is defining success in terms of response rate. Response rates does not mean cure. It does not mean improved quality of life, a disease-free state, or prolonged lifespan. In fact, response rate is often a poor way to judge the merit of a particular therapy. Our approach is not to replace these standard modalities, but to harness and augment the body’s own healing capacity.
MECHANISMS OF CANCER DEVELOPMENT
Here are some facts about cancer:
Otto Warburg, M.D. proved that the basic cause of all cancer is TOO LITTLE CELLULAR OXYGEN. Everything ever suggested as an environmental promoter to cancer acts in large part by inhibiting oxygenation of the cell:
Because it cancer takes years to develop, if caught early enough, a cluster of cancer cells can be oxygenated so that cancer tumor never fully develops. Of course genetics and hormones play a major role in setting the stage for cancer. However, once cancer has developed, there is no known mechanism for reverting the cell to normal (respiration only). The best protection against cancer is not early detection, although pap smears, mammograms, colonoscopies, prostate checks and PSA levels play an important role in early intervention. These should not be cornerstone of your cancer avoidance program. The fact is that they aren’t even the best tools for finding cancer early.
Cancer actually starts showing tell-tale signs about 10-20 years before these tests even suggest trouble. The signs of cancer predilection show up in minute, abnormal reactions at the cellular level. Just as we monitor blood levels of cholesterol, etc. for heart disease, the same is now available for cancer. In addition the anaerobic (without adequate oxygen environment (see discussion below) that promotes cancer development can been seen for years before the cancer reaches a critical size. Computerized Regulatory Thermography may tell if your autonomic nervous system responds to stress appropriately. Since your nervous system directs your biochemistry, this can be a tremendous insight into your future. Other labwork now available include measuring cellular DNA adducts that have bound to DNA and mutate its expression. protein adducts, DNA repair enzymes, lipid damage, anti-oxidant levels, NK immune cell function, programmed cell death, etc. are also indicators of the tendency toward cancer development.
While these are triggers, there are many theories about how cancer and why cancer develops. One theory proposed by Donald Kelley, DDS is that cancer is a result a misplaced germ cell that has change into a misplaced trophoblastic cell due to an excess of or sensitivity to estrogen. Just as an embryo (germ cells) develops a placenta that invades into the wall of the uterus (trophoblast), the process is hormone dependent. When the fetus begins to produce pancreatic enzymes the placental trophoblast stop invading the uterus and remain stable. Thus the malignancy is in part a disorder of protein metabolism due to inadequate production or utilization of enzymes. This then becomes an avenue to consider when managing an individual with cancer.
The National Academy of Sciences estimates 60% of women’s cancers and 40% of men’s cancers are related to nutritional factors. The cancers most closely associated with nutritional factors are breast and endometrial cancers in women and prostate cancer in men, and gastrointestinal cancer. Cancer, like many diseases, is a collision between environmental insult and genetic vulnerability. There is strong evidence that cancer prevention and treatment approaches must include nutrition.
The term cancer, neoplasia, and malignancy are usually used interchangeably and are defined by four characteristics that differentiate cancer cells from their normal counterparts.
Obviously, a successful approach will address each of these issues as well as establishing a strong and healthy mind and body. At least 40% of cancer patients will die from malnutrition and not the cancer itself. There are multiple studies showing a guided nutrition program for cancer patients improves the quantity of life by 12 – 21 fold as well as improving the chance for complete remission. The RDAs are not designed for cancer patients. Determining specific imbalances and remedies to improve your overall health requires an individualized assessment.
As an analogy to cancer, a fungus grows on a tree because of warmth, moisture, and darkness. In fact, there are several leading researchers who believe that cancer is a fungus. Nevertheless, you can cut (surgery), burn (radiation) and poison (chemotherapy) the fungus off the tree, but the fungus will return as long as the tree condition is favorable. There are conditions that favor the growth of cancer – changing those conditions are the focus of our approach. For example, the lack of assimilatable unsaturated fat and an anaerobic cellular metabolic state are common findings in patients with cancer. Impaired protein metabolism is found in patients with solid tumors. Correcting these factors is a must. In addition, maintaining a positive nitrogen balance, strengthening liver and kidney detoxication functions, ingesting adequate amounts of negative valence sulfurated proteins (I believe the reason for this is because negatively charged sulfurated proteins aid in the body’s manufacture of glutathione), and optimizing immunologic competency are management goals.
Because we can learn from all information related to cancer, looking at preventive measures could be useful for the patient who already has cancer. There is evidence that certain pre-cancerous changes may be reversible with supplementation. Cervical dysplasia, for example, may be reversed by folate (not to be confused with folic acid, which is not a natural substance in the body) supplementation, especially if deficient. Calcium supplementation may reduce the number of rapidly proliferating cells in colonic epithelium in patients with family histories of colon cancer. Because iodide promotes the conversion of estrogen to less carcinogenic forms, iodide can be a powerful inhibitor of hormone-based cancers such as prostate and breast. Vitamin A and beta-carotene reduce the percentage of genetically-damaged cells inside the cheek when betel liquid, a tobacco-like mixture, is chewed regularly. Vitamin A supplements provided complete or partial remission in patients with benign breast disease. Vitamin D insufficiency is associated with an increased incidence of breast, colon, and prostate cancer. Nitrosamine levels in the stomach are reduced with 1 gram of vitamin C given daily. Calcium D-glucarate and indole-3-carbinol show great promise for breast cancer by reducing specific estrogens that promote cancer and by enhancing detoxication of potentially damaging chemicals. Components of green tea appear to inhibit the formation of breast, skin, and esophageal cancers. There is a long-standing well-accepted link between elevated insulin levels and risk of cancer. This suggests that excess sugar and carbohydrates with a high glycemic index contribute to the development of cancer. Sugar is one of the most powerful ways to a cell to become non-aerobic. You must go on a sugarless diet. Information like this may help provide clues for managing specific type of cancers…
CONSIDERATIONS FOR THE PATIENT WITH A MALIGNANCY
It should be clear I am not claiming or implying any anti-cancer effect or any part of my care substitutes for conventional or investigational anti-cancer regimens. Furthermore, I am not advising you against seeking other qualified medical opinions with regard to your cancer care. I do not and will not give any advice on conventional treatments. I do advise you to question your doctor as to the long term effect of your therapeutic options. For example, question a choice to use a chemotherapeutic anti-cancer agent to which the cancer responds but does not confer a high-quality longer life-span (win a battle but lose the war). My role is to support you and let the cancer specialist treat the cancer. Realize that most adults have a small and hopefully transient number of cancer cells at any one time. The difference between developing uncontrolled cancer and staying “cancer-free” is staying out of a prolonged “cancering” mode – in other words making your internal environment resistant to disease. This is what we hope you can accomplish.
One of the great conflicts that many cancer patients face is whether or not to combine traditional methods of addressing cancer (surgery, radiation, or chemotherapy) with nutrition, anti-oxidants, etc. The debate often focuses on the use of anti-oxidants during chemotherapy or radiation therapy. The issue becomes even more problematic because many oncologists are adamant about the issue and do not let the data speak for itself or help you make an informed decision about what you want to do. Here are some facts – There is increased tumor kill rates, no interference of the therapy, and decrease side effects when nutrients are given with chemotherapy and/or radiation based on 61 studies over 40 years. There are 145 references using studies using lab studies (cell) and 135 reference using animal studies to support this. Even more convincing are studies involving humans in involving 9,617 patients, of which 5,917 of whom were given nutrients as part of the study. There was increased survival for 3,975 patients using the nutrients, which is %. There is not a single published study in humans that shows anti-oxidants are harmful in cancer therapy and there are no published studies that show antioxidants protect cancer cells against radiation. This should be no surprise given the fact that anti-oxidants have been shown to improve cell differentiation and growth inhibition through several mechanisms (1. inhibit bad genes: gene expression and/or activity of p53 mutant, c-myc, H-ras, Bcl, c-neu, cerbB, VEGF, phosphotyrosine kinase, Protein kinase C; 2. enhance good genes: gene expression and/or activity of p53 wild-type, p21, c-fos, c-jun, HSP70, HSP90, connexin, TGFb, Map kinase, Caspase, Cyclin A and D and their kinases; 3. antioxidants selectively inhibit repair of radiation damage of cancer cells but protects normal cells when antioxidants are used before, during, and after radiation). Whatever you decide, do it based on facts not opinions, no matter how emphatic someone is.
GENERAL DIETARY SUGGESTIONS
Specific Foods: In addition to the anti-oxidants, research shows there are additional cancer-fighting substances in fresh fruits and vegetables. Cruciferous vegetables (broccoli, cauliflower, cabbage, and Brussels sprouts) contain indole-3-carbinol (13C) and di-indolemethane (DIM) that shifts the metabolism of estrogen to less problematic forms and is associated with reduced breast cancer. Broccoli also contains sulforaphane (one of a group of chemicals called isothiocyanates), which increases the activity of enzymes that detoxify cancer-causing agents. Foods high in glucaric acid include broccoli, oranges, carrots, spinach, and apples. Soybeans and red clover contain genistein, a substance that interferes with the formation of new blood vessels. Genistein also acts as an anti-oxidant. Other substances found in soybeans are phytoestrogens that act as partial antagonists/agonists to estrogen. Tomatoes contain a variety of carotenes, including lycopenes, which are anti-oxidants thought to deter cancer formation. Because sugar is a strong promoter of a pro-cancer metabolism, fruit juices should be avoided because of their high sugar content relative to the whole fresh fruit.
Go sugarless: Nobel Prize winning Otto Warburg, Ph.D. demonstrated that all cancer cells develop in an oxygen-free environment, for which sugar is the primary fuel. An Israeli study confirmed that cancer cells have three times the amount of insulin and take up glucose 3-5 times more than normal cells, supporting the concept of a sugar-based metabolism. Furthermore, sugar intake has been shown to suppress your immune response from 30% by white blood cells and up to 50% by lymphocytes for at least 6 hours. It is important to realize that most packaged carbohydrates are made with white flour, sugar, fruit juices, corn and rice syrups, high fructose products, etc. all are sugar! Almost all breads, muffins, baked goods, etc. to some extent are simply forms of processed sugar. Recent studies have shown that aspartame (EqualÒ, NutraSweetÒ) stimulates insulin release, which is especially encouraging to cancer cells. In a 10 year study of 500 women with breast cancer showed that there is twice the death rate in women with higher serum insulin levels.
Protein Consumption: With regard to protein, a key issue is that cooking or heating protein destroys much of its value and actually creates a cancer-promoting food. The type of protein depends on the type of cancer.
Based on the work of Donald Kelley, DDS, protein consumption must be carefully chosen. It was his theory that the pancreas could not manufacture enough enzymes to digest the large amount of processed protein we consume (dairy, meat, and peanuts). He claimed that 83% of the solid tumor cancers in America would be eliminated if we would stop eating protein after 1pm. This would allow the body time to regenerate the enzymes needed for digestion as well as the metabolic cleanup. While certainly this is not what the American Cancer Society would endorse, Dr. Kelley reportedly had over 22,000 cancer patients with an envious track record of success. This alone warrants examining his observations. For patients with solid tumors (other than myelomas, lymphomas) we recommend no red meat (beef, pork, lamb, venison, etc) at all, only small amounts of organic fowl (without use of hormones or arsenic), no dairy products except for unpasteurized yogurt and cottage cheese in the morning, and no peanuts. Peanuts are high in protein and are commonly contaminated with a fungus that produces and aflatoxin, which is used in research to stimulate cancer. Raw almonds, raw vegetables, and whole grains are the preferred source of food proteins. Kelley recommended 10 almonds at breakfast and 10 for lunch. The vegetables were best consumed as fresh raw juices with the fiber remaining along with just enough fruit to make palatable. The grains were organic and soaked overnight to make a Muesli-like cereal.
Eat Essential Fatty Acid rich foods: Essential fatty acids are oxygen magnets that draw oxygen in to all cells. Foods that contain EFAs include raw seeds, nuts, and green leafy vegetables. Any animal proteins should be from grass-fed animals, raw milk only, and free-range chicken and eggs, or sushi/sashimi. The type of fat you consume also profoundly effects cancer and your immune system. Corn oil should be avoided.
CONSIDERATIONS FOR THE PATIENT WITH A MALIGNANCY
There are specific suggestions associated with each type of cancer. For example, melanomas and glioblastoma multiforme consume excessive amounts of phenylalanine and tyrosine. Prostate and breast cancer are often influenced by hormones. Other cancers have different characteristics, and thus each cancer patient type warrants a specific strategy
There are eight general goals when using nutrition in an individual who has cancer.
As I have mentioned already, one of the great discoveries about cancer was made by Otto Warburg, who received a Nobel Prize for showing that the difference between normal cells and cancer cells was the ability to use oxygen. The normal cell requires oxygen to produce energy from glucose, but the cancer cell does not. Glucose metabolism when oxygen is used creates 30 units of energy (ATP) per molecule of glucose. Glucose metabolism without oxygen, as is the case in cancer cells, only produces 2 units of energy per molecule of glucose. As a result of this anaerobic (without oxygen) metabolism of glucose, the cancer cells build up lactic acid. Lactic acid is what you feel in your muscles after a work-out. The liver and to some extent the kidneys can convert the lactic acid back into glucose. Since the cancer cell is so inefficient in making energy from glucose (2 units of ATP compared to 30), it takes a large amount of glucose to quench the energy demands of the growing cancer. The cancer ultimately starts to steal the glucose supply from the body and the malnutrition begins. Finally the weight loss and fatigue sets in and the cachexia becomes more dangerous than the cancer itself. As you can see sugar and simple carbohydrates should always be avoided.
Lactic acid build-up induces an acid build-up within the cell, which now causes changes in the DNA of the cell to promote unlimited reproduction. In other words, the cancer feeds itself in an acid environment. This is one reason that your program will include alkalizing or oxygenating nutrients – minerals like calcium, magnesium, oxygen, sodium, germanium, etc. found in vegetables. Some specific cancer therapies like cesium can raise the pH (move it toward alkalinity rather than acidity) and thereby reduce the cancer’s growth cycle. Cesium has been used at Texas Tech for sarcoma, Germany for lung cancer with bone metastasis, and University of Wisconsin for colon cancer. The moral of the story here is to have a diet rich in alkalizing minerals by eating a lot of fresh organic vegetables. (Organic vegetables tend to have a higher mineral and nutrient content compared to others). One of the best ways to get healthful vegetables is Beiler’s Broth, which is listed elsewhere on my website. It is rich in nutrients that supply vitamins and minerals and assists in liver detoxication. Another potential way to starve the cancer then is to interfere with the liver’s ability to produce glucose from lactic acid (the enzyme is called phosphoenolpyruvate carboxykinase) through hydrazine sulfate. Again, the specific agent is not the emphasis but rather the conceptual approach to altering the tissue environment.
It is important not to confuse immune stimulation with immune support. Cancer seems to thrive and even induce inflammation. For example, increased levels of several small chemicals called cytokines, are associated with disease activity, poorer outcomes, metastasis, etc. A few relevant examples include Nuclear Factor-kappa B (NF-kB), interleukin-6 (IL-6), IL-8, and Tumor Necrosis Factor-alpha (TNF-a), which all promote inflammation. One strategy to consider is to monitor and attempt to reduce the levels of these pro-inflammatory cytokines. There are many nutritional supplements that down-regulate their production. An effective strategy is to optimize hormone levels since hormones like DHEA, testosterone, estriol, etc. reduce inflammation, etc.
But we must be certain that in an effort to improve detoxification, you are not reducing the effectiveness of the treatment you have chosen. Many of the programs and products have been studied for their influence on killing the cancer cells. Whenever possible we try to not get in the way of other therapies but to support the healthy parts of the body as it deals with the extra metabolic-toxic burden.
I would be less than truthful with you if I did not tell you that the hardest and most uncomfortable part of dealing with the patient with cancer is without question, detoxication. In reality, because our patients should not die from malnutrition, the biggest burden we will face is toxic waste products from the either the cancer itself or the accumulated toxins that have never been eliminated successfully. Repair and recovery only occurs when the body has become purified. The liver is the major gland of detoxication and this is the organ to focus on in most cases. The colon is the primary avenue of elimination and this too must be healthy.
Tissue detoxification – matrix
H.Riordan and his group (RECNAC) as published in Medical Hypothesis (1995), ascorbic acid and its salts (AA) are preferentially toxic to tumor cells in vitro and in vivo. Given in high enough doses to maintain plasma concentrations above levels that have been shown to be toxic to tumor cells in vitro, AA has the potential to selectively kill tumor cells in a manner similar to other tumor cytotoxic chemotherapeutic agents. Most studies of AA and cancer to date have not utilized high enough doses of AA to maintain tumor cytotoxic plasma concentrations of AA. There is a 10 — 100-fold greater content of catalase in normal cells than in tumor cells. This potentially creates a large gap between the toxic dose of hydrogen peroxide for normal cells compared to tumor cells. Ascorbic acid and its salts (AA) are preferentially toxic to tumor cells both in the lab (in vitro) and in the body (in vivo). This preferential cytotoxicity has been demonstrated to be related to intracellular hydrogen peroxide generation. AA thus belongs in a class of substances which, given at the correct dosage, can preferentially induce cytotoxicity of tumor cells with negligible toxic effects to the host. AA concentrations exceeding those required to kill 100% of tumor cells in vitro can be sustained in humans and that those levels can generally only be obtained by intravenous administration of AA. Here is a partial list of what is reported in the scientific literature about IV AA use:
The worst thing you can do in terms of reducing cellular oxygenation is to consume trans-fats. Even foods stating there are “0 grams” of trans-fats can contain some (< 0.5g) based on labeling laws. Trans-fats are often listed as partially hydrogenated oils. The type of oil that has been hydrogenated is not relevant. Another problem area is thinking that olive oil is acceptable. Olive oil contains a high percentage of oleic acid, a non-essential fatty acid, which competes with the essential omega-3 and omega-6 oils for incorporation into the cell and mitochondrial membrane. Because oleic acid is 50% as effective in oxygen transfer compared to LA (omega-6), choosing the proper oils is critical to optimizing cellular oxygenation.
The autonomic nervous system must also be considered when balancing the metabolism. Solid tumors that have originated from epithelium include the liver, breast, lung, pancreas, colon, ovaries, prostate, and uterus seem to occur only in individuals with an overly active sympathetic nervous system (and therefore a weak parasympathetic nervous system). A vegetarian diet emphasizing fresh fruits and vegetables (particularly leafy greens) contains large doses of magnesium and potassium. It has been shown in many studies that magnesium suppresses the sympathetic nervous system while potassium strengthens the parasympathetic nervous system. Melatonin reduces sympathetic outflow. While melatonin supplementation is convenient, resting in a dark quiet room (sleep, nap, etc) also stimulates melatonin release. In addition, fruits and vegetables are alkalinizing, and this too has a balancing effect on the autonomic nervous system by reducing sympathetic activity and increasing parasympathetic activity. For these individuals, a diet largely vegetarian with fruits, vegetables, nuts, whole grains, and seeds with occasional fish, eggs, or yogurt with no other animal protein is suggested.
On the other hand, blood or immune based malignancies such as leukemias, lymphomas, and myelomas do best on a high animal protein, high fat diet because these seem to occur in individuals with an overly active parasympathetic nervous system (and therefore a weak sympathetic nervous system). Such a diet is rich in phosphates and promotes acidity that stimulates the sympathetic nervous system. The Nerve Express used in our office to assess heart rate variability gives a scientifically valid profile of the sympathetic and parasympathetic nervous system.
From an observational study by L Michaels of Canada, patients kept on permanent anti-coagulant therapy (fro stroke or heart reasons) had only 1/8th the expected number of cancer deaths. In fact there was not a single case of death by cancer metastasis. Although anti-coagulants do not reduce the viscosity (stickiness) of blood, parent omega-6 fats reduces platelet clumping and thus increases the speed of blood flow.
In a long term project begun in 1946 by Caroline Bedell Thomas at Johns Hopkins School of Medicine charted students over decades of time to see what specific psychological indices were associated with the development of cancer – poor relationship with parents, self-pity, self-deprecation, passivity, a compulsive need to please. And above all an inability to rise from depression after some traumatic event such as the death of a loved one or loss of a job.
As a corollary to this is how you decide on your course of action. You no doubt will be bombarded by information and suggestions by well-intentioned friends, family, etc. Whatever you decide, do it without doubt. Do not reduce the power that having control and a clear intent provides. The mind is an extraordinarily powerful tool, let it work uninhibited without doubt and uncertainty. That doesn’t mean new approaches and inquiry are to be avoided, rather the choices you make are with all your heart and soul…
Although not exactly the same as emotions, the mind is a powerful tool and weapon. Harnessing the power of your mind to influence your immune system, behavior, etc. should not be underestimated. Just realize that a person (just like you) put in the proper frame of mind can walk on hot burning coals and not burn his/her feet! Imagine what you can do!
Russian reports indicate that using magnetic therapy along with chemotherapy increases success in the treatment of brain tumors. Patients given magnetic therapy were less sick than patients who did not receive it, and they recovered more quickly. They also had fewer problems with their adrenal glands, which chemotherapy can sometimes affect.
Since the amount of information available on magnetic therapy with cancer is so limited, and since cancer is such a serious condition, one should never consider magnets as a sole therapy. Again, we are not trying to treat cancer with magnets, only to make your cellular environment as resistant to disease (including cancer) as possible. To entice you to research Electro-Negative Static Magnetic Energy (ENSME) further, it is reported to increase cellular oxygen, pull fluids and gases, reduce fluid retention, encourage deep restorative sleep, fight infection, promote mental acuity, support biological healing, reduce inflammation, normalize acid base balance, relieve/stop pain, reduce/dissolve fatty deposits, reduce/dissolve calcium deposits, etc.
GENERAL BREAST CANCER PREVENTION
Cultural Diets: Traditional Oriental diets are associated with very low risk, traditional Mediterranean with an intermediate risk, and Western diets with a very high breast cancer risk. Of all of the literature I reviewed regarding beneficial dietary substances, iodine insufficiency seems to be a common denominator in breast cancer. This is not surprising given the fact that other than the thyroid gland, the breast tissue contains the most iodine than any other tissue.
General Nutrients: Vegetables, fruit and fish provide protection. Beans, whole grains, non-fat yogurt, and extra-virgin olive oil are fine. High animal and/or saturated fat intake seems to be associated with increased incidence of breast cancer due to increased estrogen exposure. EPA (from fish) and GLA (from black currant seeds, primrose, borage) apparently alter the properties of tumor cell membranes to make them more responsive to chemotherapeutic agents as well as being selectively toxic to human breast cancer cells in vitro.
Avoiding estrogenic agents: Agents with estrogenic effects include pesticides such as DDT, heptachlor, and atrazine, ingredients in plastic (polycarbonates and polystyrenes), magnetic fields, and petroleum by-products. Certain drugs have estrogenic effects such as cimetidine (Tagamet®) and alcohol. In addition the metabolism of estrogen can take one of two paths, one that promotes cancerous behavior (the 4 and 16 OH pathway) and the 2 OH pathway that appears to reduce cancer potential.
Specific Chinese herbs have been shown to dramatically lower estradiol levels. This herbal product directly decreases estrogen production by inhibiting Aromatase, the enzyme that converts androstenedione to estrone and converts testosterone into estradiol. This herb has been shown in several studies to directly reduce estrogen levels through this mode of action. It also competitively attaches to estrogen receptors in estrogen-sensitive tissues. By attaching to the receptors, estrogen can no longer stimulate the tissue to proliferate. Whether or not other estrogens are reduced or the profile of estrogen metabolism is altered by these Chinese herbs has not been reported.
One study showed that EPA, an omega-3 oil found in fish, lowered the level of estradiol in 25 women at risk for breast cancer. As published in the Journal of the National Cancer Institute (Nov 2, 2005; 97 (21): 1611-5), gamma-linoleic acid (GLA) found in evening primrose oil and black currant seed oil can inhibit the action of the cancer gene, Her-2/neu. This gene is responsible for almost 30% of all breast cancers. GLA also improves the response to the drug Herceptin up to 40 times (not 40% but 40x).
IF YOU HAVE CANCER AND WOULD LIKE TO ADD A NUTRITIONAL/METABOLIC PROGRAM
To be successful, you must have a comprehensive and individualized approach. Winning the battle against cancer and then losing the war to malnutrition and toxic build-up is all too common. I can not make generalized nutritional recommendations in good conscience. There is no other condition where careful monitoring is as crucial. We have employed several objective monitors of your physiology in an attempt to be sure that what are doing is actually working. We want you to be sure that you are doing the right thing and not just something for the sake of doing it. The wrong supplements may actually promote further cancer. If you would like to get us to get involved in caring for you, call the office and we will make your visit as soon as possible (top priority on our pending appointment list). Do not give up; we have many healthy survivors of cancer in our practice and for those without detectable cancer focus on reducing their cancering tendencies.