September 30th, 2009
02:11 PM ET

Join Dr. Gupta and Fit Nation on the road

By Matt Sloane
CNN Medical Producer

There are few things that excite me more in my job than a run of Fit Nation Tour events, and that's exactly what we're kicking off this weekend! It's not the travel so much that I'm excited about, but the opportunity to meet thousands of people who are eager to hear the latest information about obesity, losing weight and healthy living.

I've written these numbers over and over again: 66 percent of Americans are either overweight or obese; 33 percent of children fall into this same category. This is NOT OK! So, we've partnered with the YMCA – a fantastic community organization – to get kids moving again. We've taken a page from the YMCA of Cleveland's book and modified a program called "We Run This City" – where kids run 25 miles of a "marathon" over the course of two months, and run the final 1.2 miles during their city's big marathon. Once they cross the finish line, they receive a medal, a certificate and a sense of confidence – a feeling, that they CAN stay healthy and have fun.

This Sunday, we'll hit the Medtronic Twin Cities Marathon in St. Paul, Minnesota, followed by Chicago on Sunday, October 11. We’ll also be at the Marine Corps Marathon in Washington, D.C., on Sunday, October 25th. If you're in one of these cities, come out and visit! Dr. Sanjay Gupta will be joining us in Minneapolis and Chicago, and he'll be signing advance copies of his new book: “Cheating Death.”

To learn more about the Fit Nation Tour, and for tips and tricks to help you get fit, plus stories of how other people have conquered the battle of the bulge, go to CNN.com/Fitnation.

September 28th, 2009
12:43 PM ET

Pushing ahead with multiple sclerosis therapies

By Georgiann Caruso
CNN Medical  Associate Producer

When I first heard about the possibility of a pill for multiple sclerosis (MS), I exlaimed, "No way!" As a person living with MS, I know that this would be a enormous advance for the MS community. The option of a pill instead of needles sounds incredible, making it so much easier for many people to stay on their therapies since currently they all involve needles. Delving into this further, I realized that several drugs in trials seemed to hold great promise, and they are not light years off.

But things aren't as simple as they first appeared.

First off, an explainer for those unfamiliar with the disease who might be curious, because chances are you know someone affected by MS. The National Multiple Sclerosis Society defines it as a "chronic, often disabling disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves." The cause isn't yet known and there is no cure. What happens is the myelin - the covering of the nerves - is destroyed by the immune system. The result is scar tissue; therefore nerve impulses, or messages, are slowed down leaving people with any number of symptoms including balance, speech, vision and memory problems as well as fatigue and heat sensitivity, to name a few.

Currently, there are five potential first-line disease-modifying therapies on the market, which became available starting in the early 1990s. Four are injectibles, and vary from being given once a day to once a week. Then a few years ago, the drug Tysabri was introduced, offering a new option for people with MS as it is given intravenously once every four weeks. The choice is up to the patient and the provider.

The drugs are intended to reduce the frequency and severity of MS attacks and slow the progression of the disease. Depending on the therapy, clinical relapses can be reduced by between 1/3 and 2/3.

But the FDA has yet to approve a therapy that can be taken orally. That may soon change.

Scientists from the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) just wrapped up a meeting in Düsseldorf, Germany where they discussed this and other exciting developments in the MS community. So what does this mean for the more than 400,000 people in the U.S. - and the more than two million people worldwide –that have this debilitating neurological condition? And what does it mean for their families, friends and caregivers?

I posed that question to Dr. John Richert, Executive VP, Research & Clinical Programs of the National Multiple Sclerosis Society, who emphasized that this is a very exciting time in the MS community.

He brought back news of the emerging trends discussed at the conference:

– The first oral symptom-management drug designed to improve nerve conduction, Fampridine, is already before the FDA for review. Fampridine has been shown to improve walking speed, but may also prove to help with other symptoms of the disease (which are less easy to quantify.) Expected to follow soon are the oral disease-modifying therapies Cladribine and Fingolimod. It's important to note though, these new drugs may well carry different risks than some of the currently available options. So while the method of taking them may be easier, they will not come without their own set of possible side effects and, as Richert suggests, there will be some unchartered territory as more people take the drugs.

-Therapies with infrequent dosing (such as once a year) are being studied.

-Stem cells hold promise for new MS treatments. Of particular interest are adult bone marrow mesenchymal stem cells. According to Richert, it's a bit too early yet to know whether this approach will prove safe and beneficial, or how exactly the therapy will work.

-Within the next year or two, most of the common genes that predispose people to develop the disease will be identified. This is important not only for prevention, but for treatment as well. However, further research is needed about environmental triggers to see how genes and the environment interact to cause MS.

MS is a complicated disease and varies among individuals. What is your realistic hope for the disease and research? Now or 5-10 years down the road? We'd like to hear from you.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

September 25th, 2009
10:07 AM ET

Nick Jonas shares his diabetes journey

By Leslie Wade
Producer CNN Medical News

I had the pleasure of meeting pop star Nick Jonas when he and his band were touring in Atlanta, Georgia, in late August. I know he's had media training and been in front of cameras for years, but I was impressed with his composure as he told me about his journey with a disease that affects one in 300 teens.
[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/images/09/23/art.nick.jonas.jpg
caption="Nick Jonas talks about living with diabetes."]

Four years ago Nick, the youngest member of the Jonas Brothers band, spent three days in the hospital. He'd lost 15 pounds in the previous three weeks and he and his family knew something was terribly wrong. Nick had developed type 1 diabetes - his body was no longer producing insulin, a hormone needed to convert sugar into energy for our bodies.

Nick made a promise to himself that day. "My commitment to myself, when I was on my way to the hospital, was that I would not let this slow me down. And I didn't," said Nick.

Nick and his family jumped into action, learning all about diabetes and how to treat the disease. "I was devastated. I didn't know anything about diabetes, had no knowledge,” said Nick's mother, Denise Jonas. “I knew he was very ill just by looking at him."

"We had to take steps to have everyone in our family and my brother, who toured with the boys on a regular basis, trained on how to care for Nick. How to monitor him, how to administer his insulin shots, how to test his blood, how to give him a glucose shot if for some reason he passed out and went into a diabetic coma. It's a lot of work," said Denise.

After leaving the hospital, Nick was determined to write a song about his experience. But the piece didn't come together for another 2½ years. "I was having one of those days where it [the blood sugar] was out of range, things were not where I wanted them to be with my diabetes. I sat down at the piano and wrote the song and it came out in 15 minutes," explained Nick.

His song "A Little Bit Longer" seems to touch a chord in teens with diabetes, some of whom feel stigmatized and ashamed to have the disease. "He's had a great voice in helping encourage children and teenagers with type 1… to let other people know they have it,” said Denise Jonas. “I didn't realize how much of the population was ashamed."

Nick's doctor, pediatric endocrinologist Francine Kaufman of Children’s Hospital in Los Angeles, California, also knows about the concerns of teens. "The real driving force for a teen is to be just like every other teen, so having anything different - and particularly a chronic illness - sets you apart and many, many of these teenagers feel it, " explained Dr. Kaufman.

Nick is trying to raise awareness and money for diabetes through the band's Change for the Children Foundation. (He's also a paid spokesperson for Bayer, which makes a device to monitor blood glucose levels.)

Nick checks his blood sugar 10 to 12 times a day and his doctor says he takes his disease seriously. "Nick does what somebody with diabetes needs to do: wears an insulin pump, worries about how much insulin he's taking, monitors his blood sugar, stays healthy and gets exercise," says Dr. Kaufman.

But if the demands of his schedule mean a skipped meal before show time his brothers sometimes have to improvise. "I just give them a look and tell them to cover for me while I go off stage and take care of some stuff," says Nick. Which usually means grabbing a little apple juice, orange juice or a bit of food to normalize his blood sugar before heading back out on stage. "All of the crew on the tour are aware that I'm diabetic and they all know how to react in case of an emergency or a situation where I may need assistance," says Nick.

And fortunately those times are rare - a testament to his promise to himself four years ago: Nick, now 17, has not let diabetes keep him from sharing his craft and living his dream. "I'm just thankful to be able to be out here doing what I love with diabetes... and if there is something that I can do personally to inspire and encourage somebody that means the world to me, " says Nick.

Question: Do you or anyone you know struggle with telling others about diabetes? Tell us your story.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

September 24th, 2009
10:40 AM ET

Do I need the H1N1 vaccine if I think I already had the virus?

As a regular feature of CNNhealth.com, our team of expert doctors answers readers’ questions. Here’s a question for Dr. Gupta.

From Birgitta in Newcastle, Washington:

I think I already had the swine flu but do not know for sure if it was swine flu, do I take the vaccination anyway? Is it safe to take if I suspect that the flu I had was swine flu?


Tens of thousands of people right now, like Birgitta, are suffering from or getting over the H1N1 virus. Those numbers will continue to swell as the flu season wears on, and these questions will inevitably come up over and over again.

Incidentally, I can relate. I contracted the H1N1 virus recently while reporting on the war in Afghanistan, and I was miserable for days. I got my immunity to H1N1 the hard way, so I can take a pass on the vaccine this year. But what about people who are not as sure, like Birgitta?

The bottom line is, unless you got a laboratory test confirming it, you cannot be sure that you actually got the H1N1 virus. There are several strains of influenza floating around out there this season, two of which are H1N1 and seasonal influenza. There are a handful of other strains you could have contracted.

The old adage, "Better to be safe than sorry," may apply here. Unless you're sure you had H1N1, the Centers for Disease Control and Prevention recommends that you get vaccinated. Even if you did, in theory, get H1N1 the CDC reports no evidence that subsequently getting the H1N1 vaccine would cause problems for you.

You can think about your vaccination like an insurance policy. If you did have H1N1 during your recent illness, then you're protected. If you did not, you're also protected.

If you're wondering when the vaccine will be available, the largest shipment of H1N1 vaccine is scheduled for mid-October. By then, the first 45 million doses of the vaccine will be ready, with another 20 million doses shipped out each week until December.

And don't forget, the CDC recommends that you get the seasonal flu vaccine as well.

September 23rd, 2009
09:51 AM ET

I went to Afghanistan and all I got was H1N1

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

It started as a cough. It wasn’t the kind of cough where something is temporarily stuck in your throat. It wasn’t the kind of cough where simply clearing your throat would’ve been adequate. This was the kind of cough that hurts when you do it. A stinging pain that makes you wince and guard and hope that you don’t have to cough again any time soon. I thought I might have a fever, but of course, I was in the middle of covering a war in Afghanistan, and the conditions were… well, hot. So, maybe it was that. Problem was, the next day I wasn’t feeling any better – in fact, I was worse. I woke up in my dusty desert tent and tried to step out of my sleeping bag. Two steps later, I almost hit the deck. Incoming. Except this wasn’t due to any sirens going off, this was due to my own body simply being unable to hold myself up. I was lightheaded and freezing cold – even though it was over 100 degrees outside at that early hour of the morning.
[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/images/09/23/art.sanjay.sick.jpg
caption="Dr. Sanjay Gupta, who contracted H1N1 in Afghanistan, receives treatment."]

I was nauseated and my entire body hurt. I tried to explain away my symptoms with lots of different excuses. You don’t sleep much while covering a war. My bulletproof jacket didn’t fit perfectly and was very heavy. There was a lot of dust and dirt, and maybe I had what the Marines referred to as the Kandahar Krud. It turned out to be none of those things.

I remember looking over at my camera man, Scottie McWhinnie. He looked absolutely awful. He was wearing a scarf on his head, and it was completely drenched in sweat. He was coughing so loudly and frequently that I was really starting to worry about him – and about myself. We each had it, whatever “it” was. I made a command decision. As a physician reporter in a war zone, I was going to get us medical care. That prompted our visit to a battlefield hospital, not as reporters this time, but as patients.

It is worth pointing out the irony of a medical reporter getting influenza type A, which was then ultimately confirmed as H1N1. (The term swine flu is a misnomer, as this strain is made up of several different components, including swine, but also avian parts.) It really didn’t matter if I got tested, as my doctor told me. It was the only flu strain circulating and I had it, and so did Scottie. We both had high fevers, the lack of appetite, terrible sinus congestion, body aches, and yes – that hacking, come out of the blue.

I am not someone who gets sick, really ever. And this was the sickest I have ever been. I would’ve much preferred my own bed with all the comforts of home – including a wife who would’ve taken great pity on me and allowed me lots of rest and relaxation. Still, I am here to blog about it, after taking the requisite few days to stay at home and not spread my gift from Afghanistan to all my colleagues at work. In case you are curious, there wasn’t much the doctors could really do for me. Some Tylenol and a sinus decongestant (the same my wife would’ve given me). We also got IV fluids, given our inability to keep anything down. Within a couple days, I felt a lot better, and a few days after that – I was back to normal. It was a lot like… the flu – with a different name. A lot of people will get the exact symptoms I described above, and for most people, it will simply mean a few miserable days, hopefully spent in your home – and not in a war zone.

September 21st, 2009
12:44 PM ET

Health care in the real world: duct tape won’t suffice

By Ashley J. WennersHerron
CNN NY Medical News Intern

Come May 2010, I may be forced to trade in my health insurance for my college diploma. The results of the ongoing health care reform debate may determine what happens.

My current insurance carrier, TriCare Standard, is common for military families. I am coverd by them until I’m 23 years old, or until I can no longer classify myself as a full-time student. If I continue through graduate school, I can keep my health insurance for two more years. The problem is that when I finish graduate school, I’ll have to work to pay off any loans. With the current job market, my chances for finding long-term work that provides healthcare coverage, are slim to none. Not only will I have to worry about loan payments, I will also carry the extra concern of finding and paying for a health insurance plan.

My predicament is a familiar one for most college students. About 20 percent of us are uninsured, according to a report conducted by the U.S. Government Accountability Office. For the 80 percent of us with coverage, our insurance will turn to dust soon after we flip our tassels to the right side of our mortarboards in May.

However, we can protect ourselves. We must learn the details of our current plans, and our options for the future. Insurance regulations vary state to state, meaning a plan based out of Virginia may strip me of insurance the day after graduation, but the same plan in Florida may allow me to keep my insurance until the age of 30, as long as no one becomes dependent on me.

President Obama’s health care plan calls for a national age limit of 25 years old before a person is removed from his or her family’s insurance plan, which would provide the time necessary to find a job and make a dent in loan repayments. Students and recent graduates might also consider short-term coverage plans with catastrophic caps, to be used for unforeseeable health emergencies. It’s something, but that type of plan doesn’t provide for the every-day possibility of minor injuries or common illnesses.

Consider moving out of the college dorms the day after graduation: You can accidentally cut your hand with the scissors you are using to cut tape. That’s an out of pocket expense for stitches. You could drop a heavy box on your foot. That’s another expense. The dust you inhale from under your bed may induce an asthma attack. There’s the possibility of an ambulance ride and a hospital stay, none of which is covered in a short-term plan, because it’s a pre-existing condition.

Are you a college student, or a parent of a college student, worried about your future health care insurance options? Are you a recent graduate who can’t find a job that offers health care?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

September 18th, 2009
06:00 AM ET

Soldier: "Do they realize we're still over here?"

By Danielle Dellorto
CNN Medical Producer

I remember shuffling through moondust up to my knees in Helmand Province when a U.S. Army combat medic turned to me and said, “If I ask you something, do you promise you’ll be honest?” I nodded yes. “Do people back home still think about us? Do they realize we’re still over here?”
[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/images/09/17/medic.chopper.custom.jpg caption="U.S. Army medic chopper in Afghanistan."]
I’ll never forget that moment.

Truth is, while most of America might know that 62,000 U.S. military personnel are in theater, they apparently aren’t happy about it. A recent CNN/Opinion Research poll found support of the war in Afghanistan has hit a new low. Only 39 percent favor U.S. military action in Afghanistan.

But does supporting the overall mission go hand-in-hand with supporting the troops?

Dr. Sanjay Gupta and I recently embedded with U.S. Army combat medics in Afghanistan. I slept where they slept, ate what they ate, and followed them day in and day out. Their job is to rescue and triage injured soldiers at a moment’s notice. They are always ready. They even slept with their shoes on.
[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/images/09/17/cnn.team.with.rescue.medic.custom.jpg caption="CNN team and rescue medic in Afghanistan."]
It didn’t take long for me to realize that these soldiers were no different from the factory worker in middle America. Both work tirelessly in their jobs, both want to succeed, both want to provide for their families. And despite the echoes of mortar fire over their shoulders, extreme heat and no communication with loved ones – I never heard the soldiers complain. I watched the medics save countless lives: sons and daughters, husbands and wives from all around the world. Why? It’s their job.

So as I looked in the eyes of that U.S. soldier – the one who feared America might have forgotten about him – I realized my job is to not only report on the medical military operations but also to highlight the courageous stories of those risking their own lives to save others in Afghanistan.

I am back home now…and I still think about them.

September 17th, 2009
09:39 AM ET

Are there new treatments available for lupus?

As a regular feature of CNNhealth.com, our team of expert doctors answers readers’ questions. Here’s a question for Dr. Gupta.

From Carolyn in Goliad, Texas:

What is the latest treatment or drug that is showing success in treating lupus?


Thanks for your question Carolyn.  Lupus  is a chronic autoimmune disease which seems to affect mainly women.  Essentially your body’s immune system begins to attack not only foreign invaders, like viruses, but your own tissues and organs.  There are four types of the disease but the most common is called systemic lupus erythematosus.  Doctors don’t know the cause, but they believe it’s a combination of family history and environmental triggers.  Those triggers can be something like an infection or even sunlight.  

Lupus can cause inflammation in just about any organ or tissue in the body, from your skin and your lungs to your kidneys.  Your doctor will determine your best treatment depending on what type of lupus you have, your signs and symptoms and their severity.  This is a disease of flare-ups and periods of remissions so your medication may also change depending on what stage you’re experiencing.  Plus, it can take months to nail down the most effective combination of treatments to best control your symptoms.  The three most common medications are nonsteroidal anti-inflammatories, corticosteroids and antimalarial drugs. 

There are currently more than 200 lupus clinical trials testing hormones, immune suppressives, stem cell transplants and biologics.  But Carolyn, after getting your email we put a call into the Lupus Foundation to find out what they considered to be the most promising.  They said lupus is difficult because patients with the same symptoms on the same medication can have different outcomes, so they consider targeted therapies the best hope – specifically biologics.  Biologics are compounds that block or interfere with your body’s immune system response.  They gave us a heads up about a large clinical trial ending in November on one such drug that they hope will help patients looking for new treatments.  Granted even if this drug is shown to be beneficial it will still have to go through the FDA review process so it will be some time before it’s available in your doctor’s office.

September 16th, 2009
11:00 AM ET

Secrets for aging gracefully

By Leslie Wade
Producer CNN Medical News

This may sound corny, but I really enjoy spending time with my Mom. In August she turned 80 and could probably beat me in an arm wrestling match - no kidding, and I'm not exactly a weakling.
[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/images/09/16/leslie.mom.art.jpg caption="Jean Wade knows the secrets of healthy aging."]

Mom is healthy and strong because she has truly taken care of herself physically, mentally and emotionally. You know all of the nagging you get each time you see your doctor for your annual check up? All the talk about not being a couch potato and eating yummy things like raw broccoli? Well, Mom actually listened and followed instructions.

Having Mom around means the world to me. Being around for your family or loved ones may be a gift worth considering. Here are some of Mom's health secrets, so perhaps we can all make it to 80 and beyond.

Back in the 60s Mom hosted a half hour TV show. One morning she interviewed an exercise instructor who was so impressive, Mom decided it was time to get back in shape. She's been exercising virtually every week since then. Unless she's sick, she gets some sort of weekly exercise: she walks, bikes, takes aerobics classes, swims laps in the pool and hits the ski slopes in the winter. From mid May to late September she rises with the sun and swims in the ocean off the Carolina coast: 400 strokes out from the beach and 400 strokes back, for a total of about 45 minutes. Exercising consistently for more than 45 years has a lot to do with her good posture, strong hand shake and brisk stride, but it's also a key component to her longevity.

We all know the benefits of exercise but let me remind you of a few. Consistent aerobic exercise strengthens the heart and keeps our blood vessels flexible and healthy. Exercise also helps keep cholesterol numbers, as well as blood pressure readings, in the healthy range - all good things when trying to keep heart disease at bay. Exercise is good for brain health, perhaps making us sharper mentally and reducing the risk for dementia and stroke. Exercise helps enhance our moods and may have a positive effect on our sex lives.

Good nutrition is about as important to Mom as exercise. She started cooking at age 13, when her mom went off to work in the factories during World War II, and has never stopped. She reads books about nutrition, has notebooks and cookbooks filled with healthy recipes and subscribes to health newsletters. Even during vacation and holidays, Mom eats a balanced diet with plenty of fruits and vegetables. She eats meat, but not every day, and the cuts are always lean. You rarely find fatty hamburger or fried chicken on her table and I don't think she's ever bought chips or soda except when having a party.

How can eating right help all of us stay healthy? Low fat meals filled with fruits, vegetables and whole grains can help lower our risk for heart disease, certain cancers, type 2 diabetes and keep our waistlines trim. I know it's tempting to eat fast food and high-fat meals, especially when on the run, but eating right may help keep your heart pumping longer, your blood vessels coursing more smoothly and your cholesterol down.

There is no doubt that having a good marriage can reduce stress. Having my dad around for the last 50+ years has not only been entertaining for Mom - he's a very funny fellow - but his kindness and love are like a balm to her, plus he forgives easily. Studies show that reducing our stress level is good for our bodies and minds. When we're stressed out we release chemicals that doctors believe play a role in forming plaques that clog blood vessels in our brains (making us more prone to losing mental capacity as we age) and around our hearts (leading to coronary artery disease). Stress has been linked to high blood pressure, heart disease and depression. So good marriage or not, reducing stress should be a priority.

No one can predict the future of course, but it wouldn't surprise me if the family gathered to celebrate mom's 100th birthday in 20 years. She's going strong and showing few signs of slowing down. Her bones are as strong as someone in their 20s, her cholesterol and blood pressure numbers are low and her resting heart rate matches that of many a seasoned athlete. She has lived life wisely by eating well, exercising often and keeping an eye on her stress levels. I for one plan to take a page from her playbook: I may not be able to beat my kids in an arm wrestling match when I'm 80 but I sure hope I'm around to give it a try.

What helps motivate you to exercise and stay healthy. How do you stay on course?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

September 14th, 2009
10:24 AM ET

When words fail you

By Andrea Kane
CNNHealth.com  Producer

September is National Ovarian Cancer Awareness Month. Each year in the U.S. about 21,500 women are told they have it; approximately 14,600 die of it. Detected early, it has a five-year survival rate of almost 94 percent, according to the National Cancer Institute. Unfortunately, only 15 percent of ovarian cancers are found when the disease is still localized.

A good friend of mine died of ovarian cancer six years ago. She was only 41. We weren’t talk-to-you-every-day best friends, but when we saw each other, we connected.

After I had a baby, we had less time to spend together. Still, she faithfully came out to visit the baby and me.

In 2000, shortly after my daughter turned 1 and my friend turned 39, her doctor found an ovarian cyst. Unfortunately, in the Russian roulette game of health and disease, she lost: Her cyst contained a malignant tumor – a one-in-a-hundred chance, she was told. The good news was that it was “only” stage 2 (In stage 1, the cancer is still contained in the ovary; stage 4 is considered terminal). But even stage 2 was not good enough.

Everyone agrees that ovarian cancer needs to be found earlier, but the question is how? Part of the problem is, the symptoms of ovarian cancer– bloating, increased abdominal size, changes in bladder and bowel function and a feeling of pelvic fullness or pain - can be also caused by a number of other maladies. And there is no accurate blood test.

For my friend, surgery was followed by chemotherapy, and more chemotherapy. Still, she found time to visit my daughter and me, and we found time to talk about motherhood, religion, relationships, life. Our parallel but sometimes intersecting lives went on.

At the end of 2001 I had a second daughter, and her cancer returned. I drove her to a couple of chemo appointments; she had more surgery and some radiation. We talked about dying, but only in the abstract – because neither one of us wanted to think it would happen to her.

But her worsening condition cracked our carefully constructed illusion. The drugs made her terribly sick — not that they were actually helping - and surgery was just a temporary fix. She knew her options were limited; she desperately looked to get into a trial for a new drug.

The last time she came to visit me, she told me that she recently had realized that this thing could actually kill her. But she still held some hope.

Then, before she could go into remission again, the complications started in earnest.

Her parents arrived from Florida to take care of her. The morphine made her sleep 20 hours a day. She stopped communicating with all but a very small group of friends; they gave the rest of us e-mail updates.

I desperately - and selfishly - wanted to see her, to talk to her one last time. And then I got my chance: My husband prepared some legal documents for her that required signatures. He asked her parents whether I could be the one to drop off the documents. They obliged.

I was nervous before seeing her; I didn’t know what to expect. On the appointed day, I headed over with my younger daughter.

Seeing her wasn’t exactly a shock, but she didn’t look like her old self: Her skin was yellow, her face looked gaunt and she sported a feeding tube. She didn’t smile – not even once. She and her mother both looked exhausted. I tried to be cheerful enough for the two of us.

After she signed the documents, we all sat on her back porch and chit-chatted about trivial matters: my daughter’s sandals, her nap schedule, my other daughter. Blah, blah, blah. We talked about everything except the pink elephant in the room. What I really wanted to ask was how she was doing emotionally: Was she afraid? Bitter? Angry? Or had she come to terms with dying? Was she at peace? I could not tell.

Impulsively, I asked her mother to take a photograph of us with a camera I saw sitting on the nearby table. Her mother snapped two photos and then my daughter and I left. The visit had lasted 15 minutes.

Maybe I couldn’t talk to her about the things that mattered most because her mother was there, or maybe because I didn’t want to upset her by openly acknowledging something she never had: She was dying. In any case, I will always feel that I missed my last chance to talk to her honestly and openly, to hold her close to me and whisper “Goodbye, I love you.”

Two weeks later Jennifer Lisa Bertoni died.

A while later I received an envelope in the mail: the two photos. As it turns out, they were the last ones taken of her. Surprisingly, in both of them, she gazes back at me, smiling.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

Filed under: Cancer • Women's Health

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About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.