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Cancer warriors
By JIM ROSS and ALEX LEARY © St. Petersburg Times, published May 21, 2001
An entire subset of the medical community is dedicated to the disease. In Citrus alone there are dozens of doctors, nurses, aides and clerical workers who fight cancer for a living. And that's not to mention the less visible troops, like Terri Lynn Hope, who sells wigs to cancer patients who lose their hair during chemotherapy, or Susan Smith, who goes from hospital to hospital collecting information for the huge cancer data bank Florida maintains. Only a disease this widespread and devastating -- cancer killed 447 Citrus residents in 1999, and doctors diagnosed 935 new cancers here that same year -- could require such attention from so many people. Dr. Jayanth "Jay" Rao is one of those cancer warriors. He operates the Florida Regional Cancer Centers, a radiation oncology operation with offices in Beverly Hills and Ocala. Rao almost missed the fight. He was an internist for six years with an eye toward specializing in gastroenterology. "We are not taught about cancer in medical school," he said. "The knowledge of (general) practitioners is very poor." When Rao came to this country from England, his sponsor was Dr. Nisar Syed. For a variety of reasons, mostly logistical, Rao decided to switch from gastroenterology to cancer treatment, which is what Syed practiced at Long Beach (Calif.) Memorial Medical Center. While at Long Beach, Rao witnessed Syad's work with brachytherapy, which involves briefly implanting radiation seeds or ribbons into a tumor so it can be internally bombarded with high doses of radiation. "Here was a surgeon by occupation but he went into cancer medicine because he saw his mother die of cancer," Rao said.
"Otherwise," he said, "I would have been a gastroenterologist" today. Although he came relatively late to cancer medicine, Rao hasn't wasted any time. He spent 1993 to 2000 operating the Cancer Treatment Center of the Nature Coast on County Road 491 near the Beverly Hills Bowl. There, he practiced brachytherapy and became a pioneer in the use of 3-D images of tumors for treatment planning. His patient suffered from cancers of the breast, prostate, lung and other body parts. At the time, the business belonged to health care giant Tenet, which also owns Seven Rivers Community Hospital. But Florida Regional, whose investors include Rao, Syed and some doctors who teach in California, bought the building and practice. Fighting the warThe intellectual challenge attracted Dr. V. Upender Rao to cancer medicine. He is a specialist in hematology and oncology, which means his patients suffer from ailments such as leukemia or lymphoma. Staff and patients call him Dr. V. Rao to avoid confusion with Dr. Jay Rao. The men are not related. Dr. V. Rao said radiation has a limited application: It works where it is directed. But cancer spreads, and it's not always clear where in the body it's going or why. He said he and his colleagues must have a wide range of training in internal medicine because they handle chemotherapy, hormone therapy and gene therapy. Rao said the molecular biology, the combination of therapies and the ever-present challenge make the field more interesting than cardiology, which he had been pursuing. "I feel this field is more challenging. These are some of the sickest people who need the most care," he said. His mother, for whom his Lecanto office building is dedicated, died of cancer. But the intellectual challenges take a human toll. Cancer doctors become dispirited sometimes. "You need a special personality, in my opinion," Dr. Jay Rao said. "It's very difficult. Not everybody can do it year after year," according to Dr. V. Rao. "People ask: 'Is it depressing?' " said a third cancer doctor, Timothy Brant. "Not at all, it's very rewarding." Brant is a radiation oncologist at the Robert Boissoneault Oncology Institute, which has offices in Inverness, Lecanto and Marion County. He said he was attracted to the specialty because of the measurable results. "Either they do well or they don't," he said. Even if he can't cure someone, he might be able to ease their pain. Sometimes, the doctors don't just battle cancer and their own feelings -- they must battle other doctors. Some doctors are ready to give up on patients, either because they don't know what kinds of treatments are available or because they don't want a patient to suffer during a futile search for answers. One day, Dr. Jay Rao checked his mail slot at Seven Rivers hospital. There was a note, presumably from another physician: Why do you treat lung cancer patients? Other cancer doctors received the same missive. Of course, good doctors try to be sensitive to patients' needs. And they understand why physicians would object, in specific cases, to recommending cancer treatment and perhaps incorrectly boosting a patient's hopes for living a longer and better life. "I don't blame them," Rao said of the skeptical doctors, "because they have no knowledge until they get into the specialty. There's a resistance from some doctors, and that's from ignorance." Resistance or not, cancer medicine is bound to continue growing in Citrus. There was a time when patients had to travel beyond the county line for cancer treatment. Some still do: About 370 Citrus patients sought treatment, surgery or just a second opinion at the H. Lee Moffitt Cancer Center & Research Institute in Tampa during the first six months of this fiscal year; the number was 409 at Shands at the University of Florida during its 1999 fiscal year. For the most part, though, cancer treatment is available here. Doctors say they are extremely busy and some fear patients might have to be turned away unless more specialists, nurses and technicians settle in Citrus. "We can meet demand," Brant said, "but it's close." Battling behind the scenesOf course, doctors and their staff members are only part of the story. Many less visible people help cancer patients cope, either through financial assistance or by making them feel better about their bodies. The Citrus County Health Department, for example, helps people who generally can't afford to pay the huge bills that accumulate for a cancer patient. Poor people qualify for Medicaid. Better-off people can afford health insurance. Treating the so-called working poor -- too poor to afford coverage, too "rich" to get government assistance -- is the department's constant challenge. "We're really fortunate in this community," said Marybeth Nayfield, who leads the Health Department. Cancer doctors have been generous donating their time in treatment and handling diagnostic screenings, although there is a waiting list for patients to receive a colonoscopy. The news might get better. Soon, women in the the "working poor" category will qualify for Medicaid if diagnosed with breast or cervical cancer, Nayfield said. Other people help cancer patients feel better about themselves. Terri Lynn Hope began selling wigs at her beauty salon in Beverly Hills seven years ago after a few women came in with ill-fitting hairpieces. Hope, who sells the wigs for between $49 and $200, has become much more than a saleswoman. "I have learned to be a friend and listen. They are thinking about life and they are thinking about death. When I fit these women with wigs it makes such a difference. A glow comes over them. It makes them stronger." Hair can always grow back over time. A breast cannot. Connie Crider of Connie's Mastectomy Boutique in Crystal River has been fitting local women with prosthetics for the past decade. The silicone devices sell for between $100 and $600. Crider, like Hope, got into the business because she wanted to help fellow women in distress. "I couldn't make a living doing this if my husband didn't pay the bills," she said. "I found I really like working with these ladies. I like their attitudes. So many of them are upbeat even though they are going through trauma." Susan Smith of Spring Hill helps in another way: She drives hundreds of miles each year collecting the latest cancer statistics from area hospitals. Under Florida law, all new cases of cancer must be recorded in a huge data base maintained in Miami: www.fcds.med.miami.edu. Smith looks for the type of cancer, how aggressive the tumor is, whether it has spread to other areas and what treatment was used. The information can be used for research and to pinpoint unusual pockets of the disease, or "hot spots" that may be linked with potential environmental threats. Believe it or not, some of the most cutting-edge cancer warriors can be found inside the truck trailer parked outside Citrus Memorial Hospital every Monday. The trailer is a mobile medical unit. Inside, workers perform positron emission tomography, or PET, which is a full-body scan similar to an MRI. The scans allow doctors to detect and see disease by viewing how cells' metabolic activity and chemistry change. PET scans are particularly helpful as a diagnostic tool for lung cancer, lymphoma, melanoma and colorectal cancer, experts have said. There are plenty of cancer fighters inside the hospital, as well. One who is well known to patients is registered nurse Carol Poteet, a 23-year veteran who manages the surgical and endoscopy unit. Years ago, Poteet managed the hospital's second floor, where patients underwent chemotherapy. That work typically is accomplished in doctors' offices these days. "The main thing is being able to talk to the patient . . . and let them understand" about their bodies and the treatment, Poteet said. Poteet still facilitates a cancer support group, and she continues to work with cancer patients who come to her part of the hospital. "It's rewarding," she said, "because you are there to help them." * * * Special report: The impact of cancer A dreaded diagnosis (May 20, 2001) Cancer takes its toll on body, spirit, family (May 20, 2001) Minister soothes souls in final days (May 20, 2001) Upbeat, exuberant survivors rally to raise money and spirits (May 20, 2001) A teacher's final lessons for life (May 20, 2001)
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Quickly, Rao's practical decision became a passionate one. He enlisted in the cancer war.
