Your Body Is A Sacred Trust
SMART BUT, NOT SO SMART?
In a sense yes. But then again no. It is complicated, and without question, more of a cultural problem than a Steve Jobs problem Puppychow. Allow me to explain if I may be so bold. I'll open with a statement that will seem like it is coming from even further out than left field. As I continue, it's relevance should began to sink in.
YOUR BODY IS A SACRED TRUST
Steve Jobs was diagnosed with pancreatic cancer, the endocrine cell type, in 2003. Jobs was 47 or 48 years old at the time and DID NOT EVEN KNOW WHAT HIS PANCREAS WAS, had no clue as to its function, let alone know how its dysfunction/malfunction might make him ill. If you are unaware as well, I'll say a few words before moving on to give my views on our community's situation generally, and Jobs in particular.
Your pancreas sits in a place called your retroperitoneum. The best way to think of that for openers is simply to think of it as a place/cavity "behind" that space where your intestines formed.
Your pancreas makes 2 things primarily. The exocrine glands(a gland secreting into a system of ducts) of the pancreas produce the enzymes/chemicals that digest food, break it down so that it may be absorbed. The endocrine(a gland secreting hormones into the blood stream to have effects on cells throughout the body) portion of your pancreas makes insulin and glucagon. Insulin is the hormone which "turns the key" allowing for entry of sugar in to your body cells, and once inside, for that sugar to be used in anabolism. The latter term meaning "to build things up". Glucagon sends a signal to cells to release sugar and is "catabolic" in its effects. "Catabolic" meaning to break tissue down.
Insulin/glucagon are "counter regulatory hormones". That is, they work in opposition to one another, opposing forces. One hormone, insulin, pushing sugar in and building things up. The other hormone, glucagon, releasing sugar into the blood and breaking things down. In human physiology, indeed in biologic systems generally, this "opposing forces" scenario is common and to be expected. For example, we have a native blood clotting system, and in opposition, a native blood dissolving system, opposing forces. These clotting/blood dissolving systems are beyond delicate, breathtaking, systems of awe inspiring beauty, systems of immense and quite literally incomprehensible complexity. We feebly try to manipulate the clotting system in "modern medicine's" context, such as when we give blood clot dissolving chemicals to patients in the "middle of a stroke". Don't get me wrong, this helps a lot of people, but at the same time, it is indeed fairly primitive when you get down to it. I like to think of modern medicine at times as a situation in which doctors have to decide whether or not they really do want to try fixing a torn spider's web with their fingers. "Hey doc, sure you ain't gonna' mess that spider web up more than you're gonna' put it back in working order? Them hands of yours look pretty clumsy to me." I work in a hospital where we make the attempt to treat the "sickest" stroke patients in northern California. We of course do other things too, in addition to making feeble attempts at patching up this particular variety of a broken spider's web. Back to the pancreas.
Because the pancreas is where it is, in a place behind your intestines/stomach, with lots of room around it, if you start to develop a cancer there, a cancer that will take your life, more likely than not, you will not "feel it", or know it for any reason until it is way way way too late, curtain time folks. Matter of fact, not infrequently, patients with pancreatic cancer "present" with painless jaundice. That is, out of the clear blue, they turn yellow. The tumor at the head of the pancreas finally gets so big that the bile drainage system is blocked. The bile that is supposed to go into your intestine to dissolve fat, winds up in your blood and turns your eyes and skin yellow.
Pancreatic cancer, as is the case with most cancers, is more common as one gets older. The median age at diagnosis is about 72 years old. There are roughly 44,000 cases of pancreatic cancer diagnosed every year. The one year survival rate is 25%, and five year survival rate is 5%. So that means of the 44,000 diagnosed with pancreatic cancer here in the USA in 2011, there will only be 11,000 survivors when 2012 comes to a close, and 220 survivors when 2016 comes to a close. Pretty sobering.
When I was a medical student, there was this very famous 50ish year old general surgeon/teacher/professor that used to say, "The only way to treat a cancer is to cut it out and throw it in the garbage can". He was an old Alabama boy, and in his inimitable southern way, he would "drawl" each of those words out slowly and with consummate derision. His drawl's implied criticism and contempt were intended for the ears of any medical student idiotic enough to consider a career in oncology, a discipline in which cancers are treated with chemical poisons, the tumors being been left in the patients' bodies and not thrown in the garbage can where they belong.
Of the 44,000 cases of pancreatic cancer diagnosed this year in the US, only 20 %, one in five are addressable by way of surgery. The operation is called a "Whipple Procedure", AKA pancreaticoduodenectomy. An Italian, Codivilla, came up with the idea for the operation over a hundred years ago. However, it was the insanely talented American surgeon Allen Whipple who relatively early on in the 20th century, 1935 or so, fully elucidated the best techniques. In this procedure, the patient loses his/her stomach, the first part of the small intestine, gall bladder, pancreas/part of it at least, lymph nodes. It is a radical operation, very difficult to do WELL technically and results in the up front survival of only 20% of those receiving the operation. So even if you are lucky enough to be offered a "Whipple", as most physicians refer to them, more likely than not you will still die from the cancer. Some tumor will be left despite the surgeon's best efforts and its recurrence will be no fun for not a one, least of all the patient.
Steve Jobs as it turns out had a better chance than most to survive his "pancreatic cancer". The description/discussion provided above refers for the most part to pancreatic cancers that arise from the exocrine cells. That is the portion of the pancreas that makes the digestive enzymes. Jobs' cancer cells were the endocrine cell misbehaving descendants of the insulin/glucagon secreting family of cells he was born with.
Jobs is no one's fool, and though he did not know what his pancreas was to begin with, he learned. Though 44,000 people are diagnosed annually with PANCREATIC EXOCRINE CELL CANCER, only 3,000ish are diagnosed annually with PANCREATIC NEUROENDOCRINE TUMORS. Generally speaking, these tumors behave much differently than the mainstream, more common, exocrine tumors that I discussed rather thoroughly already. These tumors, the Steve Jobs variety, generally speaking are not as aggressive. They are much more benign than the deadly garden variety exocrine cell derived pancreatic cancers.
Reading between the lines, one would assume that Job's cancer was identified as neuroendocrine from the get go and NOT the more common, conventional, and conventionally deadly, exocrine cell adenocarcinoma, the latter being the one with the horrendous prognosis as discussed above. As such, and despite surgery presumably having been recommended when initially diagnosed in 2003, Jobs took his chances, relatively speaking. It should also be pointed out, the surgery at that time, say 2003, when Jobs was initially diagnosed would NOT have been a "Whipple". Such an extensive radical surgery is NOT typically done in the case of the more benign neuroendocrine tumors of the pancreas that Jobs had. He may have "gotten off easy", had he opted for surgery right then and there in 2003, right out of the blocks.
Knowing what he knew, and he probably read a lot, Jobs figured there was wiggle room. Many neuroendocrine tumors are not malignant, that is, they will grow locally, but will not spread through the blood, lymphatic system and so forth. They will stay put and remain relatively well behaved, perhaps indefinitely so. Presumably, Jobs thought he was in such a situation. He did not want to be cut open some say. He treated himself with a special diet, and after 9 months, the tumor was bigger and now clearly was a big time threat to him. As such, Jobs underwent a Whipple Procedure. That's a bad sign in a sense. It means the surgeon is going after EVERYTHING, the same way he or she would in the case of the more common and deadly exocrine variety of a pancreatic tumor.
Jobs' then requiring a liver transplant meant the tumor had spread to that major organ. In a very real sense, this is a desperate move medically. The tumor is now confirmed to be malignant. One does not treat malignant cancers with organ transplantation. It cannot go well.
So here is a wickedly smart guy that at age 47 knows everything in the world about computers, but absolutely nothing with regard to what it is that his pancreas actually does for a living. Sure Jobs learned, but learned very late, and guessed wrong for himself with regard to his chances. There is no need for this. Children should learn about their bodies in grade school. It is even more fundamental than 1,2,3……..
We live inside of bodies and not recognizing this hurts us badly in many many ways. I am not advocating people study medicine in grade school, but I do advocate the teaching of basic anatomy and physiology starting from grade one. By the time young people finished high school, they would have a good sense as to what they were about, and a have a good practical appreciation for the grand machine providence has entrusted to them, a practical appreciation and a sense for themselves they hopefully would act on, and act on early in life, continuing until they died.
The last situation one wants to be in is the desperate one where doctors are trying to fix spider webs with their fingers. It tends to not go well. That is not to say doctors can't help and don't want to, but we'd rather never see you make it to us. We'd rather see you not in need of repair.
Jobs certainly did not do this to himself, he is a super cool guy. I am typing on an Apple now. But he was NAIVE, and this naivety is a cultural problem. Somehow I think if he started earlier he would have done a better job making decisions for himself about his body. But he was busy. We are are all too busy to take care of that which is most important.
What concern could remotely approach in importance the truth behind our marvelous physicality? NOTHING!
YOUR BODY IS A SACRED TRUST!