Archive - September, 2009

Is it Melanoma or a Benign Mole? It Depends on Who You Ask.

To follow up on this post: the pathology report indicates all the affected lesion was removed and I have been given a clean bill of health. I’ll be monitored by a dermatologist. But the news could not be better.

An article on “diagnostic drift” today in the New York Times sheds light on a personal experience I’ve had the last month. Four weeks ago I underwent a biopsy for an unusual looking mole. The pathology report came back indicating it was melanoma in situ, a malignant lesion. I had skin cancer. A form of cancer that is successfully treated but which in later stages can be fatal. This is not exactly the kind of news that makes your day.

I was first referred to Fort Worth Dermatologist Dr. Peter Malouf, then to a surgical oncologist and after a ten-day wait marked by anxiety, questions and numerous visits to the Mayo Clinic webstite and WebMD, I heard from the oncologist that a second pathology reading indicated the mole was more likely a melanocytic nevus, a benign mole. According to this interpretation I did not have cancer. Never the less, he said, the chances this mole could develop into a malignancy were good and it needed to be removed.

This is the diagnostic drift referred to in the study highlighted in the article–the growing tendency of some physicians to diagnose benign moles as malignant cancers.  The reasons are discussed in the article. What the article does not discuss is the dilemma of the patient. After having the bejeebers scared out of you, how do you evaluate such discrepancies? To the patient it’s more than an academic reading of the data. Regardless of the second opinion, the diagnosis that stuck in my mind is the first. I had cancer or I would get cancer.

These conflicting opinions presented me with several issues, not all of them related to health. I tend to keep my own counsel on such matters and would have preferred not to make this health condition public. However, given the earlier interpretation, I agreed with the oncologist that the lesion should be surgically removed. As it happened the only surgical date available fell on the same day as a meeting of the board of directors of our organization. I could not leave a meeting of my own board of directors without providing a good reason, so I told them about the situation. They were understanding and supportive.

And I cancelled attendance at another meeting out of town out of concern for hauling and lifting luggage with an incision on my shoulder. So now the word is out.

The surgery was uneventful. I am surprised at the length of the incision (six inches). It’s considerably longer than I expected, but the surgeon said he believes the excision removed all the affected tissue and the prospects for a positive outcome are quite good. I’ll get that pathology report on Thursday.

Whatever it says, I’m convinced we did the right thing. And I learned an important lesson. You have to arm yourself with knowledge from reliable sources. You have to ask questions. You have to assert yourself into the process. And you have to balance your fears against objective information and keep your head in the conversation. This isn’t easy but it’s necessary in order to manage your own care.

It falls to the patient to swim through the cross currents of diagnostic drift.

An Old BMW “Airhead” Comes to Life

Nothing recently has caused my heart to soar like the sound of a BMW motorcycle roaring to life after ten years of sitting in the garage. It’s a 1977 R100RS. To my mind a classic. I commuted into New York City from New Jersey on it for ten years. I rode it with my son behind me as we traveled the northeast on camping trips. The old bike holds a special piece of my heart. I couldn’t part with it. It sat unused for this past decade, deteriorating. My guilt was heavy with the neglect of an old friend.

We maneuvered through congested traffic on route 4, crossed the George Washington Bridge, traversed the West Side Highway and Riverside Drive. We went down a couple of times. Once under the West Side Highway on a diesel slickened intersection and once when kids playing at an open hydrant managed to direct a water stream into the fairing and carried us unwillingly and uncontrollably down Riverside Drive into oncoming traffic. Once I hunkered down low on the gas tank when, unable to stop, I rode into a shootout on Riverside Drive. Men holding guns on one side of the street hid behind a car pointing guns at men on the other side crouching behind their vehicle. Fortunately, no shots were fired as we drove through their line of sight.

Once, a stupid, dangerous character dropped a baseball bat from the pedestrian walkway of the GWB onto us. The bat, surprisingly, passed through an impossibly narrow space between my leg and the fairing and fell to the pavement doing no harm. When I got to the end of the bridge I saw officers taking reports from a line of drivers. Cars and trucks had also been hit with all manner of rocks and bricks and some had broken windshields.

There were also good rides. I reveled at the sight of sunset on route 4 as we headed west in wintertime and felt the cool air rising from the Hudson River as we passed on the bridge high above.

The bike is geared for the German Autobahn and it was constrained by the slow, lumbering speeds of U.S. highways but when it gets close to its top speed, the fairing actually creates an envelope of protection and the bike settles down noticeably, gripping the surface and providing a remarkable sense of stability. It was the first bike with a full fairing tested in a wind tunnel and it caused traditional BMW riders to question where the company was headed.

The bike will talk to you, if you listen. It’s among the last of the horizontally opposed air-cooled engines that made BMW motorcycles distinctive for several decades. When the tappets click and the dual exhausts hum, you know it’s in good health. When those familiar noises and quirks change, however, it’s time to look into them. And I mean literally look into the bike’s innards.

Nearly everything on these old “airheads,” as they are called, can be repaired or replaced. Hardly a single part is beyond diagnosis, disassembly and repair. I’ve fixed the brakes, replaced the points, plugs, and exhaust pipes, re-set the timing and valve clearances, re-built the carbs, cleaned every electrical contact, taken apart and repaired at least three switches, one relay and the dashboard clock. No LEDs or circuit boards. (Well, it has one but it’s hardly a major feature.)

I’ve not taken the engine, transmission or drive shaft apart. In the past I have done this. But it takes time and a few gear pullers, and I’ve decided that if it’s necessary, I’ll leave this to the real mechanics. Maybe in the winter downtime.

In the meantime, I could be satisfied just starting it up and listening to it purr. Sometimes it’s not just about the ride, it’s also about the memories and something intangible like the freedom to dream of what’s over the horizon, and let yourself go there, perhaps on two wheels.

The church must report its own news, good and bad

One of the cornerstones of a free and democratic society is a healthy and free news media. The editors of the New York Times write of it with concern about the tension between transparency and national security. It is not an easy issue to grasp in all its dimensions. Watching crackdowns in China and Iran this year has given me a greater appreciation for living in a country where information is freely shared.

We in the church wrestle with the challenge of openness and transparency as well. In our age, institutions are distrusted and leaders are viewed skeptically. An open and transparent church, I believe, needs a news service that not only tells the church’s positive stories but is able to report news that might make us uncomfortable at times. In their wisdom, the leaders of The United Methodist Church in the past provided for this important function.

It is, in my opinion, one of our great strengths.

In my role as publisher of United Methodist News Service, I am often called on to defend or explain a decision to report on a sensitive issue. You can take your pick of issues – homosexuality, church trials, constitutional amendments. People often ask me why the church’s news agency would disclose information about disagreements or problems in the church.

The answer is simple: Reporting the unvarnished truth is our responsibility to the church and to you. It’s a core value. Out of our collective experience as a people of faith our forefathers and foremothers determined it is necessary for the good of the whole. This is a remarkable stand for integrity and truthfulness.

Being a truly open church requires being transparent about what goes on in our congregations, conferences and agencies. It means being accountable, from the local level right up to the Council of Bishops. The absence of accountability leaves room for a host of problems, ranging from complacence to the misuse of power.

Those who formulated this reporting role also decided it was better for the church to report its own news than to cede that role to outside entities.

As a result, The United Methodist Church’s Book of Discipline provides for a newsgathering function that is editorially independent. This is essential for several reasons.

Having a news agency with the ability to report both the good and bad news generates a high level of credibility for the church itself. It’s a sign that the church holds itself accountable and strives to be transparent in its work. A news service without that freedom would essentially be doing public relations – an important function but one that is distinct from news reporting – and that symbol of transparency and accountability would be diminished.

An editorially independent news service also means the church is the primary source of news about itself, so the church is telling its story in a way that is journalistically sound and credible. If the church didn’t report its own news, then it would be defined by outside media that don’t understand the church as well. Other media also have less stake in how the church’s stories are told and, for that matter, whether they are told at all.

The presence of a healthy news service makes a statement that the church believes it has stories to tell about how its members are making a difference in the world and how people’s lives are being transformed through the church’s role as the body of Christ. For a denomination the size of The United Methodist Church, those stories are limitless. Moreover, we find that nearly every major news story has a potential United Methodist angle, and the stories of individual people living their faith journeys in interesting ways are innumerable.

Our editorial standards are consistent with the best practices and standards of the news profession. Our staff comprises professionally trained journalists who have had experience working in secular media. We apply the same news values to our work as our secular counterparts, with an additional sensibility that our role in the church brings. That means that while we use the same criteria in determining what stories are newsworthy, we also make allowances for stories that might be very important to some segments of our audience but that wouldn’t excite a secular reporter.

Our stories are largely a mixture of news reports and human-interest features on how the church and individuals are making a difference in the world. They are stories that can make you laugh, cry, pray or take action. If we are doing our job, some of our stories will occasionally make you squirm or even make you mad.

As we move forward into a new era of reporting through social media, I am excited about being even more engaged with our audiences. I invite you to engage with us as well via e-mail, comments on our story pages and posts on our Facebook page. Let us know how our stories resonate with you, and let’s be in conversation.

Low Power FM: Radio for the Community

Is low power FM set to roar? Some think so. In this era of personalized communications choices, could low power FM radio become one of the choices? Possibly.

Low power FM has been around for a while but hasn’t really blossomed to its full potential. It could now. Commercial broadcasters centralized and homogenized, losing the real value of radio, its ability to inform, involve and serve local communities. They have hastened the demise of broadcast radio.

Internet radio hasn’t really taken off yet. It has potential but it is even less community oriented and more affinity-based than any radio format. Similarly, satellite subscription services offer choice, but not local community service.

Low power FM has been used successfully to reach ethnic communities. It has been a valuable tool for community organization among migrant workers. It’s a tool for under-served rural communities to share information locally, and for education among specific groups such as women’s organizations in many parts of the world.

I’ve long advocated, not successfully, for mainline religious denominations to engage in low power FM. The United Church of Christ has been most aggressive promoting expanded licensing and access. But no mainline group has stepped up to the plate and assisted low power FM to become a tool for communities to organize. This seems strange because many of these same denominations have great numbers of small membership congregations in rural communities that would derive benefit from a low power station.

This could be an outward bound service consistent with the missional goals of these congregations. There are obstacles, of course. None are insurmountable with energy and commitment. But the greatest of these, as I have observed over the years, is how congregations see their role in the community and how local pastors view the relevance of the church to community service. If media involvement is not considered a relevant expression of faith, the tool goes unused.

It’s my minority viewpoint that when we in the mainline fail to engage in this medium, we fail our communities. If there is renewed interest in opening and expanding licensing, perhaps we will get a chance for a “do-over.” I wonder if we’ll take advantage?

Depression: A Silent Global Burden

In twenty years depression will affect more people globally than any other disease, according the World Health Organization. A BBC report points out the prevalence of the disease among the poor and those living with disabilities. The BBC says developing nations spend only 2% of their health dollars on mental health while developed nations spend 200 times more.

However, the persistence of depression in the developed world reveals how difficult it is to treat the disease successfully. In a fairly comprehensive article U.S. News says medications are effective for 30 to 40% of the depressed.

Mental health is a sensitive subject, often misunderstood worldwide. The burden of depression adds to the struggle to survive in places where hardship is daily reality. Yet it’s a silent disease, often untreated and in some areas unrecognized.

The seeds of mental health treatment are being sown in many countries where these conditions haven’t been identified before. But they are very few and of limited scope. Anyone who’s seen people traumatized by war, natural disasters or political oppression, those left vulnerable by physical disabilities and diseases, and those struggling with emotional pain of the daily grind of poverty has also seen how these external conditions exacerbate depression. In most developing nations this includes the majority of the population.

WHO’s identification of the problem is a good first step, but many more steps will be required if the projection is correct.