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Recently a friend passed on some studies looking at the overall rate of occurrence of HPV, Human Papilloma Virus, in lung cancers. Basically what they found was that depending on where on the planet your looking the rate ranges from 15-35% of lung cancers are infected with that virus. Given that lung cancer is one of the leading causes of cancer deaths it sounds like a good thing to know about.
Now HPV is actually a family of viruses that cause warts. And it’s a big family of viruses; over 100 different types of HPV have been identified. Plantar warts most likely caused by HPV-1. Warts of your palms, HPV-2. Genital warts, HPV-6, -11, -42, -44. Cervical cancer, HPV-16 and -18 are the main culprits. See the interesting thing about papiloma viruses, is that they are incredibly site specific. The same virus that infects your hands isn’t going to be able to infect your juicy bits.
But did you notice that cervical cancer was in that list? Yeah, we know what cause the vast majority of cervical cancers. The same virus that causes anal cancers. Some other genital cancers are also linked to HPV, but not with the same degree of specificity. Someone got the idea to start looking for HPV in head and neck cancers, probably because sometimes we put other people’s genitals, which may be infected with HPV, in our mouths. And lo and behold there are group of cancers in the head and neck that behave differently then other head and neck cancers, in terms of treatment response, location and prognosis, and they are infected with HPV.
And now it’s been linked to some forms of lung cancer.
And before you run out in terror regarding the wart cancerous death rest assured that the body actually does a pretty good jump of cleaning up HPV infection over a few years. After two years, 70% of HPV infections are gone from the body. Which leaves 30% of the infections persisting for longer.
A few years ago the Gardasil vaccine came out for HPV-16 and -18. I’m going to avoid the debate around vaccines for now, and just say that I believe preventing infection is more effective than treating infection. But given our current attitudes towards vaccination and the hundreds of types of HPV, a vaccine probably isn’t going to solve the problem of what to do about a known cause of cancers. Even if it was 100% effective, it’s kind of like taking the biggest piranha out of a tank of piranhas. I’m still not willing to stick my face in it.
In the next week or so, I’ll look at some of the treatments for HPV infection.
Ah, halogen groups, they are by far my favorite way of turning regular ordinary molecules into bubble gum chewing, ass kicking molecules that just ran out of bubble gum. Just stick a chloride, bromide or a fluoride onto an everyday molecule and living things don’t really know how to process it. Like DDT or Splenda.
5-Fluorouracil or 5-FU was a regular old RNA nucleotide, uracil, until science attached a fluoride onto the 5th carbon. After that it was a cell killing menace.
5-FU works in a couple different ways. The most important way 5-FU works is by gumming up the enzyme thymidylate synthase. Excuse me if I geek out in organic chemistry, but this is where I think it starts to get interesting.
Thymidylate synthase is responsible for sticking a phosphorous group onto thymine. Eventually, Thymine will get three phosphate groups and a sugar and become a DNA nucleotide, one of the building blocks of DNA. Now another name for Thymine is 5-methyluracil. 5-methyluracil and 5-fluorouracil are a lot a like. So much so that 5-fluorouracil can bind onto thymidylate synthase. (For those of you that studied enzyme kinetics, I don’t know if the reaction is an example of competitive or suicidal inhibition.) Because 5-FU is inhibiting the enzyme, thymidylate synthase can’t make DNA nucleotides that the cell needs for repair or division. DNA synthesis comes to a halt and the cell dies, which is good cause we’re talking about cancer here.
Where it gets a little neat, and naturopathic, is thymidylate synthase depends on folic acid to work. Without folic acid, thymidylate synthase isn’t going to bind to 5-FU, and it’s not going to bind to thymine to make DNA nucleotides. A fairly standard practice is to give 5-FU with leucovorin, which is a form of folic acid, because giving leucovorin makes 5-FU more effective at killing cancer cells. To me, that implies that the people who have benefit from leucovorin don’t have enough folic acid to run all of their metabolic pathways at 100%. It makes me want to assume people who get the kind of cancers that 5-FU is used to treat, colon, pancreatic and breast, are deficient in folic acid or have genetic errors in folic acid metabolism.
It’s always taken me awhile to get ready in the mornings. I need at least an hour to be fully combobulated in the morning before work. Shower, shave, neti pot sinus rinse, iron work clothes, scramble some eggs, fry up some bacon, do the hair, eat, get dressed and get out the door with 15 minutes to drive to work. I can do it in less time, but well I like a relaxing morning. This strategy had worked great when I had to be up at work at 9, 10 or 12. In fact, that’s kind of when it evolved.
In contrast, the hospital opens at 8am, when the first patients are seen. Radiology opens even earlier, but I’m not a radiologist, so let’s be thankful for that. The thing is everyone is pretty busy throughout the day. The hospital prides itself on an integrative approach, which involves medical oncologists, radiologists, surgeons, pathologists, nurses, dieticians, counselors, pastors and naturopaths all sitting in a room discussing patient care. It’s actually pretty awesome. Unfortunately, the only time all of us are free is before work. Thus, the 7am meeting was born.
I normally only have two regularly scheduled 7am meetings a week. But if anyone wants to schedule a special meeting, guess when it is. I’m averaging about three a week. The first week, saw me adjusting to being awake at that hour. I have to admit, the first week may have seen me nodding off at one or two of those meetings. Running out the door, having woken up thirty minutes earlier, to sit in a dark room looking at slides of tissue biopsy. All the excellence in the world couldn’t keep me awake.
But we are excellent, and I really like being able to follow the MRI report at 7:15am in a dark room. So, the adjustment was bedtime is 10pm, and I wake up at 5am to start my day. This morning, I woke up at 4:59, a minute before my alarm, ready to discuss adjuvant chemotherapy and patient concerns. I might not be as bright-eyed as the people who’ve been doing this for years, but I’m awake enough to realize that.
Today is the last weekday before I start my job as a Naturopathic Resident. I got into town on Tuesday and have spent the last few days dancing with Human Resources. I’ve never had a Human Resources department before, so really I was kind of expecting something out of the movies instead of the relatively friendly ladies I’ve met. Still it has been a little daunting. The first day I got my toxicology screen, drug test, which I passed. Yeah for passing tests.
I’ve signed two or three dozen pieces of paper stating that I have read and accept the description of my job, the compensation package, the code of ethics, the management style, the HIPPA guidebook, not eating French toast on Tuesdays, the list goes on and on. Then there was the respirator mask fitting, in the event I’m working with a patient with active tuberculosis. I wear a regular sized respirator mask if anyone was wondering. Blood tests to establish baseline liver and kidney function, and if in three years my kidney and liver are non-functional, I can now blame it on my job. It all finished off with an appallingly brief physical exam. Somewhere in there, I met with the benefits coordinator.
At 29, I finally have a job that gives me benefits. It has taken over 10 years, but I’ve got health insurance through my employer. I don’t really want it. I have almost no desire to be treated with allopathic medicines except in an emergency. At 7% of my income, its not terribly expensive, but I’d rather put my money into a Health Savings Account (HSA) that would actually cover the few medications I take. (Magnesium taurate, I’m looking at you.) I’d feel stupid not taking insurance, it’s only $4.00 more then a high deductible plan and I’m covered in an emergency.
The benefits package I went with is a combination of traditional insurance, an HAS, and reimbursement for a gym membership. You’d think as a physician, I’d have a better idea of all this, but really I’m just as clueless as everyone else. Refreshing, no?
Add the benefits to federal and state withholding and I’m making less money then I had as a student, which is only slightly more then I made six years ago, when I decided to walk down this path to being a doctor. I remember thinking, “If I’m going to work this hard, I might as well make some money doing it.” And then I chose Naturopathic Medicine. I’ve certainly worked harder these last four years than I have before. I’m excited to be starting this new chapter; let’s just hope I love my job.
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