European Stars And Stripes (Newspaper) - November 8, 1988, Darmstadt, Hesse                                Taking charge Over illness by Victor Cohn the Washington Post y of re told you have a form of cancer of Somo Olhorn deadly disease Wilh Littler no Hope for a euro. Erml. If anything Canyon Donell. Fifteen years ago. 12-year-old Edward we. Kennedyjr. The Massachusetts senator s son developed a dangerous Bone and cartilage cancer o the Ngun ing his leg was amputated but this was not enough. The cancer was still spreading. Or. Lawrence Horowitz then the senator s aide remembers Hal Teddy or. Was faced wish a situation where attic outcome of Tho known treatments for that disease were very poor. The advice sen. Kennedy got was it s very difficult chances of survival Are very poor there is no known and tested and accepted treatment Wilh a High Chance Tor cure " the senator and his stall in Horowitz s words tanned Oul with a Quick research Effort. To matted internationally to see whether any experimental drug any idea was under development. In other words faced with a situation whore the known outcome was horrendous the senator refused to accept what he was generally told.". The senator and the doctors he consulted settled on a new combination of anti cancer chemicals for Teddy or s Luither and successful ire Alment. Horowitz Calls the process taking charge lading. Responsibility Lor one s illness. And to maintains that almost everyone can and should do this. Obviously everyone can l readily phone and even Gallei together the most illustrious consultants As the senator did. To help decide on a difficult course. Bill anyone con exorcise a Large degree of personal responsibility to gel the Best care and can do so even when the verdict is gloomy Horowitz maintains in a. Concise cogently written new Book. Taking charge of  fare random House $18,95. Anyone not so simple. Some physicians will argue Ilia advice like this will Lead Many patients on discouraging and costly wild Goose chases Man patients through no fault of their own Lack the drive the re sources the education to Lake charge some arc too sick too upset perhaps too afraid of authority perhaps More comfortable being told what to Doii you can l speak apr yourself Horowitz advises Lind a representative a spouse relative or Friend to speak Lor you. Again that s Good advice but such representatives Are nol always to easy to find. Most patients however ctn and should Lake charge As Lully As possible. And everyone  one thing the first thing anyone should do when Given almost any medical verdict or recommendation. Ask some questions. ,. The person to ask them of is the doctor who tells you some such words As. I m Soffy. Bul i have to Tell you thai there s nothing More to be  have several close friends who Are alive today because they refused to give up when their doctor  Horowitz reports. When their doctors walked away  Light he explains. When a doctor says there s nothing More he can do in s not necessarily True Hal nothing Moie can be done by anyone. The fact is that Rifle real doctors give up at different times Lor Rifle real reasons. When a doctor says that there s nothing More lobe done it really Means there s nothing More to be done by him. Or the colleagues and consultants he knows whether there s something that someone Edward m. Kennedyjr. Stag 12, the Loti Riding with hit father six weeks after his Teg was amputated in 1st3, else can do must be explored. Never accept someone else s judgment that you be reached the end of the line that there Are no More options left. You must come to that judgment by yourself after you have ought As hard As you can to find out if there s someone somewhere who just might be Able to  ,. Some questions then for your doctor Why do you believe there s Lilette or nothing to be done please explain. Is this an area where you yourself have a lot of experience and have treated a lot of patients have you consulted with any of the most knowledgeable specialists on this condition Are there any experimental treatment programs anyplace that i might be Able to get into and might want to  s to be gained irom such questions Horowitz asks. Surely if the doctor knew of anyone else to consult or anything else to 1ry. He would have done it already. Right wrong he might have. He might in tact be Correct. Most  time when your doctor. Gives up it is with Good reason. Most of the time in " fact he will be right. But most of the Lime is no necessarily your  in some cases Horowitz says the doctor might have made a value judgment about not putting you through More tests. More treatments More operations because inn slim Chance of Success was outweighed by the difficulties and risks of the treet Meni. He might have made a value judgment that your Quality of remaining life should not be sacrificed Lor so Little Chance of Success. 1 Bui it s not his value judgment to make. It s yours. Confronted with death the Quality of your remaining life May be  important to you than taking any Chance any risk no matter How unpleasant. In order to prolong your  Steps  doctor encouraged by you might decide to try. Harder or take other Steps ". ". E in any Case with almost any medical recommendation or verdict that profoundly affects your life get a second evaluation and opinion one that is Given directly to you. If possible get it irom a doctor who is nol associated in practice or not a golfing buddy of the first doctor. Your doctor May not agree with the , Horowitz Points out. Or different consultants May give. You Dilfer enl opinions. If this happens he says Only one physician at a Lime can Captain the team you must choose. Either follow your doctor and ignore the consultant or change doctors. Talk to the doctors. Yourself to get a personal feel for How thorough their approach is. Then  you decide to iry further treatment. The question then which doctor should real you who should be the Captain your Glrst doctor at this Point Well might have said doctor soands is the very Best or  or perhaps All right i la  should you Row stay with this doctor maybe yes. Maybe no All physicians want to do right by their  Horowitz writes. The problem is thai Many limes there Are different views  s right. In Medicine generally the More complicated the problem or the More advanced the disease the More important it is to find the right doctor almost All doctors can handle routine problems. Almost All can handle hopeless cases those for which no treatment exists with equal compassion. But in the vast Middle ground whare the bulk of serious cases fail the Choice of doctor can make a profound  u -. Take cancer new drugs new combinations of drugs new hormonal therapies new forms of radiation. Treatment develop  the same to a lesser extent is True in Many other Fields. Some of the new treatments work. Many do Nobui you Tho patient must decide whether you want to try and what doctor or doctors to stay with. You probably won t get a second Chance. Take the Case of Teddy Kennedy jr.," Horowitz says. Vat was not wealth and Power that made successful treatment possible it was his lather s taking charge. What sen. Kennedy did was to gather information about experimental treatments anyone can do the  Page i6 the stars and stripes tuesday november bm98b