Dear Dr. Roach: My brother-in-law is 57 and has pancreatic cancer the size of a golf ball. He is on his second chemo treatment. The doctors first want to shrink the tumour. They eventually want to take out the tumour. Do you think this is wise? He does not have cancer anyplace else in his body. I am worried that once the tumour shrinks it will probably spread to his other organs.
M.M.
Pancreatic cancer is so dangerous because it usually shows no symptoms until the cancer is very advanced. The only hope for a cure is a complete surgical removal, but that is not possible for most people. There are some tumours called 鈥渂orderline resectable,鈥� and in those cases, the team 鈥� consisting of a surgeon and a medical oncologist 鈥� will sometimes recommend treating the tumour with chemotherapy to try to shrink it enough that it can be removed. This is called neoadjuvant chemotherapy. It is also hoped that if there has been some spread already that can鈥檛 be seen by a CT scan, the chemotherapy might kill those cancer cells.
It does not always work, but if his team has recommended it, it is the only hope, outside of a miracle, for a cure.
Dear Dr. Roach: When people cough while eating, a typical response is: 鈥淲ould you like a glass of water?鈥� This is my take: Let鈥檚 say you are eating popcorn and, when you take a breath, you start coughing. A small piece happened to lodge itself in the entrance to the windpipe. The body鈥檚 reaction is to build up air pressure and expel it in a burst so as to try to remove it.
There is a 鈥渧alve鈥� that opens to allow only air to enter the lungs when necessary.
This 鈥渧alve鈥� shuttles in another direction to close off the lung鈥檚 air intake while opening the entrance to the stomach when swallowing.
Now, if I am correct so far, it is impossible for water to remove the object to stop the cough.
B.B.
When witnessing someone in distress from a medical issue, it is a natural tendency to want to do something to help. However, often the best thing to do is to allow the person the time needed to solve the problem on his or her own. Of course, there are some times when an intervention is lifesaving (such as the Heimlich manoeuvre), but often as a physician, I tell well-meaning bystanders just to wait for a few moments.
In the case of a cough while eating, it is certainly true that a small portion of food can enter the trachea 鈥� that鈥檚 the 鈥渨rong pipe,鈥� headed to the lungs. Food should go into the correct pipe, the esophagus, on its way to the stomach. The epiglottis is the 鈥渧alve.鈥�
There is a gag reflex that prevents any further food or liquid from going down either pipe, and this often is associated with a very uncomfortable feeling of being unable to breathe for a few seconds. The primary way the body has to get rid of the stuck food is the cough: an explosive, high-pressure burst of air to clear the airway.
A few sips of water can lubricate the throat and help the body stop the gag reflex. However, it is time and cough that are needed most, not water.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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