NJMS - UMDNJ Logo

Graduate School of Biomedical Sciences
Alumni Association

Dear Alumni,

Let me start from the beginning: I was initially reluctant to place this announcement in the Alumni Pulse Newsletter about my recently diagnosed hepatocellular carcinoma because I thought that my fellow alumni preferred to hear only "happy news": births, engagements, weddings, new board certifications, successful new practices and hospital appointments, delicious recipes, great wines, and tough clinical cases successfully solved. After much deliberation, I felt that my fellow alumni have a right to know the details of my experience living with a "terminal diagnosis", especially as it taught me valuable lessons of being a better clinician, pain manager and physiatrist.

I remember feeling so empty and sad when I learned that my first pain management teacher, Dr. Elizabeth Narcessian, had died from cancer. I wished that I had had more contact with her during her life - especially after her diagnosis. When I learned that she had died, I felt that I had cheated myself of an opportunity to better know this beautiful and talented physician and to reach out to offer my help in achieving her last wishes. I felt there was a lot to learn from a physician of her caliber who advanced the legal regulations of pain management for all of us suffering pain.

Moreover, I have also learned many lessons about the art of medical professionalism - from the perspective of a pharmacist-physician-researcher now turned full time patient and fighting for my life. I now am not afraid to die and thus I now am not afraid to live fully as well. This diagnosis allowed me a peace and unique window of happiness that I would like to share with all of you.

 

"Look to your right, look to your left on this first day of class". "Look to your right, look to your left…because some of these people will NOT be with you in four years." I have heard this "natural selection - weed 'em out speech" four times in my life: on my first day of Pharmacy school at Rutgers University; my first day at the School of Osteopathic Medicine; my first day at the Graduate School of Biomedical Sciences, UMDNJ; and, most recently, on the first day of my MBA program in Global Health Systems Management. Each time, I resolved that I would prevail in the classroom, and it would be the other folks sitting to the right and left beside me who would be selected out.

Now, as I sat in the waiting room of The Thomas E. Starzl Liver Transplant Center in Pittsburgh, PA, I thought of those words again "Joe, look to your right, look to your left…" However, this time, the statistics overwhelmingly showed that I was the one who might not be around soon. In fact, the textbooks all state that "the great majority of Hepatocellular Carcinoma patients are dead less than 12 months after diagnosis, with early transplantation being the only possible cure" (Fauci 1998, Chang 1997, Bruix 1997). I looked around and had never seen so many desperate, depressed, jaundiced, emaciated faces in one waiting room in all of my life. I wished that this waiting room was a classroom instead and that I was here to take a written or oral exam, instead of a physical exam.

I made jokes to hide my depression and desperation. I told those to the right and left of me that I didn't like to be labeled as someone with "liver cancer"; rather, I would much prefer to think of myself as simply being "Hepatically Challenged" - a little rehab joke. "Hey, my chairman is very proud of me for being a professor on the "co-terminal" tract, rather than the "co-terminus" tract. No one laughed. It was Monday, and Mondays at this University Center in Pittsburgh Presbyterian Hospital are for liver cancer patients and initial evaluations for liver transplants. Very serious day. "Come on folks, lighten up a bit". A try at making common conversation: "Hey, maybe they will start offering livers on e-bay, not just kidneys." People started moving away from me, in fear. I had just taken a seminar on effective use of humor in the the office based practice but clearly, my timing was still a bit off. Back to the drawing board.

After my visit to the University of Pittsburgh, being true to my alma-mater, I brought all my diagnostic data back to UMDNJ-NJMS for review. Distinguished professor, Dr. Carroll Leevy of NJMS's "Sammy Davis Jr. International Liver Center," summarized my diagnosis on familiar bright cherry UMDNJ stationery to my Aetna primary care physician, Dr. David Abend: "Your patient, Dr. Joseph Cheu, was evaluated at the New Jersey Medical School Liver Center on August 30, 2000. He has hepatocellular cancer with seven lesions and is in urgent need of the newest available cancer therapy…He is not a candidate for either resection or transplantation".

Since the carcinoma had already aggressively spread throughout all lobes of my liver, resection would be useless. I already had advanced stage III or possible stage IV disease. Transplant would only invite recurrence of this highly malignant cancer in the new liver, plus an unacceptable chance of dying on the table. I had a questionable enlarged node in the cardio phrenic plexus, which might be a sign of early metastasis to the lung. I was offered only chemotherapy with hepatic artery and vein embolization to attempt enhancement of survival time beyond the dismal few months. The quality of life under main stream chemotherapy, however, may be worse than death.

The letter and summary diagnosis by Dr. Leevy of UMDNJ was preceded by 2 months of pure torture. I was very busy experiencing being a patient after July 4th, 2000. I spent one week as an inpatient having multiple tests done. I then made multiple trips to Pittsburgh Presbyterian Hospital, Thomas E. Starzl Liver Transplant Center, Mount Sinai Hospital and transplant center in New York, Burzynski Institute in Houston, Texas and the Sammy Davis Jr. International Liver Institute at NJMS, UMDNJ. Additional visits were made to Pascack Valley and Barnert hospitals. There were countless local doctor visits and hours of paper work and arguing with my health insurance carrier, Aetna US Healthcare. I underwent more than 10 scans of varying types. I had ingested all the gallium, barium, gadolinium, isovue and radioactive iodine I could stand and then some. Also performed were ultrasounds galore, countless blood tests and 3 passes of a 16-gauge core biopsy needle through my abdomen and liver. That's how I spent summer 2000.

I was told that the biopsies would be "only slightly uncomfortable" and that conscious sedation would not be necessary. The radiologist was wrong on both counts. It was an extremely painful experience on the procedure table and it also hurt even a week afterwards. I would have appreciated a little honesty about the procedure so I could have at least "braced" for it. (I would've appreciated a little pre-emptive anesthesia pain management as well). He never had it done to him, so maybe he truly didn't know. Either way, it felt like deception. Two lessons I learned were: I will never again minimize anticipated discomfort or pain - the patient will never forgive me whether or not I achieve my strategic medical objective. I will always be the doctor who hurt them. Next, the bombardment of information, the anticipation of results and the absorption of the treatment plan can be overwhelming for anyone. I will always keep that in mind in my practice of medicine.

 

My reactions as a reluctant cancer patient: At first, I thought that this was not possible. It must have been an error. However, going through the films, tumor markers, liver enzymes and other objective medical evidence myself, I had to conclude that the current diagnosis is on target. This explained the dull aching radiating visceral pain, early satiety, fatigue and fevers that I had been feeling progressively for almost a year, increasingly low moods and short tempers - no, I guess it wasn't stress or just burnout syndrome after all.

I held an unrealistic belief that doctors don't themselves get sick, especially terminally sick. We are supposed to be caregivers not care receivers. In fact, I didn't know how to be a patient - I had to learn. I somehow convinced myself that pain managers won't ever experience pain (physical or psychic), physiatrists will never experience disability (physical or psychic) and even that electromyographers never will need electrodiagnosis. It appears that I was wrong on all counts. I was introduced so intimately to a personal aspect of cancer pain management and cancer rehabilitation that I deserve primary continuing education credits until my renewal exam.

Immediately after I learned of my diagnosis, I thought of one of my early and beloved mentors in pain management, Dr. Elizabeth Narcessian, who recently passed away also from cancer. My next thought was of my brother Lt. Colonel Henry W. Cheu M.D., a pediatric surgeon and flight surgeon in the US Airforce who, ironically, specialized in liver transplants. He died in August 4 summers ago, 1996, in a plane crash along with his daughter Sally Cheu. He thought erroneously that flight surgeons and pilots never would have plane crashes.

I also thought of my 3-year-old daughter who may grow up fatherless as I did, since my birth father died when I was very young. Since the death of Henry Cheu and grand daughter, Sally Cheu, my mother has been treated at UMDNJ by Dr. David Dwyer, the Chairman of cardiology, for cardiac arrhythmias. She now may have to cope with the death of both her children, Henry and possibly myself, the loss of her first husband some years ago, and also possibly her second husband, Peter Cheu, who is presently under the care of UMDNJ oncology surgeon, Dr. Harrison. My stepfather, Peter Cheu, was diagnosed with pancreatic cancer only one month before my diagnosis with liver cancer this memorable summer of 2000. All of this is proving to be too much for that dear old lady I call "mom".

I learned first hand that many patients are exposed to multiple stressors during certain times in their lives. When "it" hits the proverbial fan, it can hit very hard. When it rains, it really pours. I will never again assume initial noncompliance to be non-cooperation in a patient living with multiple stressors. I will always take time to put the chart and stethoscope aside to ask the patient "what else is really going on in your life?" Take a spiritual history and consider psychosocial needs. Take the time to care - despite managed care.

I also I thought of all the patients who allowed me to treat them during my residency and fellowship. The patients used to call the staff and providers the "temporarily abled" bodies and many of the severely disabled and medically ill patients had a deep spiritual ability to accept their newly disabled bodies with courage. I always admired them for their strength. I wondered whether I could be half as strong as those patients which I had the privilege of treating and learning from. I realized that only by putting myself in each of my patients' sick beds could I then, and only then, truly understand their needs.

My deceased brother, Henry W. Cheu M.D. I am not afraid to die. Finding out I have liver cancer is only a close second to the very worst news I had ever received in my life, when I learned, 4 years ago, that my older brother and only sibling had died in a plane crash with his daughter Sally. When I received the news of my diagnosis, I thought of my mission to endow a permanent research chair in the name of my brother. This is the reason I am in private practice today instead of being an academic basic science researcher, which is what I intensively trained to be for 5 long years. My brother died in August of 1996 when I had just finished my residency training and was starting to explore the best way to approach my Ph.D. thesis in neurobiology. By most people's standards, I was considered to be impractical in not seeking a high-paying job after my residency. Rather, I was facing my Ph.D. qualifying exam and an unpredictable number of years as a graduate student and Ph.D. candidate, with Drs. Alan Siegel and Joel DeLisa as my thesis advisors. My goal was to integrate basic neurobiology, rehabilitation medicine and alternative holistic medicine to help the disabled.

When my older brother and I were very young, and he just started to walk, I learned that walking is possible. When he rode a bike, I rode behind him trying to catch up. When he drove a car away to school, that too opened a whole new world of possibilities for me. After my birth father died when I was only 6 months old, I relied on my big brother to show me how to be in the world, how to enter adulthood. He taught me how to shave, how to make different knots in a tie and how to dress for dates. He was always better at everything and, of course, did everything first. He was the wind beneath my wings. When he graduated as valedictorian of his class and became a physician, a new rocket of desire opened up for me. I went into medicine as well. I was always, in his mind, the kid trying to catch up to him on a bicycle with training wheels while he wanted to zip ahead on his ten speed bike through Verona park. He sometimes resented not being able to zip ahead as fast as he wanted to because our mother told him to "take care of the little brother." As a physician researcher himself, he taught me to "be cool to ideas and warm to people". From that, I learned to always test my ideas but to accept people and love them as they are.

There were a lot of hard acts to follow in my family. My mother has a Ph.D. degree from Columbia University, my step dad has his Ph.D. from Rutgers and all my uncles were "chairing" something or other around the world. Henry Cheu, M.D. was triple-board-certified in general surgery, critical care medicine and pediatric general surgery. I just wanted to achieve something so stellar that my brother would, one day, turn around and pat me on the back saying "Good job, kid-brother. Way to go!" He had never uttered any such words close to those (he wasn't a mushy guy anyway) when he prematurely died, at 37 years of age, in a tragic plane crash. He was a U.S. air force Lieutenant Colonel flight surgeon at the time of the accident. My brother's middle child, Sally Cheu, died along with him. He was survived by his wife, Carolyn Cheu, and 2 children. Just like my brother, my mother and I were also survived by the death of my father nearly 38 years ago.

When I learned of my brother's death, I acquired a deep desire to pick up the torch he had been carrying which, I felt, was a very noble one. Henry had always planned to endow his own chair at a medical school and thus allow an infinite number of professors and research ideas to flow through that endowment without a time limit. I wanted to endow a chair in my brother's name: the Henry W. Cheu, M.D. endowed chair. The purpose of this endowed chair would be to: 1. Memorialize my brother in his untimely death; 2. Continue his life-long dream of such an achievement; 3. To establish a means to benefit patients for many generations to come. In addition, I thought that taking up my brother's quest would serve to fight off a massive depression that came over me at the time by giving some form of meaning to my brother's death.

I called the UMDNJ Foundation in 1996 to speak to then Vice President Carl Schneck and, to my surprise, was told that it would cost about 1.5 million dollars to endow a permanent chair! This would allow me to name the chair after my brother. This became my new "specific aim". For someone who was living on about 30 thousand post-tax dollars per year, this sounded like a task of Mount Everest proportions. I had to take a detour from bench and clinical outcomes research if I was to be able to command that kind of money. I shared this goal of mine only with my family and closest friends to avoid disappointment if I failed in this task. I put my research aside to pursue clinical private practice.

I feared failure and didn't know how to ask for help because I couldn't accept weakness in myself. My recent diagnosis has helped me to overcome these issues however. At the 1998 Resident/Research Fellow awards dinner at Richfield Regency Caterers in Verona, Dr. DeLisa was surprised that I had nothing to say. I was surprised too for I am seldom at a loss for words. I was too depressed and ashamed that I didn't have a strategic plan to achieve the new goal I had set for myself, that of endowing a chair for my brother Henry. I couldn't fully enjoy the celebration of my achievements thus far despite being awarded the first annual Stanley Bergen, M.D. Medal of Excellence for Graduate Research and being valedictorian of my Ph.D. cohort at the Graduate School of Biomedical Sciences with a GPA of 3.905. Dr. DeLisa warned me while we were waiting for our cars at the Richfield Caterers, that "most people don't return back to academic medicine and research after anything more than a one year absence". Those words weighed heavily on my mind but I had a promise to keep for my brother.

I even enrolled in a program to earn my MBA degree in global systems management to facilitate my overly ambitious seven-year goal of endowing a chair in my brother's name by eventually selling the practice equity or making an initial public offer and then returning to my research. My diagnosis threw a small monkey wrench into my plans.

I don't think I am alone in my self-driving, workaholic state. Life is so short, my dear colleagues, and no one on their deathbed ever wished that they had worked one more day in their life. So make each day count; the achievements will come in time anyway. When I couldn't love myself unconditionally, I couldn't enjoy the achievements anyway. I am not afraid to die simply because the arrangements I plan to make will use my estate to establish the Henry Cheu, M.D. memorial endowed chair. Whether I live or die, I can honor my big brother. However, I would certainly like to have the opportunity to give the inaugural address at the establishment of this permanent endowed position. But every day now I remind myself: "it's really nice to be important but it's more important to be nice."

 

Self Cancer Treatment: I know from my bench research training that, at least in tissue culture, cancer cells need very consistent conditions, acidity, temperature, nutrients and growth factors in order to survive in vitro. I learned that, when attempting to grow any type of cell or tissue culture, any forgetfulness or laziness on the graduate student's part leads to a change of conditions, which kills the culture and ruins the experiment. After my diagnosis of hepatocellular carcinoma, I hypothesized that in vivo cancer cells must have a similar need for conditions consistent to favoring their own survival relative to the healthy cells that they invade. I then decided that there is no such thing as cancer, only the failure of the body to control its growth. This placed the responsibility and power to get well squarely on me alone.

I do not attribute any power to the tumor cells and therefore have no responsibility to kill them, only to manage them until my immune system, which is now my greatest ally, can escort them to the trash can. So, to get well, I hypothesized, all I need to do is to drastically change the conditions under which these nasty tumors grew and then they must shrink, like my failed cell cultures in the culture dish.

My specific aim is to survive. Since I believe that cancer is a multi-level disease, my method and experimental protocol is also multi-level. After an exhaustive international search on the subject of hepatocellular carcinoma, my conclusion is that there is no consensus and no known definitive treatment (Simonetti 1997, Bruix 1997). I am truly on my own with this one. The null hypothesis is that my plan simply is wrong and my experimental protocol will fail. I refused all chemotherapy, radiation and stopped any discussion on living donor transplants. The statistics presented in the literature were very poor for a 2-year survival no matter what I chose as treatment. The statistics are based on the average population of people who chose the current conventional medical model and who were not lost to follow-up on surveys. I decided that these statistics don't apply to me since I am formulating my own independent research project with me as the subject. (Don't let your new IRB get wind of this one, Dr. Delisa!)

I set off to completely change the internal conditions around the tumors, which means entirely changing my life style. The problem is that I wasn't living such a poor life style to begin with. I didn't smoke, I didn't drink, and I didn't party late. I am a family man and father of the cutest (in my opinion) little 3-year-old girl. I worked hard; I practiced 1-2 hours of Tai-Chi every day plus other aerobic exercises and was national grand champion in Tai Chi Chuan in 1993 and 1994. It was a hard reach to try to improve on an already decent lifestyle. I realize that nothing I do now in an attempt to reverse my cancer is evidence-based, by strict definition (Geyman 2000).

But then again, there is nothing "evidence-based" about conventional chemotherapy either (Geyman 2000). Each combination is a separate protocol. Each cancer treatment center wanted me to enroll in some kind of study to add to the base of their evidence. So my choice was between their non-evidence-based and my non-evidence-based protocols. I decided to bet on me and my own hypothesis-driven protocol. In the process, I learned to always be very gentle when enrolling patients into clinical studies. Patients don't care how much you know until they know how much you care. I felt very annoyed that, on my initial evaluation, my physicians were splitting their focus between their data sets and me, even though I had great interest in clinical outcomes research myself. They wanted to enroll me in a research study.

I qualitatively noted, at home, the pH of my blood and urine over two weeks and discovered that these fluids were slightly on the acidic side. I changed my diet to increase my fluid pH to a more alkaline one. In order to do that, I found I had to eat almost 80% raw foods, deep greens, wheat grasses, and lots of roots and fruits. I use a combination of whole live foods as well as extracted juices. I eat a ton of shitake mushrooms, which increase Natural Killer cell activity and am on a modified macrobiotic diet. Nothing tastes very good but I know I am trying to save my life and no one else can do it for me. I attempt to control angiogenesis (Falcone 1994), using large amounts of shark cartilage daily. I am considering the use of Thalidomide as well

I carefully administer self-induced hypoglycemia using insulin and completely cut out all glucose and sucrose from my diet to starve the rapidly expanding tumors (Klaber 2000). I read a lot about guided imagery - instead of using guided images to violently "blast" away the tumors, I imagine cuddling and loving the tumors like babies, to encourage them to grow up, become mature, and get a real job as the good hepatocytes that I know they can be. I tell them to be mature and healthy, "be all you can be, join the hepatocyte army now!"

I judiciously use herbals and nutritionals such as Laetrile from my own organic apricot seed-and-almond milk shake recipes, MGN-3, IP-6, Flax oil and Essiac Tea. I sprout my own seeds, nuts and beans. I learned that almonds are the only nuts that will sprout, however. For 3-4 hours a day, I practice a specialized Qi-Gong breathing and moving meditation exercise developed by cancer experts in China. This exercise is specifically designed to combat carcinomas.

I decided to choose a totally non-toxic medication treatment using a peptide called sodium phenylbutyrate (Chung 2000, Peledis 1998, Lea 1998, Boudoulas 1996). This is converted in the normal liver to a nontoxic compound, phenylacetate, which putatively achieves anti-cancer activity by increasing apoptosis (genetically altered scheduled cell death) through the p53 locus and ras-oncogene. This compound, which is already approved for use in urea cycle disorders, is currently in phase-2 FDA investigation for efficacy in carcinomas including liver cancer and glioblastomas. Because sodium phenylbutyrate is non-toxic in its active form, this medication fits my specific aim of working with my immune system instead of against it. In fact, Mike Lea in Biochemistry at UMDNJ NJMS had also published data on phenylbutyrate (Lea 1998). My Ph.D. training taught me to be an independent thinker. This will now cure me or kill me.

Spiritual Changes: Some of my patients and friends say that, unconsciously, my grief for my deceased brother may have contributed to the growth of my hepatoma. As a physician and Ph.D. basic science researcher, I know this sounds ridiculous. However, my hepatologists estimate that my hepatomas started about 3-4 years ago, which places it right after my brother died. Also, I was diagnosed on the anniversary of his death. Moreover, liver transplantation and liver surgery was my brother's sub-specialty. Grief may be more deadly than I had given it credit.

Another lesson I learned as a physician after being a patient is to always take an accurate spiritual history and take care of the deeper psychosocial needs of the patient by referring them to someone who is trained to treat emotional imbalance. This synergistic, holistic "whole person treatment" will enhance the patient's therapeutic reaction to your prescriptions and procedures. The patient will respect you more for this because you have demonstrated respect for their whole being. But we will never know if we don't take a good spiritual and psychosocial history (Sloan 1999, Highfield 1997).

When I would travel on a business trip, I would write on an index card all the basics that I need to bring, in order to facilitate packing. When I was told of my diagnosis and read the poor prognosis of hepatocellular carcinoma, all of a sudden, I realized that there is nothing on that index card I would be taking along with me. In fact, none of my degrees, board certifications, awards, money, house or family would I be taking going to meet the big Chairman in the sky. Nor would anyone be interested in any of my worldly achievements where I would have to travel - alone. I thought of what I can put on my new index card as a packing list reminder and I thought of only one thing to write down - the only thing that will matter to my maker: The ability to give thanks and gratitude for whatever situation is presented to me. Often, when disaster strikes repeatedly, this is the only thing we have absolute control over, our response to the disaster. The ability to give thanks will lead to two important side effects - peace of mind (which, in itself, is pain management) and love in our heart (which is like a beacon that calls for God's angels and human messengers to attend to us). A book that helped me understand happiness is by the Dali Lama (Cutler 1998).

Lesson: When things are going against you, you are in danger, and are faced with terminal diagnosis, you reach into your pocket and what do you find for comfort? Nothing. You look for help and whom do you get? No one. Turn around your life by giving thanks for the first thing that comes to your mind - however big or small. Teach your patients to do the same and explain this paragraph to them, let them know that you heard their pains and understand the level of their suffering. Explain to them that pain sometimes is unavoidable but suffering is optional.

This diagnosis allowed me a unique window of happiness that I would like to share with you. Disease, pain, disaster and disability are inevitable. These reveal to us the parts of ourselves that we do not know and thus bring us closer to God. Suffering is optional. For further reading on this concept, see works by Carolyn Myss. It is only by practicing the art of gratitude during the most trying of times that we become stronger in our ability to give thanks for everyday blessings. This is like the use of progressive resistive exercises or the ten repetitive maximum (10-RM) technique of spiritual muscle training. The greater the pain and adversity through which we must give thanks and appreciation, the greater the weight lifted. May I suggest that when we are suffering the most, it is an opportunity to strengthen our faith through thanksgiving and prayer (Harmon 1999).

It is during those hardest times when the angels are near us praying for us. I imagine them compassionately holding up score cards like the judges do after a dive in the Olympics, rating our ability to be thankful in those difficult times. The score has two components just like in the Olympics: a difficulty factor, multiplied by the magnitude of true thanksgiving. Then like an instant bolt of lightening, a jolt of grace is returned which gives one the strength to face whatever task is before one, through peace of mind and love in the heart.

I believe that illness and suffering are a means of revealing to myself the parts of me that I do not know by the following mechanism: 1. They allow me to practice gratitude in the face of desperation, pain and hopelessness. 2. They give me the time to be alone and do nothing, to still my mind and hear inner guidance. 3. They force me to let go of any true attachments to material things.

Is there a review class or workshop to learn the important lessons of love, gratitude and the ability to still the mind despite challenges? There is the annual Kessler board review class; there are workshops in pain management and electrodiagnosis that qualify for continuing education. The workshop to learn the important lessons of decreasing resistance to natural flowing, God-given love, gratitude and inner peace is called life. And to introduce yourself to your teachers and workshop leaders, look to your right and look to your left, and look in front of you. There is no insignificant task, there is no un-meaningful conversation, there is no shortage of miracles in my daily life. The ordinary is truly extraordinary and it isn't necessary to develop cancer or experience tragedies to believe this.

I suggest that, on the final transitional trip in death, which we are all headed toward since the day we were born, we can only take with us our ability to love, give gratitude and manifest peace and stillness of mind. Everything else is left behind - so pack lightly my dear alumni, because you never know what miracles tomorrow will bring. So look to your right, look to your left on this first day of class in your schoolroom of life, here you will find your classmates and your professors.

 

Some good news and what am I doing now: As far as the standard good news in my life that I feel the Alumni Newsletter should carry, I am writing a book on my experiences as a cancer patient (the proceeds to go to the Henry Cheu Memorial Research Fund). I am running as well as joining support groups for alternative cancer treatments. I am doing spiritual prayer research with Tom Findley, M.D., Ph.D. at the University of Pennsylvania and I continue to chair the Medical Holistic Institute. I was recently board certified in pain management, and I am currently Chief of Rehabilitation Services at Barnert Hospital. My daughter, Julianna Joan Cheu will be 4 years old soon on March 11. I will be graduating with my MBA in Global Health Systems Management in May 2001. AND my most recent scans and ultrasound show no progression of disease with about 5% improvement. In addition to beating this cancer, my goals remain to acquire the funding for the Henry Cheu endowed chair and to get back to research. I thank everyone for their prayers for me and I truly believe in the efficacy of this form of distant healing which is also supported by literature (Aston 2000, Harmon 1999, Targ 1997).

I am grateful to the "Alumni Pulse,"Scott Nadler, D.O., and Joel DeLisa, M.D., M.S., for this rare chance to communicate with you, my brothers and sisters in rehabilitation training at UMDNJ. Peace and health be with you!

References

Hepatocellular Carcinoma

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998:319-21.

Chang MH, Chen CJ, Lai MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. N Engl J Med 1997; 336: 1855-59.

Trichet JC, Beaugrand M. Treatment of hepatocellular carcinoma in patients with cirrhosis. J Hepatol 1997; 27: 756-65.

Bruix J. Treatment of hepatocellular carcinoma. Hepatology 1997; 25: 259-62.

Hanley AJG, Choi BCK, Holoway EJ. Cancer mortality among Chinese migrants: a review. Int J Epidemiol, 1995;24:255-65.

Oda T, Tsuda H, Sakamoto M, Hirohashi S. Different mutations of the p53 gene in nodule-to-nodule hepatocellular carcinoma as evidence for a multistage process. Cancer Lett 1994;83: 197-200.

Ishak KG, Anthony PP, Sobin LH. Histological typing of tumors of the liver. In: WHO International Classification of Tumors, 2nd ed. Berlin: Springer-Verlag, 1994.

Bhattacharya S, Davidson B, Dhillon AP. Blood supply of early hepatocellular carcinoma. Semin Liver Dis 1995; 15: 390-401.

Simonetti RG, Liberati A, Angiolini C, Pagliaro L. Treatment of hepatocellular carcinoma: a systematic review of randomized controlled trials. Ann Oncol 1997; 8:117-36.

Sato Y, Nakata K, Kato Y, et al. Early recognition of hepatocellular carcinoma based on altered alpha-fetoprotein. N Engl J Med 1993; 328: 1802-06.

Evidence-Based Medicine

Geyman JP, Deyo RA, Ramsey SD, Evidence-Based Clinical Practice Concepts and Approaches. Butterworth-Heinemann Publications, 225 Wildwood Ave, Woburn, MA, 2000.

Alternative Cancer Cures

Falcone R, The complete guide to alternative cancer therapies: What you need to know to make an informed choice. Citadel Press Book Co., 600 Madison Ave., New York, NY, 1994.

Insulin

Klaber T, A cancer treatment for the millennium, Alternative Medicine, January 2000, 34-42.

Sodium Phenylbutyrate

Carducci M, Bowling M, Eisenberger M, et al., Phenylbutyrate (PB) for Refractory Solid Tumors: A Phase I Clinical and Pharmacological Evaluation. The Johns Hopkins Oncology Center, Baltimore, MD, Proceedings of the AACR, 1996.

Boudoulas S, Lush RM, CcCall NA, Samid D, Reed E, Figg WD. Plasma Protein Binding of Phenylacetate and Phenylbutyrate, Two Novel Antineoplastic Agents. Ther Drug Monit. 18:714-20, 1996.

Pelidis MA, Carducci MA, Simons JW, Cytotoxic effects of sodium phenylbutyrate on human neuroblastoma cell lines. International Journal of Oncology. 12(4):889-93, 1998.

Engelhard HH, Homer RJ, Duncan HA, Rozental J, Inhibitory effects of phenylbutyrate on the proliferation, morphology, migration and invasiveness of malignant glioma cells. Journal of Neuro-Oncology. 37(2):97-108, 1998.

Yu KH, Weng LJ, Fu S, Piantadosi S, Gore SD, Augmentation of phenylbutyrate-induced differentiation of myeloid leukemia cells using all-trans retinoic acid. Leukemia, 13(8): 1258-65, 1999.

Lea MA, Randolph VM, Induction of reporter gene expression by inhibitors of histone deacetylase. Anticancer Research. 18(4!):2717-22, 1998.

Chung YL, Lee YH, Yen SH, Chi KH, A novel approach for nasopharyngeal carcinoma treatment uses phenylbutyrate as a protein kinase C modulator: implications for radiosensitization and EBV-targeted therapy. Clinical Cancer Research. 6(4):1452-8, 2000.

Spiritual History Taking

Sloan RP, Bagiella E, Powell T. Religion, spirituality and medicine, The Lancet, 353(9153); 664-667, 1999.

Highfield MF, Spiritual Assessment Across the Cancer Trajectory: Methods and Reflections. Seminars in Oncology Nursing 13(14);237-241, 1997.

Buckman R, Doctors can improve on the way they deliver bad news, MD maintains. Can Med Assoc J, 146(4):564-66, 1992.

Ptacek JT, Eberhardt TL, Breaking bad news: a review of the literature. JAMA, 276(6);496-502, 1996.

Poncar PJ, Inspiring Hope in the Oncology Patient. Journal of Psychosocial Nursing, 32(1); 33-8, 1994.

Achterberg J, Simonton SM, Simonton O.C., Psychology of the exceptional cancer patient: A description of patients who out live predicted life expectancies. Psychotherapy: Theory, Research and Practice, 14, 416-22, 1997.

Georgesen J, Dungan J, Managing spiritual distress in patients with advanced cancer pain, Cancer Nursing 19(5), 376-83, 1996.

Dalai Lama - Happiness book.

Cutler HC, His Holiness The Dalai Lama, The Art of Happiness: A handbook for living. Riverhead Books of Penguin Putnam Inc., 375 Hudson Street, New York, NY, 1998.

Prayer

Targ E, Evaluating distant healing: a research review. Alternative Therapies in Health and Medicine, 3(6):74-8, 1997.

Aston JA, Harkness E, Ernst E, The Efficacy of Distant Healing: A Systematic Review of Randomized Trials, Annals of Internal Medicine, 132(11); 903-10, 2000.

Harmon RL, Myers MA, Prayer and meditation as medical therapies. Physical Medicine & Rehabilitation Clinics of North America. 10(3):651-2, 1999.