The Family Connection
Some men and women have a hereditary tendency toward developing various types of cancer due to a genetic mutation.
Given five generations of family history, Jean Stokes of Ozark, clearly was at risk for breast cancer with multiple family members who tested positive for a genetic mutation in genes BRCA 1 and 2 (breast cancer type 1 and type 2).
Jean's mother, grandmother and uncle all developed breast cancer.
At age 73, Jean was diagnosed with breast cancer. Because of the strong family history, her radiation oncologist, Steve Stokes, MD, of Southeast Cancer Center, ordered genetic testing. She tested positive for Hereditary Breast and Ovarian Cancer Syndrome.
Since then, several other family members have also tested positive, including a son, a granddaughter and her first cousin's daughter.
Mutation of good DNA-repairing genes that suppress tumors is a strong indicator of heredity breast and ovarian cancer. The risk of developing breast, ovarian and prostate cancer is greatly increased through inheritance of this mutation. That's the reason Dr. Stokes says families must share the information.
"It's pretty rare to see this many in one family," he said. "I am thinking Jean's grandmother must have been positive as well. They just didn't know."
Though she has always had annual mammograms, Jean said she could have been more proactive. "Nothing has been uncared for. With all this cancer, I didn't connect the dots at all. I just had my regular appointments. If I had the test run and had learned earlier that my risks were higher, I would not have waited a whole year for a mammogram."
In fact, this genetic predisposition was not known by the family until after Jean had surgery, chemotherapy and radiation for cancer in her right breast in 2007.
"My cousin in Atlanta who had cancer has a daughter married to a surgeon. He wanted my cousin tested. She was positive and she passed the mutated gene to her oldest daughter, who also had a mastectomy," she said.
Having her cousin's medical records in hand, Jean was tested. After a positive read, she took her records to her children and grandchildren.
"Having my cousin's paperwork was sufficient for me to go have it done and my paperwork was enough for other family members to have it done. My oldest son is the worrier so he was tested. He is positive. His oldest daughter went to Birmingham a little over a year ago. She was positive and had a double mastectomy and reconstruction.
"My grandmother passed it to my mother, who passed it to me. I passed it to my son, who passed it to his daughter. Dr. Stokes was amazed – there are so many of us with the abnormal mutation."
Jean is overcome with emotion talking about this family legacy.
"I look at them and worry. It's a hard, hard feeling to think that you are the carrier, that you handed that down," she said. "They try not to make me feel that way. I couldn't help it and my mother never knew she had the mutation. I got it from her, but she never knew that.
"Getting tested has made me feel better though, knowing it could save their lives in the long run. They are now aware of it. We have all done really, really well."
Today there is no sign of cancer in Jean. She has taken the drug Arimidex for nearly five years and has a breast MRI and mammogram every six months.
"I take extra precautions. There are several doctors who examine me. I see them all twice a year. There are only two or three months a year when I am not examined," she said.
Jean said she has had enormous support from family and friends, especially the congregation at Ozark Baptist Church and her Agape Sunday school class. Her middle son even shaved his head when his mother lost her hair during treatment.
"There was no way I was not going to be fine," she said. "I had wonderful prayer warriors. People from 10 different states were praying. I turned my cancer over to God. I couldn't do anything about it. I was totally helpless."
Every Saturday in the fall, Jean dons her Alabama wardrobe – shirt, socks, earrings, the works – and settles down with family to watch the Tide. Life as she knows it is certainly changed, but she relishes the time God has given her.
"Cancer is a mean, mean disease. You've got to always be watching out for it. I knew I was in a battle for my life. I fought and I won. No matter how hard it gets, you can beat it. And when you do, there's a new life waiting for you. You will be able to see things differently."
She finds solace in Romans 12:12: "Be joyful in hope, patient in affliction, faithful in prayer."
WHAT YOU CAN DO:
• Have regular mammograms and do self-breast checks. Get involved with Buddy Check 4 by reminding friends to perform their self-breast exam. Visit samc.org to sign up.
• Know your family history.
• If there is a strong family history, talk to your doctor about genetic testing. Through our affiliation with the UAB Cancer Care network, we offer web-based genetic counseling.
MANAGING HEREDITARY BREAST AND OVARIAN CANCER RISKS:
Many patients with the BRCA1 and 2 mutations choose to take preventative action after a positive testing, including surgery, while others limit their risk factors, increase their number of screenings and watchfully wait. You may:
• Perform monthly self-exams starting between the ages of 18 and 21.
• Have annual or semi-annual clinical breast exams starting at 25 to 35.
• Have annual mammograms beginning between the ages of 25 and 35.
• Begin annual or semi-annual ovarian cancer ultrasound and testing between the ages of 25 and 35.
• Drugs such as tamoxifen have been shown to reduce the risk of breast cancer in high risk women.
• Oral contraceptives may reduce the risk of ovarian cancer in women with BRCA 1 or 2 mutations.
• Preventive mastectomy significantly reduces the risk of breast cancer in women with the mutations.
• Preventive removal of the ovaries after child bearing significantly reduces the risk of ovarian cancer and breast cancer in women with the mutations.
Patient's Best Friend
The human-animal bond is strong. The love we receive from our pets is unconditional and the comfort incomparable.
Dogs might be man's best friend indeed. The heartbeat inside that furry chest might actually keep your heart beating, according to studies which have found that the presence of a pet might just boost the survival rate of heart patients.
Research has shown that owning a pet can reduce stress, lower blood pressure, boost mood, enhance social interaction and add years to your life. With that in mind, SAMC has launched the region's first dog therapy program featuring certified and specially trained dogs, and their handlers, who visit patients at the bedside.
Lisa Gunn, a registered nurse at SAMC, is the first pet handler to join the Pawsitive Therapy program, begun by SAMC's Volunteer Services department. Gunn works the night shift and volunteers during the day with her Labrador Retriever, Lily.
They are one of about a dozen handlers and their dogs who are participating in the program.
"The dogs are calming and generally soothing to our patients," Gunn said. "Our visits have been very positive."
The Pawsitive Therapy program helps patients express their feelings and offers comfort during a stressful experience. The dogs and their handlers receive special training customized for the hospital setting to ensure patients receive the maximum benefit from the visit.
Pawsitive Therapy began in pediatrics and has expanded to the cancer floor, neurology and behavioral health. Visits are made based on handlers' availability, but usually several dogs visit weekly.
On the day of a pet visit, nurses ask patients if they'd like a visit with a therapy dog. Just before a visit, volunteers confirm the patient is up to it. Then Lily and Gunn make their way from room to room.
A sheet is placed on the bed for patient safety and comfort. The dog is gently positioned on the bed and the petting begins. The visit usually puts a smile on patients' faces as they recall their own dogs, cats and other friends. Hand sanitizer is used before and after a pet visit.
On the pediatric unit, Lily finds a soft spot on top of the bed next to 5-year-old Jaycie Palmer of Hartford, who was being treated for a broken arm. Jaycie's mother, Ciji, said the visit helped brighten her daughter's stay in the hospital.
"She has a black cocker spaniel at home named Charlie," Ciji said. "This visit has meant a lot to her."
Animals have been used as therapy in hospitals as early as the 1700s in Europe because of their calming influence. The relaxing effect of touch is also beneficial. And, pets in behavioral health facilities are thought to give patients a useful purpose while teaching both self-control and caregiving.
It is also believed that pets contribute to longevity by providing a daily purpose, especially for seniors living alone. Pet owners often feel needed and responsible, stimulating survival instincts. That effect can also be felt at the hospital bedside.
The SAMC Foundation contributed funds for pet therapy/training, handlers' uniforms, general supplies, sending pets/trainers to community events, a brochure and community education materials. In the upcoming year, Foundation funds will be used to train more dogs through customized obedience classes.
Is your dog a patient's best friend?
To find out more about certification classes and training, contact Volunteer Services Director Jamie Weeks at 334-793-8122.
Gregory Gibson and his sister Amanda took different paths, but they led to the same destination.
Cheryl and Ray Gibson laid the foundation. As an educator, Cheryl says she recognized the importance of building strong reading skills and giving her children the tools to succeed. "We read to our children early and often," said Cheryl. "We encouraged good reading habits which built their comprehension and vocabulary skills. We believed that would be an asset in any career choice, but especially in medicine."
Taking every advantage of what was given, Amanda and Gregory Gibson, DO, set high goals for themselves. Their foundation is helping build their careers in medicine.
Dr. Gibson, internal medicine, joined Southern Clinic last summer. His younger sister, Amanda Gibson, is currently in the Alabama Medical Education Consortium pipeline, completing her last two years of medical school with rotations at SAMC.
The siblings acknowledge medicine always interested them but they became unconventional medical students, working a few years before taking the Medical College Admission Test (MCAT) and applying to medical school.
Gregory went back to college to complete his undergraduate degree before applying to medical school. He worked for several years as a photographer and a landscaper on a golf course.
Amanda, the family agrees, was destined for a medical career, having spent her summers doing hospital volunteer work since she was about 12 years old. Many days, she worked 8-10 hours in recovery, labor and delivery, and outpatient.
"We continue to be amazed that both our children are following the same career path," Cheryl said. "We never tried to direct our children's career decisions. Instead, we tried to provide a home environment which supported learning. We helped with homework, provided resources for projects and communicated with teachers and other school staff. We were very involved."
Gregory and Amanda also both have a unique connection with the Alabama College of Osteopathic Medicine (ACOM), which will accept its first class of 150 students this fall.
After completing his degree in preprofessional biology at Jacksonville State University, Dr. Gibson was accepted at the Lake Erie College of Osteopathic Medicine in Bradenton, Fla., where he interviewed with June Flaim. June later left Lake Erie to become a consultant for ACOM, working closely with Craig Lenz, DO, dean of ACOM.
Dr. Lenz was at DeBusk College of Osteopathic Medicine in Tennessee when Amanda applied there after graduating from the University of Alabama at Birmingham with the same biology degree as her brother. Before applying to medical school, she spent six years working for the Alabama Eye Bank. Dr. Lenz interviewed Amanda for acceptance at DeBusk.
"It's really strange, this connection, but fortuitous for both Greg and me," Amanda said.
HIS PATH: After graduating from Dothan High School in 1992, Dr. Gibson continued his studies at Wallace Community College and Troy State University before deciding to leave school and enter the workforce. He worked at the Gadsden Country Club before becoming a school, sports and wedding photographer. He then took a job as a research technician at UAB.
"I worked at UAB for two years in the protein chemistry lab, looking for ovarian cancer biomarkers. In the back of my mind, I always wanted to go into medicine, but I wasn't sure I could do it. Working in research made me realize I wanted to go back to school. I am grateful I did other things before going into medicine, but after I saw what was out there, I didn't mind the sacrifices on my time which medicine requires."
He started his medical education in Florida at the age of 29. After medical school, he did his residency at St. Joseph's Hospital in Warren, Ohio. The road then led back to Dothan.
"I was always open to returning home, but I didn't specifically plan it. It is clear to me that Dothan is a wonderful place to practice."
And had ACOM been in existence, Dr. Gibson said he would have applied. "It is a fantastic opportunity for students," he said. "There are a lot of people interested in going into medicine and who will make great doctors. This is another avenue for them.
"And I can tell you for me, it is an honor and a privilege to practice medicine," he said.
Dr. Gibson married his wife, Shannon, right after graduating medical school. They have a daughter, Abby, who is 2, and are expecting their second child in March.
HER PATH: Amanda was a sophomore at Dothan High when she was accepted to the School of Math & Science in Mobile. The expansive curriculum better prepared her for what she always believed would be her career choice. After graduating college, she took the job at the eye bank to learn more about medicine and to be certain this was the path she wanted to pursue.
Once she was sure, Amanda began studying for the MCAT and undertook a monthlong shadowing experience with James Jones, DO, medical director of SAMC's Emergency Department.
"I had the little doctor kit toy when I was a child," she said. "I always wanted to be a doctor, but it is a big decision. At 22, I was not equipped to do that. Working in the medical field at the eye bank showed me I could pursue medicine."
Amanda has completed two years at DeBusk and these next two clerkship years will lead her toward a specialty, whether it be family practice, surgery, psychiatry, obstetrics and gynecology, pediatrics or internal medicine like her brother.
"There's a huge difference in the specialties. I have to decide what's most meaningful to me. Right now I am keeping my options completely open."
"I was always a really good student. I never saw becoming a physician as anything extraordinary. More like, choosing this path is something to be proud of."
Amanda, who is seven years younger than her brother, said the two try not to talk medicine when the family is around. They get lost in the passion of the work, she said, and tend to go on and on in their discussions.
WHAT IS A DO?
A doctor of osteopathic medicine, known as a DO, is a fully qualified physician – just like an MD. The difference is the physician's approach to their craft. Osteopathic medicine stresses a comprehensive approach to health. In order to maintain good health and prevent disease, emphasis is placed on the interrelationship between the musculoskeletal system and other body systems.
The fundamental principles of osteopathic medicine stress that the body is a unit and the person is a unity of body, mind and spirit. The body is capable of self-regulation, self-healing and health maintenance, and structure and function are reciprocally interrelated. Osteopathic physicians use rational treatment based on those principles.
The American Osteopathic Association estimates that 60 percent of DOs practice in the primary care specialties of family medicine, general internal medicine, pediatrics, and obstetrics and gynecology – filling a critical need for physicians by practicing in rural and other medically underserved communities. Some 63,000 licensed osteopathic physicians now practice in the U.S. ACOM will become the 35th college of osteopathic medicine in the U.S. when it opens in May.
"I don't draw a strong distinction (between MDs and DOs)," said Amanda. "Medicine is medicine. The training program is equivalent in just about every way and we all have the same goals. We want what's best for our patients.
"Sure, I would have considered attending ACOM," said Amanda. "And even though I didn't, I can see myself returning to Dothan one day. It's a great place to practice medicine."
For more information go to www.acomedu.org.