Pragmatic 37: The Sledgehammer Solution

15 September, 2014


Cancer is the number two cause of death in the US and can affect anyone at any age. Federico Viticci joins John to talk about the history of the disease, what it is, how we fight it and Federicos first-hand experience with Hodgkin’s Lymphoma.

Transcript available
Welcome to Pragmatic. Pragmatic is a weekly discussion show contemplating the practical application of technology. Exploring the real world trade-offs, we look at how great ideas are transformed into products and services that can change our lives. lives. Nothing is as simple as it seems. This episode is sponsored by Audible. Visit for a free audio book download. And this episode is also sponsored by ManyTricks, makers of helpful apps for the Mac, a long time sponsor of the show. Thanks again to them. Visit ManyTricks, all one word, .com/pragmatic for more information about their apps, Butler, Chemo, Leech, Desktop Curtain, TimeSync, Usher, Moom, NameMangler and Witch. If you visit that URL, You can use the code pragmatic25, that's pragmatic, the word, and 25, the numbers, in the shopping cart to save 25% on any ManyTricks product. And I'm John Chichy, and I'm joined today by my guest host, Federico Vittici. How are you doing, Federico? Hey, John. Thanks for having me. No problem at all. Thank you for coming on. Before we get stuck into today's topic, and we do have a strict time limit, so we'll be keeping it to about an hour today, I just wanted to quickly reiterate that by popular I've now added separate RSS feeds for the show that are just episode only as well as follow-up only in both mp3 and IAC Formats so you can choose which you would like to subscribe to the existing feeds of course They're unchanged and they can all be found in a nice little table at tech slash podcasts slash pragmatic So also once again, we are live streaming the show Yes, and there is an IAC chat room on But you you go to the URL tech slash live you can access the stream there or you can use the embedded IRC chat box to join in that way. We also have a Q&A segment after every show so during the course of the show in the chat room if you have any questions please feel free to pose those questions with apostrophe QA and we will try to address them at the end. So right now I do have a basic show bot you can also have title suggestions and you can vote afterwards and yes it's using Casey Lisses accidental bot or rather a fork of it so Thank you, Casey. Also, I want to give a quick shout out to Daniel H. from Germany for the lovely review on iTunes. Always greatly appreciate it. If you are enjoying the show, don't forget to please rate it or give it a review on iTunes if you've got a few moments because it really does help and I really appreciate it. Today is potentially going to be a heavy topic. It's something that has affected my life and has also affected Federico's. we're going to talk about the C word and that would be cancer. So I guess it's one of those topics that I realize, it's one of those things that people, I've heard the expression that someone knows, everybody knows somebody who's been affected by cancer in their lives and I wanted to talk about this because it's, people don't talk about this, you know, and It's so common and it's such a big deal. And this is not a medical podcast. Okay, I'm not a doctor. I know this and that's fine. And no, no, no, Federico, I'm assuming you're not a doctor. Are you? - No, I'm not. - No, no. So we're not medical practitioners of any kind. Okay, but we both have vested interest in this subject. Mine is from only second and third hand experience, but Federico's is from firsthand experience. So that's one of the reasons I wanted to get you on the show to talk about it, because you can talk about it from firsthand experience. So thank you for agreeing to come on to talk about it. I know it. Yeah, sure. I'm a, I am a extremely comfortable talking about this. I really have no problem. I mean, because I used to, you know, like you said, it used to be kind of weird, you know, to talk about cancer before, but now it's like talking about a vacation for me. It's, it's just another experience. So no problem at all. - Fantastic. Oh, that's great. So, okay, cool. So I just wanna start like I start most episodes of "Pragmatic" by just going through a little bit of history really quickly. But the aim of this is to sort of increase people's awareness and sort of demystify what is really quite a complicated and can be a personal sort of an issue. So in any case, okay. Cancer is also known as a malignant tunor, a group of diseases and it involves abnormal cell growth and that has the potential to invade and spread to other parts of the body. Not all tumors are cancerous and this is something that people sometimes struggle with is there is such a thing as a benign tumor and that does not actually spread to other parts of the body, doesn't affect bodily function in any way. So possible signs and symptoms include a new lump where there wasn't one before, abnormal bleeding, prolonged coughs, unexplained weight loss, you know, all sorts of things like that. There's a multitude of potential symptoms, but those symptoms alone don't indicate that you necessarily have cancer or, you know, because they could occur to all sorts of other issues. So there's over a hundred different known cancers that affect humans and traditionally it was actually sometimes referred to as the wasting disease because, you know, in In its latter stages, people tend to lose their appetite and they get very skinny and very... Yeah, it's not pretty. And the earliest known descriptions of cancer actually appeared on papyrus, written, they think, around about 1600 BC, and they were believed to have been sourced from medical stories going back as far as 2500 BC. So certainly not a new thing. And Hippocrates described several kinds of cancer, referring to them with the Greek word "karsinos", which actually stands for, or actually means "crab" or "crayfish", roughly, loosely translated, so I'm assured. And that comes from the appearance of the cut on the surface of a solid malignant tumor, with the veins sort of stretched on all sides, like an animal, like a crab has its feet, if that makes any sense. Crab feet. You know, I guess. Their feet. Anyway, not a biologist either. Sorry, engineer. Anyway, so the treatment back then was based on humor theory, which I'll admit I had not heard of until I just brushed up on this one. The theory of four bodily fluids. Okay, here we... I'm sorry, I've got to throw this in because I read this and I'm like, I've got to talk about this. Black and yellow bile, blood and phlegm. That's right, phlegm. So, based on those, that is, those bodily fluids, they would decide what treatment would be for you, which could be dietary, bloodletting, or laxatives. So, anyway, the really depressing part about that is that that was actually the most popular method of treatment until about the 19th century when they realized that there were these things called cells and anyhow, so never mind. Okay, so in Latin the word "Celsus" sometime between 25 BC and 50 AD roughly translated carcinos into Latin anyway, also of course meaning crab, and 2nd century AD they started to call benign tumours "oncos" which is Greek for swelling, and they reserved Hippocrates' original carcinoma for malignant tumors. Later on they added the suffix "oma" on the end of it. I'm terrible at Latin and Greek so I just go with "oma". Anyway, so hence that leads to the name carcinoma which is still in use today. Okay, so what causes it? The human body consists of somewhere between 60 to 90 trillion, that's a lot, of individual cells and each cell has its own DNA genetic structure that tells it first of all obviously how to behave, react, grow and it's the blueprint. A master copy of itself such that it can replicate when it dies and the perfect example of cell replication and the most obvious visible one is our skin right so damaged by sunlight, scratches, just general wear and tear, skin cells die and fall off every single day to be replaced by new skin cells from underneath and when you live in a house and sweep the floor one of the constituents of dust is dead skin. Hold on to that mental image for a second. Sorry, that always freaks me out, actually. Mind you, the dust mites in pillows and stuff also freaks me out. So, yeah, it's not good. Anyway. OK, so in every lifetime, the cells in our body will regenerate thousands and thousands of times. And that's normal. So, how cancer starts is when something goes wrong with that replication. So the new cell's DNA isn't copied correctly. And another option is that there's a hereditary trait for certain types of cells that was inherited from your parents that they can go wrong after a certain period of time. So like those cells were always destined to go wrong at some point, statistically it would happen at some point, a genetic predisposition to a copy and, guess you can think of it like a copy and paste error, really. Well, there you go, that's tying it back to tech, anyhow. So the immune system is able to track them down destroy them usually. Well, but the problem is of course the immune system is also based on cells and that immune system can also go wrong when it replicates. So essentially through one means or the other, either through the actual defect being replicated in a cell or a defect in the immune system trying to filter out those cells, through one means or the other, these cells can be missed and be allowed to survive and eventually the faulty cells themselves or replicate and they will form what's referred to as a tumor. Now we've reached a point at which we have now, okay that is what cancer is and that alone doesn't mean that you have a cancerous tumor. Again like I said it could be benign and there's a great number of tumors that are and they don't spread and they don't impede bodily function and all that stuff. But of course it could also be cancerous. So every animal can get cancer. aren't special in that way. Every animal can get cancer. And every person is at risk, although there is a genetic history, found some family histories, people can get pre-warned in some cases there are genetic tests that they could be at a higher risk for certain cancers. Now the reason that this is such a big deal is that in 2010 the Center for Disease Control in the United States reported that cancer was actually close to equal number one, not quite number one. It was beaten out by heart disease but very close so it's the number two cause of death in the United States. But the thing that freaks me out about cancer is that unlike heart disease which is the leading cause, that's very heavily lifestyle dependent. Whereas a lot of cancers that manifest have nothing to do with your lifestyle and this is a thing that you can eat healthier and so on and that will improve your chances but it'll have more of an impact on improving your chances of not getting heart disease than it will of getting cancer. So for me that's what freaks me out, you can live the healthiest lifestyle that you like and still that's not necessarily no real protection. So it's at this point we talk about detection of cancer, which is the problem because there's so many different kinds. So it's possible you'll have no symptoms or symptoms you might just ignore, but thankfully most of the common cancers will cause some kind of secondary pain, discomfort, or be related to soft tissue. So we can feel lumps on the surface of our skin or in soft tissue, and we can see discoloration in our skin, skin cancers and so on. And you can get them checked out by a medical professional. And it's more or less at this point that I'm gonna shut up for a second. And I would like to talk to you about your experience and about how you discovered that you actually had cancer and actually what type of cancer also that you had. - Yeah, well, the symptoms were all the ones that you mentioned. weight loss, losing my appetite, and coughing up blood like each morning, and lumps, of course. And my kind of cancer was a blood-related cancer. It's a lymphoma, right? - Okay. - And there's two kinds of lymphoma. The one that I got was Hodgkin's lymphoma, which is one of the two variations. And this one caused basically like late night fevers just randomly. And my skin was very itchy just for no reason. So basically I lost around 20 kilograms, which in pounds, Yeah. I don't know how many pounds is that. 2.2 pounds per kilo. So that would be 40. 45. Yeah. Yeah. It was a lot. And it was super strange for me. And the signal was that basically the blood, initially I thought that maybe it's because, you know, I was a smoker back then. And so I quit smoking and I thought that that was the reason. And, but the blood, you know, didn't stop. So each morning I would just, you know, cough a lot and there was blood. And so after a while, in fact I should have, at least I think, I should have talked to a doctor earlier. And when I decided, when I realized that I reached the point that something was off, was too strange, the weight loss, and I was feeling weak and sometimes I felt like I was not really there mentally. Like I could lose focus and just wander, and just completely black out everything else. And fevers, and I didn't have much appetite. So eventually I decided to go see my doctor, and he couldn't find anything, you know, because he listened to my breathing and, you know, all that a basic doctor does. And he told me to have, you know, the usual procedure like an MRI and, you know, see based on the images what, you know, if there was something strange. And of course they found like a large spot in my right lung. And so after a week in the hospital for the various procedures to diagnose exactly what the cause was, basically it was this lymphoma that caused like... The problem with the blood is that the bad cells cause like, I would say, basically like a little cut in my lung tissue. And this cut were basically a lot of cells accumulated in there. And they were basically producing a mixture of fluid and blood. So from the images you could see this large spot. But the main problem was not necessarily just in the lung, it was in all my blood system basically. And that's the problem with the lymphoma, is that you cannot treat an area specifically. I couldn't have a procedure to just fix my lung, because the problem was in the blood. So I needed to start, basically I was stage four, which was the highest stage for that kind of cancer. And that's why I said that I probably, I should have gone to a doctor a few months earlier. And initially, of course, it was a roller coaster of emotions with my parents and my girlfriend and my friends. But I learned, I guess, quickly to understand that when a doctor tells you, when an oncologist tells you, "Look, it's serious, but we can fix it," you gotta believe him. And so when I... And another thing is that even though I continued to have all my symptoms after I was diagnosed officially, they appeared somehow less concerning in a way, because I knew what the problem was so I just needed to fix it. And I think that one of the hardest things about having cancer is not knowing what happens next. But the moment that I had a plan, right, and that I had an oncologist that I could trust, And when she told me, "Look, it's going to be hard and you're going to receive a lot of treatments and you're going to be sick and you're going to be doing chemo and other stuff." But the moment that I knew what the plan was and that I saw that she was certain about the outcome, it became more, I would say, more comfortable. And so I began to accept that I just needed to trust medicine and, you know, to just keep going. And yeah, so that was the initial process was in early 2012. So how old were you when you first had symptoms? I was 20, 23. Wow. Okay. And you first saw a doctor how long after the first symptoms roughly? or six months. Okay. Yeah. I should have really, really gone earlier because those months allowed the blood to basically cause that little problem in my lung. And of course, several months can facilitate cell growth. So yeah, I should have really gone earlier, but thankfully, I was just the last minute was, at least so far, it worked anyway. Okay. Well, okay. So, in your particular case, the detection was, like you said, there were quite a few things that you listed off. You had some discomfort, some... Well, coughing up blood, that's generally considered bad. Lumps and so on, and feeling lethargic, you know, to no energy and spacing out. I don't know what the technical medical word for spacing out is, but yeah. Yeah. I mean, all, yes. Yeah, and it's a really strange feeling because I remember distinctly one day I sat down on my computer and I was looking at the screen And I panicked and I called my girlfriend because I was seeing an article on Mac Stories that I didn't write, right? I was seeing words on the screen that I didn't publish. So I completely panicked and I called my girlfriend and I asked her, what do you see on the screen? I didn't publish this article. And she looked at the screen and she said, what are you talking about? There's the article you just published. So I drank a glass of water and I composed myself and I looked at the screen again and sure enough, there was the article that I just published. So I saw a thing that just wasn't there and I panicked for no reason. And that was super, super strange. And I remember that clearly because at that moment, I realized what is going on. Yeah, yeah, yeah. Becoming a little disconnected from reality, which is not good. All right, well, you've talked about some of the treatment that you've had just briefly. I guess just to cover a little bit of the history just before we go too much further, the obvious one is that if there is a physical treatment that they can remove, then the simplest and most obvious way is to cut it out and cauterize it, which is the oldest description going back to 1600 BC where they noted that they could cauterize ulcers of the breast that they found but then noted also that there is no long-term treatment other than that. The thing is with cancer is that people realize from a treatment point of view that research needs to go on to try and find better ways of fighting it. Since the early 70s the US alone has invested over $200 billion in research and that's both and private donations. But yeah, despite that effort, this is a really tough nut to crack. This is a really difficult problem. And they've only really seen in the US at least a 5% decrease in their cancer death rate from between 1950 to 2005, which is where the stats I got from, which should illustrate that it's a difficult problem to solve. So also with an aging population and obviously that was not the case for you being 23 at the time, greater than three out of five cancer diagnosed in people aged 65 and over. However, as you know in your case obviously that was not the case. So it does just because you're younger does not mean you're exempt and that's something that a lot of people need to get their head around I think. - Yeah, so I just looked up the definition for the lung involvement that I told you about. Basically it's in the adult kind of Hodgkin's lymphoma. It's called lung parenchymal involvement with lymphoma. - Okay, cool. - Yeah, I'm sure there was a bunch of words that I could remember, sure enough. I just needed Google. - Yeah, I know what you mean. And it's the sort of thing that they rattle them off when you're sitting there, rattle them off so fast. And you're like, "A rother fomer what a hammer?" Yeah, exactly. Yeah, because that's... Anyway, but yes, I feel like I should be taking notes sometimes. So I've always been the kind of guy that wants to actually know what is being told. So I was always asking questions to my oncologist and the team of other doctors in the structure. Because they understood that I was a very visual guy that wanted to know everything, so they started to do mind maps on a piece of paper for me to explain the various medicines and drugs that were into the chemo. And so they drew all these little arrows and boxes to explain the process to me. And every time it was pretty funny, because they said that I didn't really need to understand what was going on, but still I wanted to know all the details. People like us, we need to know. They say we don't need to know, but we need to know. We just, yeah, that's it. Well, that's great. I'm glad that they took the time to do that because some doctors will just, you know, they're not interested. They're like, you know, I'm a doctor, you're not, you know, and I'm just not going to tell you because, well, you just won't understand. Or I don't know actually what they think, But sometimes it feels like that. It's like, you know, but hey, you know what? I'm relatively intelligent, you know, give me five minutes to explain it to me and I'm sure I'll get the gist of it. So, you know. Yeah. Well, you know, the day that I was officially diagnosed because I had this scan, right. And I went to the hospital in my town, in Piterbo. And the doctors there were super unprofessional and rude. And they basically told me that I was going to die, you know, right away, before an official diagnosis, just after a scan, they saw this spot. And they called up my parents and they said, you know, the boy, unfortunately, doesn't have much time left and, you know, all that kind of crap. It was super unprofessional. And then, so after a few minutes, I went to the oncology department in my town's hospital. And I was called into this room by this supposedly oncologist, and he told me... Like, he wasn't even looking at me in the eye. It was just, you know, this is serious and we can try to do something. And they didn't, he didn't even allow my girlfriend to be in the room. And so I don't want to curse on the show, but you can imagine my reaction. So, um, yeah. And so I went to-- all my treatments were done in another city, in another region of Italy. And I really found professional people there in these other two cities, actually. And sometimes I think about going to see this doctor and maybe trying to approach him, I don't know, like in the parking lot, and say, hey, you know what? Yeah. But eventually I realized this guy doesn't even need my attention, you know He doesn't even need my time. But plus I don't want to lose my temper. So Yeah What's she gonna do walk up and wave and say hey, guess what? I'm not dead. You suck. Bye. Bye. Yeah It's not gonna be positive but Yeah. All right. Cool. All right. Well, yeah, so anyway, there are some some doctors are really uncool people but there are many, many doctors, luckily. They save lives and they help you and they listen to you and they explain stuff to you. So I was lucky enough to find many, many of them and just one bad guy. - Well, I'm really glad you found some good doctors because yeah, it makes all the difference in the world. And that's really good. - Oh yeah. - It's good to hear. Okay, so before we go into the next section, I just wanted to quickly talk about our first sponsor, which is Audible. So Audible is a leading provider of premium spoken audio information and entertainment that allows listeners to choose from audio versions of their favorite books. Why would you want to do this? Well, so many of our day-to-day activities that we do need our eyes on the job. So when there's a book you really want to read, but you're so busy doing other things you just can't find the time, that's where audiobooks come in. It's much easier to multitask when you're listening to music, a podcast, or an audiobook. Whether you're driving, doing housework, or yard work with Audible, you can still read your favorite book and not miss out. It's pretty cool. So you can buy books individually or you can sign up for the Audible listener program which gives you book credits each month for a low monthly fee. 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So I'd like to personally thank Audible for sponsoring Pragmatic. So the next thing I wanted to talk about, we sort of started talking about it was the treatment options. And the first and most obvious one is finding the tumor and cutting it out. That only works for certain kinds of cancers, of course. But when they do do that, they'll also take a bit of the surrounding tissue and test it to see if there's any other cancerous cells in the surrounding tissue. Sometimes, if they find some in that surrounding area, they will have a follow-up surgery to remove more tissue to make sure that they get it all, or at least get as much of it as possible. Sometimes, in certain cases, in certain cancers, they can actually test it quite quickly. They can test that tissue around the tumor during, well, like when you're actually still in there, in surgery under the general anesthetic, and they can actually, that only works for certain cancers, it doesn't work for all of them. And that requires a very fast test. Sometimes they have to put them, they have to slice it up, put it on slides, microscope out and visually check for the cells a lot of the time and sometimes it's not obvious. Other times they can use certain dyes and different other techniques. It's different for every kind of cancer, so there's different methods of doing that. But that is the first step for most cancers that are, you know, obviously that form tumors. But you mentioned chemotherapy and that is by far and away, some people just call it chemo and it's by far and away the most common treatment after you've had a surgery. Not always prescribed but in many cases it is. The thing that I didn't realize about this originally and I only found this out recently was that it was actually discovered as a side effect of mustard gas in World War I, which is kind of crazy but it wasn't until 1942 that there are a group of related compounds nitrogen mustards they're loosely referred to as and they were used intravenously as an attempt to reduce the replication rate of cells in the body for people that had had cancers and they had actually you know short short-lived but they were effective results and enough so that they continue investigating it. So the chemicals have been refined over the years but work in much the same kind of way. They either stop or significantly slow down the replication rate of aggressive fast replicating cells and that's a trait of a cancerous tumor. Unfortunately this is kind of the medical equivalent of hitting a nail with a sledgehammer and unfortunately it It takes out other normally quickly replicating cells, or like hair follicles, for example. And hence many people on chemo tend to lose their hair. Which is something I was curious about in your case. You have been on, how long have you been on chemotherapy at this point? - I was on chemo for Eight months. Okay. Yeah. Did you lose your hair at all? Oh yeah, after five months, after four or five months. Yeah, I did. Okay. Yeah, it wasn't a problem at all, actually. I quite enjoyed my new hairstyle, or lack thereof. Well, you know what? I shaved my hair off, so I can tell... I'm with you on that. It's simpler. Yeah. Yeah, I let a friend of mine shave my... I cut my hair really short when I realized I was losing hair, so the transition wouldn't be too weird. And we took photos and videos. And yeah, it was quite fun, because my friend is not a hairstylist of any kind. But yeah, after a few weeks, I started seeing all this little hair on my pillow in the morning. And so, yeah, it took four or five months to get there. Fair enough. Well, the interesting... My parents actually took it worse than me because I've always had medium to long hair. So for my mother, especially seeing me in that way was pretty rough. Yeah. Yeah, it's pretty confronting when you're used to seeing someone with a full head of hair and then suddenly they're bald. It's generally, yeah, through normal, natural means is something that would happen gradually over a decade or more. In my case, you know, I'm losing my hair, but it's very gradual. But to lose it in a matter of, I mean, you say it took a few months, four months or so, four or five months, but the point at which you just, what did you say, was it like two or three weeks? You just started losing it and then it was like, right, that's it. and it's gone, you'll just get rid of the rest of it? Or did you, how long was it before? Was it just like, yeah, right, that's it. It's all bald now. Would you say? A few weeks or? Yeah. Yeah. Just a few weeks, I think. Yeah. Okay. So yeah, that's, that's pretty shocking to, for people that are used to seeing a full head of hair. So, and that's the, that's the problem with chemo. The interesting thing is that some people don't actually lose their hair, but It is very, very common and certainly in my second-hand experience Yeah, my relatives lost their hair Anyway, so chemo drugs are actually referred to as cytotoxic And they're essentially poison, right? So, when they're handling these things in hospital The hospital staff are usually required to wear protective clothing and gloves. And from my recollection, I'm not sure if it's the same the world over, but certainly there are large bright warning labels on these bags. You know, caution, warning, you know, this is not stuff that you, yeah. Yeah. The doctors and hospital staff, they don't always wear protection. Right. At least in my experience, you know, they don't always wear like protective gloves and that kind of stuff. It's just only when they need to, uh, like to do an injection or to, for instance, I had a portacath installed, which is a little basically, uh, like a, like a little, uh, button under your skin that has a tube attached that goes into a big vein. So when they needed to flush that or to inject chemo into that, into the little valve, they needed to wear protection on their hands. When breathing, for instance, near you, they needed to have the little mask. But not all the time. So one of the many kinds of chemo that I did, did, it required me to be in a hospital bed for 22 days, 22 consecutive days. And I needed to be in a, in a locked room. And because, you know, um, it was a super basically like hard chemo that destroyed my immune system and rebuilt it from the ground up. And so during the process, I needed to be in this special room, a special air conditioning. and only people with extra protection could visit me only twice a day. It was, there are different, many, I guess, many kinds of chemo that require different kinds of attention for the patient. - Absolutely. - And in my case, it was a bit of both. You know, I did the chemo where I could just go there, do the chemo and just hop back into my car and go back home. And I did other chemos that required me to be completely alone, you know, extra protection measures. - Absolutely. When you were in there for 22 days, were you allowed an iPad? - Yeah. Yeah, it was, the doctors and staff needed to basically wash it with a special fluid before. And it was like some kind of, you know, to remove bacteria and other stuff. So they cleaned all my devices, my phone, my iPad. And I had a Nintendo DS, I think. And, but yeah, I was allowed to keep that. Cool. So, yeah, I would have, I would have gone crazy. I was going to say, I would not have been, you know, 22 days of isolation from, yeah, that would have been rough, but you had the iPad. So, were you posting on Mac stories during that 22 days? Yes. Yes, I was. That's awesome. Yeah. Yeah, there were days that I could barely move or, you know, I was constantly throwing up and that kind of stuff. And so those days I was just trying to survive, basically. But the other days, before and after the chemo, yeah, I just needed to pass the time. So I did a bit of email. I actually think I was writing Python scripts at one point, because I was trying Pythonista, the iPad app. So yeah, I used that time to do something, because otherwise if you just stay there and keep thinking about "Oh my God, I'm doing chemo" and that kind of stuff, it doesn't help you, I think. Yeah, it messes with your head. Too much time to think, yeah. I think it's great that you're able to do that, because having a creative outlet makes a big difference. I think that my work and my job and the people on Twitter and the readers of the site were a huge help for me because they helped me, not just with encouragement and the kind of positive reactions that you get, but also to distract me and to, as you said, a creative outlet and it's been a huge help for me. Fantastic. Cool. All right. Well, you sort of alluded to this, that there are different kinds of chemotherapy. So, you've got different strengths, different blends. I mean, I make it sound like coffee, but it's not. Obviously, that's terrible. - Different flavors of chemo. - Different flavor chemo. So, single agent and poly chemotherapy, which is, you know, obviously multiple chemicals in the one go. And obviously, it depends on the specific kind of cancer being treated. And obviously, there's the ones that you just described that will completely destroy your immune system. And then it builds itself back up again from the ground up, which is quite extreme, but also I understand to be very effective. It's just, it's quite a bit to go through. So the dosage, interestingly, I know there's a lot of debate about dosage and traditionally it was based on person's height and weight and their build, but that's not really 100% accurate. It tends to, oncologists tend to lean towards overdose rather than underdose. Otherwise, if you underdose, then the treatment is not going to be effective. So, they tend to lean towards the over than the under. So, anyway, and again, also, as you suggested, there's different ways of doing it. People refer to, sorry, oncologists refer to a round of treatment as your start. You'll go in for, you know, usually daily or, you know, sometimes you can do it as an outpatient. other times like the 22 days, you're actually in the hospital, checked in, yeah, and that's it. But other times it'll be, it could be a few weeks and it's daily, and that's like quote unquote, a round of chemo. And then you'll have a break and recover, and then it's back for more. - So the terminology was for me the hardest part to figure out, because when they keep talking about a round of chemo, I thought that a round was a session, a single session on a single day. And it turns out that a round differs from chemo to chemo. So I did a round, what could be a day for me, or twice a week, or three times a week, with a break of 21 days between each round. And I also wanted to quickly say that many people, and myself included, before I started doing chemo, I thought that chemo was some kind of obscure and, you know, strange kind of medicine. It turns out that it's just an IV. Yeah. It's basically just drugs that they inject into a vein just like any other IV. And they have different colors. There are some kind of beverages that I don't drink anymore because the color reminds me of chemo. You know, are you familiar with Campari? Yes. I don't drink Campari anymore because it reminds me of a drug, of one of the types of chemo that I did. - Wow. Well, I don't drink it because I don't like the taste of it, but yeah. Yours is far more... because it's the association, right? Because the chemo makes you feel terrible, generally. Well, I mean, so I am assured. I have not been through it, but you can tell me I'm sure. Generally, it doesn't make you feel that great, does it? - No, it doesn't make you feel... I mean, while you're doing it, It's just an IV, so you don't feel anything, mostly. There was a drug that basically, was all these little bags, right, of fluid, of medicine, of chemo stuff. And there are different colors and different labels, and you don't feel a single thing while you're doing chemo. But it was a drug, and I think it was Dacarbazine, which was part of the ABVD treatment. If you go to Wikipedia, there's a list of various kinds of chemo and ABVD is the first one that you do when you have Hodgkin's lymphoma. And there was this drug that basically when they inject it in your vein you can feel the vein burning because the drug is so strong it burns the tissue of the vein and that's also the reason why I didn't have to, I didn't want to have a portacath installed right away in my upper chest, so I did the first few rounds of chemo as a normal procedure with a needle in my arm, right? So my veins in my arm, they don't give blood anymore because they've been burned by the chemo. So that's fun, yeah. Every time I need to do some blood tests, they need to find small veins like in my wrist or in my hand because the ones in my arm are completely gone. I mean, they do work, they just don't give blood anymore. - Yeah, I understand. Yeah, I had heard of that, but I'd never, I didn't, yeah. Wow. Okay. Well, moving on from chemo, let's talk about the other goodie, which is radiation therapy. - Oh yeah, that's awesome. I love that. - You love radiation therapy. Yeah, because it's just like five minutes a day. You don't feel a single thing. And it's quite fun because the machinery is super cool. (laughing) Like there are lasers scanning, like forming a grid into this room. And you need to be aligned with grid because there's this huge machinery that rotates around you. And that basically beams protons and other kinds of light beams into your body and you don't feel anything, it's just five minutes and it's done. And it's super effective, really. And the radiation is the, it was for me the final step of my treatments. And it was the one that basically consolidated the cells in my right lung. And now I have, basically I have like a scar, right? In my right lung of tissue. And it burned completely whatever was left after the chemo. And yeah, radiation is, I'm sure now you have a really solid explanation and history, but in practice for me, it was like just, you know, passing 30 minutes every day between, you know, going there and doing the radiation. And yeah. Wow. It's super cool. The machinery was amazing. Yeah. You know, that sounds pretty cool. That's one of the one things I didn't actually physically witness was I was not going in with my relatives when they had their radiation therapy. Chemo, yes. Radiation therapy, no. But the idea of radiation therapy is, you pretty much already said it, which is it uses ionizing radiation such as a photon source. and usually, older machinery typically used cobalt cesium, they call the newer machines, line act machines, which are essentially a linear accelerator and they accelerate photons and they actually will pass through your body and disrupt the DNA. And well, by say disrupt the DNA, they'll destroy the DNA chain sets that the cells simply will die. They can't replicate after that. So obviously if you've got tumor cells, you're trying to get rid of them and you know the chemo didn't get them, well this will get them and it's not going to survive. So it destroys DNA in the cells in the area, it's also a bit of a blunt instrument but it's a lot less blunt than the chemo because it can be physically focused on a specific spot and obviously again that only works in cases where you know the cancer is a tumor in a specific spot and which it was in your case in where it had manifest in your lungs. The radiation is measured in grays and ranges between 20 and 80 grays depending on the type of cancer being treated, whether it's applied curatively or preventatively. There you go, that's radiation therapy. Apparently, it's a very cool machine. Yeah, and it's photons you said, not protons. photons you're right, because I remember there was a little plate with a description of how the machine worked. And I was super fascinated by this machine. And I remember there was a... I took a photo with my iPhone of the room, and a doctor, she was... I think she was my age. She approached me and she said, "Oh, you have an iPhone." Basically, inside the audition room, we started talking about... She said, "I have a Galaxy iPhone." And I was like, "What does it mean you have a Galaxy iPhone?" So, basically, she had a Samsung S3, I think. So, of course, I started talking about the iPhone. And we started talking about Mac stories, and she realized that we spent 10 minutes talking about my job and the iPhone. And I should have... you know, I was in my underwear, because I needed it that's great so there were people, because there are cameras, right? looking at what's going on in the room at one point a doctor from the other room goes back in and said what are you guys doing? you need to do the radiation we're just talking we're just talking about the iPhone oh, that's brilliant oh dear, cool Alright, well then, a little bit about some newer treatments then. And I guess the areas that are showing the most promise, specifically are targeted therapies, sometimes referred to as molecularly targeted therapies or precision medicines. And unlike chemo, which is a broad spectrum drug or set of drugs, it'll affect all the rapidly dividing cells in the body, cancerous and non-cancerous alike, so good and bad. therapies are designed specifically to disrupt the division of a specific type of cancerous cells. As a result, obviously they have to be specific and they tend to only work on a much smaller subset of cancers. So because they're very specific, they're a lot less common, they're more expensive to produce and the the other side, the flip side of course, the reason you want to go down that road is because you're gonna have a lot less side effects and you'll have a much faster recovery time. But the bottom line is that, you know, it's still experimental, there's hundreds of different kinds of cancers and they're still developing these. There are a lot of cancer cells that cannot be treated this way yet. That's where a lot of the research is going to try and create these, well, I guess for the want of a better word, a design of drug specifically targeting the problem rather than the sledgehammer solution. So that's sort of, as far as I'm aware, that's where it's heading. So anyway. Yeah, I didn't do any of those. No. I knew about this kind of new techniques. I just said straight up old fashioned chemo and radiation. And most people do. The only new kind of thing that I did was... And that was, I think, the strangest part of the experience. Because the chemo and the radiation, after you learn how they work, they're pretty much boring stuff. One is an IV, the other is a machine. It was the extra stuff that you do around those treatments That's the strange experience. I had to, at one point I needed to basically stimulate my bone marrow to produce stem cells. And to do that you buy this little medicine that it's like a little tube with some fluid in it and it costs like 5,000 euros for just this little thing. And of course I didn't pay a single euro for this, because in Italy we get all for free. And I mean, for free after taxes, of course, you gotta pay your, your taxpayer euros. But anyway, I didn't pay myself. So, this little thing, you inject it into your muscles, anywhere on your body, doesn't matter. And this fluid goes into your bones, and it stimulates the bone to produce stem cells. And so a few days pass, you do this once a day, and basically you start feeling this crazy, crazy, crazy pain inside your bones, because your bones are trying to put more stem cells than necessary into your blood. So you gotta resist for a couple of days with this insane pain that I was basically screaming all day and I wanted to just, I needed, I was asking for morphine at one point because I just couldn't, it was too much. - Very painful, yeah. - But you gotta resist and when you stimulate the bone to produce all these cells that go into your blood, you go and they basically, they take your blood, they wash it with a machine, they isolate the cells from the plasma and the other parts of the blood And in the other arm, they give you your blood back. So you do this little washing procedure, you isolate the cells, and then those cells, they get frozen for a couple of months. And when I did the chemo that I told you about for 22 days, and they destroy your immune system, and they use those cells to help you rebuild it back up in just a week instead of like three months. So that was super strange. It was strange to do, you know, the stimulation. Um, it was strange because the pain was insane, more, much more insane than the chemo and the other stuff and the symptoms. And, but, and it works surprisingly. That's the strangest part is that all this crazy stuff that you basically stimulate your own bones to do more than the necessary, and then you use that. the result as an aid to grow your immune system back. - Yeah, that's pretty cool. - That was super strange. Yeah, it's pretty cool, but also strange and painful. Oh, yeah, well, the painful bit was not cool, but yeah. - Yeah. - That's amazing. That was insane. I was screaming all night and I couldn't sleep, I couldn't walk, I couldn't stand and I couldn't sit down. I just, you know, it felt like a thousand knives into your bones in each part of your body. Yeah, at one point... Did the painkillers helped it much or were you... Did they just not... Did they just not touch it or... Yeah, basically my oncologist wanted to avoid painkillers because they... she wanted to avoid any additional heart toxicity but it became too much, so I didn't get the morphine but I got... well, I don't know what the name in other countries is but it's basically one step before the morphine And that helped a lot, yeah Yeah, okay Yeah, it was an injection and it took like two minutes and then it was amazing Yeah, it's like a switch, flicking a switch I'm sorry, I just recently was in... I'm not suggesting this is of the same level of pain as we were describing But I had kidney stones and I was in quite a bit of pain and when they gave me the shot of morphine, it was like a switch being flicked in your brain from being in unbelievable agony to being able to look around the room and actually have a conversation because you were just incapable and then suddenly it's fine. Yeah, that was my experience anyway, and I'm sure I was in another, but near the level of pain you were in though. Yeah, this stuff is weird. When you talk about it and you remember the experience for me. In my experience, I think that describing the chemo, because that's the thing that most people are curious about, right? They ask you. And sometimes they even, sometimes I feel like they want to ask me, but they're not are asking me, so I just tell them. 'Cause you can feel when somebody's interested in the, so what is chemo like, or what is radiation? And you can understand that they want to know, but they don't have, you know, they feel uncomfortable asking, so I just explain that. But then when you need to explain all the other extra stuff that you need to do and the consequences and the side effects, that's the strangest part because they sound just crazy. Like the steroids and the effect of the cortisone on your body and the growth stimulation done on purpose and that stuff is just crazy. But also cool, so yeah. - Fair enough, okay. And you don't hear too much about it, so I'm glad that we're talking about it. So, all right, before we go into, I just wanna talk a little bit about my secondhand experiences, which I don't have too much more to say and then we'll probably wrap it up. But before we do, I wanna talk about a second sponsor of this episode, and that's ManyTricks. a long time supporter of the show. And ManyTricks, they're a great software development company whose apps do, as their name suggests, many tricks. Their apps include Butler, Kimo, Leech, Desktop, Curtain, TimeSync, Usher, Moom, NameMangler, and Witch. There's so much to talk about for each app, so what we'll do is we'll touch on some of the highlights for just four of them. So with Witch, you can think about Witch as a supercharger for your command tab app switcher on your Mac. Witch is great for and very popular with ex-Windows users like myself. If you've got three or four documents open at once in any one app, then with Witch's beautifully simple pop-up, you can quickly and easily pick exactly the one you're looking for. With NameMangler, let's say you've got a whole bunch of files that you need to rename quickly, efficiently, and in large numbers. Well, NameMangler can extract metadata from the files, use it to rename those files with search and replace, as well as creating staged renaming sequences. And if you mess it up, you can revert back to where you started and just have another go. It's great. Moom makes it so easy to move your windows to whichever position you want. Halves, corners, edges, fractions of the screen, whatever you like. And then you can even save and recall your favorite window arrangements. There's even a special auto arrangement feature when you connect or disconnect an external display. Like when you arrive at work or when you arrive at home. It's awesome. So with Usher, it can access any video stored in iTunes, Aperture, iPhoto, or any connected hard drive on your Mac, allowing you to easily group sort, tag, organize them all in the one app. If you install Parian and Flip4Mac, then there's no need to convert anything into an iTunes format to watch it, so if you've got a video collection that's scattered across different programs and drives, then Usher can help you straighten it out. Now that's just four of their great apps, but there's still five more that I haven't spoken about and you can check them out on their website. So all these apps that I've talked about have free trials. You can download them from ManyTricks or try them out before you buy. They are also available to buy from their respective pages on the site or through the Mac App Store. However, if you visit that URL before mid-September and yes, they have extended their offer just for Pragmatic listeners, you can take advantage of that special discount off their very helpful apps exclusively for Pragmatic listeners. Simply use Pragmatic25, that's Pragmatic the word and 25 the numbers in the discount code box in the shopping cart to receive 25% off the price. And this offer is only available to Pragmatic listeners for a limited time. So take advantage of it while you can. So many thanks again for ManyTricks for their continued support of Pragmatic. So I haven't talked about one of the reasons that I wanted to cover this topic. And that is that in recent years in my life, some close family have been affected by cancer. And I don't wanna go into too much detail, but I'll just touch on the key points. and because everyone's experience with cancer is subtly different because there are so many different kinds of cancers. There are lots of common things that we've talked about and that's fine, but some of the specific details varied based on where the cancer was and how severe it was and how early they detected it and so on. So my grandfather was diagnosed with bowel cancer. He was first detected when he was 74 years old. They cut out a section of the bowel, he underwent chemo and they thought that they had got it all. Unfortunately, they didn't. And when he was 77, they found that it had come back and it was considered to be inoperable at that point. And he was given the option for chemo. Having been through it once, he said, they told him that the chemo would at best give him, you know, a few extra months, but he decided not to take that option and he passed away when he was 78. So my father-in-law, he had prostate cancers diagnosed that when he was 60 years old. They operated and they got it all with no further treatment and thought he was all you know good and in the clear. Unfortunately there was a melanoma on the top of his head. It was initially wrongly diagnosed as an age spot. That was when he was 62. But by the time they figured out that it was actually a melanoma and they had surgery to remove it but it had spread to lymph nodes in his neck and he had multiple rounds of radiation therapy around his neck, at which point he lost his sense of taste. And they did some follow-up chemo, but by which time it had spread to his bones in his ribs and his liver. And he passed away within five months of its initial detection. He was 63 years old at the time. He served in Vietnam in the Australian Armed Forces and having two different cancers so close together, they ruled that it was most, the most likely explanation was his exposure to Agent Orange and other defoliants that they were using at the time, which is a very sad but very common story, unfortunately. So those are the two sad stories. The one positive story is my mother-in-law, and she had a routine mammogram when she was 62, found a lump. She had no idea it was there. It was not visible, was not physically detectable, but a biopsy revealed that it was cancerous. It's HER2 positive, which means that it was fed by estrogen. And the breast tumor was surgically removed. They had required two separate surgeries to get it all. She's had a round of chemo and radiation therapy. And during that time, she was admitted to hospital twice with low blood count. but she's also on a new drug called tamoxifen, which is specific to that kind of breast cancer that is fed by estrogen. And she's now two years out from surgery with no further signs of any other issues. So, so far so good, keeping an eye on that one closely. So, that's sort of been my, that's been my secondhand experience at least. While we wrap up on this, I guess I just want to wrap up with some advice. And again, to reiterate, I'm not a medical professional, I'm not a doctor, nor is Federico. But honestly, as you said earlier, mate, it's about catching it early. And if you see or feel anything that isn't right, just get it checked out. And if you're unhappy with the answer that the GP gives you, your general practitioner, your medical practitioner gives you, go see a different one. Get a second opinion. Ask to see a specialist. Sometimes it's that feeling inside that something is wrong. That's maybe what you need to listen to sometimes. Anyway, Australia has a problem with skin cancer because of the ozone layer depletion in the southern hemisphere and Australia is sometimes referred to as a sunburned country. We have one of the highest, in fact I do think we do have the highest incidence of skin cancers in the world. As a result, the government has a thing with Medicare they call bulk billing. And so far as skin cancer goes in Australia, being one of the top cancers on the list, there's lots of clinics around that you can go to and you can bulk bill. They'll bulk bill you, meaning there's no out of pocket expense. You just show up and they'll just take photos of any spots on your skin. they'll check you over and they keep them on file. So you can come back in six months and they can see if there's any changes or any discoloration or growth or anything that you might miss just looking at it visibly. And rather than just relying on you walking into a GP and saying, yeah, I've got this little lump on my leg and I don't know if it's a problem or not. But the message is, don't matter how old you are, don't think it won't happen to you because it could. Because Federico, you were 23, right? and it happened to you. So if you had any advice, 'cause that's sort of the end of my advice, what would your advice be to people? - Well, the first one is that if you feel that something isn't right, go to your doctor and ask for blood tests, because you can easily spot the early signs in your blood, usually. Don't ever be afraid or feel awkward or embarrassed about exposing your fears and the things that you feel in any part of your body. Because I know that it can be strange to explain to a doctor that you feel something in a specific part of your body and you don't want to be touched and you don't want to get undressed. But you know, that's the stuff that you need to do. While you're doing, if you're ever, and I hope you're not, but if you're ever diagnosed with cancer and you're doing chemo or other treatments, just keep in mind that you need to trust the doctors. Don't go read opinions on the internet because it's full of people that tell you you're going to die. And just try to always believe in science and medicine. And if a doctor tells you that it's doable, then it's doable because that person has a degree and it's their job and then they usually know what they're doing but also don't be afraid to ask for second opinions also when you're doing treatments if you if you're not sure about your oncologist go see another oncologist because the world is full of oncologists so you can always get second or third or fourth opinions on anything. Keep an archive of everything that you do either on paper or on PDF in Evernote or Dropbox whatever it is you do. My family and I keep two copies of each document and each test and each image and each scan that I have and try to organize the archive for type and year and while you're doing treatments keep in mind that life is not all about treatments try to do other stuff if possible try to have fun try to read have a hobby play games be with friends done it's not a shame it to be on chemo to do radiation, you're not worse than anybody else and it's a perfectly normal thing that happens to a lot of people and you don't have to be ashamed for you know for being sick, it's not the kind of disease that you give to other people, it just happens to you and there's no shame in it and after that just always try to be cautious even after they tell you that you're you know it worked, try to be cautious, try to keep a log of your symptoms if you ever feel anything tell it to your doctor right away don't think that it's stupid to call your oncologist because they don't want to hear from you they want to always hear from you because after all there are people helping other people so they become attached to you as much as you become attached to them so don't be afraid to call your oncologist and tell you if you feel even after months if something isn't right. And in general just try to think about the fact that it could always be worse because there are worse, there are other people in the world that are suffering more than you even if you're doing chemo or if you're doing something else. There are people that are not as fortunate as you, don't have access to treatments and there are people that die without a single chance of having a blood test and just try to you know to take it easy and try to understand that it's a lot of people do this and you got to do it too. So just try to enjoy life in the process if possible and keep focused on, you know, I got to do this and then I will get better. That was my general policy, I guess. Cool. Well, I think that's a good note to leave it on right there. And if you'd like to talk more about this, you can reach me on Twitter @johnchiji and check out my writing at If you'd like to send any feedback, please use the feedback form on the website and that's where you'll also find the show notes for this episode. Under "Podcasts Pragmatic," you can follow Pragmatic Show on Twitter to see show announcements and other related materials. I'd like to thank two sponsors for this episode, which is Audible and you can visit this URL for your free audio book. I'd also like to personally thank ManyTricks for sponsoring the show. If you're looking for some Mac software that can do ManyTricks, remember to specifically visit this URL, for more information about their amazingly useful apps and use the discount code pragmatic25, pragmatic the word and two five the numbers for 25% off the total price of your order. Hurry it's only for a limited time. I'd also like to deeply thank my special guest host for today Federico Vittici and what is the best way for people to get in touch with you Federico? They can find my writing on or they can find me on Twitter as @vittici that's V I T I C C I. I see you We tweet this sometimes as a hashtag and if there's anything you want to say to Cancer, what would you say? I want to say f*** Cancer. F*** Cancer, exactly. Yeah. Thank you so much for coming on, mate. I really appreciate it. Thank you. Thank you. I really appreciate it too. [MUSIC PLAYING] [Music] [MUSIC PLAYING] (upbeat music) (upbeat music) (upbeat music) (upbeat music) (upbeat music) (upbeat music) (upbeat music) (upbeat music) (upbeat music) (upbeat music) [Music] (explosion)
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Federico Viticci

Federico Viticci

Federico is the man behind MacStories and co-hosts two excellent podcasts on in Virtual and Connected.

John Chidgey

John Chidgey

John is an Electrical, Instrumentation and Control Systems Engineer, software developer, podcaster, vocal actor and runs TechDistortion and the Engineered Network. John is a Chartered Professional Engineer in both Electrical Engineering and Information, Telecommunications and Electronics Engineering (ITEE) and a semi-regular conference speaker.

John has produced and appeared on many podcasts including Pragmatic and Causality and is available for hire for Vocal Acting or advertising. He has experience and interest in HMI Design, Alarm Management, Cyber-security and Root Cause Analysis.

Described as the David Attenborough of disasters, and a Dreamy Narrator with Great Pipes by the Podfather Adam Curry.

You can find him on the Fediverse and on Twitter.