How Quitting Smoking Can Save More Than Your Life

How Quitting Smoking Can Save More Than Your Life - Most smokers have probably calculated how much they would save after cutting out a weekly pack (easily $300 a year). Imagine that on a larger scale. Currently, about one in every five American adults is a smoker. If the rate dropped to 4.9 percent, the U.S. could save $70 billion in medical costs.

The Smoking Prevalence, Savings, and Treatment (SmokingPaST) Framework calculates how quitting smoking translates to such impressive figures.

We’re not just talking about saving money, but saving the lives of your loved ones and yourself. Smoking is the leading preventable killer, according to the American Heart Association.

Dragging Down Sex, Health & Beauty

Each time you take a drag, thousands of chemicals enter your body, including the toxic and carcinogenic kind. Smoking’s effect on your beauty serves as an immediate reminder of what’s going on inside that puts you at risk for disease down the line, like heart disease and stroke.

While nicotine is the addictive agent, it is not the huge health-and-beauty buster (if you forget it is addictive). But the hydrocarbons you absorb with every tobacco puff are huge, health-and-beauty busters.

Hydrocarbons set up an inflammatory reaction that destroys the inner lining cells of your blood vessels, contributing plaque, but also destroying those cells ability to make that beauty-and-pleasure champion nitric oxide. You want nitric oxide -- it dilates key blood vessels for men during sex (it’s what Viagra prolongs) and gives women orgasmic pleasure also (both as a result and for women even if you do not partner with a guy). And since even social smoking increases plaque in arteries to your brain, and the brain is the biggest sexual organ, tobacco ruins performance, enjoyment and desire.

If that weren’t enough, your complexion is another telltale sign of smoking’s aging effects on you, whether it shows now or ten years down the line. Healthy blood flow sends much-needed nutrients throughout your body and nitric oxide gives your face its healthy glow. Smoking compromises this blood flow as well as the nitric oxide release, resulting in a yellow or grayish skintone -- not your best look.

Your skin texture itself suffers too, since the hydrocarbons of tobacco reduce the production of collagen and elastin. These structural proteins keep skin supple and without the passive wrinkles of aging (the ones not associated with muscle contraction -- these passive wrinkles can’t even be made non-wrinkles by Botox). Further, without this buoyancy boost your skin creases with movement (like puckering your lips and squinting your eyes), forming wrinkles, which can be seen under a microscope before you can see smoking’s aging effects.

But we’re not done talking smoke yet. (Exhausting, isn’t it? Imagine how tired your body gets from this stuff.)

When smoke robs your body of oxygen, your hair becomes dull and prone to more breakage. Tar can yellow or even brown your teeth and nails. You may be able to mask these very visible effects of smoking, but there are some things that just cannot be stopped inside your body.

Free radicals oxidize (chem class refresher: snatch away an electron from) molecules in your body. They can be damaging in large quantities -- or if antioxidants inside your cells aren’t available to fight them -- and can increase your risk of lung, breast, bladder and many other cancers.

Unfortunately, all these beauty blasting and pleasure ruining risks even extend to secondhand smoke. The majority of smoke isn’t inhaled, but goes into our environment. Being around a smoker for four hours is the equivalent of you smoking a cigarette!

Taking Action

But this problem is not beyond our control, and the government, employers and colleges are taking action. As of this summer, 500 U.S. colleges began enforcing 100 percent tobacco- or smoke-free policies. Even the University of Kentucky will expel you for your third on-campus smoking event. And these policies are making a difference. The first published report came out showing that student smoking rates declined with the Indiana University smoking ban, and those who didn't quit still smoked fewer cigarettes as a result.

What’s the best quitting method? According to recent research, a combination of behavioral therapy and medicine. A new study from the University of Missouri found that college-aged smokers are more impulsive, so programs directed at changing this impulsivity may be effective on a grand scale.

Social pressures may be enough to force someone to consider quitting. Even after college, there will be a new cost to smoking. Soon enough, it’s going to become acceptable for places to not hire smokers. The Cleveland Clinic has already taken the lead in this initiative.

So we say, please pass along our quitting guide from the “You” series to those smokers in your life. Nothing is worth the cost of cigarettes. ( huffingtonpost.com )

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The Orgasmic Diet

The Orgasmic Diet - A sexual diet has the power to give women back their sexual health and ability to enjoy sexual pleasure. Essentially, the Orgasmic Diet is based on four essential factors that impact and enable healthy sexual functioning in women:

• sufficient free testosterone,
• balanced dopamine-serotonin levels,
• PC muscle tone, and
• healthy genital circulation.

The Orgasmic Diet achieves all four of these effects, enabling high sexual desire and intense sexual responsiveness. Lindberg is in the process of acquiring support for her research protocol and has garnered medical and professional support from experts in the field of sexual responsiveness. Here is how The Orgasmic Diet works; it

• raises free testosterone by emphasizing high protein, zinc, and magnesium;
• balances the levels of two important neurotransmitters regulating women's libido and sexual functioning, specifically dopamine and serotonin, through an increase of Omega 3 fatty acids in fish oil supplements;
• further boosts dopamine (the neurotransmitter enabling women to experience sexual pleasure) via healthy amounts of dark chocolate;
• keeps serotonin from spiking and interfering with a proper serotonin-dopamine balance by decreasing or altogether eliminating caffeine; and
• improves blood flow by the pro-circulatory benefits of fish oil and increases vaginal muscle tone through targeted exercise.

High dopamine does improve female libido, so much so that several dopamine drugs are currently in Phase I clinical trials. High serotonin does decrease sexual function—antidepressants are already being prescribed for premature ejaculation, and the crippling anti-sexual side effects of antidepressants use for women are a well-documented and active field of research for the medical community. Free testosterone does control desire, and the number of women getting off-label testosterone replacement therapy to help with FSD and the enormous popularity of books on the topic attest to how widespread and generally accepted it is, to the point where it has generated a backlash movement among some sex therapists at the blanket use of TRT for all women, no matter their case histories. PC muscle tone has already been proven to help female sexual response, especially with a high correlation to vaginal orgasmic ability. And finally the importance of good genital blood circulation has also entered the mainstream. It didn’t have enough of an effect for Viagra to pass clinical trials, but there is enough anecdotal evidence of women out there "borrowing" their husbands' little blue pills and enjoying the results to make the idea certainly plausible, in combination with other factors to make a more noticeable improvement in the general population.

So the diet is quite simple: high in protein, low in carbs, and high in particular fats. Take fish oil supplements, some vitamins and minerals, lower or eliminate caffeine, eat a good amount of dark chocolate, and finally, exercise your PC muscles. That's it. There is nothing outlandish about the diet; everything a woman needs can be purchased at her supermarket or local drugstore, except for the PC muscle exercise device, a $40 purchase easily done online. There is nothing exotic or dangerous in the diet. In fact, the diet consists of common vitamins and minerals and foods most of us are already eating anyway. The only rather unusual things in the Orgasmic Diet are the recommendations for eating dark chocolate and consuming lots of fish oil, but chocolate and fish have been eaten (and overeaten) and studied for centuries. And really, don't you want someone telling you to eat chocolate every day because it's good for you anyway? ( lifestyle.yahoo.com )

So what I suggest is -- try it!

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What causes bad breath?

What causes bad breath?. Most people suffer from bad breath occasionally. However, if it becomes permanent you should consult your dentist. Bad breath is usually due to the breakdown of proteins by bacteria somewhere in the mouth. However, there are several other possible causes in the airways, oesophagus and stomach that can also lead to bad breath.

1. What you eat affects the air you exhale. Certain foods, such as garlic and onions, contribute to objectionable breath odour. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. Brushing, flossing and mouthwash will only mask the odour temporarily. Odours continue until the body eliminates the food. People on a diet may develop unpleasant breath from infrequent eating.
2. If you do not brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odour. Dentures that are not cleaned properly can also harbour odour causing bacteria and food particles.
3. One of the warning signs of periodontal (gum) disease is persistent bad breath or a bad taste in the mouth. Periodontal disease is caused by plaque, the sticky, colourless film of bacteria that constantly forms on teeth. The bacteria create toxins that irritate the gums. In the advanced stage of the disease, the gums, bone and other structures that support the teeth become damaged.
4. Bad breath is also caused by dry mouth (xerostomia), which occurs when the flow of saliva decreases.
5. Tobacco products cause bad breath, stain teeth, reduce one's ability to taste foods and irritate gum tissues. Tobacco users are more likely to suffer from periodontal disease and are at greater risk for developing oral cancer.
6. Bad breath may be the sign of a medical disorder, such as a local infection in the respiratory tract (nose, throat, windpipe, lungs), chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Factors in the mouth that cause bad breath:

• Dental decay
• Gum disease
• Food stagnation between the teeth
• Dry mouth
• Excessive bacterial activity on the tongue, possibly due to postnasal drip (catarrh coming down the back of the throat from the sinuses and nasal passages)
• Throat or tonsil infection

Factors in the airways that cause bad breath:

• Sinusitis
• Polyps
• Dryness
• Foreign body
• Hindered air or mucus flow
• Bronchitis
• Pneumonia

Factors in the oesophagus and stomach that cause bad breath:

• Gastritis and food reflux
• Food stagnation
• In rare cases, bad breath can be a sign of a significant general health problem, so it should not be ignored. However, the usual cause is oral, which can often be treated to resolve the problem

How is the diagnosis made?

Regular checkups will allow your dentist to detect any problems such as gum disease, a dry mouth or other disorders that may be the cause. Schedule regular dental visits for a professional cleaning and checkup. If you think you have constant bad breath, keep a log of the foods you eat and make a list of medications you take. Some medications may play a role in creating mouth odours. Let your dentist know if you have had any surgery or illness since your last appointment. If your dentist determines that your mouth is healthy and that the odour is not of oral origin, you may be referred to a specialist to determine the cause of the odour and for treatment. With regular dental checkups, your dentist can detect and treat periodontal disease early.

What is the treatment?

Maintaining good oral hygiene, eliminating gum disease and scheduling regular professional cleanings are essential to reducing bad breath. Brush twice a day with a fluoride toothpaste to remove food debris and plaque. Brush your tongue, too. Once a day, use floss or an interdental cleaner to clean between teeth. If you wear removable dentures, take them out at night. Clean them thoroughly before replacing them the next morning.

Mouthwashes are generally cosmetic and do not have a long-lasting effect on bad breath. If you must constantly use a breath freshener to hide unpleasant mouth odour, see your dentist. If you need extra help in controlling plaque, your dentist may recommend using a special antimicrobial mouthrinse. A fluoride mouth rinse, used along with brushing and flossing, can help prevent tooth decay. If you suffer from dry mouth, your dentist may prescribe an artificial saliva, or suggest using sugarless candy and increasing your fluid intake.

What can you do for yourself?

• Maintain a high level of oral and dental hygiene. In addition to brushing, it is important to clean between the teeth using dental floss.
• Use a tongue cleaner and clean right to the back of the tongue.
• Use a mouthwash recommended by your dentist or pharmacist. The best time to use it is just before sleeping
• Drink plenty of fluids, avoiding too much coffee
• Clean your mouth after eating milk products, fish and meat
• Chew sugar-free gum, especially if your mouth feels dry
• Eat fresh, fibrous vegetables
• Visit your dentist regularly and have your teeth professionally cleaned as required.

( ndtv.com )

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A Genetics Company Fails, Its Research Too Complex

DeCode Genetics, a pioneering company that used the Icelandic population as its guinea pigs in detecting disease-causing mutations, filed for bankruptcy on Tuesday.

The company’s demise suggests that the medical promise of the human genome may take much longer to be fulfilled than its sponsors had hoped. Based in Reykjavik, Iceland, it was founded in 1996 by Dr. Kari Stefansson, a research neurologist who worked at the University of Chicago and at Harvard. After the human genome sequence was achieved in 2003, Dr. Stefansson quickly realized that Iceland’s excellent medical records, combined with the genealogical information available on its close-knit population, provided a fine test bed for seeking the roots of genetically complex diseases like cancer, diabetes and schizophrenia.

deCode

A lab at deCode Genetics, which found that the genetic nature of human disease was far more complex than anyone thought.

DeCode quickly became the leader in the worldwide race to identify the causes of common disease. The company’s researchers discovered mutations linked to schizophrenia, heart disease, diabetes, prostate cancer and many other illnesses. Its approach was to identify the mutations first in Icelanders and then to confirm them in other populations.

Whatever business errors deCode may have made, a principal reason for its downfall is scientific — the genetic nature of human disease has turned out to be far more complex than thought.

Many researchers expected that just a handful of genetic mutations would explain most cases of any given major disease. But the mutations that deCode and others detected in each disease turned out to account for a small fraction of the overall incidence. Natural selection seems to be much more efficient than expected at ridding the population of dangerous genes, even of those that act well after the age of reproduction. That leaves thousands of different mutations, each very rare in the population, as the probable culprit. And because most of the mutations are rare, they are extremely hard to find.

The mutations that deCode detected in each major disease were responsible for too few cases to support the development of widely used diagnostic tests or blockbuster drugs.

Today’s bankruptcy affects deCode Genetics, the parent company based in the United States that owns the Icelandic operation, called Íslensk Erfagreining. That operation is being put up for auction and, depending on the wishes of its new owners, could continue its gene-hunting efforts much as before.

“It’s not a happy day but it would be worse if the genetics operation were not to continue,” said Edward Farmer, deCode’s chief communications officer. The discovery that major diseases do not have any simple genetic pattern of causation has dealt a serious setback to the gene-hunting field as a whole, and researchers are trying to figure out their next move.

“DeCode has been very successful using genome-wide association studies, and among the first to publish many discoveries,” said Dr. David Altshuler, a medical geneticist at the Massachusetts General Hospital. But he expressed optimism that the human genome project would succeed despite deCode’s stumble.

“It would be a mistake to draw any connection between the medical promise of the human genome and the success of a specific company and business model,” he said. ( nytimes.com )

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Breaching a Barrier to Fight Brain Cancer - ( 2 )

Breaching a Barrier to Fight Brain Cancer - ( 2 ). The headaches had returned. New scans, displayed on a computer screen, showed signs of brain swelling and bright spots that should not have been there. Dr. Boockvar recommended more surgery and then chemotherapy with Avastin, which had recently been approved for recurring glioblastoma.

Fred R. Conrad/The New York Times

PREPARATION Dennis Sugrue, of Stamford, Conn., had staples removed before undergoing a procedure in which the cancer drug Avastin was injected into his brain.

It was approved for intravenous use — to be dripped into a vein, usually in the arm — but he said Mr. Sugrue would be an ideal candidate for his study, in which the drug would be infused directly into an artery in the brain, producing levels at least 50 times what the intravenous route could achieve. One other patient had been treated that way, and M.R.I. scans showed that recurring tumors seemed to have melted away.

Mr. Sugrue said he was all for it, even though Dr. Boockvar warned him that the drug was no magic bullet. Then Dr. Boockvar ticked off the risks from a second brain operation.

“I have to quote you a 5 percent risk you’ll be visibly weak,” he said. “A 1 percent chance of paralysis on the left side.”

Mr. Sugrue wiped his eyes and began to apologize for losing his composure, but the surgeon cut him off and said, “In neurosurgery they say that if you don’t make your patient cry, you haven’t gotten informed consent.”

The trial grew out of a conversation about a year ago between Dr. Boockvar and Dr. Riina, an expert in using microcatheters to treat strokes.

“I said, ‘Why can’t you infuse chemotherapy for my brain tumor patients?’ ” Dr. Boockvar recalled. “And he said: ‘I can. Just show me what you want to do.’ ”

Dr. Riina said, “Technically, I can go anywhere in your brain.”

He said microcatheter technology had advanced “light-years” in the last decade and was just waiting for a new drug to come along for glioblastoma.

They wrote up a plan to test what they called “superselective intra-arterial cerebral infusion” of Avastin in 30 patients with glioblastomas that had recurred after standard treatment. Each patient would receive just one treatment directed into the brain, followed weeks later by a series of intravenous treatments with Avastin.

Their study involves a technique first developed about 30 years ago, which uses mannitol to open the blood-brain barrier temporarily to get chemotherapy into the brain. Mannitol pulls water out of the tightly packed cells lining the capillaries so that they shrink and pull away from one another, opening up gaps through which drug molecules can pass into the brain.

The technique was developed by Dr. Edward A. Neuwelt, a neurosurgeon at Oregon Health Sciences University and the Veterans Affairs Hospital in Portland. Its best results have been in people with a rare type of brain tumor called a primary central nervous system lymphoma. But it has not been helpful with glioblastoma, because until recently there was no chemotherapy to infuse that would have much effect on those tumors.

Dr. Neuwelt said that Avastin had helped to renew interest in opening the blood-brain barrier but that researchers disagreed about whether the drug would lend itself to that use.

Avastin starves tumors by blocking the growth of new blood vessels, which they need to survive. Dr. Boockvar said microcatheters should increase the odds of success by delivering a high dose of the drug directly to where it was needed most. Earlier research with other drugs used larger catheters inserted into the carotid arteries, which feed the entire brain — meaning that the tumor did not receive the most concentrated dose and that healthy brain tissue was exposed to the toxic drugs.

By mid-November, the researchers had treated five patients, including Mr. Sugrue; they first infused mannitol, waited five minutes and then sprayed in the Avastin. In all the patients’ M.R.I. scans, the telltale bright spots that marked tumor growth faded away after the treatment.

“I can’t tell you what it means,” Dr. Boockvar said. “Nobody knows.”

Indeed, the death of the first patient was a reminder that glioblastoma can invade other parts of the brain and the spinal fluid and that the highly localized spray of Avastin might miss deadly seeds of cancer.

But Dr. Boockvar remained hopeful for the remaining patients, describing the scans as “astronomically far better than I had anticipated.”

Hope and Anxiety

Mr. Sugrue was still in the hospital in late September when Dr. Boockvar burst into his room and got him out of bed to look at his own before-and-after scans.

“He took me to this room with all these computers and said, ‘I’ve got to show you this,’ ” Mr. Sugrue recalled. “This M.R.I. was a thing of beauty. I’m excited that he’s excited. That means a lot to me.”

Dr. Boockvar said: “Avastin may not be the best drug for this delivery technique. What’s exciting about our results is that we’ve proven there is a local effect.

“Suppose someone said, ‘I have much better drug.’ Now I can say I at least have a delivery system.”

With patients, Dr. Boockvar tries to walk a fine line, trying to level with them and yet not rob them of all hope. He knows the emotional toll that a cancer diagnosis can take: his own father had leukemia for about eight years and died in September. Mrs. Sugrue said the doctor urged her and her husband to resist doing an Internet search for glioblastoma because they would just read that it was a death sentence.

They said they tried to follow his advice, but when the subject of prognosis came up in an interview, both had tears in their eyes.

“You don’t ask the question if you don’t want the answer,” Mrs. Sugrue said. “What will be, will be. You do what you can.” ( nytimes.com )

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Breaching a Barrier to Fight Brain Cancer - ( 1 )

Breaching a Barrier to Fight Brain Cancer - ( 1 ). Experiment Dr. Howard Riina looking at scans during a procedure performed on Dennis Sugrue, 50, who has glioblastoma, the cancer that Senator Edward M. Kennedy of Massachusetts had.

Fred R. Conrad/The New York Times

Dr. Howard Riina threaded a slender tube through a maze of arteries in Dennis Sugrue’s brain, watching X-ray images on a monitor to track his progress. At the site where a previous operation had removed a malignant tumor, he infused a drug called mannitol and unleashed a flood of the cancer drug Avastin.

Chemotherapy Dr. John Boockvar, left, watched as Dr. Howard Riina and Dr. Jared Knopman infused drugs into Mr. Sugrue's skull. The technique uses microcatheters.

Doctors and nurses watched intently, worried that the Avastin could cause brain swelling, a hemorrhage or a seizure. But Mr. Sugrue emerged unscathed. A half hour after the procedure, he woke up from anesthesia mumbling, “More is better,” and wishing aloud that he could have had a bigger dose.

It was an experiment. Mr. Sugrue, 50, who works for a hedge fund and has two teenage children, was in a study for people with glioblastoma — the same type of brain tumor that killed Senator Edward M. Kennedy of Massachusetts in August — and was only the second person ever to have Avastin sprayed directly into his brain.

Getting drugs into the brain has always been a major challenge in treating tumors and other neurological diseases, because the blood-brain barrier, a natural defense system, keeps many drugs out. The study that Mr. Sugrue is in, at NewYork-Presbyterian/Weill Cornell, combines old technologies in a new way to open the barrier and deliver extraordinarily high doses of Avastin straight to these deadly tumors — without soaking the rest of the brain in the drug and exposing it to side effects.

The goal is to find better ways to treat glioblastomas. But the technique might also be useful for brain metastases, meaning cancer that has spread from other parts of the body, like the breasts or lungs — something that occurs in about 100,000 people a year in the United States. The same procedure could also deliver other drugs and might eventually be used to treat neurological disorders like multiple sclerosis or Parkinson’s disease, if suitable therapies are developed.

The defense system that doctors are trying to breach evolved to keep out toxins and microbes. It consists mainly of cells that line the walls of capillaries in the brain and are so tightly packed that many molecules in the bloodstream cannot slip out between cells to reach the brain tissue itself. But certain drugs, like mannitol, will temporarily open the barrier and were first used more than 20 years ago to help other medicines reach the brain.

The new technique refines the art of opening the barrier: it uses microcatheters — fine, highly flexible tubes that are inserted into an artery in the groin and then threaded up into tiny blood vessels nearly anywhere in the brain — to spray chemotherapy directly onto tumors or areas from which they have been removed. The catheters are normally used to deliver clot-dissolving drugs to the brain to treat strokes.

“This will substantially alter the way that chemotherapy is given in the future,” said Dr. John Boockvar, the brain surgeon who devised the trial. “But we have to prove that at certain doses, nobody gets hurt.”

Referring to glioblastoma patients, Dr. Riina said, “Everyone is looking for something to do for these people.”

“Even if you buy someone just a year, that could be a wedding or a graduation,” he continued. “You never know what might happen in the year they hold onto.”

The study, which began in August, is still in its earliest phase, meaning its main goal is to measure safety, not efficacy — to find out if it is safe to spray Avastin directly into brain arteries and at what dose. Nonetheless, the doctors were pleased when M.R.I. scans of the first few patients showed that the treatment seemed to erase any sign of recurring glioblastomas. But how long the effect will last remains to be seen.

“A beautiful M.R.I. scan doesn’t mean it’s cured,” Dr. Boockvar said.

Despite a beautiful scan, the first patient who was treated died in October, from pneumonia and the spread of glioblastoma to his brainstem.

Innovations are desperately needed to make headway against glioblastoma, which is “one of the most deadly tumors that exist in humans,” said Dr. Russell Lonser, chairman of surgical neurology at the National Institutes of Health.

“This is a very good start,” Dr. Lonser said. “The early data is very interesting and exciting.”

The complexity of a study like this goes beyond the science. Clinical trials are also a complicated pact, emotionally and ethically, between desperate patients and doctors who must balance their ambition as researchers against their duty as clinicians, and must walk a fine line between offering too much hope and not enough.

“I tell patients, ‘I’m going to try to cure your disease, but so far glioblastoma is an incurable disease,’ ” Dr. Boockvar said.

Extending Life

“I’m optimistic,” Mr. Sugrue said one morning in September, after scheduling a second brain operation. But he had tears in his eyes.

There are about 10,000 new cases of glioblastoma a year in the United States, mostly in people over 45. The tumors are notorious for growing back like weeds even after being cut out and blasted with chemotherapy and radiation, and they are nearly always fatal. With the best treatment, the median survival time is about 15 months.

But in the last five years, the number of patients who survive 2 years has increased to 25 percent, from 8 percent, largely because doctors began using a chemotherapy pill called temozolomide, or Temodar, along with radiation (Temodar is believed to seep through the blood-brain barrier).

Dr. Boockvar said he thought that if he could just keep patients alive for two years, more advances might come along and give them time.

“The glioblastoma population is very studyable, unfortunately, because the prognosis is so grim,” he said.

Patients often wind up on the frontlines of research, figuring they have little to lose and hoping they will be lucky enough to test the big breakthrough. More than 500 studies for people with glioblastoma are listed on the government Web site www.clinicaltrials.gov.

Mr. Sugrue, who lives in Stamford, Conn., with his wife, Donna, and their children Molly and Tim, began having headaches in April. He thought he had a sinus problem. But a scan found a brain tumor nearly the size of a golf ball. A local doctor referred him to Dr. Boockvar. He had the standard treatment: surgery, temozolomide pills and six weeks of radiation, which ended on June 25.

By July, an ominous bright spot on his M.R.I. scan suggested that the tumor might already be growing back. He continued chemotherapy, but the spot kept enlarging.

By mid-September, the Sugrues were back in Dr. Boockvar’s office to plan their next step. Stubbly hair was growing in on Mr. Sugrue’s scalp, except for a bare patch, around an arcing scar above his right ear. His eyes, bright blue with thick, dark lashes that gave him a boyish look, searched the doctor’s face. ( nytimes.com )

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