Case Examples From My Practice

****Please Note:

Due to personal health issues, Dr. Stritter is no longer taking new cases.

Case 1: Navigating the breast cancer diagnosis maze

A 57 –year old artist was newly diagnosed with Stage IIa invasive ductal breast cancer. She was naturally quite frightened. This was around the time that a few tragic cases of death due to radiation therapy overdose had come to light and she was unsure whether to avoid radiation by getting a mastectomy. She was also torn between doing chemotherapy and avoiding it – the high grade of the cancer meant that her prospective oncologists recommended it but the early stage meant the likelihood of improved survival from chemotherapy would be small. She asked for a consultation.

Together we reviewed the recommendations of her prospective surgeons, advice from radiation oncologists, and the medical literature on the probability of radiation toxicity. With that information in mind, she made a confident decision in favor of lumpectomy. In preparation for her surgery, I arranged for several special tests of the breast cancer specimen: a Mammaprint, the Oncotype DX test, a molecular profile and chemosensitivity testing. The Oncotype DX test revealed a borderline high risk for future metastasis that would be significantly diminished with chemotherapy. (The specimen was not adequate for the Mammaprint folks so we had no report from them.) Based on this information, she felt comfortable proceeding with chemotherapy.

Being very interested in an integrative approach to cancer treatment, she selected a well-known integrative oncology clinic that used the results of her chemosensitivity testing to devise a maximally effective yet minimally toxic chemotherapy regimen. This worked so well that she was able to continue a challenging Ashtanga yoga routine and to go on 3-mile jogs during the 4 months she was on chemotherapy.

To cope with the emotional distress caused by the cancer diagnosis, its treatment and general upheaval in her life, I referred her to a well-known cancer therapist. Their frequent telephone appointments resulted in a very successful coping strategy that greatly reduced her fear.

For the next stage of her treatment, she opted to have the newest type of radiation therapy protocol, partial breast radiation therapy. I arranged an exhaustive review of her lumpectomy specimen by a pathologist specializing in breast cancer – he confirmed that the cancer had been entirely removed and that partial breast irradiation would be feasible.

After the brief course of radiation, we reviewed the oncologist’s thoughts on the relative risks and benefits of Tamoxifen versus aromatase inhibitors. I suggested CYP 2D6 testing – it revealed that she was a “good metabolizer” so she elected to proceed with Tamoxifen therapy for 3 years then switch to aromatase inhibitors. Finally, an intensive integrative protocol that included exercise, diet and psychospiritual wellness was devised and implemented to minimize the risk of cancer relapse. The molecular profile test results were used to help define the best pharmaceuticals and nutriceuticals to use for her maintenance protocol.

Now one year after her cancer diagnosis, she is stronger than ever, both physically and emotionally, and has actively re-engaged with her career as an artist.

Case 2: Navigating the metastatic breast cancer treatment maze

A 60 –year old Turkish carpet importer found a lump on her chest wall near her breastbone. A CT scan revealed a large (4-inch) mass that was likely a breast cancer metastasis and enlarged lung lymph nodes. Her oncologist, in consultation with her surgeon and radiation therapist, recommended chemotherapy as her only hope of preventing the cancer on her chest wall from breaking through the skin. He reluctantly admitted that the chemotherapy would work only for a few years at best. The woman was quite distressed – she’d had chemotherapy 2 years previously when initially diagnosed with triple-negative breast cancer and found the experience extremely difficult. She resolved never to do chemotherapy if it wouldn’t save her life. On the other hand, the chest wall cancer was getting larger and beginning to cause pain. She asked for a consultation.

At the time of our first conversation, she was terrified of the cancer eroding through her chest wall but she was even more terrified of the palliative chemotherapy. After some intense research, I found a top-notch academic radiologist who specialized in tumor cryoablation, a minimally invasive procedure where tumors are destroyed by freezing them. Upon reviewing her medical records and CT scans, she was found to be an excellent candidate for the procedure. She traveled across the country where 95% of the tumor was successfully ablated.

Being mindful of her imperative to avoid chemotherapy, I researched non-chemotherapy approaches for the residual cancer. In my search for clinics that would offer non-toxic treatments, I found one in Europe that specialized in immunological approaches to cancer treatment. This clinic was run by a physician who had spent time training in well-respected US institutions: Memorial Sloan-Kettering Cancer Center and the National Institutes of Health. He has an excellent reputation in Europe for leveraging pre-clinical and clinical research into top-notch treatment protocols. He put together a 5-week program based on dendritic cell vaccines and hyperthermia.

Currently, she is in Europe and happy to get treatment that is supportive, both physically and emotionally. Upon return to the US, she plans to begin an intensive maintenance protocol of diet, exercise and stress management. A molecular profile done her tumor at the time of the cryoablation will be used to individualize a pharmaceutical and nutriceutical maintenance program.

Case 3 : Finding a solution the patient could accept

A 51-year old woman was diagnosed with Stage 2 breast cancer. Because the tumor was relatively large and her breast was relatively small, she was advised by two separate oncologists to have a mastectomy. The patient was greatly distressed as she did not want a mastectomy but also did not want the poor cosmetic outcome of lumpectomy. She asked for a consultation.

After reviewing her scan and pathology reports, I told her about a procedure called skin-sparing, nipple-sparing mastectomy with immediate reconstruction. She was very enthusiastic about the procedure since it would clearly have a better cosmetic outcome. She wondered aloud why none of her surgeons told her of this option. I referred her to a nearby academic medical center who had experts in the procedure and could give her plenty of information regarding its high benefits and low risks. When her insurance company would not cover the surgical procedure, I helped her negotiate the insurance maze. She ended up having the surgery done by her preferred team and her insurance covered the expenses.

Case 4: Getting into a clinical trial

A 62-year old musician and entrepreneur was diagnosed ureteral cancer (the ureters are the tubes leading from the kidneys to the bladder). She had recently been diagnosed with Lynch syndrome, a rare disorder that puts one person at risk for getting multiple types of cancer. In fact, she had already survived a bout of colon cancer. She was upset that her doctor had dropped the ball in not discussing chemotherapy after her ureteral surgery, so she never knew it was even an option. Now that she had metastases to her lungs and liver, she was given a grim prognosis. This time, she wanted to be sure to leave no stone unturned and to consult with me.

My initial research into urothelial cancers revealed likely tumor sensitivity to a type of targeted therapy called VEGF inhibition. Further review of active clinical trials revealed a brand-new trial investigating Sutent (a multi-targeting agent whose effect includes VEGF inhibition) to maintain a chemotherapy-induced remission. Unfortunately, the nearest trial location was thousands of miles away. With further research, I found about a new research site opening up within a hour’s flight of her home. She was the first patient enrolled at that site and now, 2½ years later, continues on the clinical trial protocol with no signs of cancer.

Throughout this time, she has maintained an intensive integrative maintenance protocol using diet, exercise, and a proactive psychospiritual wellness program.

Case 5: Implementing the latest research

A 55 year-old lecturer/author was found to have squamous cell cancer of the back of the tongue with metastases to the neck and lung. His oncologist (a well-known doctor in a large city) recommended a treatment with the standard chemotherapy regimen that had a 30% – 40% rate of partial or complete remission. The patient wanted to know if more effective treatments were available.

This man contacted me around the time of the American Society of Clinical Oncologists’ annual conference. While I was there, I specifically researched this case. Happily, a breakthrough was reported at the conference: a new type of targeted therapy, EGFR inhibition, doubled the percentage of partial and complete remissions in this kind of cancer when added to the chemotherapy. The oncologist, when presented this information, was very uncomfortable with the newness of the protocol and convinced the man to proceed with the standard chemotherapy. Within six weeks, he landed in the intensive care unit, near death as the cancer had progressed dramatically. The oncologist then told  him that there was nothing more to offer, that he should just accept having only a few weeks to live. I was able to find another oncologist who was comfortable with adding an EGFR inhibitor to the treatment plan. Soon thereafter, the man went into a partial remission. He went on to have an additional 13 months of quality life instead of the few weeks predicted by his original oncologist.

Case 6: A misdiagnosis

A 51-year-old woman had metastatic lung cancer. She was very unhappy with her oncologist who rushed appointments, didn’t return phone calls and generally appeared uncaring. She was certain that her oncologist had given up on her.

The preliminary pathology report diagnosed the cancer as a non-small cell lung cancer. I obtained a copy of the final pathology report. The final report revealed the cancer to be of the small cell type, a completely different tumor from the non-small cell variety. That meant the oncologist was giving her the wrong chemotherapy for her type of tumor. With my help, they found another oncologist who was much more meticulous in his attention to the case. The chemotherapy was changed to a more appropriate combination. All test results were subsequently sent to me for review. Our discussions of those results helped the patient understand her disease process and her treatment choices more fully. Despite the initial mistreatment, she outlived her prognosis by almost a year of quality life.

Case 7: A missed diagnosis

A 45-year-old woman suffered from moderately severe chronic shoulder pain. After shoulder surgery, she had the misfortune to trip over her dog and fall on the bad shoulder. Her pain worsened. Her surgeon could find nothing wrong and was at a loss as to how to help. She consulted a second surgeon who then performed two more shoulder surgeries. Despite this aggressive treatment, her shoulder pain continued to worsen, requiring daily treatment with strong opioid (narcotic) medication.

I contacted the country’s leading authority on shoulder injuries and arranged for an appointment. She traveled to Texas where the shoulder expert found that a shoulder tendon had been pulled away from the bone (avulsed) when she fell after her first surgery. The original orthopedist missed it. The second orthopedist not only missed it, but also compounded the problem by performing two further, inappropriate surgeries. The needed corrective surgery was done and resulted in a much better quality of life.

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