June 2024

The cause behind a case of CMML seems to be unknown

DEAR DR. ROACH: My husband recently passed away one week after his 80th birthday. According to his death certificate, he died of lung cancer (not a surprise) and chronic myelomonocytic leukemia (CMML), which was a total surprise. He was always a very healthy and vital man; he never had surgery or other medical problems.He had his first-ever surgical procedure in 2020 and got the lower lobe of his right lung removed. Over the years, he would develop small tumors in both his right and left lungs. He received very aggressive chemotherapy in 2020, which knocked him for a loop. He was then given Keytruda for two years and developed an irregular heartbeat that he never had before.Then his bloodwork had started becoming so irregular that he could not have Keytruda sometimes. Could Keytruda have been responsible for those blood tests, the irregular heartbeat, and the CMML? Our son died at the age of 5 of aplastic anemia, and my father-in-law died in 1963 of leukemia. (But his death certificate also said "aplastic anemia.")I am very confused. I am now thinking that my husband's genetics were his downfall because of the CMML and the aplastic anemia. Could you explain how all of this could have happened? -- P.C.ANSWER: I am sorry to hear about your husband, and I will try to help make some sense of it.CMML, a type of blood cancer, is not thought to be an inherited disorder, so it isn't a genetic issue. However, about 6% to 10% of CMML cases are related to chemotherapy or radiation, so this could be possible. Keytruda is a type of immunotherapy called a checkpoint inhibitor. Cancer cells can block the immune system cells (specifically T-cells) from doing their job of destroying cancers, so Keytruda blocks the ability of cancer cells to do this. Even so, it has significant toxicities.An irregular heartbeat is reported in 4% to 11% of recipients. It may also cause anemia, but this happens generally less often than with chemotherapy. Keytruda often causes abnormalities in many blood tests, particularly those related to kidney, liver and endocrine-gland function. Despite all of our advances, medication for cancer still has the potential to hurt the body.As far as the CMML goes, there are case reports of blood cancers following checkpoint inhibitors, but I couldn't find any of Keytruda being associated with CMML; in fact, Keytruda is being studied as a treatment for CMML. It's more likely that your husband's blood cancer is related to the initial chemotherapy. Still, the average time from chemotherapy to the development of CMML is five to seven years, so it seems unlikely to be related.DR. ROACH WRITES: A recent column on quinolone drugs, such as levofloxacin (Levaquin) and ciprofloxacin (Cipro), generated strong emotions from people who had complications from this treatment. Most people said they were never told about the potential for harm from this class of medicines, but some reported that they were given specific warnings. My major point here is to highlight the dangers of antibiotic use and hopefully decrease the unnecessary use of quinolone drugs, which have more potential for harm than many other antibiotics.One reader who has taken multiple courses of levofloxacin without problems asked whether they are less likely to develop tendinopathy. It's a great question, but one I couldn't find an answer to in the literature. However, since the antibiotic gets into and damages the tendons, it is more probable that a person actually has an increased susceptibility to tendon damage after multiple courses.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

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Kansas Profile – Now That's Rural: Zoe Rhodes, ED ASTRA

“Ad Astra per Aspera – To the Stars through Difficulties” is the Kansas state motto. As a kid, I learned a lot about Kansas from wonderful teachers. What if that motto said ED Astra, and what if it could be used to inspire more teachers to work in rural Kansas? Today we’ll learn about an initiative to accomplish those very goals. Zoe Rhodes is a freshman in agricultural education at K-State, a newly elected state FFA officer, and president of a new student group called ED ASTRA – a name inspired by the Kansas state motto. ED ASTRA is an acronym for Education Advocates Supporting Teachers in Rural Areas. ED ASTRA is the brainchild of Lori Goodson, assistant director of the Rural Education Center in the K-State College of Education. “I’m the product of a tiny school in northwest Missouri and I know the impact those small rural schools can have,” Goodson said. Even before she joined the REC, Goodson made a list of things that could be done for rural students. Creating a rural student teacher organization came to mind. “It started as an effort to send people to rural communities to help them,” Rhodes said. “We have reframed it to highlight the great things about being in rural communities so that people will want to go back.” Rhodes was asked to be president. Students were invited to an ED ASTRA ice cream social in April 2024. More than 30 attended. Todd Goodson, professor and interim dean of the College of Education, told the group about his experiences with rural education and the impact that dedicated teachers can make in rural classrooms. The purpose of ED ASTRA is to encourage education majors from rural areas to return home after graduation and to encourage others to consider teaching in a rural district. The faculty advisors are Lori Goodson and instructor James Alberto, both with the Department of Curriculum and Instruction in K-State’s College of Education. Rural communities need well-trained and qualified educators to prepare students for post-secondary success, said Debbie Mercer, K-State interim provost and executive vice president. She served as dean of the College of Education before stepping into her current role. "Rural schools are not only powerhouses of learning, they also help drive the Kansas economy," Mercer said. According to the 2023 State of Kansas Economic Contribution Report, agriculture and related sectors provide $81 billion in output. These sectors support 253,614 jobs, or 13 percent of the state’s workforce. Rural schools have been identified as cornerstones of the communities they serve. "Kansas needs excellent teachers and school administrators so that employers have the workforce they need to protect our economic base and to grow industrial opportunities across the state,” Mercer said. Rhodes said she is passionate about rural education. “My teachers were all so outstanding,” she said. “In rural communities, everyone helps build each other up.” She adds: “All the women in my family are educators. We’re equipped to help people. It’s rewarding to see students make progress and grow.” The officers and committee chairs of ED ASTRA represent a cross-section of majors, such as secondary math, elementary education, music education, secondary biology, secondary social studies and psychology, secondary art, modern languages, and agricultural education. They come from such Kansas communities as Abilene, Belleville, Clearwater, Derby, Fredonia, Frontenac, Topeka, and Maize, plus Nebraska, Missouri, and Illinois. Rhodes comes from the rural community of Girard, population 2,496 people. Now, that’s rural. “My teachers had a huge impact on my life,” Rhodes said. “It’s important to give back. I hope to go back and teach in Girard or a small school like it someday.” Ad Astra per Aspera – To the Stars through Difficulties. That’s the Kansas motto and the inspiration for the name of this new student group called ED ASTRA. We commend Zoe Rhodes, Lori Goodson, James Alberto, Todd Goodson, Debbie Mercer, and especially the other students involved in this rural teaching organization. I’m sure they will make a difference in rural education. They will overcome difficulties and become star teachers.

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