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Ask HN: I Have Cancer. What Should I Do?
310 points by dammit_lump on May 30, 2015 | hide | past | web | favorite | 153 comments
I just left my engineering job at a medium-large employer to join an 18-person startup. I am set to start the new gig late next week.

I found a marble-sized lump under my armpit a few days ago. I quickly got it checked out, and the preliminary report just came back that it's probably cancerous.

What the hell should I do?

I'm 25, and otherwise healthy, so was not expecting this.

I really care about this new team and was excited to work with them. I feel horrible about joining a young business as an albatross instead of an asset.

I left my old job on good terms but have no idea how they could justify re-hiring an employee who left and may not be productive / able to work.

If I start at my new job I'm afraid I will endanger the business and raise everybody's premiums. I think they have a fairly generic group plan.

If I don't start my new job, how will I support myself?

My fiancé also works at a small startup so if I joined her insurance the same issues would apply.

I think I can still purchase my old insurance through Cobra, but I don't know how long that will last.

Thanks.




First, that sucks, and I'm sorry.

Second: if what you're facing is lymphoma (not unlikely given what you've said), you've probably already been told this, but: lots of good outcomes, especially for younger patients. I've known multiple people that faced it (more than one of them older), and all of them beat it.

Third: what you really want to know: do nothing differently. Retain your new job. You're fortunate in that you have a career in which you'll be able to remain productive during treatment.

Having an illness doesn't make you an albatross. Your condition almost definitely won't meaningfully impact your employer's HR costs (speaking from some experience here), and those costs are not your problem. You are not endangering your new employer. Don't listen to anyone who suggests your are.

Stay frosty, and do not casually make decisions that will impact your insurance coverage.


I don't know if you'll ever read this comment, Thomas, but that was probably one of the most positive examples of condensed wisdom I've ever seen you write.


Imagine you didn't have cancer, but I told you that if you killed yourself, I'd give everyone at your startup an extra $200/month for a couple years (or however long you would've worked there). That's it. That's the entire deal.

Would you take it? I imagine not, but that's essentially what you're proposing.

Everyone will want you to survive, and anyone who begrudges you for being human because it cost them a trivial amount of money shouldn't really factor into your health decisions.


This is a phenomenal comment.


What it ignores though is the interesting part, if the hiring manager knows of his illness.

I'm quite right wing, but that's why imho medical costs should be socialized. But of course, there are many problems that come along with that.


> medical costs should be socialized

I couldn't agree more. Most importantly, our career choices shouldn't be coupled to our health needs. It's ridiculous, and it's even more amazing that the US health care industry has somehow convinced conservatives that this is a good situation. As we can see from the OP, the coupling of job to health care in the US literally stifles innovation and job mobility.


I'm generally conservative too but this won't happen until we have tort reform (which won't happen so long as politics is governed by lawyers).

I heard someone say that health care is completely provided in Australia for about 2% of your gross pay because the leeches have been removed from the process ... is this true?

P.S. Leeches = anyone that inserts themselves into the process without adding meaningfully to the quality of care provided.


Malpractice litigation increases health care spending by 2.4% [0]. Many states have already passed tort reform that limits how and when a patient can sue and recover. There are lots of factors that increase health costs in this country, but litigation barely registers. Getting insurance companies out of the game (the BIG Leeches, in your example, who take 20% of the dollars in the system) would go a much longer way.

[0]http://content.healthaffairs.org/content/29/9/1569.abstract


Health insurance is far less predatory in Australia. We have a hybrid public-private system, where everybody is covered by single payer universal healthcare (including specialists, but not dental), but if people have the means they can opt for private health insurance to cut down on wait times or have things like remedial massage or optical included.

There are zero cases of bankruptcy due to medical illness, or people being denied care because of a lack of insurance.


Even if it's a large amount of money tell them to go stuff themselves.


Well what if this person was unemployed or unable to work? I think that maybe having health care depend on your employer is a bad idea.


Then it would suck to be them.

The healthcare system in the USA has many problems, but this thread isn't about that.


per obamacare, small business health insurance is not medically underwritten


(1) Buy COBRA. Do it now. You have 60 days from when you left your old job. Fill out the COBRA form, either your old carrier or old employer should have sent it to the last address you had on file. If you haven't received it or lost it, call your old HR person & ask to discuss in person.

(2) When you start at your new job, they will submit forms for you to be covered. Those forms will take 30-45 days to process, because carriers do all this stuff by hand. It will be retroactive to the day you start. Most doctors are cool with waiting, but it's a risk.

(3) Some small percentage of the time, this will get goofed up by the outsourced data entry people carriers use, or the insurance broker your startup uses, and you won't get covered. You would find this out when you go to the doctor's office.

(4) Because of (2) and (3), you should sign up for COBRA from your old employer, so you can start using it now (it is retroactive to your end date at your old job). As soon as you are confirmed to be enrolled on your new company's plan, you can, if you want, drop the old COBRA.

(5) From the financial perspective of your employers, startups buy insurance from carriers on the "small group" market. Rates are determined by your employees' age, gender, smoking status, zipcode, etc, not past medical history. In other words, you will NOT raise everyone else's premiums.

(6) I'm an engineer at Zenefits, so I hear about & deal with this stuff day-in, day-out. If by chance your new employer uses us for health benefits (quite likely in the startup space) please ping me (email in profile) and I will personally make sure everything works out on your insurance enrollment. If you're not sure, ping me and I can check.

All the best.


(7) Thank Obama and vote for Democrats. They are the sole reason small group health insurance isn't medically underwritten and you aren't a financial disaster for your employer. Plus, in case anything happens with the new job, you can always get obamacare, even mid year because of a change in job status, with guaranteed issue, and it may well be much cheaper than cobra.

Best of luck with treatment.

ps -- my father went through this. Be pushy with your doctor if you need. They're not exactly lazy, but your outcome is more important to you than it is to them. They should be able to describe in detail the experience of treatment, but they may not do so unless forced. ie what drugs, what radiation, for how long, how will it make you feel, what are reasonable activity levels, etc.


> Plus, in case anything happens with the new job, you can always get obamacare, even mid year because of a change in job status,

This happened to me and I got into obamacare mid year. It was pretty awesome.


Can you explain what you mean by "got into obamacare?"


7) As an aside, it will be difficult to enroll on your fiance's health insurance. You are not dependents of each other & not married.

If you guys did tie the knot, you would have two qualifying events (marriage & you losing your coverage from old job), either of which on its own would let you sign up for coverage under her plan.


7 is not necessarily true in CA. You generally will be able to get your opposite-sex unmarried partner on your health insurance. You will have to prove pseudo-domestic partnership status. Typical proof would be joint leases, joint car ownership or loans, joint bank accounts, having each other as life insurance beneficiaries and next of kin, etc.

If your fiance's health insurance is better, or if you are worried about what happens if you aren't able to work for a period of time, it may be worth asking.

ps -- this is from experience on Anthem and blue cross/blue shield


This is true in most states, have done this in both Virginia and California. I was surprised at how easy it was, just a matter of sending in some information. The things I had to supply in both cases were:

1. Proof that we'd been living together for 1 year

2. Proof that we owned joint property (in our case a car)


I got diagnosed with a lymphoma (Hodgkin's) in my early thirties. Otherwise healthy also. With your age and lumps in the armpit, it sounds like lymphoma. Luckily, lymphoma treatment has a pretty good success rate. A few things I would recommend.

Get a biopsy. Getting cut open sucks, but until they take a tissue sample, they really can only guess. Get it as soon as possible.

If you decide to take 'normal' western treatments (chemo/radiation), before you start, bank sperm or eggs, depending on your sex. I had a difficult time beating mine, and the chemos I eventually took left me sterile.

If you are an American, get in contact with the American Cancer Society. I can't say enough good things about this organization. They should be able to help with financial options for you, as well as alternative therapies and medical trials. If you qualify for some of the trials, the cost may be reduced.

If you decide to go with chemo, it affects different people differently. I personally had 5 different types, with effects ranging from nauseous for a couple of days to unable to move. You may be able to work through it, you may not. But your co-employees will generally have nothing but empathy for you.

Don't delay treatments. The success rate only goes down with time.


> If you decide to take 'normal' western treatments (chemo/radiation), before you start, bank sperm or eggs, depending on your sex. I had a difficult time beating mine, and the chemos I eventually took left me sterile.

I'd file this under good advice OP, regardless of where your head is at right now.


> If you decide to take 'normal' western treatments (chemo/radiation)

> Don't delay treatments. The success rate only goes down with time.

No kidding!

> Steve Jobs died regretting that he had spent so long attempting to treat his cancer with alternative medicine before agreeing to undergo surgery, his biographer has disclosed.


I am just recovering from cancer myself so a few thoughts from having just gone through something similar.

1. Get all your information first. Just because it's been deemed cancerous doesn't clarify what's ahead. It could range from intensive treatment, down to rather localized surgery. Talk to your specialists about the specifics and you'll know what you're in for.

2. Cover yourself foremost. I understand the altruistic desire to not affect those around you but you do need to take care of yourself. Ultimately that has to be your top priority. That said don't assume you would just be a burden on a team. Once you get all your details you may find you could still contribute during treatment.

3. Don't panic, that will only stress you and make things worse. We still call cancer "The big C" but in reality the outlook varies widely and many are completely treatable. Once you have all your information lined up you'll feel better.

My email address is in my profile if there is any way I can help further or if you just want to talk. All my best.

Edit: In retrospect these should be 3, 1, 2 in order of priority.


These sound right to me. I had cancer my senior year of college; not the same at all but also in a position of trying to hold all my classes together, not let potential employers find out, etc. Four months of treatment and I was done; I sincerely hope you're as lucky.

Whether you are or not, though, it's true don't panic and cover your ass are critical. Fortunately we live in an era of obamacare, though, as well as regs about covering prexisting conditions. A hitch in what the top commenter said is that you may not in fact be able to keep your job through treatment. I had three week rotations, where the first five days of each rotation (sat - weds) were sitting in the hospital all day hooked up to an IV, and it's not a reasonable work environment.

Obviously gather all the information, but I'd say get ready to get the cobra if you can't hold it down at work with whatever scheduling arrangements the hospital can make, and if that runs out on you you'll still be able to pay for something that will cover you.


Almost all cancer diagnoses protect you under the ADA and you are entitled to reasonable accommodations. What is reasonable or feasible can vary widely, but reasonable employers should attempt to work around such diagnoses. If you were to be fired or retaliated against, consult an employment lawyer.


Note that the responses here are universally in favor of you getting covered and getting treatment.

I have a second recommendation that comes with some unjustified stigma: seek counseling.

Any healthy person can/will feel depression or even guilt about this diagnosis. You might be able to manage those emotions, but they might also sneak up on you when you're not expecting it. And these strong (and natural) responses can help you focus your priorities, but they're not a great asset to help you navigate all of these major decisions that impact you and your loved ones.

Imagine you're about to take a massive exam, but just went through some major emotional trauma (a divorce, the loss of a parent). You are given the option of having a TA check your math as you take the exam, pointing out where you should go over your reasoning or proofs one more time. You're smart, studied, and maybe you'll be fine. Even so, why would you ever say no to that option?

So, look for reliable objective support, not to replace, just to supplement your decisionmaking. (Like you're sort of doing here, and HN can be great, but a professional will be there next week too...)


The fact that this thread exists makes me want to move back to Europe.

It's really hard, for someone who grew up with state-provided healthcare, to understand how dealing with an illness involves decisions about employment.

To the OP: the system is deeply unfair, and you shouldn't feel bad for obtaining what in the rest of the civilized world is an unalienable right.


I expect that there are people reading this thread for whom it is the last straw that makes them move back to Europe or Canada. And there are some Americans for whom this thread convinces them to emigrate for good.

The Internet is making the world a much smaller place where people know what life is like in other places. Over time, this forces everyone to raise their game. The old ideas of independent nation states are fading and being replaced by the global village in which we are all family.


As an Australian living in Canada, it shocks me that a thread like this even exists.

That someone has to consider money when they get diagnosed with a life-altering condition is saddening.


American in Norway here. I have been struggling with immigrant life the last year or so and recently started thinking seriously about moving home.

The existence of this thread reminds me that I absolutely should just suck it up do what it takes to stay.


Things have improved drastically in the past couple years. Small business insurance rates no longer depend on employee health costs, pre-existing conditions aren't a problem anymore, if you're not covered under an employer you can get a plan through the exchange, and if your income is low the premiums will be subsidized. It's basically moved in the direction of the French and German systems, except with for-profit insurance and without price controls on medical services.


Doctors in the Netherlands WILL NOT treat you unless you come in kicking and screaming whereas in the capital of Poland you will die in the waiting room waiting 12 hours to be seen by the ONE ER doctor on staff. You WILL DIE waiting for an ambulance because there are so few available and the onboard crew doesn't have any real sense of urgency. There are not even enough seats in the emergency hall for incoming patients so I had an IV drip while sitting on the floor next to the OR where a guy died inside while I was there. I ended up paying 80 dollars for the whole ordeal including a chest X-ray and I have no insurance over there. So yes it was cheap as hell but the treatment is extremely ghetto.

Free healthcare SEEMS good on paper. It is GARBAGE in reality. For example most sensible people in Poland pay an annual retainer fee for a private doctor network just for the PRIVILEGE of being able to see a doctor in that network if they need to. I am utterly terrified of going back to any hospital in Poland. God help the poor souls in all of the poorer countries. Those guys will make sure your heart keeps beating and lungs inflating but that's about it.

Stay in America and pay the price or go to Europe and die.


Comparing health care in the US (per capita gdp: $53k or so) to Poland (per capita gdp: $13k maybe?) is a dumb exercise. Healthcare in west europe is excellent -- often much better than the united states measured on outcomes. It is notably much cheaper too.

See a million links on the internet, or start here:

https://www.iom.edu/~/media/Files/Report%20Files/2013/US-Hea...


Dutch healthcare is definitely not free. In fact, I believe it's the most expensive in Europe, costing more than half of what US healthcare costs. And that's probably because much of it is privatized or semi-privatized.

There has been a problem with excessive waiting lists in the past, but ERs and general doctors have always been totally accessible.

Of course there are always budget issues, but at least they don't drive anyone into bankruptcy here.

> Stay in America and pay the price or go to Europe and die.

Despite their high cost of healthcare, life expectancy in the US is actually lower than in western Europe.


> The fact that this thread exists makes me want to move back to Europe.

I'm sorry to break it to you, but TTIP wants to export the "American" healthcare model to Europe. So maybe when you come back things are not to so great.


The draft text includes this section to avoid that:

"The EU reserves the right to adopt or maintain any measure with regard to the provision of all health services which receive public funding or State support in any form"

http://www.bbc.co.uk/news/uk-scotland-scotland-politics-3163...


Whose health care system has contributed most to research and development of increasingly successful diagnostic tests and treatments for cancer?


I don't know. Who? It's really hard to tell.

I think pharmaceutical companies produce a lot of them, but I wouldn't consider them a "health care system" as they are typically public companies, nor would I consider their IP to be a "contribution".

The large pharma companies are often in the US and Switzerland, but much of their revenues are not cancer related so it is hard to work out which one is doing the most.


But that should infuriate you!

America pays more per capita for their health system, and yet here's this guy struggling to know if he's going to be treated or not.

Cancer is a disease of mostly older people. They get treatment via medicaid / medicare. That "socialised" health care distorts US spending to the diseases of old age. It's certainly not US insurance that pays for that cancer research.


I don't know. You seem to know, so please provide evidence.


Six and a half years ago, my wife was diagnosed with cancer. I'm fairly level-headed, and there was initially all the project management of tests and doctors' visits and insurance company stuff and test results to deal with, which kept the feelings of "poor her", "poor us" at bay. And then I remembered that her son (first marriage) had successfully dealt with HIV, other friends with cancers of various sorts, and so forth.

Now cancer is serious, and you're still going through the diagnosis and test roller coaster (and it sucks), but there are lots of different ways that this can come out, and I'd agree the signs, so far, are ok to good.

You're not an albatross. This is what insurance is for, precisely. And you're not just a co-worker, you're a friend, a human being, and you'll give your friends and colleagues a chance to express their care and concern, to help.

Live a day at a time, take the diagnosis seriously, use all the skills you have to understand what you're dealing with, and hang in there.

And it still sucks, and I'm so sorry.

PS. After a nasty but standard protocol of chemo (including a drug called -- I kid you not - 4FU, because 2FU just wouldn't do) and radiation, she came out on the other side, and we've been swing dancing, and skiing, and loving, and all that jazz, so nowadays people get lucky a lot.


This is one of those times where you are literally allowed, even encouraged, to think of only yourself.

You have cancer. You can't avoid that. It sucks. It's one of the worst hands to be dealt. Get treatment. Get the best damn treatment. If you don't already do so, start taking care of your body 100%. If you do, bump it to 110%.

Cancer is not easy. It is a vicious plague that wants nothing less than to overtake your body for its own growth. It's ugly.

But you can beat it.

Take the time and effort you need to fight this, and use what you have left doing what you love to do, which if you're anything like me, it's the work that you'll be starting very soon.

It'll be exhausting. When you get into chemo, and maybe into marrow transplants and stem cell procedures, you won't often have much energy--both physically and mentally--to contribute, so do it now.

Sorry if this is blunt, but I don't want to give off the impression that everything is going to be fine and everything is going to be normal. Shit is going to hit the fan.

But you can do this.

You're fucking dammit_lump; you can do this.


I've been on the opposite side of the fence; I was a founder of a (~20 person at the time) startup when one of the engineers told me they had cancer.

We did everything we could to help him. He didn't want to just sit at home and feel sick, so with a few modifications to his normal schedule/workload he could be productive.

It didn't really have any negative impact on the company, and years later even I definitely don't regret that he joined and don't feel that he "burdened" us with his problem.

I would think that most startups would feel this way. So 1) don't quit 2) get them to help you and 3) stay positive :-)


Update: thanks for all the encouragement. Looks like this was caught early so I am fairly optimistic about the outlook, just wish it didn't need to affect others around me as I face it.

I should note that I haven't actually signed up for insurance at my new employer yet, as that's typically done after the first day. And my old employers' coverage ends on the 31st. I'm going to check out Cobra to tide me over. Does anyone have an opinion on the prospect of sticking with Cobra and perhaps asking my new employer to help out with the premium versus being on their health insurance? If I did need to eventually transfer to their insurance I think new Healthcare Laws would mean I couldn't be denied coverage due to pre-existing condition. I'll do some digging.

And btw fiancé has been helping from the beginning and we are dealing with this together -- she's a keeper.


No, do not do the COBRA thing. Opt in to your employer's group coverage. COBRA expires. You are not responsible for optimizing your employer's health insurance premiums and will probably have far less of an impact on them than you're worrying about.


Don't listen to this. Don't let yourself have any gap in coverage and if the new plan isn't as generous with the coverage then it may pay to cover the COBRA premiums and use your old insurance as the primary.

There will be a gap between quitting and getting the paperwork and mailing in your premium. They will reactivate your old insurance retroactive but that's something to be aware of.


Don't have a coverage gap and don't use COBRA instead of your employer's group coverage.


Don't get on COBRA with a plan to stay on it, I think you're saying, and I agree.

If your new employer doesn't offer health care, go buy some: switching jobs is a "qualifying life event" and lets you buy outside the yearly sign-up window.

If they do offer health care, then you're set. Wait for that. This one-week gap isn't going to mean anything or change anything.


Yeah, I could have been clearer about this. At 18 employees, his new employer surely offers group coverage (if they didn't, he shouldn't work there regardless of whether he's dealing with an illness). And of course, if temporary COBRA coverage is the only way to ensure he has no coverage gap, he should make use of COBRA as well.

Just don't do COBRA as an alternative to the employer's group plan.


It's easy to misread tptacek's comment, I'm pretty sure he's saying "get COBRA as needed to cover a gap, but don't stay on COBRA instead of your new employer's policy."

Staying on COBRA would likely suck, even if your new employer kicked in something to cover it. COBRA can be remarkably expensive, and anything extra the new company paid you would also be taxable income in ways that employer subsidized plans wouldn't along with being awkward if you later signed up ("Lump, we're cutting your pay since you're getting onto our insurance now.").

I'll note that once the ACA plans became available, coverage for my wife and I (on a pretty good Gold plan with no subsidy) was somewhere around 60% of the cost of COBRA for the two of us from her previous job - and the ACA plan wasn't an HMO or anything like that, it was a standard PPO with a decent network.

Delaying a change to the new employer's plan would likely not fly - much like the exchanges, you have two times you're eligible to sign up: during the open enrollment period, and after qualifying events such as a change of employment or marriage. If you bypass the new employer's plan, you're stuck until (most likely) January, 2016 after an open enrollment period in November/December.


Live.

Breathe.

Your chances of living happily for a long life are very high. In doing so, you are a valuable person with immensely insightful lived experience.

What decision makes the most sense for someone living to 89?

Make that one.


Be sure you don't let your insurance lapse. Go on COBRA if you have to until your new policy is in force. If you let coverage lapse more than about 30 days you are more likely be hit with a pre-existing condition exclusion.

You say fiance; if you are not actually married her plan may not cover you? Unless they cover "domestic partners" not actually married (some will, some won't).

Anyway, manage the insurance situation. This sort of thing (unexpected, and potentially costly) is EXACTLY what insurance is for. Much more so than birth control or annual checkups which are entirely predictable expenses. Don't feel guilty about using it for what it's meant for.

Take the job, it will keep your mind busy on something besides your health. You're not contagious; you are not endangering anyone by going to work.


First, I wish all the best of luck to the OP. It's such a scary thing to go through, but it's something you will get through, like many others said, the outcomes nowadays are so much better than even 10 years ago.

As for the insurance, could someone explain this to me. I thought that with ACA (Obama Care) the pre existing condition was not enforceable anymore an you could get a private insurance based on your age, income, etc, not medical history. Am I wrong about that? If that's not the case, than what's the point of all this ACA nonsense to begin with. I thought that forcing me and other people to buy insurance was exactly so someone like the OP wouldn't be left out in the cold when they really need the help. Am I missing something.

Also, if pre existing conditions do not matter any more, how can the insurance company raise the premiums for the company the OP would be working for. It doesn't make much sense to me. In any case, take care of your self first and foremost.


"Health insurance companies can't refuse to cover you or charge you more just because you have a pre-existing condition. They also can’t charge women more than men.

Being sick won't keep you from getting coverage

Your insurance company can't turn you down or charge you more because of your pre-existing health or medical condition like asthma, back pain, diabetes, or cancer. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.

This is true even if you’ve been turned down or refused coverage due to a pre-existing condition in the past.

Medicaid and the Children's Health Insurance Program (CHIP) also can't refuse to cover you or charge you more because of your pre-existing condition.

When you get care for a pre-existing condition, you’ll still need to pay any deductibles, copayments, and coinsurance your plan requires. It doesn’t matter whether you’re being treated for a pre-existing or new health condition.

One exception: Grandfathered plans

The only exception to the pre-existing coverage rule is for grandfathered individual health insurance plans -- the kind you buy yourself, not through an employer. They don’t have to cover pre-existing conditions.

If you have one of these plans you can switch to a Marketplace plan that covers pre-existing conditions.

You can do this during open enrollment, but be sure to contact your insurance company first to learn about how and when you can cancel your current plan. You can also buy a Marketplace plan outside open enrollment when your grandfathered plan year ends. Your plan ending gives you a Special Enrollment Period to enroll in different coverage."

From https://www.healthcare.gov/health-care-law-protections/pre-e...


Eh yeah I forgot about that change. I would still think you would want to avoid coverage gaps, unless the law definitely mandates retroactive coverage. As to how the insurance companies are allowed to calculate premiums, I guess under the new law I have no idea. I don't see how they couldn't be allowed to consider claims experience at some level, but maybe they can't do it per employer anymore. But at the end of the day they still have to make a profit otherwise why bother?


> I would still think you would want to avoid coverage gaps, unless the law definitely mandates retroactive coverage.

You do, but not for the reason you think. If you have a coverage gap of more than three months you'll see a fine added to your income tax at the end of the year, which for most people on HN would be 1% of household income above the filing threshold[1]

[1]: http://www.irs.gov/Affordable-Care-Act/Individuals-and-Famil...


Pre existing conditions is not a thing anymore. Thanks a lot Obama.


That's actually not entirely true, unfortunately.

Ask me how I know.


How do you know?


Great question!

If you get shafted by your employer during maternity and they pull coverage early, and give you misinformation re: COBRA timing, and it's not an open enrollment window with the state exchange, even if you can convince the state exchange to let you in before the next open enrollment period, the soonest they might do that is at the end of the month.

And if you have any ongoing treatment issues, the temporary/indemnity insurance you'll have to buy won't cover any preexisting conditions.

TL;DR–if you get left in a lurch, you're still stuck on temporary insurance which won't cover preexisting conditions.


The chairman of the company I consult with has been managing a major engineering project and last week headed off for a cruise and train vacation in Alaska, all in between radiation treatments for colon cancer. He's 59 and determined to beat it and not let it slow him down.

Take the job and follow the treatment regime.

You will beat it, too.


Don't do anything rash. Be prudent sure, e.g. move assets around before a big surgery. But don't retire early, don't upset your daily existence any more than you have to.

Collect as much clinical data as you can. My oncologists encourage me to troll the internet, and give me URLs to check out. Be data-driven. Don't sweat the unpleasant possibilities so much, and deal with what is.

You may have more than one oncologist: I've got a surgeon, a radiation oncologist, and a GI oncologist. Keep them all informed of what the other is doing; you shouldn't count on them to touch base with each other regularly.

I went totally open-book with my friends and family and employer. Anything they want to know, I deliver in clinical detail. Some folks don't want to know and that's okay. I've gotten tremendous support from everybody.

Keep a positive attitude. That's key. Better for you and better for your loved ones. Tell jokes. Co-worker: "How are you doing?" Me: "I'm glad to be at work! You can't wipe this smile off my face. How weird is that?"


Well, other people have said it all... but I think I should emphasize their words.

What were/are your symptoms?

I had Hodgkin's lymphoma some years ago, and I can tell you this: Don't panic. Not all cancers are the same, and the earlier the discovery and treatment, the better. I suggest to read as much as possible about your specific illness. There are lots of resources online, and many support/help forums. Also, seriously, don't blame yourself because it is not your fault, you don't control it. And finally: you should care about yourself first, forget money or other people's little problems.

Keeping yourself active is the best thing you could do. You have to care a bit, though, and try not to get sick. You probably won't be able to work for a few days after chemo (this depends on the treatment, though), and it may affect you in many different ways.

I don't know much about insurance and related things in the US.

Just ignore "alternative" medicine, it's just a waste of time and money.

Make sure to eat well, but also make sure that the food won't affect you.

My best wishes to you. Hope this helps.


I was diagnosed with cancer at 25, and underwent multiple rounds of chemotherapy and was out of work for some months. I was working at a small software company ~25 people. Outside of the advice that has already been given, I was very glad everyone around me so understanding and willing to help. When I say willing to help, I mean people can really rally together. I took paid my vacation and short term disability, and my employer continued to cover my insurance and hold a position open for me without ever asking when I was coming back. They never gave up on me, and I wouldn't expect any less of your employer. Once you have a diagnosis, the doctors and nurses can really help point you in some good directions if you need any financial or insurance assistance. Also, don't be afraid to ask questions. Write down questions and answers, write down prescriptions, doctors orders, ect. Don't be afraid to lean on those that care about you and ask if you need help (not financially, but with tasks, errands, or just to hang out).


It's difficult to imagine the shock and stress your must be carrying on you shoulders at the moment.

- Keep doing whatever you are doing, normally. Nothing changes in the routine.

- Change only things that will affect your mental and physical health positively. Seek professional counseling and familial moral support.

- Will to live. I cannot stress how important this one is. One of my acquaintances, given 15 - 30 days by doctors in his early 40s, survived 25 years, married off his children, retired from government job at 58, and lived peaceful later years. I personally think his will to live was the primary factor.

- Solitude has healing properties, but don't isolate yourself generally. Try to stay in the company of people who make you happy and calm and stay away from people who constantly keep talking about your predicament in a way that will bring your mood down.

- Start treatment, as soon as possible.

My prayers with you!


First off, wait for final results. I know more than one person (including my wife) that had a scare like this and it turned out to be benign. It really doesn't have to be cancer.

Second, if you do get bad news, don't change anything. Be honest with your employer, and go on with your life. At your age, chances are you'll be able to continue working through the treatment and long after that. It's unlikely that your company's premiums will go up, but that shouldn't concern you.

Third, if you do get bad news, ask the doctor for a professional to talk to. At your age, you need some guidance and perspective from someone you trust.


Do not worry about your job or feel guilty for being ill. Recovering will help your company. Find an Oncologist that has treated this specific type of cancer 100s of times if not 1000s. THIS is key to getting a good outcome. Like engineers doctors are not interchangeable. Their level of experience makes a hugh difference. See https://medium.com/backchannel/should-surgeons-keep-score-8b... This is true for things other than surgery. Good luck


You should absolutely, completely, without hesitation do what it takes to get insurance.

I don't know if a company's insurance premiums actually rise if an employee gets sick. Even if they do, that's not your problem.


Do everything you can to stay alive. Make sure you keep your coverage. Get cobra coverage until your new plan takes affect.

Take your new job and work until your dr advises otherwise.

Being alive > personal finances > startup finances

Contemplate the differences between time and money, time has a fixed and unknowable amount which is constantly ticking away, money is virtually infinite and you can always get more of it, and you can live on very little of it.

Paul Allen didn't kill MSFT and when your read his story MSFT sounds like the morally bankrupt entity and not Paul Allen.


First, use your first instinct: SURVIVAL. Do what you must to get the best insurance you can -- if that's cobra, do that (it's more expensive than a regular ppo/hmo plan as a regular employee, but also usually better). Also, doesn't Obamacare now allow you to be under your parent's plan up to 26yo? If you're getting married soon, then get on your spouses plan if it can cover your treatments -- don't be concerned with raising premiums for the startup... this is what insurance is for.

Figure this out pronto. This is your top priority! Have someone help you!!

My wife was diagnosed with metastatic breast cancer back in 2006. I worked for Oracle at the time via the acquisition of PeopleSoft. I never wanted to stay at Oracle, but I ended up staying for 6+ years just so I can stay on Oracle's United Healthcare PPO which was the best. It covered almost everything including getting multiple opinions to crazy expensive clinical trials. I finally left Oracle in 2011 and moved over to Atlassian only once I knew for sure that switching insurance plans would not affect my wife's care, but even then, I still bought Cobra for the first month into my new job just in case.

I know it sounds unheard of for many people here on HN to stay at a job you don't like just so you can keep you and your loved ones healthy and alive, but when it comes down to it, surviving is top priority.


Well I can't help you on what's financially the best choice (I'm not in the US). But I might be able to give some suggestions on how to live based on my experience.

First off, don't care about other people. There is no reason to think about what effect it might have on your employer, or who gets screwed when you make certain decisions. If you end up dieing because your treatment sucks, you won't need to feel sorry. You really need to be selfish, the stakes are too high not to be.

That aside, what you said sounds very similar to what I had. When I was 15 I also discovered lump under my armpit, ended up being Hodgkin lymphoma. If that is what you end up having, you should be extremely thankful. First of all because if you need to get a cancer, that is the one you want (at least that's what they told me). But also, in this endeavor, you are probably the lucky one. At least in my case, the worst part was seeing what it did to my mother and brother. I knew exactly how good/bad I felt but they could only guess at it.

As to what to do, well this varies significantly from person to person. Some people I met in the hospital wanted to learn everything about the disease, why it occurred, what they could have done to prevent it, how they could of discovered it sooner, ... Other people socialized a lot in the hospital and talked to each other about chemo side affects, ... For me this all seemed like a waste of time since in 8 months or so I would be a "normal" person again. I tried to keep my life as close to normal as I could. I got to the hospital and left as fast as I could, continued to go to as many classes as possible, kept doing the same hobbies, meeting friends, ... So I would suggest, just do whatever makes you happy =).

Anyway, hope this is somewhat useful. Good luck!


I've also been to the doctor earlier this week for the same reason, a lump appeared in my axilla but fortunately the diagnosis was an odd tear in the top of the latissimus dorsi muscle. A family member (nurse) indicated me that it could be dangerous (a swollen lymph) so I needed to be checked ASAP.

I'm extremely sorry to hear that you haven't had the same luck dammit_lump. But I'm sure you're going to get out of this situation stronger and with a renewed illusion for life. I'm sorry I can't help you with your questions cos I'm european and I don't know much about your healthcare system there.

Things like this makes me wonder why we (engineers) are not building or taking more jobs at eHealth startups to help defeat these diseases.

During this week StackOverflow has been showing me this ad [0]. A company trying to disrupt cancer research unifying under the same platform all the cancer research centers worldwide and (apparently) plugin in bigdata analysis. I've been lurking their site and the founder is a MD who also studied CompSci on the side (online) while doing cancer research! I have enormous respect for this people.

I'd encourage anyone who knows Java/BigData seeking a remote position to check them out [1]. I'm sure in the coming years Cancer will be controlled the same way AIDS has been turned into a chronic disease and is starting to be completely wiped out from patients. But first we need to help doctors to build tools and better understand the disease.

I wish you the best dammit_lump! stay strong

[0] http://i.imgur.com/F1IxsCf.png

[1] http://www.medbravo.org/


My brother has survived having B Cell Non-Hodgkin's Lymphoma twice throughout his mid teens and early 20s. The kind he had was pretty rare/aggressive as well. He's going on 30 this year and has been clean since. The diagnosis probably hit you and your family like a ton of bricks, but your chances of getting through it are likely good and I know treatments have improved quite a bit in the past 10 years.

If you do happen to have one of the aggressive forms, start treatment ASAP after having proper consultation. I know my brother started the day after he was diagnosed, but his was aggressive and already advanced. If yours is not, it may not need to be so rushed, but I'm not a doctor, so don't take anything I say as proper medical advice please.

If there's anything I can answer about the experience my family went through with my brother, just drop me an email (can be found at my github account linked in my hn profile).


Sorry you've gotten cancer. Cancer sucks.

Get it treated aggressively using science and medicine. A great many cancers can have good outcomes. Worry about yourself first and foremost.

But start the job. You may be surprised at how little time good treatment will take. If your employer is set up correctly, you'll have good insurance, good vacation policy you can use and long-term disability in case you need to be away for an extended period while you take care of yourself -- don't worry about their premiums or any of that other stuff tptacek has it right, it won't be a huge problem for them.

Also, being sick sucks, having some place to go where you are needed and having things to take your mind off of being sick can help. But remember, and this is hard to do with startups, put yourself and your health first, then the company second. Nobody can reasonably blame you for that.

Now go kick cancer in the ass!


Really sorry to hear that this is happening to you.

First of all, it's good you found it now rather than, say, months from now.

Second and most importantly, focus on taking care of your health first. I once knew someone who had something similar to what you're experiencing. It was lymphoma and he was just about to begin what was a very competitive program.

He was fortunate enough to be able to defer it.

Your health comes first, no matter what. So look hard at all your options (eg. parents, friends, etc) before killing yourself to deliver on someone else's bottom line.

Life's way too short.

In terms of insurance coverage, the only thing that matters is make sure you have coverage. Don't go cancelling or changing coverage at this point -- especially to the benefit of the employer. Now that you have a known/likely diagnosis, no insurance will want to touch you.


If I were in your position I would:

1) Calm down.

2) Gather information. More specifically, if you know a doctor, contact said doctor. If you can't, find a way to meet with a physician as soon as possible and get a second opinion. Get someone to explain to you what this diagnosis means. Explore fully your plan, Cobra, etc.

3) Tell fiancee, family, etc (not in an alarming way). Or not. That is, decide whether you want those closest to you to know. This is very personal and we can't choose for you.

4) Save money

Above all don't panic. The most important step is getting informed on what is happening and what your alternatives are and what options you have.

Perhaps right now you don't see this, but like others have said, you can beat this. Now is the time to act swiftly and gather information. Don't waste time. See a doctor ASAP.


I'm sorry to hear that. As others have noted, find out all the details asap before you start making decisions.

On the COBRA side of things, you have 60 days at minimum: http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html and it must last at least 18 months and can go as long as 36 depending on how they have it set up.

Also, I hope you have people around you to get support and talk with. I've never dealt with cancer personally but I have to belief your mind is racing and you're flooded with some mix of panic, fear, and more panic than I can imagine. This is not the time to keep close friends and family in the dark.


Just came here to say very sorry to hear this news, that really sucks. I will pray for you tonight. There have been a few cancer threads on here in the past, hopefully some people who overcame it can chime in with some infinite wisdom (srsly no pun intended)


>> I feel horrible about joining a young business as an albatross instead of an asset.

Stop that. Did you get cancer on purpose? Then don't act like you foisted it on them on purpose. Don't worry about the company, worry about yourself.


I've been practically bedridden for 9 months with medical problems. I've also been producing code that entire time.

Everyone is right that you should not freak out until you get all the info from the doctors.

But lets assume you are going to be sick for a while. Once you get into that phase, figure out 2 things:

1) When can you be focused and productive? Work at those times.

2) How can you take care of yourself, stay sane, have fun, and not let a disease ruin your emotional stability. This is just as important,if not more so, than the work.

One last thing - this is your life we are talking about. Startups are just jobs. Keep your priorities straight as you make decisions.


Could you clarify that you have had this biopsied? It doesn't sound like you have, particularly on the current timescale you intimated.

That is the only way to know for sure if it's cancerous (I've got first hand experience).

I'm not saying don't worry about it, but 'probably cancerous' doesn't sound like a biopsy report and that is needed first as that's the only way to tell.

Keep a cool head, take the precautions the others are recommending here regarding your medical cover (God bless the USA) and get some confirmation of what the lump is before you move on.


Don't be so noble. This is a good time to be selfish. Once you've recovered you can pay back the world.


Do not worry about your job or feel guilty for being ill. Recovering will help your company. Find an Oncologist that has treated this specific type of cancer 100s of times if not 1000s. THIS is key to getting a good outcome. Like engineers doctors are not interchangeable. Their level of experience makes a hughe difference. See https://medium.com/backchannel/should-surgeons-keep-score-8b...


Go on, live life, take the new job, get a biopsy, and if needed, kick cancer's ass. A lot of the crappy things insurance companies would do in the past regarding pre-existing conditions and cancer are now illegal. Your new co-workers should understand that this came out of the blue, and that you'll be doing what you can to work hard, and to beat cancer. You've caught it soon, so there is a good chance that you'll be able to pull through without any problems. Good luck.


Dont pull a Jobs and go all homeopathic, and follow your doctors advice.... But smoke, eat and otherwise imbibe a shitton of cannabanoids (eg marijuana). Including drinking the juice of the plant (non-psycoqctive). There is.a large lack of scientific studies on cannabanoids due to its schedule 1 status, but the majority of the stuff that is used in government approved programs is actually extracted and then sprayed onto plant matter (eg its not the real deal, some of the 400+ cannabanoid compounds are missing), so be wary of stufies using the missisipi university stuff. (Im a combat vet with ptsd so it helps me in a different way)

Then i would make sure your legal stuff is taken care of, just in case, such as power of attorney and your will. The last time I went to Iraq i included my will and video messages yo my family and friends in a safe deposit box only accesible to my executor.

Then I would start getting all philosophical and reading while doing chemo and hope for the best, and live life a day at a time.

Much love to you through this tough time (talk about understatement eh?)


I had stage 2 Hodgkin's lymphoma when I was 25, did chemo for 4 months (ABVD) and radiotherapy afterward. Healthy ever since (I'm 30 now).

One problem you might be having is dealing with an avalanche of advices, so I'll keep mine short.

Mainstream treatments (chemo+radio) are very effective against lymphoma. From my research the 5yr survival rate is over 80 if not in the 90s, and that's not even the latest stats. I wouldn't replace chemo with other alternative treatment, despite the damage chemo could potentially bring. I did take herbal medicine during treatment, but that's just to alleviate the side effects of chemo, not replacing it.

Everyone is different, but base on my personal experience and people who have gone through similar situations, you should still be able to work and live normally, except on the days you have chemo and possibly a day of two afterward.


Others in this thread have first-hand experience with cancer and have offered better advice than I could try to, and I don't have anything else substantial to contribute. I just want to wish you good luck with your new job if you proceed there, and many years of happiness with your soon-to-be wife!


Best wishes with getting well and surviving.

Think about your parents and your fiancé. Those who are close to you, matters more than [a relatively small amount of money to your future colleagues. Or a large amount.]. How would your parents and fiancé feel if you quit your job and risked your life (by getting less access to good health care?) in order to in effect give money to a company?

You are more important than the company. And your future colleagues, will agree with this, I think. Companies are built to make people happy. Not the other way around.

(I think I a little bit can feel how you feel about joining the company and then later on they will know that you have this illness. And I think that they will think you did the right thing, when you joined. Assuming you don't over work yourself, but take time to rest when you feel you need to.)


First: Go get a second opinion on that lump. It's possible that it's a benign cyst caused by your pores not being able to do their job by being clogged with anti-persperants. If it's a cyst and you switch to deodorant only, it could go away on it's own. I've had this happen before, and it is exactly as you describe. Regardless of what deodorant you use though.. go get a second opinion.

Second: Don't be scared if it is cancerous. If it is, it seems you've found it at such an early stage that a small surgery and some follow ups will ensure you're fine. If you're worried about the insurance affecting the rest of the startup, get insurance on your own (you don't actually have to purchase insurance through work).


I can't really help you with the legal issues as I'm not from the US, but, as others have mentioned bear in mind these days many cancerous lumps can be removed with non-that-intrusive local surgery. So, be positive! If that's the case then the positive is that you've found about it while you're very young and doesn't have expanded!

Moreover, if that's the case and there is a good outcome, then you've been blessed with something that many others like me discover on their late thirties, fourties or fifties. To appreciate life and enjoy every minute of it.

Good luck.


The only change I'd make is to ensure you prioritize your overall health more than you might otherwise, while working at your new job. If that means working efficiently 40-45 hours/week vs. being less-efficient for 50-60 hours/week, shouldn't be a big deal.

I don't think an 18 employee company is self insuring the risk, so it will be a very small impact.

I would probably not do a founding role at a startup while dealing with cancer or other serious medical or family issue, but an 18 person employer isn't a big deal.


The existing top comments (tptacek and calcsam) have already covered the useful practical advice for your situation.

So, I just wanted to say that I really feel for you. Cancer sucks. A stranger across the ocean is tearing up just reading about your situation and wish I could help in some way. So, I am sure there are a lot of real friends and family in your life who care about you and will help you get through this. Don't be afraid to ask them for help when you need it. You aren't alone.


Hey. I'm sorry you've had your world turned upside down in this way. I'll add my prayers to those already mentioned. There seems to be a lot of good advice here about temporal matters. As someone who is going through a similar journey, my advice is, please consider eternal things. If you're interested in a Christian perspective, check out http://digitaltrousers.wordpress.com


IF this turns out to be malignant and requires chemo, avoid stress if at all possible. Also consider going on a high food value diet (tons of veggies) with natural high fiber powders. Exercise.

I'm not saying any of this will help with cancer. Diet and exercise combined with a low stress lifestyle will maximize your bodies ability to recover from the chemo. Also this will help your brain keep optimized so depression won't bring you down which will cause stress.


Hi

That's rough and I'm sorry you have to face it.

1 - Try to think positive, I know it sounds hard but it actually helps a lot.

2 - Keep working as much as you can, it will help you not to think about the negative stuff

3 - If your employer doesn't understand the problem then the job's not worth it.


Join back the medium-large engineering job if you could. Cancer treatments are getting better everyday. But priority one is buying yourself as much head room as possible both in terms of money and time.


Try becoming a raw vegan. Inform your employer and join the company you want to work.

chrisbeatcancer.com/how-a-high-fruit-diet-can-reverse-cancer-the-science-behind-the-nori-protocol/


I think it's analagous to taking a new job and finding you were pregnant. Would you resign in those circumstances?

//edit// And all the best for the future.


The affordable care act should protect you and your company from rate increases due to preexisting conditions. This practice is now illegal.


A question:

Should the OP tell his new employer right now? Or hold off until down the line?

OP: As far as your lump, dammit indeed. Good luck and beat that thing!


Your medical problems are not your employers business. Period the end.


Unless it's something that prohibits you from doing your job (e.g. a paraplegic flight attendant), it's nobody's business but yours.

Think of it this way: that they hire someone else who thinks they're healthy doesn't guarantee they're hiring someone that stays healthy. In fact, they might just think they're healthy because they're less cautious and end up in a much worse spot than you.

Life happens. If the company is not equipped to deal with that, it's not your fault. It's part of running a business.

Besides, most of the problems we're talking about here are related to the shitty American healthcare system, not the business itself.


Sorry for your situation, I have very little advice for you.

What signs/symptoms prompted you to seek further help?


You may want to look into HyperBaric Oxygen Therapy (HBOT), it is what I would do if I had cancer.


Don't stress. You said 'probably' but are not 100% sure, stress alone can cause cancer.

Mediate.


your future colleagues are literally the last thing you need to focus your energy on. don't worry about them. worry about yourself.


I wish you to get well soon. Stay strong.


Hi, I am gladful that I stumbled across this question. I am not going to tell you a sorry.

The essence of my answer first: You can heal yourself. The body follows the mind. First there is reality in your head, and then in the physical world.

Second, read the book by Dr. Joe Dispenza, called "You are the placebo". If you have a bit of patience, read the two earlier books mentioned there ("Evolve your brain" and "Breaking the habit of being yourself").

I have read a lot of books, covering spiritualist topics, healing, taoism, traditional chinese medicine, ritualist magic and psychology as an overall topic. The essence is, that what we call the rules of physics and medicine today are short-sighted and often plain damaging. One example for this is the belief that you can't change certain things.

Denying your own possibilities when they exist is a self-fulfilling prophecy, you cannot disprove it if you don't really believe in it. Doctors telling you that you have a serious illness (or just in the risk of becoming ill) are doing serious damage to you if you believe them, because your mind is making it real.

Illnesses are an expression of something going wrong, which means you have to fix it by changing how you live, what you do, and essentially, who you are. I have had some minor illnesses such as cavities and hay fever, both of which I fixed using meditation and visualization.

The books I mentioned show a practical way for us people today who essentially believe science to be "true". It builds upon that belief, and I can really recommend it if you don't have time wrapping your mind around ancient chinese belief systems.

The reason I was not going to tell you a sorry is that I don't feel sorry for you, I feel hope and I feel gratitude - there is a reality (which implies it is real and exists right now) in which you are 100% healthy, and giving your experiences of becoming healthy out to the rest of the world. It is possible, and it is your choice. I am not wishing you luck, because luck is not what you'll need. I wish you will be able to grow yourself from being a victim, to having your live in your own hands. I wish you'll be able to take action, and make decisions, and for the entire time, enjoy your process wherever it leads you.

One last word, you will be free of injuries or problems if you find yourself being free of them, it is the moment when it makes "click" in your brain, and that is the moment when reality changes. For me it was the moment when I discovered that I had no cavities, and that they are healing, and that my doctor was wrong. And in the same moment, my doctor became wrong because reality had changed. That is how it works.


I just finished treatment for tonsil cancer in November. Don't be afraid. You're not alone. There's more support for you than you realize and you're stronger than you can imagine. Everyone you've met has been touched by cancer somehow. Everyone.

I was afraid, but not alone. Family and friends showed up strong in every way. You'll find that people are really caring and compassionate if you let them be. Ask for help.

Your employer wants you to get better and they want to help you. I'm a freelancer with hourly clients so it was especially hard on my finances. I turned to credit cards, savings, and family to help out. Ultimately, I tried to handle as much as I could, as long as I could. Depending on the type of treatment, you can still work. My clients understood and stuck with me when I had to take a break.

I did work up until the really bad parts of treatment. Throat cancer is a very hard course of treatment as you have radiation daily plus weekly chemo. I was very nauseous and tired, but mentally I was ok for a good while. There are pain meds you can take that don't mess with your head very much. Take them if they prescribe them.

Get the best coverage you can. Fight your insurance company if you have to. Don't back down. The last thing they want is a cancer patient getting denied care. I had to fight the insurance company for all the tests up to and including the needle biopsy. After they found it was cancer, the insurance company rolled over and paid for everything without argument. I hit my out of pocket maximum within the first round of treatment.

The other patients you will meet can be a great resource. If you go through chemo, it will most likely be a big room with lots of chairs so you can talk to the other patients. Ask about tips and tricks. There's lots of good info on how to combat the side effects.

Confirm any supplements/vitamins with your doctor as some chemicals can hinder the chemo meds. Buy Ensure Plus. It's hard to feel like eating & that's a good way to get calories. Make sure you get enough calories. You need energy to fight.

Don't believe people that tell you X cures cancer. They don't fucking have cancer. Go with what the medical community can validate with science. All those treatments have all been debunked thoroughly and there is no conspiracy against vitamin C. Doctors want you to get better. Survival rates have doubled in the last 10 years.

Chemo is not worse than cancer. That's ancient history. Nowadays the anti-nausea/pain/steroid meds are amazing. It's not like the old days where you vomit constantly for a year. I'm not saying it's easy, but it's better than it was even 5 years ago.

Take it serious. Don't give in to fear or negativity. Ask your Doctor to shoot straight and not sugar coat the facts. Don't think about the future. Stay in today. Don't lay in bed all day. If all you can do get is up just sit outside. Let your friends/family see you sick. You don't need to be alone.

Choose life. I mean it. Make that choice every day.

It's hard to explain, but you'll face a choice at some point during this path. Choose life.


I hope this is readable, my english is quite rusty since I don't have to write much.

Get a biopsie (if that didn't happen already, not sure from reading) with preferrably multiple samples. I don't know if you have that where you live, but where I live one sample is examined in the hospital and one to three samples are examined by external reference laboratories. The people in the hospital are good, but the people in the reference laboratories (my oncologist called them cancer nerds) are better since they often specialize on specific cancer groups and do noting else but examine cancer samples.

This way you get the best result, and if it turns out to be really cancer you can get the best treatment (definetly get a second opinion). If it turns out to be Lymphoma (non hodgkin to be precise, but hodgkin would be more likely) get your vitamin d levels checked if your doc doesn't check them on his own.

In case you get chemo newest studies show that vitamin d could be helpful [1]. Last year when I got my treatment the study was not finished but I asked my oncologist about it anyway. We checked and found out that I had only 4.4 µg/l of vitamin d3. It should be >30 µg/l, but if you live in northern areas it's likely to be between 20-30 µg/l if you're healty. Two years before my cancer was discovered I had my last vitamin d check and then it was >30 µg/l.

Also ask your oncologist about the rituximab level you will receive, newest studies show that young men and woman need a higher dosis than whats standard [2][3][4][5]

Speak to your doc about optimal 60. Some study results were presented at the international ash congress. It uses a liposomal formulation of vincristin and doubles the dosis. First results are realy promising and show even better results than 1.5 times the normal dosis.

Should you be a young high risk patient (young matches definetly) like me ask your doc about R-CHOEP 14. Studies show better results in young patients than the standard which in most countrys is R-CHOP 14 or 21.[6][7][8]

Depending on the chemo and other variables it could be that you should avoid some kinds of food. In that case remember the following sentence: "cook it, boil it, peel it or forget it".

Go for a walk/be active every day if you can, a good cardiovascular system distributes the drugs better and you preserve your muscles.

Avoid sick people and don't be near young kids if your chemo destroys leucocytes which is typical for Lymphoma treatment. In the earlier cycles your immunsystem should be able to handle it, but in later cycles sick people or young kids (they are ill often and depending on the chemo you can get sicknesses again that only kids get) are dangerous. My leucocytes dropped below 0.5 every chemo cylcle even though I had to take G-CSF to push my leucocytes. But discuss everything with your doctor.

Also, think about a port catheter. It has it's own risks but also benefits (it spares your veins) and makes the cancer treatment easier.

It's very likely that you are steril after chemo so bank sperm/eggs depending on your gender.

I'm the same age as you and was diagnosed with non-hodgkin lymphoma stage 4 (with multiple bulk tumors > 10cm and bone marrow involvement) last year after relly bad backpain for a few months. Which I thought came from my chair at work or my mattress since I was in good shape physically and my diet was balanced. But when I got checked for a herniated disk with an MRT they found the unwanted lodgers. After more checkups in the hospital they found them in my pelvis, spinal column, rib, muscles, spleen and lung but luckily not my brain or cerebrospinal fluid.

After getting 8 cycles of R-CHOEP 14 and 2 additional cycles with only Rituximab directly after that I am in complete remission. The PET-CT after my chemo showed that and now 3 months later my first aftercare CT shows that as well.

I wish you luck, and if it really turns out to be cancer, don't panic. Stay calm, think about your next steps (but I probably don't have to tell you that, since you showed that by asking here on ycombinator instead of putting your head in the sand like some people do) and do your research ,especially about newest studies, if you know your cancer type. My oncologist was very knowledgeable (lymphona is her speciality and she reasearches and publishes about it herself since 20 or so years) about newest studies but liked it that I informed myself and even found infos she did not read yet (no wonder, she gives around 500 chemos each year, teaches at university etc.). With this she could alter my chemo before my first treatment.

[1] Bittenbring J, Neumann F, Altmann B et al. Vitamin D deficiency impairs rituximab-mediated cellular cytotoxicity and outcome of DLBCL patients treated with, but not without rituximab . J Clin Oncol 2014

[2] Murawski N, Pfreundschuh M, Zeynalova S et al. Optimization of rituximab for the treatment of DLBCL (I): dose-dense rituximab in the DENSE-R-CHOP-14 trial of the DSHNHL. Ann Oncol 2014

[3] Pfreundschuh M, Poeschel V, Zeynalova S et al. Optimization of rituximab for the treatment of DLBCL (II): Extendet rituximab exposure time in the SMARTE-R-CHOP-14 trial of the DSHNHL. J Clin Oncol 2014

[4] Pfreundschuh M, Poeschel V, Zeynalova S et al. Increased rituximab doses eliminate increased risk of elderly male patients with aggressive CD20+ B-cell lymphomas: Results from the SEXIE-R-CHOP-14 trial of the DSHNHL. J Clin Oncol 32[6], 2014

[5] Pfreundschuh M, Schubert J, Ziepert M et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol 2008;9:105-16.

[6] http://www.ncbi.nlm.nih.gov/pubmed/21460380 [7] http://www.ncbi.nlm.nih.gov/pubmed/23168367 [8] http://i.imgur.com/bq5ZZsr.png


Sorry to hear about your diagnosis. There is a lot of good advice from other posters and I would like to offer you my suggestions having performed the role of patient advocate for all the members of my immediate family who all were diagnosed and treated with various forms of cancer (5 out of 6 family members, everyone except me). I have built an extensive library of info, articles, resources, etc. through the process of caring for my family members which I would be happy to share with you and could offer more help if we could speak so if you want to do that please provide me a way to contact you.

1) Get a definitive diagnosis & treatment recommendations from the best doctor you can find (I know a number of internists, oncologists, oncology radiologists, cancer surgeons, etc. that I could possibly recommend depending on where you are located).

2) Get a second opinion to confirm the diagnosis is accurate and also a second opinion on treatment recommendations.

3) Much of what to do next will depend on #1 & 2 above but there are a number of things you can do immediately to greatly improve your chances of fully beating your illness including:

-try and switch to a vegan diet and eat plant based foods. All cancers are fueled by animal foods and there is proven evidence vegans get fewer cancers and do better with cancer treatments than non-vegans. There are a number of foods that are especially good at preventing and fighting cancer including allium foods (e.g. garlic), cruciferous vegetables (e.g. broccoli, brussels sprouts, etc.), spices such as turmeric, ginger, etc., green tea, nuts & seeds, and others on the list of top cancer fighting foods.

-significantly reduce and/or eliminate as much sugar as you can from your diet, especially high fructose corn syrup and other highly processed forms of sugar. Sugar fuels cancer growth and to limit its growth and possible spread, cutting out sugar will really help.

-try and get as much cardiovascular exercise as you can ideally at least 30-40 minutes at least 5-6 times per week. Highly oxygenated blood which results from exercise inhibits cancer cell proliferation plus it will make you stronger and give you more energy especially before/after treatments.

-try and get as much sleep as you can. Proper rest is critical to help your body rejuvenate your normal cells and boost your immune system to fight the cancer. Maximizing your immune system is one of the most important things you can do to fight and beat the disease.

I don't have the space to include more but I can offer you advice & suggestions if we can speak. One thing to know is that there are many new promising approaches to treating cancer that are proving to be highly successful including immunotherapy and others. You are young and if you caught it early your chances of a successful treatment and full remission and a long cancer free life are very good.

Best of luck to you.


I'm sorry to hear this. Cancer is awful. Best wishes.

I feel horrible about joining a young business as an albatross instead of an asset.

Don't. It's not your fault. You don't even know that you're going to have any effect on their premiums and even if that happens, it's going to be a small effect in comparison to everything else that startups have to deal with.

If I start at my new job I'm afraid I will endanger the business and raise everybody's premiums.

Don't worry about that. You shouldn't feel guilty about anything... unless you're a health insurance lobbyist or executive or a legislator who fought healthcare reform, which you're obviously not.

Just focus on getting well and giving the people around you, your job, and most importantly, yourself, your best. Seriously, fuck everything else. This is your life.

Besides, an 18-person company that can't survive one employee getting cancer (and I suspect that it can) is a company that doesn't deserve to stay in business.

So: take the job, get covered, and work when you can.

I left my old job on good terms but have no idea how they could justify re-hiring an employee who left and may not be productive / able to work.

You'll be able to work, although not at 100%. It's not like life stops when you undergo chemo or radiation. Yes, those therapies are brutal (my mother had cancer, twice) and you'll probably need to take a few days off for each one, but you can still be productive some of the time.

Let's say that you need 6 cycles of chemotherapy (over 18 weeks) and that each involves three days during which you can't work. (There's a lot of variation. Some people drive themselves to chemo. Some people need a week to recover. Three days seems to be average, from what I've heard.) That's only 18 sick days. It's nowhere close to a deal breaker.

Focus on getting well. Don't feel guilty because you didn't do anything wrong.


[flagged]


No, the best treatment is SEE A FUCKING DOCTOR. Yes, the chemical in question shows promise. It's nowhere near ready for prime time though, and certainly not something you should be peddling.


Right. Cancer is not a single disease, and so the drugs that will be effective depend on the particular cancer, and in some cases on particular mutations in the tumor (see for instance http://en.wikipedia.org/wiki/Oncogenomics). So any time someone hears you have "cancer" and suggests a chemical to treat it, you can safely conclude their advice is not worth following.


[flagged]


Oh, I thought I'd never encounter this on HN. But since I did, here's the story:

Somewhere in late 80s my mother started to have pain in the abdomen. She went here, then there, then she finally did something like CAT scan or whatever, I don't remember, I just remember is was difficult to get this scan because there was just so few such devices in my home country (friendly advice for those who dream about state-provided health service: you don't take into account that you literally can die while sitting in line for months)

Well, it appears that she got gallstones and quite sizeable ones. Traditional conservative medicine (pills) didn't help much and she was recommended to take the surgical route. She declined because someone told her about urinotherapy. And she did that shit (well, piss) for the next 10+ years. The pains never completely went away, so she used some over the counter painkillers and was getting by so-so. Then one day she felt acute pain again, she was diagnosed with Stage IV pancreatic cancer, and died in agony in 6 months. She was always dreamed about having grandchildren and my wife gave birth to our daughter the same day my mother went to (totally useless and just an act of despair) surgery to remove the metastasis. Which failed (well, stage 4 and pancreatic - it sounds worse than death penalty conviction). She lived just enough to see my daughter once when she was 3 months old or something. The hospital literally threw her away to die at home (remember, my friends, you want state-controlled health service. The hospital was free. Free comes at a price) and I drove my wife and child to her. She died a few weeks later. In pain and agony.

(did I tell you about the state-controlled health service? I don't remember, but just in case if I didn't - strong painkillers are controlled like weapon grade plutonium. So the doctor decides how many pills you deserve and even if the doctor is good person, the state mandates the limit. And it's a serious felony for a doctor to break this mandate. Painkillers are not technically free, but cost peanuts. You can buy them on the black market though and get 8 years if caught)

An autopsy showed that her gallbladder was full with stones. Doctors said that with a VERY high probability this is a sole cause of cancer. If she haven't listened to the idiot who advised her to take urine instead of the knife or ultrasonic she probably have survived until now (her birthday was 10 days ago and she would have been 75) and was able to see her granddaugther grow in front of her. She died at 61.

You can probably figure out from this rant what do I think about you and your religion. Drink this stuff alone.

I'd probably be downvoted to hell for this, but fuck it.


To quote you - "You can probably figure out from this rant what do I think about you and your religion. Drink this stuff alone."

I have only one thing to say. Comrade - you are ignorant and come across as a racist. Not that i give a shit.


I have no idea what the original post said, because it appears to have been too godawful to even stay in the thread, but I saw nothing in kika's that sounded like racism. Just seems like the commenter is opposed to whatever groups are pushing the treatment he says killed his mom -- hard to fault somebody for that.


May I ask which country?


Soviet Union. The country which basically invented and implemented state-owned free healthcare on a very large scale (the USSR population was on par with the USA population).

And, frankly, I believe USSR succeeded in this implementation. I mean you can't make it substantially better than it was (taking technology advancements into account). It was great at preventing epidemic outbreaks, vaccinations, general population health, etc.

My sister picked up typhosus in a very remote part of the country, disease not known to primary care physicians for decades (well, they study it in medical schools but just like a historical artifact). But the system worked perfectly, she was diagnosed, sent to a special facility, got necessary treatment (and became a subject of research with daily visits of medical students from all across the city) and got out perfectly well (besides losing all her hair, but that part recovered quickly).

It's just everything has its pros and cons. And when you preach socialized state-owned healthcare, don't think you'll always be at the 'pros' side. Some people end up at the 'cons'. I'm not saying that my mother fell victim to this system, she fell victim to the idiocy. But the system made her suffer beyond what is acceptable in the civilized world.


Is it very safe to drink your urine? As far as I know, urine contains toxic chemicals excreted by your body.

If I had to give him advice, it would be to change his diet and try to eat as much vegetables as possible while at the same time reducing protein and carb intake.


Urine is safe to drink. Contrary to popular belief, urine contains antibodies which heal any health issues.

Don't take my word - just google it.


After reading some articles on the Internet, I'm not too convinced about it, especially about the toxic metals. People that suffer cancer generally have higher than normal toxic waste (I guess both because cancer produces toxics as a by-product and because cancer generally appears in people that do not eat very healthy or live in contaminated places).


Hm... it appears that this claim is contrary to most beliefs, by people who have jobs involving them knowing things like this.


[flagged]


> Why do certain foods harm some people and help others? How come the same weight loss program shows different results on different individuals? And, why do some people fall sick more often than others? Answers to these questions and many more lie in Ayurveda where your body is not just looked upon a holder of flesh and bones but the finest vehicle of experiencing all pleasures and sorrows.

This sounds like a book about an interesting philosophical approach to examining one's life, but claiming that "practical wisdom" is all that's needed to "live a healthy life with virtually no disease" is absolute, equivocated nonsense completely divorced from the experience that OP is facing IN REAL LIFE. The guy has cancer, and you're telling him to read a book featuring the "science of ages," based on the "wisdom" of people who were written about hundreds of years before the rise of the concept of a spherical earth.

Normally it's totally cool with me that people believe whatever silliness makes them feel more in control of their lives, but there's a person with an actual, real problem, and I had to speak up against spreading this garbage.


Your comment sounds a reply made in rush. I feel sorry for the OP and regarding the book I specifically mentioned "curious readers" and not a specific recommendation to OP.

But then didn't I know that I'd receive this kind of response very quickly? I knew most would respond like this here, but I care for the single one who might get inspired to proceed and read the book till the last page. If I can help transform one life for the better my job is done!

Everyone is entitled to have his own opinion. But a lightbulb is required to remove the darkness.


[flagged]


> Another note: Don't you think it's worthwhile not down-voting every idea that hasn't become widely used?

Yes. Bullshit deserves to be downvoted and flagged. Every time someone discloses they have or possibly have cancer people come out of the woodwork pushing total bollocks.

"You got cancer because you're stressed"; "you can cure cancer with fasting"; "you can cure cancer by not eating sugar"; "you can cure cancer with this particular herb or spice"; "you can cure cancer with medidation and exercise".

It's fucking disgusting and I proudly downvote and flag this bullshit.

See also John Diamond's books about the things people said to him when he disclosed his cancer.


For the record, I never said it was a cure...


Oh, you've got the cure for cancer when you don't even know what OP has? No worries mate. Don't know why all these scientists waste time on cancer cures when you can just starve yourself so the body eats the tumour and corrects the mis-generation of cells.


how do you know? did you do experiments or something?

https://news.usc.edu/63669/fasting-triggers-stem-cell-regene...

Science!


Is this similar to nk cell therapy? http://stemcellthailand.org/natural-killer-cells-nk-cell-can... My brother was recently diagnosed with non-hodgkins lymphoma and after reading about chemo we just think stem cells are a better option. Also living in Bali at the time and our options are very very limited


Never said that. Just said there was an article about this, and with my limited knowledge of biology it's a plausible thing that I'd personally try (along with everything else). Certainly I'd do whatever the doctor says, and then add this only if they said it was likely it wouldn't do much harm.

https://news.usc.edu/63669/fasting-triggers-stem-cell-regene...

Seems like it might not be harmful at least.

Here's the article that I believe was at some point on HN, which I was referencing in my first comment. The guy could totally be a quack, but like I said it seems plausible enough that I'd give it a try along with everything else if it wasn't declared harmful by my doctor.

http://thequantifiedbody.net/water-fasts-as-a-potential-tact...


Eat B17.


Apart from some great advice here, do watch "Cancer: The Forbidden Cures" documentary.


Find a UPCI church and ask the Pastor to pray for you. Yes, God can heal. It happened to me (abdominal wall tear).


Stop sugar. Cancer feeds on sugar. Stop sugar for win the fight man. Good luck.


There is research indicating this. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871217/

However, it would be foolish to just stop sugar without seeing a doctor and assume all is going to be well.


This. Read "Tripping over the truth" by Travis Christofferson and "cancer as a metabolic disease" by Seyfried.

I'd start with a 3 day water-only fast and then stay low calorie keto for a long time.


Even if this is a small hope, I would suggest to take a look at these papers:

Fruit, vegetables, and cancer prevention: A review of the epidemiological evidence

http://www.tandfonline.com/doi/abs/10.1080/01635589209514201

Vegetables, Fruit, and Cancer Prevention

http://www.andjrnl.org/article/S0002-8223%2896%2900273-8/abs...

As far as I understood, this is already almost established that increased consumption of fruits and vegetables helps somehow.


http://www.healthrestorationranch.com

Mike has helped 100,s with same problem.


“Disease is natures’s effort to free the system from conditions that result from a violation of the laws of health."

He should follow that up with: "I am basing this on absolutely nothing"


Alternative medicine.

"You know what alternative medicine is called when it's proven to work? Medicine."


I am sorry to hear, This is my 2 cents from a person who has seen atleast 5 of my family members fight cancer. First thing the only thing that kills cancer cells is Oxygen its the live giver, take in loads of oxygen, food that gives the maximum oxygen is Wheat grass juice ( you can get a shot at jamba juice) take it daily you will see phenomenal difference, remember Neil Armstrong has lung capacity twice that of normal people and he is completely cured of cancer naturally . Try pranayam its the best way to take maximum oxygen and increase your lung capacity and most important be positive !!!


wat?


The People's Pharmacy is a public radio show produced in the U.S. Over the years and with occasional listening, I've found it very informative and useful.

The other day or week, I heard part of this episode while doing other things. I haven't listened to the whole thing, yet. I do recall hearing about patients who pursued e.g. nutritional reinforcement and who self-advocated, sometimes having to go through several doctors to find the one they could work with.

I hate to be one of those "try this" people. But based on the overall quality of the show, I'd feel remiss not to mention this episode.

Wishing you the best.

http://www.peoplespharmacy.com/2015/05/21/955-surviving-canc...

http://www.peoplespharmacy.com/feed/podcast/

http://traffic.libsyn.com/peoplespharmacy/PP-955SurvivingCan...


Cancer is basically a problem of the immune system. We have a lot of cancer cells in our bodies and our bodies manage to kill them quite efficiently. Something went wrong in your body and a cell or two survived. I'm in no way a doctor (I have experience with cancer, but as a, hm, 'user', or better, observer) but IMHO the thrill of working in the startup and doing stuff that you really like can substantially help your immune system to fight the hostile lifeform in your body. "Positive" hormones stimulate the immune system. On the other side, having not enough sleep, eating shit, having a lot of excess weight (having a little is considered good) would actually harm your immune system. That said, if I were you, I'd take the startup job, but would take extra care of myself, not working 6x16+1x10 hours, eating right (not necessarily fancy or organic, just basically good food), exercising enough and having enough fresh air and rest. One doctor once said to me that I can cure any illness by just sleeping 10+ hours a day. He was joking, but every good joke is just partially a joke.

Yeah, and buy COBRA. Just in case. Most likely you will just waste a couple grand on it, but this is your life on the line. Small companies use complete idiots as insurance brokers (large ones do too, but they learned how to hide this) these idiots may screw up you forms/submissions/cards/accounts/whatever even multiple times in a row. You'd better be covered while you sort this out.


Hey Friend,

That sucks to hear. You are young yet, you can beat this. At risk of sounding like a snake-oil salesman. You should look into a Green/Vegan diet. I'm talking about wheat grass and kale. Mix it up, juice it, doesn't taste all that bad.

I don't think you should worry about your co-workers premiums. It's all money, honestly who can't go without an extra $50-300 a month or whatever. People spend what they have usually, it'll all work it. It'll all work out.

It's called Insurance for a reason. Don't worry about the Insurance companies. Focus on getting well, and staying stress-free as possible.

Good luck my friend.


If you were my sibling, I would probably entertain a discussion similar to the following:

0) I am sorry

1) if you think about cancer like most people, then you are looking death in the face ... Do so. Let it focus you on what is truly important. http://paulgraham.com/todo.html

2) define the problem to the greatest degree of specificity possible - this likely means biopsy and pathological analysis and discussion of further workup at an academic medical center or somewhere that genomic sequencing would be possible, if indicated

3) as stated elsewhere - start indicated treatment as soon as you have an answer for #2

4) if cancer is the answer, then two things (depending on the type) the outcomes may be better than you think, however, find a second oncologist - the running joke is that oncologists keep giving chemo after their patients are dead - find another experienced voice (not neccessarily an expert in YOUR cancer type) who seems comfortable with hospice as a possibility -- not all are -- a life well lived and fighting tooth and nail to the bitter end are not neccessarily the same thing.

5) get all of the insurance you can asap - don't worthy about the premiums


My uncle had stage 3 colon cancer and beat it using a mixture of both traditional and alternative medicine (such as a raw food diet and some other treatment which wasn't available in the US). I strongly recommend looking outside the mainstream. I recommend watching the Burzynski documentary and checking out the Burzynski clinic.


Or you could stick with evidence and science based medicine. For another perspective on Burzynski you can read SBM: https://www.sciencebasedmedicine.org/tag/stanislaw-burzynski...


You should consider that the 'evidence' based medicine you speak of is largely based on 53 studies, of which 47 could not be reproduced. http://www.reuters.com/article/2012/03/28/us-science-cancer-...

Which is probably why cancer survival when it can be surgically removed is fairly good, but incredibly poor in general when it can't and must be treated by medicine.

I don't know if Burzynski has something better, but I have seen the documentary and researched the background. It is clearly not a case of the FDA trying to stop bad medicine. He has been in trouble mostly due to protocol and a clandestine attempt to take his patents. He has been in court many times, and won every case, and never was he in court due to damage to clients, it was always about some break of protocol, such as how medicine is delivered across state lines etc.

Anyway, in general you aren't allowed to even try Burzynski's medicine until all FDA approved medicines have already been tried. Only then can you apply to be part of the FDA trial for his medicine.


I am all for evidence-based medicine... this link is arguing that terminally-ill patients should not have the right to try various experimental treatments, which I find appalling..."those who sacrifice liberty for security deserve neither."


Just to clarify: there is value in mainstream medicine, but there is also danger. I believe in evidence-based medicine, but I also believe that human greed is very active in the pharmaceutical industry, and that greed causes all kinds of lucrative drugs to be put on the market, even when they are totally ineffective and even harmful.




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