My Sister Liv

From Grammy Award winning Director Alan Hicks and Academy Award winning Producer Paula DuPré Pesmen, MY SISTER LIV is a feature documentary following the inseparable sisters Tess and Liv. Liv is a young girl growing up with the pressures of social media, depression, body dysmorphia, and, often, suicidal thoughts. The film takes us into the intimate journey of a young life on the edge, and ultimately a family finding healing through hope.

SuperSurvivors: Stage 5

Coming August 2026

Welcome to Stage 5.

The only stage of cancer you’d ever hope to reach.

How thousands of patients with advanced cancer are now living 10 years and more. The survivorship secrets even doctors don't always have time to share.

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SuperSurvivors: Stage 5 is the life-changing book that may help prolong your life after receiving an advanced cancer diagnosis. The notion of a new “ Stage 5” phase dares to declare: Now is the time for good — no, great — news about serious cancer! What used to be Stage 4 "fatal” now is often "treatable” for years. Oftentimes, for 10 years or more. Welcome to Stage 5. Written by a long-time survivor and fueled by experts, this book shares insider survivorship secrets that even doctors don't always know. With the advent of truly personalized drugs and immunotherapy, the "country" of 18+ million U.S. cancer survivors today deserves a manifesto like SuperSurvivors: Stage 5 — the only stage of cancer you’ d ever hope to reach. For patients and families, the book relates how tens of thousands of survivors now serve as inspiring models of How to Live Now, and for longer, in and on a New Stage.

A Summary of the Fight Colorectal Cancer Working Meeting: Exploring Risk Factors and Etiology of Sporadic Early-Age Onset Colorectal Cancer

Summer 2019: BoCo Media collaborated with oncologists, researchers, and patient advocates to report on recent developments of early-onset colorectal cancer in the US and beyond. The resulting Gastroenterology article offers new views of an area of rising concern.

Smoke Rings Rising

From inception to publication, BoCo Media helped shape, edit, and market this memoir from an emerging California author.

Learn more and buy the Smoke Rings Rising: Triumph of a Drug-Endangered Daughter on Amazon.com

Quincy

From 20016-2019, BoCo Media partnered with co-directors Al Hicks and Rashida Jones on pre-production, test-screenings, and post-production collateral of this Grammy™ Award winning documentary. (Netflix)

Major Taylor Film

Documentary film in pre-production, (2019) based on the book by Todd Balf.

Follow the film on Facebook

For a glimpse of author and producer Todd Balf, see this Marshall "Major" Taylor story by Hennessy.

This video is not intended to be seen by persons under the legal alcohol drinking/buying age nor in countries with restrictions on advertising on alcoholic beverages.

Fight Colorectal Cancer - FIGHTcrc.org

As a member of the Research Training Advocacy and Service group, I have worked with oncologists and public health scientists on patients' behalf in translating discovery into action.

Artist Profile: The Studios of Ana Maria Hernando

Working with Coloroado Homes & Lifestyles magazine, we helped shine light on Colorado artist Ana Maria Hernando, whose paintings and multi-media exhibits meld striking South American influences with a postmodern design ethos.

Step into the Boulder studio of Ana Maria Hernando, and your eyes don’t know where to turn first. On one wall, affixed to a gesso-white expanse reached by ladder, a massive pastiche of pastel floral designs beckons, waiting only for what appears to be minor final accompaniment. On the tall wall opposite, a gleaming, dark collection of luminescent oil paintings-in-process huddle together, closer to the natural light. These shapes inspired by nature are arranged tightly, painted opaquely, as the artist contemplates the next layers of sheen. Of their blackness amid all the bright, Hernando says she has asked herself time and again, “What happens in the color of the night?”

And decorating the far wall is a passel of elegant imported fabrics, plus pancaked stacks of bright silken circles and round woven patterns that await their fate as cameos in one of her next arresting installations.

It is, to an outsider, a lot to take in. But to Hernando, not so much. Born in 1959 and raised in Buenos Aires, she studied as a young artist at Escuela Nacional de Bellas Artes and went on to the School of the Museum of Fine Art in Boston and the California College of Arts in Oakland, California. She descends from a line of creative women who passed down a love of beautiful patterns in nature that have stoked in Ana Maria a desire to move masterfully beyond the expected when it comes to creating art. Of all types.

“I have painted since I was 5 years old,” Hernando says. “I was a painter when I began to work with an order of nuns in Argentina—when my pieces, without me even realizing it, started to become installations. As a teenager in summers I would go to work in my family’s textile factory. And I would draw. But I moved to Berkeley not to be an artist but because I fell in love.

“I am very sensitive to light; I love the light here. I love that there is so much sun here—it is also in my emotional space,” she adds, speaking of what has been her home since 1986. “Colorado has been really kind to me.”

So has her homeland, apparently. For it is clear that her mixed media contains storied elements of both South and North America. Over the past decade, Hernando has found an unlikely but spiritually driven collaborator for her larger works and installations: a monastery of Cloistered Carmelite Sisters from Buenos Aires, from whom she buys original fabrics and whom she hires to cut and sew designs from patterns she carefully constructs.

“At first I was not allowed to see my partners (the nuns), as they were only allowed to talk to me from behind a screened wall,” Hernando relates. Consider: An artist who has jetted in from Colorado, a mother of three artistic children, describing vast works of art-to-be to women she cannot see, to sisters from an ancient order with whom she hopes to work, on projects slated to be at once intricate and intimate?

She makes it work. So too, the sistren. As for her new installation pieces, Hernando remains keenly interested “in the poetics of the collaborative nature of women in different cultures.” 

Following solo exhibitions at contemporary museums in Duluth, Minn. and Boulder in 2005, she had a solo show at the Kemper Museum in Kansas City, Mo., in 2010. In 2009, she created an installation, “La Montaña,” from hand-crochetedPeruvian petticoats for a solo show at Denver’s Museum of Contemporary Art(MCA).

“Ana’s work is poetic and magical. And who doesn’t want to believe in magic?” says Karl Kister, former board president of MCA Denver.

Hernando staged a solo traveling exhibition at contemporarymuseums in Oklahoma City and Marfa, Tex. in 2014. This year she is preparing for a  2016 solo show at the University of Colorado Art Museum.

Yet whether paintings, sculptures of nature, or installations predominate in her shows there is one constant fairly bursting forth: the art of the flower.

“For me flowers are beauty,” she says. “They are desire; they are fire; they are time; they are sex. It gives me pleasure to move the brush following their shapes.”

Her works speak a language that harks back at least two generations to the intricate designs of mantones and mantillas, traditional garb Ana Maria found herself transfixed by in childhood and still today. Flowers, blossoming shapes, and sensual fabrics, evolving into a figurative language all their own.

“I drink from many places, though I really am South American in my colors. It just happens.”

anamariahernando.com

2015 AACR Scientist↔Survivor Program

BoCo Media's Curt Pesmen was invited to join the 2015 Scientist↔Survivor Program at the American Association for Cancer Research conference in Philadelphia, PA.

Participants in the 2015 SSP during the AACR Annual Meeting 2015 pose for a group photo.

Time Magazine's The Best Place for Keeping Fit

How Robin Williams Helped My Fight Against Cancer

Originally published in Esquire in August 2014

Though we all think we "knew" him from his work, the truth is there's so much we don't know about Robin Williams' life and why he died. One thing we know: They don't hand out Academy Awards(R) for dick jokes.

Celebrated, loved, and praised for so much of his life for being "manic," it maybe hurts more now for his friends and fans to think about how deeply, how painfully, he must have fought the darkness of depression. And to think now: He won his Oscar pretending to be a shrink called upon to help a gifted young man with a manic streak who couldn't shake the depressive.

My wife, Paula, and Robin's former wife, Marsha, met on the set of Mrs. Doubtfire in 1993 and have been friends for more than 20 years. As two of the few female producers on that film, they bonded early on during some of the quieter moments of production.

While it might be a stretch to say that Robin and Marsha Williams saved my life, it's no stretch to say that nearly 14 years ago, on a day that I got my shock diagnosis, Marsha and Robin and their friend and neighbor Chris Columbus helped convince me to move my newly-christened, Stage 3-advanced, colorectal cancer ass 1,250 miles from Colorado to San Francisco—in hopes of my receiving the best treatment I could possibly find.

It was not a roll-the-dice move. It turned out to be a reasoned decision made after the din died down that had more than a random Hollywood connection at its core.

At the time, Paula was working as an associate producer with Columbus on the first Harry Potterfilm. But we all had spent months together in the 1990s during the making of Doubtfire and Nine Months and Bicentennial Man in San Francisco. It was there, not in L.A., where Chris and Robin had both chosen to live—and it was there where they and Paula had held a number of film fundraisers and gotten to know some key people at the University of California-San Francisco, a top cancer hospital in the country.

UCSF was where I got my fourth and fifth opinions related to my cancer case. It is also no stretch to say it's where I met a few other people who wore white coats and who did save my life.

On and off through the 1990s, I shared dozens of dinners with Robin and Marsha, many of them on movie sets. Marsha's voice was always quiet, warm, and inviting; and still is. Back then, I was struck not by how loud Robin was in social situations, but how quiet and reflective he was at the dinner table. I remember being surprised by his deference to others in the room. That is, up to a point.... Time and again, sometimes an hour or two into the evening, he eventually would rise up and take over the room, launching into an improvisational sketch or two—or four.

That's the Robin Williams we all knew. Or thought we did. The quieter man was the one who visited his friend and Juilliard classmate, actor Christopher Reeve, immediately in the hospital in 1995 after the debilitating accident that made Reeve a quadriplegic; and who, along with Marsha, helped Reeve's wife, Dana, through the worst medical times of her own, including the lung cancer that took Dana's life in 2006 at age 44.

Then again, one day between takes on the set of Nine Months, while Hugh Grant was rather busy grabbing the headlines, I witnessed Robin talking on set with a brain-injured teenage girl in a wheelchair, who was working as an extra that day on a wedding scene. There was that soft, tide-pool voice again, softer than you ever heard on Leno or Letterman or on the umpteen years of Comic Relief. It wasn't a scripted moment. And he didn't just make a bit player's day. He made her year. I remember stepping back, moving out of the huddle, feeling I didn't want to intrude on their space.

From then, six years later and 45 pounds weaker, I found myself back in San Francisco, flat on a couch, a post-surgery cancer sad-sack survivor, moaning my way through recovery, wondering which goddam Ensure smoothie was gonna be the highlight of my day.... when Paula tells me Marsha and Robin are coming to visit after lunch.

Half a smoothie later, I make the mistake of telling Robin that the doctors who operated on my colon told me they had done a type of experimental surgery on my body. Turns out they used a 'nerve-sparing' wand—usually used for prostate, not colon, cancer operations—when they cut through and around my perineum to get some cancer out. And it's no stretch to say the perineum, sited perilously close to the prostate, is also the site of many bundles of nerves—nerves that transmit significant sexual pleasure and all sorts of get-up-and-go that helps forms erections. The docs were doing me One Big Favor.

When Robin heard that, he could sit quietly no longer. He bolted upright from the couch next to Paula and me and immediately—autonomically—placed his right elbow above his crotch, formed a tight tumescent fist, and started waving his wand back-and-forth, wildly to and fro, as if the surgeons had hit the wrong nerves, sending a spasmodic organ into erectile function disorder, one that was now leading a whole body around, one that wouldn't ever never quit.

Until, that is, Robin swerved around the glass coffee table, pulled a deft 180, and sat down swiftly.

I was howling and hurting by now. Trying not to laugh in the way you can't stop a sneeze that's passed its trigger point. But the truth is, I was also a bit scared: wondering whether the 42 metal staples holding my lower torso together would hold. I hadn't laughed this hard in months.

Then Robin became quiet again, as Paula and Marsha took back the floor, as I settled into my supine sprawl on the couch opposite the big screen TV that played ESPN for me eight-to-10 hours a day. That is, that was, until Comic Relief (home delivery edition) paid a little visit to my bedside.

Wouldn't it be something if Robin did have a hand—a full-length, out-of-control, arm erection parading around a cancer patient hand—in saving my life. Thing is, he sure made it worth living for a while.

Keep On Keepin' On

As Associate Producer on this award-winning feature documentary, BoCo Media worked with director Al Hicks and Executive Producer Adam Hart to prep the initial investor and marketing documents as well as filmmaker bios and story edits during production of the film.

My Cancer Year

Working with director Aly Nicklas (Knee Deep), we distilled 175 pages of "family medical memoir" to 2:58 minutes, to create a trailer for my latest book (2014).

Survivorship Memoir: My Cancer Year

In MY CANCER YEAR, Curtis Pesmen, a veteran health journalist and book author, chronicles his successful fight with advanced colon cancer in a brutally honest and illuminating memoir. Through this moving account--which takes the reader through his initial shock of diagnosis, through treatment, experimental surgery and finally recovery--Pesmen's insights and experiences cast light on how to manage the challenges of cancer people don't like to talk about. This intimate memoir of a successful fight helps the fast-growing group of survivors--as well as family and friends--put cancer in its place while moving forward with the power of new knowledge.

Chasing Ice

Chasing Ice follows National Geographic photographer James Balog across the Arctic as he deploys time-lapse cameras designed for one purpose: to capture a multi-year record of the world's changing glaciers.

Curt Pesmen and BoCo Media worked with the post-production team on video and interviews during marketing of the film—and the Movement.

Director: Jeff Orlowski
Writer: Mark Monroe

Your Prostate Cancer Survivors' Guide: Living Stronger, Longer

Written to help men manage the challenges of survivorship of this devastating but beatable disease. With a chorus of survivors' voices -- and the insights of their doctors, nurses and others on their support team - veteran authors and health journalists Bob Condor (nominated for two Pulitzer Prizes in health journalism) and Curtis Pesmen (Esquire writer and Money magazine health columnist) pinpoint exactly what it means to be a prostate cancer survivor today - and for decades to come. Ultimately, this book will help patients PUT PROSTATE CANCER IN ITS PLACE while moving forward with the power of new knowledge.

In Good Company?

For most cancer survivors, as this LiveStrong magazine/online post makes clear, getting through treatment isn't the only major goal. They also have a job to return to—in order to truly heal.

"Don't even think about it," she thought that morning. And then she couldn't help but think about it: her breast cancer diagnosis, the surgery, the chemo, and the fears of a young mother with an infant son and five-year-old daughter. And the impact of that awful year, 2006, flooded back.

Yet on the same day this spring, when Adrienne Ambraziunas, 40, prepped for her callback job interview at There With Care (TWC), a Colorado-based, family service nonprofit agency, it finally hit her: Maybe this was one of the few job openings around in which survivor status might actually help her land the job. She also felt (but didn't see the need to share right away) that her experience fighting cancer would even help her perform her job. After all, the TWC mission is: "Helping children and families facing critical illness." And she was gunning to become a volunteer coordinator — one of the few administrative positions on staff — which helps direct the kinds of care and services that client families receive daily.

Chillingly, Ambraziunas later allows that she had been diagnosed at 36—the exact age as her maternal grandmother, who unfortunately didn't survive to age 40. Unlike her grandmother, Ambraziunas had been tested for the (BRCA) breast cancer genes and so far had been found to be clear of an ominous future. Would all this knowledge and worry crimp her confidence during her interview? It didn't seem to do so that day. The interview went well. Really well.

HOW MUCH DO YOU SHARE?

Of course, survivor interviews and human resources sessions on the job don't always match up well. Especially when you have an unenlightened employer who may view you or your situation as a drain on the company's resources. Fact is: Employees with checkered health histories have had a difficult time changing or obtaining high-quality health insurance. Legislation such as the Genetic Information Nondiscrimination Act, which went into law in 2008 and bars companies from using genetic information in hiring, firing, or promotion decisions, is new enough that even its initial impact is still being weighed. And the full effects of the Patient Protection and Affordable Care Act, the health care reform bill signed into law in March, won't be felt for at least a few years, as final pieces of the reform settle into place closer to 2013-14.

It's no wonder, then, that patients and survivors don't always share their diagnoses openly on the job. "I kept information from the company until I had all the facts about the cancer, had my medical team picked, and the treatment options," says Steve Nelson, 46, a Southern California colorectal cancer survivor and real-estate investment analyst. "I had a plan of attack to 'beat the beast' set in motion. This was done to eliminate the judgments and second-guessing of others, my coworkers' opinions, and the 'advice' of others."

While coworkers' intent may often be kindhearted or good-natured, Nelson felt protective of his job, career, and his long-term status as vice-president of a solid, mid-sized company. "It was ultimately up to me to do this," he adds of his delayed, strategic download of his case to his colleagues. When Nelson talks about the "judgments" of these same colleagues, he is referring to part of the social stigma of cancer diagnoses that remains, even in our technical, supposedly medically savvy society. Otherwise, why would a middle-aged husband, dad, and exec on the West Coast be so hesitant to talk to people he works with every day? Especially about fairly common aspects of his biology that ran amok and attacked his intestines, his colon. In 2010, certain diagnoses, such as lung cancer ("Did he smoke?"), skin cancer ("Didn't she do tanning salons?"), or colorectal cancer ("Was he a vegetarian?/Did he eat a lot of meat?"), are especially apt to act as targets for such stigmatized beliefs.

On a corporate level, the CEO Cancer Gold Standard is a national program that attacks stigma, outmoded beliefs about cancer, and laggard reimbursement or health insurance support for cancer prevention. (It was created and is run by the CEO Roundtable on Cancer, a nonprofit collection of top chief executive officers across the U.S. who join to help relieve the burdens of cancer on organizations and families. The Roundtable was formed in 2001.)

The CEO Roundtable on Cancer announced recently that its CEO Gold Standard) certification now covers more than 1.25 million employees (see "Corporate Cancer Pedigree", below). What's more, CEO Gold Standard hopes to have three million employees covered by firms accredited with the Gold Standard by 2011, according to Bill Weldon, the chairman of Johnson & Johnson, who chairs the CEO Roundtable on Cancer.

In brief, the Gold Standard calls for firms to take actions in five key areas of health to fight cancer in the workplace:

• Discourage smoking
• Encourage fitness in or near the workplace
• Promote healthful eating, nutrition
• Detect cancer at its earliest stages
• Provide access to quality care, including potential clinical trials

"I did not want the rest of my company to know," says one colon cancer survivor, after he told his CEO. "But as you know, COMPANY SECRETS LEAK OUT over time."

LIVESTRONG is among the organizations that have achieved the CEO Gold Standard rating. Other firms that have been cited for inclusion are Aetna, Dana Farber Cancer Institute, Li Destri Foods, State Farm, U.S. Oncology, and the Wistar Institute, to name just a few. Quest Diagnostics, considered the world leader in medical diagnostic testing and services, won the designation this spring. In response to a question from LIVESTRONG Quarterly, Surya Mohapatra, M.D., the CEO of Quest Diagnostics, explains how he and his firm see real value in reaching out to survivors and caregivers in the workplace, and more specifically to those on his payroll.

"In 2005, we made a formal commitment to the health and wellness of our more than 40,000 U.S. employees and their families through our HealthyQuest wellness program," he says. "At the heart of this program is our Blueprint for Wellness service, whichprovides employees and spouses or partners a comprehensive health risk assessment. It includes a panel of up to 30 tests, including screenings for prostate and colon cancer."

This last component is the missing link in so many corporate wellness programs today. What's more, Quest and other Gold Standard designated firms share the costs of the screenings, fitness programs, or both with their employees.

"The feedback we have received," Dr. Mohapatra says, "has been extremely positive and heartfelt, whether we helped find cancer early, or enabled [employees] to lose weight or stop smoking. Healthy, motivated employees are more productive today, and they strengthen a company's workforce for tomorrow, creating business power and advantage."

In Nelson's case, a small group of volunteer coworkers met with him every Wednesday (unsolicited) to see how things were going and what they might do to help him out at home an at the office.

Meantime, survivors and their families outside the CEO Gold Standard umbrella often quickly learn of a few key laws and acronyms that may help with transitions on the job. The first, commonly known in employment circles is the Americans with Disabilities Act (ADA), has been in place since the 1990s. In a few key areas, the ADA helps the outlook for cancer survivors improve when they apply for or return to a job. As the cancer survivor population continues to grow (12 million Americans are now living with cancer), employers will continue to recognize that millions of cancer survivors can and do return to productive careers after treatment.

SAFETY IN NUMBERS?

"The biggest role the Americans with Disabilities Act plays for cancer survivors going back to work is it discourages discrimination in the first place," says Barbara Hoffman, an attorney with the National Council on Cancer Survivorship and one of the leading authorities in the U.S. on the employment rights of cancer survivors.

When Lance Armstrong was diagnosed with testicular cancer in October, 1996, he didn't have health insurance in place. While he didn't suffer outright "discrimination in the workplace" due to his diagnosis, he found himself in an unusual place: casting about for a "team." An insurer. He was "lucky," he says, that one of his sponsors, Oakley eyewear, threatened to move its health insurance business elsewhere if the firm's health insurer didn't step up and insure Lance. "Without their help, I might not be alive today," Lance has said.

For Nelson, his feelings of being alone and fears of being shunned at work faded as his support at the office seemed to grow.. "My advice for others is: Do not change your daily routine. Try to remain independent. If you exercise, do not stop [though you'll obviously need to back off your personal best a bit]. Since your mind and body have been doing the 'work routine' thing for years, it is the simplest item you can maintain when you're feeling at your worst."

As for Ambraziunas, turns out she got the job. And perhaps more important, as a breast cancer survivor and therapist who formerly counseled domestic abuse victims, she gets the job, as a volunteer coordinator serving families hit suddenly by cancer or other lifethreatening conditions. Her survivorship status may not have won her the job. But in retrospect she can say it certainly enhanced her value to her employer, and even more importantly, to her survivor clients every day. Sometimes things work out.

Article first published Fall 2010 in LIVESTRONG Magazine

YOUNG MVP! Tyler Blick Tackles ALL—Acute Lymphoblastic Leukemia

When cancer strikes a child—especially part of the LIVESTRONG/Oakley family—as it did Tyler Blick, then 5—it's instantly clear help takes many forms.

Sometimes a fever isn't just a fever. So when Tyler Blick, then 4, of Mission Viejo, Calif., seemed fatigued one day in June and spiked an unusual summer fever—one that lasted eight days, under his pediatrician's watchful eye—his mother, Jen, and father, Steve, a marketing manager at Oakley, took him to the hospital near their home for extra tests. For over two weeks, the new doctors suspected post-viral neutropenia (low white blood cell count), but his counts did not improve. Despite all the tests (plus the fact that Jen has a lab-strewn, scientific background as a geologist), they weren't thinking "cancer."

Then the ground shook. The next day, after a bone marrow test, a doctor came into Tyler's room and told Steve she had the results (he'd returned early from his business trip to the Tour de France) and asked him "if Jen was around. I said, 'Does she need to be?' They asked me to get Jen on the phone."

Steve remembers feeling scared and frustrated that he was alone, and that there wasn't a phone in the room where doctor led him. He had to hold his cell phone up in the air—on speaker—so that Jen, at home with their 3-year-old daughter, Kira, could hear the diagnosis. On July 13, 2010, Tyler was diagnosed with ALL, or acute lymphoblastic leukemia, a type of childhood blood and bone marrow cancer. He turned 5 in August.

 "Oakley has been a supporter of LIVESTRONG and I have been in the front row doing what I can to push the message to create awareness about [fighting] cancer," says Steve. "I never thought it would touch my life, then…BAM! It smacked me upside the head."

Approximately 5,300 new cases of ALL will be diagnosed this year in the U.S., according to the Leukemia & Lymphoma Society (leukemia-lymphoma.org). ALL is the most common type of leukemia among children, although people of any age can develop it. The society also reports that most children with ALL are cured of their disease.

"I tend to look at things as half-full," Steve says, "and I see that glass as half-full. In my years as an athlete, I was always challenged to win. Now we're challenged [as a family]."

In the initial treatment phase (the goal: remission), Tyler will receive a combination of drugs for approximately six months. Plans—drawn up at the Peckham Center for Cancer and Blood Disorders at Rady Children's Hospital San Diego— then call for a typical follow-up treatment for three to three and a half years, to kill any possible lurking cells. Fortunately, Jen says, her parents (and her childhood home) are situated within four miles of Rady Children's, which brings comfort and a sense of support. The hospital is more than an hour and a half (each way) from the Blicks' Southern California home.

"The 'new normal,'" says Steve, "is JUST HAVING EVERYONE UNDER ONE ROOF and not in a hospital."

Over the next few months, because Tyler's immune system will be compromised due to the cancer and treatment, Jen and Steve will aim to keep his environs as germ free as possible. The Blicks also will start homeschooling.

"My way to de-stress is to be outside," Jen offers, "working in my rose bushes and in the garden the kids and I planted in the backyard. On a typical day at clinic, we leave with the kids at seven in the morning and don't return till six at night."

And as most families touched by cancer can attest, there aren't as many "typical" days as might have been first foreseen. "The 'new normal,'" says Steve, "is just having everyone under one roof and not in a hospital."

For Steve, his bike has served as his main tool for stress relief. "When things get tough, I put my energy into the pedals and push beyond normal pain thresholds." The family "team" has grown to include Jen's parents and brothers, all of whom dropped their daily routines this summer to help give the Blicks much-needed early support. "This was great," says Steve, "as it gave me the feeling of getting another chance at growing our family bond tighter." Steve's parents also pitched in big time.

In August, when Taylor Phinney, 20, a friend of the Blick family, made his pro cycling debut with Team RadioShack at the Tour of Denmark, he rode with a custom decal that read, "I Ride for Tyler Blick" (see LIVESTRONG.com/teamradioshack/news_ taylorphinney-rides-for-tyler-blick/). Lance Armstrong called the Blicks from the Tour de France to offer support when he heard the news; Mark Cavendish dedicated his Champs-Élysées stage win to Tyler. And mountain bike racing champ Brian Lopes, in late August, dedicated his fifth downhill victory to Tyler on his fifth birthday.

Also in August, Tyler's first biopsies after initial treatment came back looking good. Meantime, blood tests showed the cancer retreating.

"Tyler is doing well with his treatments and winning the battle," says Steve. But he and Jen realize the fight will stretch for years. Due to immunity concerns and vigilance against possible infection, Tyler will not be able to have playdates for a while. Truth is, it might get a bit lonely at times. But the Blicks will be anything but alone.

Article first published Fall 2010 in LIVESTRONG Magazine

Rx Side Effects: What Patients Need to Know

THE MOTHER OF THE YOUNG MAN WHO died from taking too much Tylenol had flown from Florida to Washington, D. C., to tell her son's story. In the room full of doctors, she was anxious, not herself.

Kate Trunk, 52, had practiced for weeks before giving her five-minute talk to an FDA advisory panel on September 19, 2002. As she spoke with a shaky voice, she explained how Marcus Trunk wasn't a drinker, and how his doctor had prescribed a ten-day course of Tylenol and codeine to treat his serious sprain. She said that when his prescription ran out, her twenty-three-year-old son switched to over-the-counter Tylenol for pain, then added TheraFlu to the mix when he felt sick a few days later. He thought he was doing everything right, until his life went suddenly, horribly wrong. The autopsy said acute liver failure, acetaminophen (the main ingredient in Tylenol) toxicity. He died awaiting a liver transplant.

"You cannot allow more innocent [people] to suffer - death isN't an acceptable side effect."

"You cannot allow more innocent men, women, and children to suffer," Trunk told the panel convened to weigh the dangers of over-the-counter painkillers, especially acetaminophen, which is used by a hundred million people annually in the U. S. "Death is not an acceptable side effect."

"My husband works for EMS; he's a pilot," she says today, eight years after Marcus's death. "We knew about [the potential dangers of] alcohol and Tylenol, but not about this..." Accidental overdose, she believes, is easily prevented if you know what to look for. Tens of thousands of people each year apparently don't.

THREE THINGS went wrong for Marcus Trunk, besides the wrenched wrist caused by a bucket of rehab construction materials: First, he didn't realize that the risk of liver toxicity from taking maximum doses of acetaminophen can rise markedly the longer you take it. (Of the over-the-counter painkillers, acetaminophen, due to its chemical makeup, is the most likely to be liver toxic when overdoses occur.) Second, he likely caused his overdose by combining Tylenol with TheraFlu, apparently unaware that TheraFlu also contains acetaminophen. Third, after he became ill with what he thought was flu but was actually liver injury, he temporarily stopped eating — a possibly fatal mistake. Most people outside an ER have no way of knowing that fasting exacerbates liver toxicity caused by excess acetaminophen. Something as simple as food might have saved his life.

HERE'S WHAT MILLIONS of Americans should know: The leading over-the-counter analgesic in the United States is Tylenol. And the leading cause of acute liver failure in America today, according to a landmark study in Annals of Internal Medicine, is not alcohol or hepatitis but overdose of acetaminophen.

Dr. William Lee of the University of Texas Southwestern Medical Center published the article last year along with colleagues after studying hundreds of failed livers at seventeen hospitals across the country. The problem, he believes, is that because acetaminophen pills and other painkillers are available over the counter, people often assume they are relatively harmless and "pop them like M&M's." When Lee excluded the cases of intentional overdose, or attempted suicide by acetaminophen, the accidental acetaminophen cases still outnumbered any others in terms of hepatotoxicity, or liver injury that leads to failure. In total, approximately 56,700 people visit U. S. emergency rooms each year due to acetaminophen overdose — that's roughly the capacity of Yankee Stadium.

"We have twenty-six thousand hospitalizations [of ER patients] per year due to intentional and unintentional overdoses of acetaminophen," says Dr. Peter Lurie of Public Citizen's Health Research Group, in Washington, D. C. "For the companies [involved], this is a very unpleasant fact. They have a product that is making them millions of dollars and is clearly a useful drug, but they don't want their product besmirched." Lurie's and Public Citizen's suggestion: Manufacturers should print larger, bolder warnings, not just on bottle labels and product inserts, as the FDA is wont to have them do, but also on the outside of the boxes.

After Trunk and others spoke, the panel voted twenty-one to one to change the labels on all acetaminophen products sold in the U. S. to bolster the warnings about possible dangerous side effects regarding the liver and discourage combining products containing acetaminophen. It's a start. Even so, one year later, the FDA has yet to put the recommendation into practice. Dr. Jonca Bull of the FDA refuses to give a time frame for new labeling requirements. But this isn't a story about the FDA's at-times creaky ways. It's more a matter of medical risk versus benefit, and how a good drug, a really good drug most of the time, can sometimes go bad.

To its credit, Tylenol's manufacturer, McNeil Consumer & Specialty Pharmaceuticals, a division of Johnson & Johnson, began to strengthen the warnings on its packages last fall — "taking more than the recommended dose (overdose) could cause serious health problems" — well ahead of any official orders by the FDA. And since 1994, on its Tylenol labels, McNeil has also advised consumers not to mix different products that each contain acetaminophen. (Not all manufacturers of generic acetaminophen have followed suit.) But what most drug companies want to avoid are any additional scary warnings or changes in packaging. Whether these kinds of preemptive moves will help keep that from happening in the future is still to be determined.

In the past, surprisingly, as far back as 1977, an advisory panel to the FDA warned the agency about the possible liver-related dangers of acetaminophen. And, like the panel at which Kate Trunk spoke, the '77 group advised the FDA to make label changes in support of consumer safety. But the FDA decided not to accept its own panel's recommendations. More than a quarter century later, as scientists better understand the process of pain-blocking in humans, the echoes of this long-ago panel grow ever more audible.

"ONE OF THE THINGS we would like to do is eliminate misuse of our product," says Dr. Anthony Temple, McNeil's vice-president of medical affairs. "Consumers need to know what a 'dose' is and what a 'total daily dose' is." As things now stand, the maximum recommended adult daily dose of acetaminophen is four grams (4,000 mg), or the equivalent of eight extra-strength, 500 mg tablets per day. For starters, consumers need to be more mindful of whether their Tylenol is regular strength, 325 mg, or extra strength. The difference is more than just ad copy; it's a matter of safety.

EXTRA-CARE LABELING is how it's already done in the United Kingdom, where acetaminophen is known as paracetamol, and where, before changes were made to the packaging, seventy thousand people each year apparently used the drug in suicide attempts. That number has decreased more than 20 percent since 1998, when British medical authorities limited the number and manner in which consumers could buy paracetamol tablets: a maximum of sixteen tabs in blister packaging (which is thought to deter overdosing) per box in a supermarket, or thirty-two tabs in a pharmacy &mdashl up to a total of one hundred tablets at a time without a prescription. And the corresponding labels — and boxes — in the UK are now decidedly starker than those in the U. S.: "Do not take with any other paracetamol-containing products. Immediate medical advice should be sought in the event of an overdose, even if you feel well, because of the risk of delayed serious liver damage." Problem is, no matter if they're Brits or Yanks, most people don't seek medical advice when they feel well.

ALL DRUGS HAVE side effects if enough people take them. And as approximately a hundred million Americans annually take some form of acetaminophen to fight pain and fever — more than any other over-the-counter painkiller — there are bound to be negative reports. Aspirin can cause gastrointestinal bleeding and other problems in millions of users, which is why acetaminophen use soared in the 1950s and 1960s, soon after it was introduced. The first Tylenol was an aspirin alternative for kids called Tylenol Elixir for Children (and sometimes packaged in boxes that looked like little school buses). Aspirin became associated with deadly Reye's syndrome in children in the late 1970s, furthering acetaminophen's reputation as the safer analgesic. The newer nonsteroidal anti-inflammatory pain and fever drugs (NSAIDs), such as Aleve (naproxen), Advil, and Motrin (both ibuprofen), can also cause gastro and kidney problems for some consumers. But the key difference between acetaminophen and all other nonprescription painkillers is that the window between therapeutic and toxic doses of acetaminophen is far narrower than with the other drugs. Bottom line is, there's not a lot of room for error.

Unlike aspirin or the increasingly popular NSAIDs, acetaminophen leaves toxic residues in the liver, however temporarily. Regular meals and fluids (not alcohol) work to clear the residues completely as they are broken down by glutathione, the substance robbed by excess intake of acetaminophen. In brief, acetaminophen, like NSAIDs, reduces pain and fever by interfering with the activity of enzymes called cyclooxygenases, of which there are more than one variant. These enzymes stimulate production of pain-messenger substances called prostaglandins. Each analgesic works slightly differently, depending on its ability to uniquely affect the cyclooxygenase enzymes that are involved with either inflammation or maintaining certain body functions (like keeping the lining of your stomach healthy). While typical NSAIDs and aspirin treat inflammation, acetaminophen doesn't. Acetaminophen's biochemical claim to medi-fame is due in large part to the fact that it doesn't thin the blood or normally cause stomach upset or gastro bleeding, as aspirin can. Which also means that when first introduced, it made good sense as a short-term drug — and still does — for countless seniors, post-surgical patients, pregnant women, and post-childbirth mothers.

"Are physicians surprised that acetaminophen is the number-one cause of [acute] liver failure?" asks Dr. Michael Lockshin, a joint-pain specialist and clinic director at the Hospital for Special Surgery in Manhattan. "I guess I'll say from the time I was a med student in 1968, I've been seeing acetaminophen overdoses in emergency rooms." Yet he also says, "Probably everybody in the country takes Tylenol sometime during the year, while the person who gets into trouble is few and far between. I feel very comfortable telling people to take Tylenol."

ANTONIO BENEDI FELT quite safe taking Tylenol for a bout of flu in 1993. Benedi, then thirty-seven, had just left the White House, where he'd worked as a scheduling assistant to George H. W. Bush. This was well before most people knew about the risks associated with mixing alcohol and acetaminophen, and Benedi had a habit of drinking two or three glasses of wine with dinner. His weakened liver failed, and he was rushed to the hospital not having a clue about the cause or severity of what was happening.

Following an emergency liver transplant, Benedi decided to sue McNeil Pharmaceuticals, in part because he was angered by the company's ads that stated Tylenol was "the safest type of pain reliever you can buy." He won $8.8 million in a federal court for his pain and suffering and the manufacturer's failure to warn consumers. An appeals court upheld the verdict two years later. In 1996, in a full-page newspaper ad for competitor Advil, Benedi was quoted as saying: "We proved in a court of law that the makers of Tylenol had known for more than a decade about the danger of devastating liver injury caused by Tylenol in people who regularly drink alcohol.

"Liver disease experts had asked the company for many years to warn the public about the risk. Tylenol ignored the plea."

Within a day of the original court's ruling in Benedi's favor, the FDA mandated label changes to all acetaminophen products. The swiftness of the FDA action was unusual but perhaps had something to do, political types couldn't help but observe, with the West Wing location of his former job.

"WE NOW KNOW the mechanism of toxicity," declares Olivier Boutaud, of Vanderbilt University's pharmacology department, who is being partially funded by Merck to help find a new and improved acetaminophen. "We are working on a drug with less side effects. When you want to design a drug, you want to know how the other drug works," he adds, taking care not to reveal trade secrets. But he believes he has discovered how acetaminophen works molecularly — as well as how it causes harm. Not an easy feat, considering that after a hundred years of use, we still don't know how aspirin works.

And as Boutaud ascends to minor fame among the drug-designing set (his university is already promoting him as a kind of pharmaceutical supersleuth), he will at some point have to explain how it is he thinks he and his colleagues can ape acetaminophen's positive actions, both legally and inexpensively, and thereby help make the world a safer place. "I am not saying acetaminophen is a bad drug," he said this past summer, pausing slightly for effect. "But it has one very bad side effect. The problem is that its toxicity leads to death. It's more than toxicity... If you take too much, you die."

"MY HUSBAND AND I have been working so hard to boost consumer awareness of the problem," says Kate Trunk, explaining why she went to Washington last fall to talk about her son and acetaminophen. "Now there are three hundred products that contain it... Excedrin has acetaminophen in it. People don't realize that. How many people have also, like Marcus, gotten sick and passed away? How many other people has this happened to?"

If the word gets out, truly gets out, about the uncommon but perilous side effects of acetaminophen, a few changes could occur beyond stronger labeling laws. As in the UK, the number of pills sold at a time could be limited and the packaging changed. The strength of each pill might also be reduced, so that "extra strength" becomes 325 mg instead of 500. And television ads for over-the-counter drugs might face stricter review or regulation. But McNeil Consumer & Specialty Pharmaceuticals of Fort Washington, Pennsylvania, is nothing if not prepared. Turns out they also make and market Motrin.

O.T.C. PAINKILLERS: THE BOX SCORE

First came aspirin, in 1897, then Tylenol/acetaminophen in 1955. Here's a look at how the "ancient" over-the-counter painkillers stack up against the newer analgesics...

HOW DO YOU KNOW IF YOU'VE TAKEN TOO MUCH?

BEYOND THE OBVIOUS CAUTIONS — "READ LABELS carefully" and "don't take extra pills when you feel extra sore" — pain-medicine experts suggest a few key ways to reduce one's chances of suffering liver poisoning from acetaminophen.

First, don't take acetaminophen for longer than ten days at a time. Although generally safe when taken as directed, the drug is a known liver toxin; negative effects can, in some cases, build over time. "Those individuals requiring the use of analgesics [including ibuprofen, naproxen, and ketoprofen] for longer than ten days should be under the care of a doctor," says the FDA.

Second, when treating flu symptoms, don't take different medicines that contain acetaminophen at the same time. Many cold and flu products, such as NyQuil and TheraFlu, contain acetaminophen but don't prominently advertise this fact.

Signs of liver toxicity (which can mimic those of a wicked flu) include:

> severe nausea

> vomiting

> loss of appetite

> sweating

> convulsions

> paleness

> coma

One complicating factor: During a bout of acetaminophen-induced liver toxicity, nausea and/or vomiting are often followed by one to two days of feeling symptom-free. The danger here is that patients can feel much, much "better" even as their livers are failing.

If you do find yourself in the emergency room and know that you have been taking acetaminophen for a while, remember the letters N-A-C. They stand for the nutrient N-acetylcysteine, a natural ingredient most widely used in emergency rooms to counteract acetaminophen toxicity. In brief, NAC replenishes the liver's depleted amounts of glutathione, and it does so in a hurry. (It is sometimes administered intravenously.) Unfortunately, not all doctors or hospital ERs are familiar with signs of hepatotoxicity and thus may not administer NAC in time.

Finally, as the key to preventing long-term or fatal liver damage is to receive treatment as fast as possible following an overdose, four Stanford University professors have recommended an elegant solution: Why not precombine Tylenol and other acetaminophen products with low doses of NAC? Studies have shown that it doesn't affect the efficacy of the drug, and the additional manufacturing costs would be minimal.

"Two hundred milligrams of added NAC per 500 milligrams of acetaminophen can prevent liver toxicity," says James P. Andrus of Stanford University's pediatric critical-care division.

Warnings would be obsolete.

Originally published in Esquire as "Side Effects May Include Death" in September 2003 issue

Creative Commons photo "Pills" by Jamie

The Cove

Oscar-winning documentary (2010) featuring state-of-the-art equipment, a group of activists, led by renowned dolphin trainer Ric O'Barry, infiltrate a cove near Taijii, Japan to expose both a shocking instance of animal abuse and a serious threat to human health.

BoCo Media worked with director Louie Psihoyos to write and distribute the first trailer for the film, introducing the Ground Zero notion of the world's captive dolphins, from Japan to the West Indies to Sea World. BoCo's co-founder, producer Paula DuPre' Pesmen, joined Louie, Ric and producer Fisher Stevens on the Oscars' stage.