The First Rule: Eat When You Can, Sleep When You Can, And Don’t Screw With The Climate!


My prognosis is very likely to be very good, despite the ominous sounding diagnosis — a small well-defined pancreatic neuro-endocrine tumor (PNET). Today, Thursday, I had surgery at Johns Hopkins to remove it. It wasn’t causing symptoms (that I’m aware of).

A PNET may or may not be cancer depending on your definition of cancer. In any case, it’s not what people normally think of when they hear the word cancer, particularly pancreatic cancer. You can read a “layman’s guide” to PNETs by Matthew Dallek at Slate.

I don’t generally blog about my health, in part since it takes a lot to stop me from blogging, but this is blogworthy, I think for a few reasons:

  1. There are many analogies between dealing with early stage climate change and dealing with early stage diseases, analogies I’ve often made myself. As you can imagine, I’ve thought of a few more in the last several weeks.
  2. Steve Jobs had a PNET, too, so there is a lot written about them for a general audience — and a lot written about Jobs’ 9-month delay in seeking conventional treatment (i.e. surgery).
  3. It is Rare Disease Day. No seriously, click here. If you can’t write about a rare disease today, when can you? [And yes, my surgery was scheduled today purely coincidentally.]

Analogy-wise or coincidentally (take your pick), Hopkins uses a consensus-based approach for cases like mine. So every Tuesday night, one of the doctors presents the case to the entire multi-disciplinary pancreatic cyst team — a big group of gastroenterologists, surgeons, pathologists, researchers, radiologists, and others — and they come up with a recommended course of treatment. [A key reason this team exists is that CAT scans and the like are so good now they pick up a lot of cysts and tumors at an early stage incidentally — as in my case and Dallek’s — and folks need to figure out what to do with them.]

The doctors say my prognosis is very probably very good — won’t know for sure until they remove and examine it. But then the prognosis was apparently quite good if I didn’t do anything — but there was chance it would metastasize, so the recommendation is to take it out. Can’t argue with the consensus, can you?

So one big difference between this PNET and global warming is that global warming is highly likely to be fatal to a livable climate and modern civilization if left untreated. Still, I think it safe to say  that most people would take it out, but then most people act considerably more risk averse toward worst-case scenarios in their own life than society is acting towards the business-as-usual scenario of  unrestricted emissions of greenhouse gas.

The other reason most folks would take this out is that Steve Jobs delayed removing his. Jobs had a PNET, too, though his may have been symptomatic and functioning (i.e. releasing hormones) and mine does not appear to be (it was discovered incidentally). His was at the head of the pancreas, which required far more extensive surgery. Also, he put off surgery for 9 months doing alternative medicine, which may or may not  have contributed to his death — there is huge controversy over that.

I’m more of an integrative medicine person (where you add some alternative medicine to regular medicine). My sort of thing would be “Modified Citrus Pectin,” for there is a fair amount of  scientific support and not a lot of downside — see the literature review at the MD Anderson Cancer Center website if you know someone who is worried about metastasis. Interestingly, I wouldn’t have heard about “Modified Citrus Pectin” if not for this interesting article, “Did ‘Alternative Medicine’ Kill Steve Jobs?” by the editor in chief of Integrative Medicine: A Clinician’s Journal.

It is simply impossible to know whether Jobs’ delay contributed to his death. You can read one of the blog posts that started the debate at quora (you must sign up) by Ramzi Amri, MD/PhD Candidate, MGH Surgical Oncology, who argues the delay may have been fatal.

But for differing views see and the NY Times piece, “A Tumor Is No Clearer in Hindsight.”

I certainly have no idea whether Jobs’ delay contributed to his death — but it is quite clear from published interviews with Jobs and his close friends that Jobs himself thought it did.

So as you can imagine, there aren’t many folks who leave these in anymore. Mine is small — a half inch or 1.3 cm (whichever sounds smaller). Dallek’s was the size of a “large tennis ball.” I’ve never seen the size of Jobs’ PNET published.

That is another difference between this PNET and global warming. With the PNET, we have the benefit of seeing what happens when other people do or do not remove them. With global warming,  there is no such information. I’m pretty certain that if people actually saw what climate inaction does to a planet with 9 billion people, we’d have a whole lot of action.

I got a laparascopic distal pancreatectcomy at Johns Hopkins. Your post-surgery prognosis is probably a product of your surgeon’s competence and the hospital’s likelihood of not making a mistake. Apparently 1 hospital patient in 4 (!) is subject to a major mistake.

That’s why I had the surgery done by the same folks who pioneered the checklist approach in hospitals.

Still, this is a delicate operation (It’s a week in the hospital — less if I feel better and have no complications — and then 4 – 6 weeks recovery).

Indeed, if you use Google you can find the unofficial first rule for surgeons is, “Eat when you can, sleep when you can, and don’t f@ck with the pancreas!”

And, with a one-word change, that will eventually be the rule for humanity. The sooner, the better.

P.S. They say laughter is the best medicine, so if you want to post links to humor — nothing gut busting of course — please do. If this link here doesn’t make you smile, nothing will.

P.P.S. I don’t think I’ll generally be posting blog updates on my progress, but I will be tweeting on it.

P.P.P.S. My new motto: When life gives you lemons, make Modified Citrus Pectin.

72 Responses to The First Rule: Eat When You Can, Sleep When You Can, And Don’t Screw With The Climate!

  1. cathy strickler says:

    I will be thinking of you. Please don’t rush your recovery. sending thoughts of gently lapping tropical beaches.

  2. Mulga Mumblebrain says:

    Very good luck, indeed. I’m pretty much with you in combining traditional medical approaches with alternatives. My aunt is following a regime of chemotherapy plus Chinese herbal medicine to treat lung cancer, and, at 83, when they gave her six months, she’s been going for two years, and her last scan showed the lesion to have shrunk almost to nothing. She’s got the correct stoic attitude, too. One day at a time. Easy at 83.

  3. Mike Roddy says:

    We expect nothing less than a full recovery. The world needs you, Joe, and there is nobody who can fill your shoes.

  4. Thanks for sharing, Joe. It sounds as if you can live with it. I had a tumor removed from the brain 3 Nov 2011. Glioblastoma multiforme (Stage IV).

  5. Best wishes for a quick recovery, Joe!

  6. Paul Magnus says:

    Hey, Joe, man! Good advice… Eat when you can, sleep when you can, play when you can, and don’t spend too much time on the puter.

  7. Stewart Hardison says:

    My apology, Joe, for somehow posting my get well note under the Chevy Volt article, duh?

    Here’s what I said the first time:

    Get well, Joe! You’re one of the true climate heroes and we need you to stick around for a good long while and keep fighting the good fight.

  8. Joe Romm says:

    Surgery went well. Clear margins. Spleen was saved, which is a key reason I chose the surgeon I did. Updates on twitter.

  9. Yes, ditto to all the above. Heal fast. And feel free to come out here with the family if you need to recuperate. Boondoggle can be organized.

  10. Merrelyn Emery says:

    One of my favourite sayings is “Life is a terminal disease”. Yeah, I know, black, but the corollary is “Love life, laugh a lot and you may have more of it”. I wish you good science, good luck and lots of laughing Joe, ME

  11. question says:

    Best wishes and many thanks! Recover soon (but don’t push it) and keep leading the fight.

  12. Joan Savage says:


    Best wishes and I hope you have some playful moments while recuperating. Good for the immune system, y’ know.

    A solid piece of advice from one of my doctors was to not take personally the general prognosis statistics that came with a cancer biopsy. That’s the general population, she said, it’s not you!

    Sounds like our usual distinction between a single case and an overall pattern, eh?

    Have some fun while recuperating. Terrible puns would be welcome.

  13. Chris Mclean says:

    Stay safe and healthy.

  14. Chris Mclean says:

    Stay safe and healthy.

  15. Chris Dudley says:


    Wishing you a quick recovery and a long healthy life.

    Best regards,


  16. Harry Middlemas says:

    Best wishes and a quick recovery!!


  17. Ben Lieberman says:

    Best wishes for a speedy recovery.

  18. Keep blogging, Joe. It’ll speed your recovery! ;-)

    Your analogy is on the right track: we have others’ experience to realize the wisdom of attacking PNETs, but climate change is absolutely unprecedented.

    But the lack of comparable experience isn’t the only issue. AGW is on a planetary rather than a personal scale. I can personally remove a PNET, but I can’t personally stop AGW, or even make more than a symbolic scratch in it, and even as I do, I see no immediate personal benefit.

    That is the nut of the problem: it takes us all to have a communal realization and take communal action for any of us to gain from it. And we are personally disadvantaged (at least in our current economic system) if we take it much farther than our fellows.

    It’s a classic prisoners’ dilemma, solved positively for all only by trust and agreement.

    Too bad there isn’t a surgery to implant those attributes in every human on the planet.

  19. Rabid Doomsayer says:

    I know of a few good results mixing traditional with alternative medicine. Just check with your Doc that it will do no harm, Alternative therapies do contain active ingredients that can compound or nullify traditional medicines.

    Get well soon. That you are blogging this early is a good sign, but do get the rest you need.

  20. Ozonator says:

    Since Obamacare is not needed because laughter is the best medicine, AGW from Frick and Frac –

    “U.S. Sen. Jim Inhofe, R-Okla., was awarded the “True Blue” award from the Family Research Council. The award honors … leadership and commitment to the defense of family, faith and freedom … Tony Perkins, president of the Family Research Council” (“Family Research Council recognizes Senator Jim Inhofe with award”; Special to The Sun; Local News;, 2/25/13). Meanwhile, in Evil Inhofe’s Oklahoma, “Midwest City Police Chief Brandon Clabes said he has received reports minor of damage from residents, such as ceiling cracks and molding and pictures being knocked off” (“Earthquake reported near Nicoma Park”; FROM STAFF REPORTS;, 2/27/13).

  21. Steve Bloom says:

    You named your tumor Ming? Hmm, not quite sure what to make of that… Aha, gone in a Flash? :)

    Best wishes for a quick and permanent recovery, Joe. The planet needs you.

  22. bill mckibben says:

    Strength, brother–we need you going long and strong!

  23. Mark Shapiro says:

    All the best !

  24. Sasparilla says:

    My best wishes, take the rest you need and a speedy recovery Joe…thanks for choosing to share this with us.

    I look at the comments and it looks like this whole group you’ve brought together is at your virtual bedside here.

  25. elisabeth says:

    I read the article about Steve Jobs in the link below and thought you might find it interesting as well. Sounds like your situation is quite different, thankfully. Speedy recovery to you…

  26. Brian R Smith says:

    I just today finished reading Language Intelligence (thank you!) which ends with:
    “.. fighting the good fight in the face of the fiercest foes.” Best to you & thanks for all you do.

  27. Dennis Tomlinson says:

    Best wishes for a full and apeedy recovery Joe.

  28. Mulga Mumblebrain says:

    I like the version that says, ‘Life is a sexually transmitted disease with 100% mortality’.

  29. Mulga Mumblebrain says:

    Dennis Potter, the playwright, named his ‘Rupert’ after his least admired media mogul.

  30. Tim Laporte says:

    Much love to you Joe. The doctors at Hopkins are the best in the world. I’m sure you’ll be up and about before you know it!

  31. prokaryotes says:

    Medicinal Cannabis and its Impact on Human Health

    Notice i do not advise anything just want to leave that here. In a nutshell – THC kills cancer cells – The oil should be legal for self medication.

  32. David Goldstein says:

    Joe- best wishes for your recovery. I can very much relate. I have created and presented a 90 minute presentation based on my health journey- 2 major autoimmune diseases, removal of colon, liver transplant, diabetes, cancer, 18 hospitalizations, etc. I compare and contrast my early avoidance and denial of medical science with that of climate change. I do the same with the early onset, medium onset and late onset symptoms of the liver disease. It is almost a perfect mirror- my rising liver enzyme numbers over the years even create very similar graphs to rising Co2, temps, etc. It is a pretty amazing process watching humanity, to a great extent, ignoring the diagnoses and prescriptions of the ‘doctors’. I know what the consequences of such denial/avoidance can be- and they aint pretty. Conversely- bold and courageous action can make all the difference- I am happy and healthy today.

  33. Merrelyn Emery says:

    Ah yes but you can always “Avoid the consequences: don’t grow up!” ME

  34. Monica M says:

    I checked in to see what you had to say on the AFL-CIO statement (which I’m completely disgusted with) and find you’re barely hours out of the O.R. and blogging and tweeting! Incorrigible. The nurses were the heroes in Orlando, and I’m sure they’ll come through for you, as well, as you recuperate. Take care.

  35. Salamano says:

    All The Best, Joe.

    It’s got to be a scary thing, even if you are on the right side of early diagnosis, treatment, and prognosis.

    Your blogging is insatiable, and naturally your audience’s appetite always seems to match with consumption. I pray you are restored to full health (or permitted to maintain the same, as the case may be).

  36. Lucas says:

    I’m interested to hear what your definition of the term Alternative Medicine is.

    The snake oil salesmen define it as medicine that is reliable and used in the East. Sceptics define it as medicine that necessarily doesn’t work, otherwise it would be part of conventional (evidence-based) medicine. Quackwatch says: “Alternative is a slogan often used for promotional purposes. Methods should be classified into three groups: (1) those that work, (2) those that don’t work, and (3) those we are not sure about.”

    Take care, and thanks for your awesome blog!

  37. Artful Dodger says:

    … and you as well, Bill. Namaste!

  38. Daphne Wysham says:

    So glad the surgery went well! We’re all pulling for you, Joe.

  39. Well, I may disagree with you on climate change, Joe, but I’m glad to read that you’re doing OK. Here’s to a long, long life for you.

  40. Mike Roddy says:

    That’s been my game plan, Merrelyn. Otherwise, all of the frustration and bad news we endure these days would be very hard to take.

    Joe’s got a sense of humor. I wish he’d express it more.

  41. Paul Klinkman says:

    Bless you for being upfront with the issue.

    May your surgery go well.

    “Rare” diseases are the other huge environmental issue. Our people around us are more often than not getting sick from illnesses that almost didn’t exist 200 years ago. The whole universe of cancer was a 1 in 18000 people disease from Greek times, where it was identified as a rare disease, until about 200 years ago.

  42. Paul Klinkman says:

    Keyboard double bounce. 1 in 1800.

  43. Jim says:

    Get well soon brother. You’re a warrior and we need you.

  44. Nan says:

    Sending you very warm wishes for a speedy recovery. You are more important than you realize.

  45. todd tanner says:

    Best wishes for a full & speedy recovery, Joe. I hope you feel better soon.

  46. TerryM says:

    Best wishes Joe

    6 years free after 7 surgeries in 3 years. Last checked 2 days ago.
    FWIW last surgeon trained at John Hopkins.


  47. john atcheson says:


    Get well, and don’t rush things. If you need sun, come on out to San Diego. You’re always welcome.


  48. Chris Winter says:

    Get well, Joe.

    At the risk of telling you what you already know…

    As Norman Cousins wrote about his illnesses, plenty of laughter is indicated. I don’t think you will have any trouble filling that prescription. (Cousins used Marx Brothers films.) His experience is recorded in Anatomy of an Illness.

    As you probably know, Cousins was editor at the Saturday Review for may years. His legacy includes the The Norman Cousins Center for Psychoneuroimmunology at UCLA. There is considerable support for the idea that laughter can augment the effectiveness of conventional medical techniques, earning it the term humor therapy from the American Cancer Society.

    Here’s one take on the subject:
    A Laugh a Day Keeps the Doctor Away?
    by Jackie Chew, 2001.

  49. Glen says:

    Best Wishes, Joe

  50. Joe,

    Although I’m a devotee, I usually just lurk in the background, absorbing all your essential and insightful posts and the comments of others. But this post got me out of my cave. We need you. The planet needs you. All my very best for a quick and full recovery.


  51. SecularAnimist says:

    Be well, Joe.

  52. Gingerbaker says:

    Best wishes for a happy recovery, Joe!

  53. James W. Crissman says:

    Hey Joe! Heal fast, my friend. I got the incidental dx of kidney cancer almost 5 yrs ago — stage 1, grade 1 — so I’m going to have to think of something else to die from. But the great thing about having only one kidney is that you get only half as pissed off. I don’t think losing a chunk of pancreas will have the same effect, and I sure hope you’re right back on the beat, asap. You’re necessary! Get well soon! Jim

  54. Greatgrandma Kat says:

    Joe, Get well soon, though it sounds like you are going that way fast already which is really good to hear. Our whole family is sending positive thoughts and giggles from the greatgrand kids which I have found to be the best medicine for recovery for everything from sad thoughts to surgery.

  55. Merrelyn Emery says:

    Everybody still has those attributes Change, you see them when people spontaneously organize themselves to help with disasters etc. Unfortunately, our dominant organizational form encourages the opposite set of attributes but we could change that if we chose, ME

  56. PeterM says:

    Best of health Joe- you are one of my Heroes.

  57. Zach Shahan says:

    Best of luck to you! Happy to hear the surgery went swimmingly! And since you only requested funny things, I think this is pretty funny:

    You might like this:

    I think this definitely is… but also isn’t in some ways, but think you’ll enjoy it if you haven’t watched it already:

    And this movie scene always makes me laugh:

  58. Brooks Bridges says:

    I do wish you the best Joe. You do so much for so many.

    And for some great curative humor: I had a bad day today and decided to put on the way-over-the-top, adolescent humor perfected, “Up in Smoke” – Amazed to find it is still one of the funniest movies I’ve ever seen.

  59. Joe, having gone through laproscopic surgery for prostate cancer, and having achieved a “surgical cure”, I can say that it is very uncomfortable for longer than you want it to be, but it sure as hell beats the alternative.

  60. Dick Smith says:

    You make good lemonade. My best wishes for a fast and full recovery.

  61. Scott says:

    Best wishes, Joe. Your great attitude will help you through!

  62. jean says:

    I found it to be moving to be writing about your problem and then keep on target w Global Warming!I look forward everyday for my email from Climate Progress…Don’t forget to focus on the breathe…Inhale slowly and say to yourself”Breathe in I relax the body”…

  63. chidananda nath says:

    i love this….thanks

  64. Lionel A says:

    Having just escaped the grim reaper a few years back from myocardial infarction, twice in two days, and now facing increasing difficulties as various organs degenerate I am still smiling and cracking jokes and thinking positive – every day is a bonus and I have seen three grandchildren who I would not otherwise have done.

    It is for their future that I wish you the best recovery, you well deserve your place in the Guardian Climate change abolitionists list.

    It is people like you who keep me plugging away at those who side with the deniers, delayers and incorrectly programmed.

  65. Lionel A says:

    Alternatively, and borrowing from pilots WRT take off and landing: Conception is optional, death is mandatory.

  66. Ken Hayes says:

    Joe, you are one of my heroes! I visit your website several times a day and often share your blog with friends and colleagues.

    Humor is indeed a boon to our spirit. How about we all share with Joe some humor!

    My students love these videos:

    An advert that’s a parody of the 1984 video “We are the World”

    Another parody by the same company of the video “YMCA” by the Village People:

  67. Lionel A says:

    Having escaped the grim reaper a few years back from myocardial infarction, twice in two days, and now facing increasing difficulties as various organs degenerate I am still smiling and cracking jokes and thinking positive – every day is a bonus and I have seen three grandchildren who I would not otherwise have done.

    It is in part for their future that I wish you the best recovery, you well deserve your place in the Guardian Climate change abolitionists list.

    Best wishes for recover Joe for it is inspiration from you that keeps me plugging away at those who side with the deniers, delayers and also the simply mislead.

  68. Mulga Mumblebrain says:

    Congratulations! I know that I’d be lost without my spleen.

  69. Mulga Mumblebrain says:

    German physicians, in the days before mass cigarette smoking, would gather their students when a patient with lung cancer was found, it being, then, so rare an affliction.