Friday 31 October 2014

Prostate cancer's fatal weakness…copper?



Many thanks to my good friend Chaz Dowie for finding this...


Prostate cancer's penchant for copper may be a fatal flaw
Date:
October 15, 2014
Source:
Duke Medicine
Summary:
Like discriminating thieves, prostate cancer tumors scavenge and hoard copper that is an essential element in the body. But such avarice may be a fatal weakness, scientists report. Researchers have found a way to kill prostate cancer cells by delivering a trove of copper along with a drug that selectively destroys the diseased cells brimming with the mineral, leaving non-cancer cells healthy.
Like discriminating thieves, prostate cancer tumors scavenge and hoard copper that is an essential element in the body. But such avarice may be a fatal weakness.
Researchers at Duke Medicine have found a way to kill prostate cancer cells by delivering a trove of copper along with a drug that selectively destroys the diseased cells brimming with the mineral, leaving non-cancer cells healthy.
The combination approach, which uses two drugs already commercially available for other uses, could soon be tested in clinical trials among patients with late-stage disease.
"This proclivity for copper uptake is something we have known could be an Achilles' heel in prostate cancer tumors as well as other cancers," said Donald McDonnell, Ph.D., chairman of the Duke Department of Pharmacology and Cancer Biology and senior author of a study published Oct. 15, 2014, in Cancer Research, a journal of the American Association of Cancer Research.
"Our first efforts were to starve the tumors of copper, but that was unsuccessful. We couldn't deplete copper enough to be effective," McDonnell said. "So we thought if we can't get the level low enough in cancer cells to kill them, how about we boost the copper and then use a drug that requires copper to be effective to attack the tumors. It's the old if-you-can't-beat-'em-join-'em approach."
McDonnell and colleagues searched libraries of thousands of approved therapies to identify those that rely on copper to achieve their results. Among those they found was disulfiram, a drug approved by the FDA to treat alcoholism. Disulfiram had at one time been a candidate for treating prostate cancer -- it homes in on the additional copper in prostate cancer tumors -- but it showed disappointing results in clinical trials among patients with advanced disease.
The Duke team found that the amount of copper cancer cells naturally hoard is not enough to make the cells sensitive to the drug. But when the Duke researchers added a copper supplement along with the disulfiram, the combination resulted in dramatic reductions in prostate tumor growth among animal models with advanced disease.
And there was another surprise: Androgens, the male hormones that fuel prostate cancer, increase the copper accumulation in the cancer cells. McDonnell said this finding could make the combination of disulfiram or similar compounds and copper especially beneficial for men who have been on hormone therapies that have failed to slow tumor growth.
"Unfortunately, hormone therapies do not cure prostate cancer, and most patients experience relapse of their disease to a hormone-refractory or castration-resistant state," McDonnell said. "Although tremendous progress has been made in treating prostate cancer, there is clearly a need for different approaches, and our findings provide an exciting new avenue to explore."
McDonnell said clinical trials of the combination therapy are planned in upcoming months.
Andrew Armstrong, M.D., associate professor of medicine, was involved with a recent study at Duke testing disulfiram in men with advanced prostate cancer.
"While we did not observe significant clinical activity with disulfiram in men with recurrent prostate cancer in our recent clinical trial, this new data suggests a potential way forward and a reason why this trial did not have more positive results," Armstrong said. "Further clinical studies are now warranted to understand the optimal setting for combining copper with disulfiram or similar compounds in men with progressive prostate cancer, particularly in settings where the androgen receptor is active."

Story Source:
The above story is based on materials provided by Duke MedicineNote: Materials may be edited for content and length.

Journal Reference:
  1. R. Safi, E. R. Nelson, S. K. Chitneni, K. J. Franz, D. J. George, M. R. Zalutsky, D. P. McDonnell. Copper Signaling Axis as a Target for Prostate Cancer TherapeuticsCancer Research, 2014; 74 (20): 5819 DOI: 10.1158/0008-5472.CAN-13-3527

Cite This Page:
Duke Medicine. "Prostate cancer's penchant for copper may be a fatal flaw." ScienceDaily. ScienceDaily, 15 October 2014. <www.sciencedaily.com/releases/2014/10/141015084514.htm>.

Wednesday 29 October 2014

To a friend who's worrying right now but needs to know he's not alone...

I've just found that a friend has been examined by his doctor and consultant, and is now going for a biopsy next week. I want to write to him here because so many other men will be in his position right now, wondering what the next few months will hold, and this letter may benefit them...

Dear friend,
                     At this stage you don't know if you have prostate cancer but you've researched it to death, so you know a hell of a lot more than you did a few months back. But it's information overload and you're worrying yourself to death over things that probably won't turn out anywhere as near as bad as you're thinking right now. You may even be told that you don't have prostate cancer, only one in ten enlarged prostates turn out to be cancer!

A guy in the states said, "You shouldn't look at a diagnosis of prostate cancer as a visit from the grim reaper, more a long slow waltz with the angel of death". I liked that, because when I was first diagnosed, I just thought I was going to die, yet 4 years later, hey man I'm still kickin! Winning the battle in your mind is critical at this stage, and not imagining the worse, but staying focused on today. Your mind will try and play out dozens of different scenarios on the information you already have, but why bother, you know nothing yet!
There is a urine test that will tell you if you have prostate cancer, but I'm afraid it won't tell you what gleason grade you have; that's why the biopsy. I would describe this as 'uncomfortable', but you do get a local anaesthetic and antibiotics before you leave to prevent infection. You will have usually 12 needle samples taken, and these are guided by the nurse on an ultra sound scan, so that they can go for areas that look suspicious. The whole thing takes around 20 minutes and I have to confess, it's not as bad as the dentist!
Take a nice big cushion for the seat of the car and whatever you do, don't drive yourself back! They will tell you that there may be a bit of blood in your urine. Ha ha, everyone is probably different but I had blood in everything, yes, everything, but that's perfectly normal and takes a few days to go away.

The result, 8 days or so later will tell you what grade cancer you have if they find any, but it is possible that if they don't find any, that cancer is still there but may be in an awkward place to biopsy. If you need a second biopsy it will be a 'saturation biopsy' under general anaesthetic, but that doesn't often happen.
At this stage, if no cancer is found then that's still an excellent sign, because if there is any, it's going to be very small. You may even be put on what they call 'watchful waiting', where they just keep an eye on you for years ahead with 6 monthly PSA's.
If you are told you have prostate cancer, Gleason 6 is the dream ticket at this point. Very early stage, unlikely to have travelled to anywhere else in the body, my brother Paul had this. I had Gleason 7 (3+4), a little more nasty but as it was contained, only a 5% chance of recurrence for me now. Gleason 8 to 10 is more likely to travel, but if caught early is completely treatable with surgery.

The next stage is an MRI, but that's not possible for around 6 weeks after the biopsy as they need to give the prostate a chance to heal. During this time you will also be booked in for a bone scan (that's routine), just to make sure the cancer hasn't metastasised, but if you've already been told the cancer is localised, it's rare that a bone scan will show anything going on. Only after the biopsy, bone scan and MRI will your MDT meeting take place, where all specialists involved will get together to offer you 'best advice' on the way forward. At that stage, there are several paths open to you, from surgery to radiotherapy, radioactive implants to alternative medicines, but the choice is left to you. I'm happy to help you if needed, but it may not even come to that, because today is 'today' and officially, you're still all clear until told otherwise.

Having said all this, know that I am only a Skype away if you need to talk and take it one day at a time. Good luck with the biopsy, treat yourself to a nice drink that night and I'll toast to your long and healthy future.

Best wishes always

Daniel

Tuesday 28 October 2014

PSA 4 year all clear...

                                                                              
Christmas has come early for me. I went to the doctors yesterday after having problems with my heart all weekend. The ECG turned out fine, apparently 10% of the 'elderly' population experience what I had. 'Elderly'? Am I? The pulse was regular but every so often I was missing a beat. Sometimes after 2 or 3 beats, other times after nearly a minute, but I could feel it in my chest, though there was no pain. The doctor sent for a thyroid blood test so while we were at it, may as well have the PSA done, be it a few weeks early.

The all clear came through at 6pm from the surgery…same feeling of delight that I've experienced 8 times now since surgery. The hours of dread before hand are the same and I feel sorry for Beverley putting up with me during that time.

So I'm clear until May 2015 until we do it all again. No announcements on Facebook this time as there are people I know who have been far less fortunate than me, going through the mill right now. I pray for them in my own way, wishing I could do something, anything to help.

Lloyds Bank had 62,132 complaints referred to the Ombudsman in the first 6 months of 2014


My complaint at...
http://complaintslloydsbank.blogspot.com/
is the tip of the iceberg!


Giant state-backed banking group Lloyds was the most complained about financial institution in the first six months of the year, figures show.
Across its different brands, which include Halifax and Bank of Scotland, it attracted a third of the total complaints received by the financial ombudsman, which settles disputes between banks and their customers.
The ombudsman received 62,132 new complaints about Lloyds Banking Group between January 1 and June 30. The total across all institutions was 191,129.
Lloyds was followed by Barclays, which had 27,487 complaints. Royal Bank of Scotland, another state-backed giant, had 13,654 complaints passed to the ombudsman (see table below).
However, these three groups, which account for a large proportion of banking customers, saw overall complaint numbers decline from the previous six months.
Figures were lower than in the second half of last year due to a shrinking number of payment protection insurance (PPI) cases, the ombudsman said.
Complaints about PPI fell to 133,819 from 266,000but still accounted for seven out of 10 cases.
Outside of PPI, banking complaints rose 7pc overall and the ombudsman warned there are signs that banks and other firms were failing to handle complaints properly.
The proportion of cases where the ombudsman found in favour of the customer rose from 51pc to 57pc.
Among the worst offenders were the smaller lender MBNA, which lost 93pc of cases. HSBC lost 78pc, and Barclays and Lloyds Bank both lost 66pc.
Caroline Wayman, chief ombudsman, said: “We’re seeing more and more people turn to us in frustration where they feel their bank or insurer simply doesn’t understand or really care. And we’re hearing growing dissatisfaction from people about being processed industrially as a number rather than being listened to as an individual customer.
“By giving their customers more thoughtful, considerate and personal responses – clearly setting out the reasoning behind an individual decision – we know that businesses can help sort out problems earlier on, prevent complaints being escalated to the ombudsman and rebuild trust and confidence more generally.”
James Daley, director of consumer website Fairer Finance, said while banks had improved complaints handling procedures in the first few years after the financial crisis, those improvements seem to be stalling.
"If more than 50pc of complaints to the ombudsman are being upheld in favour of the customer, then quite simply banks are making the wrong decision when a customer first complains, more often than they're making the right one,” he said.
"Banks need to make every effort to sort out complaints at the very beginning of the process, and should be ready to give customers the benefit of the doubt more often – rather than forcing them to appeal to the ombudsman, which can drag out disputes for months on end."
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Sunday 26 October 2014

Julie says, "Get yourself checked"...


Alvin's last words of love: Speaking just hours after losing the man she adored, Alvin Stardust's wife reveals his deathbed wish and why he hid his fight with prostate cancer.


  • Julie was married to Seventies pop star Alvin for a blissfully happy 27 years. She was in the bedroom when the glam-rock singer died on Thursday. The 72-year-old had been battling prostate cancer for 18 months.
  •  
  • This interview was arranged by Alvin to encourage testing for the disease
Alvin Stardust’s widow Julie is an astonishing woman. Four hours before our meeting at the home she has shared with the Seventies pop star for a blissfully happy 27 years, she was lying beside him as he struggled through the final, painful minutes of his life.
‘Go to your mum, my darling,’ she had urged him. ‘She’s waiting for you. I need you to know you can go now and be at peace and that I love you and you don’t need to worry about us.’
‘Us’ is Julie, 44, and their gorgeous 13-year-old daughter Millie Margaret Mary. They were both there in the bedroom alongside Alvin’s grown-up children from two earlier marriages when the legendary glam-rock singer, who has been battling prostate cancer for 18 months, mouthed ‘I love you’.

Devoted: Alvin with his beloved wife Julie and daughter Millie Margaret Mary at their home in Ifold, West Sussex
Devoted: Alvin with his beloved wife Julie and daughter Millie Margaret Mary at their home in Ifold, West Sussex

Within an hour, he had died. He was 72 years old.
Julie wept, raged then dried her eyes and now here she is, showered and buoyed with a cup of strong coffee, pulling upon every last ounce of strength she has to give this interview.
The undertakers have not even been to collect Alvin’s body and some of their dearest friends have yet to be told, but this is of the utmost importance to Julie. She says it was to Alvin.
He had, you see, arranged this interview himself after learning on Monday the cancer he’d been battling for a year-and-a-half had spread to his liver. As his oncologist explained, ‘you have to prepare yourself. You’re coming to the end of the journey.’
Pop star: The singer in his glam-rock heyday in 1974. He battled prostate cancer for 18 months
Pop star: The singer in his glam-rock heyday in 1974. He battled prostate cancer for 18 months
‘That was the hardest moment because we both looked into each others’ eyes and were kissing each other saying, “I love you, I love you, I love you,” ’ says Julie, her eyes streaming with the tears that are a constant throughout our discussion.
‘I said: “Now is the time to stop fighting, darling. Now is the time to be peaceful and calm.”
‘Luckily that happened at 7.10 this morning. What day are we now?’ Thursday, I tell her gently. Does she want to stop? Perhaps I should come back another time?
‘No, I want to do this for him,’ she insists. ‘At 3am this morning he was still determined he was going to give this interview himself. But he was so weak. I was worried in the middle of the night thinking: “Oh what will I do? I’ll have to talk for him and he’ll just nod.”
‘If that had happened you’d have seen in his eyes whether or not I was interpreting what he felt and thought correctly. He had the most amazing eyes. They were so honest. He was such an honest and decent man...’
Again, she weeps. ‘What am I going to do? I’ve been loved by the best. What now?’
This lovely family home in Ifold, West Sussex, is filled with the couple’s close family. Perhaps Julie should be with them instead of sitting here surrounded by the many family photographs of happier times? What about their daughter, Millie? Doesn’t she want to comfort her?
‘Millie’s with a friend,’ says Julie. ‘She’s not good. She’s had five minutes on her own with him, but she said, “Mum, I don’t want to see him being cold.” So I sent her off.
‘But she’s the point of this, don’t you see? If Alvin had been diagnosed earlier, our 13-year-old daughter would still have had a father. That’s why he wanted to do this. He wanted to tell people to get checked.
‘But sadly, it caught him before he could say it, so I have to be the voice for him. I want to do this for him because I know he’d have wanted me to. He wanted people to know he’d battled on and that you can keep fighting.’
Indeed, as recently as five days before his death, Alvin was on stage in concert in Evesham, Worcestershire, blasting out his top ten hits such as My Coo Ca Choo, Jealous Mind and I Feel Like Buddy Holly. The only clue he was so desperately ill was the fact that he had to sit on a stool instead of stand up.
‘The cancer was in his spine and his back was so painful, he couldn’t stand for long,’ says Julie. ‘Only his family and a few very close friends knew.
‘Alvin’s instinct was the show must go on and, as long as he kept fighting, it would. He wanted to say to his fans in this interview today that they might have noticed he’d been a little doddery and this was the reason why.
‘He didn’t say anything earlier because if everyone had been wonderful and kind to him, he wouldn’t have been able to go on stage because it would have been too emotional. The love would have just wiped him out.’
Alvin Stardust, born Bernard Jewry, was that rare thing in showbusiness: a thoroughly decent man.
While his dear friends included the likes of Eric Clapton, Gary Brooker of Procul Harum, The Who’s Kenney Jones, Suzi Quattro and Cliff Richard, who is godfather to Millie, a glitzy lifestyle wasn’t really his scene.
Rare: Alvin Stardust, born Bernard Jewry, was that rare thing in showbusiness: a thoroughly decent man
Rare: Alvin Stardust, born Bernard Jewry, was that rare thing in showbusiness: a thoroughly decent man
Instead, he preferred to spend time with his family, pottering around the garden and playing with his little girl. Julie was just 18 when she met 45-year-old Alvin — who was by then separated from his second wife Liza Goddard — in a 1988 production of Godspell.
Her parents, who are here in the house this morning, were horrified she’d fallen in love with a man so many years older and took the best part of a year to warm to him.
On Wednesday, when his condition began to rapidly deteriorate, they told him they wouldn’t have ‘changed a hair on his head for the world’.
During Alvin’s lifetime Julie never gave a thought to the fact he would probably leave her a widow. He was, she says, ‘such a vibrant, young man’.
Professional: As recently as five days before his death, Alvin was performing for fans. Above, the singer on stage last year
Professional: As recently as five days before his death, Alvin was performing for fans. Above, the singer on stage last year
‘The age thing never ever came into it because as he grew older and slightly frailer towards the end, I just grew to love him more.’ She snorts a half laugh.
‘We did have a wry smile at the beginning of the week after we’d been told it was the end of the journey. I said: “well there is one thing about it, darling. I’ll remember you like this. You’re still handsome — which he is — and I’m not going to be remembering taking you here, there and everywhere in a Zimmer frame.”
‘He could have lived to the ripe old age of 88 and I’d have been there, because I adored him, but I might have resented it.
‘The only time I’ve thought about the age difference is my guilt surrounding Millie now,’ she says. ‘I thought, if I’d been with a younger man, this wouldn’t have happened to her at such a young age because prostate cancer usually happens to older men.
‘We’ve just got to find a way through this together. I’ve said to her, “we’ve got to be a team so Daddy can see us as a team”.’ The many lovely photographs in this warm, lived-in home show the close bond between father and daughter.
‘Millie used to say: “Daddy, why am I called Millie Margaret Mary?” and Alvin used to say, “because you’re mmm, mmm, mmm delicious.” She had this thing where she called him Superdad.
‘If I was tickling Millie or whatever, she’d shout out, “Superdad, Superdad, help me”, and he’d come in and pretend to throw me off . . .’ She stops to collect herself. ‘He talked about Superdad on Monday. He cried about it. He said: “I can’t be Superdad anymore.” That was hard. I said: “You’ll always be Superdad to me.” Sorry . . .’ She wipes her eyes with the back of her hand.
From the moment Alvin set eyes on Julie he knew, as he told her many times, ‘this was it’.
Not proud of the fact he’d been divorced twice — the second time from actress Liza Goddard, with whom he had a daughter Sophie and stepson Tom as well as two sons, grammar school headmaster Shaun and DJ Adam from his first marriage — he insisted he and Julie renew their vows every seven years.
‘He said we’re never going to be in that position where after seven years it goes funny. We won’t have the seven-year itch, we’ll have the seven-year hitch.’
They renewed them three times — in Barbados, the village church near their Sussex home and, most recently, in Portugal. Their 22nd wedding anniversary was last Saturday, the date Alvin performed for a final time. These coincidences assume an importance of sorts in Julie’s grief.
Alvin was diagnosed with prostate cancer 18 months — perhaps two years — ago. Understandably, Julie is struggling with that sort of detail this morning. The symptoms, though, were there for several years, unbeknown to both of them.
Unknown: Alvin was diagnosed with prostate cancer 18 months — perhaps two years — ago. The symptoms, though, were there for several years, unbeknown to both the singer, pictured in the 1980s, and his wife
‘Years before he’d had a well-man thing done and had his prostate checked,’ says Julie. ‘We were told his PSA [a protein produced by the prostate — raised levels in the blood can be an early indication of prostate cancer] was up a little bit but that it was completely normal in a man of his age. I won’t blame anybody for this but if I had anything to say it would be, “please don’t say that again to somebody”.
‘I was naïve. Alvin was naïve. I wish they had said “keep an eye on that”. But they didn’t and he didn’t have a lot of symptoms. It didn’t affect his sex life and he didn’t have any urinary symptoms.’
He did, though, begin suffering three years ago with a nagging hip pain.
‘We were in Paris walking down the Champs-Elysees when he started complaining about his hip. I now know prostate cancer can present itself as hip pain — if only I’d known that then.
‘I can’t say it is connected and I can’t say it isn’t, but perhaps if I’d known how significant it was, things might have been different. What do you think?’ I tell her there is no point torturing herself over the ‘what ifs’. She shrugs.
They sat me down when Millie went to bed. He said they’d found some lesions and they were 99 per cent sure they were cancerous. My life just fell apart at that point. I think I was in disbelief for a few days — a bit like now 
‘We had to get a cab that day, which is unheard of for Alvin,’ she continues. ‘I’ve got to be honest with you, there were times when I thought “if this was a woman we’d just be getting on with it”.’
The cancer was only diagnosed a year or so later, when Alvin underwent a barrage of test and X-rays after suffering what Julie believed to be a panic attack.
‘I was in London for three days in a show when Alvin got a call from his doctor to say: “You need to come in because the radiologist has found some stuff on your X-ray we need to discuss.”
‘There were lesions on his spine. He’d had the cancer for quite a while and it had spread. Being the sort of protective person Alvin is, he waited for me to come home and asked my mum and dad to come up from Swansea so they’d be there when he told me.
‘They sat me down when Millie went to bed. He said they’d found some lesions and they were 99 per cent sure they were cancerous. My life just fell apart at that point. I think I was in disbelief for a few days — a bit like now.’ I ask again if she’d like to stop the interview. Again she refuses.
‘It was an aggressive cancer. They did that Gleason test [tests providing a score between two and ten predicting the aggressiveness of the cancer]. He was about a seven. I was in denial about that, I should have seen the grim picture but I just hated everyone for telling me that because I didn’t want to hear it.
‘Constantly, it’s in your mind, “if only they’d discovered it sooner”. There were times I’d look in the paper and see somebody having an operation to remove it and I’d say “whoopee for you”. I’d feel angry because Alvin didn’t have that chance.’
Alvin’s cancer was too advanced for surgery. Instead, doctors attempted to treat it with hormone therapy — which was unsuccessful — and chemotherapy.
Dedicated: Alvin, pictured in 2000, continued to perform throughout his treatment as well as  recording his first album since 1984, on which he has dedicated two songs to Julie, It Had To Be You and Love You Until I Die
Dedicated: Alvin, pictured in 2000, continued to perform throughout his treatment as well as recording his first album since 1984, on which he has dedicated two songs to Julie, It Had To Be You and Love You Until I Die
‘He sailed through the first round of chemotherapy,’ says Julie. ‘But the second round wasn’t so good. That’s why it all went pear-shaped, because his bone marrow never really recovered properly. He wasn’t strong enough because the cancer was getting to him.’
Unbelievably, Alvin continued to perform throughout his treatment as well as co-writing and recording his first album since 1984, on which he has dedicated two songs to Julie, It Had To Be You and Love You Until I Die. The second of the two will now play at his funeral in the church where their marriage was blessed in Swansea.
‘He knew when he wrote it he was dying,’ says Julie. ‘They stopped the chemotherapy in July. They just had to observe him to see if his body got strong so they might be able to give him some other clinical trials they were doing.’
Alvin, remarkably, performed in a concert with The Who at drummer Kenney Jones’s polo ground Hurtwood, in Sussex, to raise money for prostate cancer, which his friend Kenney had successfully beaten. Few of those present were aware he was going through the final stages of the disease himself when he stood on that stage.
I’ve cried myself to sleep in his arms until it got to the point where I couldn’t be in his arms any more because I couldn’t even do this to him (she brushes my hand) because he was in so much pain 
‘August wasn’t so good. He was getting very stiff,’ says Julie. ‘The last eight weeks it’s been worse. He’s been in constant pain.
‘I’ve cried myself to sleep in his arms until it got to the point where I couldn’t be in his arms any more because I couldn’t even do this to him (she brushes my hand) because he was in so much pain.
‘I asked him if he was scared. He said he wasn’t scared. He just didn’t want to leave me and Millie. He was petrified of leaving us.
‘On Monday he said: “I don’t want to lose you Jules. I don’t want to leave you. I won’t hear your voice. What am I going to do?” ’ She sobs. ‘That’s what I feel: I’m never going to hear him talk to me again.’
Julie contacted Alvin’s children this week. They all joined them — Adam flying from California where he works — at the family home. ‘Adam was the last to arrive, on Wednesday night at 7pm. Alvin opened his eyes and gave him the biggest beaming smile because he adored him — he adored all of his children.
‘This morning I was in lying in bed with him at 6.30am and he was breathing oddly. That’s when I told him not to worry any more and to go to his mum. We had half an hour of funny breathing then at 7.05am the noise stopped.
‘I looked him in the eye and knew he was taking his last breaths. So I ran out of the bedroom, grabbed my mum to get Sophie and I grabbed Millie.
‘Millie was holding one hand, Sophie the other and, just as one of his sons walked into the bedroom, his breath went. I had my face next to his, saying, “I love you darling” as he died.’
The sitting room falls silent. There is no more to add. Julie looks exhausted but as if a weight has been lifted. She has done as she feels Alvin would have wished. It is a hugely poignant moment that ticks seamlessly into the next until the undertakers arrive.
When they carry his body down the stairs, past the many happy photographs charting this lovely family’s life together, Julie’s words reverberate: Get yourself checked.