CANCER - LOOKING FOR TROUBLE makes trouble in all the wrong places?

No, I don't subscribe to the ANNALS OF INTERNAL MED.
but I remember 20 years ago at work when doctors were doing test/don't test for prostate cancer.

http://annals.org/aim/article-abstract/2667696/scrutiny-dependent-cancer-self-fulfilling-risk-factors#.WmqoLPsPE-w.twitter

If you only get to read the first paras:  DO!

Scrutiny-Dependent Cancer and Self-fulfilling Risk Factors

Brought to my attention from Ken Covinsky on TW  @jeri_doc

Breast Cells discovery on Twitter

"Researchers Identify Estrogen Receptor Stem Cells In The Mammary Gland"

CANCER

By Scienmag On Aug 16, 2017

COFFEE BREAK - From Kaiser Health News

Have you seen/read this?

Widespread Hype Gives False Hope To Many Cancer Patients

By Liz Szabo April 27, 2017

For me, the interesting thing about this article is: 

 just reading and comparing what doctors say versus what medicine manufacturers say.

CANCER - No, it won't be this week but it's a big step

The LA Times this week announced that a tech bigwig is donating millions to USC for a new cancer research center.  According to the Times, oncologist Dr. David Agus was the inspiration for the gift, as he had treated a relative of the donor and also a famous friend..  

The doctor mentioned some expectations of the coming center - possibilities like sequencing cancer and studying huge blocks of data.  

A google search today showed a picture of Oracle founder Ellison, the donor.

I wish you health. 

SURGERY, AFTERMATH AND . . .why second opinions are not optional!

Friday night:
I am so upset about the story I just read  in PULSE - Voices from the Heart of Medicine.  It's dated May 16, 2014, and called Collateral Damage.

Saturday morning
I didn't want to get out of bed his morning  Finally I realized that Pulse story is still in my mind.  It reminded me of a short film created by a doctor I was once lucky enough to meet and talk with.  It was called Patton, MD, and it was about doctors who want to solve everything by cutting.

It reminded me that I take Tamoxifen and there's a tiny chance I may need hysterectomy some day.  And it told what can happen when we're too overwhelmed to really hear scary answers to our good questions--about side effects, about after effects, about how we will be after surgery.  And questions about what can we do instead.

The most important question wasn't asked.  We should never leave home without that one: What's the phone number of a doctor I can ask for a second opinion!

When we are overwhelmed, we can't  hear alarm bells ringing in our heads.  Can't hear little wise warnings our experience, our instincts give us: "There is something wrong here: This doesn't sound right! I've never heard of so much surgery!  This sounds like overkill!"  

After a surgery, we may not feel like suing; we may think the only problem was the surgeon didn't listen.  We may be even more overwhelmed than before.  But in fact, her surgeon gave plenty of evidence about not giving a damn for her or for his mistake.  And her primary doctor doesn't count as a second opinion.

If you've had cancer, if you fear cancer, if a woman you love has cancer, please read that Pulse story and think about what to ask doctors.  I use the plural intentionally.  Yes, her experience may scare you.  No, it may not happen to us.  If it doesn't, it may be because we asked the right questions, like: Who's a good doctor to go to for a second opinion?   

I wish you health.  And caution.

TAMOXIFEN, CANCER, THE BREAST. . . and the power of paying attention

I was serious when I told the medical oncologist that the effects of a month of Tamoxifen were a matter of degree more than any new problems.  And my life was constantly changing; even seeing another new doctor meant one more adjustment.

Now I find myself feeling so much fatigue, and weight, feeling old and walking slower.  I remember having a lot more energy during the weeks of radiation!

I got out my copy of The Immune Power Personality.  Dreyer focuses a lot on paying attention to the body and our life.  He offers a chart we can use to connect a symptom to what's going on in us and to us at the time--emotions, moods, memories, physical sensations, work, relationship, and so on.  I tried the chart long ago, and had trouble staying with it.

But based on the work of Gary E. Schwartz,  former Director of the Yale Psychophysiology Center,  Dreyer has a list of what to look for after we've done that chart for just a week.  I can use these. Here are a few sample questions: 

Do particular symptoms worsen when certain emotions are activated?

Do particular symptoms worsen when certain events take place?

Are particular emotions associated with other physical sensations?

Are certain sensations associated with particular moods?

Do your worst symptoms occur at work?  During interactions with particular individuals?


Could asking these questions be useful even for patients with more immediately dangerous cancers than DCIS?  Even for problems with chemo?  

For me, the list is right on target, and could guide me on what I report at the next oncologist visit.

CANCER - tiny miracles in totally unexpected places

Medpage this morning directed me to a NYTimes article about a wedding in intensive care.  No, the patient didn't get married.  She got what was perceived as probably her dying wish - to be at her daughter's wedding, which quickly changed venues to ACU.  I see this as a Must Read.

LUMPECTOMY - THE SEQUEL . . . Day 12 and brain fog

I really have been making a lot of mistakes since the diagnosis.   Some of them with time-consuming results.

What is really important for me now is:  thinking back to before the diagnosis and even before the callback for additional mammogram films.  Some of my mistakes that seem big actually started before the latest mammograms.  So, the confusion is not from DCIS.  For instance, an email gift wasn't received because I've always had the wrong email address in my contacts list.

Also, I told a friend (who also has DCIS) that I feel a little depressed some days.  She reminded me that this disease, and anything that starts with the word cancer, is stressful and can be overwhelming.  Add this to moving twice in two years - once to a different state- and overwhelm is practically a given.

I also need to remember the old joke, "After a certain age, mood swings don't count as exercise."

She talked with me awhile, and her diagnosis was that I'm having a "Human Attack."  She advised being nice to myself.

Also, I went into the building the other day for my radiation appointment, and in the lobby was a man a lot younger than I am, in a wheelchair, accompanied by his family.  And while in the reception room, I heard someone say to a patient, "So you'll go to chemo after radiation today?"   I need to be grateful every day that chemo is not on my To Do list.  And be kind to people who may be doing both.

What do you do when a depression elbows its way into your day?


PS Breast Cancer Action SF is having a survey on what members think the group should tackle for the new 5-Year plan.

LUMPECTOMY - THE SEQUEL . . . Radiation Day 8, life

 After the second mammogram, the days flew:  meeting doctors, feeling rushed to have the steriotactic biopsy.  I guess they still fly by, but during the day, things seem to take a long time.

I actually looked up stereotactic:  it just means x-ray guided, image guided, or mammographically guided.  I haven't had breakfast, so I'm delighted that I can spell that.

 Because of the two holidays, radiation will actually go to the middle of January!  20 days.

Last week the radiation therapist said we're advised against wearing underwire bras.  I just told him I don't wear them.  I think what prompted him to mention it is that my soft bra slides around sometimes. When I looked in the mirror Monday, I saw that the band can be pressing on the softest lower edge of the breast.  Will a new bra be more elastic, and where it belongs?

Yesterday, I took one Christmas walk.  Spent most of the day drawing and talking to my younger daughter on the phone.  Forgot to exercise with my tiny weights.  Strong Women Stay Young says I can break up the workouts into 4 20-minute workouts per week.  I haven't hit four since I've been here.  Before the spine got so bad, (seems like another lifetime) I was doing floor work every morning.  Not possible here.

The list:

Put up a big sign based on the Breast Cancer Patients Rest in Peace post* that I hope you read.  Instead of walk for the cure, my new mantra is:  EXERCISE TO SAVE MYSELF!   Talk about deferred reward!  You can't just step on the scales to see if exercise is making you live longer.

 Order a new bra, same design, but is won't be older
Order a leisure bra just in case I have skin problems before the radiation is over.

* from Sunrise Rounds  http://sunriserounds.com

LUMPECTOMY FOR BEGINNERS - The other F word

My friend was right.  It is a shock to hear the word cancer on the phone or in the doctor's office. My supportive neighbor says I'm handling it well.  I don't talk about fear -- but now I'm thinking about it

Learning about the steriotactic biopsy was Fear and resistance - the procedure sounded barbaric to me. And yet it went well and I had a good time at the hospital.

And I was able to compartmentalize about the lumpectomy.  I trusted the surgeon, and after all, I've had plenty of successful experience with surgery.  I didn't even feel fear beforehand.  Maybe the doctor's telling me he had said a prayer was a help.

Then the post-op two-week appointment!.  (The surgeon had told me when we met that he would recommend I see a radiation oncologist and a medical oncologist.)  I read the pathology report again, more thoroughly.  Nothing on the report, as I've mentioned, gave me any hope of avoiding radiation.  So after we talked a little about the incision and the size of the specimen, he gave me the paper with the oncologists' contact information, and his reasons for choosing them.  

 I went home and put the contact information sheet in a red file.  I talked with my neighbor, I blogged about when to call the radiation doctor's number.  I reminded myself that she couldn't make me do anything I don't want to do.

I focused my research, still a lot of it from Mayo Clinic, on radiation.  I read other women's stories, and I felt Fear.  I made a list of my radiation concerns and felt FEAR.  I quoted some things, and felt FEAR.   I included a list of medical conditions I already have, and the one thing I've shared with friends:  how many x-rays I've had.  

I copied statistics from Sloan Kettering on how much longer I would be free of cancer if I had radiation and certain long-term meds.  They were compelling.  But . . .

There is a pattern here:

 In spite of having lost a best friend to cancer, I'm obviously more afraid of the treatment than I am of getting more cancer.  Or is the Fear of cancer buried so deep that I don't feel it, and so huge, that I don't dare feel it?

LUMPECTOMY FOR BEGINNERS - Post Op, take a breath

The steri strips are off.  I wish I'd asked the doctor to take them off - it had been two weeks.  I liked the surgery area better with the strips on.  But I'll see him next month and we can talk about how it looks and feels.  I didn't have any infection; no serious bruises.  Sometimes it hurts for a bit, then doesn't.   I do wear my soft bra, but usually not to sleep.

My friend, who has been through some of this already, advised me not to judge myself--that some of the fatigue can be due to the diagnosis that led to the lumpectomy.  She reminded me that nobody is really prepared to hear she has cancer (despite what some now call DCIS. . . "baby cancer" or "doorway to cancer" or "not cancer."  Hearing it is a shock at some level.

 Life does change.  New doctors (a fear of mine in a new state), appointments, reading the Mayo clinic site like the daily newspaper.  And reading my pathology report . . . which was more disappointing than I admitted to myself.

I'm older than my friend and in this new state and  my new environment.  I need to be realistic instead of apologetic, and take the breaks I need.  Breaks to be sure how I really feel and then to put it in perspective.

And a wise, kind person left a Starbucks gift card on my steering wheel!  Treats are good.

LUMPECTOMY FOR BEGINNERS and Don't leave the locker room without this

There are legions of women my age who know more about sports than I do.  This does not stop me from writing about hoops and pigskin and jocks.   

In the movie Hoosiers, and a million other films and books, the players don't leave the locker room between halves (or whatever) even after an avalanche of abuse, without some bit of encouragement like:
Plow 'em under! (Yes, I"m in Texas) Or Make me Proud!  Get out there and make  HISTORY!   Or Show 'em whatchu got!

The advice I get in hospital locker rooms is usually:  Put the gown on open to the front and go thru the brown door.   This is somewhat inadequate to prepare me for what's behind the brown door,  and leaves WAY too much to my imagination.   

Before I go out the brown door next time, I should have locker room wisdom in my pocket, or hidden in my underpants if necessary.   For instance:  I'm a Healer!   Some of the best moments in life are in the future!  I've got plans!  Or, to be more locker-roomish,  “You gotta play till the ninth inning, man.” * And even  Show 'em whatchu got!

What I got is a surgeon I trust.  What I got is a successful lumpectomy.  What I got is a history including  successful recovery from spine fusion despite postponing too long. (Note to self:  If I agree to more cancer treatment, don't wait too long.)  What I got is the prayer and meditation.

What I got is good-looking, active CHEERLEADERS who lived through what's in this next quarter.  I got them by daring to speak up about DCIS.   And I spoke to these men and women because they didn't keep their own cancer a secret.


I hope what you got is PLANS for your own particular future.  GOALS.  Show "em whatchu got!  


*John Croslin in Austin Kleon, 

CANCER Are we really making progress?

Today Dr. Miranda Fielding told a wonderful story of a courageous patient on KevinMD.com

I encourage you to read it.  At the risk of plagiarizing myself, this was approximately my comment:

I salute the woman in the story, her doctor, and other brilliant oncologists. For me, the key phrase is "the cost of that survival."   And Dr. Fielding is courageous enough to use the phrase "radiation induced."

On this one patient, radiation has been used for about forty years.  

Trying to concentrate on the story, I kept thinking: Where is the research?  Where is the research? 

 We can make a six-speed automobile; we can equip it so it avoids hitting the car in front of it. Have we spent more money on automotive research than on  cancer cures? Do we spend more money on automotive research than on cancer prevention? Who pays for the research?  Who's in charge?

 What do we care about?