tag:blogger.com,1999:blog-62947816221864384992024-03-05T13:45:31.174-08:00Merely a detourAn unscheduled stop in the land of Breast CancerCathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.comBlogger53125tag:blogger.com,1999:blog-6294781622186438499.post-12696162014916078822008-11-09T08:12:00.000-08:002008-11-09T09:29:01.947-08:00Mammography: An Imperfect Tool<span style="font-family:arial;">The more one learns about detecting breast cancer, the murkier it gets. An opinion piece published in the <em>LA Times</em> earlier this month suggested that mammograms are over-prescribed because they cause doctors to over-diagnosis breast cancers. The author, a medical professor at Dartmouth, was arguing that doctors who counsel women to have less frequent mammograms, or wait until they are age 50 to begin them, might be on the right track. His theory was based on the premise that because mammograms will sometimes detect cancers that may never develop into anything dangerous, the medical community needlessly scared women with too much mammography.<br /></span><a href="http://www.latimes.com/news/opinion/commentary/la-oe-welch3-2008nov03,0,2369816.story"><span style="font-family:arial;">http://www.latimes.com/news/opinion/commentary/la-oe-welch3-2008nov03,0,2369816.story</span></a><span style="font-family:arial;"><br /><br />Naturally, I had something to say on this point, and I dashed off a letter to the editor. The <em>LA Times</em> was kind enough to publish my response, and I've attached it here:<br /><br /><blockquote><p><span style="font-family:arial;">Re </span><a href="http://www.latimes.com/news/opinion/commentary/la-oe-welch3-2008nov03%2C0%2C2369816.story"><span style="font-family:arial;">“The excessive focus on mammography,” Opinion, Nov. 3 </span></a><span style="font-family:arial;">H. Gilbert Welch argues against excessive use of mammography because the test identifies some cancers that will never will never develop to cause symptoms or death. I also argue against too much dependence on mammography, but for the opposite reason. My cancerous breast tumor could not be seen on my mammogram, and I received a negative<br />result. </span></p><p><span style="font-family:arial;">Fortunately, I could feel the peanut-sized tumor with my fingers and pursued necessary medical treatment. Mammography is far from perfect because it misses cancers, not because it detects too many. </span></p></blockquote></span><span style="font-family:arial;">It's hard to know what the best approach to cancer-screening actually is. Even with my experience with mammography, my doctors, all experts in the breast cancer field and people whom I trust, insist that I get frequent mammograms. Of course, they only use state-of-the-art digital mammography, which produces a better image than traditional film x-rays.<br /><br />So I do what I'm told. But I continue to think that there must be a better way to screen women, a method that is both medically meaningful and cost effective. Until we have one, however, I will get my mammograms, but only with digital technology. (Women should ask their medical providers which type of mammography equipment they use and avoid facilities that have not yet upgraded.) Beyond that, it seems prudent for all of us to stay vigilant and know our own anatomies, so that we can detect when something has changed. While finding a lump may be scary, the idea of a tumor going undetected is even scarier.</span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-23128134998042715712008-10-12T04:03:00.001-07:002008-10-14T01:00:56.990-07:00Breast Cancer Awareness Month<span style="font-family:arial;">October is Breast Cancer Awareness Month, and there is much to report on many fronts.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">At the moment, I'm traveling in Europe, having delayed my 50th birthday celebration until now. My one year anniversary of diagnosis will be on October 23, and I'm happy to say that, all in all, I feel well. My old self is gradually returning.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">On the fight against breast cancer, a couple of things you should know. Results of a recently released study showed that women with early-stage breast cancers responded equally well to lower overall doses of radiation. My radiation therapy was administered in 35 separate doses, but doctors are finding they can reduce the number of treatments markedly. So if you, or someone you know, is facing radiation for breast cancer, please ask about this study. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Second, Dr. Susan Love has launched a new effort to tap into women who are willing to participate in studies and clinical trials. Sponsored by Avon, Dr. Love's new program is called the Army of Women. Her goal is to register one million women, so that researchers can have better access to women of all ages, races, and health histories. If you have not already done so, I urge you to go this link, learn more about her effort, and sign up. <a href="http://www.dslrf.org/army/">http://www.dslrf.org/army/</a> </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Finally, I have agreed to participate in the Komen Walk next summer with my friend, Diana, who completed the Chicago event this year. I'm saying this in print here to prod myself a little further toward actually acting on this pledge. A three-day walk is an enormous undertaking, but it's worth the effort. Maybe you should consider walking, too. </span><br /><span style="font-family:Arial;"></span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-78113627243797367492008-08-19T21:25:00.000-07:002008-08-20T07:33:42.752-07:00Healthy and Cured<span style="font-family:Arial;">That's it. I'm done. Last week, my oncologist offhandedly said, "We now consider you to be healthy and cured."</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">He and I were talking about the level of follow-up and screening I would now have, and he wanted to put my situation in context. So he told me that from a medical standpoint, I was not that different from other women my age. Thus, he used the phrase "healthy and cured."</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Whether or not he intended it, I latched onto those three little words, and I've been basking in their undeniable brightness ever since. Good health takes on such a greater significance when it disappears for a time. When it's been regained, simple healthfulness is valued as a far more precious commodity than it was before it ebbed. As Joni Mitchell wryly observed, "Don't it always seem to go. You don't know what you got till it's gone." </span><br /><br /><span style="font-family:Arial;">While Joni was mostly referring to the environment, her words provide an excellent segue for me to the next chapter (or the next blog, if you will). Simply put, the goal is to appreciate what's around me in a literal sense, and learn how I can make more out it. Healthy body, healthy planet -- it's all so intertwined. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">The internet headlines today were about a 36-year-old TV actress, Christina Applegate, who recently underwent a double mastectomy. She was diagnosed with cancer, but she opted for extra surgery because she learned that she carried the breast cancer gene. I began this blog many months ago with my own breast cancer diagnosis. As I come to the conclusion of my treatment, each week thousands of new cases are being detected. Well-known and unknown, wealthy and destitute, educated and unschooled, women of all races, faiths, and backgrounds are being told that they have breast cancer. Maybe a means of prevention is close at hand. Maybe we'll soon have better detection in order to save more lives. Keep checking here periodically, and I'll keep posting breast cancer information as I find it. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">In this fight, we need to raise funds, raise awareness, raise our voices. To win this battle, we need to help each other. To be healthy. To be cured. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com1tag:blogger.com,1999:blog-6294781622186438499.post-84953367470767208362008-08-08T08:51:00.000-07:002008-08-09T09:52:24.949-07:00New Blog is Up<span style="font-family:arial;">Although it's still in its infancy, the new blog is operational. The link is: <a href="http://eatingmygarden.blogspot.com/"><span style="font-family:arial;">http://eatingmygarden.blogspot.com</span></a></span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Meanwhile, </span><span style="font-family:arial;">the on-going story published here is not quite finished. I still have to see the medical oncologist next week and get my marching orders, but I am transitioning. Thanks for reading during these long months. Knowing that you've been following along has made the writing enormously fulfilling and a true pleasure. </span><br /><span style="font-family:arial;"></span><br /><br /><br /><span style="font-family:arial;"></span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-47892770177293998342008-08-03T09:55:00.000-07:002008-08-03T10:07:31.369-07:00Cap And Gown<span style="font-family:Arial;">Bring on the pomp. The circumstances call for it. Time to trade the hospital gown for a graduation gown. Let's switch out the bandanna for a mortarboard. </span><span style="font-family:Arial;">It's graduation time. I'm done with surgery. Done with chemo. Done with radiation. I've attended my last session and passed my final doctor's exam. </span><br /><br /><span style="font-family:Arial;">I've crossed the stage, graduating from cancer patient to cancer survivor. Of course, that's not exactly how the moment feels. A better description is that I am a survivor of cancer <em>treatment.</em> The cancer itself, that cunning and stealthful enemy, never caused a hint of noticeable trouble. It was quietly invading, flying under radar, undetected by x-ray. </span><br /><br /><span style="font-family:Arial;">We always ask graduates about their plans. More education? New career? Answer is who knows. I have a writing project lined up, but no real</span><span style="font-family:Arial;"> plans are on the table. The radiation technicians advised me to keep busy and guard against depression. Although I'm rarely depressed, I'll heed the warning anyway. The nurse also said that I might experience an increased level of fatigue over the next week or two. After the last treatment, she explained that some radiation patients feel as if they've been hit by a bus. So, I'll watch out for that possibility, as well. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Right now, I'm just enjoying the knowledge that I no longer need to drive to the hospital every day, disrobe, lie under a huge machine for few minutes, get dressed again, and drive home. That routine was getting monotonous. I'm also trying to take in the information that I've reached the end of a 10-month trek. That my all-consuming detour through the land of breast cancer treatment is at its conclusion. For the moment, I'm paused at the main road. A little time, please, before I make the turn. </span><br /><span style="font-family:Arial;"></span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-78288112320016204032008-07-29T08:48:00.000-07:002008-07-29T12:22:30.889-07:00Ten Things I Learned<span style="font-family:arial;">Although it may be cliche, it's still true: In every challenge, lessons are derived. Here are a few of the things I learned during the past 10 months while detouring through the land of breast cancer. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">1. <strong><em>I love to blog</em>.</strong> This fact must be obvious to those who've been reading along. But this notion extends beyond the blogosphere. The real message is not to ignore or discount one's creative side. Don't wait until retirement, or when the kids are grown, or when the garage is cleaned to nurture your creative spirit. Whether it be writing, sketching, singing, playing an instrument, dancing or sewing, make time for it. The rewards are innumerable. (Along this line, my next blog is under development, but more on that later.)</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">2. <strong><em>People surprise you. </em></strong>You can never predict who will step into your life when you're in the midst of an ordeal. Without being asked, people whom you barely know will reach out in a particularly thoughtful way, and, from there, they will evolve into good friends. Conversely, others whom you counted on may not be up to the challenge. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">3. <strong><em>Don't hesitate to connect with someone going through a bad patch.</em></strong> Some part of us wants to hold back and not risk the emotional fallout of talking to those who are bereaved, sick, or suffering in some way. But human contact is a good thing. Pick up the phone and dial. If people really don't want to interact, they just won't answer. But they will know that you made the effort. And that knowledge goes a long way on a bad day. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">4. <strong><em>Ask your doctor if you have dense breasts.</em></strong> If so, find out what screening methods, beyond mammography, are available to you, because mammograms simply don't do a good enough job on dense tissue. No diagnostic tool can prevent cancer. But good screening can lead to early detection, which can help doctors treat cancer before it spreads. Given what I know now, I would have paid for annual breast MRIs, despite the prohibitive price tag. At the very least, I would have enrolled in the clinical trials for the Sonocine, which is a whole breast ultrasound. (You can find the link to Sonocine on the list to the right.) The most compelling evidence is this: I had a second smaller tumor, the size of a pea, in the same neighborhood as the peanut-sized growth that I discovered. This smaller lump was lying deeper in the tissue. Neither I, nor any of my doctors, could feel it, and it was not visible on my mammograms. However, the radiologist saw it on my MRI. Given its location, this little tumor could have kept growing unnoticed until it was quite large. I was fortunate, really, to have </span><span style="font-family:Arial;">had a palpable growth close to the skin. So while MRI is very expensive, think about it if you have very dense breasts. </span><br /><br /><span style="font-family:Arial;">5. <strong><em>Find out what you can about your medical history.</em></strong> Ask older relatives about how their parents and grandparents died. Should you face a cancer diagnosis, doctors want as much genetic information as you can give them. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">6. <strong><em>Do your research and know the facts of your condition. </em></strong>Doctors seem to respect this. If you can talk intelligently about your treatment, you and your doctors will have a more meaningful dialogue and you'll feel better about the decisions that everyone makes. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">7. <strong><em>Chemo was not as bad as I feared</em>.</strong> The best advice I heard from my oncologist was not to make assumptions about how chemo would affect me. He was right, because I fared much better than I imagined I would.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">8<strong>. <em>Fitness matters</em></strong><em>.</em> But not for the reasons you think. There is no magic bullet that prevents serious illness. Eating broccoli and running six miles a day are no guarantee of immunity. However, should illness strike, being in excellent physical shape helps to overcome the rigors of surgery, chemo, radiation, or whatever the treatment happens to be. If you get sick, you want to be strong in order to fight back. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">9. <strong><em>Enroll in the best health insurance plan that you can reasonably afford.</em> </strong>If your develop a major illness, you want the freedom to select the best doctors and facilities. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">10. <em><strong>You're stronger than you think and your loved ones are, too</strong>.</em> You wonder how you will cope, should you develop a serious health problem.,or how your spouse or kids will manage. While the whole experience is scary, everyone will fall in line and do what needs to be done. I don't have enough distance on this experience yet to be certain, but I expect that a battlefield mentality takes over. You just move through whatever the next task is. Fretting and worry consume valuable energy that is needed elsewhere. My best advice is to check those emotions at the door and stay focused on the remedies.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">My last treatment is tomorrow!!!! The next blog is getting underway. Stay tuned. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"></span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com1tag:blogger.com,1999:blog-6294781622186438499.post-14169021200641963932008-07-21T13:22:00.000-07:002008-07-21T13:38:22.849-07:00Power To You<span style="font-family:arial;">Walking along the corridor of the hospital the other day, I saw another patient who I'd exchanged glances or half-smiles with, although we'd never spoken.</span><br /><br /><span style="font-family:Arial;">This woman was walking a little ahead of me, but as I was moving at a much faster clip, I quickly caught up with her. I expected that we would share the usual greeting -- or non-greeting, really -- and I would continue on my way. But as I passed by her, she turned to me and said, "I've been wanting to talk to you." So I slowed my pace to match hers, and said, "Yes?"</span><br /><br /><span style="font-family:Arial;">She surprised me by revealing that she had been watching me and wished that she, too, could leave the house with her head uncovered. At the moment, she was wearing a bucket hat, and I remembered that she always wore a hat or a wig. Cancer-related hair loss is so devastating, it was no surprise that this woman needed shoring up. I assured her that before long, her hair would come back and her hat days would be well behind her. </span><br /><br /><span style="font-family:Arial;">"Do you want to see my hair?" she said. Then, in the middle of hospital hallway, she lifted off her hat and uncovered her head, which was encased in the black netting that football players wear under their helmets. Next, she began to peel off the netting. I expected to see a combination of bald spots and patchy growth. To my surprise, this woman's dark gray hair was much longer than mine. She had more than an inch of perfectly fine hair all over her scalp. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">I was dumbfounded, and stammered, "You have lots of hair. You don't need to cover it up." She demurred, although I'm not sure why. But by initiating a hallway conversation and showing me what was under her hat, she </span><span style="font-family:Arial;">was clearly reaching out for support. I suspected that she wanted a push toward the next step. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">My family and friends know that I love to offer solutions. If they present me with a quandary, they will get my ideas on the best fix, whether or not they actually want to hear them. So seizing a chance to hold forth, I suggested the following remedy: Put on some make-up, and do one errand with your head uncovered -- the post office, the bank, the supermarket, whatever. Just take on one errand and, after that, assess whether you still need the hat or the wig. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">She didn't sign on to this idea, but she didn't say, "No," either. As the conversation ended, and I turned to go, she called after me. With her fist raised and clenched, she said, "Power to you." Puzzled by this whole encounter, I walked to the car thinking about all of the ways in which we trip ourselves up and let inhibitions take charge. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">This happened on Friday, and I saw her again this morning. I asked if, over the weekend, she had gone out bare-headed, and she said, "No." But today she appeared stronger and with more resolve. She told me that she was going to attempt a trip to the supermarket. "Good luck," I yelled as she walked away.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">We'll see what happens. I have seven treatments left. I'll consider it a victory if within that time, this woman walks into the waiting room, head uncovered and newly empowered. </span><span style="font-family:Arial;"> </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-89367602474939004712008-07-14T16:42:00.000-07:002008-07-14T17:02:52.489-07:00Box of Chocolates<span style="font-family:arial;">Cancer treatments do eventually come to an end. Last week, Frank, another patient whose daily radiation treatment was scheduled close to mine, received his last dose.<br /><br />I talked to Frank's wife, while he was with the technicians. She told me that Frank was so diminished by all of the attacks against his cancer, she wasn't sure he was aware that he was receiving his last treatment. Frank's tumor is located in his throat and is inoperable because of its proximity to the carotid artery. He finds it difficult to speak, and his wife stays close to his side. Nearly 80-years-old, Frank underwent chemo and radiation simultaneously. His wife said that he was so weak after his treatment the day before, the hospital staff transported him to their car in a wheelchair.<br /><br />Frank returned to the waiting room after his last session, and he and his wife exchanged a few words before Frank left again to change into his street clothes. Frank's wife then reached into her totebag and pulled out a box of chocolates. At the same time, Bill, the ever-present hospital volunteer, walked into the room. Frank's wife stood up, presented Bill with the chocolates as a gift, and expressed her deep appreciation for all of his support.<br /><br />The waiting room for radiation patients is tiny and intimate. I was sitting only a few feet away, and by chance, I was very much drawn into this private exchange. Bill was obviously touched by the gift, and Frank's wife was clearly grateful for whatever words of encouragement Bill had imparted during the preceding weeks. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><span style="font-family:arial;">In talking to Bill earlier, I had learned that he had cancer, himself, four years ago, so he brings a survivor's perspective to his conversations with patients. My guess is that he and Frank, men who are close in age, understood each other and formed a solid bond. B</span>y the time the chocolates had changed hands, everyone was misty-eyed, including me. </span><span style="font-family:arial;">Although it was only a token, the thank you gift to Bill -- and the emotions that accompanied it -- spoke loudly about giving and receiving and about our collective need to lean on each other.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:Arial;">I don't know what Frank's future will hold -- only that he has a strong network in his wife, four grown daughters and his grandchildren. Like Frank, my cancer treatments will also soon come to an end, but emerging from 10 months of medical care raises questions. Where will I find myself when the detour is over? In what ways will I have changed along the way? </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-81501383985122885382008-07-06T18:47:00.000-07:002008-07-07T08:39:18.833-07:00Radiation Wisdom: Arrive Early and Borrow From Bossie<span style="font-family:Arial;">This weekend marked the half-way point in my radiation treatments. Aside from causing a little tiredness, the treatments are more of a recurring episode in my daily routine than anything else. Every weekday, I drive 15 minutes to the hospital, always with the goal of arriving promptly for my 10:10 a.m. slot. If I can be gowned and seated in the waiting room by then, I'm usually on my way back to the parking lot by 10:25 a.m. If I arrive a little late, however, I'm likely to wait 20 minutes for my turn. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Another patient, Frank, who is in his seventies, is scheduled five minutes after me, but his treatment lasts much longer than mine. Frank </span><span style="font-family:Arial;">and his wife always arrive early, which makes me the wild card for the technicians. Their daily quandry: <em>Will Cathleen arrive on time this morning, so we can squeeze her in before Frank's treatment? Or should we just take Frank because he's gowned and ready to go 15 minutes ahead of schedule</em>? </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">If I have to compete with people who are habitually early, I'll lose every time. Because I have window in which to start a project before I go to the hospital, I get drawn into that activity, and leave the house too late to allow for contingencies, such as lingering traffic from the morning commute, or the off ramp for the hospital being closed. Don't think I'm complaining here. Compared to the unpleasantness of chemo, radiation </span><span style="font-family:Arial;">is a walk in the park. I just need to remember to bring a book -- or (is it possible?) get out the door a few minutes earlier. </span><br /><br /><span style="font-family:Arial;">While radiation is considerably easier on the patient, most people do suffer from its </span><span style="font-family:Arial;">side effect of red and irritated skin. To counter this, doctors recommend a cream that carries the following language on the jar:</span> <span style="font-family:Arial;"><br /><br /></span><span style="font-family:Arial;"></span><span style="font-family:Arial;"><span style="font-family:arial;"><strong>Directions for Use:</strong> <em>Wash udder and teat parts thoroughly with clean water and soap before each milking to avoid contamination of milk. Apply to the udder after each milking, massaging into the skin. </em></span><br /><span style="font-family:arial;"><strong>Warning:</strong> <em>Do not use on parts affected with cow pox.</em></span><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicuxNha9zJ4PIxMIfV5JKRNgAQWUzybi7xQL_I2qouitgv2kQwymi1Genhe8s1uKwaBiwfAdZhzP1Lre6IAeBcb015Oe0cQfvbayYcVP6oZHOJ7HUq6cjYSqqGWWdaXFrnHqHYX64wwiQ/s1600-h/udder+cream.jpg"><img id="BLOGGER_PHOTO_ID_5220127372930696226" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicuxNha9zJ4PIxMIfV5JKRNgAQWUzybi7xQL_I2qouitgv2kQwymi1Genhe8s1uKwaBiwfAdZhzP1Lre6IAeBcb015Oe0cQfvbayYcVP6oZHOJ7HUq6cjYSqqGWWdaXFrnHqHYX64wwiQ/s320/udder+cream.jpg" border="0" /></a><br />Yes, this cream, called "Udderly Smooth," is for cows and is manufactured by Redex Industries in Salem, Ohio. But Udderly Smooth is no ordinary animal product. This little lotion has a whole life beyond the dairy farm. The company's website, <a href="http://www.uddercream.com/">http://www.uddercream.com/</a>, has a subsection labeled "oncology," which discusses using the cream for skin problems associated with cancer treatments and diabetes. People also report using it to remove make-up, relieve sunburn, prevent skin cracking in winter, and alleviate chaffing when hiking and cycling. Even quilters praise the cream because it doesn't make their hands greasy, and thus cause stains on their fabrics. Best of all, a 12-ounce jar costs less than $5.00.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">So, armed with an ample supply of cow cream, I have only 18 treatments to go. And that's udderly marvelous. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-81881547486060697712008-06-22T10:59:00.000-07:002008-06-28T09:44:30.968-07:00Acts of Kindness<span style="font-family:arial;">You recognize them by their grey hair and burgundy blazers. George Bush (the first) would have praised them as glimmers among his 1,000 points of light. They are the legions of hospital volunteers, who donate their time and good cheer to foster our better health. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">These good Samaritans play a visible role in cancer treatment. During chemo, I noticed the same woman volunteering every time I was there. She brought pillows and blankets to the patients hooked to IVs, chatted with family members, and assisted the nurses in small ways. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">The radiation technicians and doctors rely on volunteers, too. Bill, a courtly gentleman in his late seventies, is at the hospital four mornings a week to assist with the radiation process. Because radiation is a daily occurrence, it's hard not to know Bill. He sits in the "gowned" waiting room, which is where patients, dressed in hospital robes, wait their turn to lie under the beams. Bill learns all the patients' names and gleans little tidbits about their lives -- whether or not they have children, where they work, what they're reading, etc. By doing this, everyone sitting nearby also learns a little something about the others being treated. Thus, Bill breaks the ice and creates a social network among the patients. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Bill also helps the technicians by escorting patients to and from the treatment rooms, or to the examination rooms on the days when they see the radiation oncologist. I don't know what Bill did before he retired and became a hospital volunteer. He's a natural at creating a welcoming environment and helping people to relax. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Those who prefer to keep to themselves in a hospital setting may wince at the idea of Bill facilitating conversation among strangers in a waiting room. But Bill's efforts are a good thing, because the whole process of cancer treatment wears people down. Exposure to his kindness, which he dispenses regularly and without pay, is uplifting, really. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">I had a less than kind moment myself the other day, and since confession is good for the soul, let me get this out. I was in the bank parking lot about to get back into my car when a woman passed by me and said, "I like your hair." Since I'm now sporting a credible likeness to Sinead O'Connor, I was taken aback for a beat and paused before responding, "It's the chemo. This my post-cancer look." Hearing this, the woman visibly drew in a breath and was clearly stunned. I finished off the moment by saying, "Thanks, it's starting to grow back," before getting into the car. </span><br /><br /><span style="font-family:Arial;">Later, I thought about my reaction. I could have just said, "Thanks," and skipped the explanatory language. Perhaps my gut instinct was that her words were insincere, although in retrospect I doubt that was the case. I think now that she was applauding my boldness. So I'm chalking this experience up to my being a little slow on the learning curve and not being fully comfortable in my own skin yet. The next time someone makes a comment, however, I'll be better able to respond. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">I have the example of Bill and the other hospital volunteers who dispense so much caring each day. They've taken the bumper sticker notion of committing random acts of kindness and incorporated it into their daily routines. Here's to the folks in the burgundy blazers. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com1tag:blogger.com,1999:blog-6294781622186438499.post-65310313645845059222008-06-15T13:02:00.000-07:002008-06-16T10:35:31.865-07:00Photons And Electrons<span style="font-family:Arial;">Radiation is a curious process. It differs from chemo in that the <em>gestalt</em> of radiation is more akin to a science experiment than to a medical procedure. We're all familiar with chemo. Very strong drugs are infused intravenously and circulate throughout the body on a search and destroy mission.</span><br /><span style="font-family:Arial;">Radiation, however, resides at the intersection of physics and biology. Some people have radioactive seeds surgically implanted in their bodies. My treatment is more traditional. Rays are being beamed at the site where my growth was removed. The radiation penetrates into the body's tissues and attacks all the dividing cells in the neighborhood. Later, the normal cells will reinvigorate themselves and resume their regular activities, while the dead cancer cells will lie scattered about as so much detritus.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Treatments are dispensed in small increments. My individual radiation plan calls for 35 treatments, each lasting just a few minutes. During my first 28 treatments, the technicians are sending photons, which have to ability to go deeply into the breast tissue. For the final seven sessions, they will switch to electrons and target the top layers of skin around the surgery scar. Treatments are given five days a week, which means that radiation takes about six weeks to complete. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Thus far, I've been radiated three times. Compared to chemo, this is a snap. You undress from the waist up, put on a hospital gown and wait for a technician to find you. Once you arrive at the treatment room, you remove the gown and lie down on the table. Two technicians adjust your exact positioning based on what the oncologist prescribed. They remind you to keep very still, and then they leave the room. The machine that delivers the radiation hovers about 24 inches overhead and to the right and briefly emits a high-pitched whine. Next, the machine re-positions itself about 75 degrees counter-clockwise from where it started. Again, the high-pitched sound signals treatment is underway, lasting another 30 seconds or so. Once the whining ceases, the doors to the room swing open, the technicians re-emerge, and the session is over. Time for me to move along, so the next patient can have a turn. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Finally, the last phase of my breast cancer project has arrived. Sometime in July I will be done with all of it, and move into a closely monitored maitenance mode. My hair is now about 1/8" long all around. I had a coming out of sorts last night, when my husband and I went to a nice restaurant for dinner with my head uncovered. Although some people did a noticeable double take, I just smiled, enjoyed my meal, and reveled in my return. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-49230072185155740632008-06-08T23:05:00.000-07:002008-06-09T10:20:22.634-07:00Mind And Body<span style="font-family:arial;"><em>It's Not About the Bike: My Journey Back to Life</em> is Lance Armstrong's account of his struggle against advanced testicular cancer and his subsequent successes in the Tour de France. In the book, Armstrong takes the reader through his early years as a cyclist, through his devastating cancer experience, and finally through his rise, phoenix-like, to the pinnacle of his sport.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Armstrong's theme, which he hints at in the book title, is that he succeeded in the grueling Tour de France partly by drawing on the lessons he learned in his fight against cancer. Armstrong's disease was quite advanced when it was discovered, having reached his brain and other vital organs, and his survival is indeed miraculous. He contends that his illness changed him both psychologically and physically, which worked to his advantage as an athlete. He notes that cancer helped him grow into a more mature, less cocky cyclist. Physically, Armstrong said that his post-cancer physique was leaner, which allowed him to attack the hill-climbing components of the sport more efficiently since he was carrying less bulk.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Although Armstrong goes through a period of aimlessness following his treatment, which he refers to as "survivorship,'' he mostly maintains a positive attitude throughout his cancer ordeal. What is interesting, however, is how he characterized the mental components of illness and recovery. He writes: "I believed...in the doctors and the medicine and the surgeries.... I believed in the hard currency of... intelligence and...research." But Armstrong also noted that he "believed in belief, for its own own shining sake." </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">He decided that belief in something was preferable to belief in nothing and eventually arrived at the </span><span style="font-family:Arial;">following conclusion: "I didn't fully see, until the cancer, how we fight every day against the creeping negatives of the world, how we struggle daily against the slow lapping of cynicism. Dis-spiritedness and disappointment, these were the real perils of life, not some sudden illness or cataclysmic millennium doomsday."</span><br /><br /><span style="font-family:arial;">Dr. Bernie Siegel has also written about illness and positive thinking in several books, including his bestseller, <em>Love, Medicine and Miracles. </em>D</span><span style="font-family:Arial;">r. Siegel was not really on my radar, but another woman with breast cancer told me that she found his book helpful. So I listened to an Internet radio broadcast in which he focused on breast cancer. For those who are interested, here is the link: <a href="http://www.blogtalkradio.com/breastcancerwellness/2008/02/19/Love-medicine-and-miracles-for-breast-cancer-survivors">http://www.blogtalkradio.com/breastcancerwellness/2008/02/19/Love-medicine-and-miracles-for-breast-cancer-survivors</a> </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">In short, Dr. Siegel advises patients to empower themselves in many ways: to be proactive in their treatments and to take charge of their lives. He teaches people to use positive messages, imagery, and humor to aid in healing. Dr. Siegel also believes that many of us carry emotional baggage from our childhoods with us, which can lead to illnesses. </span><p><span style="font-family:Arial;">While I agree that a mind-body connection exists (anyone who has blushed with embarrassment knows this to be true), Dr. Siegel and I part ways at the idea that one's unresolved emotional issues can morph into cancer cells. Many theories exist to explain the growth of cancer cells, including </span><span style="font-family:Arial;">exposure to toxins, hormonal imbalances, genetic pre-dispositions, and poor diet. Scientists don't fully understand all the underlying causes, but I'm skeptical of the theory that holding a grudge against one's parents is a cancer catalyst. A similar theory, which some authors have floated, is that women bring on breast cancer by being passive and "bottling-up" their emotions in their chests. This idea is ridiculous, and only casts blame on those who are unlucky enough to develop a lump in their breast. </span></p><p><span style="font-family:Arial;">The truth is that well-balanced, fully expressive, upbeat people get sick, too. One of Lance Armstrong's physicians, Dr. Einhorn, spoke to this point in the following observation: "I've seen wonderful, positive people not make it in the end. And some of the most miserable, ornery people survive to resume their ornery lives."</span></p><p><span style="font-family:Arial;">The trick of illness is not to be emotionally defeated by it, but to learn how to use its lessons to a later advantage. Lance Armstrong took the idea of the mind-body connection to the extreme and conquered the Tour de France. He also started a major cancer fundraising organization. But small efforts are good, too. This weekend, I went to Bikram Yoga, a 90-minute yoga class held in a room heated to 105 degrees. Yes, you read that right. It was definitely hot, but I persevered and felt pretty good at the end. I also </span><span style="font-family:Arial;">start radiation in a few days. At the beginning of this detour, I might have had some trepidation about being radiated, but not now. I've vanquished chemo and survived a session of Bikram yoga. How bad can radiation be? </span><span style="font-family:Arial;"></span></p>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com1tag:blogger.com,1999:blog-6294781622186438499.post-13489805954136652642008-05-29T12:18:00.000-07:002008-06-01T09:33:19.183-07:00Pack Mentality<span style="font-family:arial;">Exactly two months after my last chemo treatment, my hair started to grow back. Rather than being stark white, my scalp is mostly covered in a very Nixonian five o'clock shadow -- a foreshadow, if you will, of hair to come. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">While I'm finally able to look at my bare head in the mirror without gasping, I still haven't let anyone else see me like this. I keep my head covered at all times, even around the house, and even while I'm sleeping. My head has an alien quality to it, which is just too much to share, even with those who are closest to me. My look undeniably screams cancer patient, which is what I am. But why hammer the point home.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">On an airplane recently, I sat next to a young man, who had absolutely no hair on his scalp or on his arms. I wondered if his condition were permanent and what had caused it -- childhood illness, congenital condition, heredity, or pharmaceutical side effect. The average person has about 100,000 hairs on his or her head. This fellow had zero. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Sitting next to this man triggered my thinking about appearance and image and why they carry so much importance in our culture. It's not just hairlessness. Consider the fat kids who are teased by their peers, or the morbidly obese adults whom we privately judge. Think of Michael Jackson and his skin condition or the people who are either extremely short or extremely tall. None of these physical traits goes unnoticed. While these characteristics are involuntary, many people intentionally </span><span style="font-family:Arial;">alter their appearances in dramatic ways -- multiple piercings, extensive tattoos, outlandish hair and dress. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">After mulling on this for a bit, I came around to this conclusion: Appearance is such a fundamental core concern that it's probably linked to an anthropological need to be part of the pack. We're just like the canines. The kids who demand the expensive tennis shoes, and the gang members who wear specific colors are acting on the same basic pack mentality. Even those who opt for multiple tattoos and piercings are still signalling their membership in a sub-group (sub-pack?) of non-conformists. </span><span style="font-family:Arial;">When you get down to it, aren't skin-deep differences, when paired with fear or ignorance, the recipe for racism, which is really just pack behavior gone bad. </span><br /><br /><span style="font-family:Arial;">So my horror at being a hairless female likely stems from a deeply held human characteristic that both urges us to project health and vigor and to keep our appearance within accepted norms. No one wants to be the sick dog with the bad fur. It also explains the wig issue. During this cancer experience, many people have gently suggested to me that a wig was the perfect solution. I understand their thinking to some degree because a wig would shield me from public scrutiny, essentially allowing me to appear normal and avoid inquires from the pack. Honestly, if I were in a situation in which I wanted to hide completely the fact that I had cancer -- say, I had a customer-service job or lots of interaction with young children -- I would have considered wearing a wig. But a wig is a band-aid at best. It may blanket the evidence of illness, but underneath the wig, you still have no hair. In the mirror, you're still the sick dog with the bad fur.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Unfortunately, chemo is often the only effective treatment for cancer, and hair loss is collateral damage. So you cope as best you can because you really have no choice. And you laugh at yourself for being happy because you have a five o'clock shadow on your head. It signals how far you've come. It signals an approaching return to health and vigor. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-8646345535408388672008-05-15T14:05:00.000-07:002008-05-20T11:08:18.369-07:00The Radiation Question<span style="font-family:arial;">Maybe it's me, but meeting with doctors to get one's questions answered can be tricky. The information is complex, and sometimes physicians just don't understand what you really want to know. Should they dumb it down for you, or do you have enough background to make sense of the textbook answer.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">The problem is two-fold. One, when we talk to our doctors, we're usually not displaying our best selves. The format of doctors' appointments, and the anxiety that accompanies them, prevent us from being on top of our game. As a result, doctors may not get a true sense of who we are, at least not initially. Two, doctors have a history of being a little superior. While the profession has worked to reduce the egotism and improve patient communication, evidence of doctors' loftiness is still apparent. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:arial;">Consider the wardrobe problem. </span><span style="font-family:arial;">While having serious conversations with physicians, I'm often wearing an ugly hospital gown that is exposing my bare back. Not my best look. The doctor, however, is usually dressed professionally and sporting a bright white lab coat with his or her name embroidered on it. As patients, our forefathers must have been really ill to let this imbalance get established. Would you go to any other meeting only half-dressed and wearing a hideous shade of green or an unflattering hue of blue? I didn't think so. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:arial;">Second, the doctor's name on the lab coat is always followed by the capital letters M.D. Since it's a pre-requisite for physicianship, I just assume that they graduated from medical school. Why do they need to wear their credentials on their coats? Others with advanced degrees don't wave them around so openly. I fully accept that doctors are better at science than I am. That's why they make the big bucks. </span><br /><br /><span style="font-family:arial;">Given the considerable differences between us, maybe patients and doctors should spend a little time getting to know each other at the outset in order to establish a style of communication. I recently found myself talking to the radiation oncologist again, as I tried to get a treatment question answered. After a minute or so of conversation, my background as an investigator emerged and took over the questioning, because I just couldn't get the answer I wanted -- mostly because the doctor and I needed to get on the same page.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">My question was this: <em>W</em></span><span style="font-family:Arial;"><em>hy does a patient still require radiation if she has already undergone surgery and chemotherapy and achieved clean margins?</em> </span><span style="font-family:Arial;">Here's how the conversation went: </span><br /><br /><span style="font-family:Arial;"><strong>Setting:</strong> <em>Little exam room. Doctor has just completed a brief physical exam. I'm sitting on an examination table wearing faded blue, oversized hospital garb that keeps coming untied. Doctor is sitting straight and tall on a stool wearing a pressed dress shirt, tie, and a very clean white coat.</em></span><br /><span style="font-family:Arial;"><em></em></span><br /><span style="font-family:Arial;"><strong>Doctor: </strong>Everything looks good. Do you have any questions about radiation?</span><br /><br /><span style="font-family:Arial;"><strong>Me:</strong> I do have a lingering question. I've had surgery, chemotherapy and a re-excision. Tell me why I need radiation, too?</span><br /><br /><span style="font-family:Arial;"><strong>Doctor:</strong> In the old days, every woman with breast cancer was given a radical mastectomy. This was very disfiguring, so doctors moved away from this practice. Now we try to remove just the diseased tissue and then treat the breast with radiation. Because you didn't have a mastectomy, you need radiation. It's the standard of care. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"><strong>Me:</strong> I understand that it's the standard of care. But why?</span><br /><br /><span style="font-family:Arial;"><em>(Doctor's cell phone rings. He fishes for the phone in his pocket. Doctor looks at caller ID, answers the phone, and says "I'll be right there." He turns his attention back to me.)</em></span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"><strong>Doctor:</strong> We find that radiation reduces recurrences that occur at the site of the original cancer. Women who have had surgery and radiation do much better in the long-term than those who only had surgery.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"><strong>Me:</strong> But if women have had chemo, why do they still need to be radiated. Why isn't chemo enough to kill any remaining cancer cells in the breast?</span><br /><br /><span style="font-family:Arial;"><strong>Doctor</strong>: Chemo is more effective at reducing metastasis in other parts of the body. Radiation kills the dividing cells in the breast.</span><br /><br /><span style="font-family:Arial;"><strong>Me</strong>: But why? Doesn't chemo work the same way as radiation-- by killing dividing cells.</span><br /><br /><span style="font-family:Arial;"><strong>Doctor:</strong> That's correct. Chemo and radiation work on the same principle. They both destroy dividing cells, but they attack them differently. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"><em>(Doctor's cell phone rings again. He answers it, saying with slight impatience, "I'll be right there." He again turns his attention back to me.)</em></span><br /><br /><span style="font-family:Arial;"><strong>Me:</strong> You need to go. I'm keeping you too long. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"><strong>Doctor:</strong> No, they can wait. Do you understand what I'm saying?</span><br /><br /><span style="font-family:Arial;"><strong>Me:</strong> I understand the words that you're saying, and I know that radiation is the standard of care. But I'm still not clear on why chemo doesn't do the job. Why do we have to bring in the radioactive substances if I've already had four rounds of chemo? </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"><strong>Doctor (looking like he is out on a limb):</strong> Because surgery has changed the vascular structure of the breast, so chemo may not reach the cancer cells there. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"><strong>Me (cartoon-type light bulb over my head illuminating):</strong> Oh!!! It's a highway construction problem. Maybe the chemo drugs can't get to the cancer cells in the breast because surgery has realigned some of the veins. Essentially, the roads may be bad. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"><strong>Doctor:</strong> Yes. Also, there are lots of cancer cells at the actual disease site, so surgery may not remove them all and chemo may not kill them all off. Radiation provides extra protection and helps to prevent recurrence.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;"><strong>Me (appreciatively):</strong> Thank you. Now I get it.</span><br /><br /><span style="font-family:Arial;"><strong>Doctor (looking relieved): </strong>You're asking the types of questions that medical researchers ask. Scientists want to know why one treatment works better than another treatment or a combination of treatments. </span><span style="font-family:Arial;">I'm going to download some information for you from the Internet. </span><br /><br /><span style="font-family:Arial;"><strong>Me: </strong>That would be great. Thank you. </span><br /><br /><span style="font-family:Arial;">To his credit, this doctor did not leave the room until I was satisfied with his answer. He could have used his ringing cell phone as an excuse to exit, but he didn't. And for that, I was grateful. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-10421079956924251012008-05-09T09:30:00.000-07:002008-05-09T09:38:11.410-07:00Family Tree<span style="font-family:arial;">Although I have yet to face my oncologist with this decision, I told his nurse practitioner that I'm declining the invitation to become a human test subject. I've decided against joining the national clinical trial researching the impact of osteoporosis medicines on reducing breast cancer metastasis to the skeletal system. </span><br /><br /><span style="font-family:Arial;">No single fact tipped my hand. Rather, the cumulative bad news concerning these drugs, known as bisphosphonates, weighed too heavily against their possible benefits, at least for me. First, their potential to destroy the jaw bone irreparably, while a statistically rare side effect, was still a frightening one. Moreover, anecdotal evidence about the jaw problem just keeps surfacing, making me question how rare this side effect actually is. Meanwhile, this class of drugs has been linked to other health problems. Just last week, one such drug, Fosamax, was blamed for incidents of irregular heart beats. Additionally, in January, the FDA issued a warning advising that Fosamax and other bisphosphonates marketed as Boniva, Reclast, Zometa and other labels may be responsible for a sudden onset of musculoskeletal pain. T</span><span style="font-family:Arial;">hat's three medical complications l'd like to avoid, but who's counting. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">My overall bone health is still a question mark. With last week's surgery, we delayed the diagnostic bone density test. If my bones are crumbling, I may have to take bisphosphonates anyway, but at least my doctor and I can select the specific drug and dosage, rather than being constrained by the protocols of a clinical trial.</span><br /><br /><span style="font-family:Arial;">Genetics, of course, plays a big role here, and I don't know of any family history of osteoporosis. But you're never completely certain that a grandparent or great-grandparent didn't suffer from a particular health problem. Case in point: Since learning I had breast cancer, I've been telling doctors that I have no family history of the disease. That was before the postman brought a card last week from my Aunt Sallie. In her mid-eighties, Sallie is my father's eldest sister. She lives in Colorado with their third sibling, my Aunt Mary Jeanne. Both of my father's parents were deceased before I was born. Growing up, I rarely saw these aunts, and I know very little about my father's branch of our family tree. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">So I read with great interest Sallie's information that my paternal great-grandmother died of breast cancer. Unfortunately, this nugget was the sum total of what Sallie revealed about her. Since she was a great-grandmother, and thus a few generations removed from me, I don't know how medically significant this fact is. But my curiosity is still peaked. What was her maiden name? How old was she when she died? What was her ethnic background? Where was she born? </span><br /><br /><span style="font-family:Arial;">Each of us is the amalgamation of so much genetic code. Beyond the color of our eyes or the texture of our hair, our forefathers give us a propensity for so much else -- from heart disease, to blood disorders, to alcoholism, to longevity. Learning their life histories can be fascinating from a self-awareness point of view. Now I see that it's also medically useful. The next thing I write should be another letter to Aunt Sallie. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-15683179479487361082008-05-02T11:20:00.000-07:002008-05-03T08:26:06.559-07:00Progress Note<span style="font-family:arial;"><strong></strong></span><br /><span style="font-family:arial;"><strong>From the Chart</strong></span><br /><span style="font-family:arial;"><strong></strong></span><br /><span style="font-family:arial;"><strong>Patient: </strong>Watkins, C.</span><br /><span style="font-family:arial;"><strong>Date of Procedure:</strong> April 29, 2008</span><br /><br /><span style="font-family:Arial;"><strong>Nature of Procedure: </strong>Re-excise small amount of additional tissue from left breast. Section marked for removal is located on the outer, inferior side, around 4 o'clock (if breast were a clock face). Objective is to achieve a clean margin around the pre-cancerous DCIS. (Doubt that patient will notice much change. Surgical plan calls for removing only a couple of minutes from breast clock, say 4:17 to 4:20.) </span><br /><br /><span style="font-family:Arial;"><strong>Pre-Surgical Events</strong>: Ms. Watkins was extremely polite and well-mannered despite the fact that we kept her waiting on the ultrasound table for a full hour due to a malfunctioning ultrasound machine. Query: How were surgical guide wires placed before ultrasound? Does anyone remember?</span><br /><br /><span style="font-family:Arial;"><strong>Surgical Notes</strong>: Mission accomplished! Procedure completed in a jiffy. Patient sent home one hour following surgery. A couple of nurses remembered Ms. Watkins from her prior surgery last November. Good time had by all. </span><br /><br /><span style="font-family:Arial;"><strong>Post-Surgical Follow-up (24 hours later</strong>): Nurse placed follow-up call to patient's home. Ms. Watkins reported feeling flattened and was watching hour after hour of <em>Top Chef </em>while reclining on her sofa. Possible that she is reacting to lingering effects of anesthesia, which may have addled her brain. Propose watchful waiting to see if penchant for reality TV cooking show wears off as anesthesia dissipates. Husband advised to call immediately if patient dons white chef coat and/or toque.</span><br /><br /><span style="font-family:Arial;"><strong>Post-Surgical Follow-up (72 hours later):</strong> No pathology report yet. Hope "mission accomplished" reference above was not premature. Patient reports returning to normal activities, including blog writing. However, Ms. Watkins is experiencing a continuing craving for episodes of <em>Top Chef</em>. Suspect that patient has underlying fantasy of winning <em>Top Chef </em>competition herself. In any case, checking with anesthesiologist to see if other patients are reporting similar side effects related to cable and/or reality TV. </span><span style="font-family:Arial;">Perhaps basis for new research study. What are the recuperative effects of viewing <em>American Idol</em> or <em>Dancing With the Stars</em> while in post-surgical daze? </span><br /><br /><span style="font-family:arial;"><strong>Final Note: </strong>Preliminary pathology report is in. <strong><em>No evidence of any cancer</em>.</strong> Nurses told patient Ms. Watkins that she can relax. Final pathology report yet to be issued, but preliminarily, things looks very good. </span><span style="font-family:Arial;">Re-excision appears to have been the right course. Hurrah! We seem to have gotten it right.</span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-57163239357135496992008-04-22T14:47:00.000-07:002008-04-23T15:06:03.462-07:00Go Back Three Spaces<span style="font-family:Arial;">Remember the setbacks intrinsic to board games. Players are sent back three spaces, or maybe they forfeit a turn simply because they landed on the wrong square or drew the wrong card. In the overall rhythm of the game, these impediments are never really catastrophic, but they trigger a keen sense of frustration nonetheless. </span><br /><br /><span style="font-family:Arial;">I h<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsQbisGYXHvm0JMbMy4EgDu2-kX-q2uokQyV6JbLa0D193nvtKto7Ok3Ej58soTW3XGWKCfJG4BjyDfTFknu2NBBkyN2HlrFair4I1z6HAl931miMjhAn-JdSm7OK9jWC9SY_Ar4RMhvI/s1600-h/800px-Parcheesi-board-perspective.jpg"><img id="BLOGGER_PHOTO_ID_5192563745441495570" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" height="158" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsQbisGYXHvm0JMbMy4EgDu2-kX-q2uokQyV6JbLa0D193nvtKto7Ok3Ej58soTW3XGWKCfJG4BjyDfTFknu2NBBkyN2HlrFair4I1z6HAl931miMjhAn-JdSm7OK9jWC9SY_Ar4RMhvI/s200/800px-Parcheesi-board-perspective.jpg" width="200" border="0" /></a>ad a similar setback earlier this week. My radiation treatments, scheduled to begin during the last week of April, were taken off calendar, and I was sent back to the breast s<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXggDFuYqRAEAph0irREeDTevfYfG6Zp7QN5C70IhM-yAaPfdu4T9G8ftKAEv_vNMiu7aJOFr8SXhJAq2OPB48xQgfkhQPfKK2QeT80IrX2MMHqzO3ebDspFio_3HL_xxH4g3E8X_vWF4/s1600-h/800px-Parcheesi-board-perspective.jpg"></a>urgeon to discuss re-excision. Before I explain further, let me assure those who are quick to worry that my health status has not changed in the slightest. No new or bad facts have presented themselves. This week's shift in treatment reflects nothing more t<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLn8hZLpdoyrPiwOlZOjOCqMVH1IBmBgm_jPbAIdtmKX1P1RPNopyr9DkFSVcC7SMqQKLwdlohrilWDVzeqL5gyrhezkwCO-9CVgJM0xb5IOUaPkRn5tpcXDOl2kOzEQF_dWmW4fXo2Q8/s1600-h/800px-Parcheesi-board-perspective.jpg"></a>han a change in thinking about the next step. </span><br /><br /><span style="font-family:Arial;">If you've followed this blog for awhile, you may remember that, based on the pathology report following my surgery, the breast surgeon achieved a "clean" margin around my invasive cancer, but only a "close" margin around the pre-cancerous condition (known as DCIS). While achieving a "close" margin is not as bad as a "dirty" margin, the downside is that close margins leave lingering doubt -- maybe all of the DCIS was removed, but maybe it wasn't. Close margins call for additional medical intervention. Depending on each patient's circumstances, they are either rectified by the surgeon, who removes a little more tissue during a re-excision, or by the radiation oncologist, who increases the radiation dosage to kill off any unwanted cells that the surgeon missed. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">In my case, the breast surgeon instructed me to discuss the margin problem with Dr. Rad, which is my nickname for the radiation oncologist I'm seeing. At the time, which was back in December, Dr. Rad was confident that by increasing the radiation levels, he could eliminate any remaining bits of DCIS. My reaction to this idea was tepid at best. From a holistic viewpoint, I was a little hesitant to let Dr. Rad dial up the dosage, but I was the only one who balked. The rest of my team -- the medical oncologist and the breast surgeon -- all concurred with Dr. Rad and green-lighted this plan. Since I lack an M.D. after my name, arguing with three medical experts seemed pointless. I acquiesced and agreed to return to Dr. Rad after I concluded chemotherapy in order to begin super-charged radiation treatments. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">But this week, when I showed up for a pre-radiation planning session, Dr. Rad looked at my chart again and changed his mind, although not for medical reasons. He cited my age and said that he was reluctant to proceed because he didn't want me to be unhappy with the cosmetic results of extra radiation. To be honest, the picture he painted was not a pretty one. Given that I was never fully invested in the extra dose idea anyway, he didn't have to say much before I agreed to inquire further about re-excision. Two days later I was consulting with a breast surgeon, although not the same one who performed my original procedure since that doctor has since relocated, but everything still fell easily into place. The new surgeon believes that by re-excising, he can both rectify the margin problem and give me a better cosmetic outcome than radiation would impart. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Even though I think I'll be happier in the long run by following this course, the delay is still frustrating. I want to reach the finish line, and I don't relish being sent back 3 spaces. The re-excision is scheduled for next week, and radiation is set to begin at the end of May. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">As a kid, I always enjoyed board games, and I good-naturedly weathered the inevitable lost turns or directives to retreat a few squares. At least that's how I remember the long summer days I spent playing <em>Trouble </em>or <em>Parcheesi.</em> This experience, however, is testing even my patience. I want to get to <em>Candyland</em>. Now. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-87753621892167669282008-04-14T14:51:00.000-07:002008-04-15T14:07:55.025-07:00Three Seasons Later<span style="font-family:arial;">Done. Done. Done with that!</span><br /><br /><span style="font-family:Arial;">Chemo is finished, thankfully, and I owe some words of appreciation to those who so kindly extended their help. To my husband Dennis, to BK, and to TB, thanks so much for chauffeuring me on chemo days. Also, many thanks to EQ for stopping by to visit during my treatments.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">I'm also very grateful to my lunch/coffee buddies -- JB, BE, LR, MB and BP. You've brightened my mood over many meals and continued to assure me that my bandanna was fine. Really. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Thanks, Mom, for the meals. And thanks to everyone for your extended support over these long months since I was first diagnosed. Your kind thoughts have arrived in many forms -- e-mails, blogposts, telephone calls, greeting cards, floral deliveries, prayers and, yes, even mental telepathy. I know that you're thinking of me, and that knowledge has helped to propel me forward with my good spirits mostly intact.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">My first radiation planning session is scheduled for later this week, when I will get some better information about the final phase of treatment. This breast cancer ordeal, which began last September with a peanut-sized mass palpable under my skin, will wind down in the not-too-distant future, and I will shift into a maintenance mode. Since embarking on my detour, a Halloween, a Thanksgiving, a Christmas, and an Easter have all been celebrated. A once obscure politician, Barack Obama, now has instant name recognition. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">This past weekend in Los Angeles, the weather was more akin to July than April, the tomato plants were beginning to flower, and people's conversations were drifting toward graduations and vacations. Summer will circle around again soon, and I will return to days without cancer treatments.</span><br /><br /><span style="font-family:Arial;">The life I resume, however, will not exactly be the same as the one that I led a summer ago. I'm no longer the same. How could I be? </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com1tag:blogger.com,1999:blog-6294781622186438499.post-6163136240559292802008-04-08T11:07:00.000-07:002008-04-08T15:52:24.591-07:00In the Name of Science<span style="font-family:arial;">Fourteen days have passed since my final round of chemo. For the first time in 11 weeks, I feel that I'm at a point where I can begin to rejuvenate from the treatments.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">While my energy level is far from normal, I'm also not as fatigued as I have been. That said, at the end of April, I'm scheduled to begin radiation, which also imparts a cumulative weariness in patients. Knock you down, let you build back up, and knock you down again. Add to the fatigue level varying amounts of hair loss, nausea and low blood counts. Indeed, the cancer treatment cycle is vicious, but so are those nasty cancer cells. Doctors are only trying to match the correct level of firepower to the perceived level of threat. The side effects are so much collateral damage. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Thanks to the sacrifices of a group of laboratory mice, however, some of chemo's negative impacts may be a thing of the past. A joint study, conducted by USC/Norris and the Giannina Gaslini Institute in Genoa, recently showed that by starving mice for a few days before their chemo treatments, the rodents avoided some of chemo's debilitating side effects. The researchers believe that healthy cells, when deprived of nourishment, stop dividing in order to withstand the stress. Cancer cells, however, respond differently and continue to divide, even when they are not getting proper sustenance. Since chemo only attacks dividing cells, the researchers believe that patients may be able to ward off chemo's ill effects if they forego food for a few days before treatment. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">In this particular experiment, 28 mice received only water for 48 to 60 hours preceding treatment. Only one mouse out of the 28 who fasted did not survive the experiment. Meanwhile, another group of 37 mice ate normally before their chemo treatments, yet 20 mice in this group perished. Interestingly, the survivors in the group who fasted showed no visible side effects, while the remaining mice in the group who ate became sluggish and had ruffled fur. All of the mice were given the drug Etoposide, at levels three times the maximum <strong>human</strong> dose.</span><br /><br /><span style="font-family:Arial;">The results appear promising, and a clinical trial is expected to begin later this year to test this theory further. Until more is known, however, Valter Longo of USC, the director of the study, warns chemo patients not to fast before their treatments without instruction from their doctors. </span><br /><br /><span style="font-family:Arial;">While Longo and the others behind this study will undoubtedly get all the praise, the mice are the true unsung heroes. Out of the 65 mice who began the experiment, 21 are no longer with us. Now that's a hazardous job, and it brings to mind all of the laboratory rodents who work to further our understanding in so many fields of study. </span><span style="font-family:Arial;">If I had hair, I'd tip my hat to those furry little creatures. Instead, I'll raise my glass. Here's to lab rats and research mice everywhere. Your efforts go largely unnoticed, but your contributions are immeasurable. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-29457115789985772562008-04-02T11:48:00.000-07:002008-04-04T18:59:28.310-07:00Dem Bones, Dem Bones, Dem Dry Bones<span style="font-family:arial;">I wanted to share some of the feedback I've received on my clinical trial question. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Ge<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiieyemAUUxgYkRLjqUaWYOpqNr_9BuoxiscpQp6g7mSGxkCOb7HJ-CVll9T65_4nnkt-ehXEowYScfqFroxsLis-93y-AQIabcFsrL74Kj3Ce30hJ3QZhycbltLDYMcDUXHa-xPwXqvEU/s1600-h/skeleton.jpg"></a>nerally, people have asked whether I can replicate the benefits of taking the osteoporosis drugs by improved diet and exercise. My sense is that a targeted diet and exercise regimen would help to prevent osteoporosis, but I'm not sure it would be as beneficial as the drugs in warding off a recurrence of breast cancer.</span><br /><br /><span style="font-family:Arial;">Our bones are constantly regenerating. Old bone is broken down by cells called osteoclasts (the de<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFBQ99Kk1dCsk9eCtRoaOEZsRC6XI6sOjIFJAlugKH0KVd8RGEDPju3KSCRMUqPCbcUwXckMAAyoVJMnQ7Rc6YAfNyEvGVSuAoQznG_QLQiTEBwFUghMHA4xMhBKDkzaj8DKRsTDo_4t8/s1600-h/human+skeleton.jpg"><img id="BLOGGER_PHOTO_ID_5185500262776020962" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 95px; CURSOR: hand; HEIGHT: 168px" height="281" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFBQ99Kk1dCsk9eCtRoaOEZsRC6XI6sOjIFJAlugKH0KVd8RGEDPju3KSCRMUqPCbcUwXckMAAyoVJMnQ7Rc6YAfNyEvGVSuAoQznG_QLQiTEBwFUghMHA4xMhBKDkzaj8DKRsTDo_4t8/s320/human+skeleton.jpg" width="95" border="0" /></a>molition teams), and new bone is created in its place by another group of cells, the osteoblasts (the construction teams). This process keeps bones strong and flexible. As we age, and lose estrogen, however, the demolition teams outpace the construction crews, resulting in bone loss. Genetics, diet and exercise all influence this balance. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">This process is further complicated when breast cancer cells show up at the construction sites. Once they enter the bone marrow, breast cancer cells indulge their destructive natures and habitually sign on to the demolition parties, which just can't be a good thing. As I understand it, osteoporosis drugs, or bisphosphonates, work by interrupting the relationship between breast cancer cells and the osteoclasts. Doctors already use these drugs to treat metastatic bone cancer. The two-fold question being investigated in the clinical trial is, first, whether bisphosphonates will help to prevent breast cancer recurrence, as the European study showed, and, second, which drugs and dosages are most effective. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Elizabeth Edwards's story is a good case to consider. After her initial diagnosis in 2004, she underwent surgery, chemo, and radiation, although not necessarily in that order. Most women who follow this treatment remain cancer free. Three years later, however, she learned that her breast cancer had metastasized to the bone. The question for the researchers sponsoring the clinical trial is could she have avoided the involvement of her bones had she taken bisphosphonates in 2004 as an on-going part of her treatment? </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Although I'm not completely sure of this, let's assume that diet and exercise can generate bones that are strong enough to inhibit cancer cells from entering them. That would be a real plus. However, in the event that a few cancer cells survived the chemo/radiation and did find their way into the bone marrow, it seems too late for diet and exercise to have any benefit. Since bone is the most common site for breast cancer metastasis, researchers are hoping that bisphosphonates will deter cancer cells already in the skeletal system from making it their second home. </span><br /><br /><span style="font-family:Arial;">Another point that you've raised in e-mails is the type of bone that bisphosphonates create. Because these drugs work by inhibiting the osteoclasts from breaking old bone down, the resulting bone may be denser, but it's also old and brittle. Bisphosphonates don't generate the new, flexible bones that osteoblasts build naturally, which may explain the problems that some women have experienced with their jaws. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Finally, I've been asked to consider the holistic effect of all of the forms of treatment I've completed or will eventually complete -- surgery, chemotherapy, radiation, estrogen suppressant -- plus the possible addition of bisphosphonates. What is the cumulative impact of all of this? This is a good question for the oncologist, but </span><span style="font-family:Arial;">I'm not scheduled to see him again until the end of April. We will also do the bone scan, or DEXA study, then. Meanwhile, I'm moving ahead with the planning sessions to get radiation underway.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">I still have a little time to think about the clinical trial, and I'm finding your e-mails and comments very helpful. Your questions are pointing me in new directions and giving me new angles to consider. It's no secret that I thoroughly enjoy delving into a topic, so keep the feedback coming.</span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-87622713866762480222008-03-28T12:31:00.000-07:002008-04-01T12:39:27.035-07:00Trial Behind, Trial Ahead<span style="font-family:arial;">I'm collecting the high fives now, if you please. My last round of chemo and my final injection of Neulasta are behind me. I face three weeks of recovery from this latest round of drugs, and then I can officially close this chapter of treatment. What a relief!</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">My medical team seems to think that I weathered chemo well. During my check-up, the nurse noted approvingly that I both fended off nausea and retained my eyelashes. While I'm pleased to have been a gold star patient, I'm ready to part ways with the intravenous drugs. Indeed, the only injection system that I want any proximity to at the moment is the one that regulates the flow of fuel in my car. Unless....</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">And this a big unless. I'm currently weighing whether to participate in a clinical trial sponsored by the National Cancer Institute, which includes the possibility of receiving several IV drug doses over the next three years. Since I'm not sure how to proceed, I hope that you'll bear with me while I publicly gnaw on my decision here. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">The trial, which is being carried out at cancer centers across the country, looks at the effects of three different osteoporosis drugs on preventing bone metastases in women with breast cancer.</span> <span style="font-family:Arial;">Bones are the most common site for breast cancer cells to migrate.</span> <span style="font-family:Arial;">An earlier study, conducted in Europe, has already shown that one osteoporosis drug -- Clodronate -- had a positive impact on reducing metastatic bone cancers in patients with early-stage breast cancers. Presumably this outcome was because stronger bones are more impenetrable to cancer cells than weaker ones. Now, U.S. researchers want to compare Clodronate to two other drugs -- Ibandronate and Zoledronate. Six thousand women are being recruited for this three-year study, including me.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">All of this sounds fine. However, no drugs are free of potential side effects. Osteoporosis drugs fall under the pharmaceutical group called bisphosphonates. Basic Internet research turns up articles from all corners of the globe citing correlations between bisphosphonates and incidents of serious problems in the jaw bone. Although these complications are rare, bisphosphonates may trigger "osteonecrosis" of the jaw, which means that the cells in the jaw bone die off causing permanent damage and significant dental problems. This side effect occurs more often in one of the study's three drugs, Zoledronate, which is given intravenously. The two other drugs are given orally.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">This clinical trial is double-blind one, meaning that neither the participants nor their doctors know to which prong of the study they will be assigned. Thus, every one has a one-third chance of landing in the Zoledronate arm of the study and thus assuming the greater risk of the potential jaw problems. Since USC/Norris is a research center and one of the study sites, I've been approached several times about my willingness to participate, and I've yet to give a definitive answer. I have until the end of May to either opt in, or skip the whole thing. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Usually a decisive person, I'm stymied by this choice. On the one hand, I tend to believe I would benefit from the Clodronate in a couple of ways. Since I have no reason to distrust the results of the European study, I would receive its assistance in warding off future breast cancer problems. Also, given my fair skin and small bone structure, I am definitely an osteoporosis candidate, so the Clodronate would also pitch in on that front. Finally, a voice in my head keeps whispering to me about the inherent rightness of stepping up when one is called upon to make a contribution to the greater good. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">On the other hand, who wants problems with their jaw bones? While I'm not afraid of needles, I don't really welcome periodic doses of a strong intravenous drug over the next three years.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">So, what to do? When faced with a decision that lacks an easy answer, my habit is to look for a piece of evidence that will tip the scale one way or the other. To this end, my oncologist has scheduled a bone density test to see if I have any evidence of osteoporosis now. The bone density test is a pre-requisite to participating in the clinical trial anyway, so I'm proceeding with the preliminaries without yet committing. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Feel free to share your thoughts here. While this is my decision alone, I'd welcome your input, so post comments or send e-mails. Clinical trials conducted on actual people are one way we gain knowledge. But they're not without some risk. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">I can anticipate a couple of questions you may already have, so let me sort those out now: </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">1. Why not just take the Clodronate and skip the clinical trial? I posed this question, and my doctor's answer was only if my bones currently showed evidence of osteoporosis. The FDA has only approved Clodronate to treat osteoporosis, so he can not ethically prescribe it to a patient without evidence of bone loss. The results of the European study showing Clodronate's positive impact on breast cancer have not been replicated in the U.S., and the FDA has not adopted them. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">2. Can I pull out of the clinical trial if I land in the Zoledronate group? Technically, yes. The study does not require a legally binding contract. But that's not my style, and I'd rather not be disingenuous with the researchers at USC, where I'm a patient. Either I commit fully to the study, or I skip it. That said, if I developed some problem during the study, I would, of course, step out.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Any thoughts? </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com3tag:blogger.com,1999:blog-6294781622186438499.post-84807245594761349942008-03-24T18:25:00.000-07:002008-03-25T08:06:33.022-07:00Scenes From The Chemo Ward<span style="font-family:arial;">At USC/Norris Cancer Hospital, patients check into Day Hospital for their chemo treatments. You </span><span style="font-family:Arial;">may be imagining a foreboding place populated by really sick people. I pictured a darkened room where everyone was incapacitated because of nausea. But my preconceived notions were just wrong. Let me draw you a more accurate picture. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Instead of beds, Day Hospital is furnished with about 25 blue barca loungers. The room is bright with a large bank of windows, and the nurses are both cheerful and competent. Patients are assigned to a blue recliner, where they put their feet up, cuddle into a light blanket, and idly pass the time. Some people bring laptops. Others doze, read, listen to IPODs, or chat with the person in the adjacent recliner. Meanwhile, their IVs do the heavy lifting and control the steady drip of drugs into their veins.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">What is striking about Day Hospital is that there is no single characteristic that typifies a cancer patient -- not gender, not class, not race. Not even age is a reliable indicator, since some patients have been surprisingly young. Over the course of my treatments, I've exchanged smiles with a business woman in her fifties, who was working industriously on her laptop. I've observed a man in his forties, who napped while his wife patiently sat reading beside him. And I've eavesdropped on a couple in their sixties, who were frantically working their phones to rectify a lapse in their health insurance coverage. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">On my last visit to Day Hospital, I chatted briefly with an elderly woman who was talking to everyone who walked by her chair. Dragging my tethered IV stand with me, </span><span style="font-family:Arial;">I walked over to her to ask about her elegant knit cap. I was curious if she had stitched it herself. A flattering shade of green, the hat sat perfectly on her head, falling just over </span><span style="font-family:Arial;">her ears and low on her forehead, but still allowing her luminous blue eyes to peer out. In response, she proudly told me that her daughter had knitted several such caps for her in advance of her hair falling out. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">In turn, she asked me about my eyebrows. She wanted to know whether I had I lost them and then had re-grown a new set, or if I was still holding onto my original pair. I happily answered that I was still holding onto my pre-chemo brows, as if this were an achievement for which I could actually take credit. She confided that her brows had vanished, but she had since grown a new set. We chuckled together at the indignities. But as I went back to my own recliner, I had a twinge of worry about her. Despite her gregariousness, she appeared frail and was getting a blood transfusion while we talked.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">For the most part, though, people have not seemed that sick. Their demeanors have been normal, and as far as I can tell, people are eating. Most patients have readily accepted the nurses' offers of sandwiches or soup. I heard one man even ask if he could have a bottle of Dos Equis with his lunch. The nurse replied, "What?" He repeated, "Dos Equis." Again, she said, "What?" On his third try, he said, "A bottle of beer." The nurse responded, "Oh, if you had said <em>cerveza,</em> I would have understood." Undeterred, the man said, "Well, can I have a <em>cerveza</em>?" </span><span style="font-family:Arial;">"No" was her answer, but she did bring him a coke.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Chemo, it's just not what you expect. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-75137083588189753032008-03-17T11:34:00.000-07:002008-03-18T08:19:07.158-07:00Too Bare To Bear<span style="font-family:arial;">Women with fair skin are not meant to be bald. Trust me on this. </span><br /><br /><span style="font-family:Arial;">People have visibly winced or gasped when I've revealed this next little secret, but, honestly, I haven't looked at myself in the mirror with my head uncovered for about five weeks. "How do you tie on your bandanna?" they ask. No problem. I wrap it around my head, off-frame. Then, with my scalp safely hidden, I step in front of the mirror to make final adjustments. This regimen has worked fine. Really.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">After three rounds of chemo, one doesn't need a visual confirmation to know what lies beneath the scarf. My head undoubtedly resembled the noggin of a much abused rag doll, the kind with the patchy coiffure. So, on Sunday, when no other clients or staff were in the salon, I had Jay, the ever-dependable hairdresser, take a shaver to the loose strands. Mind you, I made him swivel the chair 180 degrees, so that my back faced the mirror for this operation. </span><br /><br /><span style="font-family:Arial;">Then this morning, I got up my gumption and peeked at my reflection. Let me say that I was right before. Some images are best left to the imagination, and scalps that have never seen the sun have no business being exposed. </span><span style="font-family:Arial;">With my final chemo cycle scheduled for the last week of March, I'm hoping that I can achieve a fine covering of fuzz by mid-May. Just in time for summer.</span><br /><br /><span style="font-family:Arial;">The good news is that, except for a diminished energy level, I haven't felt that bad. I do admit to having a little trouble in the kitchen, however. Chemo has caused my taste buds to go off kilter, particularly in the salty ranges. But I enjoy cooking so much that I haven't stopped. My husband and son, who are always grateful for whatever food I prepare, have assured me that my meals are still up to par, even if nothing tastes quite right to me. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Thankfully, the end of this chemo trip is starting to come into focus, and it couldn't arrive too soon. By the middle of next week, when I undergo my last treatment, I'll only have to sustain the final three-week recovery period. Knowing that the debilitating drugs are behind me, those days will most assuredly zoom by.</span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0tag:blogger.com,1999:blog-6294781622186438499.post-78985882181587495822008-03-10T11:02:00.000-07:002008-03-11T14:35:44.719-07:00Sticker Shock<span style="font-family:Arial;">Last Wednesday, when I offered up my vein for the third chemo cycle, I arrived at the 50 percent point in my treatment. Following the same orders he prescribed after my second cycle, the oncologist again instructed me to return the next day for an injection of Neulasta, a drug that stimulates the bone marrow to make white blood cells and thus prevents infection.</span><br /><br /><span style="font-family:Arial;">This time, however, before I arrived for my dose of Neulasta, I received an astonishing phone call from the hospital. An insurance person was calling, as a courtesy, to clue me in on Neulasta's price tag. </span><br /><br /><span style="font-family:Arial;">I should say that three weeks earlier, after receiving my first dose of Neulasta, I thought to myself that the drug racing to my bone marrow had to be on the pricey side. After all, Neulasta has an important and specialized job, and it seems to keep working at its assigned task for the duration of the three-week chemo cycle. Both smart AND highly focused, all in a single dose -- these attributes don't come cheap. </span><br /><br /><span style="font-family:Arial;">Idly considering what such a drug might cost, I reasoned that about 18 months earlier, I had paid a little more than $100 for an inoculation for my son, Joe, to prevent him from contracting meningitis in the college dorms. Given that the meningitis vaccine's price must be at least partially set by its volume distribution to students nationwide and given that cancer is generally a big-ticket disease, I assumed Neulasta fell into a much higher price bracket. I was guessing that it hovered in the $400 per dose range.</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Imagine my surprise when the woman on the phone calmly stated that Neulasta cost $1200. Startled, I said, "For the series?" I was quickly doing some mental arithmetic and figured that if I received three Neulasta doses, each worth $400, my bill would total $1200. "No," she said, "Apiece."</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">So, I'm now the proud purchaser of $2400 worth of Neulasta, and since I'm still due for one more chemo cycle, my tab for this drug is likely to reach $3600 before March is over. This sticker-shock scenario raises so many questions about universal health care and the pharmaceutical industry and the insurance companies that they furrow my normally untroubled brow. But wait. Don't we pay elected officials to grapple with these conundrums? </span><br /><br /><span style="font-family:Arial;">Not to worry about me personally, though. I'm one of the fortunate sick people who has health insurance. By receiving a designer drug, I've done nothing more than guarantee that I'll meet my shockingly high deductible sooner in the calendar year rather than later. </span><br /><br /><span style="font-family:Arial;">The situation does cry out for a cost-benefit analysis, however. On the benefit side, Neulasta did impart some good effects. I felt better overall during the second chemo cycle than the first one. Presumably, my good phase was due to the addition of Neulasta, which quietly urged the growth of white blood cells. Moreover, should I have not taken the drug and developed an infection, a hospital stay would have been far more expensive than the total cost of the Neulasta injections. Cost-benefit analysis: Probably worth it. </span><br /><br /><span style="font-family:Arial;">Anyway, it's too late to be counting hundreds now. Combating a serious disease is -- at least in this way -- similar to finding yourself tired and hungry, but the only available restaurant is a posh one. You look at a menu, and you're aghast at the prices. But you really have no choice, except to order. You need food, and now is not the time to quibble over the cost of an entree. </span><br /><br /><span style="font-family:Arial;">One more thought, Amgen, which manufactures Neulasta, is a Southern California company, based in Thousand Oaks. At least I'm buying local. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com2tag:blogger.com,1999:blog-6294781622186438499.post-29183164340157022202008-03-06T15:55:00.001-08:002008-03-06T21:37:42.091-08:00Birthday Blog<span style="font-family:Arial;">A year ago, when I quietly celebrated my 49th birthday, I imagined that this February, my husband and I might be in Rome or in Madrid toasting to my 50th. When I learned that chemotherapy was going to forestall those plans, however, I started to grapple with some nagging "what if" questions about how best to mark the milestone birthday on the horizon. </span><br /><br /><span style="font-family:Arial;">1. What if I felt too awful to celebrate at all?</span><br /><span style="font-family:Arial;">2. What if I looked terrible?</span><br /><span style="font-family:Arial;">3. What if I had no hair?</span><br /><span style="font-family:Arial;">4. What if I had no eyebrows?</span><br /><span style="font-family:Arial;">5. What if I let my birthday pass and did nothing? How would that feel?</span><br /><br /><span style="font-family:Arial;">Truth is that all of those vain and self-absorbed questions, except for maybe the last one, were much trepidation about nothing. In the end, I felt good. I looked fine. I did lack hair, but my new bandanna collection has been serving me well. I still had eyebrows, thankfully. And, yes, I would have been really mad if I did nothing to celebrate the event.</span><br /><br /><span style="font-family:Arial;">Despite the chemo, I spent a lovely afternoon at home with close friends and family. Those who live in other parts of the country sent cards and flowers and left phone messages. Whether they were present in person or in spirit, everyone's good wishes reaffirmed how generous and caring people have been to me during this period and how very much I appreciate your continued support. My sincere thanks to all of you. </span>Cathleen Watkinshttp://www.blogger.com/profile/05272296179776537008noreply@blogger.com0