Friday, January 25, 2008

Eat Your Fish Oil!

I am intrigued with the possible insulin connection to hormone-receptor-negative breast cancer, so a study in the Journal of Physiology caught my eye. Researchers in Canada found that omega-3 fatty acids may help regulate insulin sensitivity and build muscle mass. The study, which used steers as subjects, concluded that omega-3s can jumpstart the protein synthesis in the skeletal muscle that slows down with age and causes insulin resistance and loss of muscle mass.

Patients who have gone through chemotherapy might benefit from omega-3s for another reason: These fatty acids have been shown to be beneficial to heart health, which could help with the damage that might be done to the heart muscle by Adriamycin, one of the most common chemo drugs.

Omega-3s come from oily fish like tuna, salmon, herring, mackerel, anchovies, and swordfish. Flaxseed, walnuts and wheat germ contain some omega-3s, but not at the levels of fish oil.

Sunday, January 20, 2008

Can Tamoxifen Help Hormone-Receptor-Negative Breast Cancer?

Neither Tamoxifen nor Arimidex are recommended for hormone-negative cancer. Breast cancer research, especially from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), demonstrates that these drugs do not help hormone-receptor-negative cancer. The Arimidex Web site specifically notes that the drug is for women with estrogen-positive breast cancer.

The situation gets a little muddy in terms of weakly positive tumors, which was true in my case—I was weakly positive for progesterone. These tumors are considered a mixture of positive and negative and, therefore, might react to the anti-estrogen drug Tamoxifen or an aromatase inhibitor like Arimidex. Wendy Chen, MD, of Dana Farber Cancer Institute and Brigham and Women's Hospital and a participant in the Nurses Health Study (NHS) research, says the NHS studies classify a tumor as hormone positive if it is even borderline positive. So those of us with mixed readings, in that case, would have been included in the data for estrogen-positive patients.

Still, she says, “The cut-off for ER positivity can vary from lab to lab and study to study.” Because of this, she says, “there is no one right answer” to the question of whether Tamoxifen or Arimidex might help women with weakly positive tumors."

The California Teachers Study (CTS) , published in the Archives of Internal Medicine , has another take on this.

According to the CTS, even though tumors of hormone-negative cancer do not need estrogen to grow, at the stem-cell stage they may be initially formed because of out-of-kilter hormones that are linked to insulin. So, while estrogen is not the perpetrator, it may be an accessory to the crime, aiding insulin in the initial formation of the disease.

Tamoxifen, then, could be of some benefit, says Leslie Bernstein, PhD, professor and dean for faculty development at the City of Hope National Medical Center. Bernstein, who was a researcher on the CTS study, says that Tamoxifen “suppresses the insulin-like growth factor. Its effects could work with ER-negative cancer.”

Data from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), show the overall recurrence rate after five years for women on Tamoxifen as 3.2 percent a year. For women who had not taken Tamoxifen, it was 4.5 percent a year. This is an average, of course, so half of the women in the study had higher recurrence rates, half had lower. Does this mean that women with mixed or weak readings would benefit less than average? That sort of information may be embedded in research, but I have yet to dig it out. I’ll keep trying.

Again, we get back to the fact that cancer is as unique as our DNA, so one woman’s breast cancer is not the same as another’s, and the decisions on treatment have to be made based on her specific circumstances.

Wednesday, January 16, 2008

My Kids, Madame Bovary and Rodney Yee

When I first met my kids, neither one knew a thing. Eat, poop, burp; eat, burp, poop. That was it. Now I am the point in my life where I need to own only five books because by the time I finish the fifth, I have forgotten what the first one was about. Too much time away from one title and they all blur. Was it Madame Bovary who jumped in front of that train in Russia because she was depressed about not catching that white whale?

Is there some social equation that shows at which point kids' knowledge matches, then surpasses their parents? My kids will probably never know as much as I do in some areas, but in far too many other aspects they leave me in the mental dust. It’s not the effects of cancer treatment, because it started way before my cancer.

Josh used to ask me questions about current events and history. Now it is the other way around. And geography, well he’s the king, regularly traveling to places most of us can’t even pronounce. Ellen used to come to me for health advice. Now I go to her as well. She was the first to warn me that milk has hormones that can throw cancer out of kilter. And she introduced me to hummus, which gives my mid-afternoon broccoli extra panache.

I remember the first time she went into territory once reserved for her wise mother. She told me not to put my finger in my mouth after I cut it—"You could infect it," she warned. She learned this at camp in middle school. But is her advice any better than my mother's, which was to rub it with Ivory soap? Sixty years of sticking my finger in my mouth and then rubbing it with soap created a habit that is difficult to break. Plus, I have never had an infected finger, so that proves…well, it probably proves nothing.

She also had advice for burns, but I never can remember what it was. Am I supposed to rub a burn with margarine? Or does that make it worse? The charm of my mother's advice is that we used Ivory soap for just about everything external and baking soda for everything internal.

I miss that sort of simplicity in a world jammed with information, some of it actually worthwhile but much of it not. I mean, for Pete's sake, everybody and their mother has a blog! My kids can navigate this world with ease while I often find it a royal pain in the brain. One Thanksgiving, Josh emailed asking for advice on how to cook a turkey in the tiny oven he had in his apartment in Belgrade, Yugoslavia. I told him to keep the top covered with foil, watch it regularly, and keep a fire extinguisher handy. He checked the Better Homes and Gardens web site and used the editors' advice instead. How am I supposed to compete with that?

I suppose this is one of those cycles of life we are supposed to celebrate, and I am proud of these kids of mine. When cancer nuzzled its way into our lives, their knowledge came in especially handy. Both are fans of yoga, and they encouraged me to get started. Ellen and her husband, Steve, even bought me my first Rodney Yee DVD and I am now addicted to the buff little guy. Every morning, I get up, go down to the kitchen, have a glass of green drink, then tell my husband, “I’m going up to do Rodney.” He nods and goes back to reading the paper.

Yoga and meditation have helped me immeasurably to keep my attitude positive, my head balanced. I suppose I would have discovered it on my own eventually, but the kids gave me a jumpstart. And the mat to go with it.

To keep up the exercise I know will help me stay well, I walk at least four hours a week. Recently, while Josh was home for Christmas, I got a bump on my foot. Of course, in my mind, it was bone cancer. In his, it was some sort of stress injury. He told me to stay off it for a couple of days and it would be fine. He had to tell me this several times because it was difficult for me to stop my daily walks. I mean, here I was with cancer in my foot and he was telling me to stop doing what research demonstrates helps reduce recurrence. I finally started thinking straight, took his advice and rested. Sure enough, the bump went away.

I obviously have gotten accustomed to technology—Josh recently called me an "early adaptor," bless his dear heart. Of course, this blog would not have existed had he not helped me figure out things like hyperlinks and showed me how to add the Sitemeter, which helps me obsessively check how many readers I have and where they come from. Hello, Berlin!

I still beat them both occasionally at Scrabble or Trivial Pursuit, but these human beings to whom I gave birth ended up pretty smart. And those smarts now help keep me healthy.

That and Rodney.

Saturday, January 12, 2008

Bring Your Own Breast: My Pick of Breast Cancer Books and Web Sites

My Favorite Books:

While the books below don’t focus directly on hormone-negative cancer, they do provide a thorough overview for understanding breast cancer and managing treatment and recovery.

Dr. Susan Love's Breast Book . This book should be on every woman’s bookshelf—not just those with breast cancer. It has been called the “breast cancer bible,” and rightfully so. I like Dr. Love’s attitude—she has faith in the wisdom of her patients as well as in medical science. The book is thorough, going even into metastasis, which she handles with such good sense it makes the possibility less frightening.

Sat Dharam Kaur’s The Complete Natural Medicine Guide to Breast Cancer . This wise naturopathic book is a great complement to Dr. Love’s book. I would also recommend it for all women as it offers great advice for staying healthy overall. It approaches treatment from an alternative perspective, while showing respect for traditional Western medicine. The book offers suggestions for natural ways to make chemo and radiation less toxic; a soothing breast massage that can double as a less intimidating breast exam; and plenty of details of types of cancer and their treatment. My daughter gave me this one and it is dog-eared from use—it gave me a sense of control over my illness, a way to help heal myself.

After Cancer Treatment: Heal Faster, Better, Stronger, Julie K. Silver, MD . A breast cancer survivor herself, Dr. Silver is an assistant professor of physical medicine and rehabilitation at Harvard Medical School, making her advice personal as well as medically sound. She helps you move on with your life through exercise, healthy eating, proper sleep, and a focus on mind, body, and spirit.

Straight Talk About Breast Cancer: From Diagnosis to Recovery,” Suzanne W. Braddock, M .D., Jane M Kercher, M.D., John J. Edney, M.D., Melanie Morrissey Clark. This book is a simple and helpful guide, strengthened by the first-person perspective of Dr. Braddock, a breast cancer survivor. My doctor gave me this one—sort of a prize gift for getting breast cancer.

Breast Cancer Husband: How to Help your Wife (And Yourself)Through Breast Cancer Diagnosis, Treatment, and Beyond, by Marc Silver. When Silver's wife (not Julie, above)  was diagnosed with breast cancer, he thought he was an inadequate caregiver, so he wrote this book to help guide other men in caring for their wives. Our daughter bought this for her father, who was an excellent caregiver, so it looks to me like it works.

Cancer Made Me A Shallower Person: A Memoir in Comics, by Miriam Engelberg. This book gave me the permission to laugh in the face of my disease. Engelberg used cartoons and a sharp wit to take us through her diagnosis, treatment, and, sadly, metastasis. She didn't try to be heroic, settling for being real. My favorite line: "Maybe I caused my cancer by being so depressed. That's so depressing." My son gave me this one, understanding his mother's need to laugh, no matter what.

My Favorite Web Sites:

These are also listed on the left, but I thought it might be good to explain some of them.

The Dr. Susan Love Research Foundation’s mission is to “eradicate breast cancer and improve the quality of women's health through innovative research, education and advocacy.” The site is comprehensive, easy-to-navigate, and offers information that doesn’t frighten, with an expert perspective and an engaging blog. In October 2007 Love was on NBC Nightly News and discussed the benefits of chemotherapy for hormone negative cancer. Love, who is author of Dr. Susan Love’s Breast Book, has a simple philosophy that is hard to beat: “We need to go beyond a cure. We need to stop people from ever getting breast cancer in the first place.”

Hurricane Voices is a breast cancer foundation that funds and supports research and advocacy. The group encourages new members to speak out for a “world without breast cancer” by being a Hurricane Voice. The foundation recently did a survey on cognitive problems associated with cancer treatment , which has been called “chemobrain.”

Breast is winner of the 2007 Platinum Award for Best Healthcare Content and the Silver Award for Best Overall Internet Site. It’s full of great information to help you with everything from navigating your pathology report to understanding breast reconstruction. News, illustrations, research reports. The group offers online Ask-The-Expert Conferences and chat rooms.

The Susan G. Koman Breast Cancer Foundation is probably the best-known breast cancer organization because of its Race for the Cure. The foundation also supports breast cancer research. Its site offers background information on breast cancer, news, research reports, and helps hook you up with a support group. There’s even an online breast exam. Bring your own breast.

Tuesday, January 8, 2008

EBCTCG Shows Chemo Works for Hormone-Receptor-Negative Breast Cancer

Research in The Lancet once again underscores the effectiveness of chemotherapy for hormone-receptor-negative breast cancer. It also shows that tamoxifen has little effect on recurrence or death for hormone negative patients. has a good overview of the research, which uses data from the Early Breast Cancer Trialists' Collaborative Group (EBCTCG).

The study looked at chemo from the 1970s and 1980s, which has been shown to be less effective than newer regimens.

Friday, January 4, 2008

The Johnny Depp Diversion

Watching chick flicks seemed like a good diversion during chemo. No big issues, just love and happiness, a hunk or two, and a gorgeous female lead who looks just like me. In my mind, at least. Well, I guess I chose the wrong flicks, because the movies we rented on Netflix kept jolting us with plots that involved women dying of breast cancer. And they did sort of look like me.

First, we watched Stepmom , released in 1998 with Susan Sarandon as Ed Harris’s ex-wife and Julia Roberts as the stepmom-to-be. Susan’s breast cancer treatment has not worked and the doctor tells her she can no longer do anything. She is terminal.

I was pretty annoyed with Susan throughout the movie, largely because she tried to be a quiet martyr, not letting those around her know how ill she was, taking treatment by herself, throwing up in her home, alone. Not that I wanted others to stand around the toilet with her, but I did want her to tell Ed and Julia what was going on. She eventually did and the movie ended with a nice warm shot of the three of them and their shared kids. In my heart, I decided that Susan was miraculously cured and that one day she went to the door for a UPS delivery and there was Tim Robbins.

Then we tried The Family Stone , a 2005 release. Diane Keaton is the woman with breast cancer this time. She is also the mother of five kids—Rachel McAdams, Dermot Mulroney, Luke Wilson, Brian White, and Elizabeth Reaser. The family is chaotic and Mom once again is reluctant to let them know that her cancer has returned. She eventually shares the news and the family deals with it—pretty doggone well, in fact. The final scene is the next Christmas—no mom, just the rest of the chaotic family, going along as usual. It was a little difficult for me to take home a positive message from this one. Maybe it was quieter in heaven? I dunno. Diane’s love continued in the love of her family? That’s sweet, but a little more extreme of a message than I needed at that point.

And here is the frustrating thing: In reviews, Diane’s illness is seldom mentioned—just the fact that Sarah Jessica Parker plays an uptight businesswoman who does not fit it. Yes, that is the big news, folks. The mom dies of breast cancer, but the big news is that Sarah Jessica Parker does not fit in.

So, we gave up on chick flicks and watched Pirates of the Caribbean: The Curse of the Black Pearl (2003), and Pirates of the Caribbean: Dead Man’s Chest (2006) . Plenty of people die there, but no big deal; they don’t stay dead for long. And Johnny Depp is just a delight. He is having so much fun it is hard not to enjoy his crazy, ghoulish frolics.

Throughout the Pirates movies, I kept thinking what fun they must have been to make.
They ultimately transported me into multiple fantasies—the fictional world of the pirates themselves (plus a nice little love story with Orlando Bloom and Keira Knightley) and my own personal fiction of being behind the scenes, watching how makeup was applied, how the sets were built, how Johnny swung from all those ropes.

So, ultimately, Johnny and his pirates provided the diversion we needed. The hunk, the romance, even the gorgeous female lead who does not look like me in the least, but is lovely nevertheless. So thanks, Johnny. Let me know next time you're in town. We'll go out and swing on some ropes.

Wednesday, January 2, 2008

Rah! Raw Broccoli: Indole-3-carbinol (I3C) and Breast Cancer

A diet rich in cruciferous vegetables, like kale, cabbage, broccoli, cauliflower, can help fight breast cancer, according to research published in the journal Carcinogenesis. Studies in Milan show much the same effect.

Cruciferous veggies have high amounts of Indole-3-carbinol (I3C) , which has been shown in tests to combat the development of breast cancer cells. The Carcinogenesis researchers, from the University of California-Berkeley and the Kochi Medical School in Japan wrote that “Indole-3-carbinol (I3C), a naturally occurring compound of brassica vegetables, has promising anti-cancer properties.” The Italian studies used synthetic I3C and concluded that it “may be a considered a new, promising therapeutic agent for both ER+ and ER- breast cancer.”

So, the juice I started when I was first diagnosed, thanks to my sister Phyllis and the juicer she sent me, turns out to be a solid cancer fighter. My husband, God love his vegetable-slicing heart, juices 1-2 cups of kale, a half cup of cabbage, 2-3 ounces of wheatgrass, 2-3 carrots, and half an apple, to make roughly 2 cups of juice. Occasionally he adds a beet. It tastes about how you would expect, sort of like grazing in a swamp. I don’t care—if it keeps cancer away, I’ll even grow a cud. Lately, he has added about a quarter of a lemon and that makes the thing a whole lot more palatable.

I also have about a cup of raw broccoli every day with homemade hummus—my daughter Ellen’s recipe—for a mid-afternoon snack. That is actually tasty. Rah! Raw broccoli.

Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

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Tuesday, January 1, 2008

Happy 2008!

Here's wishing you all health, love, peace, and all manner of good things as we head into another year.

If your New Years resolution is to lose weight and eat better, do it. Join a group, find a buddy, plan a program and stick with it. Do it for your health and for all those who love you. Do it one meal at a time and be patient. Sometimes you will lose a lot, sometimes you will go backwards and gain a little. Don't give up. Keep at it. Allow yourself to fall off the wagon occasionally, but always get right back on.

Spend some time each day with yourself—doing yoga, meditating, praying, simply enjoying nature. Give yourself a break from the stress that takes over our lives too quickly and too thoroughly. You deserve it. You need it. There is nothing inherently cool about stress. It does not make you important—it only makes you sick.

If you can, exercise at least 30 minutes five days a week. If you can do more, do more. Every few weeks, add 5-10 minutes on to your daily routine. You don't need to be fancy—walking is excellent exercise. Ever better when you do it with a friend or loved one.

Remember your old friends and keep making new ones.

Love your family.

Take the best care you can of your body, mind, and spirit.

And have a blessed 2008.