My daughter and son-in-law just celebrated their second wedding anniversary. I was sure it was their third. That might be partly because I am crazy about my son-in-law and I think he has been in the family longer than he has. Part of it, though, might be that I subconsciously want to separate the joy of their wedding from the stress of my cancer.
The two overlapped, but I don’t remember it that way. I remember the one and then the other, but the two don’t blend in my memory. Perhaps because I love to think about the wedding and its celebration, but would rather forget about the stupid cancer.
I did this sort of compartmentalization at the time as well.
When Ellen and Steve got married in March 2006, I did not yet know I had cancer. They were married in Lake Tahoe with just the immediate family there. A beautiful ceremony in the snow by the lake. Two months later, we had a reception for them in Des Moines. It was also beautiful—a room full of friends and family surrounded by flowers at the Botanical Center, a beautiful couple in love, great music, and much fun.
Between the wedding and the reception, I was diagnosed with cancer.
As we were preparing for the reception, my son-in-law’s mother asked me how I was holding up. I looked at her, surprised. I had forgotten the cancer and was focusing on the delightful moment. That is still the way I see it. One beautiful series of events on its own. The cancer as a separate event. No need to blur the two.
Monday, March 24, 2008
Let Me Tell You How I Feel: Writing about Cancer is Therapeutic
I am doing the right thing. Or, I could be clever and say I am doing the write thing. Or that I chose the right rite. Or I could just get to the point, which is: Writing about your emotions can help improve your physical quality of life after cancer, according to research in the February 2008 issue of the The Oncologist.
Some details:
• 49.1 percent of participants said writing changed the way they thought about their illness;
• 35.2 said writing changed the way they felt about their illness.
Representative quote from a participant: “"I felt a lot calmer and more able to move on after writing about it and being forced to think about it. I loved writing about my experience."
• Those who said writing made them think about their disease differently also reported a better physical quality of life.
• A great majority of the participants wrote that cancer transformed their lives positively, and those writers focused on issues of family, spirituality, work, and the future.
Representative quote from a participant: "Don't get me wrong, cancer isn't a gift, it just showed me what the gifts in my life are."
Interestingly, just writing about the facts did not have any effect.
Some details:
• 49.1 percent of participants said writing changed the way they thought about their illness;
• 35.2 said writing changed the way they felt about their illness.
Representative quote from a participant: “"I felt a lot calmer and more able to move on after writing about it and being forced to think about it. I loved writing about my experience."
• Those who said writing made them think about their disease differently also reported a better physical quality of life.
• A great majority of the participants wrote that cancer transformed their lives positively, and those writers focused on issues of family, spirituality, work, and the future.
Representative quote from a participant: "Don't get me wrong, cancer isn't a gift, it just showed me what the gifts in my life are."
Interestingly, just writing about the facts did not have any effect.
Sunday, March 16, 2008
Diet Coke and Cancer: The Debate
I seldom pine for forbidden tastes, now that I am striving for a healthy lifestyle. Giving up Diet Coke, though, has been a chore. I have succeeded fairly well. I now have it once or twice a week instead of once or twice a day. But I miss it. I crave it in a way I crave nothing else. I now drink caffeine-free, which I delude myself into thinking is healthier. And I try to drink an equal amount of water at the same time, to encourage an early exit of the drink’s toxins.
So when I read that Coke was testing the use of the herb stevia as a sweetener instead of aspartame, I thought my soda dreams had been answered. I have researched to see the progress of that plan, but I found nothing authoritative so far. Plus, even with stevia, there is no way Coke could exist in an honestly healthy universe.
Studies have been somewhat inconsistent in finding a connection between the aspartame in Diet Coke and cancer. One study found that aspartame increased breast cancer, leukemia, and lymphoma in rats. When scientists replicated the study on humans, though, they found no correlation between the sweetener and cancer. Research on cancer can be difficult to track, as one study contradicts another, and some folks do just do outright crazy things. One odd study mapped the increase in the use of aspartame in relation to the growth in cases of cancer and determined that one caused the other. Sort of like saying the Honda Civic caused roads deaths because both saw growth at the same time.
Still, aspartame turns into formaldehyde in the body and that simply cannot be good. Formaldehyde has a checkered past, with links to a variety of cancers, although not breast cancer. Although no direct connection has been determined, the threat is there.
And you know what else is there? My continued craving for this unhealthy stuff.
So when I read that Coke was testing the use of the herb stevia as a sweetener instead of aspartame, I thought my soda dreams had been answered. I have researched to see the progress of that plan, but I found nothing authoritative so far. Plus, even with stevia, there is no way Coke could exist in an honestly healthy universe.
Studies have been somewhat inconsistent in finding a connection between the aspartame in Diet Coke and cancer. One study found that aspartame increased breast cancer, leukemia, and lymphoma in rats. When scientists replicated the study on humans, though, they found no correlation between the sweetener and cancer. Research on cancer can be difficult to track, as one study contradicts another, and some folks do just do outright crazy things. One odd study mapped the increase in the use of aspartame in relation to the growth in cases of cancer and determined that one caused the other. Sort of like saying the Honda Civic caused roads deaths because both saw growth at the same time.
Still, aspartame turns into formaldehyde in the body and that simply cannot be good. Formaldehyde has a checkered past, with links to a variety of cancers, although not breast cancer. Although no direct connection has been determined, the threat is there.
And you know what else is there? My continued craving for this unhealthy stuff.
Tuesday, March 11, 2008
My Stats and My Story
When my gynecologist found my tumor, she said it was small and probably nothing to worry about. This was on a Friday, and my mammogram was on a Monday. In the middle was Mother’s Day. I did not worry about the lump. I figured I was OK.
But the radiologist thought otherwise. She looked at my mammogram, then did a sonogram. She kept poking and probing, talking about some television show—I cannot remember which one—to keep my mind off what it appeared she was finding. She pulled no punches and told me she was pretty sure the pathology report would come back showing “something abnormal.”
That night, I hit the Internet and found a variety of studies that showed that most breast lumps were not cancerous, so once again I decided I was OK. I wasn’t. This was becoming a lousy pattern.
The radiologist called and told me the bad news, but said my tumor was small, telling me, “Patricia, this is not that bad.” I wonder if she has any idea how often I still think of those reassuring words.
I got little reassurance in the ensuing days, but I did get a lot of confusion, starting with the size of my tumor. Breast tumors are measured a variety of ways. First, there’s the size from the sonogram. Mine was 1.5 cm at that point. There’s also the size from the mammogram; mine was 2.1 there. Then there’s the size the pathologist determines after surgery by measuring the tumor itself. Mine was 1.3 X 1.1 cm at that point. This is a big deal, as tumors under 2 cm are considered Stage 1, or early stage.
Then I began meeting with the docs.
At my first meeting with the surgeon, he told me that I had an invasive ductal carcinoma—the cancer had broken through the wall of the milk duct and invaded other tissue. He said I would have a lumpectomy—an elegant lay term for a partial mastectomy—and radiation, unless the cancer had spread. Only if it had spread would I need chemo, he said. At this point I knew nothing about hormone negative cancer, so I asked few questions, and trustingly made plans for the surgery. I somehow knew it had not spread and so I figured I would have the inconvenience of radiation, but that was it.
Wrong again.
The surgeon explained that he would take out only one lymph node—the sentinel node, or the node to which the cancer would move. This is determined by injecting a radioactive tracer consisting of blue dye into my tumor and seeing where it moves. The node to which it heads first is the sentinel node.
He ended up taking out two sentinel nodes, both of which were negative, thank God. The cancer had not spread. He told me this immediately after surgery, while I was still in recovery. Then he quietly dropped a bombshell. He told me he got all the cancer—with a healthy, clear .3cm margin—but that he wanted me to see an oncologist about chemo. “But it has not spread; I don’t need chemo,” I argued. He was adamant. His nurse would set up the appointment.
It was not until my husband and I naively went into the Oncologist Number One’s office a week after surgery that I learned that there was such a thing as hormone-negative cancer and that it is more aggressive than hormone positive. I was estrogen-negative, weakly positive for progesterone and negative for Her2. The oncologist said they treat that weakly positive as negative and that I needed chemo because of the aggressive nature of my tumor.
He said the tumor was poorly differentiated, which meant it could grow rapidly. And he said it was 2.1 centimeters, making it a Stage II rather than a Stage I. He used the size from the mammogram. Had I gone with his interpretation, I would have had four rounds of adriamycin and cytoxen followed by four rounds of taxol, or 16 weeks of chemotherapy.
I had 100 percent chance of losing my hair after two weeks of treatment, he said, but nausea and vomiting are “no longer an issue” because of drugs. He said I would not feel 100 percent normal, but could count on being about 85 percent of my charming self. The taxol, he said, might cause some degeneration of nerves, but it goes away with time. He was so calm and cool and officious, I wish I had asked if he had ever had chemo.
My husband and I left the office in shock. Chemo put an entirely different color on the whole thing. When you lose your hair, you are a cancer patient, with a capital “C.” Without chemo, it is lower-case cancer.
After reeling for a few hours, I decided to get a second opinion, but I was still depending on the advice of doctors; I had not yet done research into hormone-negative cancer. Magically, I ultimately made the right decisions, but I wish I had been better informed from the beginning.
We met with Oncologist Number Two three days later. He looked through the chart and said the tumor was only 1.1 cm—what the pathologist determined after surgery. It wasn’t very big and it had not spread, so it was early stage breast cancer. But it was hormone-negative and therefore very aggressive. “This is a young woman’s cancer,” he said. “We take it very seriously. You don’t get a second chance.” However, because my nodes were negative, he said I would need the adriamycin and cytoxen in a dose-dense regimen every two week, but I would not need the taxol. I would then have radiation.
And he looked at the Nottingham Histologic Score, which was Grade II, meaning it was in the mid-range in terms of aggressiveness. The higher the grade, the more aggressive the tumor: Grade I is slow growing; Grade III is fast growing. I felt a little calmer, knowing I was middle-of-the-road.
I went with Oncologist Two and his regimen, which, I learned through research, is the standard for early-stage node-negative hormone-receptor-negative cancer. So many negatives, and I was trying so hard to be positive.
I had four rounds of chemotherapy—adriamycin and cytoxan—and I did, indeed lose my hair. Three weeks after chemo started, just as Oncologist Two predicted.
But the business about no nausea from Oncologist Number One? Well, we took him seriously, and went out for lunch after the first chemo treatment. I still cannot look at spaghetti with meat sauce without a sense of revulsion. Ick. I learned to eat small, mild meals before chemo and the nausea was better, but I still felt ill the day or two after treatment. I also started visiting an acupuncturist on the day of treatment and that helped the nausea and my well being immensely. I still see her. I think she is magic.
I continued walking for exercise throughout treatment. That, I think, helped the nausea. I worked as much as I could, often at home, and found the frustrations of academic life to be a nice reprieve from cancer treatment. Cancer does put everything into perspective. I had a thoroughly supportive workplace, which was a blessing and, I am sure, helped my recovery.
After chemo, I had 33 days of radiation. Every weekday for six and a half weeks. I loved my radiation oncologist—a truly positive woman—and the technicians, who all had a good attitude and a sense of humor.
I began this adventure May 15 with the mammogram, sonogram and biopsy. I had surgery exactly two weeks later, on May 29. Chemo went from June 16 through July 27. Radiation started August 14 and ended September 29.
On October 7, two weeks after my last radiation treatment, I was hiking in the Colorado Rockies. My longest hike that year was a three-hour trek up to 9,000 feet. As I walked I enjoyed the warm autumn sun, the purple mountains, the orange and gold fall leaves, and I thought of how I loved this part of my world. We walked briskly and I had no trouble keeping up with my husband, brother and nephew, all usually stronger hikers than me. It wasn’t until I reached the top of a canyon and asked my husband to take a picture of me with my still-bald head that I remembered I had just finished cancer treatment. It all seemed like a bad dream. Or perhaps, a good one. I had, in fact, awakened, with energy and sprit and, most important, health.
But the radiologist thought otherwise. She looked at my mammogram, then did a sonogram. She kept poking and probing, talking about some television show—I cannot remember which one—to keep my mind off what it appeared she was finding. She pulled no punches and told me she was pretty sure the pathology report would come back showing “something abnormal.”
That night, I hit the Internet and found a variety of studies that showed that most breast lumps were not cancerous, so once again I decided I was OK. I wasn’t. This was becoming a lousy pattern.
The radiologist called and told me the bad news, but said my tumor was small, telling me, “Patricia, this is not that bad.” I wonder if she has any idea how often I still think of those reassuring words.
I got little reassurance in the ensuing days, but I did get a lot of confusion, starting with the size of my tumor. Breast tumors are measured a variety of ways. First, there’s the size from the sonogram. Mine was 1.5 cm at that point. There’s also the size from the mammogram; mine was 2.1 there. Then there’s the size the pathologist determines after surgery by measuring the tumor itself. Mine was 1.3 X 1.1 cm at that point. This is a big deal, as tumors under 2 cm are considered Stage 1, or early stage.
Then I began meeting with the docs.
At my first meeting with the surgeon, he told me that I had an invasive ductal carcinoma—the cancer had broken through the wall of the milk duct and invaded other tissue. He said I would have a lumpectomy—an elegant lay term for a partial mastectomy—and radiation, unless the cancer had spread. Only if it had spread would I need chemo, he said. At this point I knew nothing about hormone negative cancer, so I asked few questions, and trustingly made plans for the surgery. I somehow knew it had not spread and so I figured I would have the inconvenience of radiation, but that was it.
Wrong again.
The surgeon explained that he would take out only one lymph node—the sentinel node, or the node to which the cancer would move. This is determined by injecting a radioactive tracer consisting of blue dye into my tumor and seeing where it moves. The node to which it heads first is the sentinel node.
He ended up taking out two sentinel nodes, both of which were negative, thank God. The cancer had not spread. He told me this immediately after surgery, while I was still in recovery. Then he quietly dropped a bombshell. He told me he got all the cancer—with a healthy, clear .3cm margin—but that he wanted me to see an oncologist about chemo. “But it has not spread; I don’t need chemo,” I argued. He was adamant. His nurse would set up the appointment.
It was not until my husband and I naively went into the Oncologist Number One’s office a week after surgery that I learned that there was such a thing as hormone-negative cancer and that it is more aggressive than hormone positive. I was estrogen-negative, weakly positive for progesterone and negative for Her2. The oncologist said they treat that weakly positive as negative and that I needed chemo because of the aggressive nature of my tumor.
He said the tumor was poorly differentiated, which meant it could grow rapidly. And he said it was 2.1 centimeters, making it a Stage II rather than a Stage I. He used the size from the mammogram. Had I gone with his interpretation, I would have had four rounds of adriamycin and cytoxen followed by four rounds of taxol, or 16 weeks of chemotherapy.
I had 100 percent chance of losing my hair after two weeks of treatment, he said, but nausea and vomiting are “no longer an issue” because of drugs. He said I would not feel 100 percent normal, but could count on being about 85 percent of my charming self. The taxol, he said, might cause some degeneration of nerves, but it goes away with time. He was so calm and cool and officious, I wish I had asked if he had ever had chemo.
My husband and I left the office in shock. Chemo put an entirely different color on the whole thing. When you lose your hair, you are a cancer patient, with a capital “C.” Without chemo, it is lower-case cancer.
After reeling for a few hours, I decided to get a second opinion, but I was still depending on the advice of doctors; I had not yet done research into hormone-negative cancer. Magically, I ultimately made the right decisions, but I wish I had been better informed from the beginning.
We met with Oncologist Number Two three days later. He looked through the chart and said the tumor was only 1.1 cm—what the pathologist determined after surgery. It wasn’t very big and it had not spread, so it was early stage breast cancer. But it was hormone-negative and therefore very aggressive. “This is a young woman’s cancer,” he said. “We take it very seriously. You don’t get a second chance.” However, because my nodes were negative, he said I would need the adriamycin and cytoxen in a dose-dense regimen every two week, but I would not need the taxol. I would then have radiation.
And he looked at the Nottingham Histologic Score, which was Grade II, meaning it was in the mid-range in terms of aggressiveness. The higher the grade, the more aggressive the tumor: Grade I is slow growing; Grade III is fast growing. I felt a little calmer, knowing I was middle-of-the-road.
I went with Oncologist Two and his regimen, which, I learned through research, is the standard for early-stage node-negative hormone-receptor-negative cancer. So many negatives, and I was trying so hard to be positive.
I had four rounds of chemotherapy—adriamycin and cytoxan—and I did, indeed lose my hair. Three weeks after chemo started, just as Oncologist Two predicted.
But the business about no nausea from Oncologist Number One? Well, we took him seriously, and went out for lunch after the first chemo treatment. I still cannot look at spaghetti with meat sauce without a sense of revulsion. Ick. I learned to eat small, mild meals before chemo and the nausea was better, but I still felt ill the day or two after treatment. I also started visiting an acupuncturist on the day of treatment and that helped the nausea and my well being immensely. I still see her. I think she is magic.
I continued walking for exercise throughout treatment. That, I think, helped the nausea. I worked as much as I could, often at home, and found the frustrations of academic life to be a nice reprieve from cancer treatment. Cancer does put everything into perspective. I had a thoroughly supportive workplace, which was a blessing and, I am sure, helped my recovery.
After chemo, I had 33 days of radiation. Every weekday for six and a half weeks. I loved my radiation oncologist—a truly positive woman—and the technicians, who all had a good attitude and a sense of humor.
I began this adventure May 15 with the mammogram, sonogram and biopsy. I had surgery exactly two weeks later, on May 29. Chemo went from June 16 through July 27. Radiation started August 14 and ended September 29.
On October 7, two weeks after my last radiation treatment, I was hiking in the Colorado Rockies. My longest hike that year was a three-hour trek up to 9,000 feet. As I walked I enjoyed the warm autumn sun, the purple mountains, the orange and gold fall leaves, and I thought of how I loved this part of my world. We walked briskly and I had no trouble keeping up with my husband, brother and nephew, all usually stronger hikers than me. It wasn’t until I reached the top of a canyon and asked my husband to take a picture of me with my still-bald head that I remembered I had just finished cancer treatment. It all seemed like a bad dream. Or perhaps, a good one. I had, in fact, awakened, with energy and sprit and, most important, health.
Wednesday, March 5, 2008
Oncotype DX test minimal help for hormone-receptor-negative
The Oncotype DX test can predict the likelihood of recurrence in early stage invasive breast cancer, but it has one flaw: It works with hormone-positive cancers, not hormone-negative. Once again we’re the wallflowers at the breast cancer prom, with the docs dancing with the girls with the popular cancer.
Still, the test might be worth asking for (check to see if your insurance covers it first) because it will include your estrogen (ER) and progesterone (PR) receptor status. This is factored into the likely rate of recurrence and is used to determine the potential benefit of chemotherapy and tamoxifen.
A sample test nicely demonstrates how pathologists define ER and PR scores. The higher you are in the positive range, the more you will benefit from tamoxifen. I did not have a graph like this to clarify my readings. I just got a generic “ER-negative; PR weakly positive” statement. When I finally came to my senses and realized I needed more data, I called the lab to determine how weakly positive I was. They said they no longer had the sample and had just the information I already had on my pathology report. They gave me their definition of “negative” as being less than 50 percent of the sample. It would have been great to have had the additional data this test provides, even if it could not determine the rate of recurrence of my cancer.
Still, the test might be worth asking for (check to see if your insurance covers it first) because it will include your estrogen (ER) and progesterone (PR) receptor status. This is factored into the likely rate of recurrence and is used to determine the potential benefit of chemotherapy and tamoxifen.
A sample test nicely demonstrates how pathologists define ER and PR scores. The higher you are in the positive range, the more you will benefit from tamoxifen. I did not have a graph like this to clarify my readings. I just got a generic “ER-negative; PR weakly positive” statement. When I finally came to my senses and realized I needed more data, I called the lab to determine how weakly positive I was. They said they no longer had the sample and had just the information I already had on my pathology report. They gave me their definition of “negative” as being less than 50 percent of the sample. It would have been great to have had the additional data this test provides, even if it could not determine the rate of recurrence of my cancer.
My husband, though, reminds me often: My cancer is not coming back. Period.
Sunday, March 2, 2008
Newly Diagnosed with Hormone Negative? Where to Start?
Try to remain positive. Look at this: Overall 86.8 percent of patients with hormone-negative tumors were disease-free ten years after diagnosis, according to research presented at the Fifth European Breast Cancer Conference . This comes even with some advanced cancers. Of those survivors with hormone-negative tumors who were disease-free after five years, 35 percent had had lymph node involvement, and 11 percent had grade 3 tumors.
So focus on survival and taking care of yourself right now. Some tips on doing that:
• Get your pathology report. Thebreastcaresite.com has some great information on how to understand it. Dr. Susan Love's Breast Book also offers a comprehensive explanation. The report is where you will learn your hormone receptor status, plus the size of your tumor and how aggressive it is. You can get your report from any of your doctors. Get is as soon as you are diagnosed, read it carefully, and ask your doctors to explain what you don’t understand.
• Plan on chemo. It works. Newer forms (high-doses of cytoxan and adriamycin every two weeks plus taxol) are especially effective, according to research published in the Journal of the American Medical Association. This regimen reduced the risk of death by 55 percent as compared with older forms (low-doses of cytoxan and adriamycin plus fluorouracil every three weeks) in women with hormone-negative cancer that had spread to the lymph nodes. Typically, women whose cancer has not spread to the lymph nodes do not need taxol.
• Get your body in shape. Exercise helps reduce the risk of recurrence, improves your mood throughout treatment, and keeps you from gaining weight during chemotherapy. Weight gain during chemo? Yes, that is sort of adding insult to injury but it is true. In a study in the Journal of Clinical Oncology of 514 breast cancer survivors three years after diagnosis, 68 percent gained an average of 8.6 pounds, with a maximum increase of 60 pounds. Women treated with chemotherapy gained the most, adding an average of 4 percent to their pre-diagnosis weight.
• Get your mind in shape. Being positive makes this all a lot easier. Look to family and friends for support, be open to what they give, and be patient with their occasional stumbles. This is new and stressful for them too. If you’re the least bit religious, remember the importance of prayer. I’ve written on how prayer helped me . Meditation and yoga can also help you maintain your sanity. Its basic emphasis: balance.
• Go outside. ”Natural intervention,” or spending two hours a week in nature watching birds, tending to plants or gardens, sitting by a window with a view of trees or a garden can cut the fatigue that is often associated with cancer treatment.
• Watch your diet. Women with hormone negative benefited the most from a low-fat diet, with a 42 percent reduction in recurrence, according research in the Journal of the National Cancer Institute.
• Before surgery, check into brachytherapy instead of standard radiation. It cuts radiation time from five or six weeks to one, and it is far less invasive. Doctors embed radiation seeds into the breast, so this needs to be coordinated with your surgeon. I waited too late to ask for it and my wound had already healed, so I had to go the traditional route.
• Consider acupuncture. It can help ease the nausea of chemo and it can you relax and find peace. I visited my acupuncturist before each treatment and she made me feel calmer, no matter what.
• Live your life. Your chances of that life being a normal length are far better than you might think right now. Continue doing what you did before, only try to make it a little healthier.
So focus on survival and taking care of yourself right now. Some tips on doing that:
• Get your pathology report. Thebreastcaresite.com has some great information on how to understand it. Dr. Susan Love's Breast Book also offers a comprehensive explanation. The report is where you will learn your hormone receptor status, plus the size of your tumor and how aggressive it is. You can get your report from any of your doctors. Get is as soon as you are diagnosed, read it carefully, and ask your doctors to explain what you don’t understand.
• Plan on chemo. It works. Newer forms (high-doses of cytoxan and adriamycin every two weeks plus taxol) are especially effective, according to research published in the Journal of the American Medical Association. This regimen reduced the risk of death by 55 percent as compared with older forms (low-doses of cytoxan and adriamycin plus fluorouracil every three weeks) in women with hormone-negative cancer that had spread to the lymph nodes. Typically, women whose cancer has not spread to the lymph nodes do not need taxol.
• Get your body in shape. Exercise helps reduce the risk of recurrence, improves your mood throughout treatment, and keeps you from gaining weight during chemotherapy. Weight gain during chemo? Yes, that is sort of adding insult to injury but it is true. In a study in the Journal of Clinical Oncology of 514 breast cancer survivors three years after diagnosis, 68 percent gained an average of 8.6 pounds, with a maximum increase of 60 pounds. Women treated with chemotherapy gained the most, adding an average of 4 percent to their pre-diagnosis weight.
• Get your mind in shape. Being positive makes this all a lot easier. Look to family and friends for support, be open to what they give, and be patient with their occasional stumbles. This is new and stressful for them too. If you’re the least bit religious, remember the importance of prayer. I’ve written on how prayer helped me . Meditation and yoga can also help you maintain your sanity. Its basic emphasis: balance.
• Go outside. ”Natural intervention,” or spending two hours a week in nature watching birds, tending to plants or gardens, sitting by a window with a view of trees or a garden can cut the fatigue that is often associated with cancer treatment.
• Watch your diet. Women with hormone negative benefited the most from a low-fat diet, with a 42 percent reduction in recurrence, according research in the Journal of the National Cancer Institute.
• Before surgery, check into brachytherapy instead of standard radiation. It cuts radiation time from five or six weeks to one, and it is far less invasive. Doctors embed radiation seeds into the breast, so this needs to be coordinated with your surgeon. I waited too late to ask for it and my wound had already healed, so I had to go the traditional route.
• Consider acupuncture. It can help ease the nausea of chemo and it can you relax and find peace. I visited my acupuncturist before each treatment and she made me feel calmer, no matter what.
• Live your life. Your chances of that life being a normal length are far better than you might think right now. Continue doing what you did before, only try to make it a little healthier.
Thursday, February 28, 2008
When a friend gets sick
Several years ago, an acquaintance of mine died of breast cancer. We were not close friends but I had known her for years and our sons were good friends—they still are. What’s most important, though, is that I highly valued her as a person—she was simply one of those people who are plain good. I knew her cancer had returned and that she was terminal, and I kept intending to call her and tell her that she was important to my life. I didn’t call in time and I deeply, deeply regret how slowly I moved.
Why didn’t I just pick up the phone and call whenever the thought occurred to me? Part of me thought it would be an intrusion—she was sick, why would she want to talk to me? Part of it was fear—I didn’t want to call and hear she was too ill to talk, or worse. All of it, in retrospect, was stupid.
So, when a friend recently mentioned not knowing how to react to an acquaintance who had recently been diagnosed with cancer, I told her to do what I valued when I was sick:
• Visit. I cherished those times when my family and friends came to me. Those visits gave me courage, motivation, and strength, and brightened my life. One of my alums was in town and stopped by for a brief talk and he made me laugh and think about the world elsewhere. He emailed his alumni friends with a “thumbs up” on my outlook, prompting other alums to email me, which I loved. What was especially great was that, when he visited, my sister and brother were both here as well. I had a full house of people who cared about me. What an elixir!
• Call. If you don’t feel comfortable barging in, make a brief phone call. If your friend is not up to talking, tell her you’re thinking of her and ask her if there’s a better time to call again. I got several short calls from people at various levels of connection to me and they all perked me up. Never once did I think, “Why is this person bothering me?” I always used to worry about invading people’s privacy. Showing concern is not an invasion.
• Send cards. A good friend sent me a card every two weeks or so while I was going through treatment. They were often funny, even irreverent, and helped me keep my perspective upbeat. Now I know how it feels to open up an envelope and find it filled with caring thoughts, so when friends or acquaintances get sick, I make sure I send at least one card, with a note telling them they are in my thoughts and prayers, which they are.
• Emails work as well. I loved the chatty emails I got that expressed interest in my health but touched on broader issues. Funny comments were always welcome.
• Offer food, within limits. A neighbor stopped by with a fresh loaf of bread and I was warmed by that thoughtful gesture. A friend brought me a smoothie and sat down to chat while I drank it. I was not receptive to much food, though, partially because I was trying to eat healthy and partially because food did not always taste that good, so the bread and smoothie were bland and thoughtful choices. Roughly 60 percent of all women going through chemotherapy gain weight, so don’t tempt them with brownies. Pick up a bowl of fresh fruit instead.
• Do lunch. People going through treatment still like to get out and they still eat, although their appetite will probably be somewhat modified. Ask your friend to choose the restaurant. If she has no preference, go somewhere that keeps its food smells to itself—the odor of fried foods can be especially icky to a chemo patient. I have a highly sensitive nose and was occasionally even offended by the smell of mashed potatoes. I continued to enjoy the aroma of fresh coffee, though.
• Send flowers. A graduate sent me a fun bouquet with a “Thinking of you, Prijatel!” note, which was a cheerful surprise. I still have the vase—shaped like an ice cream cone—and it makes me smile and think of her every time I open that cabinet.
• Be normal. In general, don’t treat sick people like they are broken. Show that you care and are interested in their well-being, but try for as much normalcy as you can muster. Ask them about their illness and how things are going, listen well, and then talk about other things. That way, you acknowledge their illness, you show care and respect, and you open them up to thinking about things other than being sick.
Why didn’t I just pick up the phone and call whenever the thought occurred to me? Part of me thought it would be an intrusion—she was sick, why would she want to talk to me? Part of it was fear—I didn’t want to call and hear she was too ill to talk, or worse. All of it, in retrospect, was stupid.
So, when a friend recently mentioned not knowing how to react to an acquaintance who had recently been diagnosed with cancer, I told her to do what I valued when I was sick:
• Visit. I cherished those times when my family and friends came to me. Those visits gave me courage, motivation, and strength, and brightened my life. One of my alums was in town and stopped by for a brief talk and he made me laugh and think about the world elsewhere. He emailed his alumni friends with a “thumbs up” on my outlook, prompting other alums to email me, which I loved. What was especially great was that, when he visited, my sister and brother were both here as well. I had a full house of people who cared about me. What an elixir!
• Call. If you don’t feel comfortable barging in, make a brief phone call. If your friend is not up to talking, tell her you’re thinking of her and ask her if there’s a better time to call again. I got several short calls from people at various levels of connection to me and they all perked me up. Never once did I think, “Why is this person bothering me?” I always used to worry about invading people’s privacy. Showing concern is not an invasion.
• Send cards. A good friend sent me a card every two weeks or so while I was going through treatment. They were often funny, even irreverent, and helped me keep my perspective upbeat. Now I know how it feels to open up an envelope and find it filled with caring thoughts, so when friends or acquaintances get sick, I make sure I send at least one card, with a note telling them they are in my thoughts and prayers, which they are.
• Emails work as well. I loved the chatty emails I got that expressed interest in my health but touched on broader issues. Funny comments were always welcome.
• Offer food, within limits. A neighbor stopped by with a fresh loaf of bread and I was warmed by that thoughtful gesture. A friend brought me a smoothie and sat down to chat while I drank it. I was not receptive to much food, though, partially because I was trying to eat healthy and partially because food did not always taste that good, so the bread and smoothie were bland and thoughtful choices. Roughly 60 percent of all women going through chemotherapy gain weight, so don’t tempt them with brownies. Pick up a bowl of fresh fruit instead.
• Do lunch. People going through treatment still like to get out and they still eat, although their appetite will probably be somewhat modified. Ask your friend to choose the restaurant. If she has no preference, go somewhere that keeps its food smells to itself—the odor of fried foods can be especially icky to a chemo patient. I have a highly sensitive nose and was occasionally even offended by the smell of mashed potatoes. I continued to enjoy the aroma of fresh coffee, though.
• Send flowers. A graduate sent me a fun bouquet with a “Thinking of you, Prijatel!” note, which was a cheerful surprise. I still have the vase—shaped like an ice cream cone—and it makes me smile and think of her every time I open that cabinet.
• Be normal. In general, don’t treat sick people like they are broken. Show that you care and are interested in their well-being, but try for as much normalcy as you can muster. Ask them about their illness and how things are going, listen well, and then talk about other things. That way, you acknowledge their illness, you show care and respect, and you open them up to thinking about things other than being sick.
Sunday, February 17, 2008
British Black Women at Risk of Hormone-Negative
British black women are more likely to have estrogen-receptor-negative breast cancer and to get the disease at a younger age than white women, according the research published in the British Journal of Cancer . The clinical study, of black patients from 1994 to 2005 at an East London hospital, determined that these women:
• Were diagnosed at a median age of 46, or 21 years younger than white women.
• Had a higher rate of more advanced tumors and lymph-node involvement.
• Were more likely to have triple-negative tumors.
Results of this study are reflective of earlier research on African-American women.
• Were diagnosed at a median age of 46, or 21 years younger than white women.
• Had a higher rate of more advanced tumors and lymph-node involvement.
• Were more likely to have triple-negative tumors.
Results of this study are reflective of earlier research on African-American women.
Saturday, February 16, 2008
Breast Cancer Web Info Generally Accurate
Patients can depend on the information in most breast cancer Web sites, according to a study published in the journal Cancer. Researchers at the University of Texas looked at 343 Web sites and found only 41 inaccurate statements on 18 of the sites, meaning a 5.2 percent rate of error. Information about complementary and alternative medicine (CAM), they said, was 15.6 times more likely to be inaccurate than information on Western medicine. They tested accuracy by asking clinician-reviewers to assess content.
There is not much online about hormone-negative-breast cancer, but it is good to know that what is there is likely to be on target. And the coverage is increasing—most likely because of increased research on negative.
I found the Web invaluable when I was diagnosed. Apparently being a bit of an egghead, I used the cancer sites as a starting point, then dug into the research itself for a deeper perspective. Few folks want to read medical journals, though, and the sites I have listed on the left do an excellent job of presenting up-to-date research in accessible language. Research articles were especially important in my quest for information about hormone-negative. I especially like breastcancer.org’s research updates
My advice on using Web information:
• Use multiple sites for multiple perspectives. This will help guard against accuracy problems—you’ll see inconsistencies and know which information might be suspect. This is true of all media—you're more likely to get a broader base of information if you have a broad base of media use. Depending too much on television can be especially problematic, as TV reporters have only a minute or two to decode complex information—and you have no opportunity to go back and reread the data for clarity.
There is not much online about hormone-negative-breast cancer, but it is good to know that what is there is likely to be on target. And the coverage is increasing—most likely because of increased research on negative.
I found the Web invaluable when I was diagnosed. Apparently being a bit of an egghead, I used the cancer sites as a starting point, then dug into the research itself for a deeper perspective. Few folks want to read medical journals, though, and the sites I have listed on the left do an excellent job of presenting up-to-date research in accessible language. Research articles were especially important in my quest for information about hormone-negative. I especially like breastcancer.org’s research updates
My advice on using Web information:
• Use multiple sites for multiple perspectives. This will help guard against accuracy problems—you’ll see inconsistencies and know which information might be suspect. This is true of all media—you're more likely to get a broader base of information if you have a broad base of media use. Depending too much on television can be especially problematic, as TV reporters have only a minute or two to decode complex information—and you have no opportunity to go back and reread the data for clarity.
• Use sites associated with known organizations, or that come recommended by others.
• Don’t look to cancer chat rooms for information. These are OK for support, perhaps, but it’s too easy for a person to share her misinformation in these arenas.
• Don’t forget good old-fashioned books. In an earlier post, I recommended my favorites .
• Talk to your doctor or nurse about questions you have, and don’t let them dismiss your research or your concerns. They are medical experts, but it is your body and your life. If you don’t feel your doctor is on the right track, get another opinion. This is too important an issue to leave to somebody you might not entirely trust or who does not answer your questions with clarity and respect. My favorite doctor—my radiation oncologist—even drew me a picture of how radiation works.
• Don’t look to cancer chat rooms for information. These are OK for support, perhaps, but it’s too easy for a person to share her misinformation in these arenas.
• Don’t forget good old-fashioned books. In an earlier post, I recommended my favorites .
• Talk to your doctor or nurse about questions you have, and don’t let them dismiss your research or your concerns. They are medical experts, but it is your body and your life. If you don’t feel your doctor is on the right track, get another opinion. This is too important an issue to leave to somebody you might not entirely trust or who does not answer your questions with clarity and respect. My favorite doctor—my radiation oncologist—even drew me a picture of how radiation works.
Sunday, February 10, 2008
Alcohol Raises the Risk of Breast Cancer; Folic Acid Can Help
One lovely ritual my husband and I enjoy is a martini in front of the fire as we listen to Prairie Home Companion on Saturday evening. Alcohol can be a pleasant addition to a social occasion—or a cause for one. I have relaxed over an Irish coffee with family on the Colorado ski slopes; watched the sun set over the island of Lesbos, Greece, while sipping a glass of the Greek’s legendary retsina (which tastes a little like turpentine); and warmed up with the Slovene pear brandy slivovka while shopping for a Christmas tree in the Ljubljana open market.
I like the taste of alcohol and I love its rituals, so it has been difficult for me to step back and cut down my drinking, but I have done it because several studies have linked alcohol and the risk of breast cancer. The most recent, by Kaiser Permanente researchers and presented to the European Cancer Conference in September 2007, showed that one drink a day of alcohol of any type—beer, wine, spirits—increased breast cancer risk by ten percent. The risk rose by the drink—three drinks equaled a 30 percent risk. This is a relative risk—it is compared to the risk faced by a woman who drinks no alcohol or less than one drink a day.
Folic acid can help—just 600 micrograms can reduce the effect of alcohol on breast cancer risk, according to research in the Journal of the American Medical Association. Folic acid is the synthetic form of the B-vitamin folate. Folic acid can also reduce the risk of colon cancer, control the side effects of the cancer drug methotrexate and help with everything from inflammatory bowel disease to rheumatoid arthritis. The National Institute of Health gives a good overview of folic acid—where you can get it, how it can help with various medical conditions, how much you need, plus some cautionary notes about how it interacts with B12. They warn again too large a dose—1000 micrograms or more.
My daily green drink and my broccoli snack both have folate. Fortified breakfast cereals have a good deal of the stuff, as does beef liver. Ugh! Natural foods, though, are not as good a source of folic acid as dietary supplements—I'd have to eat six cups of broccoli to get my 600 micrograms—so I take a B-complex capsule every day, plus a multivitamin with folic acid.
With ample fortification, I feel I can still enjoy the one martini. And, occasionally, a glass of wine or a beer during the week. I find I do not miss alcohol as much as I thought I would. I often sip pure black cherry juice in a wine glass and find it highly satisfying—the ritual without the risk. And when I go back to Greece, I may just enjoy its beauty without the turpentine.
Please consider a donation to Positives About Negative to keep this site going. This work is entirely supported by readers. Just click on the Donate button in the right of the page. Thank you!
Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.
I like the taste of alcohol and I love its rituals, so it has been difficult for me to step back and cut down my drinking, but I have done it because several studies have linked alcohol and the risk of breast cancer. The most recent, by Kaiser Permanente researchers and presented to the European Cancer Conference in September 2007, showed that one drink a day of alcohol of any type—beer, wine, spirits—increased breast cancer risk by ten percent. The risk rose by the drink—three drinks equaled a 30 percent risk. This is a relative risk—it is compared to the risk faced by a woman who drinks no alcohol or less than one drink a day.
Folic acid can help—just 600 micrograms can reduce the effect of alcohol on breast cancer risk, according to research in the Journal of the American Medical Association. Folic acid is the synthetic form of the B-vitamin folate. Folic acid can also reduce the risk of colon cancer, control the side effects of the cancer drug methotrexate and help with everything from inflammatory bowel disease to rheumatoid arthritis. The National Institute of Health gives a good overview of folic acid—where you can get it, how it can help with various medical conditions, how much you need, plus some cautionary notes about how it interacts with B12. They warn again too large a dose—1000 micrograms or more.
My daily green drink and my broccoli snack both have folate. Fortified breakfast cereals have a good deal of the stuff, as does beef liver. Ugh! Natural foods, though, are not as good a source of folic acid as dietary supplements—I'd have to eat six cups of broccoli to get my 600 micrograms—so I take a B-complex capsule every day, plus a multivitamin with folic acid.
With ample fortification, I feel I can still enjoy the one martini. And, occasionally, a glass of wine or a beer during the week. I find I do not miss alcohol as much as I thought I would. I often sip pure black cherry juice in a wine glass and find it highly satisfying—the ritual without the risk. And when I go back to Greece, I may just enjoy its beauty without the turpentine.
Please consider a donation to Positives About Negative to keep this site going. This work is entirely supported by readers. Just click on the Donate button in the right of the page. Thank you!
Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.
Wednesday, February 6, 2008
Great Gifts Support Breast Cancer
Breastcancer.org has a gift shop that offers books, candles, Lenox crystal, jewelry, clothing, plus services such as hotel reservations. A portion of all sales goes to the fight against breast cancer. Some nice ideas for birthdays, weddings, anniversaries, Valentine's Day, or whatever. You can also buy red and pink roses through Organic Bouquet. It's a fun shop, with some unusual items, so it could come in handy even if it weren't supporting the cause. Just click on the title of this post and you'll get to the shop.
Monday, February 4, 2008
Nurse Navigators As Breast Cancer Caretakers
When I was going through breast cancer treatment, I would have given even more of my breast if I could have had a nurse navigator guiding my care. These professionals follow cancer patients from diagnosis through follow-up care and help make sense of the doctors, treatments, jargon, and options while providing a supportive presence. In most cases, navigators collaborate with all members of the medical team; educate and counsel patients and their families; and coordinate care with oncologists, surgeons, pharmacists, dieticians, and counselors.
Nurse navigators are available at hospitals across the country. Their numbers are growing, as more nurses are being trained in this speciality. Most so far are focused on breast cancer, although other types of cancer are increasingly starting to be covered. To see what nurse navigators can do, check out the information about the navigator program at Mission Hospitals in Asheville North Carolina. Denise Steuber has been a nurse navigator at Mission for 12 years. She specifically works with breast cancer patients—even going to chemo and doctors' appointments with them—but she says the Mission nurses are also involved with overall cancer screenings. The program is funded by the Mission Foundation and is free to patients.
Check with your doctor about the possibility of having a nurse navigator on your team. If your hospital does not have this service yet, encourage them to start one. This might be a good time to be a squeaky wheel.
Nurse navigators are available at hospitals across the country. Their numbers are growing, as more nurses are being trained in this speciality. Most so far are focused on breast cancer, although other types of cancer are increasingly starting to be covered. To see what nurse navigators can do, check out the information about the navigator program at Mission Hospitals in Asheville North Carolina. Denise Steuber has been a nurse navigator at Mission for 12 years. She specifically works with breast cancer patients—even going to chemo and doctors' appointments with them—but she says the Mission nurses are also involved with overall cancer screenings. The program is funded by the Mission Foundation and is free to patients.
Check with your doctor about the possibility of having a nurse navigator on your team. If your hospital does not have this service yet, encourage them to start one. This might be a good time to be a squeaky wheel.
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.
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.
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.
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 Cancer.org 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.
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 Cancer.org 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.
Breastcancer.org 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.
Breastcancer.org 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.
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.
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.
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.
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