Life with the damn cat

Today he is the damn cat. Last night he woke me up throwing up next to the bed. This morning he was annoying enough to get me out of bed - I thought he wanted breakfast. No, he wanted to go outside and eat grass so he wouldn't throw up inside. I didn't understand. He threw up inside. Then I let him out and he ate grass.

He is an indoor cat and he has a plant pot that is growing grass for him on the window sill. But grass is better on the outside. However he can be very determined.

He is also approaching the ripe old age of 19. He can't hear - we can tell because he is no longer capable of walking quietly. Nor can he tell how loudly he meows at us. He can't see. We can tell this because I can wave my arms at him across the room and he can't find me. He can't really smell. We can tell this because he can't find food unless it is right under his nose.

He also has swollen ankles on his back legs where it looks like some kind of arthritis but it doesn't seem to bother him much. His coordination is bad - we can watch him slide off the edge of the coffee table, miss the edge of the sofa when he tries to get up on it, and all sorts of other things that impair his dignity.

He was REALLY mad at us when we left him on vacation. He had a live in baby sitter who fed him and took care of him. He stopped eating for a few days and left a few presents around the house.

But he is very cuddly. Its now fall. I can tell because he sleeps next to me  and I appreciate it now. When it was hot out, I didn't appreciate it as much.

He was also my chemo buddy and whenever I am not feeling well, he follows me around to take care of me with his snuggles.

That is life with the damn cat. It definitely has its ups and downs.

About that risk assessment

There is all this talk these days about what you can do to reduce your risk of cancer, dementia, chicken pox, or the common cold, among a million other things. You know all the advice - eat broccoli, exercise, don't drink, lose weight, exercise, eat margarine no eat butter, drink red wine no white - and all it does is confuse the crap out of us.

Then they start to give people personal risk assessment for an ailment and expect us to believe them. How much conflicting medical advice do you hear on a given day? A lot. Eat red meat and chocolate, no don't, yes, well a little, and the famous words - in moderation. How can you be expected to believe anything?

When you are told what your risk of some thing is - whether being diagnosed with cancer or being hit by lightening, don't you always harbor that little thought in the corner of  your brain that of course they are only talking about other people and not you or anyone you care about. Its always going to affect those other faceless people you don't know.

So why all the surprise when a new study shows that one in five women don't believe their breast cancer risk? I can honestly tell you I was very surprised by both my cancer diagnoses. I thought my back pain was the result of muscle strain and not the permanent debilitating state of the disks in my spine. I thought my aches and pains that turned out to be rheumatoid and fibromyalgia were just normal aging.

Sometimes I think, they were all wrong and I am really a healthy person who can live the way I used to - working full time, having a social life, and going off on adventures regularly that involve beaches, mountains, and the great outdoors.

Seriously, we hear so much conflicting medical advice and then if someone gives us a risk assessment, we are supposed to believe them? I think a risk assessment is like listening to the weather forecast - there is a good chance Saturday will be rainy and it should clear out for Sunday but watch out for a hurricane next week. How do they really know?

Not a profound thought in my head

Some days I actually write a profound blog post that is coherent and other people read and share. Today is not one of those days. My brain is full and I haven't even left for work yet and here is why:

Weather: Tonight's low is going to be down around 50 - this means I need to start bringing in some plants from outside - particularly my Ponderosa lemon and my Key lime plant. They are just starting to produce fruit and I want to be able to enjoy them. But they are tropical plants and aren't supposed to be out in temperatures anywhere in the 50s. There are even some frost/freeze warnings near by.

Its New England and the summer was unplugged last weekend - it was Labor Day. Time to think about snow shoveling, raking leaves, and (brace yourself) winter. Never mind that summer doesn't really start around here until mid-June.

Flabbiness: While I didn't gain or lose weight on vacation, I came back with a vow to stop snacking at work (where there are always snacks). That lasted about two hours. I have to reinforce my will power or I will never lose weight.

Birthdays: What the hell to buy for my husband for his birthday next week? I have some ideas but he is difficult to buy for to say the least. And what to do to celebrate his birthday. Damn. I'll have to figure this one out.

Work: I'm buried. I was out for two weeks and my in box filled up as my brain emptied out while I was away. And I am getting no sympathy because I am taking another week off at the end of the month.

Crafting: My knitting is burying the house. I need to start finding places to sell it all. But first I need to finish projects, block them, and label them all. Crap.

And I have four more weeks until another doctor appointment.... (insert tiny cheer here)

See nothing profound here today. I'll try to be more profound by tomorrow but don't hold your breath.

Privacy and support

With a cancer, or other 'icky', diagnosis, life has significant ups and downs. Sometimes people want support and sometimes they want privacy. It depends on lots of things - patient and family member's personality, type of diagnosis, current state on the medical roller coaster, among other issues. So the outsider is left to figure out when to intrude and when not to.

I have a friend who is coping with her husband's Stage IV cancer diagnosis and on-going treatment. It is hard to get together with  her these days as she can't tell day by day how he will be doing and if she will be comfortable leaving him. We communicate by email and try to set up times to get together - which sometimes it takes months to meet.

Another friend has a long term friendship with another couple who have suffered a horrible family tragedy last year and now the wife is dealing with metastases in her Stage IV cancer diagnosis. They are normally a very private couple and usually keep their personal issues quiet. The husband sent my friend an email about his wife's disease progression.

My thought is that this is a cry for help and I think my friend should call them up and offer to bring lunch on Saturday or something so they can get together. If they are opening up at this horrible time in their life, it is a request for support that they know my friend can provide through her own experiences and their long term friendship.

My friend, on the other hand, isn't so sure and thinks they would not want the intrusion. She knows them and I don't so perhaps she is correct here. But it is very hard to tell in these situations

When is it time to intrude and when is it time to honor their privacy. This goes beyond the issue of hospital visits that I blogged about the other day.

Many patients with icky medical diagnosis set up ways to control communication so they are not overwhelmed - whether a blog (like me), a web page, Facebook page, Twitter feed, or email blasts. It can be very difficult to control the communication flow. How to balance the latest medical information, need for privacy, and over anxious friends and family members is a huge problem for many patients.

The last thing many patients need is daily phone calls from the same people asking for the latest updates - what did the doctor say, what did your scan show, are you worried, how are your children coping -  have you told them yet, and a slew of other questions that pressure the patient to share when they may not be ready to do so.  And if there are repeated requests over and over the patient's stress mounts at an already stressful time.

A patient's right to privacy must be respected but sometimes they do need some support. The tricky part is figuring out when to intrude.

What RA does

As I approach my one year anniversary of being diagnosed with rheumatoid arthritis and fibromyalgia (because I didn't have enough ailments prior to then), I can reflect back. Although my mother has had RA for more than 20 years and I thought I was fairly educated on the subject, its different when you are the one living with the disease.

To be fair, I will say I had long since moved out of my parent's house when my mother was diagnosed so I was exposed to less of the day to day issues. For many of those years, I was busy with a career which involved lots of travel and pressures. But now that it is affecting me, I find I have learned a lot more.

I do not know what the standard protocols were for treating RA when she was diagnosed in 1989, but now the protocol is to treat it strongly and quickly to prevent many of the side effects and degeneration that accompanies the disease.

I was promptly put on prednisone for the short term, as a quick acting treatment, and plaquenile, as a long term treatment, and found out I was allergic to both. Then I was switched to methotrexate oral, dose upped, and finally switched to injections in the spring. That was until my compromised immune system caused my husband's mild cold to give me a double ear infection and put me out of circulation for two weeks while I recovered. I had to go off methotrexate to treat my ear infections with antibiotics.

Finally, I have been back on weekly injections for about six weeks and am starting to feel normal, or as normal as I ever will be, again.

Over the year, I have learned all sorts of fun things about RA and how it affects the body:

• This is how RA affects the rest of your body
• It can also cause hoarseness and other laryngeal symptoms.
• RA can have a significant impact on work and relationships.
• Its not just the disease but the treatments that can cause problems with your skin - ones I have include Raynaud's syndrome, bruising, red dots, and increase sun sensitivity.
• My favorite is how RA affects both your hands and feet.

And the treatment for fibromyalgia? Its just treating the pain so we are trying to manage that. But now I have both fibro fog and chemobrain so I can claim brainlessness regularly. I have problems remembering words and names these days and am constantly misnaming things and people.

What do I have to look forward to with RA and fibro? I have blood tests every eight weeks to monitor my blood levels, particularly liver function as methotrexate is hard on your liver. I bruise very easily and every cut, scrape, or bruise takes forever to heal.

In the meantime, as life gives me lemons I keep on working on that lemonade.

Insurance wars and woes

This morning's news includes a story on a gentleman with stage IV esophageal cancer who is disputing with his insurance company to cover the costs of his treatment. He is treated at Dana Farber and is pursuing alternative treatments. I am fully supportive of efforts to prevent insurance companies from making medical decisions.

Also, I am a big fan of preventing bloated insurance costs where people expect everything to be covered and then can't understand why their premiums keep going up in leaps and bounds. There has to be a happy medium while is why insurance companies need to be allowed to draw the line somewhere.

As you are aware, I do not believe insurance companies are capable of making individual medical decisions. They may employ their own oncologists and other doctors to review decisions. But unless the doctors have met with the patient and examined them, they have no idea what they are doing. At the very least the patient's doctors recommendations should be the guidelines followed. Not someone who is reading an actuarial guide and cost/benefit analysis. That is no way to make a decision that might permanently affect some one else's life.

However, and this is a big fat HOWEVER, if the treatment has not been shown to have any proven results I do not believe the insurance providers should be required to cover it.

There are all sorts of quackery theories on curing cancer and myths about treating and curing cancer. There are also many alternative treatments that are not necessarily covered by insurance but have proven to be beneficial to cancer and other patients. This would include things like acupuncture.

The problem with this gentleman's request is that he is asking for coverage for something called Insulin Potential Therapy or IPT. I googled it and the first two results were from Quackwatch.org and from the American Cancer Society showing that their was no real proof it works.

While I understand he is fighting for his life, I am actually on the side of the insurance company here. The treatment he wants has not been shown to be effective. He has a full medical team available to him where he is being treated. While he may be feeling better currently, there is no way to tell if it can be attributed to the IPT or some other reason.

An annual pledge against pinkification

As we approach the month of Pinktober (with 30 days advance notice), it is time for all of us to raise our hands and pledge the following. Please join in.

Raise your right hand and repeat after me:

I (state your name [and not the Animal House version]) promise that during the month of Pinktober, formerly known as October, I will not arbitrarily purchase pink items or donate to pink causes with out first researching how much actually goes to breast cancer research or screening services. 

I will first research them using services such as Charity Navigator (www.charitynavigator.org) to ensure they are legitimate.

I also promise that I will not support pinkification efforts to paint things pink, light up buildings in pink, or other such activities.

Thank you.

We need to focus our efforts on research and screening services for under served populations. We do not need any more awareness. The American public is plenty aware of breast cancer at this point.

Between now and then September is Prostate Cancer, Childhood Cancer, Thyroid Cancer, Leukemia and Lymphoma, and Ovarian Cancer month. It also contains the Jewish holy days of Rosh Hashana and Yom Kippur. Those all seem to be overshadowed by the looming Pinkification of October.

In October, there are other lovely holidays to support. Halloween for one - the one where we dress in costume and eat lots of candy, never mind Columbus Day and a host of other minor celebrations.

November includes many events including Veterans Day and Thanksgiving but it in recent years the squabbling that has resulted from Pinktober overwhelms everything until Thanksgiving. It also includes the great American Smokeout, Lung Cancer Awarness and Pancreatic Cancer awareness month.

What I am trying to say is stop supporting on pinkification and focus on research and screening for underserved populations.

Sharing the burden

Recently UPS was criticized for dropping employee health insurance coverage for spouses who are eligible for health insurance through their employers. But that's only 15,000 people. The majority of their drivers and other employees are covered through Teamster's Union benefits so they will not be affected by the change.

A recent article called Employers Play Obamacare Blame Game discusses reactions to the shared costs complaints and how other companies are reacting to the upcoming changes.

The whole point of mandatory health care is to have a healthier population. This requires change. So of course employers are going to start shifting burdens around as much as they can. Companies which have provided the most benefits I am sure will be some of the first to start making changes.

There is a separate requirement, starting in 2018, where employees who offer richer policies will be required to start shifting more of the costs to employees or start paying a penalty.

People are dying or going bankrupt due to lack of medical care or the high costs associated with it. We need to share the burden and can't assume our employers or the government will hand us everything we need. Its part of taking our place in society and being a contributing human being.

There are those, including me, who face health or other issues, who can't contribute as much as others. But that doesn't make them any less of human beings.
If you do not like the current and upcoming changes for whatever reason, then you can do your part by cooperating with the existing legislation and work to find ways to change it.

What this is all called is change. Get over it. Change is needed to make health insurance more affordable and health care more available. Our current system does not work. Insurance companies, not doctors, are making decisions about the health of people.

Dieting and such

Here's a theory: skip focusing on which diet is best and start focusing on changing eating habits.

This translates to stop focusing on what we eat and getting the balanced diet and change to focus on how we can get people to make healthier food decisions. Are we eating because we are stressed? Do we have bad habits related to the drive through where we make a quick stop on the way home and eat the food in the car?

Researchers look at all sorts of diets - Paleo, Atkins, Weight Watchers - and compare them all. The FDA issues the nutrition pyramid which is now a plate. But does anyone stop and look at the eating habits we have developed and why we have them?

We live in a world full of light this and fat free that and a widening population. Why?

I used to work with a woman who was a fairly healthy eater at work. She did not snack, she didn't go out for donuts. But she was quite large. I never really figured out why.

Then I went on a business trip with her and  she insisted we stop at the grocery store on the way to the hotel so she could get some stuff for her room. I was happy to go and get some seltzer (my secret addiction). She bought a couple boxes of crackers and cookies - for a three day business conference. I think she went out and made another grocery run later on. I think she was an evening snacker - hence her hefty weight.

So why does a normal, bright, well educated person, sit and eat for hours at night by themselves? That is the question to answer.

If you watch the greater loser shows, people talk about their bad eating habits and are taught how to eat healthy -  no soda, no drive through, healthy snacking. They also get exercise and lose weight. But they change their eating habits. Maybe they eat more salads and fewer french fries but often these shows are accompanied by tears and emotional breakthroughs as well.

I know my weight stems from three issues I have.

1. At my job, there are more snacks than any place I have ever worked and the kitchen is right next to my office.
2. I snack after dinner which I shouldn't do. (Why did I eat that granola bar after dinner last night? I didn't have dessert is my justification and I wanted something crunchy. But I didn't need it.)
3. Sometimes I eat when I am not hungry because I am bored, stressed or in pain.

So if I can get rid of those habits, I can lose weight. I have been working on them, my weight is going in the right direction. The funny thing is I am still eating desserts sometimes and normal food. I didn't switch what I eat. I switched when I eat. My goal is to modify my eating habits so I can get to and maintain a healthy weight but still enjoy eating. I will no live on lite versions of crappy prepared food.

Maybe that's what researchers need to figure out so other people can more easily lose weight.

Hospital visitors

When I am hospitalized, I have a list of people who can visit me. They include my husband, my parents, and my siblings. Anyone else has to call and ask. I am serious about this. If people visit unannounced, they will find out how rude I can really be.

My strong feelings about this are due to the fact that once, after a significant surgery, a friend had to stop at the hospital for an early morning appointment, the day after my surgery. So she decided to stop by my room at 830am. I was not ready for guests.

I was talking to someone who was a friend and a nurse who was giving me some information. I did not want to socialize. She didn't understand the concept of good manners and to think that the morning after major surgery might be a bad time to visit someone.

When I am in the hospital:

1. I probably feel like crap.
2. I probably look like crap.
3. I am probably cranky.

Its not that I don't want visitors at all - they do help the time go by - but my goal is to get better enough so I can leave as soon as possible. If I can't get my naps in, I won't be able to get better.  I find the concept of visiting people in the hospital for hours on end to be a bit ridiculous.

I actually feel sorry for the patient's whose families come to visit and stay for hours in big groups. If you are sick enough to be in the hospital, you don't want to host a party, you probably want to take a nap.

There is a hospital in Hawaii which has started the policy of visiting hours 24/7 and let the patients set their visiting times. This was done at patient request citing a study that found that people surrounded by family and friends heal faster and cope with their hospital stay better.

At first I was pretty appalled by this. But then I started to think.

There are lots of people who work odd shifts or have child care issues or travel distances or work nights and I can go on and on that have off hour schedules normally and are used to getting a lot of sleep during the day wherever they are so why should hospital visitation be any different?

Hospitals are where they wake you up for a sleeping pill or to take your blood and vital signs at 2am. So you might as well have a friend hang out with you for it.

Trust

Most people you meet, you generally don't share lots of private information until you have gotten to know them. Your doctor is different. You go see a new doctor for whatever reason and then you start spilling your guts on the state of your gut and other body parts.

If you think about it they are a stranger. I sometimes have to scrape doctors off the floor when I start telling them about my issues and allergies - they all love the fact that I am allergic to benadryl. I have had them start laughing too - with me, not at me.

But it is all about trust. How much do you really trust a stranger?

I think we believe doctors are ethical and honest human beings, with the best interests of the patient in mind. Personally I believe people are honest and ethical for the most part and don't start to lose trust unless I feel betrayed.

I don't mind if my doctors talk about me together in order to figure out how to best treat me. But I would be really upset if my doctors were trying to scam me. You hear the horror stories. I have blogged about a few of them as well. Here's a story with some more but also some good advice:

1. Research your doctor. 
2. Make sure your doctor isn't practicing outside his/her field.
3. Be cautious of doctors who advertise too much.
4. Ask a nurse or other hospital support staff.  
5. Get a second opinion.

Be an educated patient, do your homework and most importantly pay attention to your gut (feelings).

So are you an inpatient or an outpatient?

The hospital and Medicare get to decide. Not your doctor who is actually treating you.

I found this pretty appalling. Medicare patients can be in the hospital for DAYS and be called and an outpatient because they are only being 'observed'. They get the same care as everyone else. But then they get a big fat bill if they were an outpatient.

Their doctor can even admit them and make them an inpatient but then the hospital can change it back to outpatient. Hospitals like this because they get reimbursed more that way.

"Medicare originally intended observation care as a way to give doctors time to evaluate whether a patient should be admitted to the hospital or is stable enough to go home, usually within 24 to 48 hours. But hospitals are increasingly keeping patients in observation status longer: 8 percent of Medicare recipients had observation stays longer than 48 hours in 2011, up from 3 percent in 2006.
Apparently the government can tell by looking at a rule book to figure out how sick you are, not but diagnosing you and reading your chart. Or, God forbid, even talking to you.

That increase may partly be a response to aggressive reviews of hospital billing practices in recent years. Medicare contractors have demanded refunds from hospitals that admit patients the government believes should have been treated as observation patients or outpatients. Medicare pays hospitals less for those patients."

And also hospitals are now rated on their readmission rates. If you aren't admitted the first time, you are not readmitted later on.

"Toby Edelman, senior policy attorney at the Center for Medicare Advocacy in Washington, D.C., said she believes hospitals also could be trying to avoid readmission penalties, which are assessed if too many patients are readmitted within 30 days. Harold Engler, for example, went home after five days, grew sicker, and then returned for another five-day observation stay. If he had been an inpatient, he would have counted as a readmission within 30 days."

Hospitals claim they are working on it because they computer tells them what to do. The computer even knows more than the government:

"Dr. James Hart, who heads a Beth Israel Deaconess committee that makes sure the hospital follows Medicare rules, said he could not comment on Engler’s case. But he said the hospital uses a sophisticated computer program that tries to match patients with the correct Medicare designation based on their illness and the intensity of hospital services required. “We are very focused on getting the level of care accurate,’’ he said."

Medicare knows this is a problem and even has created a brochure on this telling patients the difference. But if you are sick in bed, do you really care about semantics? No.

"Case managers generally inform patients of their status, especially if they require skilled nursing care, he said. But that doesn’t mean patients digest the information, at a time when they have so much to focus on. “Part of the challenge from a patient perspective is there really is an information overload,’’ Hart said."


You just want to feel better and go home where you can be in your own bed eating real food instead of the crappy hospital food they serve.

I knew Medicare had its issues but I didn't think it was out to impoverish seniors. I thought it was supposed to be the other way around. Clearly some changes need to be made here.

Update: 8/30/13 - One of the former heads of Medicare wants the rule on observation to be abolished.

Geographic variances in breast cancer

Recently a  new strain of triple negative breast cancer was found in Ghanian women. This is a strain that is not found elsewhere. The result - a new treatment needs to be developed.

It is a fact that different groups - ethnic and racial - are diagnosed with different diseases or types of diseases at different rates. For example Ashkenazi Jewish women develop breast cancer at a higher rate than other women.

But I have never heard of a new variant of cancer being diagnosed by geographic area.

This opens a whole new direction for cancer research. Women from different parts of the world could be influenced by their local genetic, food, and environmental factors which could skew research results. I don't know how much this is taken into account by the pharmaceutical industry.

I do know that drugs are developed and tested world wide and then start getting approvals from the FDA and its counter parts in other countries. To be eligible for these clinical trials, patients have to meet specific criteria. The rates of clinical trial participation vary from city to city, state to state, and country to country, for a variety of reasons. But this means it is possible that patients who do not meet the criteria could have specific variances in their disease that are not noted.

Am I making sense? Sometimes I wonder.

The point I am trying to make is does current cancer research focus on the big groups that fit into the clinical trial criteria and not take into account the little subgroups that are now being discovered?

The guilt factor

This is a less discussed issue relating to cancer diagnosis and treatment - the guilt factor. Sometimes its not even mentioned, while other times it is just brushed off as something you need to learn to live with.

Guilt is what got you to do what you were supposed to when you were a child. Guilt is what your morals use to keep you in line.

But then we feel cancer guilt which is different. Why didn't I get it and they did? Why did they have a recurrence and I didn't?

The more cancer friends I have gained, I have also lost some. I have the little list of in memorium blogs I used to follow, the group of friends on Facebook that are no longer here and are in memorium, there are the phone numbers in my phone that I know don't work any more. And when they do again, it will be a stranger's voice on the other end.

It seems now every month or two, or even more frequently, someone I know either has just learned about their stage IV diagnosis or I learn about their funeral arrangements.

Each time, there is a double dose of emotions the little tiny - "I'm glad it wasn't me" which is immediately followed by the huge "how could I even think that?" and then followed by cancer survivor guilt.

Sometimes the guilt lurks in the back ground and sometimes it emerges up front. It gives us down days but then we stuff it away and we learn to cope again. But its always there.

New Breast Cancer Guidelines

The St Gallen International Breast Cancer Guidelines were recently updated to include the Oncotype DX test for breast cancer as the only screening tool for women with early stage ER+/Her2- breast cancer to determine the benefit of chemotherapy.

On some levels this is great news but again it is not for all women. The criteria for the Oncotype DX test for breast cancer are:

"You may be a candidate for the Oncotype DX breast cancer test if you are medically eligible for chemotherapy and:

• You have been diagnosed with stage I,II or IIIa invasive breast cancer.*
• Your breast cancer is estrogen-receptor positive (ER+) and Human Epidermal growth factor Receptor -negative (HER2-) and you do not have lymph node involvement (also known as lymph-node-negative breast cancer).

        OR

• You are a post-menopausal woman recently diagnosed with node positive, hormone-receptor-positive, Human Epidermal growth factor Receptor -negative breast cancer"

The problem is that while most women have ER+, Her2- and node negative breast cancer, not all do. For example, I was not given this test because I had one tiny positive lymph node. Apparently they are starting to do some testing on women with node positive disease. The Oncotype DX test is also available for colon and prostate cancer as well.

I have digressed. I do like the fact that this test is available for some if not all. I do like the fact that it is covered by most insurance companies. I do like the fact that it helps determine if a patient will benefit from chemotherapy before they receive it. I do like the fact that it is part of standards for treatment.

I do not like the fact that it is still part of the conversation about treatment - do you remember the little analogy - an ounce of prevention is worth a pound of cure? Why can't we put that into the guidelines?

Its all about the language

Who calls it a relapse when cancer recurs? I didn't know anyone did. It has a different connotation. But maybe in Australia its common.

There is a new bit of medical research (because we have to keep those researchers working) in Australia where they found a gene that half of women with estrogen positive breast cancer have. If women have the gene, they could alter the timing of chemotherapy.

Basically a basic blood test could determine if patients have the gene. 

"The test would be used to determine when cancer cells are most vulnerable to chemotherapy, which would be used to kill them off and prevent a relapse.

At present patients with this type of cancer typically receive anti-oestrogen therapy and generally respond well. Within 15 years, however, half develop drug resistance, followed by relapse and death."

How's that for putting it morbidly? Nice - huh?

"Scientists believe the anti-oestrogen therapy weakens the BCL-2 gene, which protects the cancer.

The idea would be to test all patients and correctly time the use of chemotherapy to kill off the cancer and prevent a relapse when the gene is sufficiently weak."

So its much more specific.

But its a theory now and has to go through testing and trials and don't go holding your breath because it will be quite a while.

I just wish that they could be a  little nicer in their phrasing and skip the damn word 'relapse'.

The Battle of The Bulge in History

I never know where I am going to end up on the internet these days. Its really amazing - even without the cat here to help - he is very helpful in websurfing.

Yesterday I found the historical battle of the bulge or "A Slim History of Dieting" on Ancestry.com (see you never know where I will end up).

Its pretty funny. I can tell you that we are much safer these days in our dieting techniques. Previous diet tips have included that fat people should move to swampy areas or "daily cold baths, lots of exercise, chastity, temperance, and hard mattresses".

Personally, I would prefer watching what I eat vs. daily cold baths and living in a swampy area.

Stupid me

I have excuses. I have chemo brain. I have fibro fog. But sometimes I am just plain stupid. This was one of those times.

We are on vacation (note to all the burglars - we have a house sitter and our neighbors know we are away and we don't have anything valuable anyway). Two weeks before we left I made a big project to make sure we had enough of prescription medications to get us through our trip. I checked all of the bottles, refilled a couple.

The day before we left, I went through and filled up our medicine boxes - daily ones - with enough pills to get us through. I carefully packed my break through pain pills. We then designated a little tote bag for all of our medical needs. The first tote was rejected because it was too small so we moved to a slightly larger one. This is serious business.

Then I packed up some over the counter medicines including some Emergen-Cs - you know the packets of vitamin C. I put those in the little zip pocket because they are flat. I put in Tylenol, Mucinex and all that kind of thing.

The next day I went and put elastic bands on the pill boxes so they would not pop open in transit. Then I put in the extra prescription bottles  and double checked and triple checked. I had everything I needed.

As we went out the door I said to my husband the only thing that would get me to come back home would be if I forgot any medication. I told him that I had it all under control and had triple checked it twice.

We arrived on Sunday after driving 90 minutes (we are on the beach if you must know). Monday is pain patch change day. I am on Butrans pain patches - they last a week and provide a consistent dose of opiate medication to keep my pain all under control.

I went to get a replacement patch. THEY WEREN'T THERE!!! What I thought were replacement pain patches were the Emergen-Cs. Damn, triple damn, [insert all obscenities you know here].

Yesterday I went with plan A - taking my breakthrough pain tablets every four hours. It wasn't enough. At all. I didn't even tell my husband until last night. His first question was when was I going home to get them? I said I hadn't decided.

This morning I decided. I was in so much pain. I got in my car at 10am with the plan on going home and coming back by 2pm so I could enjoy the beach. While driving, I was trying to decide what didn't hurt. The answer was my right shoulder. [But now that is hurting too.]

I had to lie down for a couple hours before I could contemplate driving back. Now that I am back I am finally getting to blogging and have taken pain pills and am lying on an ice pack until I feel better.

I was really stupid.

PS The cat is royally pissed off at me. I left. He is not happy. He doesn't eat when I am not there. He will just have to suck it up until I get home.

When Its Not News!

But you think it is. Yesterday I was cruising through the Health section of cnn.com, reading an article here, and another there. At the bottom of each article were links to more articles. I was reading titles, clicking, and reading some more.

I always look at the cancer one, in case they have discovered a cure and I missed it while sleeping or something. The one I saw yesterday was called "Chemotherapy Game-Changer for Stage IV Cancer". Immediately intrigued, I clicked the link and landed here.

Its looks like a lovely article on chemotherapy and stage IV cancer patients. ITS NOT! Its a paid ad or blog post or whatever.

A week or so ago, I was also cruising around the health section of cnn.com and found this article on inflammation which I found barely interesting and biased. It was titled "Chronic Inflammation is the Fuse for Cancer" and it also was an ad. And from the same website, Envita.com, which is the website for a bunch of medical centers.

I felt duped. I found a link on cnn.com and thought I was reading articles, not ads. I did some more poking around and found that it seems there are always more ads linked in among the true articles.

The third article down on the left is titled 'The Secret to Sleeping Throughout the Night". Its basically an ad as well. You will note the source - Simple Skin Care.

I don't think CNN is trying to scam us. I think the stores at the bottom are found by search engines and compiled there - which is why when you go back to the article, chances are the list is different. Its the advertisers who are trying to fool the search engines into thinking they are news and not a load of propaganda.

So the moral of the story is basically 'buyer beware'. Just because you think its news doesn't mean it is.

Time for a change

Through the past forty years, there have been changes in the way we view and treat breast cancer. It started with the 'lets cut out as much as we possibly can'. Radical mastectomies were carried out regularly, permanently disfiguring patients - both emotionally and physically. And leaving them with life long health problems of lymphedema and more.

Gradually, times changed and focused more on detection with the advent of mammograms. My original cancer book printed about 1980, says that they were just beginning to recommend regular mammograms as screening for breast cancer. After this the Komen foundation began to promote early screening which some how devolved into the pink ribbons, pinkification, sisterhood and giant pink wave that overtakes the world every October.

The Komen foundation has managed to give themselves several black eyes in recent years which are proving their downfall. However their efforts, along with that of many other,  have greatly helped destigmatize the disease, allowing people to shout the word cancer instead of whisper it in corners.

But as Karuna Jagger, (www.twitter.com/karunajagger) Executive Director of Breast Cancer Action, points out, its time for a change from this pink world to one where we focus on what is really important:

"As the nation's attention focuses on breast cancer during Pinktober, let's stop selling women a false narrative about screening, and instead advocate for more effective treatments, less treatment when possible, and fewer breast cancer diagnoses in the first place. It's time we change the breast cancer narrative once again."

We do not need all the pink to focus on these efforts.