Happy New Year

Wow - I don't know about you but, for me, it feels absolutely fantastic to say those words. Happy New Year.

Pardon me if I sound a little self-involved, but I have to tell you if there is one thing I have learned it is that the passing of time is forever changed for people who have gone through life threatening illnesses, both for the patients and their loved ones. And still the world continues to turn. Life goes own, people heal, babies are born, people get sick, and people rally around in love to help.

And that is the gift of cancer...the opportunity to bear witness to the gift of compassion.

So in the spirit of this new year, I would like to return the gift and offer up love and appreciation for the people who have helped me this year. 

To my support team, whatever you are doing this fine evening...playing games with friends (hi Diana, Shaun, Tom, Laura, Niamh, Finn, Jack and Ella), celebrating in high style (hi Sandra, Haydn, Robin, Alex, Heather, Colette, Evan and friends), relaxing after a day in the sun (hi Christi, Fred, Owen and Willem), retiring early (hi Mom, Dad, Jim and Lillian, Judy and Carl) or finding your own way to ring in the New Year (hi Rich, Tricia, Zach, Sam, Jen, Sev, Gabriela, Marco, Karen, Parker, Quincy, Kirsten, Simon, Ian, Erik, Louise, Robert, Pat, Merit,Tina, Doug, Jeanne, wonderful cousins (first, second and third), Linda, Ray, Terryn, Pat, Alison, Lisa, Cathryn, Audrey, Pam, Caroline, Nancy, Johanne and all my other friends all over this fine world, Dr. Yun, Dr. Nguyen, Dr. Parsons, Martha, Ann, Brigitte, Nancy, Hershey, Toy, Glenda, Taruna, Roxy, and every other nurse, doctor, technician and health care professional with whom I have had the pleasure of meeting and working), I wish you many, many more days of laughter, sunshine, love and delight. May you find peace, be blessed, and rejoice in the warmth of loving and being loved.

all my best,
Cyn

Monday's health links - on Thursday

Sorry for the delay.

1. Researchers find that most cases of breast cancer happen to those who do NOT have a family history of the disease. I thought we knew this. The article, published by Reuters, also states that, "studies have shown that more than 70 percent of primary care doctors ask women about their family histories, while less than half collect information on other known risk factors such as whether a woman's period began before age 12 - which raises risk - or whether she has given birth, which lowers risk." The researchers used  Breast Cancer Risk Assessment Tool  to go back in time and predict the odds that the women would develop invasive breast cancer over the subsequent five years. This tool uses age of first menstruation, current age, ethnicity, reproductive history, prior breast biopsies and family history to establish a score on a scale of zero to eight to represent a woman's five-year risk. They found that nearly all the women in their study with a family history of breast cancer (about one in ten) also fit into the high-risk category according to the tool. But, more than half of the women without a family history also fit into this category. I am heartened by the remarks of one of the researchers, Dr. Lawrence Wickerham of the National Surgical Adjuvant Breast and Bowel Project (NSABP). He points to the Risk Assessment Tool as one of the methods that doctors should be using beyond asking about family history. "Such efforts can help better identify women at increased risk and can better focus screening and prevention strategies for them."
2. The Canadian government unveils our new cigarette packaging. Have you seen our smokes? They are covered in warnings and horrifying pictures of what cancer does to your body. Now, images are going to get even bigger. After previously covering half the pack's surface panel, images and text highlighting the dangers of cigarette smoke will take up three-quarters of the surface. Some of those images will feature Barb Tarbox, a fierce anti-smoking crusader who unfortunately succumbed to lung and brain cancers in 2003. She may also soon be featured on packages in the United States. This is a remarkable legacy for a remarkable person. We should thank her family for continuing her fight. Let's hope her work helps prevent more people from picking up this terrible habit. Although this initial story about response is more than a little depressing. We need to start taking more personal responsibility for our choices. Do you hear me immortal young hipsters?
3. Same topic. Lung cancer is the most deadly form of cancer; every year it kills more Americans than colon, breast and prostate cancers combined. And, for the most part, it's easily prevented. And this may be the reason why lung cancer gets less research dollars than the other major cancers. And still the tobacco companies pump them out and provide advertising support to rock concerts and sporting events. And we carry on like it's OK. It's not.
4. Making resolutions? The American Cancer Society would like you to look after yourself in 2011 by making your health your priority.
5. More evidence that a plant-based diet can be a life-saver - women who eat more olive oil and leafy vegetables are less likely to develop heart disease. This study comes from Italy, a place where they know a lot about the Mediterranean diet.

Be it resolved...

It is that time of year again - my pants are tight from too much turkey, beef and tarts and someone is going to ask me again if I have made any New Year resolutions... sigh.

Yes, this year, I resolve to lose weight. I would love to look cute in my clothes. I would love to look younger. I would love to be able to keep up better with my kids. But, mostly, I would love to not die. :-) Can I get an amen?

So after a bunch of reading, researching and ruminating, I have chosen The Pink Ribbon Diet as my guide book in this new endeavour. The Pink Ribbon Diet is the product of the work of research dietitian, Mary Flynn, PhD, RD, LDN, who set about exploring the link between diet and breast cancer. Turns out, she found that low-fat diets can increase the risk of cancer, but a plant-based one, similar to the Mediterranean diet, helps you shed pounds while gaining important nutrients beneficial to the fight against cancer.

To prepare this book, Flynn teamed with Nancy Verde Barr, a former culinary associate of Julia Child's.You can tell - there is a lot of passion in the recipe introductions and lots of sensible food wisdom. The book begins with a thorough explanation of the diet, the science behind it and stories from women who have tried it. The rest of the book is devoted to recipes, 150 of them, covering everything from breakfast foods, soups, sandwiches and salads through a range of main dishes, sides and desserts. The emphasis is on vegetables and healthy doses of olive oil for fat, with small portions of meats allowed. There are lots of notes on ways to customize or adapt recipes and they all look really, really doable.

As a bit of a foodie, I am often sceptical of diet books. The recipes often look boring and, well, uninspired. These ones are different. I actually want to try them. There are lots of fresh herbs used, you can use store-bought sauces for convenience and speed, and I can even see the occasional mention of cheese! Woo hoo! There are also a range of global influences and cooking methods, so you should find recipes that fit your own personal cooking styles.

The rumour has it, this is a diet you can live with, like, forever. I'm going to take it one day at a time. But I will report back here and in my recipe blog to share my results.

Good luck with your own resolutions! And now one last glass of eggnog before a workout session with our new Wii Just Dance game. Cheers!

Merry Christmas

This past year has made me more grateful than ever - for life, for family, for friends. And you are part of that circle. So thank you. Thank you to everyone who has read my blog, offered a voice and helped spread the word.

I send you warmest wishes for a wonderful holiday season, whether you celebrate it as Christmas, Hanukkah, Kwanzaa, Eid, Yule or something else. May you spend it in good health with people you love and may you carry that love and good health forward into a long and happy life.

Big cyber hugs and a toast to your health, cheers!
Cyn

Good news on cancer survival for Canadians - let's spread the love

Note: the following article discusses cancer survival rates. In the throes of cancer treatment, the last thing this patient wanted to do was read about statistics. So, even though this is a good news story for people in this part of the world, you may want to proceed with caution. Fair warning. :-)

Last night, my mother-in-law (hi Lillian) phoned with good news she had heard on the radio - if you have breast cancer, there isn't a better place in the world to be than British Columbia (my home province). On Tuesday, members of the BC Cancer Agency presented the news that was published the same day in the Lancet - when compared to  five other regions (Australia, Denmark, Norway, Sweden and the UK), positive outcomes were highest for breast and ovarian cancer patients here in BC. News was also good for BC lung and colorectal cancer patients. The one-year survival rate for lung cancer patients jumped from 36.6%  in 1995-99 to 43% in 2005-07, and for colorectal cancer patients it went from 59.8% to 64%.

The Globe and Mail discusses the report from a national perspective and the news is very good for all Canadians. The research examined survival rates for lung, breast, colorectal and ovarian cancer between 1995 and 2007 in these six countries whose common link is their universal health-care systems. The study found that survival rates have increased for all four cancers in all the countries during this time period, but the disparities indicate that there is a significant number of avoidable deaths.

Read the article for more specifics. But now let's talk about what we do with this information. My husband's aunt (hi Judy) has been very involved in cancer care in Washington State and it, too, is a remarkable hot bed of talent and teamwork. When my father was diagnosed with prostate cancer, he opted to head to Seattle for faster treatment than he would get here in BC. We feel very fortunate in this neck of the woods to have access to so many smart people all working together to share and build on common knowledge in pursuit of better prevention, more accurate diagnosis and more effective treatment. But it isn't good enough to sit and glow in our own successes; we need to find new and better ways to share it with health care teams across the world.

I had an interesting moment with my oncologist in September. We were discussing the things I would be doing to help prevent a recurrence and I was asking questions about bone loss and inflammation and the few other things my sleepy post-chemo brain had held onto. And he said a neat thing to me - "We'll see in December. I'll have more news for you after the conference I'm going to in December." As a patient, I take a great deal of comfort from that kind of interaction. I have a doctor actively seeking new information on advances in cancer treatment and care and doing it with an eye to how it affects his patients. And I wish that for every other patient in the world.

One final note: as the year closes and some of us consider making donations to charitable foundations before 2011, could I ask you to consider groups working on childhood cancers. Many thanks.

Monday's health link

Just one link today: Can depression influence breast cancer survival?

As mentioned in an earlier post, I am going through a blue phase. Christmas is a hard time of year for many of us, though normally not for me. Yes, I get stressed and find it hard to do everything and see everyone I want to; but I am generally quite happy throughout the season. This year, however, I feel sad and am having trouble shaking it. 

But I want to. I really, really, really want to. So I am reading about, talking and, most importantly I think, acknowledging depression. My hope is that shining a light on it will take away some of its hold. And if I feel like its getting worse or not going away, I'm going to seek professional help. 

Now a study out of the University of Calgary here in Canada has given me extra incentive to fight harder for my happy. Turns out, women who suffer from depression following a breast cancer diagnosis have a harder time fighting this disease. While they don't know exactly what is behind this, they do know that depression can put stresses on the body in many ways  that are linked to cancer progression, from decreasing immune function to increasing inflammation. According to lead researcher Janine Giese-Davis,"When these physiological changes become chronic, we believe that they may deplete the resources of the body, making it more difficult for patients to recover." 

Researchers have found that more than half of cancer patients go through some form of depression, and around 38 percent develop major depression. In this study, the researchers focused on more than 100 women who had recently received a diagnosis of metastatic breast cancer, cancer that has begun spreading to other parts of the body. Half the patients underwent weekly group therapy and all received education materials. Participants reported their depression symptoms at four, eight and 12 months. The researchers found that half of those whose depression symptoms decreased over the first year lived at least another four and a half years, compared to just over two years for half of those with worsening symptoms. Reduction in depression also raised the chances of longer-term survival, in this case more than 14 years, by as much as 68 percent. There didn't seem to be a connection between the severity of the depression and later survival, or between the method used to deal with depression, i.e. therapy or medication. The only thing that seemed to matter was the decrease over time in the symptoms of depression.

The ultimate finding for researchers? Doctors, patients and their families need to be aware that chronic depression can have an impact on survival. Giese-Davis says that while it is normal for patients to feel anger, sadness and fear, talking openly about those feelings could be helpful, and that overcoming depression will "improve your quality of life, your social relationships, healthy behaviors, and your ability to follow through on your doctor's recommendations." 

So what am I doing about this? Today I am baking cookies with my boys, going on an adventure, singing  Christmas carols and getting some exercise. And if you call me to see how I am doing, I will probably tell you that I am feeling a little sad. Bear with me. :-)


Question: How do you deal with depression?

Charging forward anyway in the face of conflicting studies

Fighting the cancer recurrence battle can feel a little like playing craps. One day we're told to drink a glass of wine for our hearts, the next we're told DON'T, it might give you breast cancer. Now that you've got breast cancer from all that wine you've been drinking, you find out you need to eat ground flax seed to cut down on your chance of recurrence. Ok - not so fast person with HER2+ tumours...flax seed might increase your chances of a return. Green tea may or may not be good for fighting many cancers but studies seem to say now breast cancer is probably not one of them. Not always eating right? Don't rely on a supplement to fill in the gaps in your healthy eating plan because multi-vitamins have been linked to an increased risk of breast cancer.

Next up - folic acid. Recent studies suggest that folic acid intake may be linked to cancer. That was interesting for me  because my nutritionist at the cancer clinic recommended that anyone at risk for breast cancer who chooses to continue drinking alcohol take a folic acid supplement to reduce the risk of recurrence.

So if you take the time to read these studies, what do you do? Well, I am choosing moderation. I am trying to eat a balanced diet, rich in anti-oxidants (omega 3s, beta carotene) and fibre, and low in fat. I drink green tea, but I am not a fanatic. I limit my intake of flax seed to 2 tablespoons a day. I take the maximum recommended dosage of vitamin D, fish oil and calcium. I take aspirin every day to cut down on inflammation. In the new year, I am adding green tea supplements, just in case, and I am also adding a new one, turmeric. I have cut back on my multi-vitamins, and now only take them a few days a week.

And folic acid? Well, in the absence of conclusive studies saying the benefits of folic acid outweigh the risks, I'm going to have to err on the side of caution. That means cutting back further on alcohol and relying less on folic acid to offset it's dangers.

And now my wee boy wants to paint! So you will pardon this cancer girl who needs to get back to her real life. :-) That's the best supplement of all. I dare a researcher to prove me wrong!

Doing the work

In the early days of my cancer diagnosis, I had trouble coping with my new reality. Not so unusual, I'm thinking. One of the ways I got through it was to pick and choose what I wanted to learn about and what I would choose to ignore. I always had it in the back of my head that, one day, I would read and learn more about this thing my body was doing.

So some people found it strange that I didn't always remember the name of my particular form of cancer, the names of my drugs or the statistics on survival. OK, that last one shouldn't surprise ANYONE! At the time, that was just fine with me. Knowing this stuff wasn't helping me launch a successful battle. I needed to know where I needed to be, who I was going to see, what I could expect for side effects, and how I should cope with any and all the changes I would be going through. And that worked. For a while.

Now I am in that year out limbo land, seeing my doctors and nurses less and dealing with cancer solo more. And, man, I have to tell you, I feel like an idiot. I feel like I don't know much about what happened this year and even less about what I can expect in the future. So I am taking baby steps towards doing the work of learning more about my cancer so that I can begin to form my own strategies for survival.

First up, depression. I noticed in a number of my intake forms that my health care folks were concerned about whether or not depression during treatment might be an issue for me. Well, I certainly had very blue days. And, I am going through a blue phase right now. So, today, I went online at the National Cancer Institute website to learn more about depression during cancer.

There was lots of really good information. I will include the overview below, but I highly recommend anyone with questions about depression during or after cancer treatment take a look at their coverage of the topic. They discuss diagnosis, treatment, suicide, end of life and palliative issues, and depression in children.

It is officially time to start edumecating myself.

Overview

Depression is a disabling illness that affects about 15% to 25% of cancer patients. It affects men and women with cancer equally. People who face a diagnosis of cancer will experience different levels of stress and emotional upset. Important issues in the life of any person with cancer may include the following:

• Fear of death.
• Interruption of life plans.
• Changes in body image and self-esteem.
• Changes in social role and lifestyle.
• Money and legal concerns.

Everyone who is diagnosed with cancer will react to these issues in different ways and may not experience serious depression or anxiety.
Palliative care begins at diagnosis and continues throughout the patient's cancer care. Patients who are receiving palliative care for cancer during the last 6 months of life may have frequent feelings of depression and anxiety, leading to a much lower quality of life. During this time, patients in palliative care who suffer from depression report being more troubled about their physical symptoms, relationships, and beliefs about life. Depressed terminally ill patients have reported feelings of "being a burden" even when the actual amount of dependence on others is small.
Just as patients need to be evaluated for depression throughout their treatment, so do family caregivers. Caregivers have been found to experience a good deal more anxiety and depression than people who are not caring for patients with cancer. Children are also affected when a parent with cancer develops depression. A study of women with breast cancer showed that children of depressed patients were the most likely to have emotional and behavioral problems themselves.
There are many misconceptions about cancer and how people cope with it, such as the following:

• All people with cancer are depressed.
• Depression in a person with cancer is normal.
• Treatment does not help the depression.
• Everyone with cancer faces suffering and a painful death.

Sadness and grief are normal reactions to the crises faced during cancer, and will be experienced at times by all people. Because sadness is common, it is important to distinguish between normal levels of sadness and depression. An important part of cancer care is the recognition of depression that needs to be treated. Some people may have more trouble adjusting to the diagnosis of cancer than others may. Major depression is not simply sadness or a blue mood. Major depression affects about 25% of patients and has common symptoms that can be diagnosed and treated. Symptoms of depression that are noticed when a patient is diagnosed with cancer may be a sign that the patient had a depression problem before the diagnosis of cancer.
All people will experience reactions of sadness and grief periodically throughout diagnosis, treatment, and survival of cancer. When people find out they have cancer, they often have feelings of disbelief, denial, or despair. They may also experience difficulty sleeping, loss of appetite, anxiety, and a preoccupation with worries about the future. These symptoms and fears usually lessen as a person adjusts to the diagnosis. Signs that a person has adjusted to the diagnosis include an ability to maintain active involvement in daily life activities, and an ability to continue functioning as spouse, parent, employee, or other roles by incorporating treatment into his or her schedule. If the family of a patient diagnosed with cancer is able to express feelings openly and solve problems effectively, both the patient and family members have less depression. Good communication within the family reduces anxiety. A person who cannot adjust to the diagnosis after a long period of time, and who loses interest in usual activities, may be depressed. Mild symptoms of depression can be distressing and may be helped with counseling. Even patients without obvious symptoms of depression may benefit from counseling; however, when symptoms are intense and long-lasting, or when they keep coming back, more intensive treatment is important.

Blip

My blogging has sputtered and slowed of late. I am sure I am not the first person to go through this, but I am going through a bit of a blue phase. And now a friend who is also going through cancer has had some bad news. For this to be happening at Christmas seems even crueler.

I am pushing through the fog and looking for positive and interesting things to write about here. And, I am watching my kids enjoy the early days of Christmas and focusing on the blessings in my life.

See you tomorrow, I hope!

The passing of Elizabeth Edwards

I just wanted to make a brief acknowledgement of the passing of Elizabeth Edwards.

For many people living with cancer, she was a symbol. A symbol of fighting with grace and good humour. A symbol of fighting for others when you could choose to fight just for yourself. A symbol of putting love before fear.

And lest anyone wish to chime in here about anything else, please don't. She did this all in the public eye facing scrutiny most of us could never believe. I won't participate in that.

And so her passing has made me quite sad. I had hope that she would be here much longer to continue to provide inspiration for others living with cancer. I also hoped, for her sake and ours, that she would get to finish some of the fights she had taken on for health care reform. Perhaps we need to pick them up and finish them for her.

Monday's health links

1. Debating the health benefits of aspirin. My doctor has given me the OK to take aspirin daily for its possible anti-cancer benefits.
2.  I can't find any way to summarize this article beyond this woman is a-ma-zing.
3. Get your hands off my damn apples.
4. Seattle Genetics seeks approval for a drug they believe will do a better job of fighting cancer without the traditional side-effects. It combines an antibody that targets cancer with a cancer-killing agent - healthy tissue is unharmed.
5. Burning up cancer cells with magnetic pulses. More movement towards side-effect free cancer therapy.
6. I will not make a "size matters" joke. Using finger length for prostate cancer risk-assessment.

 Have a glorious day!

Sucking at pessimism

 Thanks, Jon.

http://imgs.xkcd.com/comics/positive_attitude.png