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Wednesday, July 30, 2014

The Power of Denial

By Heather Millar

woman covering her eyes

Facing reality is hard.

Our neighbor, and long-time family friend, is declining. As I’ve written several times before, he has metastatic lung cancer. It’s been nearly 2 years since the docs told him that “nothing can be done.” At 83, he’s a fighter. He’s outlived his prognosis two or three times over. Even now, he goes out with his hiking poles and does his daily walk. But his exercise sessions are much shorter now. He’s having trouble breathing—oxygen tanks now clutter his living room—and his chest is hurting. Morphine is a daily reality now.

He had been resisting the idea of hospice care for months, scoffing, “I’m not ready to give up yet,” and “That means they’ll do nothing more for me.” Family and friends tried to explain, over and over, that hospice doesn’t mean the end of care. It means, rather, that patients, doctors and caregivers shift the priority from cure to comfort. But he would have none of it.

Then, a couple weeks ago, he gave in and accepted hospice care, grudgingly. When I went over to visit this past weekend, he said he hated the hospice caregivers. “They look at me with those big eyes, as if to say, ‘You poor thing!’” he griped.

Suddenly I realized that hospice, for him, represented the reality of his cancer. For him, accepting hospice meant accepting that cancer will be the end point.

Most of us live our lives as if there will be no end point. If we didn’t, we’d all end up brooding endlessly about our mortality. So most of us ignore the reality that, as my neighbor’s primary care doctor put it, “We’re all swimming toward Hawaii, and none of us will make it to Hawaii.”

When you have cancer, it’s much more difficult to avoid the reality that life is finite. Yet even then, many of us find ways to actively avoid looking at our cancer.

For my neighbor, that meant avoiding hospice. And now, when hospice has become unavoidable, it means resisting the sympathies of the hospice caregivers.

In my case, I chose to start a blog. Surely, if I researched everything about my cancer, and if I wrote honestly about it, sparing nothing, I could tame my disease. If you know your enemy, you can vanquish it, right?

Some people choose to remain unfailingly cheery, not showing their fatigue, their misery, their fear. If you don’t let your enemy get you down, you can win, right?

Others, like Nancy G. Brinker, founder of Susan G. Komen for the Cure, throw themselves into their work. When Brinker herself got breast cancer, she worked throughout treatment. When I read Brinker’s book, Promise Me, during treatment, I thought she seemed to be saying, “If you don’t let cancer slow you down, you can beat it, right?”

I know other cancer survivors who throw themselves into a cause. They start a survivor’s support group. They do cancer marches or races. They crusade for cancer research. They organize services for cancer patients: housecleaning, post-chemo haircuts, camps for the children of cancer patients. If you’re giving back, surely cancer won’t kill you, right?

When I think about it, though we may tend to think of denial as a negative thing, our reluctance to look at cancer straight on may result in a lot of good: For my neighbor, it staves off hopelessness. For the rest, it results in books, movies, and other artistic expression, it adds to cancer patient support, to research, to charity.

We may all be swimming to Hawaii, but at least we’re doing something on the way.

What do you think? Do you prefer to look at cancer directly, or do you channel your feelings and fears into other endeavors? Let us know here.

Posted by: Heather Millar at 4:17 pm

Thursday, July 17, 2014

Flipping to the Back of the Book

By Heather Millar

woman reading

I’ve always been one of those people who want to flip to the back of the book. But I think the experience of going through cancer has made me less insistent on control, less adamant about knowing “how it’s going to turn out.”

And lately, life has been re-emphasizing that “one day at a time” is probably the healthiest way to go forward.

As I’ve written before, my mother, who’d been ill and bedridden for years, had been receiving hospice care since last Christmas. Even before she officially went on end-of-life care, I’d thought, “This is it,” more times than I can count. But each time, that wasn’t it. Life had more in store. Again and again, I tried to see where the road was going. Again and again, it turned in an unexpected direction.

This past Memorial Day weekend, as my husband, daughter, and I prepared to leave town for our church’s annual family retreat, I once again found myself trying to anticipate what direction life would take. Mom seemed to be taking a turn for the worse, again, but everyone (hospice nurses, chaplains, caregivers) told us it was a matter of weeks, not days. So we said good-bye to Mom and loaded up the car.

Then, 36 hours into our weekend away, my mother died. That’s why I was absent from this blog for a while.

The twists and turns of my mother’s last years underscored how life is always unpredictable. Life is always bigger than we are. And I think that we’re usually much happier when we try to let go of the illusion that we have control.

Here are some ways I’ve tried to acknowledge my lack of control — ways I’ve tried to let go and let life take the lead:

• When I get too hyper, too fixated on “how it’s going to turn out,” my husband always tells me: “All you can do is all you can do.” In other words, do your best, but realize that this won’t always mean things turn out the way you want. Do your best, then let go.

• My late mother was a brilliant woman. She became a trail-blazing divorce attorney in the 1950s when women didn’t do things like that. She always told me, and always told her clients, “Do not worry about a bridge until you come to it.” Deal with problems as they come. Don’t imagine all the possible things that might happen. Only some of them will. You’ll waste time and energy worrying about all the possibilities. Deal with what’s in front of you now.

• Even when things seem truly awful — when chemo or some other treatment is making me miserable or I’m nervously awaiting a crucial test result — I try to find at least one thing each day that gives me joy. Whether we have cancer or are in remission, we’re all fighting for our lives. Don’t forget why life is worth the fight. Life is always a tangle of good and bad. When things are bad, don’t forget to notice the good, too: It can be something as small as fragrant rose, a warm bath, a beautiful cloud formation. When you see it, grab on and savor the moment.

• I try to accept that there are no guarantees. The docs make their best guesses about which treatment is best for my cancer, and I just have to hope that they make the right judgment call.

• I try to accept that sometimes things just don’t make sense. Like I said before, life is so much bigger than you or me. Who knows why we got cancer? Who knows why one treatment works and another does not? These are mysteries that may never be explained. But even as scary and big and complicated and unpredictable as life is, I still think it’s worth the fight.

What do you think? How do you cope with our lack of control?

Posted by: Heather Millar at 1:48 pm

Thursday, July 10, 2014

Dealing with Pain

By Heather Millar

woman in pain

I’m writing this post on the couch, leaning up against a bolster of throw pillows and bed pillows, trying to ignore the pain in my head. Last Sunday, my husband accidentally whacked me in the head with the hatch door of our Subaru Forester, and I ended up with a long, jagged Harry Potter-shaped gash just above my hairline. We spent the evening in the ER, and I gritted my teeth through various painful procedures: flushing the wound, enduring the pinch and sting as the nurse practitioner applied an anesthetic directly into the cut, the weird pinch and pull as the staples went in. Now, 2 days later, the pain is just dull and annoying.

The experience got me thinking about how varied pain can be. The adjectives I can apply to my recent injury are many: hot, blinding, sharp, pinching, dull, pounding. The source of the pain is absolutely clear, though. And the course of action is also clear: I know that if I just take it easy for a few days (not my strong suit), I’ll be fine.

If only the pain that accompanies cancer were so straightforward. In my experience, cancer pain is sneaky. It can come out of nowhere. It can be hard to explain. It’s often ongoing and difficult to treat.

When I was going through chemo, pain flared in my right shoulder. More than a decade before, I’d torn a tendon in that shoulder doing some overly enthusiastic push-ups during a fitness class. I’d done physical therapy, which had seemed to take care of it, so I hadn’t really thought about it in years.

But not long after my first infusion, that shoulder started acting up. The pain would come on suddenly, last a few hours, and then disappear. When it came on at night, the pain would wake me out of a deep sleep and would keep me awake.

The pain was deep, but it didn’t force me into bed. Thank goodness, because the pain also didn’t respond to the usual painkillers, not even the stronger ones that have codeine. I’m stubborn, so I just soldiered on: driving carpool, fixing dinner, and so on. It did make me cranky, though, and more than once I had to apologize to my daughter for snapping at her — “Sorry, honey, I’m not in the greatest mood because I’m in pain.”

But when I had my two surgeries for breast cancer, I found the recoveries to be really difficult. The first surgery was particularly icky. A small blood vessel may not have been tied off, or may have started to leak somehow, and it created really painful swelling that lasted almost a month. The only thing I could do for that kind of pain was to retreat to my bed, try not to move, and wait for it to get better.

Pain is difficult for anyone, but for cancer patients, I think it creates an extra overlay of fear and misery. When you’re in pain, it seems that cancer is really attacking you. I don’t know if I always dealt with my pain in the best way, but I did find that I usually felt better if I just told people that I was in pain and grumpy.

My brother, who has had liver cancer and has endured many painful procedures related to that, takes the opposite approach: He says nothing. He doesn’t complain, but he does get grumpy. It works for him, but I think it makes it difficult on those around him. It’s not easy to help someone who won’t admit he needs help.

How do you cope with the pain of cancer treatment? Do you take my “tell all” approach, or do you take my brother’s “suffer in silence” approach? What works for you and why? Let us know here.

Posted by: Heather Millar at 10:28 am

Monday, June 30, 2014

Outliving Your Prognosis

By Richard C. Frank, MD

happy patient

Few other things are more shattering than to receive a diagnosis of an incurable cancer with a prognosis of less than a year to live. Someone’s response to this “news” depends on many factors, including: a person’s age and stage in life, whether or not they have dependents (especially young children), whether or not they feel they’ve achieved their main life goals, knowledge of cancer, past experiences involving death and dying, and how they traditionally respond to adversity. But regardless of background, when someone receives that kind of diagnosis, their focus shifts from future goals and desires to what can and should be done with the limited time that may be left.

But sometimes, death can be cheated and for quite some time. The aggressive cancer responds much better than expected to the treatments given.  This has a remarkable effect on the person fighting for their life. They experience relief from the cancer symptoms – the pain, lack of appetite, weight loss, exhaustion, and shortness of breath begin to gradually fade. The body starts to heal, gaining in vigor and weight, and the person begins to have a more positive outlook. Weeks turn into months, and scans show that the cancer is in remission. This situation can be hard to grasp for someone who had been preparing for death. They may ask their oncologist, “Am I still dying?”

One patient of mine who is in this situation recently exclaimed: “I did not expect to be here. I am elated, of course, but shocked.” One year previously, she lay in the hospital near death after having been diagnosed with widespread pancreatic cancer, blood clots in her lungs, and a bloodstream infection. Somehow, some way, the chemotherapy, antibiotics, and blood thinners pulled her back from the brink of death.

“Am I still dying? Can I make vacation plans? Should I renew my gym membership? I’m just not quite sure where I am and what I should be doing,” she said at a recent office visit. As she talked, her eyes widened and filled with light. It seemed to me that she was in a place few are familiar with. Her expression of disbelief gave way to a tentative smile and then to a broad grin. Then I smiled, feeling a deep appreciation for being a part of this special moment with her. I happily said as I looked her in the eyes, ‘’No, you are not dying,” and: “Yes, you should make plans and resume exercising. You are very much alive.” She understands that the cancer will at some point take her life. But we don’t know when that will be, so for now, she’s living her life.

Has anything like this happened to any of you or someone you know?

Posted by: Richard C. Frank, MD at 10:50 am

Tuesday, June 10, 2014

Have You Checked Your Skin?

By Glenn Meuche, MSW, LSW

Glenn

A young client of mine, David, visited his dermatologist one day for a rash that had appeared on his chest. While his skin was being examined, David’s dermatologist noticed a suspicious mole on his upper left bicep. The mole turned out to be melanoma — the most serious form of skin cancer.

Had the dermatologist not discovered David’s mole, the young man’s chances of survival would have greatly diminished. Melanoma in its advanced stages can quickly spread to other parts of the body, such as the brain, lungs, and liver.

Although melanoma is an extremely aggressive cancer, it is highly curable if detected early. Survival rates for early stage melanoma can sometimes exceed 90% to 95%. Melanoma is often visible on the skin, which can make it easier to detect than other cancers that impact internal organs.

Like many people, David had spent countless hours in the sun as a young adult, unaware that he was at risk for melanoma. This summer, and indeed all year round, it’s important to know how to protect your skin from the harmful UV rays that can cause this potentially deadly diagnosis.

  • Be mindful of when the sun is at its strongest, during the hours of 10 a.m. and 4 p.m.
  • Always use sunscreen. Use a product with an SPF level of 30 or higher that protects against UV-A and UV-B rays. If you swim or are sweating, use a waterproof sunscreen and reapply often. Cover your whole body with screen, including ears, eyelids, nose, and lips.

  • Avoid tanning beds. Using them before the age of 30 can heighten a person’s risk by 75%.

People who are fair skinned, freckled, and have light hair and eye color can be at greater risk. If you have a large number of moles or a history of abnormal moles, it is important to do self-examinations and to have your skin checked regularly by a dermatologist.

Here are some easy steps for checking your skin:

  • Perform self-examinations regularly in front of a full-length mirror. Use a hand-held mirror to look at your back and other hard-to-see places. Also examine your head, between the toes, back of the ears, soles of feet, and undersides of the arms.
  • Search for new growths on your skin and spots or sores that do not heal normally. Take note of any changes in moles, freckles, and birthmarks.
  • Know the ABCDE’s of moles:

Asymmetrical – Is the mole oddly shaped?

Border – Does the mole have irregular or vaguely defined borders?

Color – Does the mole have uneven coloring or multiple colors?

Diameter – Is the mole larger than a pencil eraser or is it growing in size?

Evolution – Has the mole grown or changed in any way?

If you’ve been diagnosed with melanoma, it can be tremendously helpful to connect with others who’ve received a similar diagnosis.  Organizations such as CancerCare and The Melanoma Research Foundation offer free support groups, where participants can share their experiences with melanoma and learn from each other. Also, speaking to an oncology social worker can help you process your experience and address challenges you may contend with in treatment and recovery.

If you or a loved one has been diagnosed with melanoma, visit www.cancercare.org/diagnosis/melanoma to find reliable information, emotional support, and helpful resources.

 

Glenn

Glenn Meuche, MSW, LSW is an oncology social worker with CancerCare. Based in CancerCare’s New Jersey office, Meuche moderates support groups and provides individual counseling over the telephone and face-to-face to help people manage the emotional and practical challenges of cancer.

Posted by: WebMD Blogs at 12:00 pm

Friday, May 23, 2014

The Power of Rest

By Richard C. Frank, MD

resting

I was playing tennis with my 14-year-old son and went for a difficult shot. I sprinted toward the overhead shot, twisted in the air, and ended up falling backward, crashing on the small of my back and snapping my head back — hard. After a few moments of holding my head, I got up and tried to walk. Everything was spinning. I went down. Soon I was in my hospital’s emergency room. A CAT scan confirmed that there was no internal damage, but my brain had banged into my skull, causing a shock to my brain cells. I was diagnosed with a concussion and sent home.

Then I learned what a concussion really is: pure agony. For two weeks I could not do a thing but lay in the dark and be still. That did not stop me from trying to get back to work after a few days, which was a complete no-go because cancer patients require a lot of thought and attention. When you have a concussion you cannot think; you cannot pay attention. You must completely rest the brain. I learned this the hard way.

For one solid week I was a vampire. I could not stand the light of day, I had nonstop headaches, and I couldn’t walk very well because of the vertigo. I could not look at a computer screen and could not send texts without provoking a massive headache. My normally very active body and mind wanted to do only one thing: nothing. But that is not an easy thing to do. Like a lot of people, my thoughts naturally race and I have a hard time quieting them. Between work, family and hobbies I rarely take a breath. Now I was forced to slow it completely down. But how? Though I have spent a lot of time during the past three years learning the importance of meditation and spirituality to promote day-to-day healing (you can read about my post on mindfulness here), now I was forced to put it to the test.

I developed what I now call “power healing.” A power healing session consisted of the following: I would light a faintly scented candle (of cedar or spruce), turn on soothing music (NPR classical radio or a CD of “Vibrational Healing Music” by Marjorie de Muynck or the rhythmic sitar sounds of Ravi Shankar), lay on the couch, wrap myself like a mummy in my favorite old blanket, cover my eyes with an ice cold eye cover, be completely still and focus on my breath. My thoughts would visit their usual haunts but eventually these would give way to a space of no thoughts. At that point I felt suspended between alertness and sleep. My body would tingle and I would feel locked into a zone of deep peace and healing. This would last for approximately 45 minutes. I would emerge from these periods feeing incredibly rested and just a little bit better with each session, with each passing day. I am certain that being left alone to heal in my own way enabled me to overcome my concussion in three weeks. I am still not 100% but am able to do everything I want to do (except play tennis).

I have a newfound understanding of what my patients go through when they are exhausted from cancer, from treatment, from the stress of it all. I can now more confidently recommend rest, knowing full well the recuperative powers of achieving peace in our minds and in our bodies.

Posted by: Richard C. Frank, MD at 11:13 am

Thursday, May 22, 2014

Why Don’t We Have a Cure for Cancer Yet?

By Heather Millar

mother daughter talking

“Mom, why don’t we have a total cure for cancer yet?” That’s what my 13-year-old daughter asked me a few nights ago as I walked into her room to kiss her good night. She was 9 and 10 when I was going through active cancer treatment and didn’t say much about it at the time. Her musings about cancer now come out in dribs and drabs.

“Well,” I said, getting ready to put on my science geek hat. “The main reason that we don’t have a ‘cure’ for cancer is that cancer is not one thing. As researchers learn more and more about the genetics of cancer, we’re finding that breast cancer may be dozens of different diseases caused by dozens, if not hundreds, of different things. That’s also true of other cancers. So we’re not looking for one cure; we’re looking for hundreds of cures.”

I was going to go on. As my daughter says, this is one of my “rant” topics. But I could see her eyes starting to glaze over. So I stopped. But here’s what I’m going to tell her, eventually, in bits and pieces, as she gives me the openings to do so:

We don’t have a cure for cancer because:

• Scientists are just figuring out the genetic code, the “genomics,” of different cancers. That’s making us reevaluate lots of things. For instance, where your cancer started doesn’t seem to be as important as how your cancer functions.

• Even as we’re figuring out the different genetic codes of cancer, we’re just beginning to figure out how that cancer code is translated into instructions, just beginning to understand how those instructions turn into the proteins that both sustain life and fuel cancer.

• There’s still a ton of work to be done to understand how our environment influences cancer. Sometimes, a patient may have a gene that might cause cancer, but it doesn’t go into action until something in the environment “triggers” that gene to “express” itself, making proteins that fuel cancer.

• There’s still a massive amount of work that needs to be done regarding cancer prevention. We don’t talk nearly enough about prevention. But to be fair, to really prevent cancer, you have to understand exactly what causes it. And except for general advice like “exercise, eat right, and reduce stress” — or in clear cases like the connection between smoking or asbestos and lung cancer — we just don’t know exactly what steps we can take that will definitively prevent cancer.

• Researchers are finding that cancer is so varied that we need to rethink how we research cancer. We need to develop new ways of doing studies that will result in proven treatments more quickly. We need ways of accessing data from more patients.

Of course, work is going on in all these areas and more, by scientists who are far more knowledgeable than I am.

Yet when you’re a cancer patient, it feels like a massive betrayal when you learn how much we still need to know about cancer. “What do you mean, ‘We don’t know’? I need a cure NOW.”

Just remember, the puzzle of cancer is almost more complicated than we can imagine. Thousands of doctors and research biologists are working on these questions. But I doubt we’ll ever have a “total cure” for cancer because we’re always changing. The environment is always changing. Cancer is always changing.

What do you think? Does it upset you when your doctor says, “We don’t know”? Do you think a “total cure” for cancer is a realistic goal?

Posted by: Heather Millar at 8:28 am

Thursday, May 15, 2014

At a Cancer Treatment Crossroad? What to Consider

By Heather Millar

at a crossroad

I’ve always loved the Robert Frost poem “The Road Not Taken,” which starts:

“Two roads diverged in a yellow wood,

And sorry I could not travel both.

And be one traveler, long I stood. …”

During my journey through cancer, those lines became even more profoundly meaningful – it felt like I was constantly faced with the question, “Which road should I choose?” As cancer patients, we stand at crossroads all the time. Should we opt for this treatment or that treatment? Have chemo or not? Decide on hospice? Or fight a while longer? Change doctors, or not? Exploratory surgery, or a PET scan? And once we make a decision, it feels like we can’t “un-make” it. And the stakes are so high: life and death.

I’ve been thinking about this a lot in the last week. I’ve had several conversations with both cancer patients and survivors in which they lament the lack of clarity when you have cancer. What if one doctor tells you that this is the best treatment, and then another doctor tells you the opposite? How do you know which one is correct? Is one incompetent, or do these doctors just have a professional disagreement? How do you know you’re doing the right thing?

I think that in cancer, as in the rest of life, there are times when you just can’t know if you’re choosing the right path.

But here are some things I’ve learned about health crossroads, and I hope they may help you when “two roads diverge” in a cancer clinic:

  • Always, always remember that doctors are not infallible gods. They are people with opinions and their own ways of doing things. Doctors disagree. Don’t be surprised by that.
  • If you’re in a situation where the docs are giving you different advice, then start asking questions. Ask about risks. What is the risk associated with A versus the risk with B? What makes them think this is the right course? What are the arguments for and against A and B? What would they do if it was one of their family members facing this decision? (Sometimes this last question is enlightening, but sometimes it’s just another way for that doc to push his or her point of view. It’s worth a try, though.)
  • If you’re the kind of person who likes doing research, then look up what trusted web sites like WebMD, the American Cancer Society, the National Institutes of Health, and the American Society of Clinical Oncology have to say about A and B. If you’re not a researching type, then enlist a family member or friend who is.
  • Write things out. Start two charts, one for option A and one for option B. Use more sheets if you have more than two choices. On each sheet, draw a line down the middle. On one side, list the things that support that choice. On the other side, list the arguments against that choice. Once they’re completed, line all the charts up side by side so that you can “see” the crossroads you’re facing. Then start another sheet on which you list your “Goals of Care.” What are you hoping to get out of cancer treatment? Complete remission? The most aggressive care? The least uncomfortable treatment? And if docs tell you a cure is no longer possible, what’s most important to you now? Quantity of life or quality of life? That is, do you want more days, no matter what? Or would you opt for fewer, but more comfortable, days? We all have different answers to these questions, and our answers may change depending on where we are in the journey. Once you’re done writing out your options and your goals, compare all the sheets, and then make your decision as best you can.

Remember: It’s your crossroads, not your doctor’s. You have the power to make a choice, and you have the power to change that choice. Don’t ever forget that.

Let us know if you have other methods that have helped you when you’ve had to decide between conflicting medical paths.

Posted by: Heather Millar at 1:34 pm

Friday, May 9, 2014

Giving What’s Really Needed

By Heather Millar

scale

Five years ago, my stepdaughter, now 32, decided to quit her job as an elementary school teacher and travel around the world for a year. As part of her departure preparations, she cleared out closets, drawers, and cabinets of all of the random makeup, scented candles, and unusual moisturizers given to her over the years by her students’ well-meaning parents. The gestures were always appreciated, but the gifts were often way off the mark.

Why do we find it so difficult to give each other what we actually want and need?

This is an especially difficult challenge for cancer patients, I think. When we’re going through treatment, we are overwhelmed and we need help with everything: shopping, cooking, housecleaning, scheduling appointments (and getting to them) — you name it.

But we may be reluctant to be brutally honest about what we really need: How do you say, “Yes, I’d love you to bring over a meal, but roast chicken tastes like a tin can now thanks to chemo, and what I’m really craving is mac and cheese.” Or: “Hot soup hurts my mouth sores. Could you just bring coffee nut fudge ice cream?” How do you say that you really don’t have energy to socialize, so please just leave the casserole on the stoop? Or, how do you explain that sometimes answering the question “How can I help?” feels like just one more burden? How do you spell things out for your friends and family without seeming ungrateful and nasty?

And I know it’s hard for the people on the “giving” side of the equation, too — they love you and want to help, but aren’t sure how.

Social media tools and apps have become game-changers in how we give and get help during illness: Lotsa Helping Hands, Caring Bridge, Caring Ties, CareZone, and Caregiver’s Touch, to name a few. And there’s a new app coming out in the fall called StandWith that will allow you to send push notifications out to your caregiving network to ask for help with a specific task. It’s like sending out a police “all-points bulletin” to your peeps: “Help! Please pick up my kid from school. I’m stuck in the infusion ward for an extra hour.”  And the app will allow you to group folks into categories such as family, friends, and acquaintances. That way you can choose to have the “pick up my kid from school” request go to just close friends and family, and not the person you’ve spoken to only a few times at church coffee hour.

When I was sick, there were already some caregiving web sites up and running, but I didn’t even think to look for apps. We’d just moved to my hometown of San Francisco from New York City, where we had lived for 10 years. And while we definitely had friends and family nearby, we didn’t yet have the wide circle of acquaintances that we’d developed in New York. The fact that I was in a “between two homes” transition made the gestures that came during that next 15 months of treatment all the more special. Help, in big ways and small, came from all sorts of people. A bunch of my friends in New York City took up a collection and, out of the blue, sent me several hundred dollars to pay for take-out and household help. My oldest childhood friend took my daughter to her first day in a new school because I had my first surgery that day. An assistant priest at our church, who I barely knew at the time, brought over delicious meals AND wine. The ceramics teacher at my daughter’s Brooklyn school sent a beautiful cookie jar that she made, just because I’d once mentioned that I’d like to pay her to make one for us. The parent from my daughter’s new school — who I didn’t know at all — organized a meal train during my radiation treatment.

All these gestures were lovely and needed. And even the things that weren’t needed made me feel loved. They gave me strength to put one foot in front of the other, to slog through the cancer treatment marathon.

But boy, it would have been great to have an app. Have you found other tools to organize your caregivers? Let us know here.

Posted by: Heather Millar at 12:23 pm

Friday, May 2, 2014

Cancer Weight

By Heather Millar

scale

I’ve been putting on weight.

When I was diagnosed with cancer in 2010, I was about 20 pounds above my ideal weight (the weight where I feel I could see my high school boyfriend again) and 10 pounds above my healthy weight (the weight I realistically maintained for more than a decade from my 30s to my mid-40s). Since then, the pounds have added up slowly, a couple here, 3 or 4 there. By my last check-up, I was 30 pounds above my ideal weight, 20 above my healthy weight.

Breast cancer is notorious for packing on the pounds. No one’s exactly sure why. It might be that most breast cancer patients are pre-menopausal or menopausal, and just “being a woman of a certain age” means weight gain. Or it may be the hormone-inhibiting drugs that many of us take wreak havoc on how our bodies store energy (i.e. make fat). Or it may be that breast cancer can be pretty depressing/scary/exhausting, and many of us snack or drink for comfort.

I’ve blamed all of those things in the last 3 years: Darn chemical menopause! Darn drugs! Darn stress-eating/drinking! Stupid cancer!

But at my 6-month check-up yesterday, I got a kick in the pants: I’ve gained 13 pounds since my last check up in October. My oncology nurse practitioner knows that I’m active and generally don’t eat junk, but she told me gently that I can’t gain more weight.

You see, my cancer was unbelievably reactive to estrogen. It doesn’t just say “estrogen-plus” in my chart. It says, “estrogen-plus-plus-plus.” I take a drug that blocks my ovaries from producing estrogen, but the rest of my body’s cells still make it. And where does estrogen like to go to hang out? Fat cells. Basically, if you’ve got more fat cells, you’re just building cocktail lounges for deadly estrogen hoodlums. I’ve been building an entire estrogen entertainment district.

I’ve known all this for years, but I’ve been making excuses. (See “Stupid Cancer!”) So I asked my nurse practitioner not to be gentle, but to give me orders. If I’m given a clear directive, I can be very disciplined. And once I make a decision, I usually stick to it.

So here’s what she said: Keep exercising. Keep eating a balanced diet. Eat small meals every 3 hours or so. Don’t eat much after about 6 p.m. Until I lose the weight, quit drinking, except for special occasions. Same story with refined carbs like bread, pasta and sugar: Drastically cut them back for now. Don’t expect it to come off fast: Younger women may lose 1 or 2 pounds a week; I should be happy with a pound every 2 weeks. Don’t worry if I stray occasionally, just don’t give up the effort.

Sometimes, when we need to do something, we need an “Aha” moment. We need that breakthrough honesty that lets us see things clearly. (I’m not “curvy,” I’ve let myself get fat.) Today was my kick-in-the-pants day. No more estrogen-loving fat cells!

Hopefully, by my next oncology appointment, I’ll have gotten rid of what I’ve gained since the last check-up. Maybe by this time next year, I’ll be within reach of my healthy weight. I’m saying it here to keep myself honest.

Cancer survivors, like heart-attack survivors, often are exhorted to change habits: Lose weight. Quit smoking. Quit drinking. Start moving. Avoid this food. Avoid that activity.

It’s tough. I know it’s tough.

Are you trying to change a habit to enhance your health as a cancer patient or a cancer survivor? What challenges have you had? If you’ve been successful, what led to that success? Let us know here.

Posted by: Heather Millar at 2:05 pm

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