According to a recent article in ONCOLOGY TIMES by Mark Fuerst in the June 25,2014 issue, there is an substantial amount of evidence showing that patients who are obese, generally have a more difficult time with breast cancer. More surprising was the fact that is was lest clear in post-menopausal women than in pre-menopausal. Now this correlates to women who are ER positive and obese that it increases the risks. Interestingly though it only impacts those women that are pre-menopausal. A large majority of the breast cancers are estrogen positive. Now the other fact that is being observed is that we have an adult population of obese and overweight people. This definitely impacts cancer care. Now there are more involved analysis and more to come but it does demonstrate a definite link in the pre-menopausal populace. We also know that obesity increase does increase blood estrogen levels but only in post-menopausal women. So if you weren't confused before, the waters are muddier and more study is imperative. Many of the studies did involve people of normal weight but the impact of obesity may complicate the pictures we are seeing. With bariatric surgery, we say many outcomes improve in various medical aspects. I for one will continue to follow and try to keep you updated. It is a
Well, we heard the news about 3D mammo being the best thing going, Germany beat USA in soccer but we will still be playing, we are preparing for a survey at work, and there were patients in and out for treatment and also new ones looking for answers. Those that have had questionable findings on tests and those that have had a recurrence are always the hardest as hope is a powerful thing and staying strong when you are swimming with alligators is even harder. It is not like having a baby in that there were tough parts of it but you forget or we wouldn't have the population that we have today, breast cancer diagnosis and treatment conjures up memories that many try to forget. I can honestly say that we have better treatment not only to target your specific type but also better drugs to help with any of the side effects that could give you difficulties. It is still no walk in the park and I won't pretend to say it is. I had total knee replacement 14 and 15 years ago and know that someday that I will be facing it again. I know what to expect, it doesn't make it easier.
For families and friends that are trying to shore up the holes for the patient that has a recurrence, it is hard as well. What do you say at that time when they say, it is back? I don't have a tried and true answer but I do feel if you are honest and humble and express your concern, care, and support - that is the best you can do! Reinforcing that you will be with them is also very helpful but only if you follow through. As I look at the week in the review maybe I need a bigger rear view mirror and look at the years since my cancer in review. What did I learn, what can I do for others and how do I handle each day that lies before me. People can and will say stupid things and not intentionally. When a person is so uncomfortable in any given situation, who knows what will come out of their mouth albeit well intentioned. Sometimes the patient has to understand the intention and put on their suit of armor and carry on. One well intentioned person looked at me with the saddest eyes and professed how truly sorry they were and in that moment, it caught me just the wrong way and I actually looked at them and said, I am not dying, please! In review, it may have not been my finest moment but I also knew that I had told them I need support and not sympathy.
So, take a moment and review your week and see where you are standing and where others are and
It is not something that anyone thinks about but Post Traumatic Stress Disorder can and does effect cancer patients. PTSD means that there are prolonged and severe anxiety moments that affect daily life including work and relationships. Many parts of a cancer diagnosis could possible trigger PTSD. Think about just the process of getting the diagnosis and waiting for a plan and then instituting the plan, the pain, the treatment, fear of recurrence and many other associated aspects of it. Just the physical changes of your body that remain.
There are many symptoms that can be identified as signals for PTSD including: nightmares, avoiding people and events, feeling distant or showing less interest in usual plans or even a jumpiness or irritation as well as anger and difficulty sleeping. Some patients will go as far as to refuse to follow up with doctors, appointments or follow up tests.
Some factors that increase the risk for PTSD include treatment time, pain, advance disease and other physical symptoms. Factors associated with PTSD include, less formal education, low income, female gender, little or no social support, negative perceptions and a family history of anxiety or depression and the like.
So if this has some sounds of what you are going through, there is help. Something that is not used as much now as in the past due to the availability of internet is support groups. Yes, talk it out can be very therapeutic but if you are stuck, it may mean that you need more professional help including the possible use of medications. Now that doesn't mean that you are stuck the rest of your life being medication dependent but it does mean that your car is low on oil and we need to prime the pump and that could mean some medication until we get you back on your feet. You may need an anti-depressant or even something for anxiety. Regardless of your level of need, if you feel any of these things crashing in on you or you feel stuck, please seek help. Sometimes, as the saying goes,"You can't see the forest for the trees." That means that you don't even realize you are struggling or how bad you were struggling until you are actually feeling better. There are those around you that love you and if they mention that you are not yourself on numerous occasions, stop and think... are you dealing with some lingering issues that is keeping you from enjoying our life? Make it a great day and if you need help to do that,
Well, another wonderful day in beautiful Pennsylvania, rain through the night and again this morning. The weekend is expected to be beautiful and I am holding out for the sunshine. The weekend was a busy one and I was at the Pink Days in Bloom on Saturday. It was a beautiful day and lots of fun an interesting things to do as well as bands playing and food and drink. Sunday found me at the Relay for Life and it was so great to see some old friends and former students. The dedication to the event by those touched in one way or anther by cancer, is amazing. I asked one such friend if she had been there the whole time and she said yes because cancer doesn't take a break. How true and how dedicated, my days of all-nighters is definitely passed.
Yesterday was a Monday and that is about as much as can be said about that! It was busy and I spent my time with patients that were not only dealing with cancer but personal issues as well. It is humbling to be involved and also mind awakening when people are at their worst and need your help and support. Your life may be in turmoil at any given moment but you have to be fully present when helping the patient. Just as you would expect your doctor to be so too. I was so impressed by our Doctors yesterday especially when I see the time and dedication they give to their patients. I see them meet the patient need and above and I feel that they are doing such special work and with all they have on their plates, to take the time and check on this or that member of staff that is dealing with their own issues, it is heartwarming.
I keep falling back to what my minister said a couple weeks ago in a sermon and that is, are we flourishing in life or languishing? We all have choices to make. Ever wonder how one person faces such awful circumstances and seems more together than you will ever become? The fruits of their lives help others around them, with their compassion, caring, dedication,understanding, and love...not to mention humor. It is ok to laugh, even when times are tough. So for today, seek out some random act of kindness and make it a better day for you and others and check back in when I get back to more data-based inf
The last two weeks have been crazy and my husband and myself decided we needed a little break. We took yesterday off and it was delightful. We had plans to see the Pittsburgh Pirates but the weather was more than a little iffy. We started down 79 and with the rain pouring down we trudged on but made some stops along the way to some special places and although it was not what we had planned nor did we get as far as we wanted, it was so great to just be. Yes, that is what I said, just be. It has been a long time for us to just have an open day with out commitments and appointments and kids to see and things that need done. We are always rushing from one place to another and there is always work wherever we go. We did none of that yesterday, wahoo! It was a breather that we both needed more than we realized. Yes, it seems silly to take a Thursday off and then back to work on Friday but that is just one day and then the weekend. I will admit this weekend will be busy though with Pink Days in Bloom and Relay for Life but still, all in all, we had fun. How did I forget how important that is for everyone? I used to call them mental health days. You are not sick but you need a break.
Our patients sometimes need the same kind of break be it from chemo or radiation or just appointments and they may just need that mental breather. It is important to get back to a level of functioning that allows you to move forward. For each of us that is a different break. Usually I can get to the woods and feel that as well but yesterday was just even better, as we didn't have a road to take care of, birds to feed, flowers and gardens to handle, a kitchen to clean up, laundry to do, bills to pay, groceries to get or anything that we didn't want to do. We just slowed down and took a breath. A little time and space is good for all of us regardless of what trials and tribulations we are facing. Be kind to yourself whether you are in treatment or ten years out, breathe. I
Didn't we all eat some form of red meat growing up? That was more common than having chicken or pork. Sunday was a pot roast with mashed potatoes and gravy and all the "fixins". So here comes the long term follow up that links increased risk of breast cancer due to eating red meat in early adulthood. According to a study that I just read, it stated that women that had over one serving of red meat a day had a 22% increased breast cancer risk. Just changing to poultry and vegetables made a significant impact and worthy of relooking at what we are eating in our diets. I do think that we also need to included processed red meat as well with the poultry and vegetables which is something else noted in this recent review. The more we learn the better we can be at improving our health care and long term outcomes. I often was told in various classes in high school and nurses that eat fresh, frozen and canned last and stay away from anything pre-prepared and processed. Stands true at this point but now we have the numbers and studies to back it. So how does a smoothie made with fresh fruits and greek yogurt sound to you? Filled me up and made it a great day! S
I know today I am here to talk about survivorship and there have been such wonderful, inspiring stories in the paper that I hesitated when I was reviewing in my mind what I had to say. Those patients talked about : support, faith, love, determination, strength, humor, and courage. What more could I add?
We can all talk about our journeys and that each of us has faced innumerable odds with highs and lows to get us where we are today. I am no expert by any means on how to handle what life throws at us and I stand firm in saying that I don’t believe we never get more than we can handle but there are those that support us through the tough times and help us shoulder the burdens and faith abides.
From the time we hear the “C” word, our world no longer is our own. Fear overcomes us and questions fly at us in our heads anytime, day or night. Some of our concerns we discuss and many we don’t even want to say out loud because that just might make it happen. We are now running the marathon of our lives. I often relate (during treatment) about being tired, so tired that it wasn’t that I didn’t want to breathe, I was just too tired but, breathe – I did. I made it through the tests, biopsy, surgery, chemo, radiation, the therapy that followed in the form of a pill every day for five years. I have done every check and recheck and every follow-up that is needed. I follow what I am directed to do for the most part but I am human and stray sometimes outside the bounds.
Every survivor I have ever met, asks” how do I deal with the unknown and if it will come back?’ I struggle with that as well, sometimes more than others but I live each day, every day. I work with patients every day asking the same questions, dealing with the same fears and questioning what is next. I didn’t ask why me, but why not me ? We all have problems and concerns and family and health issues and so much more to deal with and no one seems to be immune. So I got cancer, someone else had a heart attack or diabetes, or lost their job or their spouse or many, many more trials and tribulations that we all have just in this crazy game called life. The big trick is how to move forward. Survivorship is that, surviving and thriving. Do I have fears when it is time to have another test, I would be lying if I denied it. It is not something that I burden others with, as we have all been there and done that and heard it before. I do have a friend that has stuck by me through thick and thin and I can verbalize that today is my test day and she gets it. Not saying that I don’t have the most supportive husband in the world, the answer to that is that we have been married thirty years and he deserves a medal for honor and duty above all expectations. His concept of what is going on, is just that-his concept. It makes me think of how differently men and women communicate and just having cancer does not change that. Every day that I am working I see other warriors/ heroes that are facing their own battles with cancer and some of them are breast cancer and many more with various other cancers. Talk about the great leveler! You know the saying that it could be worse? Well I see better and worse each day and I see the strength of each individual whether they are angry or sad or laughing or being quiet, they are facing their survivorship in their way. I am not one to say that it is right or wrong. I do believe that a person has to hold onto being positive and to find humor wherever they can. I laugh because it is better than crying. I look for those moments that we can share as you are getting your treatment. I listen to your concerns. I do what I would want someone to do for me if I am in that situation of dealing with cancer ever again. I do believe that having worked hospice years ago, laid the groundwork for what I think and do today. I do believe that we have to find moments to celebrate each and every day. I know of ladies that had hair cutting and hat parties when they were losing their hair. I have heard of picnics on the patient’s bed so that they could celebrate the day. I have seen patients watch really silly movies during treatment or those that listen to music reflectively and those that talk non-stop and those that curl up in their prayer shawl or lap robe and close their eyes and sleep to get past the difficulties of the day.
Forty six years ago I started my paid career in medicine as a nurse’s aide and I recall the day that an older patient was in his bed and rang his bell and asked me to sit with him while he smoked (yes, you could smoke in the hospital in those days) and he asked me to smoke with him. I could hardly refuse as I knew his time was ending. He lit both cigarettes and gave me one. I looked at it and pondered what to do when he took several puffs, coughed and died. Needless to say, that is an impression that has lived with me throughout my career and you might say how appalling to be smoking at the end of your life especially since that was what had gotten you to where you are at that point, but I look at it as his choice of how he wanted to have his remaining time spent.
I have chosen to move ahead, be happy, try to leave things better than I found them, help others , do random acts of kindness, treat others as I would want to be treated and to enjoy what I am, who I am, and where I am going. Survivorship is a word that means so many different things to so many different people and your definition may even change as you go through the different phases of your life. I think we all hope for grace and love and happiness and a quality of life that brings peace. As I get older, I appreciate the selflessness and compassion of the patients that I have a privilege to know and work with and hope that I have learned more from their lives and examples and the goodness of humanity than any text could provide. Yes, I am a survivor, aren’t we all?
Today, nearly 14 million people are living with cancer or have survived the disease! Cancer touches each and every one of us. Our families, friends, acquaintances, co-workers, peers, and even our pets are dealing with cancer. Cancer takes time and energy and support. I hope you can lend your help to those that are in need during these critical times. Cancer changes each and every one of us as we look to our own mortality and what we want and how we want to face our futures.
We need African immigrant and African-American women, age 45 or older, ANYWHERE in the United States, to participate in a study that is exploring whether race, ethnicity or cultural and lifestyle differences affect breast density. We have recruited for this study in the past but the research team still needs more women to sign up!
Studies have shown that women who have dense breast tissue (the non-fatty portion of breast tissue, which appears white on a mammogram) are 2 to 4 times more likely to be diagnosed with breast cancer than those with less dense breast tissue. A woman’s breast density is influenced by her genetics, but it is has also been shown to be influenced by non-genetic and environmental factors. A research team at Columbia University in New York, NY, wants to study mammograms from African immigrant and African-American women to learn more about their specific breast density patterns. In research studies, African immigrants are often categorized together with African-American women. Yet African immigrants may have certain cultural and lifestyle factors that affect their breast density and breast cancer risk.
Please read on to learn more about what is involved and who can participate. If this study isn’t right for you, please pass it on to African immigrant and African-American women you know!
What's the study about?
The purpose of this study is to examine the patterns of breast density (the non-fatty portion of breast tissue) among African immigrant and African-American women living in the United States, and to find out factors that affect the amount of breast density in women.
The researchers need to enroll 300 women to participate in this study.
If you sign up for the study “Breast Density Patterns in African Immigrants and African American Women,” the research team will contact you to confirm that you are eligible. If you are eligible and choose to participate, you will be asked to do the following:
• Sign the consent form.
• Complete a questionnaire (either on-line or over the phone).
• Request recent copies of mammograms from your healthcare provider and mail them to the research team (at no cost to you). If you prefer, you can sign a medical release form to allow the research team to request your mammograms on your behalf.
Who is conducting the study?
Tomi Akinyemiju, PhD, Columbia University. New York, NY
Anywhere in the United States
Who can participate?
You can join the “Breast Density Patterns in African Immigrants and African American Women” study if you match ALL of these MAIN categories:
• You are a first or second generation African woman OR an African-American woman
o First generation African women: women who were born in Africa and currently reside in the US.
o Second generation African women: women who were born in the US to at least one African-born parent, and currently reside in the US.
o African-American women: women who were born in the US or to US-born parents, and currently reside in the US.
• You are age 45 or older.
• You have had at least one prior mammogram or plan to have a mammogram in the next six months.
• You are able to complete an interview, either on-line or over the phone.
• You are willing to request your mammograms from your healthcare provider or provide consent for research staff to request them on your behalf.
After you RSVP the research team will ask you additional questions to be sure that this study is a right fit for you.
Yes, Sign Me Up
Recruit a Friend
How often do you run through your facebook page and you find words of wisdom that apply to you but also there are times that it fits others? Often you share as you feel that it is of value to someone else. Sometimes others words, tell exactly what you are thinking. I found several such verses this weekend and I shared it. The amazing thing was how many comments I got that were thanking me for posting it, or I needed to hear that, or AMEN! Often we think we are totally alone in our trials and tribulations and can be pulled steadily downward by the thoughts that push through. It is hard to share some of those thoughts as you may feel it is only you or that it is just too private to share.
One such saying that passed through my fingers to share was one that really impacted my thought processes.
It goes like this: It's hard to explain to someone who has no clue. It's a daily struggle being in pain or feeling sick on the inside while you look fine on the outside. Please share this message on your facebook wall if you, or someone you know, has an invisible illness: Crohn's disease, PTSD, Anxiety, Depression, Fibromyalgia, Bipolar, Lupus, MS, ME, Arthritis, Cancer, Heart Disease, Epilepsy, Muscular Dystrohy, Autism, etc.
NEVER JUDGE WHAT YOU DON"T UNDERSTAND.
I want to reiterate, I did not write this but found it on facebook but I am sending it on today as I think there is a lesson to be learned for all of us. We should never judge the book by it's cover as we never know what is on the inside even after reading the words. We all carry many things inside that few if any will ever know and then there are those things that are known but since it looks ok on the outside, we think (Hope that it is ok or getting better on the inside). Many are walking a difficult walk and there is no right or wrong way to do it, it is just how you yourself can handle it. The fact that you are dealing with it, makes you my heroes.
I hope by passing this on, it will make it a better day!
In a recent article in ONCOLOGY TIMES by Sarah DIGUILO, it talks about the three new guidelines to be included in a survivorship careplan. ASCO as previously mentioned in other articles is THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY. The three topics listed were at the top of the list in developing a survivorship careplan. Fatigue should be assessed at time of diagnosis forward, including completion of primary treatment and then as indicated clinically and at least yearly. This recommendation also talks about the need to educate the patient and also to look at causes and contributing factors as well as recommending exercise to help treat fatigue.
Another of the recommendations is to look at chemotherapy-Induced Peripheral Neuropathy. There are certain agents that may be recommended to help patients undergoing treatment. The third guideline looks at Anxiety and depression. All patients should be assessed for these as well as education and strategies on how to deal with these issues. There should also be follow-up in the referrals and a look at compliance in the case of the recommendations that the patient received.
Most patients are referred from surgeons to medical oncologists but I can truthfully say that I see great benefit in seeing your oncologist before any intervention is started. It always helps to get all the cards on the table and to make informed choices. Communication is of utmost importance between the oncologist and your primary care physician as well as there should be no room for anything to fall through the cracks. The more we work towards a plan for survivorship the better we will be to meet the patient needs and the more we will learn in what it will take to keep the patient at their optimal level. So talk to your physician and oncologist about what your needs are and about your survivorship plan and Happy Survivor Day today!
What a great day to be alive! S
Disclaimer: This website is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of any medical institution.