Wednesday, December 29, 2010

Top Twelve

A lot of bloggers are posting their favorite top ten-ish posts of the year, so I thought I'd go along and do it, too. Well, there are twelve.

First Mammogram Since Surgery The machine is hard: metal and plastic. My breasts, my body, are soft. The technician keeps telling me to relax.

Poem One day I am a person | The next day | After knowing fingers find a | Lump |I am a patient.

Spring Children run and shout| Like convicts escaped |Throw balls | Ride bikes |Grow in the sunshine

Breast MRI Fun at the Hospital "There is no graceful way to do this," admits the technician. She indicates that you should climb onto the table. "Your breasts go here, and your face goes here."Say what?

Don't chew on your mama's tefillin Two poems (not mine) about different women's experience of Judaism, juxtaposed

Incidentaloma There is a new terminology out there -- incidentalomas -- for things that are discovered accidentally during a test for something else.

High holiday wandering My earliest high holiday memory involves big white tents.

The story of a man This is the story of a man I know.

Puberty, pimples, and cups J recently turned 11, and at his yearly physical shortly after his birthday, the pediatrician opened up a discussion about puberty.

On breast cancer (a version of which was printed in our local paper) There is strong, growing scientific evidence that the cause of breast cancer is environmental, i.e. chemicals in our food, water, air, and soil.

Friends in cyberspace And sometimes, people you know only from cyberspace die.

Oy, Chanukah (a version of which was posted in the OnBeing Blog) What does it mean to be Jewish during a prolonged, public, and pervasive holiday season?

And here are some other bloggers' top posts: the Velveteen Rabbi's top 12; Scary's Mommy's top 12 (and others posted in the comments section): top White House food stories of 2010; I'll add more as I find them. Enjoy!

Tuesday, December 21, 2010

Entering data

I'm at work, entering data into an Access database. It's not very difficult, and it can be a bit soothing to enter data. I don't have to think too much. But entering this data always gives me pause. I'm entering the data that represents a child, a child who progressively became sicker and sicker, and ultimately -- always -- died at the end. Entering this data makes me feel... strange. Sad. Grateful that I have a healthy child. Sad for the families that have to go through this. Amazed and so appreciative of the folks who work in this field and do this work every day.

Even after four years, it's hard for me to talk about the study I'm working on. Improving end-of- life care in the pediatric ICU. The study is about making the end-of-life experience better for very sick kids and their families. True, this is a very small minority of kids. Most kids get sick, and get better. But some kids -- 55,000 a year in the U.S. -- don't. And most of these kids die in the PICU. So here I am.

I start out typing in very basic information. The child's date of birth. The date they entered the hospital. The day and time of their first vital signs. Often, these children are very young. Often, they enter the hospital soon after birth. These are the kids with very serious birth defects: problems with the heart, with the digestive system. Sadly, some of them never get to see the world outside the hospital. This is where you start to think about quality of life, for the child, for the parents. Does it make sense to keep them alive for a few months in the hospital, only to die a few months later? Is a few months of life worth the pain and discomfort that the baby experienced? The parents? No easy answers.

The next page has information about the diagnosis. Often I don't understand these, but sometimes I do. Kids in the PICU tend to have serious diseases. Usually chronic diseases. Cancers, genetic issues, cystic fibrosis, muscular dystrophy. Occasionally, there is something acute, like a car accident, a drowning, being hit on the head.

Next page is about the involvement of different care givers, such as social workers, chaplains, and so forth. Most of the time, there is support offered by some of these services to the child and the family. This seems like a good thing to me. After that, there is a chart that lists the different family conferences that took place. These are interesting because they tend to follow a progression: at first, the family and the doctors discuss the prognosis, and decide to continue supportive care. The next day, they consider withdrawing or withholding treatment. And finally, they decide to withdraw or withhold. One thing that I've learned from working on this project is that the acceptance of a child's death is a process. Parents need to see that everything that can be done, has been done, and if they see that and see that their child is still not improving, then they can start to consider the end.

The next pages deal with all the possible interventions that a child can have in the PICU, from differing types of feeding, hydration, medications to bring up the blood pressure, different types of mechanical ventilation, and different medications that relieve a child of pain. It's interesting to see that, again, this tends to follow a pattern. The child often receives lots of interventions at first, and as the days go by, they tend to drop off.

There is a question called "ability to communicate" and most of the time, the child in the PICU is comatose. At least they aren't aware of what is going on. Most of the time, they aren't feeling pain at all, either.

The final page describes the child's death. Who was with them, was there an autopsy, was there a decision for the child to be considered as an organ donor, did the donation actually happen? And that's it. The chart abstraction is over.

Another child has died. Another family is crushed. I exit out of the chart. And sigh.

Monday, December 20, 2010

What I don't like about winter

  1. My hands are SO DRY right now that there is actually a crack in my right thumb (and it hurts)
  2. Having to put on a scarf, long coat, and gloves every time I go anywhere
  3. Cannot find the ice scraper
  4. Have lots of gloves and mittens without mates -- for some reason, only the left ones remain
  5. It gets dark at 4 pm
  6. I'm sleepy by 7 pm
  7. It's really dark in the morning, too
  8. The first official day of winter is TOMORROW
  9. At least 3 more months of this?!?!?!
  10. Why do I live in New England anyway? Oh, yeah: the change of seasons is so beautiful...

Friday, December 10, 2010

It keeps changing

Let's review.

During the summer of 2009, my onc suggested/recommended/insisted that I switch antidepressants because there was some research that showed that the type of antidepressant I was taking might affect the functioning of the Tamoxifen, which is supposed to prevent cancer from coming back. Here's a post I wrote about that.

So I tried several of the antidepressants that were supposed to be better for women on Tamoxifen, and none of them worked. In fact, about a year ago, I was feeling pretty crappy. Here's a post I wrote at that time.

Ultimately, I got off the new antidepressant, off the ovarian suppression study, and back onto my old antidepressant (that I know works for me). Here's a link to that post.

I thought I wrote more about it on the blog, but I guess I didn't. During that time, I read a whole lot of research about the connection between Tamoxifen and something called CYP2D6, which is an enzyme in your liver. Supposedly some people metabolize Tamoxifen differently, and this can impact how well the Tamox works to prevent future cancers. Some women took this research to heart, and had the CYP2D6 test and based their decision whether to take Tamox or not on that result. My onc wasn't convinced, so I didn't have that test. That was fine with me, because I wasn't convinced either.

Then, someone looked at antidepressants, which also are affected by the CYP2D6 enzyme in the liver, and decided to look at whether women who take certain antidepressants and Tamoxifen are more likely to have a recurrence. However, reading the research, I wasn't convinced. They were using data sets from health care corporations, with records based on women filling their prescriptions.

I looked at everything I could get my hands on, and decided, based on what I read and how I felt that I had to have good quality of life, and that was more important than a possibly reduction in efficacy of the Tamox.

So today, here's some news from a large breast cancer research conference (the San Antonio Breast Cancer Symposium):
The CYP2D6 test, also called the “tamoxifen resistance” test examines a gene called 2D6, which produces the enzyme CYP2D6. This enzyme is necessary for the body to metabolize a number of drugs, including tamoxifen. Tamoxifen has to be metabolized to endoxifen in order to work. This is done in the body by enzymes. Some people have variations in these genes that result in them making less endoxifen, and there has been some data suggesting that these people don’t do as well when they take tamoxifen. This was noted at the 2007 San Antonio Breast Cancer Symposium, when researchers presented data that showed that women who inherited a certain variation of the 2D6 gene were almost twice as likely to have their breast cancer recur, even though they were more likely to complete their tamoxifen treatment.

To explore this question further, researchers took advantage of two large studies that were done to look at the benefit of tamoxifen versus an aromatase inhibitor (which is metabolized differently, and is not affected by CYP2D6). Their findings refuted the previous data, showing that the presence of common mutations in the genes that control the enzymes that metabolize tamoxifen did not have an effect on whether women were likely to have a recurrence. They also found that antidepressants that are thought to inhibit CYP2D6 actually had no effect on whether women taking tamoxifen had a recurrence. In sum, the researchers concluded that for postmenopausal patients with hormone-sensitive early breast cancer, CYP2D6 testing is not justified to determine whether to give tamoxifen. They also found that, in contrast to what has been suggested, the presence or absence of hot flashes should not be used as an indicator of whether tamoxifen is effective. (link back to original article by Dr. Susan Love)

So, as usual, I'm both relieved, and angry. Relieved because I really didn't believe the initial research that showed that the antidepressants impacted the Tamoxifen. Angry because lots of women went ahead and changed their antidepressant because of this research. Also, some women took the CYP2D6 test to see how they "metabolized" Tamoxifen and made treatment decisions based on this test. So now what do they do?

This breast cancer business is a moving target. You try to make decisions based on the latest information, but next year, it might change. Argh!

Discontented

This was the Chanukah of J's discontent (apologies to Shakespeare and to Steinbeck).

I'm not kidding. The kid really wasn't happy this year.

Here's the back-story. J received an X-Box 360 (a video game system) recently as a joint birthday/Chanukah gift from his grandma. He also purchased a bunch of games that he wanted to go along with it (sports, only sports). He really doesn't need anything else.

So for Chanukah this year, we gave him the following: a t-shirt with a cute basketball saying; note cards with a cute basketball saying (okay, I know not very kid-friendly, but he needed note cards for thank you notes); a year-long membership to X-box Live; a year-long subscription to Sports Illustrated Kids; a Needham duffle bag filled with a Nike hoody and athletic pants (he liked those gifts a lot); Celtics sweat pants; an iTunes gift card; and a photo book I'd made of this birthday party this year. I also attempted to buy him a Snuggie but I bought the wrong size and had to return it, and I attempted to buy him a Miami Heat calendar (he loves the Heat) but it didn't have the Big Three in it, so that didn't work out either.

Not so bad, right?

Wrong. Terrible.

What he wanted was: a cell phone, an HD TV for his X-Box that lives in the basement, a Kinect for his X-Box, another expensive Celtics or Heat shirt (he already has MANY)....he just "wanted something good" (spoken in very whiny, privileged tone of voice). What we gave him "wasn't good."

Also, according to J, "Chanukah this year wasn't as fun as it used to be." It wasn't exciting. Lighting the candles wasn't exciting. Singing the songs wasn't exciting. The presents weren't exciting.

Sigh.

Welcome to the real world, kid.

Tuesday, November 30, 2010

Oy, Chanukah

Chanukah begins on Wednesday night this year. Tomorrow night. December first. Yes, it is confusing. Even we Jews are confused. Why – everyone is wondering -- does Chanukah coincide with Christmas some years, and other years, Chanukah arrives weeks before?

The answer is that the Jewish calendar is different from the secular calendar. The Jewish calendar is lunar, and the secular calendar is solar. Since each Jewish month is only 28 days long, and the secular months are 30 or 31 days long, after a few years, the Jewish calendar and the secular calendar become out of sync. The Jewish calendar corrects this by actually adding an extra month every few years in order to get things back to normal. This spring, there will be an extra Jewish month (Adar II) added, and by next Chanukah, Christmas and Chanukah will coincide once more.

But I’m getting ahead of myself.

Chanukah is really a very minor holiday in the Jewish year. The Jewish holy days of Rosh Hashanah, Yom Kippur, and Passover are much more important than Chanukah. But due to its (sometimes) proximity to Christmas, Chanukah has become much more important than it was originally intended to be, especially in the U.S. And then, of course, there are the presents. Eight nights of presents.

Growing up in a mostly Catholic neighborhood, the only way my parents could convince us that celebrating Chanukah was a good thing compared to our neighbors’ exciting Christmas celebrations was by giving us eight presents: one for each night of Chanukah. Yes, our neighbors had the Christmas tree. Yes, they had Santa Claus. Yes, they hung stockings by the fire with care. Yes, they had Christmas carols. Yes, they had the beautiful decorative lights hung on the bushes and trees. But we had eight nights of presents.

In general, Chanukah traditions are much simpler than Christmas traditions. You light the Chanukah menorah. You sing some songs. You spin the dreidle (a special top). You eat chocolate gelt (coins). You eat potato latkes (pancakes). You get some presents. You give some presents. Repeat for eight nights. End of story.

Christmas traditions seem much more complicated and stressful to me. Procuring, transporting and putting up a live tree in your living-room. Decorating the house, inside and out. Buying expensive presents for everyone in your family. Cooking a special Christmas meal. Traveling to be with family. The whole Santa Claus thing.

On the other hand, Christmas takes up a huge chunk of space in the American consciousness. It’s really really hard to be left out of the Christmas festivities when all the radio stations are playing Christmas music, everyone other TV show is about Christmas, houses are decorated with Christmas lights, every store is loaded with Christmas paraphernalia of all kinds, everyone wishes you Merry Christmas, etc. As a child, I really really really wanted to celebrate Christmas. In spite of the eight nights of presents. I wanted a tree. I wanted a stocking. I wanted Santa. I wanted all of it.

Now that years have passed and I have a child of my own, I think things are somewhat better in our multi-cultural, pluralistic, internet-connected world. My son is interested in Christmas, but he doesn’t seem quite as jealous as I remember feeling growing up. We generally celebrate Christmas with a close family friend, and after decorating her tree and exchanging presents, he seems to have had enough of Christmas for one year.

But the “December dilemma” remains. What does it mean to be Jewish during a prolonged, public, and pervasive holiday season? It becomes even more complicated for interfaith couples, now a large proportion of Jewish families. Do they buy a Christmas tree even though they are also celebrating Chanukah? Do Christmas ham and potato latkes go together? Can Santa visit as well as Judah Maccabee?

I’m not sure if we will ever solve the “December dilemma” here in the U.S. Meanwhile, I’ll sing along to Christmas carols on the radio, enjoy the pretty lights around town, wish my neighbors Merry Christmas, light the candles, spin the dreidle, eat latkes, and hope that the next generation does it even better.

P.S. I'm happy to announce that this post was published last week in the "Being" blog, which was the inspiration for it being written in the first place.

Sunday, November 21, 2010

Chemicals are in us

I recently became aware of a podcast series put out by the friendly folks at Environmental Health Perspectives (a monthly journal of peer-reviewed research and news on the impact of the environment on human health, published by the National Institute of Environmental Health Sciences). I started listening to some of these podcasts today. Very. Scary. Stuff.

Here is one about long-term effects of in utero exposure to BPA. A quote from the scientist who was interviewed:
NEWBOLD: BPA is still a compound that we just don’t know that much about, and we really need to be concerned about this, because we know from studies from the CDC that over 90% of the population actually has been exposed to BPA because we’re picking it up in the urine. We also know that it’s in a lot of different plastics, so the potential for exposure is quite high. So we need to know the long-term effects—if there are truly any adverse effects. And right now the animal studies are leaning toward that direction.
Here is one on flame retardants, know as PDBEs

AHEARN: So they’re in almost 100% of Americans. How did they get there? How did they get into our bodies?

STAPLETON: That’s a big area of research that scientists are still trying to understand. We know for a fact that PBDEs are ubiquitous. They are found in a lot of our food products. They’re found in the air in our home. They’re found in the dusts in our home at fairly high levels relative to levels in the outdoor environment. There is definitely an exposure pathway from the presence of these products in our home and through our diet. Research definitely shows we’re getting exposure from both avenues.

Here's a third podcast, on breast milk:

Ernie Hood: Dr. Goldman, what do you recommend that we do to make human milk even safer than it is today? Are there actions on a macro level that we can take to reduce the presence of these contaminants we’ve been discussing?

Dr. Goldman: Yes, I think so. I think on a macro level, what we need to do is develop policies where we are much more vigilant about avoiding the use of persistent chemicals and pesticides. We do not want to have anything that’s persistent and going to build up in the environment or in our bodies in our food supply, in the air we breathe, in the water we drink. Because we’ve learned over and over and over again that these persistent substances, if they do have adverse health effects, then over time there’s very little we can do about them. So, many of the chemicals that are found in human milk are no longer used today. Many of them were banned as much as 20 or 30 years ago and yet we still find them. And yet when these chemicals are persistent we can’t simply dial down the exposure levels, because some of them have half-lives that last many, many years.

Um...yup. That's the problem in a nutshell.

Thursday, November 18, 2010

Chanukah mood

Thanksgiving is still a week away, and Chanukah comes shortly after, on December 1st. I'm trying to find that Chanukah spirit, so I'm turning to the internets for a little inspiration...

The candles sing Mi Y'Malel (interactive: click on the candles and see what happens!)

Hanukkah Hey Ya!

Hanukkah Hey Ya! Flash Mob (from last year, still great!)

John Stewart's Can I Interest You in Chanukah?

A Jewish Christmas Rap

A very young Adam Singer sings the Chanukah Song

Wednesday, November 17, 2010

Onc appt @ noon

The sun is shining, and the birds are chirping, and the squirrels are busily searching for things to eat, and the day is unusually warm for November...and I have an oncologist appointment at noon. I am inexplicably sad about it. There is really nothing to fear. It's just a check-in. We'll exchange pleasantries, and she'll ask me how I'm doing. I'll tell her I'm doing just fine now that I'm off the study drug and the sleeping pills, and now that I don't have hot flashes and can sleep. I'll tell her that my periods finally came back. Not sure how she'll take that news. And she'll do a physical exam, and all will be well. But I still don't like going. It reminds me of everything that happened, and even though I feel like I'm pretty much past that now...it's still there. And I keep hearing about women being diagnosed with breast cancer, women having recurrences of their cancer, women with stage IV cancer, women dying of cancer. And I'm still scared. And angry.

Tuesday, November 16, 2010

Published!

I'm proud to announce that an article I wrote on the connections between breast cancer and the environment, similar to something I posted here on the blog in October, appeared in our local newspaper last week. If you'd like to take a look, here it is.

I'm pretty happy with the article, and I've received some nice feedback on it. Many people are surprised to learn that breast cancer has anything to do with the environment. I'm always surprised to learn that people are surprised: it seems so obvious to me. Clearly, there is still a lot of work to be done.

Tuesday, November 02, 2010

Still here

So we made it through October. Breast cancer awareness month is over.

(Deep sigh of relief.)

Football players wore pink gloves; the White House was lit up in pink light, as were the walls in Jerusalem. Yogurt lids were pink, and just about everything else you could imagine was pink.

But breast cancer is still here.

A cousin's sister was recently diagnosed with breast cancer. A friend who is a breast cancer survivor recently experienced a scare when a breast MRI showed something, leading to ultrasound and biopsy. Turned out to be only scar tissue, but scared my friend to death. RivkA, of Coffee and Chemo, died a few days ago. She lived with breast cancer for 5 years. 1,000 people attended her funeral in Israel.

Meanwhile, today is election day, and the politicians continue to be jerks. There is no intelligent discourse. Just sound bites and accusations and yelling.

It seems like more attention in general is being paid to the connections between breast cancer and the environment, but I'm not sure if anything substantive is being done.

There is legislation -- for example, the Toxic Chemicals Safety Act of 2010 -- which basically just asks companies to test their chemicals before releasing them into the world. Although I just read that this act is dead now. Too bad, maybe next year.

This time of year makes me feel a little sad. I'm still sad that the summer is over (!) and I still haven't accepted that winter is coming. Not my favorite time of year, although it has been a pretty fall.

P.S. Damn! I just realized that November is NaBloPoMo! (national blog posting month) I'm supposed to be doing a post a day! Argh!

Friday, October 29, 2010

Friends in cyberspace

The internet is a funny place. Some of the relationships you have are with people you actually know in real life, and some are with people you only know in cyberspace. Sometimes you get to know people pretty well in cyberspace, especially if they write frequently in their blog. And sometimes, people you know only from cyberspace die. And it is really, really sad, even though you have never actually met them in person.

RivkA was one of those people.

I follow a number of "Jewish" blogs of various types, and one of them is called A Mother In Israel. When that blogger read about my struggles with breast cancer, she connected me with RivkA. I've been reading her blog for several years now, and was always amazed at her energy and ability to live fully in each moment, even while dealing with her serious and ultimately, fatal breast cancer.

An example of that is a post here from her blog from just a month ago:
Last week, for the first time, I had such a difficult time teaching swimming that I wondered if I would be able to continue. Given how weak I felt, I did not know until this morning if I would be up for teaching today. Even if I could manage to teach, I worried that it would take everything out of me and leave me like a rag again.

In the end, I felt OK, so I decided to teach, and I am so glad!

I had amazing classes!!

My beginners all accomplished a new step forward and we were all so excited!

My advanced swimmers worked hard and had a very productive lesson as well.

Of course I felt tired afterwards, but I also felt great!

I love teaching and days like today make all the efforts worthwhile!!
RivkA leaves a husband and 3 teen-aged children. Breast cancer is not fair. Some people do fine, and others die.

I remember when I first started reading RivkA's blog, in spite of her optimism, I realized that this brave person would likely not make it. Her cancer was spreading. She had some time, but not a lifetime.

Hearing of her death makes me renew my commitment to work to end this disease. To figure out how to prevent breast cancer before it begins, so other families will not have to suffer the way RivkA's family surely is.

May her memory be for a blessing.


Monday, October 18, 2010

Confusing

As much as I'm all for understanding environmental exposures and their connections to breast cancer and other cancers (and other diseases), I'm not entirely comfortable with the idea that we personally can avoid this and that product, and somehow save ourselves and our family from cancer. I just don't buy it.

My feeling is that the chemicals that are causing the problem are so ubiquitous that we really can't avoid them. These chemicals are in the soil and water, in our homes, and even in our bodies (even the President's Cancer Panel Report admits that "babies are born pre-polluted"). I don't think that making small changes in our lifestyles will really make a difference. But others feel differently. They feel that by eating organic food, avoiding microwaving in plastic, using natural cosmetics, etc., that they are at least doing something.

So I received this email today:

Dear Adena,

What's orange, yellow, and pink all over? The month of October! Fall's here with orange pumpkins, yellow leaves-- and the "think pink" campaign of Breast Cancer Awareness Month. Everything is adorned with pink ribbons, from yogurt cups to NFL football helmets. But our friends at the Breast Cancer Fund know that it's not enough to just be aware of breast cancer. We need to start preventing this disease and protect our families from cancer!

Please join MomsRising and the Breast Cancer Fund for a free and important webinar briefing to learn about practical ways to protect your family from cancer causing toxins. We’ll talk about how parents can make safer purchases and choices for their families and participate in a larger movement to protect children from toxic exposures.
This hour-long, web-based presentation, based on the Breast Cancer Fund’s report "2010 State of the Evidence: The Connection between Breast Cancer and the Environment," will emphasize the newest science connecting exposure to unsafe chemicals and radiation to increased risk of breast cancer. This important report catalogues the growing evidence linking breast cancer to, among other factors, synthetic hormones in cosmetics and meat; pesticides in food; solvents in household cleaning products; BPA in food containers; flame retardants in furniture; and radiation from medical treatments. We know exposures early in life are linked to breast cancer later in life and other health concerns, which means it’s especially important to protect children from environmental chemicals and radiation.
See what I mean? I agree with them up to a point, but then, I don't agree with the idea that we have the ability to "protect our children from environmental chemicals and radiation." I just don't think we are that powerful. I think much bigger changes -- in manufacturing practices, in lawn care practices, and so on -- will be needed to really change things. Sorry, I don't mean to be a downer, but that's how I feel.

Friday, October 01, 2010

On breast cancer

Well, it's October 1st. It's national "pay attention to breast cancer" month. I'm not really happy with the pink nausea, everyone telling you to buy this yogurt or that pair of jeans and the company will donate 10 cents to this fund or that fund... But, regardless of my feelings, here we are.

Here are some things that I feel are important:

There is strong, growing scientific evidence that the cause of breast cancer is environmental, i.e. chemicals in our food, water, air, and soil. You can see some of this evidence in the Breast Cancer Fund's report The State of the Evidence 2010. Another important source of information is the President's Cancer Panel's recent report, Reducing Environmental Cancer Risk: What We Can Do Now. Also, be sure to read the Silent Spring Institute's fact sheet on breast cancer and the environment. The point is to figure out how to prevent breast cancer before it begins. Mammograms can (sometimes) find breast cancer once it's already there - improved treatments are great for those who are already diagnosed - we want to prevent breast cancer before it even starts!

The Love/Avon Army of Women is a wonderful group put together by Dr. Susan Love, a leader in the breast cancer arena. The "army" is aiming to recruit 1 million American women who are available to take part in numerous research studies, with the goal of preventing breast cancer. You can easily join the Army of Women by clicking here.

Another wonderful organization, if you are local to Massachusetts (or even if you are not) is the Massachusetts Breast Cancer Coalition (MBCC). I recently joined the board of this organization, which is dedicated to challenging all obstacles to the eradication of breast cancer... and believes that compelling research exists linking environmental toxins to the dramatic rise in breast cancer incidence over the past several decades. The MBCC started an amazing research organization called the Silent Spring Institute, which does research on the links between the environment and breast cancer. Currently, the MBCC does education and outreach to spread the word about breast cancer/environment links. You can read more about their work here.

There are a few other great organizations worth mentioning. These include Breast Cancer Action, an agency on the West Coast that challenges assumptions about breast cancer, and which created ThinkBeforeYouPink. There is also the National Breast Cancer Coalition that has just set a 10-year "deadline" to end breast cancer, and which has an interesting white paper laying out the reality of the situation: Despite years of campaigns to raise awareness, ever expanding screening programs, and increased fund raising and research, breast cancer incidence has increased and mortality has not changed dramatically. It is time for a radically new approach.

For breast cancer information, BreastCancer.org is a wonderful resource, and the discussion boards there are particularly amazing and supportive. For people under 40 with cancer, I2Y (the I'm Too Young for This Cancer Foundation) is fantastic, and they have a weekly radio show/podcast called The Stupid Cancer Show, which I love. I also love anyone who writes truthfully and irreverently about breast cancer. For example, author Barbara has a great post entitled Not So Pretty in Pink.

The bottom line is, women are still dying from breast cancer. It's not okay. I follow the blogs of women whose breast cancers are not going away, such as Coffee and Chemo, and Mothers With Cancer. These women are just trying to live their lives as mothers, wives, friends, workers, people, and they have to battle cancer as well. This is not okay.

We can do something. Click on the links. Learn more about the environmental causes of breast cancer. Join the Army of Women. Give to some of these fine organizations. Do something. Don't give up. And don't give in to the pink.

Tuesday, September 28, 2010

The story of a man

This is the story of a man I know. This man is over 50, and has been receiving PSA (prostate specific androgen) tests for the past few years, as do many men over 50. PSA tests are controversial because an increase in PSA doesn't necessarily mean that something is wrong. It's a screening test. And as we know, screening tests are often problematic (see: mammograms).

So about a month ago, this man came home from the doctor and said: my PSA is higher than it was last time, the doctor wants me to go to a urologist for follow up.

Fine.

So this man goes to the urologist for follow up, and the urologist does a DRE (digital rectal exam) and says, hmm, your prostate is possibly enlarged, but I don't really feel anything abnormal, but I think we should do an ultrasound of your prostate and possibly a biopsy.

The man schedules the ultrasound and biopsy for 2 months in the future.

The man thinks about this, and it starts to drive him crazy. So he decides to reschedule the procedure to one month in the future.

And then he tries to forget about it.

Life goes on, the summer ends, school begins, the holidays come, and now it's time for the procedure.

The man has to do some unpleasant things in preparation for the procedure, but he does them, and goes in for the ultrasound and biopsy. The urologist does the ultrasound, says he doesn't really see anything untoward, but does the prostate biopsy anyway. Twelve tiny samples.

The urologist says the results will be back in a week.

The man waits.

Now, there is a large gap between "you have an elevated PSA level" and "you have cancer," but to the man and his family, this gap was getting smaller by the day.

There were really only 2 possible options: "you have prostate cancer," or "you don't have prostate cancer."

The man's wife works in the health field and keeps looking at articles online. This just isn't right, she complains. It says that if you have a PSA increase, that it could be due to something else. It could be a false positive. It says to follow up with DRE. If that is troublesome, you then go to ultrasound. If that is troublesome, you then go to biopsy. Why did they go straight to biopsy?

The man didn't know, and told his wife that he didn't really want to talk about it until he got the results of the biopsy.

So they waited.

And waited.

They kept thinking about the worst, and the best, and everything in between.

And they waited.

And suddenly, out of the blue, the urologist called the man one afternoon and said: there is no cancer. And the man called his wife, and said: there is no cancer. And they were very very happy.

But the man's wife was still angry. Happy, but angry.

And this is not the end of the story.

P.S. I keep finding more and more articles about cancer screening and how tricky it is. Take a look here and here.

Monday, September 27, 2010

Turning pink

I first realized that it was coming while perusing the yogurt section of our local grocery story recently. I suddenly realized that almost all of the yogurt containers had turned pink... see here and here for some examples (cups of hope? really?).

Next, the town newspaper promises to actually turn pink for the month of October. Yes, they will print the newspaper on pink paper. Not only is it difficult to read -- it looks terrible.

Little pink ribbons are fluttering around like tiny pink birds...

Yes, my friends, Breast Cancer Awareness Month - PINK month - is upon us.

Oh, I really do not like pink.

ThinkBeforeYouPink.Com helps explain why.

You know, breast cancer is something that happened to me. I'm really not very happy about it. I don't feel it was due to something I did or didn't do. I truly believe that estrogen-like chemicals in the environment that I was exposed to as a child and probably as an adult led to the overgrowth of cells in my breast that was cancer.

Breast cancer -- any cancer -- is a horrible disease. Half of all Americans will experience it in their lifetime.

I don't want to see companies touting products and acting like they really care, when all they are trying to do is make money. I don't want to hear any more sob stories, and how "cancer made me stronger." I don't want to hear it.

I want to hear about prevention. And I want to hear about it NOW.

Friday, September 17, 2010

Making nothing into something

Yesterday, I read the Jewish Advocate (Boston's local Jewish paper), as I do every Thursday, and I was puzzled to read an article about some middle school students from Wellesley who visited the Islamic Center in Roxbury who apparently bowed during the prayer services. They bowed during prayer services. This is news?

You can imagine my surprise this morning when I opened up the Boston Globe and there, on the front page of the Metro section, was a similar article.

Talk about making nothing into something.

The article in the Jewish Advocate was somewhat different from the article in the Globe, however. In the Advocate, it stated that some of the boys bowed down to the floor during the prayer services, and in the Globe, it stated only that they bowed their heads. In any case, there was bowing going on.

Who cares?

Jews bow at the waist during different parts of the prayer services. Catholics kneel. Muslims bow to the floor. It would be an interesting exercise to try out all three types of bowing, and see how what feelings each brings up.

But my point is, bowing during another religion's prayer service doesn't mean that you are in some way becoming a part of that religion. Are we so fearful of people leaving Judaism that we think one visit to a mosque and one bow to the ground will cause our children to leave the fold?

Ridiculous.

Wednesday, September 15, 2010

Puberty, pimples and cups

J has a funny little routine he does sometimes while he lounges in the tub (yes, he still takes baths - he loves them like his momma). He'll look down at himself, feign surprise, pretend that he sees a pubic hair, and declare: "For the love of G-d, it's Puberty!"

This has been going on for quite a while. J has always had a healthy (I hope) curiosity and interest in sex, reproduction, kissing, boy-girl relationships, gay relationships, etc., etc. As a former sex-ed teacher, I think I've done a pretty good job keeping up with him and giving him the right info at the right time. Also, J loves to watch Degrassi on TV, and that is also giving him plenty to chew on.

J recently turned 11, and at his yearly physical shortly after his birthday, the pediatrician opened up a discussion about puberty. Just the basics, your body is going to be changing in the next few years, muscles, sweat, pimples, yadda yadda yadda. But J was very impressed that the doctor had discussed this with him. Very impressed. As a matter of fact, he told a friend's mother later that day about the incident. Also, he's mentioned to me that, while he isn't really interested in girls yet, he doesn't dislike them as much as he used to, either. Hmm....

So, on the heels of all this, I decided that there were probably a few things I hadn't told him about. He knows the basics about sex and reproduction, but what changes would he be encountering in the near future? Oh, yeah. Those changes.

So I sat him down at the dining room table and told him about wet dreams, and about erections (G-d help me!). I still haven't gotten to masturbation yet...still saving that one for the "right time." Or maybe I should pass that one onto A. And I haven't gotten to birth control yet, although he claims to know what condoms are. And I haven't talked about STDs or any of that.

Shortly after all this occurred, J got his first pimple. It really was a pimple, right there on his chin. No idea why suddenly it arose: but it did.

Also, J is playing fall baseball this year, and A bought him his first athletic cup. I helped him put it on one day, and wouldn't you know, I had it turned upside down? Stupid mom.

Finally, I bought him a book: Linda Madaras' What's Happening to My Body? Book for Boys. I actually heard Madaras speak many years ago when I worked in family planning, so here I am now, buying her book for my own kid! J immediately turned to the section on bisexuality. Good grief. This is going to be very interesting....

Thursday, September 02, 2010

Babies who lunch

J and I went out to lunch today around noon. It was a very hot day, and it was hot inside the restaurant. It was also crowded. Three moms, each with two children (one 3 or 4 year old , one baby around 1 or 1-1/2) had pulled two round tables together, and were seated around the perimeter of the tables with their six offspring. The babies were crying, squirming, and trying to run away. Silverware was being flung off the table every few minutes. Food was raining down from the table onto the floor. The wait staff were clearly annoyed. Other customers seemed less annoyed, but the noise level in the restaurant had clearly risen since the arrival of these folks.

I watched with a mixture of fascination, annoyance, respect, and thankfulness.
  • Fascinated to watch how other moms deal with their kids' misbehavior (they were pretty nonplussed by all the chaos)
  • Somewhat annoyed to listen to all the crying and chaos during lunch
  • I respect that they tried to go out to lunch even with kids in tow, something I really did very rarely when J was a baby or toddler
  • I felt very thankful that I'm no longer at that stage...J knows how to sit at a restaurant, order his food, and eat it. We might even have a conversation. Amazing, I know.

Tuesday, August 31, 2010

Restoring honor

One of my pet peeves is when people who are supposed to be reporting the news decide to make their own news. This phenomenon -- which is happening more and more these days -- drives me CRAZY. It goes against all the principles of good journalism.

So this whole Glenn Beck thing -- "Restoring Honor," I believe the rally was called -- is driving me crazy. Glenn Beck is a conservative commentator. He makes money by stirring people up. He is also rich. According to a piece in the New York Daily News,
Between his gig at Fox News, authoring best-selling books, and hosting a radio show and GlennBeck.com, Beck pulls in $35 million a year, according to Forbes, which puts him 43rd on its Celebrity 100 power ranking list.
See, the thing is, I think that, with the election of Obama, we already restored honor to America. We now have a president who is intelligent and thoughtful. The world community respects us more. He is working, slowly, surely, at solving all the problems we having in this country. It takes time to solve problems. Beck and those of his ilk are into stirring people up and making them angry. This is not useful! Also, we certainly don't need more religion mixing into politics, as Beck is proposing.

I feel that politics these days have become very confusing. Even if you are trying to do something good, someone on the other side just talks about it and disparages it and makes it bad. Everyone's memory is short. No one wants to remember that much of the trouble we are in right now (economic, etc.) is due to policies of the Republicans. Somehow, everyone wants to blame Obama.

The whole thing just makes me feel sad, and discouraged. We started out with so much hope. And now...

P.S. Maureen Dowd from the NYTimes also wrote (very eloquently) on this theme. Take a look.

Saturday, August 28, 2010

Rosh Hashanah in video

The first, an interesting take on the story of "the binding of Isaac":


The second, just for fun:

Thursday, August 19, 2010

Eleven!

Happy Birthday, J-Man! (this is not our dog, by the way)

Wednesday, August 18, 2010

High Holiday Wandering

My earliest high holiday memory involves big white tents. No, I wasn't actually wandering in the desert during the Exodus. It was the '60s, and Temple Reyim in Newton was under construction, so services took place outside the synagogue, in tents.

The next high holiday memory I have is on the steps at Temple Emanuel in Newton. Emanuel's community was so large during the '70s that there were two sets of services: an early morning service in both the sanctuary and the social hall, and then a late-morning-early-afternoon service in both locations. But what was most fun was when the early-morning service let out and the late-morning people were arriving, and the two sets of people would crowd onto Ward Street and meet on the steps of the synagogue. This was a great place to meet friends, eye cute boys, and generally see what the community was up to.

My family then moved to Florida, and I remember several high holidays spent in giant theaters. The rabbi was very very very far away. I guess we were in the nose-bleed seats.

Then came the wandering years. In college, I went to services at various Hillels in Boston, Ohio, and Pennsylvania. The service that impressed me the most was a creative service at Brandeis University that featured a cello playing Kol Nidre. It was extremely powerful and moving.

When I moved back to Boston after grad school, I still wandered for a while. I remember going to a family member's shul where I was horrified to discover that I was supposed to bring my own machzor. I'd never heard of such a thing! How was I supposed to pray without a machzor?

Next came Boston's Young Adult High Holiday services. This was the first time I encountered anything that could be considered "creative" in a religious service. The services were developed by young(ish) rabbis and young adults from the community, so they tended to include meditations, guided visualizations, discussion, etc. This is also around the time I met my husband, so I have fond memories of the Young Adult High Holiday scene.

After our son was born, our high holiday wandering took on a new question: what do we do with a baby during those long, long services? We continued to attend the Young Adult High Holiday services for a few years, and I remember nursing my son in the women's room during his first high holiday season. When he was two (or possibly three), we signed him up for babysitting and he surprised us by allowing us to leave him for a few hours to join the adult service. By the time he was four, we had joined our current temple, and over the years we've attended a variety of babysitting groups, pre-schooler services, and school-age services there with him.

Which brings us to today.

I guess you could say that we've stopped our physical wandering, but I feel that spiritually, I am still looking for my high holiday home. I find high holiday services to be kind of nerve-wracking. From the insane parking, to the crowds of people, to making sure my son gets to his service on time, to finding a seat in the crowded sanctuary, and then trying to stop and relax and pray and connect...it's all really quite too much. But maybe this year will be different. I can always hope.

Tuesday, August 17, 2010

It's just not right

I often take a walk around the block at work to clear my head. It takes about 10 or 15 minutes, maybe a bit longer. I listen to my iPod, stretch my legs, get a little exercise. It's all good.

Yesterday, I noticed a snazzy little logo that I hadn't seen before on a building that I passed. Health Talker. It sounded kind of interesting, so I decided to look it up when I got back to my desk.

So it turns out that Health Talker is part of something called "word of mouth marketing." Basically, working for the pharmaceutical industry, they encourage patients who use a particular medication to tell others about this medication, using social media networks. The goal of this is for the pharmaceutical industry to sell more drugs. From what I can see on the website, Health Talker does not appear to pay the patients for providing this service. So the drug companies are getting free advertising.

Here's what they do in their own words:
Our innovative word of mouth (WOM) marketing programs mobilize patients and caregivers to spread the word. We help you build greater brand loyalty and grow your market share, one conversation at a time.
Am I naive to be horrified by this? I'm all for social media. I love it. I use it. I've found wonderful support on the discussion boards of a great website called Breastcancer.org. But the thought that drug companies are somehow using the information that people are discussing online in order to better market their products...ugh.

There's even an organization, WOMMA, the Word of Mouth Marketing Association, that supposedly has "ethical standards" for this type of work. Unbelievable.

Any thoughts out there on this topic? Any marketing or advertising folks care to chime in? I remain stunned. I'll just sit here quietly.

Monday, August 16, 2010

Tomatoes + Summer = Love



It's tomato time in the garden and on the farm, and I've been making some amazing things with these tasty little red orbs.

Here are some of my recent favorites:

Moosewood Gazpacho (still, and always, my favorite)

Panzanella (Italian Bread Salad) - this isn't the exact recipe that I'm using, but it's close enough

Bruschetta

and my new favorite, Pan Bagnat (a yummy, spicy, drippy sandwich - great with a side of gazpacho)

The only downside to all this tomato-y goodness is that soon all the fresh tomatoes will be gone, and we'll be back to the yucky, tasteless store-bought ones for another year... so sad...

Friday, August 13, 2010

Pokemon!

We are way beyond the Pokemon phase, but J's group at day camp did a fantastic rendition of the Pokemon Theme Song in the all-important lip sync contest, so I'm going to post it here for everyone to see...



If that doesn't work for you, click here for the link.

Gotta catch 'em all!

Wednesday, August 11, 2010

Ready or not...Rosh Hashanah is coming!

Today is not only Rosh Chodesh Elul (the celebration of the new month of Elul), the month leading up to Rosh Hashanah and the rest of the High Holidays. It is also the first day of Ramadan, a month of daytime fasting, prayer, and reflection in the Islamic tradition. I wonder how often these two holy periods align?

I've heard that the Hebrew letters of Elul (aleph, lamed, vav, lamed) can be thought of as representing the words "ani l'dodi v'dodi li" - I am my beloved's, and my beloved is mine - standing for the relationship between G-d and Israel.

Whether you buy that or not, Elul is a time for reflection and "warming up" to the High Holidays. It is difficult here in the U.S., where summer (for many) is still in full swing, and there are only hints of fall and school days to come. But like it or not, Rosh Hashanah is coming very early this year, and on Wednesday night September 8th, Rosh Hashanah will be here.

I just found something to help me get into the mood, if you will, for the High Holidays, and I'm going to share it with you. It's called Jewels of Elul, and it's something new to think about each day for the 29 days of Elul.

The creator of this idea, Craig Taubman (who is also a musician), says:
"There is a great Jewish tradition to dedicate the 29 days in the month of Elul to study and prepare for the coming high holy days. The time is supposed to challenge us to use each day as an opportunity for growth and discovery.

While conceptually the notion is noble, it was clear that acting on it was a bit more challenging. Enter . . . Jewels of Elul. For the past six years I have collected short stories, anecdotes and introspections from some fascinating people."

To sign up, click here, and a Jewel will be sent to your e-mail in-box each day. I think it's a great idea!

Wednesday, July 28, 2010

Incidentaloma - Part 2

I'm back in this room again in the hospital: the waiting room for mammograms and related breast things. I was here the day I found out I likely had breast cancer, and I was here 6 months ago for my first mammogram since my surgery. Today, I'm here for a breast ultrasound.

The women still sit in their incongruous blue pajama-like gowns. The TV blares. The women read, fill out forms attached to clipboards, stare off into space. There are still no keys to lock the clothes cubbies. The magazines are still out of date.

Someone calls my name. Surprise! I'm getting a mammogram, too. The tech is kind, but it hurts. At least she doesn't pretend that it doesn't hurt like some of the techs; I appreciate her honesty.

After more waiting, a different woman calls me in for the ultrasound. The ultrasound tech tells me that she loves her job. She uses warmed gel on my breast; she covers me with a blanket. She points out muscle, fat, and milk ducts in my breast. Fascinating. My breasts are dense, she says. What do non-dense breasts look like? I ask. "They are clear, like a clear day; yours are cloudy," she replies. I always wonder if I should apologize for having dense breasts.

The radiologist is young, Asian, very friendly, and handsome. He explains things well. Nothing untoward found today. Come back in 6 months for more. Any questions?

Now I have an hour to wait until my liver ultrasound. They don't do livers here in the breast clinic, so I have to go someplace else. I'm hungry because I'm not supposed to eat before the liver ultrasound. The coffee at Starbucks smells amazing...Everyone is eating lunch.

I walk over to the other Radiology department. They are able to take me a bit early. This technician is younger, chewing gum. I don't have to take anything off or put anything on. She just rolls up my shirt, and squirts more warm gel on my belly. She says "take a deep breath, hold it" and then "okay, you can breathe." She says this about 30 times. She takes a lot of pictures. She tells me about the liver. It is quite large, and has a lot of lobes. "What are you looking for?" I ask, trying to engage her. "The two lesions they found on the MRI," she says bluntly. Oh, yeah.

When she is done, she goes off to talk to the radiologist. I wipe the goo off my belly. Soon, she returns. Everything is benign, she says. The two lesions are hemangiomas, and there was another one she found that is just a cyst.

Well, okay.

I call A to tell him that everything is fine, and go off to find myself some lunch. I'm tired, hungry, frustrated to have to go through all this, but relieved that the news is good. Now, onto the rest of the day.

Today's agenda

Let's see, what's on for today:
  • drop of J at basketball camp
  • take recyclables to the dump
  • do laundry
  • wash floors
  • go to hospital for ultrasound of left breast and liver
  • go grocery shopping
  • pick up J from basketball camp
  • make dinner
Sounds like a fun day, doesn't it?

Saturday, July 17, 2010

Sometimes Judaism drives me crazy

This morning, I was driving to our Conservative Egalitarian shul. I was giving the d'var torah (congregants give the d'var in the summer when the rabbi is away), and also helping to set up the kiddush (the Sisterhood sets up the kiddush in the summer as well). From the sublime to the mundane, I know.

So on the way, I passed a group of about ten young Chassidic-looking men, walking along the road, looking very hot and tired. Hmm, I thought, why is a group of ten Chassidic men walking through our town? It's just not a common occurrence.

I thought about it a bit, and realized that they were probably walking to the Chabad House in our town for Shabbat services.

Then I thought about it a little more, and realized that they walked right past our shul on their way. Did they even notice it? And if they had, would they have even considered praying there? I think not. You see, our Conservative Egalitarian shul would not meet their standards. We don't have a mechitza. We allow women to participate fully in services, to have aliyot, to read Torah. So no, they would not have felt comfortable at our services.

And that makes me very uncomfortable.

So then I get to shul, and I go into the kitchen, and of course the lights aren't on, so I have to turn on the lights in the kitchen, and in the social hall, which I'm sure you aren't supposed to do on Shabbat, but did I have a choice? And then K and I started pulling things out of the freezer and putting table clothes on tables, and pouring wine and juice, and cutting things up and putting things out...And the question is, we aren't supposed to be working on Shabbat, but how come it's okay for us to be doing all this work to set up the kiddush?

It just drives me crazy. The hypocrisy. The contradictions.

But in the end, the d'var went well, the service was fine, the kiddush was tasty, and a good time was had by all. Even the Chassidic men probably made it to the Chabad house and were happy. Just another Shabbat in our little town.

Wednesday, July 14, 2010

Incidentaloma

There is a new terminology out there -- incidentalomas -- for things that are discovered accidentally during a test for something else. I've actually read two articles recently about them: here is one by Kevin MD, and here is one from the NYTimes.

The problem with incidentalomas is that sometimes you find something important, say a malignant tumor, and save someone's life, but often -- very often -- you find something that you would never had found and which would never have impacted that person's life. But now that you know about it... you have to find out more, and make sure it's nothing. So you test more. You scan. You biopsy. You may even do surgery.

And to what end?

So...guess what? My breast MRI found an incidentaloma. Actually, two. There are some "lesions" on my liver (which -- I had to check an anatomy chart -- is located just below my breast, so I guess that's why the liver was even in the picture). Also, there is an "area of non-mass-like enhancement " in my left breast. They want to do ultrasounds of my liver and my left breast "just to be sure" or, in medical speak, "for further characterization."

Great.

I spoke to several people yesterday, and everyone agreed that MRIs are very sensitive, and often pick up things that aren't anything important. Everyone said "don't worry." So I'm trying not to worry.

But the larger problem, as these two articles point out, is that finding and characterizing incidentalomas can cause well people to become, well, sick people. The NYTime article's author, Dr. Peter Libby, had this to say about it:
"Yet all invasive procedures entail some risk. If only a small fraction of the procedures occasioned by incidental findings lead to a complication, the overall burden of disease unwittingly induced by investigation may be substantial. In many cases, the “incidentaloma” proves benign, or is better left untreated. Thus, the unintended consequences of screening by imaging can make a well person ill."
I am hoping that I am not one of those people.

P.S. 1-17-13 Incidentalomas are still causing trouble, and are still in the news. http://well.blogs.nytimes.com/2013/01/17/the-fallout-of-a-chance-medical-finding/

Friday, July 09, 2010

Don't chew on your mama's tefillin

I've always loved this poem by Merle Feld, We All Stood Together, and how it describes what the experience of standing at Sinai may have felt to the women there. Especially compared to the men's experience.

We All Stood Together

-by Merle Feld

My brother and I were at Sinai
He kept a journal
of what he saw
of what he heard
of what it all meant to him

I wish I had such a record
of what happened to me there

It seems like every time I want to write
I can’t
I’m always holding a baby
one of my own
or one for a friend
always holding a baby
so my hands are never free
to write things down

And then
As time passes
the particulars
the hard data
the who what when where why
slip away from me
and all I'm left with is
the feeling

But feelings are just sounds
The vowel barking of a mute
my brother is so sure of what he heard
after all he's got a record of it
consonant after consonant after consonant

If we remembered it together
we could recreate holy time
sparks flying


Times have changed...but they haven't. Judaism -- or some strands of Judaism -- are more inclusive of women, but there are still those pesky verses of the bible or of prayers that, even with interpretation, are hard to swallow. That's why I was thrilled that Rachel Barenblat -- the Velveteen Rabbi - wrote a poem that is what I consider to be a corrective to Feld's piece. Read, and enjoy.


Another mother psalm: bringing the baby to morning prayer

MOTHER PSALM 7
-by Rachel Barenblat

Don't chew on your mama's tefillin
I say, dislodging the leather
from your damp and eager grasp.
We play peekaboo beneath my tallit,
hiding your face and revealing it
the way God is sometimes present
sometimes not. You like the drums,
the fiddle and clarinet.
You bang your rattle on the floor.
As we sing "Praise God,
all you elders and young children"
you bellow and and we laugh.
During silent prayer your yearning
opens my floodgates.
When the Torah is carried around
I waltz you in my arms, my own scroll.
All my prayers are written
in your open face.

(click here to link back to Barenblat's blog)

Wednesday, July 07, 2010

Breast MRI fun at the hospital


You are confronted with a large tube-shaped machine and a flat cot-like table. On the table are two pillows, and a few other strange contraptions.

"There is no graceful way to do this," admits the technician. She indicates that you should climb onto the table.

"Your breasts go here, and your face goes here."

Say what?

You are lying face down on the table, with your face in one opening, and your breasts hanging into another. The tech puts a pillow under your knees and tries to make you comfortable.

"What do I do with my arms?" you ask.

"They go over your head." Great. My favorite position.

"Here are some earplugs," says the tech. "The machine can be noisy."

Uh...okay.

Noisy doesn't begin to describe it. But I'm getting ahead of myself here.

You feel your body moving (on the table) and you feel wind rushing around you. You are afraid to look up. You sense that you are inside the tube.

"Okay, the first session will be 2 minutes," says the tech.

The machine starts to make clicking noises. Then noises like machine gun fire. It is LOUD. You start to recite prayers to get your mind off the noise.

Deep breaths. Uh, oh...didn't she say no deep breaths? Shallow breaths....

Time passes. Every few minutes the tech announces another interval. "This one will take 6 minutes. This one, 3 minutes." You start to lose track of time. You lose the feeling in your arms. You can't feel your hands. Shallow breaths...

Finally, it's over. How much time has passed? Will I ever feel my arms again? And what will the results show? She says I'll hear from my doctor in 24-48 hours. Great! Can't wait.

P.S. This will help you understand what the MRI sounds like.

Thursday, June 24, 2010

Cancer prevention tips from EWG

The Environmental Working Group works to "expose threats to your health and the environment, and to find solutions." I don't agree with everything that comes out of the EWG (more on that at a later date), but much of what comes from them is useful.

You may recall a few months ago I received an email from the American Cancer Society about cancer "prevention" that angered me. I received a similar email today from EWG, but this one is much more useful. Here's what it said:

Dear Adena,

You may have heard that the President's Cancer Panel issued a landmark report last month suggesting that public health officials have "grossly underestimated" the extent of environmentally-induced cancer among the in 1.5 million Americans diagnosed with the disease annually.

While we were not surprised by this high-level acknowledgment of the environmental connection to cancer, we know that hearing news like this can raise questions. So we put together nine practical tips for consumers like you to reduce the risk of environmental cancer. They're easy and could make a difference.

So here are the tips. Or you could read the original article here. What I like about EWG's tips vs. ACS's tips is that EWG's have to do with actively avoiding things in the environment that can cause cancer. I feel strongly, however, that we can't avoid everything that causes cancer because these substances are already in the air, water, and earth, but perhaps some of these things are in our control.

1. Filter your tap water. Common carcinogens in tap water include arsenic, chromium, and chemical byproducts that form when water is disinfected. A simple carbon tap-mounted filter or pitcher can help reduce the levels of some of these contaminants. If your water is polluted with arsenic or chromium, a reverse osmosis filter will help. Learn about your tap water and home water filters at EWG's National Tap Water Database.

2. Seal outdoor wooden decks and play sets. Those built before 2005 are likely coated with an arsenic pesticide that can stick to hands and clothing. Learn more from EWG.

3. Cut down on stain- and grease-proofing chemicals. "Fluorochemicals" related to Teflon and Scotchgard are used in stain repellants on carpets and couches and in greaseproof coatings for packaged and fast foods. To avoid them, avoid greasy packaged foods and say no to optional stain treatments in the home. Download EWG's Guide to PFCs.

4. Stay safe in the sun. More than one million cases of skin cancer are diagnosed in the United States each year. To protect your skin from the sun's cancer-causing ultraviolet (UV) radiation, seek shade, wear protective clothing and use a safe and effective sunscreen from EWG's sunscreen database.

5. Cut down on fatty meat and high-fat dairy products. Long-lasting cancer-causing pollutants like dioxins and PCBs accumulate in the food chain and concentrate in animal fat.

6. Eat EWG's Clean 15. Many pesticides have been linked to cancer. Eating from EWG's Clean 15 list of the least contaminated fruits and vegetables will help cut your pesticide exposures. (And for EWG's Dirty Dozen, buy organic.) Learn more at EWG's Shopper's Guide to Pesticides.

7. Cut your exposures to BPA. Bisphenol A (BPA) is a synthetic estrogen found in some hard plastic water bottles, canned infant formula, and canned foods. Some of these chemicals cause cancer in lab studies. To avoid them, eat fewer canned foods, breast feed your baby or use powdered formula, and choose water bottles free of BPA. Get EWG's tips to avoid it.

8. Avoid carcinogens in cosmetics. Use EWG's Skin Deep cosmetic database to find products free of chemicals known or suspected to cause cancer. When you're shopping, don't buy products that list ingredients with "PEG" or "-eth" in their name.

9. Read the warnings. Some products list warnings of cancer risks -- read the label before you buy. Californians will see a "Proposition 65" warning label on products that contain chemicals the state has identified as cancer-causing.

Monday, June 14, 2010

Rachael, and Michelle

I've been a fan of Rachael Ray's for years, and now I love her even more. She is working on a great new initiative with Michelle (Obama, that is), to involve chefs with schools to encourage healthier eating for kids. Here is the article, and the video is below. So cool!

Thursday, June 10, 2010

Fourth grade poetry festival

J's fourth grade class had a poetry festival today. Each child read an original poem that they had created during the year, and then, classmates commented on each poem. The child's parent or parents had a chance to make a comment, and then the teacher commented. It was incredibly touching. There was something about the kids making supportive, insightful comments about each poem, and then the teacher doing the same, and praising each child for his or her growth this year...it was really moving.

Some of the poems were funny, some were sad, most were very descriptive and surprisingly emotional. It is such a different side to these kids who we usually see being silly and running around.

They are growing up.

They also each recited a poem that they had memorized. Most of these were funny poems, and they used props. Here is J reciting the poem Toucan Tour Guide by Deborah Ruddell. The words follow, in case you can't understand him.
I was touring Peru in a silver canoe
And my guide was a toucan named Zeke
A talkative fellow with splashes of yellow
And green on his eye-catching beak

The river was cold, the sunlight was gold,
We were feeling as free as could be
When something I said made Zeke turn his head
And the tip of his beak hit a tree

So we stopped for the night at a vine-covered site
And Zeke made a fire by our tent
I tried not to peek at his curious beak
But to tell you the truth it was bent.
Makes me laugh every time!

Thursday, May 27, 2010

Weather man

J and I discussed the weather this morning on the brief ride to school. Yesterday my car thermometer read 105 steaming degrees at one point, and this morning it was at a cool 60.

J stated that he loves it when it's about 70 or 75 degrees. I agreed.

"Wouldn't it be neat if we could just order the weather we wanted?" I asked.

J thought about this for a moment, and then started making up his own prayer -- in Hebrew -- asking G-d for nice weather.

Sometimes he amazes me.

Tuesday, May 25, 2010

Random thoughts

There are a number of thoughts rolling around in my head (think, marbles...or bowling balls) so I thought I'd write about them here.
  • In local news, Paul Levy, the CEO of BIDMC (whose blog Running A Hospital is in my blog-roll) had an "inappropriate" relationship with a younger woman whom he "mentored" for many years. This has been written about in the media ad nauseum, but I am not satisfied. Did he actually have an affair with her, or not? Somehow, I need to know this before I can really judge the situation. Does anyone else feel that way?
  • The warm weather has definitely put me in better spirits. I'm starting to wonder if New England weather isn't all that it's cracked up to be...
  • Not being nauseous has definitely put me in better spirits, too. Ditto for no more hot flashes. I almost feel normal again.
  • Since writing on this blog, I haven't been doing as much other writing. Is the blog sucking away my writing energy? If I ever want to get something published (in Brain, Child magazine, for example), I'm going to have to start writing again, for real...
  • Still haven't decided about Ritual committee and what I should do. Should I continue my involvement, and feel frustrated? Should I end my involvement? Should I send A in my stead and see if he can have any impact on them (he has offered to do so)? Argh.
  • This time of year always reminds me of when we first brought J to daycare at (what used to be) Gan Yeladim. There is some plant that gives off white fluffy stuff that blows around near Gan and near J's school (which is right near Gan) and it was doing it NINE years ago when we first brought him there, and it's doing it now...
  • J is still a very intense kid. Just the way he was nine years ago. Or, almost 11 years ago...
  • This time of year is always a bit bittersweet. The end of another school year, the beginning of summer. J, on the other hand, is very ready to be done with school. I think the entire school year has just interfered with his sports activities. He is ready to close the door... Also he is very excited about summer camp. He loves camp.
I guess that's it for now. Maybe more later...

Monday, May 17, 2010

Pushing for prevention

In today's Boston Globe:

Q.
What is needed now in breast cancer research?

A. There needs to be an open dialogue between researchers and public policy makers and women with breast cancer on how research dollars are spent. Every day our congressmen make decisions about our care. Right now they are the biggest funder of breast cancer research. We should have a say in how those dollars are spent.

Q. Where do you think the focus should be?

A. Looking at ways to prevent breast cancer, where we tap into the Silent Spring model of an environmental connection to breast cancer, is an urgent need right now. A big example is the whole idea of exposure to toxins, to poisons that act like estrogen in our body. The problem is that industry is allowed to put bad things into our environment that could be harmful, with very little data before they expose individuals to the poison. It should be reversed. It shouldn’t be up to consumers to prove damage. It should be investigated first before it’s put into our environment.

Q. Your organization doesn’t do walks or promote pink ribbons.

A. The work we do is different. I get tired of hearing about “breast cancer awareness.’’ We’ve been hearing about breast cancer awareness ever since I can remember. What the heck has it gotten us?

You can read the full article here. I am so excited about how this topic -- the connections between the environment and breast cancer -- is making its way into the news almost daily!

P.S. Just had to add this article about possible connections between pesticides and ADHD. Also very important!

Thursday, May 13, 2010

Dandelions or not?

The dandelions are growing fiercely this year in my town, and there is a striking difference between the well-manicured lawns of those using a lawn service (and chemicals to kill the weeds) and those who choose to do their own (haphazard) lawn service (without chemicals). As I walk around the neighborhood, it's easy to see who has chosen to use herbicides on their lawn and who haven't. The long arms of the dandelions tell the tale.

This year, the well-manicured lawns are making me sad. Don't their owners realize that the herbicides can poison their children, themselves: all of us?

Sandra Steingraber's weekly essay is about this very topic, so I'm re-posting it here. Or you can read it on Steingraber's website.

Canadian Bylaws; American Lawn Flags - May 11, 2010

DDT is now so universally used that in most minds
the product takes on the harmless aspect of the familiar.

~ Rachel Carson, Silent Spring

Harmless aspect of the familiar was the phrase that leapt into my mind when I watched a scantily clad woman—the day was hot and sunny—lie down in a green sward of grass in front of the Women’s Center on the campus of DePauw University in Indiana. Next to her waved a small yellow flag that warned passers-by to keep off the grass as it had just been sprayed with pesticides.

I guess the word irony might also have applied. On the other side of the flag, a card table was piled high with copies of my book, Living Downstream, which, among other topics, discusses the dangers of lawn chemicals. The books were for sale. I was positioned up on the porch, encouraged by my faculty host to chat with students, drink punch, and sign books as part of an informal reception before my all-campus Earth Day lecture.

Yes, I intervened. The reclining woman seemed bewildered by my concern for her, pointing out that the yellow flags are so ubiquitous that no one notices them. She reluctantly promised to shower and launder her clothes before attending the evening’s lecture.

No flags wave from the lawns in many parts of Canada. Ontario, Québec, New Brunswick, and Prince Edward Island—and many cities across the rest of the nation—have expressly outlawed the cosmetic use of pesticides. Within these provinces and municipalities, the use of synthetic pesticides to improve the appearance of lawns and, in some places, gardens is now illegal.

Indeed, Earth Day 2009—one year ago—was the deadline for hardware and garden stores across Ontario to remove approximately 250 chemical bug and weed killers from their shelves. Beginning on that ceremonial day, as part of a commitment to decrease toxic exposures to chemicals linked to cancer, residents of Ontario could no longer use pesticides on lawns and gardens, and stores could not sell them.

And just how are the organically managed lawns of Canada faring? During my last visit to Toronto, I can’t say I noticed any barren, grub-infested yards or playgrounds abandoned to thistles—my grandfather the farmer called them Canada thistles for a reason, right?—and I’m happy to report that all the French-style gardens still looked lovely.

What I did notice is that the legislation outlawing lawn chemicals has become familiar enough to Torontonians to merit an offhand mention in the complimentary magazine in my hotel room. This lushly illustrated guidebook not only trumpeted the city’s best restaurants and hottest nightclubs, it also welcomed visitors with the following reassurance:

All green spaces are pesticide-free. In 2004, Toronto became the largest municipality in the world to ban cosmetic use of lawn and garden pesticides. The Sierra Club of Canada reports a clear link between pesticide use and breast cancer; many other studies have shown the dangers to children from chemical exposure to pesticides.

That is precisely the worrisome body of evidence that I review in Living Downstream. When I speak about leukemia and lawn chemicals here in the United States, people in my audiences sometimes tell me that the subject matter is too depressing for them to even contemplate. But in parts of Canada, doing something about it is a selling point for tourism.

The Canadian and U.S. governments have the same scientific evidence available to them—indeed much of the data on children’s exposure to pesticides and its possible contribution to pediatric brain tumors were generated on this side of the border. So why have so many jurisdictions in one nation chosen, as a response to that data, abolition of cosmetic pesticides while jurisdictions in the other rely on dinky yellow flags?

In Canada, the ban on nonessential uses of pesticides began with old-fashioned citizen activism in the small village of Hudson in Québec. (This story is documented in the documentary film A Chemical Reaction.) Upheld by the Supreme Court of Canada, that city’s ban was replicated in other communities. Such bans are supported by the Canadian Cancer Society (a counterpart of our American Cancer Society) and by the Ontario College of Family Physicians. Research partially funded by the OCFP concluded, in 2007, that the weight of the evidence indicates a “positive relationship between exposure to pesticides and the development of some cancers, particularly in children. ...The authors of the research recommend that exposures to all pesticides be reduced.”

Benefit of the doubt goes to children, not to chemicals.

By contrast, federal agencies, mainstream cancer charities, and physicians’ organizations south of the border have been more circumspect about the role of involuntary exposures to inherently toxic substances in creating health threats. Why the demurral? Is it because the impulse in the United States is to treat public health threats as issues of personal choice? Thus, lawn flags instead of bylaws?

I don’t know the answer here. Let’s ask. The mothers of children with leukemia can go first. (A 2009 study found higher levels of household pesticides in urine samples collected from children with leukemia and from their mothers than in the urine of mother-child pairs living in households unaffected by leukemia. Not all of the mothers of these child cancer patients used pesticides themselves. In fact, most did not.)

When it’s my turn, I’d like to pose the following query to the American Cancer Society, the National Cancer Institute, and the American Medical Association: I spent a lot of time this spring walking by yellow flags planted in the green lawns of college campuses, on my way to Earth Day lectures. When I pointed the flags out to my student escorts, most of them just shrugged. Meanwhile, to the north, 77 percent of Canadians already benefit from pesticide bans, Environment Minister Sterling Belliveau introduced a bill last week to ban the sale and use of nonessential pesticides for lawn care in Nova Scotia, and momentum grows for a province-wide ban on lawn chemicals in British Columbia. Why can't we do things like this?

© 2010 Sandra Steingraber

Sandra Steingraber is the author of Living Downstream, newly published in second edition by Da Capo Press to coincide with the release of the documentary film adaptation. This essay is one in a weekly series by Sandra - published at www.livingdownstream.com - exploring how the environment is within us.