Mammograms Can lead to Overdiagnosis of Cancer

Take a quick look at this article in today's Times Union on whether cancer screenings lead to over diagnosis of cancer. Of course it's not just the over diagnosis that's the problem but  the unnecessary treatments, surgery and chemo for cancer's that may never have been or become serious health issues.

What's a girl to do?

http://www.timesunion.com/news/article/More-questions-on-cancer-screening-4058455.php

Saying No to Cancer Treatment

A terrific article by Jane Brody in Today's New York Times giving voice to the little discussed choice of saying "no" to cancer treatment. Brody generously shares the experiences of her husband before his death last year, and his decision to say no.

The important part of the article is about the necessary and repeated communications required to help doctor and patient get clear. Too many patients keep opting for treatment--surgery, chemo, radiation because they believe theirs is still a malleable or treatable cancer. But if it's not?

We have this conversation often in our family. More chemo? Or go to Paris? Take a look at the article, The link is below. And talk to your doctor, and to your family.

http://well.blogs.nytimes.com/2012/11/19/when-treating-cancer-is-not-an-option/?smid=pl-share

The Emotional Preparation for Thanksgiving

This weekend we’ll be preparing for Thanksgiving. There is a lot of shopping and cooking to do --but there are also emotional preparations to be undertaken this week. Like many, you may be torn between the happy anticipation of a good meal and seeing family, but also the dread of family feuds that leave you wishing to hide in a corner of the living room.

Along with the usual  “issues” that each family faces around the turkey table—the in-laws, sibling rivalries, and adolescents with attitude—we can stir in some raw feelings about national politics and a debate on the economy. It’s Thanksgiving in the REAL America and nobody’s very happy.

So many of us so want it to be the other Thanksgiving, the one we imagine that other families have, but which really only happens in made-for-TV movies.  We think that Thanksgiving’s just not what it used to be-- But then again, it never was.

It seems that we can’t shake our romantic idea about that first one with the grateful Pilgrims and the wise Indians, but it’s safe to say that most of us wouldn’t have been comfortable at that dinner either. The truth is that the Pilgrims, with their cute buckled shoes, weren’t innocent refugees from persecution. Rather they were religious zealots and not exactly tolerant.

Here’s the history: After the Protestant Reformation and the split from Catholicism—creating the  Church of England--there were many who felt the church still needed to be “purified” of Rome’s influence. Those were the Puritans. Among the Puritans were some folks who were even more extreme and who wanted complete separation. These were the Separatists--we know them as the Pilgrims. These were not folks who believed in freedom of religion. What the Pilgrims believed was that the Church of England was corrupt; that Catholics were the Devil’s spawn and that they were superior in knowing God’s truth.

We still have some emotional resonance of those ancestors and their vibe is with us at Thanksgiving. So be prepared.

Part of the problem is that religion permeates this day directly or indirectly; someone or something is being thanked for the good in our lives, but there are political tripwires from the stuffing all the way through to dessert. Most of us will be sharing a meal with folks who not only mix their potatoes with their peas but who mix politics with their religion:  Every current event, everything in the headlines--war, terrorism, same-sex marriage, the war and the Middle East—touches religion in some way. And that intersection of religion and current affairs will cut right through the dining room table on Thursday.       

Even saying grace is tricky. When the blessing includes a prayer for peace someone at the table will be listening for what kind of peace? Do you mean Get-out-of-that country peace or the bomb them into submission kind?

Next Thursday we may be humming, “We gather together…” but in our heart of hearts we want to insist that OUR team should win, that OUR recipe for stuffing is the best, and that OUR candidate was right.

So if you find yourself dreading the doorbell, or if Uncle Harvey mentions the President when he says grace, you may want to retreat to the kid’s table or sit in the den to watch the game. But instead, give thanks that this holiday comes only once a year, and remember--- it’s all in the spirit of the day. 

Getting Your Needs Met

I come back to this book again and again. It’s called; “Daring to Trust” by David Richo, and it was published in 2010. Whenever I dip into it I get a gem or a jolt --and always what I need.

Today I read this:

“Parents are expected to fulfill 100 percent of our needs in our early life, including safety and security. As adults, we learn to find need fulfillment in ourselves, in our friends, in our family, in our career, in our spiritual program, in nature and in other resources that we discover. We then do not rely on a partner, or on any person, for more than 25 percent of our need fulfillment.  This includes our need for safety and security.”

No more than 25%. Holy cow! Talk about feeling like you didn’t get the instruction book. I know that years ago I could not even have read that paragraph without fear. Today, reading it feels like a mid-course correction. It’s also a powerful reminder that I have to have friends, family, time in nature, work that I love, and a spiritual program so that I do not suffocate my relationship or paralyze myself.

It may be that the hardest time to grasp this 25% concept and to implement this is when a loved one is ill or disabled…but it’s still true then. Gail Sheehy writes about that reality for spouses as caregivers—the need to drag yourself to work, exercise, nights out with friends, into nature and into creativity. At the VERY time is feels impossible it’s crucial to go toward the self.

Yes, I know. Easier said than done. But that is why I love Richo’s book. I can dip in, read a bit and self-correct. Or I can call a friend and say, “Really?”

How to Be of Service

Be a 

Lamp

or a

Life Boat

or a

Ladder

Twelve Steps of Self-Care for Caregivers

I have found the twelve steps of AA and Alanon very helpful in all parts of my life. Whether or not a person is struggling to address an addiction or an addicted family member the philosophy of the Twelve Step approach is both practical and inspirational.

Now I have found a book that applies the practice of the twelve steps to family caregivers and to their own self-care.

The book is, “Self-Care for Caregivers—A Twelve Step Approach”, by Pat Samples and Diane and Marvin Larsen. Pat is the editor of The Phoenix—a personal growth newsletter and Marvin and Diane are experienced family caregivers. Hazelden published the book, and it is order number 1236 at www. Hazelden.org

Given our current demographic boom and the increasing need for and demand on family caregivers, and the growing understanding of how the 12 step philosophy works this book lands at the intersection of both and it is a wonderful contribution to the language and practices for caregivers. The other growing population that will naturally benefit from  this approach is the membership of AA, Alanon, OA, NA, Nar Anon etc. who have learned to integrate emotional growth and spiritual growth with practical change in their lives. They are also part of the growing demographic bump of caregivers.

This is a book that would work well in a caregiver support group as it breaks down caregiver needs and the ways to think about care of self and others using the language of the twelve steps.

November 1st-Day of the Dead

On November 1st I celebrate Dia de los Muertos, or Day of the Dead.  It’s not a holiday I grew up with but one I’ve borrowed from the Southwest and Mexico. It’s become one of my favorite holidays partly because it’s a good spiritual counterpart to Halloween.

Except for the candy, October 31^st doesn’t leave much for grownups. Being scared of goblins and ghoulies lost its sway when I got old enough to lose people that I loved. The dead just aren’t scary in the same way anymore. In fact, I’d welcome a visit from some of them.

That’s what Day of the Dead is about. There is a belief that on this day the veil separating this world and the next is thinner and so it’s a time we can be closer to those that we love who are dead.

Day of the Dead celebration centers on rituals for remembering loved ones. We can visit in our imagination or feel their presence. It can mean prayer or conversation, writing a letter or looking at old photos. The tradition that I use includes making an ofrenda, or altar, something as simple as putting photos and candles on the coffee table and taking time to talk and remember. We also have chocolate as a symbol of the sweet and bitter separation from those we love.

A ritual is a way of ordering life. Whether Purim or Advent, hearing Mass or saying Kaddish, small ceremonies help us sort and reframe our memories. When someone dies the relationship doesn’t stop, it’s renegotiated, literally re-conceived.

This isn’t a very American idea. Culturally our preferences are for efficiency and effectiveness; even with grief we use words like closure and process.

I remember my frustration when I was grieving and well-intentioned friends would suggest I move along in my process and quoted Elizabeth Kubler-Ross. The simplified version of her theory lists stages: Denial--Bargaining--Anger--Depression, and Acceptance.  But it’s false to create an expectation of five discrete steps. This listing implies order and that a person can move from point A to point B and be done. That makes grief seem like an emotional Monopoly game where you go around the board, collect points and get to a distinct and certain end.  This false notion of linearity is apparent when we hear people judge someone who is grieving, “Oh she missed the anger stage”, or “He hasn’t reached acceptance yet.”

I always thought that “losing a loved one” was a euphemism used by people who were afraid to say the word dead.. But after losing my brother Larry I know that lost is the perfect word to describe the feeling that follows a death. Something just out of reach, still here, but also gone.

Though he died several years ago my feeling about my brother is that I have misplaced him; It’s that sensation of knowing that my book or that letter I was just reading, are around here somewhere…if I could just remember where I left him. 

I think this is why we can sometimes be so hard on the grieving, and why we want them to go through those stages and be done with it. We love closure and things that are sealed and settled. But death and grief, for all their seeming finality, are not as final as we would like.

So tonight I’ll make cocoa and light candles; we’ll look at pictures and tell stories and we’ll laugh.

The root of the word grieve is heavy. We carry our dead as a cherished burden. Death ends a life but not a relationship. Who would want to close the door on that?

Tree of Life

In most forms of shamanism the sound of the drum generates the trance state in which the shaman travels back and forth among the three realms: The Heavens, the Earth and the Otherworld.

The interconnectedness of these three realms is universally represented by The Tree of Life, which is rooted in the underworld, bears fruit on the earth, and reaches with its topmost branches into the heavens.

--from “When Women Were Drummers” by Layne Redmond

Storm Ready Reading

I cancelled my writing week on Cape Cod.  We grocery shopped and bought extra batteries. John made meat loaf and casseroles that we can eat cold if necessary. We called kids and parents and friends who are near big water on the East Coast. I'm very touched by the number of friends stepping up to help family members just in case. Here at home it feels more like an adventure than a disaster. But then it has not really begun.

Yesterday watching people grabbing videos I felt so grateful to be a reader. If we have power I'll watch movies too, but there is this blessing and bonus of being a reader--to know that we can entertain ourselves for hours and days with the simplest technology: turning pages. And with the coffee table and bedside tables piled so high with books it's hard not to think, "Oh boy, extra reading time."

The folks I think about today are those in Cancer Land. How to get to chemo? The nurses who will work double shifts. The chemo equipment running on generators and the extra worry. I constantly think about the 5FU folks who will wear the nasty beeping pumps through all of this.

Poverty and Cancer

It’s election time and as a friend pointed out to me, “No one is talking about poor people”. Even Democrats are staying in the safety zone of discussing the “struggling Middle Class”. But here in Cancer Land we have to talk about cancer and poor people.

People living in poverty take a much harder hit from cancer.

One reason cancer is harder on people living in poverty is that they are diagnosed later in their illness. They have less routine screening and less preventative care. Yes, I know there are all those “free” screening tests available, but really, if you are poor, have a couple of kids, no car and work a part-time job you are most likely having to choose between milk, Pampers and the $6-9 round trip bus fare to go to a health center (and spend the day waiting) for your “free” test.

So you cross your fingers and wait. You take your kids to the doctor but put off your physical or Pap test or Mammogram. Forget colonoscopy—who’s going to drive you home?

So it takes a lump or some bleeding or some pain to get your attention and by then things have advanced.  And then…it’s still different if you are living in poverty.

Our romantic ideal—and my reality, maybe yours too if you’ve had cancer—is being surrounded by friends and family who help you. The caregiver support group. We had an amazing team of helpers for John—meals, rides, laundry, errands. And one of the reasons that happened is that we have a lot of friends who drive, who have appliances, who have jobs with lots of flexibility, who have discretionary income—who have middle class lives.

But if you have been in poverty for a while it’s probable that your friends are poor too. So they can’t give you rides, or take your kids, or give you a week’s meals. And no, your best friends are not taking you out to lunch and pitching in for that $800 chemo wig. Not gonna happen. Emotional support for sure but no practical stuff.

And if the caregiver resource center or the support groups or the yoga classes are in the suburbs guess who gets to go? Yeah, even if it’s free it doesn’t really help.

Those of us who have had cancer—or a loved one with cancer and were able to do it the middle class way  (just the relief of having a car) have to think about those extra blessings. And then we have to figure out what we can do to give a lift to those who don’t.