Archive for January, 2012

posted by Amy on Jan 12

I got back to Boston from Denver early Tuesday morning. I had an appointment to get my Herceptin infusion that afternoon, and the rest of the day was taken up with two family crises, a trip to the grocery store, and cooking. Yesterday I worked out and cooked. I cooked steel cut oats, brown rice and red beans, made some “Better Butter” from the Laurel’s Kitchen recipe, and made yogurt. I ordered the books I need for the new semester. I also spent a lot of time on facebook. Today I plan to finish a PhD application, the third of three.

Classes start next Tuesday. It will be my last semester as a masters student at BU. The last class will be on my birthday, and graduation will be in mid-May. It feels strange to have a second day in a row with no deadlines or appointments. I could go to The Crossing tonight, and I’d like to do that, but at the moment the weather is wet, windy and cold, so I might not go. These “in between” times are good for self assessment and reflection.

I lost four pounds in the three weeks I was in Denver. I’m pleased, of course, but it’s a little puzzling. I ate sweets and treats. I had a lot of restaurant meals. I walked a lot, but I usually walk a lot. If I could figure it out I’d do more of the same.

The last time I lost a lot of weight it was involuntary. I had a broken heart, and I simply could not eat. I lost about 25 pounds in a short time, and when my appetite came back I quickly gained that back and more. It proved conclusively that crash diets backfire.

Losing weight really is a simple matter of “eat less, exercise more,” but it is not so simple in practice. I have no obvious bad habits, but I’m overweight, so there’s an energy balance issue. I have some ideas about what’s causing the imbalance and how to rectify it. The changes have to be realistic, healthy, and feasible, and I have to keep it up. I didn’t put on all these extra pounds overnight. Over time, my habits changed so that my “new normal” weight was higher than before. (Getting older and having different hormones also happened–but I don’t think that’s the whole story.) I need to make permanent lifestyle changes that will help me keep the weight off once I lose it.

Two years ago I was trying to lower my cholesterol with diet. I set daily targets for calories, protein, carbohydrates, cholesterol, total fat, saturated fat, fiber and soluble fiber. I tracked everything I ate, and tabulated it. That took too long to be sustainable.

To avoid the pitfalls of excess complexity I’m going to use an exchange system. The Mayo Clinic has an online guide to weight management based on exchanges. (Click here if you want to see it.) I can learn to tabulate exchanges in my head, and get in the habit of tracking them. I’ve also ordered a set of scales and a hot air popcorn popper.

I need a full-length mirror. I had that where I was staying in Denver, and it was quite revelatory. I simply can’t kid myself about how I look when I see it all at once–my tiny head, my Michelin-Man middle, my thighs. I don’t hate myself, but I can do better.

When I was in Denver I had a two-hour psychological evaluation. It’s required of everyone seeking ordination in the United Methodist Church. I’m happy they screen people. It would be irresponsible not to do that. But it was not fun. I had taken three written tests in May (MMPI-2, Cattell’s 16 Factor Personality Test, and a sentence completion test). The psychologist had those results, plus three letters of reference from people I had asked to write about me. She asked some follow-up questions from those tests and letters, but she didn’t ask them until I first talked about myself for over an hour. She took notes, and asked clarifying questions about my narrative. Then she gave me feedback.

I wish I could remember exactly how she phrased this, but here’s what I inferred from one of the comments she made: my answers about my level of anxiety and fear seem dishonest because I report abnormally low levels of those feelings. She also said I’m “too naive and trusting.” I found both of those assessments puzzling. I used to be quite anxious, fearful and resentful, and my current relatively calm state is the result of diligent effort, over many years, to heal and become more whole. Also I agree that I am open-minded and willing to give people the benefit of the doubt, but I am actually quite vigilant. I assess people all the time, and I have learned to avoid people who are not trustworthy. She also said I’m “defensive,” which made it difficult to respond to things that seemed incorrect, at the risk of seeming defensive.

I know I’m not perfect. But I also know I’m honest, empathetic and emotionally stable. Let’s hope the church thinks so too.

 

 

posted by Amy on Jan 5

I’m wondering about the spam that I get. The posts that get the most hits are “Bertha,” “Knitting Dishcloths,” and “Saving Jesus from the Church.” I have no idea why. I just go through and mark them as spam, so it’s no big deal. But today there was a real comment to approve. That was much more fun.

So it’s the new year. Let me just say I am especially happy to have made it to 2012. It might have been otherwise.

But of course there are the resolutions. The obvious one is to lose weight and keep it off, though not just weight but fat. I honestly don’t care how much I weigh as long as I’m happy with my body fat percentage, and right now I’m not. The two best things to do to prevent cancer and/or keep it at bay are to be lean and fit. I’m actually pretty fit for someone my age who’s 30 lbs. overweight. That’s good–a good start. There’s a free program at the hospital to help people with weight management and fitness after cancer treatment. I’ll be signing up.

My daughter Lily is getting married in September, and I don’t want to be the fat lady in the wedding pictures. Between vanity and health concerns there should be sufficient motivation for making lasting changes. Or so I hope.

I also want to start having more fun. I think I should do one thing a week just for the fun of it. I’ve been doing fun things every day since I got to Denver on December 20, and it’s great. A related resolution is to spend more time in face-to-face relationships. I have a lot of virtual friends, but no regular practice of visiting with people or playing with them. I know some wonderful people in Boston. I’m going to do more dinner parties and brunches. Or maybe it should be walks and bike rides. The other night a friend of mine and I worked out together at her gym. She says she likes to combine socializing and exercising. It makes sense.

I have completed two doctoral applications, and there’s one to go. All my recommenders did their part. I think I have all the transcripts and test scores in. After uploading one last personal statement all that will be left to do is wait. And work on the last three classes for my M.Div.

 

posted by Amy on Jan 3

I get it. People don’t really know what to say about cancer, or what to do if someone they know has it. But on Christmas Day I asked those present never to say I lost my battle with cancer if I end up dying from it. If I were run over by a truck you wouldn’t say I lost my battle with the truck. I’m no warrior. I’m not brave. I take my pills and show up for appointments on time and lie still in scanners and let them put needles in my veins for various reasons, but that’s not courageous. I feel fine, and I’m pretty sure the cancer treatments are the reason. If I hadn’t cooperated with the treatment plan I might well be dead by now. What’s brave about that?

Maybe I’ll get to the point where, either because remission has lasted a long time or none of the treatments are doing any good anymore, I stop treatment. That might be considered brave. Maybe. Or maybe that will still be a simple calculation about benefits and costs, quality of life vs. the potential to extend it.

It’s not really a battle, either. As I said in an earlier blog post, cancer is us. It’s our life processes gone awry. Genes that are supposed to turn off fail to do so, or genes that are supposed to switch on don’t, but it’s really just a horrible biological mistake, not a war. Thinking of it as a war can lead to rash decisions or misunderstandings.

The question of surgery might be in that category. Back in the days of the radical mastectomy, surgeons got better and better at doing more and more disfiguring excision of  breast, lymph nodes, chest muscles–anything on the same side as the tumor. It turns out that was never the right surgery. Either the cancer had already spread to other parts of the body, and mutilating the poor woman had no effect on that, or it hadn’t spread and it was unnecessary to cut out so much. Statistically, women who get lumpectomies and have clear margins, especially if they also have radiation treatment, have the same overall survival rate as women who get mastectomies. So most of the time mastectomies are not necessary. The old style “radical” mastectomy (with radical referring to “root”) is always wrong.

For people who are Stage IV at diagnosis, it’s not clear that surgery has any effect on overall survival. There are not yet any controlled, prospective studies on that question, only retrospective analyses of various data sets. Those studies attempt to screen out confounding variables, but without having matched experimental and control groups you just can’t be sure. For example, women who didn’t have surgery might have been too sick to have it, and they’d have died either way, so they should be excluded entirely, but most of the time you don’t know enough to tell who to screen out. Surgery might actually be harmful. The original tumor might suppress the growth of the metastases, and if it’s removed they might flare up. It’s also possible that general anesthesia can suppress the immune system enough to exacerbate cancer.

I feel fine, mentally and physically. I am adjusting to this “new normal.” I don’t know what’s going to happen next, but at least I have been through eight months of things heading in a good direction, and that makes a big difference. When I was diagnosed I had no clue. I didn’t know how treatment would affect me physically and cognitively. (One of my aunts assured me I’d have chemo brain and assumed that my medical people didn’t tell me that. They did warn me that it might occur, but it didn’t.) I didn’t know if treatment would be effective. Now I have reason to hope I’ll achieve and maintain complete remission. There’s no way to be sure I can, but there’s also no reason to think I can’t.

You never know how much time you have. People die, sometimes suddenly. Cherish the loved ones in your life. Love your life. Be grateful for every breath. Be gentle with yourself and others. I am really too busy doing those things to do any brave battling. I’m just doing the best I can with what I have.

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