Bye Lil

Yesterday we said good bye to our old family dog. We are all very sad. She was an incredibly neurotic mutt with enough Border Collie in her to spend most of her time as a puppy herding the little kids by biting their heels. She would run switchbacks, bark maniacally, growl and chomp, and we loved her. Well, some of us didn't love her so much. My niece, for example, who was one of the smallest, daintiest little babies ever born, once found her head inside Lily's mouth. It was one of the funniest things I have ever seen, which may sound a little harsh, but I was pretty sure that Lily would not close her jaw and chop off Claire's head. My mother hated Lily too. Lily always knew which one in the crowd she could most effectively annoy. She would immediately find my mom, stick her nose in mom's crotch and mom would struggle to maneuver around the furry, matted obstacle.

Lily was so annoying. She barked incessantly. She smelled. Her fur was the thickest covering of any animal that I have ever felt and was usually matted, sticky with pine sap, and knotted with burrs, twigs and leaves. She shed great balls of oily, sticky fur. She had many nervous habits some of which in her early years required that she wear the cone, which meant she scraped everyone's legs, knocked stuff over and looked sillier than ever.

In recent years, Lil moved more slowly, had trouble sitting down and standing up, but once she was up, she was her old self, barking away, stuffing her nose in your crotch, and begging for a butt massage.

The great thing about Lilabether, as I sometimes called her, was her dignity and doggy arrogance. I will never forget a day, when our other dog, Pepper, was a puppy. We were teaching Pepper how to fetch. We would throw the ball, Pepper would retrieve it, and if she brought it back to us we would go nuts with praise. Lily was watching us with an air of great superiority and boredom. Finally, after many throws to Pepper, Lily got up, retrieved the ball, brought it back, dropped it at our feet, and sat down again. She had never retrieved a toy before that day and never did so again. She merely wanted to demonstrate what a stupid, amateur trick it was that the silly new puppy was performing.

I bought Lily shortly after my husband and I had separated. The weekends that the kids spent with him were so terribly lonely for me that I decided a dog might help to fill the time and add some noise to the quiet house. She was such a small. white fluff of a thing. I would carry her around, tucked under my arm, while she nibbled at my hand until it was raw. At puppy kindergarten, she was so out of control, with biting and barking and squirming, that I remember crying with embarrassment during one class. My vet would often advise me to put her on Prozac, but I never did.

In her final months she was deaf and barked even more frequently, often in the middle of the night for no reason we could ever figure out. My husband or I would drag ourselves downstairs, reminded of the days when our children were infants, and groggily try to figure out how to shut her up. We would drag ourselves back upstairs, muttering murderous epithets with every step. We would fantasize about getting a gun to kill the squirrels, or the bunnies, or the sparrows....or Lily.  (For the record, we never fantasized about murdering our babies.)

My kids learned to love Lily with a kind of fierce loyalty. She was such a pain in the ass, and not the kind of dog that people would find lovable, but the kids were always loyal and protective and affectionate with her. They objected when we talked about murdering her.

Then came the day when we murdered her. She seemed to be having trouble breathing. Each breath labored and painful sounding, she was foaming at the mouth. She was sad and weak and miserable. We had been to the vet a couple of days before and the vet warned us that we should be prepared to say good bye. We thought we were prepared. We brought her in and said good bye. My husband stayed with her for the injection. I returned to the car. We are so very, very sad. She was such a dignified, intelligent, irritating presence in our home. She leaves an enormous hole.

Pepper, the now grown puppy, hasn't reacted too much. I let her out this morning after breakfast. Lily used to eat her breakfast more slowly than Pepper. So Pepper would go outside and sit on the porch waiting for Lily to join her. Pepper liked to follow Lily around the yard to eat her poop. Pepper didn't wait for Lil this morning. She just walked off the porch and sniffed around slowly and thoughtfully. I do not know what she is thinking.

Good bye, Lil. We miss you, we love you, and we thank you for much happiness and laughter.

Christmas #1

New season, new year, new look. The winter scene pictured in my new background struck me as soothing, which is helpful at this time of year.

On the morning of January 2, 2011 I was lying in bed feeling guilty about all of the eating and drinking I had done through the holidays. I thought about how such a lifestyle can increase cancer risk, and I found a lump in my right breast.

You know how cancer statistics refer to the five-year survival rate? I've been wondering lately from what point do you start counting the years. The day you find the lump? The day you estimate that the lump was born? The day of diagnosis? The day you start treatment? The day you finish treatment? Am I surviving right now? I have a friend who refers to post-cancer diagnosis as a period of "thriving".

To survive:
verb (used without object)
1. to remain alive after the death of someone, the cessation of something, or the occurrence of some event; continue to live: Few survived after the holocaust.
2. to remain or continue in existence or use: Ancient farming methods still survive in the Middle East.
3. to get along or remain healthy, happy, and unaffected in spite of some occurrence: She's surviving after the divorce.

verb (used with object)
4. to continue to live or exist after the death, cessation, or occurrence of: His wife survived him. He survived the operation.
5. to endure or live through (an affliction, adversity, misery,etc.): She's survived two divorces.

To Thrive:
verb (used without object)
1. to prosper; be fortunate or successful.
2. to grow or develop vigorously; flourish: The children thrived in the country.

None of these definitions seems exactly right, but if I had to pick one that best suits my situation, I might go with  "survive" definition #2...Amy remains or continues in existence or use. I guess I have been surviving for over fifty years.

Well, that's not too helpful.

I hope everyone had joyful holidays. Mine were fairly joyful. The highlight was seeing twenty members of my family sitting around a single table in my own kitchen each with a plate of cold food in front of them. I was wishing that the food was hot, but the only way that could have happened is if there had been fewer people there taking turns loading up their plates. The cold food was a fair price to pay for a super crowded Christmas dinner table.

I am now thinking about our New Year's celebration. I guess it will be good to finish 2011 and start 2012.  2011 wasn't so good, but it wasn't so bad either. I learned a lot: about how to be a good cancer patient, about setting priorities, about how I am not alone and that I have dear friends and family members who are willing to make sacrifices just to help me out. I learned that I have lots more good luck than bad. I learned that you can lose members of your family, parts of your body, a lot of your energy...and still find stuff to laugh about. I learned to be even more grateful than ever for money and education which are mighty helpful things to have when you are sick, and that probably the most useful thing I could do with the rest of my life is to help other people who don't have those resources.

My New Year's plans include dear friends, precious family, food and drink, though in smaller amounts than in years' past. I will celebrate having earned some wisdom for living a full and happy, second(?) year of survival.

Sending you all lots of love and wishing you a peaceful, joyful and healthful New Year.

Holiday Blues and Returning Daughter

Hey Friends,  

Everyone who is feeling overwhelmed by holidays, family, work, life, and death raise your hand. I knew it. All of you. And because I am the one doing the typing, I am going to tell you all about my holiday stresses. There was Thanksgiving. Lots of family - minus one major member, the daughter - around for a few days. Then my mom's sister died and we went to upper New York to visit with family. Then  a couple of weeks of more intense work than usual leading up to a conference in DC hosted by my organization. And throughout there have been many hours of physical therapy, doctor appointments and driving back and forth from those things. Whine, whine, whine.

Maybe because I've been busier and taking on more stuff, I have been having trouble sleeping lately.  Things on my mind:

• Recurrence: I can't help it. I keep looking at the data. Scary. When I am alone I spend a mentally-ill amount of time researching this and I am alone this whole week so...
• Twitter: twitter works on the principle of egomania. I hate to break it to you, but for the most part there is nothing interesting about your 140-character thoughts, so keep them to yourself. (I know what you're thinking - people in glass houses...) On the other hand I get it for marketing purposes or important news. Things like, "a million copies of my new book are now in books stores all over the world." Or, "doctors discover a cure for cancer." Things like that people want to know about immediately. But things like, "what you are is what you have been. what you'll be is what you do now" just isn't. [ This paragraph uses 608 characters.]
• Current Health: On the decline. This horrible medicine I am taking, arimidex (which is an aromatase inhibtor that works by reducing the amount of estrogen my body makes) is wreaking havoc on my joints. When I get out of bed or out of a seat after sitting for a while, its takes a painful minute or two to straighten my back, legs, and shoulders. This I have gotten used to. However, in recent days my joint pain is interfering with sleep and exercise. My knees are up in arms, so to speak, when it comes to running, and even a long walk can cripple me for the rest of the day. When I think that I am to be on this drug for 5 years, I feel discouraged...until I remember that I should feel lucky if I am around long enough to take the stinkin' drug for 5 years...

So, as you can see, I am feeling a little sorry for myself this holiday season. BUT! My precious daughter who has been in Ghana since August 26 is coming home this Wednesday. I cannot believe that I lived through almost 4 months of not seeing my own daughter! My daughter! My heart, my soul, my blood, my lungs, my genes (poor dear)...my darling, my sugar cookie, my pickle brain, my chicken bosom (please see post #1...really, is this so much worse than most twitter posts out there?) 

Right now my daughter is traveling with her papa around Ghana. They are with a professional guide, but my lucky husband is also enjoying the novel experience of being guided by his own daughter. And not just any daughter, but a daughter who still uses a GPS to get around the town she grew up in. There she is, resident in a rough and tumble African country, showing her father the sights.  How did that happen? My collicky, premie baby, 4.5 pounds on entering this world, nevertheless scored a 10 on the Apgar scale. She's been scoring a 10, in spite of herself, ever since. When recalling her infancy I like to say that if she was awake she was whaling. As a teen, if she was awake she was finding fault with herself. As a young adult, she is mostly just awake, struggling mightily to absorb, assimilate and write about all that she learns every day. Such a beautiful, difficult baby. Such a beautiful, challenging 21 year old  who just completed a 70-page paper about the cultural and political significance of the Ghana Dance Ensemble, guiding her father through a colorful, chaotic, and lush country that appears, from a distance, to vibrate with music and stomping feet.  What mother would not feel cheered by the prospect of a reunion with such a daughter?

                  

Thanksgiving #1

This way we can count how many Thanksgivings I have post diagnosis. A little too morbid for this rainy Thanksgiving eve? Not really. Each one I have is further proof of all that there is to be grateful for. I guess that goes for all of us.

Things I am grateful for in no particular order: husband, daughter, son, mommy, sisters, dogs, you, chickens, old timey music and its progeny, turkey, nieces, nephews, sweet potatoes, summer tomatoes, fall apples, apple, cherry and maple trees, horse manure, fireplaces, fleece, reggae, wine, chemotherapy, oncologists, Charles Dickens, nuts, good fiction, the Sunday Times, my legs when they take me on long walks in the woods, pasta, space heaters, washing machines, photocopy machines, Skype, computers, WBUR, my hair, my teeth, money, airplanes, mountain views, the first amendment, sleep, mocha chip ice cream, clean water, people who make me laugh.

That's all that occurs to me at the moment. Please let me know your things.

Wishing you a delicious, cozy Thanksgiving with people you love.

Poll Results and Health Update

Well. my friends, I am sure that you have been in terrible suspense all week wondering how I will shape my future drinking habits in light of our poll and recent studies. The results are interesting:

• 8 of you voted
• 1 person voted for 0 alcohol consumption
• the others were split on how many drink per week I should have, and
• 3 support the use of illegal substances while 5 do not

So here is the analysis. 

• the article was viewed 62 times. 
• 13% of the viewers thought it worth voting. 
• 87% could give a shit about how much I drink
• 1 person is really concerned about my well-being (or interpreted another way, one person wants to see me miserable)
• a healthy majority (62%) is opposed to illegal substances

So, there you have it. I continue to have insufficient justification for altering my habits. YAYYYY!!!!!! Man, I'm ready for a drunken celebration.

Ok. Enough of that silliness. In real life, things are okay. I've been dealing with what they call "lymphatic cording" which is caused by having no lymph nodes under my right arm and results in an uncomfortable and revolting feeling of tightness and palpable "cords" under my skin that hurt and reduce my range of motion. I've been going to physical therapy twice a week to deal with this issue which is time consuming and somewhat agonizing. My physical therapists joke when they see me, "time to play the guitar!" I feel nauseous just thinking about it.  I am seeing my surgeon next week to make sure that it isn't the next sign of my premature demise.  

In addition to this development, I am back to work to an increasingly stressful degree. Perhaps I should do another poll on the topic of my career. I think that there is real possibility that work causes cancer. Since the alcohol poll I've been thinking a lot about all the other things that cause cancer:

• smoking
• plastic containers
• water bottles
• celery
• the stuff that makes paper towels white
• birth control pills
• pesticides
• pollution
• radon
• chemotherapy
• radiation
• toilet bowl cleaners
• Tide
• Crest
• flea collars
• carpets

and on and on.

Adult with Breast Cancer Risk Behavior Survey

I am very sad that drinking alcohol causes cancer. I really like drinking alcohol. Even when I hate the taste, I always love the warm feeling of comfort and well being that it brings. The latest study shows that even as few as four drink a week may increase your risk of getting breast cancer. And I'm not talking vodka martinis, my friends. I'm talking vodka martinis AND that wimpy glass of chardonnay that we middle-aged suburban ladies are so fond of, AND everything in between.

I do not believe that I am alcoholic for a number of reasons:

• I never have a drink before 5:00 PM...yea, yea, yea, I've heard the joke...east coast time 
• I never drink alone
• I mostly confine my drinking to Friday and Saturday nights with a group of friends
• I usually do not drink more that 2 or 3 glasses of wine in an evening
• I do not see my aggressive efforts to get that group of friends together religiously every freakin' Friday and Saturday nights as cause for concern

So I spend a lot of time considering the impact of this bad news on my risk of recurrence, or more candidly, on my risk of dying within the next couple of years. I think that I have been aware of studies that indicated that there is an association between breast cancer and alcohol consumption for at least the last ten years. I never did much in response to this knowledge except feel guilty every time I had a drink. In fact, it was my guilt about drinking over the holidays that inspired me to do a punishing breast self exam on January 2, 2011 that got this blog started. 

So it's no surprise that I am certain I got breast cancer from alcohol consumption. You would think that this theory would put the kibosh on drinking, and through chemotherapy it did, mostly because I couldn't stand the taste of it then. Sadly, once I finished chemotherapy, my taste for alcohol returned. 

So I thought it might help to analyze here, in this public place, my risk of recurrence in connection with my alcohol consumption. A fairly pessimistic estimate, I think, of my risk of recurrence is about 20%  (my doctor tells me it is more like 8%, but I think he's just trying to cheer me up.) According to the latest study, drinking an average of 10.0 to 19.9 g of alcohol per day (6 to 12 drinks a week) results in a 22% increased risk of developing breast cancer. Although my average consumption is lower than that, I will continue with the worst case scenario approach. So adding the additional risk of .044 brings my personal risk of recurrence up to about 24%. So what do you think? Check out the new poll on the right. A couple of additional considerations to keep in mind as you place your votes:

• there is no evidence yet that discontinuing alcohol consumption lowers risk
• if I can't drink, life isn't worth living
• the anxiety that I feel with each drink might increase my risk of recurrence
• I am NOT an alcoholic 

Autumn Yoga

Happy Autumn, my friends. I've already written about changing seasons and their nostalgic associations so I won't do that again, but wanted to point out that I've selected a new background for the blog to celebrate the season. Too clever, I know.

So I thought I would give you a sense of what a yoga class with cancer patients is like. I used to like doing "hot yoga" which is basically fast yoga in a room heated to about 98 degrees. I was the least skilled at it, but it was so efficient. I got the benefit of yogic breathing and stretching in addition to the "cardio" that came from trying to keep up with the pace, and mimicking positions that hurt like hell and couldn't possibly have been good for me. But when I was in "downward dog", the resting position, I could see the sweat drip on the mat from body parts that I never knew could excrete sweat. Gross but gratifying.

Yoga with cancer patients is a different experience. I arrive at class five minutes late. No problem. The ladies (it is all ladies - with breast cancer) are still signing in, pulling out mats, strolling back and forth to the bathroom, the water fountain. Fifteen minutes after the class was scheduled to start the group is lined up, standing on their mats facing the instructor. The instructor talks for 10 minutes about the importance of breathing. The instructor tells us to swing our arms around our bodies to enjoy the "stretch" that comes with the slightest twist of the torso. Someone farts. We are instructed to pull up a chair, have a seat, breeaaaatttthhhhh. Stand up, grip the back of the chair, make sure we are well balanced, then (this is the climax of the class)  lean over to "stretch" our hamstrings. Someone farts.

Someone asks, "can you write down these steps so that I can do them at home?" Someone else says, "what a good idea! I only do this "exercise" in class. I should really try to do it more often." Someone farts.

Then the following conversation takes place:

"My daughter-in-law has been doing yoga for years, and she looks fabulous."
"Oh, is that the daughter with the twins?"
"Yes. I spent the afternoon with them yesterday. They are too funny."
"Did I tell you? My son's wife is due in December!"
"You must be so excited."
"Oh, I am. I hope I live long enough to meet the baby."

To those of us still bent over our chairs, the instructor says, "stand up straight and swing the arms to release the muscles, and breeaaaath." "Now it is time to lie down on our mats. Raise the knees and breeeeaaaaath." Relax your toes, relax your ankles (huh?), relax your knees, relax your buttocks, relax your pelvis (once again, huh?), relax your lower back, your stomach, your shoulders, your neck (you'll note one body part we needn't bother relaxing, since for most of us that body part is in a landfill somewhere).

Loud snoring is heard from the back of the room. Someone farts.