Here's an eye-opening video about the cosmetic industry.
Here's the LINK in case you can't see the embedded video.
Want to look at individual products or ingredients? Check those out on the EWG's database.
Wednesday, July 28, 2010
Tuesday, July 27, 2010
DCIS and early detection
I've blogged about my growing awareness of the negative side of early detection in breast cancer. On July 19th, the New York Times ran an excellent article exploring detection and DCIS.
DCIS is ductal carcinoma in situ -- it's non invasive cancer cells that are fully contained within the milk ducts. It is not entirely clear what the connection between DCIS and invasive cancer is. Our detection methods have enabled us in increase our rates of early detection but we have not seen a commensurate decline in breast cancer deaths. So it stands to reason that some cancers may not ever become fatal. The problem is that we don't know why, so we are treating every detected cancer as if it will eventually kill us. We have heard the mantra over and over that early detection saves lives, but to quote the Brothers Gershwin, it ain't necessarily so.
Further complicating this is something that defies logic to me. It seems like "Do I have cancer" should be a yes or no question, but apparently the accuracy of that answer depends on who is looking at the cells. Consider these startling statistics from the article:
But the problem is just limited to error; standardization is lacking in the diagnostic process.
Those were the choices I made because I wanted to be sure that I'd done everything possible. Now, in my case it was warranted. I had no gray areas. But it might not be necessary for some people and once fear starts driving the bus, the bus is in trouble.
We need more research in one very specific area -- determining why some cancers become life-threatening and why some don't. That has to be our next frontier.
DCIS is ductal carcinoma in situ -- it's non invasive cancer cells that are fully contained within the milk ducts. It is not entirely clear what the connection between DCIS and invasive cancer is. Our detection methods have enabled us in increase our rates of early detection but we have not seen a commensurate decline in breast cancer deaths. So it stands to reason that some cancers may not ever become fatal. The problem is that we don't know why, so we are treating every detected cancer as if it will eventually kill us. We have heard the mantra over and over that early detection saves lives, but to quote the Brothers Gershwin, it ain't necessarily so.
Further complicating this is something that defies logic to me. It seems like "Do I have cancer" should be a yes or no question, but apparently the accuracy of that answer depends on who is looking at the cells. Consider these startling statistics from the article:
One study in 2002, by doctors at Northwestern University Medical Center, reviewed the pathology in 340 breast cancer cases and found that 7.8 percent of them had errors serious enough to change plans for surgery.And this one concerning a more recent Komen study:
It seems that where a person lives can affect the accuracy of diagnosis.In 2006, Susan G. Komen for the Cure, an influential breast cancer survivors’ organization, released a startlingstudy. It estimated that in 90,000 cases, women who receive a diagnosis of D.C.I.S. or invasive breast cancer either did not have the disease or their pathologist made another error that resulted in incorrect treatment.
To diagnose a breast cancer, pathologists look at slides mounted with thin slices of breast tissue. The slides are stained with a purplish dye that highlights patterns of circles and dots, each representing a cell, its nucleus and membrane. The diagnosis turns on the appearance of these cells under a microscope.
At larger hospitals, the findings are often presented to a tumor board, in which a team of doctors from various disciplines reviews the pathology report and develops a treatment plan.If a person doesn't have access to a large hospital or cancer center, such procedures may not be in place. There are a couple of profiles of human error in smaller areas in the article.
But the problem is just limited to error; standardization is lacking in the diagnostic process.
Beyond diagnostic errors, there are different schools of thought about what constitutes D.C.I.S. Variations in diagnoses may depend partly on where a woman is treated.
In San Francisco, Dr. Lagios uses a criterion that says some breast lesions under two millimeters are not D.C.I.S., even if they have the other markers of the condition.
At Beth Israel Deaconess Medical Center in Boston, also renowned for its breast pathology services, those lesions are considered D.C.I.S., according to Dr. Connolly.Receiving a cancer diagnosis might be the scariest moment any of us could ever face. Imagine your doctor telling you that it may or may not be breast cancer depending on who is examining the slides. I think that the natural human tendency would be to react to fear, to have the most extreme slash and burn treatments available.
Those were the choices I made because I wanted to be sure that I'd done everything possible. Now, in my case it was warranted. I had no gray areas. But it might not be necessary for some people and once fear starts driving the bus, the bus is in trouble.
We need more research in one very specific area -- determining why some cancers become life-threatening and why some don't. That has to be our next frontier.
Monday, July 26, 2010
Deportation
Yep, it's done.
It was a pretty strange day for me, probably because I was home alone all morning. My family was out of town so I was a bit unhinged without distraction. Don't feel sorry for me, friends offered to keep me company and I declined. I wanted to drink in the enormity of the day alone. Even though none of this changes or even affects my long term outcome, it was something of a symbolic loop closing. This is big coming from a person who thinks that the idea of closure is just a fiction; an exercise is self-deception.
As the time approached I tried to call my husband and couldn't get through. I got a little basket-casey but he finally called as I was getting ready to walk into the surgery center. That was a tremendous relief. I always forget that he's a last minute kind of guy.
I got settled into the pre-op room, just like I did for my two other surgeries. I took my journal and tried to write, but I was nervous and anxious and seriously scattered. I kept thinking about my other surgeries, comparing and contrasting. This time I wasn't hooked up to an IV or any beeping equipment. It was just me in that humiliating surgical gown and since I was stone cold sober I could be supremely self-conscious about my derrière while walking across the hall to the bathroom.
For almost an hour I waited, leaning back in the reclining chair in my room just breathing. The breathing was doing its calming work except for the occasional interruption of the neighbors moaning and panting and crying. I didn't like that much. I had to keep reminding myself that was once me. And, that it was no longer me.
When the time came, I actually walked into the Operating Room. That was weird. Here I am in my gown, booties and special surgical hat being escorted by the nurse. It was like a victory march and four other nurses stood in the hallway and cheered me on like I was a rock star.
Dang, that was big.
I wish the some sort of theme song would have been playing. I'm thinking that Wide World of Sports song -- the thrill of victory... the agony of defeat.
I got all strapped in on the OR table with those big round lights shining on me. The doctor injected the area with something local and numbing and got to work. It was pretty weird. I could feel a little tugging, but there was no pain at all. I could smell a burning smell but was too afraid to ask what part of me exactly was burning. The whole time I carried on a conversation with the doctor and the nurse... one kid was at camp, one kid was visiting his in-laws, the big kid known as the husband was visiting with high school friends. We talked about local farming, the tasty corn this year and drivers ed training.
Then it was over.
They made me sit in a wheelchair to go back to post op, but I was only there briefly. Vital signs, put back on the clothes and wait for my post op instructions. The discharging nurse was in the next room giving drain stripping instructions and I was awash in two waves: sympathy for the coming journey for the newbie and gratitude that I don't have drains. Her instructions for me were brief and I was dismissed.
I've taken Advil twice for soreness, but there really is very little pain. As I write this, I am getting ready to remove the dressings, reminding me of the emotion of my last unveiling that ended up being the story in Reflections from Women. I'm not ever going to try to convince myself that it's all better now, but this procedure gave me an undeniable sense that it's time to move on.
It's a whole different mojo now.
It was a pretty strange day for me, probably because I was home alone all morning. My family was out of town so I was a bit unhinged without distraction. Don't feel sorry for me, friends offered to keep me company and I declined. I wanted to drink in the enormity of the day alone. Even though none of this changes or even affects my long term outcome, it was something of a symbolic loop closing. This is big coming from a person who thinks that the idea of closure is just a fiction; an exercise is self-deception.
As the time approached I tried to call my husband and couldn't get through. I got a little basket-casey but he finally called as I was getting ready to walk into the surgery center. That was a tremendous relief. I always forget that he's a last minute kind of guy.
I got settled into the pre-op room, just like I did for my two other surgeries. I took my journal and tried to write, but I was nervous and anxious and seriously scattered. I kept thinking about my other surgeries, comparing and contrasting. This time I wasn't hooked up to an IV or any beeping equipment. It was just me in that humiliating surgical gown and since I was stone cold sober I could be supremely self-conscious about my derrière while walking across the hall to the bathroom.
For almost an hour I waited, leaning back in the reclining chair in my room just breathing. The breathing was doing its calming work except for the occasional interruption of the neighbors moaning and panting and crying. I didn't like that much. I had to keep reminding myself that was once me. And, that it was no longer me.
When the time came, I actually walked into the Operating Room. That was weird. Here I am in my gown, booties and special surgical hat being escorted by the nurse. It was like a victory march and four other nurses stood in the hallway and cheered me on like I was a rock star.
Dang, that was big.
I wish the some sort of theme song would have been playing. I'm thinking that Wide World of Sports song -- the thrill of victory... the agony of defeat.
I got all strapped in on the OR table with those big round lights shining on me. The doctor injected the area with something local and numbing and got to work. It was pretty weird. I could feel a little tugging, but there was no pain at all. I could smell a burning smell but was too afraid to ask what part of me exactly was burning. The whole time I carried on a conversation with the doctor and the nurse... one kid was at camp, one kid was visiting his in-laws, the big kid known as the husband was visiting with high school friends. We talked about local farming, the tasty corn this year and drivers ed training.
 |
| I didn't keep it, but I did look at it. It looked just like this one (except mine was a little bloody) |
They made me sit in a wheelchair to go back to post op, but I was only there briefly. Vital signs, put back on the clothes and wait for my post op instructions. The discharging nurse was in the next room giving drain stripping instructions and I was awash in two waves: sympathy for the coming journey for the newbie and gratitude that I don't have drains. Her instructions for me were brief and I was dismissed.
I've taken Advil twice for soreness, but there really is very little pain. As I write this, I am getting ready to remove the dressings, reminding me of the emotion of my last unveiling that ended up being the story in Reflections from Women. I'm not ever going to try to convince myself that it's all better now, but this procedure gave me an undeniable sense that it's time to move on.
It's a whole different mojo now.
Friday, July 23, 2010
Poetry Friday
The nerves sit ceremonious like tombs;
The stiff Heart questions--was it He that bore?
And yesterday--or centuries before?
The feet, mechanical, go round
A wooden way
Of ground, or air, or ought,
Regardless grown,
A quartz contentment, like a stone.
A wooden way
Of ground, or air, or ought,
Regardless grown,
A quartz contentment, like a stone.
This is the hour of lead
Remembered if outlived,
As freezing persons recollect the snow--
First chill, then stupor, then the letting go.
Remembered if outlived,
As freezing persons recollect the snow--
First chill, then stupor, then the letting go.
--Emily Dickinson
Thursday, July 22, 2010
Letting go
I've said before that this whole detour has taught me about letting go. It seems that the lesson continues to unfold.
Having the port removed is turning into a big deal for me. I was actually wondering if I'll ask to keep the port as a souvenir when someone asked me the same question. That brought me to the realization that that I have a house full of reminders.
First, the woo woo. When I first started taking Jazzercise class a few years ago, I won a beach towel in an attendance contest. I used that towel on my mat for floor work like most everyone else. Within a few weeks, I started to notice that my towel was wearing out faster than everyone else's. Other class members noticed too. There were tiny holes forming all over the towel, in a pattern that looked like rain drops (rain holes). I'm certainly no clean freak so I didn't wash it all that often or vigorously, but people constantly asked me what I'd done to my towel. I still see people in class with them and while faded with age, they're all in one piece.
Now I have no proof of this, but I just might believe that my prolific sweat was toxic when I had undiagnosed cancer and actually formed those holes. It turned into a Shroud of Turin sort of mystery for me, so I kept it in my bedroom closet and told exactly two people about my theory.
And now back to Planet Earth. Down in the basement I had all of my hats, scarves and my wig all packed up on a shelf. My daughter actually asked me if she could play with them and I was appalled. NO FUN WILL BE HAD IN MY CANCER HEAD COVERINGS.
So I am seeing this port removal as a sign that it's time to let go of my holy relics. The towel went out with the garbage yesterday morning. I packed up the head gear and shipped it all to an organization in NYC that collects them and gives them out to people with limited financial means.
Matt, to fill in your blank. No.
I feel much lighter. I don't think I'm in any danger of fully putting this behind me as if it never happened. I have doctor's appointments to remind me and, oh yeah, a couple of big scars and frequent wardrobe challenges.
Having the port removed is turning into a big deal for me. I was actually wondering if I'll ask to keep the port as a souvenir when someone asked me the same question. That brought me to the realization that that I have a house full of reminders.
First, the woo woo. When I first started taking Jazzercise class a few years ago, I won a beach towel in an attendance contest. I used that towel on my mat for floor work like most everyone else. Within a few weeks, I started to notice that my towel was wearing out faster than everyone else's. Other class members noticed too. There were tiny holes forming all over the towel, in a pattern that looked like rain drops (rain holes). I'm certainly no clean freak so I didn't wash it all that often or vigorously, but people constantly asked me what I'd done to my towel. I still see people in class with them and while faded with age, they're all in one piece.
Now I have no proof of this, but I just might believe that my prolific sweat was toxic when I had undiagnosed cancer and actually formed those holes. It turned into a Shroud of Turin sort of mystery for me, so I kept it in my bedroom closet and told exactly two people about my theory.
 |
| Another opportunity to show Marc in my wig |
So I am seeing this port removal as a sign that it's time to let go of my holy relics. The towel went out with the garbage yesterday morning. I packed up the head gear and shipped it all to an organization in NYC that collects them and gives them out to people with limited financial means.
Matt, to fill in your blank. No.
I feel much lighter. I don't think I'm in any danger of fully putting this behind me as if it never happened. I have doctor's appointments to remind me and, oh yeah, a couple of big scars and frequent wardrobe challenges.
Wednesday, July 21, 2010
A letter to that thing under my clavicle
Dear Port-o-pus,
I know I didn't offer you any Martha-esque hospitality when you showed up. Frankly, I didn't think I needed you and resented your intrusion into my life. See, in August of 2008, I still believed it was all a big mistake. When the anesthesiologist put me under to have my lymph nodes removed and tested, I was still thinking "if" and not "when." But as I came out of the fog, I found out that it was indeed cancer; the invasive kind. There you were, hooked into a vein close to my heart so that the poison/medicine could circulate most effectively.
That's something I still don't want to think about.
I admit that I found you annoying at first. During my pregnancies, I'd learned to sleep on my left side because I'd read a book said that it provided the best circulation for the fetus. When you showed up I had to readjust. My right side was difficult too, as my left shoulder would sink forward as I would relax and again become uncomfortable.
As usual, my body acclimated to its new reality and three weeks after we met you were put to the test. Scared and anxious, I had my first visit to the chemotherapy suite and realized that I had been too hasty in my judgment. I sat next to a man who chose not to get a port. Several nurses, many needle sticks and a whole lot of blood followed while I looked on in horror. While they worked on him, my nurse stuck a butterfly needle (called a Huber needle) in my port. I barely felt a twinge and the medicines were flowing within minutes.
That day I started to understand that you really were my friend. I admit with some shame that you had become my scapegoat, the target for my anger and self-pity. I have known others who have gone through the needless misery of no port because they didn't like the idea of it. I can't help but question their sanity. I always stick up for you (sorry for the pun).
After a few months, I had the mastectomy. You stayed around and we never missed an appointment. Early on, nurses noted my chart; my port was deep and needed a longer than standard needle. But after the skin tightening from the surgery, you became prominent, even visible. For the next 18 months, I explained to every single nurse that a standard needle was fine, that those notes were based on my pre-surgery body. Most of them listened to me but sometimes I had to deal with a not-quite-flat needle sticking out of you.
At least that gave me some "I told you so" moments.
Every three weeks for a year a nurse "accessed my port" which isn't nearly as fun as it sounds. But I never had pain and only had trouble the one time the nurse missed. When I told my surgeon that, she laughed and said she could hit you with her eyes closed. I have to agree. Last September I had my last infusion of medicine, the one patients like me call the Holy Water.
I was hoping to dump you like a load of flaming bricks but the ninja had other ideas. She's cautious, you know, and who can blame her. Things weren't looking so good when you first came on the scene.
So I faithfully went to the doctor to keep up on your maintenance and you faithfully worked every time. Every six weeks we woke you up and fed you saline and Heparin.
But now, after two years of a tumultuous relationship, it's time to part ways. I offer my gratitude for all you have done. The medicine worked as planned and thanks to you I avoided needless, and needleless, pain.
This Friday you will be removed in a brief, likely unceremonious, outpatient procedure. Remember, port-o-pus, attachment is the cause of all suffering. I wish you the best and remind you that it's not you -- it's me. Don't take it so hard and for goodness sake, don't beat yourself up and dwell on all of the what-ifs of life.
One final thought. Even though I appreciate all you've done for me, I hope I never have to meet another one of your kind.
Respectfully,
Katie
I know I didn't offer you any Martha-esque hospitality when you showed up. Frankly, I didn't think I needed you and resented your intrusion into my life. See, in August of 2008, I still believed it was all a big mistake. When the anesthesiologist put me under to have my lymph nodes removed and tested, I was still thinking "if" and not "when." But as I came out of the fog, I found out that it was indeed cancer; the invasive kind. There you were, hooked into a vein close to my heart so that the poison/medicine could circulate most effectively.
That's something I still don't want to think about.
I admit that I found you annoying at first. During my pregnancies, I'd learned to sleep on my left side because I'd read a book said that it provided the best circulation for the fetus. When you showed up I had to readjust. My right side was difficult too, as my left shoulder would sink forward as I would relax and again become uncomfortable.
As usual, my body acclimated to its new reality and three weeks after we met you were put to the test. Scared and anxious, I had my first visit to the chemotherapy suite and realized that I had been too hasty in my judgment. I sat next to a man who chose not to get a port. Several nurses, many needle sticks and a whole lot of blood followed while I looked on in horror. While they worked on him, my nurse stuck a butterfly needle (called a Huber needle) in my port. I barely felt a twinge and the medicines were flowing within minutes.
After a few months, I had the mastectomy. You stayed around and we never missed an appointment. Early on, nurses noted my chart; my port was deep and needed a longer than standard needle. But after the skin tightening from the surgery, you became prominent, even visible. For the next 18 months, I explained to every single nurse that a standard needle was fine, that those notes were based on my pre-surgery body. Most of them listened to me but sometimes I had to deal with a not-quite-flat needle sticking out of you.
At least that gave me some "I told you so" moments.
Every three weeks for a year a nurse "accessed my port" which isn't nearly as fun as it sounds. But I never had pain and only had trouble the one time the nurse missed. When I told my surgeon that, she laughed and said she could hit you with her eyes closed. I have to agree. Last September I had my last infusion of medicine, the one patients like me call the Holy Water.
I was hoping to dump you like a load of flaming bricks but the ninja had other ideas. She's cautious, you know, and who can blame her. Things weren't looking so good when you first came on the scene.
So I faithfully went to the doctor to keep up on your maintenance and you faithfully worked every time. Every six weeks we woke you up and fed you saline and Heparin.
But now, after two years of a tumultuous relationship, it's time to part ways. I offer my gratitude for all you have done. The medicine worked as planned and thanks to you I avoided needless, and needleless, pain.
This Friday you will be removed in a brief, likely unceremonious, outpatient procedure. Remember, port-o-pus, attachment is the cause of all suffering. I wish you the best and remind you that it's not you -- it's me. Don't take it so hard and for goodness sake, don't beat yourself up and dwell on all of the what-ifs of life.
One final thought. Even though I appreciate all you've done for me, I hope I never have to meet another one of your kind.
Respectfully,
Katie
Tuesday, July 20, 2010
Face the Ninja
I can't really explain why I am so incredibly nervous, but I really felt this same way six months ago. It's time for my checkup with my surgeon.
People call her the Cancer Ninja and everyone familiar with my story knows that she was my "third opinion" two years ago. I was misdiagnosed with the first opinion and was given a scorched earth recommendation with my second opinion. A good friend of mine pointed me in the direction of a group of surgeons who specialize in breast cancer and the next day I was weeping in the ninjas office. All she did was look at my original mammogram and told me what was what. She had to do some surgery to prove it, but she was correct.
I am not the only person with that sort of story about her. She knows her stuff. The one criticism that most people have of her is that she's not the warm and fuzzy type. It's true and I will say that first day I would have liked someone to pat me on the head and tell me it was going to be okay. But she didn't know that and really, I want the best doctor I can find, not a bff.
But I do believe that she thinks I am, at best, emotionally unstable. She has operated on me twice under general anesthesia and both times I have started bawling as I was waking up. That makes me three for three, as I did the same thing when I had my wisdom teeth out twenty years ago.
In fact, she just might be on to something.
Seriously, I guess she's used to tears in her profession. A friend of mine just saw her for a biopsy and said she was so nervous that she couldn't stop talking and asking questions. At one point she even asked our Ninja if her hands were steady today. Even when I see her now, she asks me brief questions and I just babble. Extreme stress does strange things to us, I suppose.
Oh, and here's a little gem you can't live without. Despite the utter lack of evidence, I decided to stop wearing antiperspirant after my diagnosis. There is aluminum in it and that's always made me a little nervous. I couldn't wear it during radiation and I found out that it really wasn't bad at all. I am increasingly convinced that it's another marketing myth. However, I do sometimes get a little stinky, so when I work out, I wear natural deodorant that is aluminum-free. It works fine. Really. But in the winter I don't wear it all the time. I forgot the day I went to see her and, well, I was nervous.
Must I paint you a picture?
When I saw her in February, she said that if I am all clear at the next appointment, I can have the port removed. That next appointment is today. I am just about a month shy of having that port in place for two years. It feels like a another milestone.
It also feels like judgment day. I have no reason to be afraid. I have no lumps, no bumps, no bone pain, unusual headaches, double vision, etc.
It's just that she's a NINJA, you know?
I also don't know if she's just rip the sucker out (the port, that is) or if I'll have to schedule and outpatient procedure. It seems like they all do it differently. At least that's what Dr Google tells me.
So today at around 3 pm EST, be thinking of me. The anxiety dreams have been coming fast and furious!
I am not the only person with that sort of story about her. She knows her stuff. The one criticism that most people have of her is that she's not the warm and fuzzy type. It's true and I will say that first day I would have liked someone to pat me on the head and tell me it was going to be okay. But she didn't know that and really, I want the best doctor I can find, not a bff.
But I do believe that she thinks I am, at best, emotionally unstable. She has operated on me twice under general anesthesia and both times I have started bawling as I was waking up. That makes me three for three, as I did the same thing when I had my wisdom teeth out twenty years ago.
In fact, she just might be on to something.
Seriously, I guess she's used to tears in her profession. A friend of mine just saw her for a biopsy and said she was so nervous that she couldn't stop talking and asking questions. At one point she even asked our Ninja if her hands were steady today. Even when I see her now, she asks me brief questions and I just babble. Extreme stress does strange things to us, I suppose.
Oh, and here's a little gem you can't live without. Despite the utter lack of evidence, I decided to stop wearing antiperspirant after my diagnosis. There is aluminum in it and that's always made me a little nervous. I couldn't wear it during radiation and I found out that it really wasn't bad at all. I am increasingly convinced that it's another marketing myth. However, I do sometimes get a little stinky, so when I work out, I wear natural deodorant that is aluminum-free. It works fine. Really. But in the winter I don't wear it all the time. I forgot the day I went to see her and, well, I was nervous.
Must I paint you a picture?
When I saw her in February, she said that if I am all clear at the next appointment, I can have the port removed. That next appointment is today. I am just about a month shy of having that port in place for two years. It feels like a another milestone.
It also feels like judgment day. I have no reason to be afraid. I have no lumps, no bumps, no bone pain, unusual headaches, double vision, etc.
It's just that she's a NINJA, you know?
I also don't know if she's just rip the sucker out (the port, that is) or if I'll have to schedule and outpatient procedure. It seems like they all do it differently. At least that's what Dr Google tells me.
So today at around 3 pm EST, be thinking of me. The anxiety dreams have been coming fast and furious!
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