Monthly zometa

Today was zometa day, my monthly infusion treatment of a bone-strengthening drug. I've been taking this or another bisphosphonate for seven years with apparently much good effect. My bones appear to be healthy and it seems to have had no adverse impact.

Still, every month I sit in the chemo chair, have my port accessed, and am reminded that my cancer is here, there and everywhere in my bones. I'm fortunate that except for one drug, the 5FU that almost killed me in May, over these past seven years everything else I have taken has been oral. I pop a pill at home or swallow a small capful of stuff and hopefully it works.

My tumor markers (CA 27.29) have been trending upwards the past few months. I must ask the oncologist if this is something he's worried enough about to make a change in my treatment. Since I see him later this week, I should be able to remember.

Plus the Journal of the American Medical Association recently published an extract on estradiol therapy which has been widely quoted for lay people elsewhere.

As Dr. G has always said, I just have to stay alive long enough for the next thing to come down the pike.

Two publications about colorectal cancer

The Key to Stopping Colon Cancer? Med Tech Sentinel, August 30, 2009. Excerpt:

Scientists in Switzerland may have found a way to inhibit the growth of colon cancer in humans, says a new study published in EMBO Molecular Medicine. Researchers in Geneva discovered that by blocking a particular biological pathway, they could prevent the growth of tumors, metastatic lesions, and cancer stem cells. The Hedgehog-GL1 (HH-GL1) pathway appears to be crucial in the progression of colon cancer to an incurable, late stage. Cells use HH-GL1 to communicate with each other to determine position, growth and survival.

See also: 'Hedgehog' pathway may hold key to anti-cancer therapy, EurekAlert, August 26, 2009.

These news reports are about the publication: Human colon cancer epithelial cells harbour active HEDGEHOG-GLI signalling that is essential for tumour growth, recurrence, metastasis and stem cell survival and expansion by Frédéric Varnat and 6 co-authors, including Ariel Ruiz i Altaba, EMBO Molecular Medicine 2009(Aug 27) [Epub ahead of print][Abstract][Full text].

Another excerpt from The Key to Stopping Colon Cancer? (Med Tech Sentinel, August 30, 2009):

Earlier this month, scientists in North Carolina found another genetic target that may be useful in treating colorectal cancer. The pseudokinase ERBB3 is closely related to epidermal growth factor receptor (EGFR), which is already a target of several drugs used to treat colorectal cancer. Scientists found that genetically blocking ERBB3 was effective at preventing the disease in mice with colon cancer. In human colon cancer cells, removing ERBB3 caused a dramatic increase in cell death.

About the publication: Tumor-specific apoptosis caused by deletion of the ERBB3 pseudo-kinase in mouse intestinal epithelium by Daekee Lee and 8 co-authors, including David W Threadgill, J Clin Invest 2009(Aug 17) [Epub ahead of print][PubMed Citation][Full text].

all good things

Today is a pretty emotional day for my little family.

Tomorrow, my youngest, will start Grade One at a new school. While that's a pretty big deal in and of itself (at least it's the same school his big brother attends), this also marks his last day at the day care housed in his old school.

My family has been involved (except for a few years between kids and when D. was in home care), with the Glebe Parents' Day Care since 1999, when S. was a toddler. It's a great day care but the staff at their First Avenue program are truly exceptional.

When S. was "emergency airlifted" out of First Avenue in Grade One, they re-opened the day care an hour early so that staff could meet him at the bus (his temporary school was further away and the school day ended earlier) for the rest of the term (from February until June).

And, earlier this year, when I needed a space to launch my book, the staff offered their wonderful facility free of charge. They decorated it so beautifully and there was even a message on a chalkboard in the washroom telling me how proud they were of me.

And those are just a couple of examples.

This past week end, D. and I made a poster-sized card with a photo of our family. We all signed it. We also made cookies (I burned the first two batches, my spouse did the baking of the last couple, as I was becoming hysterical). We also gave them a bottle of gourmet chocolate sauce to pour in their coffee.

D. and I made cards for the three teachers who hosted the book launch. I want to make scarves for all three of them but of course, only one was finished. D. had me paste photos of the scarves in the cards for the other two, so that they would know what they are getting (I made a "Lace Ribbon" scarf for J., T. is getting a "Clapotis" and, if I can manage the pattern, I want to make "Juno" for A.)

I had T. and D. deliver it all to the day care, confessing to my spouse that I am "emotional coward." Apparently, the staff and T. have decided that I am not to be let off the hook, though, so S. and I will join T. when he goes to collect D. at the day care this evening.

There might be tears.

These photos were taken first thing this am and are thus not particularly flattering. I just wanted a photographic record.

To distract myself this, I thought I'd do this nifty little book meme that Sassymonkey wrote about at BlogHer:

"Using only books you have read this year (2009), answer these
questions. Try not to repeat a book title. It’s a lot harder than you
think!

Here's the meme with my answers. If you haven't read enough books so far this year to answer all the questions go back as far as you need to get enough books. If you've played it on your blog leave a link so I can go visit."

I was planning to do it even before I noticed that Sassymonkey had used my book to answer one of the questions but that particularly tickled me.

Describe yourself: Dragonslayer (Bone #4, Jeff Smith)

How do you feel: What It Is (Lynda Barry)

Describe where you currently live: Three Day Road (Joseph Boyden)

If you could go anywhere, where would you go? Toronto Noir (Janine Armin and Nathaniel G. Moore, eds.)

Your favorite form of transportation: Walk Through Darkness(David Anthony Durham)

Your best friend is: Tipping The Velvet (Sarah Waters)

You and your friends are: Casting Spells (Barbara Bretton)

What’s the weather like: All the Colours Of Darkness (Peter Robinson)

You fear: The Price Of Darkness (Graham Hurley)

What is the best advice you have to give: Nobody Move (Denis Johnson)

Thought for the day: Don't Look Twice (Andrew Gross)

How I would like to die: A Good Death (Elizabeth Ironside)

My soul’s present condition: Hurry Down Sunshine (Michael Greenberg)

I seem to have read a lot of books with darkness in the title.

50 x 50 Campaign ~ September 20, 2009

See Jenn Tri to raise $100,000 by competing in triathlons in all 50 states by the age of 50.

Lung Cancer Research May Lead To Early Detection

http://cbs11tv.com/health/lung.cancer.research.2.1143814.html

Recently I was interviewed by CBS 11 to talk about LC (lung cancer) and my particular case. This interview also mentions that there is some great research being done in the area of non / never smokers that are diagnosed with lung cancer. I really hope this will help people to understand that cancer and YES even lung cancer is an every PERSON disease and no one is excluded from one day possibly having to deal with a similar diagnosis. I never smoked but that is irrelevant; a persons lifestyle does not warrant whether or not they should or should not have lung cancer. The smoking stigma associated with cancer makes it a crime in the court of public opinion for pharmaceutical companies, government, and Joe the average citizen to contribute to lung cancer research.

Short Spa Trip today

Had to stop in at the spa today, I was a little nervous as I feared they might won't to keep me; (I was only there to visit my cancer homie / SOON to be transplant homie; and to get a nasal wash). I was in and out so I can enjoy football at home.

BOTM SEPTEMBER 2009

...is ready for pick-up!
When you come to pick up your beers there will be a sheet for you to sign which outlines our new policy on late pick-ups.

cheers,

dave hauslein
beer manager
415-255-0610

New Stuff

1. Ballast Point Big Eye IPA
2. Ballast Point Black Marlin Porter
3. Ballast Point Dorado Double IPA
4. Drake's IPA
5. Drake's Imperial Stout
6. 21st Amendment IPA/Watermelon Wheat (in packaging that doesn't instantly fall apart when you pick it up!)
7. Anderson Valley Summer Solstice
8. New Belgium Hoptober
9. Elysian Avatar Jasmine Ale is back!


cheers,

dave hauslein
beer manager
415-255-0610

Let's make a deal

WCK asked if she could have five books read to her at bedtime. Usually she gets two or three. I told her that, yes, if she cleaned up all of her toys without being reminded, if she could get through the entire bathtime/toothbrushing/pajama routine without complaining or yelling at me, then she could have five books.

WCK thought about this for a minute.

"How 'bout just four books?" she said.

Globe & Mail article on CSCs

Cancer stem cells spur hope, skepticism by Jill Colvin, The Globe and Mail, August 27, 2009. [WebCite cache][Twitter entry][FriendFeed entry]. Excerpt:

Ontario Cancer Institute researcher John Dick, arguably the world's leading authority in the field, first identified stem cells in leukemia in the 1990s. Today, few doubt they play a key role in blood cancers.

In addition to this comment about the crucial contributions of John Dick, research on brain-tumour stem cells by Samuel Weiss is noted. There's also mention of the MIT and Harvard joint venture, Identification of Selective Inhibitors of Cancer Stem Cells by High-Throughput Screening, published in Cell 2009(Aug 13). [See also this post in CSC News, August 14, 2009].

The criticisms by Scott Kern (such as: The fuzzy math of solid tumor stem cells: a perspective) of application the CSC hypothesis to colon, breast, or lung cancer are outlined. There's also a comment attributed to Richard Hill:

The hypothesis also hinges on the assumption that these cells are rare. Otherwise, traditional cancer therapies that shrink tumours would be killing them, too, and there would be no need to develop specialized treatments.

The "game-changing paper" by a team led by Sean Morrison, Efficient tumour formation by single human melanoma cells is also discussed. [See another post in CSC News, December 3, 2008, about this paper]. This research supports the view that "... stem cells may be key for some kinds of cancers and not for others".[This paper has attracted much attention. See, for example, Cancer Stem Cells May Not Be the Supervillains We Thought by Alexis Madrigal, Wired Science, December 3, 2008].

The article in The Globe & Mail ends with a paragraph about the hope that "new drug combinations that target all cell types" [associated with tumors] will be found, and a quote from William Hahn: "Whether the hypothesis is correct or incorrect in its full-blown beauty is really not important in the end" . [What really matters, from a clinical perspective, is whether or not efforts to target CSCs, in addition to other kinds of cells associated with tumors, will lead to improved outcomes for patients].

The article has already attracted some comments from readers.

Disclosure: I'm a co-author of some early papers about the CSC hypothesis, such as: J Natl Cancer Inst 1983(Jan); 70(1): 9-16.

Simple and Simpler

I've been busy. Really busy. That's good, right, especially when the busy business has nothing to do with illness or doctor's appointments.

As far as cooking, I like to keep things simple in the summer time. See just how simple things get at Open Mouth, Insert Fork.

Two reviews about oncolytic viruses

1) Oncolytic adenoviruses targeted to cancer stem cells by Joshua J Short and David T Curiel, Mol Cancer Ther 2009(Aug); 8(8): 2096-102 [Epub 2009(Aug 11)][PubMed Citation].

2) Targeting cancer-initiating cells with oncolytic viruses by Timothy P Cripe and 4 co-authors, including Patrick WK Lee, Mol Ther 2009(Aug 11) [Epub ahead of print][PubMed Citation].

[Found via CSC-related articles bookmarked in Connotea].

Review of current knowledge on pancreatic CSC

Role of cancer stem cells in pancreatic ductal adenocarcinoma by Gregory Sergeant, Hugo Vankelecom, Lies Gremeaux and Baki Topal, Nat Rev Clin Oncol 2009(Aug 18) [Epub ahead of print]. PubMed Abstract:

As our understanding of pancreatic cancer evolves, evidence is growing to support a role for cancer stem cells in this devastating disease. Cancer stem cells constitute a distinct subpopulation in the tumor and are considered to drive both tumorigenesis and metastasis; these cells are thought to be highly resistant to standard treatment modalities. Here we review the current knowledge on pancreatic cancer stem cells and the implementation of cancer stem cell markers as prognostic or predictive biomarkers. We also discuss prospects for the use of cancer stem cells as targets for future therapeutic regimens in pancreatic cancer.

[Found via CSC-related articles bookmarked in Connotea].

The bitch is rich!

I got my first royalty check ever today: 895 whole dollars, US.
I still owe money to the publishers of my other two books; the difference is that they paid advances. U of Iowa Press, publisher of The Adventures of Cancer Bitch, did not. So I have nearly $900 free and clear. The book is in its second printing. The only way to go is up.

in pictures

These are some illustrations for the post I wrote on August 10, about our trip out east. Thanks to my sister in law, B. for taking the horse photos. There is NO WAY I was letting go of the reigns long enough to point and shoot.

Musing on birthdays

Today is my sister's birthday -- happy b-day to you, sis! We're only 18 months apart in age, and that means I will turn 50 in November.

What is it with us that we celebrate the day we were born? As children, we look forward to a party, eat cake and ice cream, open presents. As adults, we measure milestones by how old we are. What did I achieve of my life goals by 21, 30, 40?

At 21 I was in graduate school, hoping to start my career. By 30 I was angry that I hadn't yet married or had children. And at 40 I had already had cancer for almost a year.

And yet as I wish my sister a happy birthday, I think about my own mortality. Seven years ago I wasn't sure I would live long enough to celebrate my 50th birthday. For me, these days are more precious now than ever before. Every birthday means I spit in cancer's eye once again, saying "hah!" that I have reached another marker, and thank God that I have lived another year.

Rik always sends his mother flowers to thank her for bringing him into the world. Now that's a nice way to celebrate a birthday! If you like, feel free to make this custom your own.

Beginning, Middles and Ends

Sorry I have not posted in awhile. My life has been kind of busy lately, getting both of my kids off to college. I am officially an "empty-nester" now for the first time. I have been an "empty-nester" for 7 days.

My kids have been calling often, so we are still in close touch, and my youngest plans to come home to visit often. I'm so glad for that (even though we ran over on cell phone minutes!).

I talked to a mom a few days ago who has one in college and another a senior in high school. When I mentioned to her I was an empty nester now as both of my kids are away, she got a look of dread in her eyes. She is terrified of her upcoming empty nester days. Another empty-nester mom wrote me yesterday...she is a few years out in the experience, and two of her kids now live out of the country, one in Japan and one in the Middle East. Once we let them out of the nest we don't know how far away theirs lives will take them.

I know lots of women experience a crisis when their kids leave the nest. I'm not having a crisis; but I guess my perspective is different.

When I was told I had an untreatable cancer and not expected to survive, all I wanted in life was to be here long enough to raise my kids to independence, to see them off on their own independent life journeys. So for me, in a sense, it's a celebration to have made it this far. When I was diagnosed, I did not want to abandon my kids when they needed me, I wanted to live long enough for them to "abandon" me, to fly off on their own wings as adults. I have realized that dream and am very, very grateful for that.

While I love and miss my kids, I want them to be able to achieve dreams and to be independent and not to rely upon me solely, as they did when I was diagnosed. I want them to yes, care about me and love me and for us to always be close, but I don't want their future to depend on my presence...as cancer made me understand how fragile my presence is. I want them to have dreams and goals and hopes that are theirs to motivate them, to have lots of people who support them whether I am here or not. They are amazing people and have so much to offer this world.

I always pursue spiritual growth. To me it's why we are here...I have always believed we are first spiritual beings having a physical experience vs. physical beings having a spiritual experience. To me our physical presence isn't "it", our experience in this lifetime is just a piece of a larger puzzle.

In a grocery store checkout line recently, I was intrigued by a booklet entitled "Complete Idiot's Guide to Spiritual Healing". In many ways I am a novice in life, and I am not very proud, so I love the "Idiot" books. I already own a few. I paid the $2.50 for the booklet, and haven't read it all yet, but there was a paragraph I flagged in the beginning from the chapter that I liked, "Beginnings, Middles and Ends".

I've been at all of those points with my kids...beginnings as a new mother, middle times when I was raising them, and ends, now, when they are on their own as individuals with their own dreams and values to guide them.

The paragraph I flagged in the "Idiot" booklet said this..."Life is a series of beginnings, middles and ends. Each ending is the start of a new beginning and each beginning is the start of a new ending. Often we have a hard time letting go and trusting the process. We fearfully hold on to something when it is time to let go and miss the joy life has to offer". I agree.

I am so fortunate...I've lost friends to appendix cancer who still had children under 5 years old. I've lost friends who were in the middle, with pre-teen and teen children who still needed their mom. I've lost friends who were never able even to realize their dream of being a mom. One in her 30s died only an hour after I met her in Texas. So many lives cut short. I've lost a lot of friends to appendix cancer; that tempers my empty-nest perspective now.

So I see this empty-nester time as an end of sorts...of my kids needing me less and being less dependent on me, but also a time as a new beginning, for them and for myself. While I feel a sense of loss, I also feel a sense of liberation. For my kids and for me, it is a not so much a time of endings, but of new beginnings. I'm not done yet, and neither are they.

I'm so glad that my kids, and I, have that opportunity. For a new adventure, a new beginning. I am so grateful for this time in our lives.

Bo & Adrienne bad news

Got a bit of bad news today, not about me about some of my cancer / transplant homies.

• Bo has developed clots and is being watched more closely by the Dukies (Duke medical staff)
• Adrienne will have a procedure to check her lymph nodes (making sure the BAC has not spread, this is a very uncomfortable but common FEAR all BAC patients had to undergo before transplant).
• I am felling ill so Adrienne and I might be neighbors at the SPA (look out nurses...)

Prayer List
Bo and Family
Adrienne and Family

Another day, another doctor

WCK had never had a nosebleed in her life, until Saturday, when she had three small nosebleeds in one day. They weren't too terrible and went away pretty quickly, in just a minute or two. I spent a lot of time Googling nosebleeds and was reassured that most nosebleeds in kids aren't serious, you should treat them with saline drops and Vaseline, and they're usually the result of a pick (or a scratch, as Jerry Seinfeld would say).

Today WCK had another small nosebleed at school, so I decided to call the doctor's office, just so I could have an actual nurse reassure me over the phone that most nosebleeds in kids aren't serious, you should treat them with saline drops and Vaseline, and they're usually the result of a pick or a scratch.

Instead, the nurse said, "Oh, I don't like the sound of this at all. You need to get her in here right away." She could get me an appointment immediately, but we'd have to see a resident and the "real" doctor afterwards. I agreed to come in, as my blood ran cold, imagining my child with some horrible bloody-nose disease. At least there was no time to sit around and Google "bloody nose disease", or who knows how much more panicked I would have become.

After two hours at the pediatrician's office, two consultations with two different doctors, and a $20 co-pay, I was reassured that most nosebleeds in kids aren't serious, you should treat them with saline drops and Vaseline, and they're usually the result of a pick or a scratch.

The lady at the front desk gave WCK a sparkly Hannah Montana sticker, and she was beyond thrilled, so at least the afternoon wasn't a total loss.

CANTILLON, FANTOME, ACHEL

1. Achel Extra 750ml
2. Cantillon Cuvee Des Champions 750ml
3. Cantillon Iris 2007 12oz
4.Fantome 750ml



Cheers,

dave hauslein
beer manager
415-255-0610

Trigger Happy

I haven't told you, beloved blog readers, because I don't want to be worrisome, but I've been having pain where my tumor used to be. It's been an ordeal to find an oncologist here in San Francisco- they won't assign one to you unless you've seen a GP, which I don't have, duh, because I have cancer. It took weeks to get a referral from my own oncologist back in Sacramento, but finally, I was able to get an appointment on Tuesday.

This was my first time in SF oncology and, um, talk about triggers. They make you wear a wristband regardless of whether you are getting chemo or seeing a doctor, while in Sac they only banded me for chemo. So, as you can imagine, the band sent me into panic mode and tears started welling up in my eyes.



Fast forward to the doctor visit, they don't think my pain is cancer related since I was NED on a scan 3 weeks ago. It's probably scar tissue, but we will "watch and wait" (don't you love that phrase?). I asked when I could have my port taken out, and the onc said I've got to wait until my next scan. "But when is the last time you had it flushed?", she asks. "Uh, May?" I mutter. Oh crap, I forgot about port maintenance. "You need to get it flushed TODAY." Double crap. I can't face the infusion room just yet. But... responsibilities and such. So I sit in the ugly mauve alcohol soaked recliner and try to keep it together.

No such luck. I start hyperventilating and sobbing, trying to explain to the nurse that it's the first time I've been back since chemo. She just looked sorry for me. I sucked it up towards the end and got my saline/heparin injection just like I've done a million times in the past. I was numb throughout my treatment, but now that the trauma has settled in I'm a nervous wreck during such small procedures. I hope it gets better.

On the positive front, I am getting ready to start my senior year of school, the one that I had to quit in leiu of chemo. I am excited. Let's hope I make it past the first class this time!

ottawa folk fest 2009

It's a highlight of every summer for my family, and this year's Ottawa Folk Festival was no exception (although we did miss S. a lot. He's staying with his Grandma and going to comedy camp. He says they spend their days doing improv routines and watching highlights from Saturday Night Live. The kid is in heaven). And this year, despite forecasts to the contrary (and some really nasty looking storm clouds) the weather was perfect.

I think I kept the rain away through sheer force of will.


This is Vishtèn, a group we really liked from PEI and the Magdalen Islands. Other highlights for me included James Keelaghan, the Good Lovelies and a workshop called Outstanding In Their Field that featured Digging Roots (excellent musicians, great voices, hard rocking native musicians), the Arrogant Worms, Charlotte Cornfield, Tall Trees (the teenage winners of this year's "rising stars" award. I was really charmed by them) and Stewed Roots. I also think I might have fallen in love with Victoria Vox and her ukelele.

My spouse and I both loved James Hill and Anne Davidson.

Every folk festival has moments of magic. T. (whose personal highlights were a lot like mine), D. and I all agree that those moments this year came courtesy of the Common Ground Cross-Cultural Collaboration (couldn't find a link to explain this amazing process of bringing together artists from all over North America and throwing them together to make music):

"When the artists are having fun it is infectious. Our final daytime show ended with the whole group getting off the stage and leading the audience dancing around the room. One of those special festival moments."

On Saturday afternoon, my sister and brother-in-law collected D. so that T. and I could enjoy some child free time and take in some music without being subject to the (sometimes tyrannical) whims of our youngest child. That night, we stayed to the very end (although, I did take in Bruce Cockburn while lying down with my eyes closed. It was nice).

Attending the Folk Festival with a six year old is a different experience. You don't always get to choose what concerts you attend and you can never be sure if you will hear a full set.

But I got to sit in the shade with my son between my legs. I listened to music and watched his face as he read to himself (hooray for reading!).

I balanced him on my knees and we listened to music together.

And we all danced our hearts out.

While it was frustrating to miss out on some workshops I wanted to hear (like Songs From The Road, featuring Bruce Cockburn, Steven Page and Joel Plaskett), I got to do and see some things I might have missed entirely.





We spent more than an hour building a model of a cob house.

We watched some folks learning to dance the Charleston.

D. painted his name in Japanese characters and made an origami flower.

And we did all this without setting foot in the kids' tent.

Going to the Folk Festival with a six year old is exhausting but I don't resent it for a moment (although I would probably feel differently if we hadn't had the break on Saturday).

And the thing is, I think that these are the memories that will stay with me.


And it wouldn't be the FolkFest if I didn't spend some time knitting in public.

I didn't even mind when, at around 5:00 on Sunday, D. announced that he wanted to leave. It would have been great to stay and hear the evening concert but going to St-Hubert for dinner was special in its own way.

"This is such a great feast!", D. announced. It was a great end to a wonderful week end.

(You can see the full list of FolkFest artists here).

he's only six years old

Today's scheduled post is being pre-empted by a story I want to share with all of you.

My younger son, D., had an appointment at the dentist's today. I decided to turn the day into a special outing and go out for lunch and then to the movies (G-Force. I still do not like rodents).

When the movie was over, he announced that he had to go to the bathroom. As I wrapped up a phone call with my spouse and went to open the bathroom door, a man stepped towards me and said, "I think he's way too old to go in there with you. He looks like he's at least four years old."

I thought he was kidding. I smiled and said, "He's six."

"Six! You really shouldn't be going in there."

He was serious. And outraged (I'll bust some stereotypes and tell you that he was young - no older than early 30s). As I stepped around him and gently pushed my son through the door, I heard him say, "I'm going to talk to the manager."

I was flabbergasted.

D. was quite upset as he has been really reluctant to go into the women's washroom for the last year or so (although lately he's gone in with me when we are out alone without complaining).
He was mortified.

I am not an overly protective parent nor am I prone to paranoia. I also know all that so many more children are harmed by adults they know than ones they meet in the bathroom at the movie theatre.

However:

He can barely reach the taps in public washrooms, let alone the soap dispenser.

He often can't get the stall door to close.

Sometimes, he can't get it open.

Despite his protestations, he's afraid to be by himself in an unfamiliar place.

He's six years old. And it is still several years before I am going to let him out of my sight in any public place.

When I was six years old, a stranger exposed himself to me.

I let my 11 year old go into the men's room by himself. Once, when D. had a friend with him at the movies, I let both boys go in together and stood outside with my heart in my mouth until they re-appeared (I asked if they had washed their hands. My son said, "Yes!" His friend said, "No, you didn't!").

I think the answer to "When is your child old enough to [fill in the blank]?" depends very much on the individual child and on the parents' comfort level (I often say that it's really good that my boys have two parents, otherwise they would never be allowed to do anything). I am, however, very comfortable asserting that my six year old will be coming into the women's washroom with me for a while yet.

And what's the big deal, anyway? Women's washrooms have stalls. It's not as though D. is peeking under the doors. When I went to university, at least one of the residences had only co-ed bathrooms. Now that was weird - brushing my teeth in the morning and having some guy walk by in a little towel.

How do you handle the bathroom situation when out with your kids? How do you feel when you see a child of the opposite sex in a public washroom?

The tooth, the whole tooth ...

WCK had her six-month dental checkup this morning. If you'll remember, her last dental checkup was a little bit, um, traumatizing, mostly for me and for the poor hygienist, who probably decided to switch careers and/or developed a drinking problem because of my child.

Today, though, WCK did a great job. I was so proud. She got into the chair, squeezed her eyes shut, opened her mouth wide, and let the hygienist go to work. She didn't have any cavities, and -- here's the big news -- she has two loose teeth! I know she's pretty young for that, but I started losing teeth at her age, and the dentist said it was OK. Now we just have to wait for the teeth to fall out and for the Tooth Fairy to arrive. The consensus seems to be that the Tooth Fairy leaves $1. Anyone heard anything different?

After the dental visit, I then had to make good on the heavy-duty bribes I had promised beforehand. If I were in charge of the world, I'd make insurance pay for the bribes we offer our children to get them to behave at the dentist and doctor's office. Do you know how much harder it would be to vaccinate so many children against contagious diseases if not for the promise of McDonald's? It's for the good of the nation. I know I'm not alone in the bribing. I've noticed that our local pediatric urgent-care is actually connected to a Toys R Us. Seriously. That must bring in tons of business.

Anyway. We went out to lunch at Panera, and then she was able to pick out one small thing at the above-mentioned Toys R Us. She picked out a "Puppy Pals" game for her little ClickStart computer. WCK's cousin has Puppy Pals for her computer, and WCK has been pining away for it since July. You can dress the computerized puppy in little outfits, including an eye patch, a big floppy straw hat, and a moustache. Worth every penny.

Red and Black

As a kid, it seemed that everyone else had gotten the guidebook. The other kids knew what it meant, for example, when someone asked if you were a Texan or an Aggie. They knew whether it was polite to eat fried chicken with your hands during school lunch. (They did not hunch down and eat behind their lunch kits.) They knew what the raised middle finger meant ("something about those bathroom things," H guessed in 6th grade, and I wasn't sure whether he was close or not) and how the car blinker knew when to go on. They knew what game we were playing when we wore bibs called pinneys and stood in front of "goals." They also understood Red and Black, which was a ritual at summer camp, the reason red and black bandanas were on our packing list, along with t-shirts, shorts and tennis shoes.

I think the whole camp was divided in half, and we won team points by doing activities. I barely remember, but I know I was confused. I didn't understand the purpose. I have an inkling of the purpose now: It was the last week of camp, so Red and Black got everyone all excited, knocking them out of complacency or boredom; it was a way to meet kids in other bunks and bond with them; it inculcated us into the dog-eat-dogness of the Military Industrial Complex awaiting our older selves. Red stood for Red, and Black for Black--we weren't talking Socialism and Anarchy.

And yet, the paradox is that Red and Black week was all about the communal. The Red Team worked together (I guess, but it must have been unwieldy) and so did the Black. We're talking about that sacred American institution, the team. Team spirit. Team player. The alleged ethos of our camp was carved out on a board nailed over the entrance to the mess hall: God-1, You-2, Me-3. The individual wasn't that important. Your friends were. Your teammates.

I can't remember being on a team, a real team. We must have had them so that we'd know which side of the volleyball or badminton net to stand on in gym class, but I don't remember any team consciousness. At least I wasn't always the last kid picked for a team; I should have been, since I was so ungainly and confused, but there must have been girls more outree and unfortunate than myself. I don't remember suffering in that way and I carry grudges.

In high school, for the very first time in my life, I was a little bit better than some others in a physical skill. I jogged longer and faster than a couple of other girls. I collected ribbons for accrued distances. They were printed in different colors and featured a running cardinal, our school mascot. Junior year, Title IX was passed, the law guaranteeing equality in sports, and one of the gym teachers began arranging a track team. I thought for a moment of joining, but I didn't. I have asthma that's aggravated by exercise, but I also have tremendous lung capacity. I could have been a contender.

I have rowed three times now. I do not look forward to competing with other clubs. I do not care if our scull goes faster than the other one. (I'm brought out of the boat for informal races, so that a more experienced rower can help the scull move forward--or to put it another way, so that my choppy oaring won't impede movement and others can get a workout). I'm competitive but also indifferent. If no one expects anything of me I do well. The other side of the experience is the encouragement. Practices are a mix of: Perfect! Much better than last time! and imperatives: Watch M and move when she does! Put your oar all the way in the water! Bring it on in! Watch S! Take your oar out! Push off with your legs! Sweep all the way back!

I know we should all be working together; I'm not coordinated enough to do that all the time.

Have you ever been on a team before? I asked M last week at rowing practice. No, she said, and I said No too. This is rehabilitation for us Boomers Who Were Left Out. Someone else made off with our slice of the American Dream. We want it back. No questions asked.

Catching up on life

We were kind of hunkered down over the weekend, waiting to see how Rik would feel for the few days after his fall.

Friday night was just us, no guests, but I did make a nice dinner and some peach ice cream from the four over-ripe peaches left. On Saturday I went to shul as usual and we had a brief visit from RIk's "other mother," S. As things turned out, Rik didn't experience great discomfort until Sunday. Vicodin helped a lot, as did a heating pad and taking a nap. I took the dogs to the off-leash park at Magnuson to let them have a romp.

I have finally gotten into the garden to do some much needed weeding. My plan is to clean everything up for fall and spread some mulch around to keep down the weeds. I seem to be able to spend an hour or so on my knees at a time, which is working out well. The tip of a finger from one of my new garden gloves tore right off, so I was forced to used to the old suede ones that aren't as flexible but are practically indestructible. The side yards are about done; now I have to get into the strawberry and raspberry patches, always a big job that I leave for last.

I am still picking tomatoes and enjoying my "fakin," lettuce and tomato sandwiches on a daily basis!

not done yet reviewed for the cmaj

I have recovered from chemo but a week end at the Folk Festival and a night of insomnia have left me completely brain dead.

In lieu of any original content on my part, I wanted a share a wonderful review of Not Done Yet, published in this month's Canadian Medical Association Journal.

A physician who treats breast cancer patients might wonder what this blog-cum-book could offer a busy professional whose daily practice likely holds its own heartbreaking quota of Lauries...

However, Kingston’s book provides the detail and emotional shadings that give meaning to these stark, exterior facts. The honest telling of a singular story weaves the experience of cancer into the whole cloth of a life, reworked after a devastating rupture. She vividly integrates events and see-sawing emotions...

Comfortable in her lay-expert role and an inveterate listmaker, she draws from the negative encounters to compile pointers for health care professionals: "Don’t look horrified when I tell you I have metastatic breast cancer; … Don’t ask me questions about my treatment[s] that are irrelevant to the procedure being performed and/or outside your sphere of knowledge [p 190]"

The author of the review, Sharon Batt, is a Doctoral Candidate in the Department of Bioethics at Dalhousie University. She is also the author of the book, Patient No More: The Politics of Breast Cancer about her own experience.

Many thanks to my friend N. (herself the editor of Women Who Care - an upcoming book about "Canadian Women’s Personal and Professional Experiences of Health Care and Caring") for submitting my book to the CMAJ for review.

You can download the full pdf of the review here.

Happy Birthday!

Top pic is Susan doing her best to look innocent. Apparently, cowboy boots and shorts were in vogue, circa 1956.

Bottom photo, Susan is still the little princess.....patent leathers and all.

I love my little sis. I miss those birthdays we used to celebrate together. (And the cakes.)

Ovarian CSCs play a role in tumor neovascularization?

Stem-like Ovarian Cancer Cells can Serve as Tumor Vascular Progenitors by Ayesha B Alvero and 8 co-authors, including Gil Mor, Stem Cells 2009(Aug 5) [Epub ahead of print]. PubMed Abstract:

Neovascularization is required for solid tumor maintenance, progression, and metastasis. The most described contribution of cancer cells in tumor neovascularization is the secretion of factors, which attract various cell types to establish a microenvironment that promote blood vessel formation. The cancer stem cell hypothesis suggests that tumors are composed of cells that may share the differentiation capacity of normal stem cells. Similar to normal stem cells, cancer stem cells (CSCs) have the capacity to acquire different phenotypes. Thus, it is possible that CSCs have a bigger role in the process of tumor neovascularization. In this study, we show the capacity of a specific population of ovarian cancer cells with stem-like properties to give rise to xenograft tumors containing blood vessels, which are lined by human CD34+ cells. In addition, when cultured in high-density Matrigel, these cells mimic the behavior of normal endothelial cells and can form vessel-like structures in 24h. Microscopic analysis showed extensive branching and maturation of vessel-like structures in 7 days. Western blot and flow cytometry analysis showed that this process is accompanied by the acquisition of classical endothelial markers, CD34 and VE-cadherin. More importantly, we show that this process is VEGF-independent, but IKKbeta-dependent. Our findings suggest that anti-angiogenic therapies should take into consideration the inherent capacity of these cells to serve as vascular progenitors.

Mitogen independence of glioblastoma SCs

Proliferation of Human Glioblastoma Stem Cells Occurs Independently of Exogenous Mitogens by John J P Kelly and 11 co-authors, including Gregory Cairncross, Ian F Parney and Samuel Weiss, Stem Cells 2009(Aug 1); 27(8): 1722-33. [Epub 2009(Apr 23)][ResearchGATE Citation][PubMed Citation].

Trust

I am sitting at the dining room table in the house of strangers who are vacationing in Oregon. I have never met them, but they left their key for me in the shed and have encouraged me to eat the perishables in the refrigerator. They took their computers with them but they've left two TVs and a stereo and just a few earrings on the earring holder in the bathroom. (Did they hide the valuable ones?) I am in Madison, Wisconsin, and this was supposed to be a getaway weekend with L. We'd planned it around a reading and workshop I did today at Gilda's Club in Madison which is really in another nearby town. Then L's mother was diagnosed with a melanoma on her leg and he went Downstate last week to accompany her to her appointment with the surgeon. He's going back on Monday so he can go with her on Tuesday to the surgery. He had too many vacation days and now he's worrying that he won't have enough. So I am on the getaway alone. I put an ad on Craig's List looking for a Madison-Chicago house swap, and was contacted by the owner of this house, who asked if I wanted to stay there, swapping cash for her house. I said yes (still thinking it was for both of us) and now I'm get-awaying by myself.


At Gilda's Club my audience was small and I wasn't sure who they were, what their backgrounds were, so when I told about having my scalp decorated, I didn't tell them that I'd had US OUT OF IRAQ painted in the middle. I was afraid of losing them. I talked about this with J this afternoon. She does programs for corporations and non-profits and says she can't be her whole complete self in these circumstances. She's right. In nonfiction workshops I talk to the students about different levels of formality and disclosure: You're more casual and intimate with your ... intimates than with your boss or with people interviewing you for a job.

I used a page from Joe Brainard's I Remember as a template. (See Brainard's photo, above.) For some reason it is so much easier to list aspects of an experience if you begin each sentence with I remember. Or, as Georges Perec did, with Je me souviens. in his book W (dedicated to Brainard). We went around the room and read from a page in Brainard's memoir, nearly every sentence beginning with I remember. When I was in Oakland I was pretty sure that my audience was the standard-issue East Bay Feminist, so that I could use words like patriarchy without explanation. Here I didn't know where we could and couldn't connect and I was surprised at myself for not knowing. I don't want to categorize people but that is what I do.Sometimes people laugh when I read from the book about it being axiomatic for liberal Jews to be Buddhist. Either they think it's so odd they laugh or else they laugh in recognition because it's so true. I've had both responses. Sometimes people laugh when I read the part about Amelia, my ex-best friend, and our rivalry and how I wanted every book in the world to be written by me alone. Sometimes they don't. Today they didn't. I am being so self-concerned here instead of quoting the moments of revelation when they read their own sentences aloud.


Before I leave Wisconsin, I hope to effect the Great Midwestern Pill Bottle Exchange. I have some empty pill bottles and I thought it would be a waste to throw them away so I advertised on Craig's List in the Free section. An artist wrote that she was interested in them, but in quantity. I put the same ad on Craig's List in Madison, because I could easily bring my empty bottles with me in the car. I heard from one Madisonian who's been saving hundreds of bottles. I hope I hear back from her tomorrow so that I can pile the pill bottles in my car and take them across state lines, where they will be welcomed.

We don't know what stage my mother-in-law's melanoma is in. The surgeon will cut down two centimeters and will test her lymph nodes. Hers is a relatively rare form, nodular, which is fast-growing. She happened to mention that a growth on her leg was bothering her when she was last at her internist's. It seemed to come from no where and we hope it will go back there soon.

Melanomas develop most often in people with fair skin, light eyes, and a history (however short) of sunburn.

Second day of school!

WCK's second day of school was spent, unfortunately, at home. She got some weird, 24-hour bug (no doubt picked up on the first day of school), so she wasn't able to go. It was a little sad, but she has fully recovered and will be able to go on Monday. WCK has never really had a stomach bug before -- maybe a mild one when she was a baby -- so I have to say I have a new admiration for my parents, who had to clean up after sick children on shag carpeting. I'm glad the '70s are over.

Today we were able to go to a festival near our house with a parade and some carnival rides. We let WCK get a balloon animal on the way out, and she asked for a blue poodle. If you'll remember, whenever WCK gets a balloon dog, she names it Ticklebee. Yes, Ticklebee III is home with us now! Ticklebee, how we've missed you.

I keep thinking that I should learn how to make balloon animals. It just seems like a good skill to have.

We are out of Temptation 3L and Beatification 750ml...for now.

We are expecting more Temptation 3L (hopefully) and Consecration 3L some time next week. Keep up with the blog to secure yourself a bottle.

cheers,

dave hauslein
beer manager
415-255-0610

Temptation 3L, Stone Juxtaposition and more!

Please read this announcement about Temptation 3L bottles carefully.
We received 4 bottles today. We will probably get a few more, but it's not for sure. Bottles are limited to 1 per person. They are $83.99 each. I will not hold bottles for more than 2 days unless they are being shipped. Please understand that this is due to the large demand/limited bottle situation. Consecration 3L is expected next week, hopefully with a few more Temptation 3L.

1. Anchor Foghorn Barleywine
2. Samuel Adams Oktoberfest
3. Stone/Brewdog/Cambridge Juxtaposition Ale
4. Big Sky Moosedrool Cans-6pk
5. Big Sky Troutslayer Cans-6pk
6. North Coast Blue Star-6pk
7. St. Feuillen Brune/Tripel/Saison are back in stock!

It's out today. Come in and get a 6 pack of Victory Prima Pils. It's the perfect beer to cool off and still get your hop fix!

cheers,

dave hauslein
beer manager
415-255-0610

Lyrics to "To Life!"

Here are the lyrics I like best from the beloved Jewish musical, "Fiddler on the Roof" --

Here's to our prosperity, our good health and happiness, and most important ...

To life, l'chaim,
L'chaim, l'chaim, to life,
Life has a way of confusing us,
Blessing and bruising us,
Drink l'chaim, to life!

God would like us to be joyful,
even when our hearts lie
panting on the floor.

How much more can we be joyful,
when there's really something to be joyful for?

We'll raise a glass and sip a drop of schnapps
in honor of the great good luck that favors you,

We know that when good fortune favors two such men,
it stands to reason, we deserve it too!

To us and our good fortune!
Be happy, be healthy, long life!
And if our good fortune never comes,
Here's to whatever comes,

Drink l'chaim, to life!

Cancer can arise through de-differentiation?

Tumor suppressor pulls double shift as reprogramming watchdog, Press Release, Salk Institute for Biological Studies, August 9, 2009. Excerpts:

A collaborative study by researchers at the Salk Institute for Biological Studies uncovered that the tumor suppressor p53, which made its name as "guardian of the genome," not only stops cells that could become cancerous in their tracks but also controls somatic cell reprogramming.

.....

"There's been a decade-old idea that cancer arises through the de-differentiation of fully committed and specialized cells but eventually it was discarded in favor of the currently fashionable cancer stem cell theory," says [Geoffrey] Wahl. "Now, that we know that p53 prevents de-differentiation, I believe it is time to reconsider the possibility that reprogramming plays a role in the development of cancer since virtually all cancer cells lose p53 function in one way or another."

See also: Cancer, stem cells linked in Salk study by Bradley J Fikes, North County Times, August 9, 2009. Excerpts:

A widely accepted theory of how cancer arises has been challenged by a study led by scientists at the Salk Institute.

.....

When the p53 gene is removed, normal cells can be reprogrammed into stem cells with a tenfold greater success rate, the study found.

If the link is confirmed by other researchers, it would undermine a popular hypothesis that cancers arise from "cancer stem cells," caused by genetic changes in stem cells, [Juan Carlos Izpisúa] Belmonte said. Instead, he suggested, cancer could begin when normal cells spontaneously reprogram themselves, for reasons yet unknown, beginning the process that results in a cancerous tumor.

Based on this publication: Linking the p53 tumour suppressor pathway to somatic cell reprogramming by Teruhisa Kawamura and 7 co-authors, including Geoffrey M Wahl and Juan Carlos Izpisúa Belmonte, Nature 2009(Aug 9) [Epub ahead of print][PubMed Citation].

Seventh mets-iversary

Today is my seventh anniversary of living with metastatic breast cancer. Every year on August 20th I stop to celebrate and reflect on what it means to live with cancer every day, ALL THE TIME.

Seven years ago I fell and broke my leg. Turned out the cancer had come back and was in my bones from the back of my skull to my hips. I remember lying in the hospital bed scared out of my mind that I was going to die soon, because I had asked my oncologist what the odds were. He said fifty per cent of women diagnosed with mets die within a year.

Well, it's been seven years. I have beaten all the odds and outlived all the predictions and I am still here, snuggling with my hubby, singing and dancing, cooking wonderful meals, walking the dogs, and generally living the good life.

I've been very lucky. I know that seems like a strange thing to say about cancer. But my cancer has responded pretty well to all the anti-hormonal and radiation treatments I've taken. I entered full menopause too early. I had to retire from my profession on medical disability. Cancer cheated us out of becoming parents. That was the price I had to pay to live.

Some days I don't really think about cancer. I just live. Those days are a blessing, to be normal like everyone else. Other days my back hurts from spinal mets, I pop some vicodin, and cancer is too present. Without seeming too much like Pollyanna, I have been able to live a reasonably good life with advanced cancer. Hard to believe....

This past year I had two hospitalizations, in October and May. They caused me to rethink what was happening to me. Right now I am on the last of the anti-hormonals and still don't know how well this drug, Megace, is working. What will my next options be? If I take more chemo, will it be as rough as the four rounds of 5-FU that practically killed me?

It's the not knowing that I find so tough. I realize that none of us really knows what the future will bring. That shit happens, like Rik's fall from the plum tree just two days ago. And yet there is grace as well. Rik walked away from that fall with one laceration and a stiff neck when the outcome could have been so much worse. I am still here, despite all the odds.

And so I am celebrating tonight with some of our closest friends. We'll eat homemade cardamom ice cream, chocolate cake and salted caramel coulis. We'll take a "family" photo to remember my mets-iversary. We'll drink champagne, spit in cancer's eye and toast l'chaim -- to life!

Where's my degree?

I am tired of seeing doctors and doctors and getting estimates and giving my insurance card to be photocopied and also the list of medicine I take. I'm tired of filling out forms that don't give me enough choice; I'm the insured but the place I work is not the place that provides my insurance. It's L's place of work. This week so far: Monday I saw my primary care doctor because her office called and said I had to meet with her because my last mammogram showed I had calcifications, probably benign, as I've had for the last year. The staffer who called said that my doctor had to examine me or she could be liable for malpractice, and that beyond that it was good doctoring to check me out. I did not agree but I went anyway since she was the one who first felt the cancer in me. She felt me and felt nothing. I told her I had been spotting--a few days a month ago and Sunday and Monday. My new theory was that I was having my period again. She said that didn't seem likely and to talk to my gyne. Which I did today--I left a message and she called back. I should not be so incredulous about that. What is the state of medicine that I believe this to be a miracle, even as I'm wondering if she's charging me extra for it. When you call the office you get a long recording talking about what they can and might charge for. But I charge, too, for phone consultations with my editing/coaching clients. But but.... And my gyne thought that my spotting might turn out to be the return of the period and she said to keep track and get back to her in two months. Because my uterus is just fine and dandy, and cervix and so on and so forth because she'd checked everything out in the last couple of month. She took out a fibroid in June and a polyp before that.

Is this TMI? One of my students is a Follower of this blog, meaning (I think) that she gets this delivered to her email box. Hello, J, here's info about my period and my surmising about my period. Welcome. A student applied to our program and her writing sample had much about her internal organ workings and impediments to the smooth working of her innards, and it was well-written and so she came into our program. I read last week from my book at a literary afternoon at Smart University and I felt self-conscious: I was afraid I had too much Content, that it wasn't Literary enough. I was advocating humor in the face of illness and reeling off the advantages of same. Did I have enough artistry? I wondered. So odd odd that I'm afraid that Work with Substance is not Artistic. God forbid I should provide information to an audience.

A professor from Michigan with prostate cancer wrote an essay recently about telling a class about the cancer. He mentioned me and my book, saying: "Reading the intriguing blog’s revelations and information, though, scared me straight. I could never share so much with my students." I teach graduate students and adult learners. Does the age of my students make revelation easier? I teach at least one nonfiction workshop a year, in which students write about abuse, body image, family, death, mental illness--so my natterings about Buspar, Wellbutrin and their ilk, and my bodily processes don't seem so unseemly. And the reader can always click on the X to get rid of the page.

My friend J wrote an essay once about in vitro fertilization, concluding that you can indeed be half pregnant. I am pre-post menopausal, or post-pre. After going to slee after chemo, my ovaries could wake up, my young oncologist has said, making it sound like they'd fallen asleep on the poppy field in the Wizard of Oz. I should make that singular, since my left ovary and salpingo (Fallopian tube) were removed a few years ago. The word salpingo comes from the Greek salpinx, trumpet. Gabriello Fallopio is credited with "discovering" the tubes connecting the ovaries and uterus, so you can figure how the tubes got their names.

And so immortality was conferred upon ol' Gabriello, who noticed things.

Yesterday my dentist cleaned my teeth and I met with an oral surgeon who gave his opinion about my impending implant, having a metal rod attach itself to my jaw bone, which will grow up and around it. That's three doctors in the flesh and a fourth on the phone, in two days.

And all I want is an MD degree so that I can put my vast knowledge of medicines to use.