September 30, 2007

I feel really well. The oncologists were raving about my blood work, which is apparently really good for someone who has just finished chemo. That made me feel good, because I feel like maybe my general good health is kicking in again. My hair is starting to sprout; I have a 5 o’clock shadow on my head. My eyebrows are little barely visible strips of fuzz, an outline for me to follow with an eyebrow pencil. It seems hardly fair, that all the hair I didn’t want, like on my face, is quite visible again. But I am relieved to think that I will probably have a real head of hair by the end of the year. I am working half time; after work I rush off to radiation, which takes about 20-30 minutes (the actual process is about 10, but there’s changing, getting everything lined up, changing back). So far, I have no symptoms from the radiation. My oncologist is really into everyone using lots of corn starch like powder, all over the area that’s being radiated, so there’s a film of corn starch all over my apartment. I’m glad, though, to be using something so simple and benign and cheap, rather than toxic ointments that make drug companies rich.

Last week I had a dream. Someone knocked on my door. It was a young man I knew slightly. He asked to borrow money, and I said, “You really came here to steal from me, didn’t you?” He acknowledged it. He was sorry, but said he needed the money and didn’t know who else he could get it from. I might have given it to you, I said, but it makes me angry that you pretended friendship, when you are only thinking of me as someone you can steal from. I went outside to talk to him, and when he was gone (I think without having gotten the money, though I’m not positive), I opened my door to find that I had been erased from the apartment. It was like I had never lived there. All my things were gone, my books replaced by someone else’s books, my furniture by someone else’s furniture. I thought maybe I was confused about which apartment was mine, so I looked in all the other apartments in my building, but none of them were mine. I went around asking my neighbors, “Where do I live?” and they suggested one apartment or another, but no, I didn’t live in any of them. I concluded I did not live in the building.

When I woke up, I thought, “My house in that dream is my body.”

What “someone” – the universe, karma, G-d, Bad Luck – stole from me was the sense of invincibility I have always had, the feeling of entitlement to good health. I – the me who never got sick, who didn’t see a doctor for seven years and went without insurance for three, has indeed been erased from my body. My very first professional article, written almost twenty years ago, was about women and cancer. The lead was a quote from a cancer survivor, one of the founders of the Women’s Cancer Resource Center in Oakland. “When you have cancer,” she said with tears starting to fall, “everything in your life changes.” At 29, I didn’t really understand what she meant. Now I do. Even if I wanted to go back to my old way of ignoring my physical self, the health care providers I have brought into my life wouldn’t let me. I would have to move out of the area to get away from the constant schedule of appointments. They are making appointments for me three and six months in advance. Although I am happy to say that it’s been a month or so since I swallowed my last drug, I do have a shelf full of naturopathic supplements I’m supposed to take every day, though I admit, I’m not all that good about it. I worry more than I ever did about losing my job, and I couldn’t quit unless I had another one, because I would never qualify for individual insurance.

From this year forward, I’ll always have cancer in my life. The memory of the chemo ordeal has already started fading, and in some years, I am sure it will be a distant echo. I hardly intend to let cancer take over my life, but I’ll always have that worry in the back of my mind.
A lot of people have asked if they have succeeded in shrinking the cancer, or if I’m in remission. I would probably have asked the same questions to someone else a year ago, but the fact is that I have not had any cancer in my body since March 28 (the day after my surgery). The surgeon removed the entire tumor (2.4 cm), plus a margin for error, and all the lymph nodes containing any cancer cells. Everything they have done to me since then is to prevent the cancer from coming back, a recurrence or a new tumor.

I’m taking a class right now in health and healing, that involves some magical-spiritual-meditation practice and some techniques from hypnotherapy and body work. Last week, people were talking about what is health and what is healing. Someone used the phrase, “Healing is growth,” and that made me laugh, because in my body right now, growth is the opposite of healing. In fact, the “healing” processes I’m undergoing are meant to prevent growth. I started thinking, not for the first time, about the oddness of cancer, compared to many types of what we perceive as “ill health,” where you feel bad, and when you start feeling better, you are getting healthier. Six months ago, I felt fine, but I was sick. Four months ago, I was more or less well, but felt terrible (or at least, to the extent I was sick, it was from the treatment, not the disease), and now I am well and feel well. And thank Whoever for that!

(Next week, hopefully I am doing a radio broadcast about breast cancer, for Breast Cancer Awareness Month. This week I have a piece about the Philippines; you can hear it tomorrow at 94.1 FM between 1:00 and 2:00 p.m. or online at www.kpfa.org/womensmagazine.)

Right on cue, my hair started falling out the day of my second chemo treatment. I had decided not to shave my head, though it would definitely have made it easier, because I wanted to see what it was like to lose something I had always taken for granted.

It was interesting, and it was also messy and physically painful, which they don't tell you, and emotionally traumatic.

The first couple days, I felt like my hair was some kind of installation sitting on my head; if I didn't mess with it, it would be okay, but any time I touched a hair, it came out. So I put a scarf over it to try to "keep it on." The scarf also helped dull the sometimes burning, sometimes bruised feeling in my scalp. When I would take off the scarf, or it would slip off during sleep, there would be gray and dark coils everywhere my head had touched.

By Monday, the wastebasket in the bathroom was full of what looked like an odd sort of hedgehog, but because my hair is so thick, I still had more or less a full head of hair. When I would take off the scarf, there would be a Brillo-like wedge sitting on top waiting to be plucked off. I brushed my hair out gingerly, but was still afraid to wash it. That night, I told a friend, "Now I am at the combover stage." She said she would call me The Donald.

Yesterday, finally, my scalp was itching too much, so I gave up and decided to see if I could make it all come out. I stood in front of the bathroom mirror and yanked out handful after handful, then washed my head/hair and pulled out more when it was wet. By the end of the day, I looked like Ben Franklin, with a ring of hair at the bottom of a bald head. Actually, I didn't look like Ben because my head turns out to be a perfect egg shape, no news to friends who already suspected I was an egghead.

Last night I slept without a scarf for the first time since Thursday. When I woke up I looked in the mirror and almost screamed.

"Who is that ancient woman?" I wondered.

I no longer look like an eggheaded Ben Franklin. Now I look like Scrooge or Bob Cratchett, whichever one looked like a skeleton with a couple tufts of white hair coming out of his skull. Honestly, I always knew my hair was important to me, despite the fact that I never heeded my mom's implorations to "do something with it." But I never quite realized how important hair is to how we perceive ourselves and each other. With my hair, which was really mostly gray by now, I think I looked just about my age, maybe a few years younger. Without it, I look 100 years old. Every wrinkle and line in my face jumps out.

Plus my scalp itself, which still hurts, is kind of pasty white. How do all those cool young women who shave their heads for fashion pull it off? And what am I supposed to do now? Rub it with olive oil? Dust it with corn starch, like you do with babies to keep their tender skin from getting irritated? And the most important question of all, when you're bald, do you wash your scalp with shampoo, because of all the nutrients and soothing herbs that they put in shampoos, or do you wash it with soap like the rest of your skin? Advice from the experienced welcome.

(Incidentally, for those of you who are wanting to know about more pragmatic things, the treatment went fine, Thursday and Friday were not too bad, Saturday and Sunday were bad, Monday was pretty bad, since Tuesday I've been less nauseous but still really tired. Had acupuncture today, which I think helped, and am hoping to be feeling good by Sunday.)

Oh, there's a good photo of me pre-baldness, with an article about a campaign to get the San Francisco LGBT Film Festival to stop taking Israeli government money, at http://www.ebar.com/news/article.php?sec=news&article=1838.

(this is the eve of my second chemo, so I'm getting in as much writing and otherwise mind stretching stuff as I can before I go into a five-day vegetative state.)

Until a few months ago, I hadn't been in a doctor's office for five years. In my adult life, prior to this episode, I think I got three prescriptions. This apparently is a rarity; doctors and nurses alike stared at me in wonder as I answered no, no, no, no, no, to all the standard questions – not on any medication, never had surgery before, no current medical conditions, never had any broken bones, never hospitalized before.

None of this is any credit to me, just luck and good genes (thanks, Mom). But possibly because I could, I've also developed a healthy suspicion of doctors and pharmaceuticals and tried to protect my health with organic foods, moderate exercise, fairly clean living and positive vibes. Oh and fun, meaningful political activism, which I'm convinced is someday going to find its way into the Materia Medica as a powerful tonic.

Now, of course, all of that has changed. That is, I'm still eating organics and staying physically and politically active, but that's supplemented by a plethora of little plastic bottles.

In the oncologist's office, they give me Adriamycin and Cytoxin, both of which are listed as carcinogens on the National Toxicology Program. They also give me Ativan to relax and a strong antinausea drug. The Adriamycin is bright red, which is kind of unfortunate for the psychological impact. When I go home, I can take a generic form of Zofran for nausea, which works pretty well, but I only get three days' worth because apparently it costs the insurance company $80 a pill. When that's done I can take Compazine, which doesn't work so well and has some unpleasant side effects, so I mostly do without it (not hard, since it doesn't work), but I do take Protonix for acid reflux. I can also take more Ativan, if I want, though so far I haven't. I also have an antibiotic that I'm instructed to start taking if I develop a fever over the weekend.

The Monday after my Thursday treatment, I go back to the doctor's office to get a shot of Nulasta, which stimulates production of the bone marrow that the chemo drugs are busy killing off. That in turn gives me some powerful aching in my back and neck, so I am advised to take Advil, which however sometimes aggravates the stomach upset, so sometimes I take Immodium for those symptoms. Sitting idle right now is the Percocet they gave me for pain after the surgeries, which I didn't like and didn't take much of so I have plenty left, next to the Extra Strength Tylenol which I liked better for pain. In addition to all this, it turns out that I have unrelated hypothyroid, which is mild but worsening, so I will probably need to take Syntheroid for the rest of my life.

Then there are the three bottles of herbal formulas I got from my acupuncturist to help me tolerate the chemo, big unpleasant-tasting pills that can make me nauseous on their own, and the little bottle of Rescue Remedy she recommends for anxiety (I have never found it very effective, but it used to work wonders on my crazy cat).

Suddenly there's no room for everything in my medicine closet, which used to hold things like henna and a hair dryer, but then I might as well stash those away since I'm about to have no hair, an event which has looms unnecessarily ominous as I anticipate it. The nurse told me I'd be bald in three weeks, but the radiation oncologist gave it a slightly longer timeline, and I haven't lost a hair yet, though occasional scalp tinglings in the morning throw me into panic.

BC (Before Chemo), before I knew for sure I would be encouraged to have chemo, I told people that if anyone told me to get chemo, I would keep looking until I found someone who told me not to. By the time I woke up in the recovery room, the surgeon had already told my friends that I had seven positive lymph nodes (the 7 Deadly Nodes, I call them) out of a total of 21 removed from my breast and axilla, and therefore would need to have chemo. She reiterated this to me in my dopey state. When I was feeling better enough to use the computer, I started the process of finding that elusive countervailing opinion. I read article after article on www.breastcancer.org and www.anniappleseedproject.org, both great resources with information on both western and alternative/complementary therapies. I called the Women's Cancer Resource Center and talked to two different naturopaths who specialize in treating women with cancer. My two closest friends, who are both health professionals, did lots of research of their own. One talked to a friend of hers who grew up in Romania, where they were more appreciative of alternative approaches, and also asked a naturopath she goes to. Everyone and everything confirmed what the doctors told us, that chemo greatly increases the survival rate for women with my stage of breast cancer.

When my friend and I went to the oncologist, he punched in my basic demographic information into a database and printed out some brightly colored graphs representing this information, or maybe I should say opinion: Out of 100 women in my situation, who have either lumpectomy and radiation or the equivalent mastectomy, with no further ("adjuvant") treatment, 65 will be alive in ten years. Of the remaining 35, 2 will die of other causes, and 33 will die of the cancer. Of those 33, 9 will live if they only take tamoxifen (hormone therapy), 16 will live if they take only chemo, and 21 will live if they do both.

These numbers were good enough for my friend, but I was still not sure. After all, I said, it just doesn't seem like a good idea to flood my body with toxic chemicals, cancer-causing chemicals in fact, to rid my body of cancer cells that are two-thirds as likely not to be there as to be there.

"You're right," he said. "It doesn't make any sense at all. If you think you're going to be in that two-thirds, don't do it, because it's awful."

But, he said, he wanted to show me something else. He pulled up another screen and punched in my numbers again, and ran out another set of graphs. This one showed the risk of relapse. In this scenario, 56 of the 100 would have cancer in ten years, with no adjuvant therapy. With either hormonal or chemotherapy, 26 or 27 of the 56 would be alive without relapse, and with combined therapy, 42 would be alive without relapse.

That did it for me. I asked myself, assuming I'm not one of the unlucky 14% who do everything and relapse anyway, do I want to be dealing with cancer for the next ten years, or do I want to have a bad six months and then go on with my life? It wasn't a contest. I went into my first chemo appointment with the confidence that I'd made the right decision.

Last week, while I was still feeling pretty lousy, I got a package from an out of town friend. One of the things in it was Susun Weed's Breast Health book. Susun Weed (I don't know if that's the name she was born with; if so, it's awfully convenient) is a pretty famous herbal healer. I know people who have studied with her, including the friend who sent me the book, and they say she's really smart and knowledgeable and down to earth. I eagerly started flipping through the book. It's organized chronologically, prevention, diagnosis, surgery, hormone therapy, radiation, chemotherapy. I looked at the exhaustive list of cancer-fighting foods in the prevention section, and was really pleased to see that everything I love to eat: garlic, onions, olive oil, broccoli, sweet potatoes, potatoes, are recommended for fighting cancer, and that fasting, which I hate, is not. The best news of all was that "Of 1,271 elderly Americans, those who ate the most strawberries were least likely to develop cancer." I thought smugly of the two baskets of organic UFW strawberries sitting in my fridge and turned to the section called "Choosing Chemotherapy?"

It starts with a fable called "The Poisoned Apple," and that in itself was enough to send me to my room crying. When I calmed down, I went back and picked up the book again. On the first page of the chapter, Weed cites a study by naturopaths Steve Austin and Cathy Hitchcock which purportedly found that only 25% of those who would have died without chemotherapy get any benefit from it – very different from the statistics I quoted above, that I was shown by my doctor. Weed goes on to cite several other concurring studies, including one from the US General Accounting Office in 1989 which, she says, "found no increase in longevity in premenopausal women who chose chemotherapy – as opposed to those who did not – for treatment of Stage II (or earlier) breast cancer." (My cancer is considered late Stage II or early Stage III.) She then quotes a doctor at the University of California San Francisco medical school, "Most cancer patients in this country die of chemotherapy….The fact has been documented for over a decade [that] women with breast cancer are likely to die faster with chemotherapy than without it."

Sitting here now, I cannot describe the wave of panic and fear that swept through me. I had known it. I had begged for someone to tell me this, and no one had. I felt let down and lied to by everyone I had trusted, most of all myself. I was sure I'm going to die, and it will be my own fault because I ignored what I know to be true, I broke faith. I let myself get sucked in by the medical establishment, when I should have known better. In retrospect, I think I must have felt like a Christian Science follower who let herself be given penicillin.

In between bouts of shaking and crying, I read through the chapter and pored over what she says you can do to strengthen and protect yourself against the poisons. I dropped in on a Break The Siege meeting (our local Palestine solidarity group, which I've been sitting out for a few months while they've been in a planning process) and then ran off to Rainbow Grocery to stock up on the herbs, roots and tinctures which were going to be my magic potions against the evil spirits.

Don't get me wrong. With one exception, every herbal formula I bought is something I would normally want to have in my house, like Echinacea and St. Joan's Wort. Can't go wrong with Peppermint or Ginger. But in the moment, it was like I HAD to have them NOW or some terrible fate was going to befall me. I had to have nettles, to keep my hair from falling out or make it grow back fast. The second I got home I started cooking up an infusion of nettles. I mixed all the different tinctures in water and gulped them down one after another (after checking the book to make sure it was okay to mix them). Then I started frantically cooking carrots with ginger and garlic and cauliflower in olive oil (according to the book, women of Crete get 40-60% of their calories from olive oil, and are the least likely in the world to die of breast cancer). I almost ran out to Safeway at 11:30 p.m. when I thought I was out of olive oil, but I managed to eke out just enough.

By the time my food was ready, I was slightly nauseous from mixing so many herbs, on an empty stomach, so I nibbled some nuts and dried apricots and went online to see what I could find out about the facts that had so shaken me up.

What I concluded, after a couple hours' research, is that I had, in fact, known what I was doing all along. I had known that a majority of women survive breast cancer with or without chemo and tamoxifen. The doctor himself told me that – 65%, nearly two-thirds. I knew I could decide only to do the tamoxifen, which while causing uterine cancer and having some other bad side effects (my naturopath tells me that the manufacturers of tamoxifen also manufacture a lot of the pesticides that cause cancer), is not nearly as harsh on your body as the chemo drugs. I knew if I did that, I would have a 70% chance of being alive without cancer in 10 years. And I decided that 84% was better than 70% (which is, I suppose, a mathematical fact).

Now I think that Susun Weed, for all her brilliance and good intentions, is irresponsible. Her book was written in 1996; the Austin & Hitchcock research she quotes was published in 1994, so was probably conducted earlier than that, and at that time, it was probably accurate. Chemotherapy was being recommended to a much wider group of breast cancer patients at that time, nearly all women with Stage II cancer, in fact. But her website, which is presumably current, doesn't say that. Neither do any of the other sites that recommend either her book or the Austin/Hitchcock book.

I also think, based on what I was able to find out about the studies themselves, that she slightly misstates their findings to support what she believes. To be fair, she doesn't say women shouldn't have chemo. She says to do research and consider the risks carefully, both of which I did. She also says at least one thing which I know was not true when she wrote it, which is that chemotherapy "is rarely suggested for postmenopausal women." My mom was diagnosed in 1991, and she had chemo, as did my friend's mom a few years later, and another friend's mom last year.

I believe that it is possible to heal cancer naturally, and it might well work better and be healthier long-term than chemotherapy. I know people who say they healed themselves by drinking massive amounts of wheatgrass juice. I also know of people who say they healed themselves with positive thinking. A coworker, on hearing of my diagnosis, tried to sell me on the new psychobabble craze called The Secret (Oprah is apparently into it). Using The Secret, people claim to have cured their cancers by refusing to give into them or acknowledge them in any way. I believe some of them did. Of course, remember that many people with cancer will be fine without much treatment. Going back to the numbers I was given at the beginning, 42% alive without relapse is not bad. I just think 84% is better.

I'm convinced that given the information I have available, I made the right choice for me. I'm not willing to spend hours every week brewing and drinking nasty-tasting herbal concoctions. That's not to make fun of anyone who does; I really admire them. I just know it's not for me. I don't have the strength of will right now to try to vanquish my cancer by meditation and visualization. I don't want curing my cancer to be a full-time or even part-time job for the next ten years. I want to give it six months of my life and then hopefully be able to stop thinking about it. It may well be that in five or ten years, there will be new information that will suggest that chemo isn't recommended for women with my stage of breast cancer. But that will be then and this is now. And right now, as a friend taught me to say, I'm doing the best I can.

(Incidentally, I'm still keeping the Weed book handy for info about managing the side effects.)

(My first cancer blog. But don't worry, you're not about to be subjected to online vomiting.)

I wasn't going to write about having cancer.

I don't know why not. It's not like I don't know that cancer, and every other thing having to do with the medical establishment and the health care industry, is also a political issue, or that the personal is political. I just felt somehow that writing about it would be too much like whining. It's one little thing happening to one little person, one very lucky and privileged person at that, and anyway, lots of great words about cancer have been written by lots of great writers, so unless you're Gina Kolata or Audre Lorde, shut up.

But finally I've caved into the fact that I'm a writer, and that's what writers do, we write about what's going on in our world, and right now, cancer is one of the things going on in mine. I'm not doing too well with the "big writing" just now so I might as well write about that little thing called cancer that is happening to me.

Not because I'm so special, just because.

That's a mantra I'm trying to practice. A lot of the learning that this cancer thing has to give has to do with acceptance. Accepting the diagnosis, of course, accepting that there are things we can't control, accepting the decisions that have to be made and the ones I have made.
Accepting people's help and caring is probably the hardest for me. So many people have come forward, friends and comrades, offering to do things, and it's a challenge to let them. On one hand, having the support feels wonderful. The food people made is incredible, the subscriptions to Netflix and the New York Times fabulously distracting (well, the NYT's Middle East coverage sometimes makes me feel sicker, but the crossword puzzle is comforting). Rides to and from surgery and chemotherapy are essential, as is having someone with me when I talk to the oncologist, so they can confirm that yes, he really did say I'll either have 4 Taxol treatments two weeks apart or 12 every week. One friend made a whole website (using the free tools at http://www.lotsahelpinghands.com/) so people can sign up for times to come over and hang out with me while I'm not feeling well.

Then I stop and think, well, why should I get all this help? After all, lots of people in our community have medical issues. Several of my close friends have chronic illnesses, some life threatening and some not, and all of them are frequently in more discomfort than I am now. None of them have websites coordinating support. The only difference between me and them is that my illness is hopefully going to go away, I'm going to be back in my normal state of blissfully ignoring my body. So why am I so special?

I feel like I don't "deserve" all this attention. Then I think, okay, well, I've occasionally volunteered to take food to friends who just had babies, gone to fellow activists' baby showers, visited people in the hospital, stayed over with a friend who had had a hysterectomy. So maybe
I "deserve" a little bit of help now.

Then I think about the times I have helped out and the times I haven't, and ask myself, did the people I visited in the hospital deserve it more than those I didn't? Were the new moms for whom I cooked needier than those for whom I didn't? No. Those judgments never entered my head. I did it when I could and not when I couldn't. There were times when I just called or sent a card, there were times when I didn't even get it together to do that. Sometimes that had to do with my own shyness, wondering if I would be bothering someone I didn't know that well, and sometimes it was just stress and laziness, but it never had to do with how worthy I felt the person was.

A friend of mine recently broke her ankle, and she was very reluctant to let us do anything for her. Whenever we would offer to bring over food, walk her dog or clean the house, she would say, "No, I feel like I should save it for when I really need it." We kept trying to tell her that there wasn't a limited supply of good will. She could have help now and if she needed it later, there would be more where that came from. Now I hear myself saying the same thing.

"I can go to the grocery store for myself," I told a friend.

"I know," she answered, "but do you really want to? Is that how you want to spend your energy when you're easily fatigued?"

Support from friends and colleagues isn't about cashing in earned credits. That's the State Disability Insurance I'm getting, because I've paid into it for the last two years, and because I am fortunate enough to live in California, and the company Supplemental Disability salary continuation I'm even luckier to have because of my good job.

The support of my community is a gift. And when someone gives you a gift, it's not because you deserve it, it's because they care about you. If your friend gives you a book for your birthday, you don't say, "Oh, you shouldn't have done that, I can afford to buy books and Marcy across the street can't, so you should give your presents to her." You just say thank you.
I'm also recognizing that there's an arrogance in feeling that I should always be the one helping, and never the one needing help. Our society increasingly divides people into helpers, helped, and helpless.

The other day, I had an episode of panic I'll write about later. It propelled me to do something I had been meaning to do: call the Women's Cancer Resource Center for support group referrals. In the course of playing phone tag with the very sweet hotline volunteer, I learned that they are currently short of volunteers, because many of them are pre-med students who are now having exams and getting ready to leave for the summer.

"Maybe I could volunteer while I'm not working," I immediately suggested.

In fact, it would be a good match because the work sounds very similar to staffing the ACCESS Women's Health Information Hotline, which I did for several years. However, the volunteer said they don't like people to volunteer while they're in treatment, because it can be kind of overwhelming.

I was disappointed, even though I don't actually need more projects. I realized that I would feel better accepting help if I were also giving it. There's something humiliating about simply letting myself be needy. Then I reflect, does that mean that the women I gave information and referrals on the ACCESS hotline should feel humiliated? The many women I counseled during my years volunteering with San Francisco Women Against Rape?

No, of course not, I answer myself.

"Well, are you sure?" my alter ego challenges. "What's the difference between them and you? Why are you so special?"