Category Archives: cancer

frozen pea friday post: health and poverty

moneyin last week’s frozen pea friday post – the weekly post about people dealing with cancer, inspired by susan reynolds and my friends who are dealing with cancer – we alluded to the difficulty of paying for the necessary care needed for people living with cancer. this immediately led me to thinking about the connection between health and socio-economic status (SES), or income level. having spent the majority of my career as a counsellor with people living in poverty, particularly people in vancouver’s downtown eastside, canada’s poorest urban area, i am very familiar with the connection between health and income.

says one canadian government web site:

only 47% of canadians in the lowest income level rate their health as excellent or very good, compared to 73% of canadians in the highest income group.

canadians who live in the poorest neighbourhoods are more likely than residents of the richest neighbourhoods to die at an early age.

at each rung up the income ladder, canadians have less sickness, longer life expectancies and improved health.

in the UK, “life expectancy in the wealthiest areas is ten years longer than the poorest areas. the gap appears to be increasing as life expectancy for the prosperous continues to increase while in more deprived communities there is little increase.”

the impact of poverty on health by shelley phipps for the canadian population health initiative and the canadian institute for health information gives further information:

research has found a very robust relationship between an adult individual’s income and that individual’s health. regardless of how health and socio-economic status (ses) are measured and how these measures are combined, there is little doubt that poverty leads to ill health.

  • the relationship between individual income and health is non-linear (i.e. low-income individuals suffer larger negative health consequences than high-income individuals reap health benefits, though high-income individuals do reap benefits).
  • long-duration poverty has larger (negative) health consequences than occasional episodes of poverty.
  • both income level and income changes are significant predictors of health status, but income level is the more important of the two.

further along in the study, there is mention that chronic diseases such as arthritis, rheumatism, diabetes, heart problems, cancer, and hypertension are much more common–often twice as common–for aboriginal persons, who also have generally much lower SES than non-aboriginals.theories on how SES and health are connected include these:

absolute income hypothesis
this hypothesis suggests that health status improves with the level of personal income, but at a decreasing rate. one implication is that:”…if income is redistributed from the rich, whose health is not much affected, to the poor, whose health is more responsive to income, average health will improve. other things being equal, including average income, nations (or other groups) with a more equal distribution of income will have better average group health.”

absolute deprivation hypothesis
this can be regarded as an extreme version of the absolute income hypothesis. it suggests that very low standards of living are bad for health, but that once past some deprivation threshold, additional income is not particularly important for health. the emphasis here is that individuals living with very low incomes will encounter physical conditions that may undermine their health, such as poor nutrition, more limited access to health care, hazards from poor environmental quality, health-limiting behaviours such as smoking and sedentary habits and stress resulting from coping with very low income.

neo-materialist hypothesis
this hypothesis argues that high levels of income inequality are simply one manifestation of underlying historical, cultural, political and economic processes that simultaneously generate inequalities in social infrastructure (such as medical, transportation, educational, housing, parks and recreational systems). from this perspective, inequalities in health derive from inequalities in all of the above aspects of the material environment.

lynch and co-authors employ the metaphor of a long trip on an airplane to explain the difference in interpretation between the psycho-social and the neo-materialist interpretations. on a long trip on an airplane, passengers seated in first class are treated better: they have, for example, more room and receive better food. passengers travelling in economy class are cramped and, these days, receive little–if any–food! lynch et al argue that by the end of many hours of travel, the differences in physical conditions and treatment will reduce the well-being of the passengers in economy class (beyond feeling negative emotions because they know they are being unequally treated).

(image by old shoe woman)

frozen pea friday: cancer and art for healing

wearable art to help with cancer treatmentfor this week’s frozen pea friday post – a post for and about cancer survivors, following the frozen pea friday movement – i’d like to point you to an interesting project by ms. frozen pea friday herself, susan reynolds.

susan is an artist, a mother, grandmother, prominent second life citizen, social media maven. and she has cancer.

my husband’s insurance covers cancer treatment – to a point.

while millions of americans are uninsured i’m lucky not to be among them. but copays and deductibles, transportation and complementary care not covered by insurance add up fast.

since my mixed media pieces have been published in national magazines and i’ve taught painting and helped artists use new media to show their stuff, now is the time for the art to help me.

these mixed media pieces are, in fact, “wearable art”. while you can, of course, mount them or otherwise display them at home, they’re also lovely pieces of jewellery – broches and pendants.

she calls the part of her blog that showcases this work “magpie“:

oooh shiny! handmade, handpainted papers, fibers, metallics, glass, beads and iridescence

in a twitter conversation, susan pointed out that she feels lucky that she can do something that’s not too strenuous and make some money at it – others may not be able to do this.

i have some personal investment in this – from experience i know how alternative healing can be very beneficial. i have derived great benefit from reiki, healing touch and TRAGER®. for example, when i had my gallbladder taken out and, in my crazy sensitivity to anything psychoactive, i was going bonkers with the after-effects of general anaesthesia, healing touch was one of the great boons in those days. and i’m using reiki right now to deal with this nasty cold that wants to take over my life. so i evangelized susan a bit. it looks like acupuncture is one of the things that helps susan.

and that’s what she needs money for – because those stupid insurance companies are totally happy to dish out tens of thousands for hyper-priced pharmaceuticals and sneer at giving a few bucks for well-documented complementary care unfortunately, the good insurance companies don’t have enough money to pay for it, either.

(this post was included in the may 24 carnival of healing)

mental health and cancer

peas refractedfor today’s “frozen pea friday” post on cancer, and because it’s national mental health week, i’ve interviewed someone on how she deals with the emotional effects of cancer. here’s what she says:

  • i have 100% permission to have all the meltdowns i need to have (i.e. anger, crying spells)
  • have a relationship with a psychotherapist whom i see regularly; that helps me remind me of self-care, putting my family in perspective and making sure i get my meltdowns
  • i have buddies. we’re in a group and i strongly request my buddies corner me four times a week and get me to focus on what i want. they do it and also get me to look at the guilt monsters because guilt is huge for me
  • maintain sleep, exercise and a regular eating schedule
  • i get help with sleep with sleep medication
  • i schedule regular meals and make sure i eat them
  • i manage anxiety by being really practical and taking things that i want seriously and making steps towards them if i can’t actually do them right
  • i very rarely tell myself “absolutely not!” usually it’s, “yes” or “yes, later” or “probably, later”
  • i let myself care about other people, even though right now it’s “me first time”

other info on the connection between mental health and cancer:

sexuality and cancer

this study suggests that people with mental health issues have a larger chance of getting certain types of cancer, and getting it at an earlier age

this site has a large section on the emotional effects of cancer. what i find most helpful about that is that it shows the many effects – seeing this in print, knowing that these feelings are normal and experienced by many can in itself be helpful.

yoga may help with breast cancer

(refracted pea image by fellow canadian ecstaticist, whose blog is here)

frozen pea friday: poems about cancer

today friday, as usual, a post having to do with cancer. to finish off april, the poetry month, i’ll serve up three poems.

winter sun lace

the first one is one i wrote shortly before my friend nikaiah jaguar left us.

nikaiah
butterfly woman
your bones are so thin the moon shines through

some say
the moths are eating you
but we know
you are becoming one with the light.

here one by denise larrabee, from the cancer poetry project:

you are in my thoughts
are with you are part of
the ?prayer chain? at our
church will say a mass
for you accept all
prayers on your behalf we
will say a rosary for you
tonight lots of people
are calmly, psychically
cheering you on sunday
will light a candle for
you are in our thoughts
and prayers are being
said for you need all the
health karma there is a
candle lit for you in
front of my madonna has a
special place for young
women in trouble require
positive and healthy
energy to kiss someone
you love when you get
this letter and make
magic.

and lastly, one that has been floating around the web for a while, by an author whose name we don’t know. i found it at ma walking wolf:

what cancer cannot do

cancer is so limited…
it cannot cripple love
it cannot shatter hope
it cannot corrode faith
it cannot destroy peace
it cannot kill friendship
it cannot suppress memories
it cannot silence courage
it cannot invade the soul
it cannot steal eternal life
it cannot conquer the spirit

(image by nancy waldman, a fellow canadian)

frozen pea friday: psychological research on breast cancer

it’s friday, and frozen pea post time – my weekly post on cancer. today, i’ve put together a guest post about psychological research regarding breast cancer over at GNIF brain blogger. you won’t be surprised to hear that social support contributes to higher survival rates.

two observations are more counter-intuitive, though: it is unclear to what degree being married helps with survival rates. also, surprisingly, it looks like minimizing is a good coping strategy. the authors of the studies supporting this do not go into much of a description of what is meant by minimizing and indeed, it is a coping strategy that tends not to be discussed much in detail. i suspect that is because psychologists and therapists tend to be suspicious of it – after all, we’re big on validation, which, at least on the face of it, looks like the opposite of minimizing.

minimizing refers to downplaying the impact of an event or experience, e.g. downplaying one’s pain level, the degree to which one is incapacitated, etc.

perhaps minimizing comes with a “glass half full” attitude, and that helps with better survival rates?

what do you think – should i look some more into this?

frozen pea friday: researching tamoxifen

a tamoxifen pilltoday is frozen pea friday, and as usual, i’m writing about cancer.

a friend of mine who just underwent a mastectomy and will most likely get the recommendation to take tamoxifen in the near future was asking some of her friends to do a bit of research for her (remember, sifting through tons of information can be a heavy burden for someone with cancer). so i decided to do that here. when i looked for information i tried to take into account that we are looking for information for someone who is not postmenopausal, which makes it a bit tricky because most material seems to concentrate on older women.

first of all, let’s remember this: research has shown that not all breast cancer web sites contain correct information. i think i have a relatively good nose for reliable information but let’s take all of this with a big grain of salt, shall we?

what is tamoxifen?
tamoxifen, or nolvadex®, is a drug that interferes with the activity of estrogen, a female hormone. (see this article at women to women for a discussion of the connection between estrogen and breast cancer). tamoxifen has been used for more than 30 years to treat breast cancer. the known, serious side effects of tamoxifen are blood clots, strokes, uterine cancer, and cataracts. other side effects include menopause-like symptoms. the results of the breast cancer prevention trial (BCPT) showed a reduction in diagnoses of invasive breast cancer among women who took tamoxifen for 5 years.

a good overview of tamoxifen is on a site i had never seen before, organized wisdom. it is a human-powered health search service. their guides and physician reviewers create WisdomCards to help people find the best health information, products and services on the web. i’m not sure what their background is (are they big pharma driven?) but i found their summary on tamoxifen helpful, particularly the indications and contra-indications of tamoxifen.

tamoxifen, goserelin, chemotherapy and ovarian ablation
ovarian ablation [i.e. removing the ovaries, because of their hormone production] with goserelin is equivalent to CMF [cyclophosphamide, methotrexate fluorouracil – a chemotherapy treatment] without tamoxifen, and goserelin plus tamoxifen is more effective than CMF without tamoxifen. if one has a premenopausal patient with ER-positive, lymph node-positive breast cancer, goserelin plus tamoxifen is a good alternative to treating her with intravenous CMF without tamoxifen while achieving the same results.

what happens after the first five years of tamoxifen?

the received wisdom seems to be that tamoxifen is fine for preventing the recurrence of breast cancer for the first five years. what happens after that seems to be a a thing of debate.

1. take letrozole
currently, women whose tumors were fueled by the hormone estrogen can take the drug tamoxifen after undergoing surgery, radiation and chemotherapy to reduce their risk of a recurrence. but tamoxifen only helps for five years. after that, it may be dangerous.

a recent study in conducted in canada reveals that breast cancer patients treated with the drug femara® (letrozole) several years after completing treatment with tamoxifen (nolvadex®) have a reduced risk of a recurrence. these findings were published in the journal of clinical oncology.

supposedly, letrozole is very similar to anmidex, a drug that my twitter friend susan reynolds – the original princess of the frozen pea – is planning on taking after her 5-year run with tamoxifen.

how similar different drugs really are is up for question, as this article in the obstetrical and gynecological survey shows. i certainly remember from my work with people with chronic pain that the minutest changes in medication can have a significant effect.

2. stick with tamoxifen
7,154 women at high risk for breast cancer were randomized to 5 years of daily tamoxifen or placebo. (such a placebo-controlled trial couldn’t be undertaken today for ethical reasons because tamoxifen is now approved as a breast cancer chemopreventive agent).

the primary end point was the incidence of breast cancer, which at 10 years was 3.9% in the tamoxifen arm and 5.5% with placebo, for a highly significant 29% relative risk reduction. this result included a 38% reduction in ductal carcinoma in situ and a 27% decrease in invasive breast cancers.

there were 87 estrogen receptor-positive invasive breast cancers in the tamoxifen group and 129 in controls, for a 34% relative risk reduction. tamoxifen had no effect on the rate of estrogen receptor-negative tumors.

tamoxifen prevented tumors of all grades. importantly, the risk reduction was as great in year 10 as in year 1.

drawbacks of tamoxifen and possible alternatives

long experience with tamoxifen, has shown that it does have drawbacks. the drug is considered to exhibit mixed effects, being antiestrogenic in breast tissue but estrogenic in the endometrium, bones, and liver; and a significant increase in the incidence of endometrial cancer has been consistently seen with its use. tamoxifen is also associated with a significant increase in thromboembolic events, with pulmonary embolism being a particular concern. the related but more selective estrogen receptor modulator (SERM) raloxifene, as well as other SERMs such as toremifene, have also been undergoing evaluation as potentially safer alternatives to tamoxifen.

a relatively recent article (october 2006) at the fabulous resource breast cancer research site states that

placebo controlled trials in over 25,000 women showed that tamoxifen reduced breast cancer risk by about 40% and osteoporotic fracture risk by about 32%. similarly placebo controlled trials in nearly 18,000 women showed that raloxifene reduced breast cancer risk by 44-72% and osteoporotic fractures risk by 30-50%. a direct comparison of tamoxifen with raloxifene showed similar risk reduction for breast cancer and osteoporotic fractures with less toxicity for raloxifene.

other alternatives come from complimentary medicine. that’s a whole difference bowl of wax. perhaps we’ll post about that some other friday.

(image by linda bowman)

frozen pea friday: a survivor tells her story

for a few weeks now, either here or on another blog, every friday i post something about cancer. as those of you who stop by here frequently, this is something started by susan reynolds and the people around her. in december, susan reynolds was diagnosed with breast cancer. now she’s become an activist.

in her ever-creative way, she posted a to-do list for people who want to support this cause. here is something interesting: at a site created by the american cancer society, cancer survivors share their stories.

so let me step aside for annie. cancer has stepped aside for her, too.

a buddhist carnival – february 2008 (part 1)

hello my friends! it’s time for the february edition of a buddhist carnival. once again, we have many good submissions, and i’ll post this edition in two parts.

frozen peas

chanting OM for health; image by http://flickr.com/people/lawntffoto/because it’s friday – frozen peas friday – i’ll start with a blog entry by a buddhist writing about breast cancer. like susan reynolds, “whymommy” is another person receiving online support for her breast cancer. tracy talks about members of a buddhist temple chanting for health and adds, “try and make a little space in your hearts for these women.” thank you, tracy.

mindfulness

this time around, a few people were talking about mindfulness. here is ron brown’s a skeptic’s testimonial on mindfulness meditation posted at the frame problem.

i am a rigorous skeptic. what brought me to meditation was having read a number of scientific papers published in leading psychology and medical journals on its scientifically demonstrated efficacy at promoting enhanced psychological well-being, focus, self-awareness, present-moment orientation, and as a means of treatment for depression and anxiety. i have personally experienced each of the just-mentioned benefits, in addition to insight”i’m not sure if insight has been scientifically demonstrated.

alvaro fernandez talks about mindfulness and meditation in schools:

schools have been turning to mindfulness for very practical reasons that don’t concern religion, and their efforts have been supported by a recent wave of scientific results.

steve reidman first introduced mindfulness practices to toluca lake about six years ago. reidman, a fourth grade teacher at the school, had been experiencing problems with classroom management”a first for him, after many years of teaching. conflicts on the playground were escalating and affecting his students’ ability to settle down and concentrate in class. when he confided his problems to kaiser, a personal friend, she offered to come to his class to teach mindfulness, a technique she’d taught to kids as a volunteer at a local boys and girls club.

“i noticed a difference right away,” says reidman. “there was less conflict on the playground, less test anxiety”just the way the kids walked into the classroom was different. our state test scores also went up that year, which i’d like to attribute to my teaching but i think had more to do with the breathing they did right before they took the test.”

also on mindfulness, we have dr. mike skinner with what is mindfulness meditation? and rose walbrugh asking is mindfulness meditation the key to applying the secret?

samurai

ken nubo presents lessons learned from the greatest samurai. miyamoto musashi, a samurai, used buddhism as a base line for his code of conduct. here are a few of his precepts

“accept everything just the way it is.”
“do not, under any circumstances, depend on a partial feeling.”
“think lightly of yourself and deeply of the world.”
“be detached from desire your whole life long.”
“do not regret what you have done.”
“never be jealous.”
“never let yourself be saddened by a separation.”
“resentment and complaint are appropriate neither for oneself or others.”
“in all things have no preferences.”
“do no hold on to possessions you no longer need.”
“do not act following customary beliefs.”
“do not collect weapons or practice with weapons beyond what is useful.”

the middle way

samuel discusses the middle way, balance and non-extremism, referring to research on alcohol consumption. i like how samuel takes us along in his exploration of buddhism. he doesn’t claim to be an expert, he just “talks out loud”. a true beginner’s mind?

contradiction

angela presents turn on your lovelight (and leave it on). she comments, “i usually blog about buddhism in relationship to my every day life — and sometimes review buddhist literature. i’ve only recently begun to think about sharing my comments on religion with others.” this is a lovely post on the dedication of merit, or the vow of the bodhisattva. the vow is a tall order – how can we live with it? only by allowing contradiction …

finally for today, two posts that are not directly related to buddhism but you might find them interesting anyway: live your best life by serving others, and the power of rituals: how to build positive, energizing daily rituals

this concludes today’s post. you’ll have the second part of this month’s buddhist carnival tomorrow for breakfast. and if you’d like to submit your buddhist post for the next edition (on the ides of march, march 15), feel free and use this submission form.