So Long, My Foul Weather Friend

Chemo is over. Need I say more?

Love Potion No. 9

Green tea with a hefty dash of black pepper, turmeric and ginger.

Piss Poor

Today was a doozy. I had to drive into work this morning. It's about a two-hour commute on a good day. My stomach hurt. I haven't taken a proper crap in days. Post-chemo meds make me, and anyone who is lucky enough to take them, constipated in a way that I would wish on a few people only. Bill O'Reilly comes to mind. Maybe Nancy Grace. I could barely eat my oatmeal, which, frankly, is getting a little old, and I wished I had some frosted mini wheats.

I was already hungry for lunch by the time I got to work (not nearly lunchtime). My work-lunch buddy and I went to the Thai place across the street. We'd tried to go yesterday too, but the place's credit card machine was broken. Cash only. Neither of us had any. So, this was like a two-day-in-waiting deal. They got busy fast, right after we were seated. And, nearly an hour and a half later, my friend had gotten her lunch, but I still hadn't gotten mine. I had a meeting at 1:30. We asked for our check and my food a few times; the waiter who seated us – we never saw him again. The clock is ticking. It was 1:25 – no lunch for me.

The meeting with my boss was less than stellar. I won't go into details for fear of getting dooced. Oh, and it was supposed to be 30 minutes long, only it ended up being over an hour and a half. By this time, I was running late for my Dr.'s appointment for my CBC. I was dreading it for some reason. Plus, I ran out of Lorazepam yesterday, which I usually take before my blood test because I still get so freaked out by needles. You'd think I'd be over it by now. Not so. I think my phobia has actually worsened of late. Part of that may be because my awesome vein in my left arm is out of commission for now, and the one on the right arm isn't as cooperative. It hurts when they draw blood, and I'm over it.

When parking at the doctor's office, you get a ticket when you pull in, and give it to the lot attendant on the way out. I was only there for about 15 minutes, which should have cost $1. Only I lost the fucking ticket. I looked everywhere for it. Where did it go? I had to pay for a full day of parking when I left. Lost-ticket price: $10.

On the way home, there was an accident on I-66. Right lane completely blocked. Traffic at a standstill. Oh yeah, and, on the way to the doc, I had drunk an enormous bottle of water, like, maybe a gallon, seriously. If I'm not hydrated enough, veins disappear, and more hurting. So, tons of water, and now I'm stuck in traffic and really, really have to pee. Finally, out of desperation, and I can't believe I'm writing this, but whatever, I grabbed my thermos, dumped out its contents, took my coat off to cover up my lap and what I was about to do, pulled my pants down and strategically, or so I thought, peed into it, while driving, on 66, in rush hour traffic. I emptied the first batch. And, again. This time, I miscalculated. Ok, now read this carefully: I dumped warm pee all over my car seat, and a little on me. I tried not to move too much, not to sit down. I moved my coat that was on my lap covering up the goods under my butt to soak up the huge amount of urine on my car seat. Is my car going to stink from now on? My coat needs to go to the dry cleaners. I feel bad even taking it to the cleaners. That means someone, an unknowing stranger, will have to touch it. This is absolutely terrible. All I could think of was thank God there is a brand-spankin' new prescription of Lorazepam waiting for me at Walgreen's.

At the drug store drive through at last. What a great invention. Convenient, legal, drive-up drugs. I happily declare my name, why I'm here, and that my doc called it in this morning. Tick tock, tick tock. Any minute now. Money, ID in hand. This is so exciting. But, my day takes a turn for the worse. The pharmacist informs me that they have nothing. No one has called in anything. She checked Walgreens everywhere, and there is nada, anywhere. I'm not really surprised by this, considering the turn of events up until now.

When I have a piss poor day like this one, at least I know it could be worse, like I could have a tumor in my boob or something crazy like that, but I don't, and I'm alive, so what's a little pee on my leg?

It's Complicated, But Read It Anyway

This is a fascinating article that I found on Kris Karr's website. Get her book. 


Your Genes Don’t Determine Your Fate

The decoding of the human genome at the dawn of the millennium carried the hope and promise of the beginning of the end of human suffering. However, after more than a decade of intense exploration of the human genome, the burden of human disease and suffering has only increased across the globe. Heart disease, cancer and diabetes, as well as allergic and autoimmune disorders, have all continued to skyrocket. Hope has given way to disappointment as scientists have recognized that, other than in single gene disorders like Down syndrome, your genes don’t determine your fate.

In November 2010, a review on genomics, Type 2 diabetes and obesity in the New England Journal of Medicine sadly reported on how little correlation exists between obesity, diabetes and your genes. There are associated patterns that confer small risks, but the authors lament the lack of stronger connections between genetic makeup and the biggest disease epidemic of our time (obesity and diabetes).

The story of your health is much more complex than genetic programming. It is ultimately determined by the dynamic interplay of the environment washing over genes creating the “you” of this moment. The good news is that this has been the year of discoveries about “-omics” – epigenomics, exposomics, nutrigenomics and microbiomics, and toxigenomics – that do, in fact, hold the key to unlocking our health and disease mysteries.

The Epigenome: Bypassing Darwin and Evolution
More important than our collection of genes, it now appears, is how those genes are controlled by both internal and external factors: our thoughts, stress, social connections, what we eat, our level of physical and mental activity, and our exposure to microbes and environmental toxins. These factors are switches that turn genes on and off and determine which proteins are expressed. The expressed proteins, in turn, trigger signals of disease or health.

What’s even more striking is that if your DNA is tagged by an environmental factor, such as a pesticide, the impact this environmental factor has on your genes can be passed down through generations. The “epigenome” become inheritable. That means if your grandmother ate too much sugar, or smoked, or was exposed to mercury from too much sushi, the genetic modifications she incurred from this exposure could affect you. Her epigenome would carry an increased risk of disease that could be passed down from generation to generation. Interestingly, the Darwinian and Lamarckian worldviews are intersecting in 2010.

The Exposome: Environmental Influences on Health and Disease
In October 2010, Science magazine published an important paper that reviewed the notion of the “exposome” – the idea that the environment in which your genes live is more important than your genes themselves. What this suggests is that applying genomics to treat disease is misguided because 70 to 90 percent of your disease risk is related to your environment exposures and the resultant alterations in molecules that wash over your genes.

The question then is how do we measure and change our exposome– or the totality of the impact of the environment on your genes. We must address not just one factor but the whole collection of interacting factors that determine health and disease: toxins, food, microbes, internal chemicals including all the biologically active molecules that control inflammation, oxidative stress, gut flora, and other natural processes.

Emerging biomarkers and analytic techniques will soon allow us to map our exposome from a drop of blood and measure changes over time. Using novel treatments that help identify and remove known external toxins (like pesticides and mercury) and strategies that change the internal environment including diet, nutrients, probiotics, and detoxification would help you change your exposome and lower your overall disease risk.

Once this new paradigm of understanding how a lifetime of interacting exposures interacts with your genes to determine your chronic disease risk, once the gene-environment interactions are mapped more carefully, then the promise of the genomic revolution can be fully realized.

love it.

Nutrigenome: Eating Your Way to Better Genes
The most important thing you do to control your genes every day is eat well. Food – and the combination and quality of macronutrients (protein, fat, carbohydrate), micronutrients (vitamins and minerals), fiber, and phytonutrients (plant-based bioactive compounds) – all wash over your DNA every day turning on or off, up or down signals from your genes. This field of study, called nutrigenomics, offers a powerful way for you to control your destiny.

Researchers have found, for example, that depending on your genes, you may respond better to different diets. Some do better with more fat and protein and less carbs, others may not. One of the most important discoveries of the decade is how food (whether it is plant-based, nutrient-rich, phytonutrient-rich food, or processed, high sugar, nutrient-depleted food) changes your gene expression in real time over the course of weeks to months. Dr. Dean Ornish showed how this works in his seminal prostate cancer research. He was able to beneficially affect over 500 cancer-controlling genes simply by having his patients eat a plant-based, whole foods diet.

Microbiome: The Most Important DNA in Your Body is Not Your Own
The human body hosts 100 trillion microorganisms. The DNA of the bugs living in and on you outnumber your own DNA by 100 times. This is called the microbiome. Our bodies are simply a host environment for bacteria. They use us for their own purposes. The molecules produced by the DNA of these bacteria have significant impact on our health. This field of study is called metaproteomics.

This microbiome, particularly the ecosystem of nearly 500 bugs that live in your gut, have been linked to everything from obesity, to cancer, to autoimmune and allergic disorders and even heart disease and diabetes. Our modern lifestyle and diet and the overuse of antibiotics has changed the population of bacteria living in our guts and it has made us sick.  Which bugs we grow in our intestine determine whether we will be fat or thin, inflamed or healthy. The critical discovery of this microbiome and its implications for influencing many of the diseases of the 21st century will provide novel treatments involving changing our diets and the use of pre- and probiotics to shift the gut ecosystem into a health-promoting balance. We are only as healthy as our gut bacteria.

What the Future Holds
The giddy, back-slapping decoding of the human genome has given way to a more sober view of the limits of genomics and the remarkable understanding of what we all knew intuitively: that how we live, the quality of our relationships, the food we eat, how we use our bodies, and the environment that washes over us determines much more than our genes ever will. The next decade will better characterize how the environment affects gene expression (the genome-exposome interactions) and our health, and provide us better ways to measure and improve those interactions and help us create the best expression of ourselves.

By Mark Hyman MD on January 18, 2011


Change your diet, change your life.

A Love Letter

I made white bean and kale soup for the second time in two weeks, and all I could think about was how much more delicious it would be with bacon, braised in the pot first, then pouring in the delicious veggies, spices, broth – all getting mixed up and infused with bacon grease, bacon butter. And, so, what am I to do?

Dear Bacon,

I’ve been thinking a lot about you lately. Missing you, wanting you, tasting you. There isn’t a day that goes by that I don’t think of you. I long for the good ole days. I know my white bean and kale soup would be much more delicious with you in it, my simple bar of dark chocolate would be much more amazing with some crunchy bits of bacon, and my spinach salad just isn’t the same without bacon and your best friend bleu cheese. And then there is my hankering for oysters with salty bacon. You are the perfect accompaniment to so many things. Too many to list here. Your qualities are endless. Even my turkey burgers seem to miss that special something, and I know it’s you. What about the bacon jam from the food truck in Seattle that I never even got to truly appreciate? Bacon lollis from founding farmers. Pork belly from Woodberry Kitchen. Summer corn soup with bacon, BLTs! Oh, this is disastrous.

I deeply miss writing about you, taking pictures of your beautiful, fatty, marbles. You will forever have a place in my heart. 

I am trying to go on without you. But, know that my stomach is empty. You are loved by so many, and will go on happily without me. As for me, life will never taste the same.

With adoration and deep regret,

amy

p. s. maybe I'll make an exception every now and again. you might not be good for the heart, but you're soo good for the soul. 

Ahhh. Out of the Woods.

It's kind of cool when you feel like crap, because then when you don't anymore, it's like the skies part, sunshine floods in, and I feel weightless. Although maybe that's because I am weightless these days – literally. My fourth treatment was a week ago, and today, I feel AMAZING.

Folks have been asking me how I feel, and I say most of the time that I feel fabulous. And, mostly, that's true. But, it does seem that the drugs are catching up with me, just a little. There is a laundry list of side effects from chemotherapy, but I, my friends, have only about 3. One is balding. I have about 5 eyelashes left, and those little shits better not even think of letting go. The other is a shooting pain in my arm that radiates from my monster vein that gets shot up with a 5-hour IV drip every three weeks. The vein is getting inflamed from the toxicity of the medicine. The vast majority of patients who receive chemotherapy have a "mediport" implanted into their chest wall, where the medicine is injected into. My veins are so giant and juicy that they can just shoot em up outright. Awesome. It makes my whole arm hurt, kind of a lot. And, my fingertips get tingly sometimes, accompanied by a weak grip. I hate when Jon twists on NJ's bottle tops so tightly that I can't open them.

But that's not really the part that makes me feel the worst. It's the stinkin Neulasta, which Jon has been giving me. I think he enjoys it. Clearly, he's the sick one here. Days 4 and 5 after my treatments are getting fairly brutal. It's hard to go to work, to think, to get out of bed. But, I know it's good for me to get up and go in spite of it all. It's never hard to play with NJ though. She always makes me feel better.

Time stopped nearly 3 months ago, and now it seems to be back to its normal flying pace. Days seem different though. More palpable, sweet and long.

4 down, 2 to go. Can't wait til those little bitches don't get to stick me anymore, even though I will miss them bitches. I've sort of fallen in love with them. We laugh so hard. Yesterday, when I went in for my CBC check-up, I apologized to one of the gals when we were catching up before I went in to see Marina, my main nurse. "Sorry if I stink," I said. "It's hard to remember to take showers when you have no hair anywhere on your body to remind you. Thank God Jon brought me back some perfume from France." She said no one had ever told her that before, and then we were embarrassing ourselves in the waiting room, laughing hysterically.

Also when I was sitting there, I picked up a book that was on the shelf. I liked it – a guided journal for cancer patients to write their way through treatment. That's what I'm doing, right? Only now I'll write forever and ever after it's all said and done. And by that I mean until I'm like 100. After this crap, I better live for at least another 60. I'm fairly certain that I will. So, in the journal there was an entire section on anger. I would have nothing to write in that section, I thought. That is one emotion that I haven't had. I am not angry, nor have I been at any point during this whole ordeal. Maybe that will come later. But, I don't think so. I feel grateful. 

It is so rare that something happens in your life that unequivocally changes it, forever. And, so changes you, too. Nothing good comes out of anything easy. Nothing of real value, I mean. Growth, change, transformation, love, appreciation, humility, compassion, passion itself, truth, knowledge. I feel like an entirely new chamber in my brain has opened. Something has opened. Is that crazy? This life is new, and inspired. And, how can that NOT be a blessing. The best blessing ever. (Besides NJ, and Jon, and I could go on here, but I won't right now, but also the next thing.)

And, by the way, my tumor is GONE :)

The Things We Pass On

Think positive! Positive is supposed to be a good thing. A positive attitude will take you places, I'm sure – and so I try to have one. But, positive has begun to have a weird connotation for me these days. Positive for breast cancer, positive for triple negative (ok, well that one's confusing), positive for the BRCA1 genetic mutation. Yes, it seems that I am a mutant.

My parents passed on to me many things. Some beautiful, some cursed. They blessed me with an abundance of mostly unconditional love, some fierce loyalty and stubbornness that has its privileges, a  sometimes too thoughtful mind, an understated sense of style, a simple but profound respect for the natural world, compassion and kindness, and cursed me with a lineage of alcoholics, a bloody Irish middle-class work ethic (this is a curse, trust me), and an ancestry of inbreeding Ashkenazi Jews that apparently has made its way into my DNA.

Most people who test positive for the BRCA1 genetic mutation have had a history of breast or ovarian cancer in their family. But, it seems I am an unwilling pioneer. My mother's mother died nearly at my age from what was thought at the time to be liver cancer, but I have my doubts. Ovarian cancer is notoriously sneaky, and I have a suspicion that her liver cancer may have begun in her ovaries.

And, so things are different now, yet again, more complicated. In the beginning, it seemed we were headed down that "easy" road where I could pop in for surgery, get my melted lump taken away for good, and save what's left. This is more tricky, indeed.

Before I knew my test results, I was prepared to do what needed to be done no matter what, to give myself the best possible chances of a full recovery, a full life – my gorgeous life – and so I will do the unthinkable, but not so unthinkable now. Just the next step on a road that is getting shorter by the day.

Sometimes I still think maybe they got the results wrong. All of them. And, I think of my beautiful, sweet baby girl, all grown up and taking a test like this some day, worried, wishing they were wrong, too. But, knowledge is power, and NJ will be armed and dangerous.

The tireless advocate Lillie Shockney at Johns Hopkins told me, before she even knew about my test results, that there would be a cure by the time my daughter ever has to worry about this, God forbid. I believe Lillie. In fact, I would walk through fire if Lillie was leading the way. I think that woman knows something the rest of us don't. She might be magic.