Breast Cancer? Ask questions!

In honor of International Women’s Day (even if I didn’t quite get it finished in time,) this brief message is about a book recently re-issued by Dr. William H. Goodson III that should be in the hands of every woman with breast cancer, wanting to understand breast cancer or helping someone who is going through breast cancer.

Pink flower

It’s Your Body . . . ASK is a guidebook for talking with your doctor about breast cancer. I would’ve given anything to have had it when I had breast cancer, and a mastectomy, a dozen years ago. Maybe I would’ve made different decisions, maybe not. But the reality is this: most women, unless they have had medical training, would never think to ask a question like “What are the side effects of removing axillary nodes?” Personally, I didn’t think to ask about nodes at all. Other than considering the size of my cancer, in fact, questions I might have asked about its rate of growth, alternative treatments, follow-up therapies – – were mostly not discussed because I didn’t know to ask them.

This is a book that gives not just answers (it offers many answers about families, about hormone-based therapies and other issues) but more importantly: questions. If you, a breast cancer patient, know the questions, your doctor needs to give you the answers. What’s that lump about? What about these other pains and symptoms I have? What are all of my treatment options?

(I would say, here, Full disclosure: Dr, Goodson is a friend of mine. But it would be more braggadocio than disclosure. Bill Goodson and I shared a few discussion program podiums It's Your Bodyseveral years ago when his gripping novel about sexual violence against women, The Blue-Eyed Girl and my Perilous Times: An inside look at abortion before – and after – Roe v Wade were both newly released. I’m a writer. He’s a Senior Scientist at California Pacific Medical Center Research Institute; a recognized leader in breast cancer care who has been (among other things) a Professor of Surgery at the University of California San Francisco and President of the San Francisco Medical Society, and is listed in The Best Doctors in America.)

Credentials aside, It’s Your Body . . . ASK is worth a look. It offers a pathway through turbulent times, which can be far less turbulent if you have some help in steering your own ship.

Check it out.

Holidays and the “Worried Well”

Our local paper, the thin-but-still-here San Francisco Chronicle, greeted the morning recently with a story about a new hospital facility for “the worried well.” And I say, just in time. Some of us may be sick; most of us, I suspect, are among the Worried Well. Especially from now until next January 1.

The facility in question is the Brain Health Center, part of the California Pacific Medical Center‘s Davies campus. It is designed (with a little help from an anonymous $21 million gift) to address a multiplicity of brain-related issues, including help and support for those in fear of lurking neurodegenerative disease. If you haven’t ever worried about where you put the car keys or left the cell phone you can stop reading right now. You are in that tiny population of the angst-free unworried. Then there are all the rest of us.

(Since I am a contented Kaiser member, I feared for a moment that CPMC was one-upping us. But a quick check reveals Kaiser offers things like core dementia training and behavioral understanding, not to mention support groups without end to comfort the Worried Well.)

Worried Well issues range far beyond the challenges of short-term memory loss.  WWs don’t know where the next paycheck, or mortgage payment, is coming from, or whether that little lump might be malignant. Or if the good-looking guy at the party is ever going to call. Closer to home for yours truly it’s how a half-century of accumulated Stuff scattered around a four-story Victorian will ever reduce into the 1600-sq-ft condo at the continuing-care place where worries would be less and wellness more.

Here is the good news: faith trumps angst. At the annual Thanksgiving Day interfaith service sponsored by the San Francisco Interfaith Council, the hearts of the Worried Well were encouraged by just about every known faith tradition. A little inner peace from the Buddhist bell, a few stories building trust and understanding from the Mormons and the Muslims, eloquent prayers from the Jews and the Brahma Kumaris. Pastor Maggi Henderson of Old First Presbyterian Church, who organized this year’s service, then spoke convincingly of how hard it is to be angst-ridden when simply contemplating being loved by the creator.

So it seems, with science and religion BOTH looking out for us, the worried may yet be well.

Pelosi Reaffirms Public Option, Insurance Reform; Healthcare "A Moral Imperative"

House Speaker Nancy Pelosi, addressing a Chamber of Commerce-sponsored Health Summit in San Francisco this morning about Obama’s health reform, stressed elements of the three House bills that might seem palatable to her audience: cost containment, IT design and integration with existing systems to create universal access to care. But she did not back down on a few other consistent statements such as the assertion that no bill will pass the House without a public option.

“We will invest in medical research and technology,” Pelosi said; and will incorporate elements such as electronic medical records for individuals to speed care.

It was clear there were mixed levels of support for reform in her audience. California Pacific Medical Center CEO Warren Browner MD, MPH drew muted chuckles and no boos with a throw-away comment that President Obama had “spent more time on choosing a dog” than on crafting a health policy. CPMC, a Sutter Health Affiliate, was presenting sponsor of the event.

Speaker Pelosi, though, hammered away at the primary intentions of reform: “improve quality, expand coverage and contain costs” while providing universal access to quality healthcare. “We will,” she said, focus on “quality, not quantity; wellness of the person not utilization (of facilities and technologies); value, not volume; and a commitment to prevention and wellness.”

San Francisco Mayor Gavin Newsom addressed the gathering earlier, touting the success of his “Healthy San Francisco” universal coverage program now in its second year. An independent Kaiser Family Foundation poll recently showed Healthy San Francisco to have a 94% approval record, prompting City/County Department of Public Health Director Mitch Katz, MD to ask when any program of any sort had ever gotten a 94% approval record. Citing the need for protection of such elements as in-home services in an aging population, Newsom said the program’s success was attributable largely to partnerships with local hospitals, clinics and medical facilities (CPMC is one), specifically singling out Kaiser Permanente, which signed on in July. The program does not offer a national model, Newsom said, but has many elements a national plan could adopt. Healthy San Francisco includes things that might not get into a national bill but are favorites with wellness proponents: community organic gardens, city-funded salad bars in schools and an ad featuring a soda-equipped young boy admitting to “a drinking problem.” Another key to the program’s success, Newsom said, is its ultra-simple one-page enrollment form.

Pelosi insisted that the final bill will include “insurance reform: no refusal based on pre-existing conditions, no co-pay for prevention, no cut-offs.”

And the major themes were reiterated: “As President Obama has said, universal healthcare is a moral imperative,” she said; “we are the only country in the developed world without it. I say to those who would have us do a little bit, and another little bit, and another little bit — Lyndon Johnson settled for half a loaf; this is the other half of the loaf.”