Paying New Year’s Blessings Forward

noah & zahraIn a new year with meanness and cruelty on the news every day, there are counter forces at work. Here is my favorite Pay-It-Forward story so far for 2019. It involves my lovely friend Eva Zimmerman, who agreed to let me to share it. Eva and her husband, Noah Schreck, welcomed their first child, daughter Zahra, into the world last spring. But the exuberant joy they were having was interrupted by Noah’s diagnosis of colon cancer, requiring surgery in December.

On January 2, Eva posted this story (lightly edited here) on Facebook.

“Noah is home! He has a lot more healing and resting (and eating) to do to get back to his old self and Zahra is being super helpful by screaming and screeching at a newly-discovered ear piercing volume, constantly. We’ll readjust and recalibrate and make this work. We’re thankful to be together.

“We are so fortunate to have so much support. Meals waiting on the porch, welcome signs and ice cream delivered, childcare, and just the love and prayer that we’ve felt this entire time… Thank you, all.eva, noah, zahra

“As I was leaving the hospital with all of Noah’s belongings, taking everything to the car to load it and go pick him up in the patient loading zone, I stood watching a beautiful young black couple comforting each other as they were waiting for the parking lot elevator. The elevator opened, she entered, he motioned for me to go ahead of him, he held the door open for me. As we stood there, heading to the same parking lot floor, he wished me a Happy New Year. I told him that it truly was a Happy New Year, that I was taking my husband home today after almost two weeks in the hospital.

“The woman said, ‘Our son will be here for the next two weeks.’ I told her I hoped he’d be home soon, healthy. She said, ‘Hoping for soon and cancer-free.’ I told her, ‘My husband is leaving today, cancer-free.’ She said, ‘This is why he’s here, they are doing surgery to remove his cancer.’ I told her that this is exactly why my husband has been here, they got it, they got the cancer, and he’s leaving today cancer-free. She and I held hands and I said, ‘I’m sending the blessing to you all now. It’s with you now.’ As we walked to our cars, she told her husband of the chills that went through her and simultaneously, they went through me.noah & zahra1 Though incredibly hard, we’ve been protected through this, because of you all. I gave that protection and blessing back to another family just as we left. It was a moment I’ll never forget. I don’t know their name. But as I write this, I’m watching Noah sleep next to me, and I’m thinking of them, envisioning their son home safe, soon and cancer-free.”

Take that, meanness.

Early cancer tests, surgeries questioned

Was this mastectomy necessary? It’s a question few breast cancer survivors want to ask, and one that few are likely to answer absolutely. But after years of aggressive emphasis on early diagnosis and treatment, some previous imperatives are being called into question. Noting that breast biopsy has long been considered the “gold standard,” a report in today’s New York Times addresses the new rethinking:

As it turns out, diagnosing the earliest stage of breast cancer can be surprisingly difficult, prone to both outright error and case-by-case disagreement over whether a cluster of cells is benign or malignant, according to an examination of breast cancer cases by The New York Times.

Advances in mammography and other imaging technology over the past 30 years have meant that pathologists must render opinions on ever smaller breast lesions, some the size of a few grains of salt. Discerning the difference between some benign lesions and early stage breast cancer is a particularly challenging area of pathology, according to medical records and interviews with doctors and patients.

Diagnosing D.C.I.S. “is a 30-year history of confusion, differences of opinion and under- and overtreatment,” said Dr. Shahla Masood, the head of pathology at the University of Florida College of Medicine in Jacksonville. “There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin.”

Much of the current finger-pointing is toward pathologists, where their money comes from, whether they are ‘certified’ or not and in general, how good a job they do.

In 2006, Susan G. Komen for the Cure, an influential breast cancer survivors’ organization, released a startling study. It estimated that in 90,000 cases, women who receive a diagnosis of D.C.I.S. or invasive breast cancer either did not have the disease or their pathologist made another error that resulted in incorrect treatment.

After the Komen report, the College of American Pathologists announced several steps to improve breast cancer diagnosis, including the certification program for pathologists.

For the medical community, the Komen findings were not surprising, since the risk of misdiagnosis had been widely written about in medical literature. One study in 2002, by doctors at Northwestern University Medical Center, reviewed the pathology in 340 breast cancer cases and found that 7.8 percent of them had errors serious enough to change plans for surgery.

This space has argued occasionally for reconsideration of yearly mammograms and for longer, stronger consideration of other options before a mastectomy is performed. Especially in the case of older women.

Would I insist on further studies or opt for less radical treatment if I were diagnosed with breast cancer today? Probably. Can I undo the mastectomy I had at 72? Not exactly. Second-guessing is beside the point for someone who is healthy and fit, but asking questions won’t ever hurt.

Earliest Steps to Find Breast Cancer Are Prone to Error – NYTimes.com.

Illness, loss and words of comfort

New York Times Personal Health writer Jane Brody last week noted another chapter in the wrenching drama she has shared with readers, first with the cancer diagnosis of her husband, lyricist Richard Engquist, and later following his death on March 18. In the new essay Brody tells of condolences received from friends and strangers. The writing, she says, has been therapeutic.

But one piece of therapy I never expected was the feedback from readers, friends and acquaintances: many hundreds of condolence letters, e-mail messages and comments on The New York Times’s Well blog.

Whether in a card, note, letter, phone message, hug or pat on the shoulder, some people seem to know instinctively how to show they care and will remember the deceased. What stands out most in these messages is their deeply personal quality. People who knew my husband in various walks of life (especially his advocacy for his beloved Prospect Park and his career as a writer for the musical theater) saw him in ways that had escaped me, because I was too close to have their perspective. By sharing these details, they have rounded out my memories of a life shared and separate from his — memories I will cherish for the rest of my life.

Brody gives examples of the many messages about her husband that brought comfort, and offers thanks for the fact that those unwanted messages — “Surely you’ll meet someone else;” “I know how you feel, my dog died last year” — had not arrived.

There’s one thing often of great comfort to someone who’s suffered a loss that Brody doesn’t include and that doesn’t occur to everyone. It’s the reminder of what the survivor meant to the now-deceased, one of the easiest ways to write a quick, meaningful condolence note. I learned it many years ago from someone I never met. Her Army officer brother, to whom I’d been pinned (an emblem of commitment in those olden days; I’ve no idea if such customs still exist) was killed in Korea. I could not travel across the country for the funeral, all of the sympathy and support was rightfully going to his family, but I felt bereft and unconsoled. Then I got a two-line note. “Dave said you could always make him smile,” she wrote; “and that will always make us smile.”

Thoughtful people have reinforced the knowledge of how much such a thought can mean. “Your mother was so proud of you because —.” Happily, in this fast-moving world the snail-mail sympathy note seems to survive. And I suppose even the e-mail condolence is better than nothing. If you’re stumped for a note you could be writing, try it this way.

Dr Oz worries about cell phones too

More on cell phones and brain tumors: a reader yesterday sent along a link to an earlier commentary by Mehmet Oz, the cardiac surgeon/author/media guru who has also weighed in with advice that links between cell phone use and cancer are indicated.

We rely on them to connect us to the people we love, to help us stay organized, and, in an emergency, to keep us safe. But more and more experts are saying that cell phones may pose a very serious health risk – increasing your chance of developing a brain tumor.

That means that over 270 million Americans may be playing Russian roulette with their cell phones every day. Each year, more than 21,000 adults and 1,500 children are diagnosed with brain tumors, and researchers believe some of them may have been caused by talking on a mobile phone.

A new study examined a decade’s worth of research and concluded that people who use cell phones for more than 10 years are up to 30% more likely to develop brain tumors than people who rarely use them.

Nothing has shown proof — yet — that if you use a cell phone often enough, long enough, you’re going to get brain cancer. Dr. Oz lists ways to improve your chances — keep your phone in your pocket, use it on speaker (and Lord help us all when everyone’s not just on cell but on speaker…), use wired rather than wireless when possible. And however much some of us vow we’ll resist texting to the bitter end, atrophied thumbs might still be preferable to brain cancer.

Still, the cell phone industry is not going to issue credible warnings. The FCC should do so.

New cancer insights from man's — and woman's — best friend

Lessons on love and fidelity have long been learned from the canine kingdom; now add cancer and aging.

The Gerald P. Murphy Cancer Foundation, a not-for-profit research foundation headquartered in West Lafayette, Indiana, has a mission “to accelerate medical progress in the fields of cancer treatment, cancer prevention, and aging,” and is coming up with useful data through studies of pet dogs. (The center was named posthumously, after his untimely death, for founder Gerald Murphy, developer of the Prostate Specific Antigen (PSA) test that remains the gold standard for early detection of prostate cancer.) Most recently comes news of discoveries made with the help of Kona, a Rottweiler who is getting along in years herself. It was reported last week on MSNBC by by Anne Marie Tiernon of WTHR-TV.

There are new clues about why some of us live longer than others. A new study of dogs has revealed a new role for the ovaries. Ovaries produce eggs and hormones and also have a primary role in bearing children. But the study in West Lafayette points to a larger ovarian ecology, meaning the ovaries have a role in how long we live.

Kona, a 13-year-old Rottweiler from Cleveland, has achieved exceptional longevity for her breed. Most live about nine years. Data about Kona and 304 other Rottweilers was collected and analyzed at the Gerald P. Murphy Cancer Foundation.’We are trying to find ways to promote exceptional longevity in pets and people,’ said Dr. David Waters, DVM PhD. director of the Exceptional Living Studies Center.

In combing through the dog data, the Center’s researchers found links between ovaries and a long life.

‘To reach exceptional longevity is to live about 30 percent longer, similar to the difference between a 100-year-old person and a person that would only live, let’s say, 72 years,’ Dr. Waters said. So we are talking about a big difference and that keeping ovaries longer was associated with an increased likelihood of reaching exceptional longevity.’

Being a female, Kona was born with a 2-to-1 advantage over male dogs to reach her 13th birthday.

‘But the interesting part was when we take a look at the dogs who lose their ovaries, the females who lose their ovaries in the first four years, now the female survival advantage disappears,’ Dr. Waters said.

Dr. Waters, whose research work has extended to a variety of complex issues relating to cancer and aging, sums up the bottom line for women:

The takeaway from these studies, including the one with Kona? That doctors and women will pause and question the routine removal of ovaries during a hysterectomy. In the United States, the standard practice for decades has been to remove the ovaries during a hysterectomy to prevent ovarian cancer and maybe some breast cancers that are estrogen-fed.

The findings are something new to add to your plus and minus columns when making a decision with your doctor.

Health Bill Should not Pit Women against Seniors

The health care issue is, one would think, too important for partisan games pitting one group against another. Especially when huge portions of each group are one and the same. But as Robert Pear and David M. Herszenhorn report in today’s New York Times, that seems to be happening.

In a day of desultory debate on sweeping health care legislation, senators appealed to two potent political constituencies on Tuesday, with Democrats seeking additional medical benefits for women and Republicans vowing to preserve and protect Medicare for older Americans.

The Democrats’ first amendment, offered by Senator Barbara A. Mikulski of Maryland, would require insurers to cover more screenings and preventive care for women, with no co-payments.

‘Women often forgo those critical preventive screenings because they simply cannot afford it, or their insurance company won’t pay for it unless it is mandated by state law,’ Ms. Mikulski said.

I met with my oncologist two days ago and decided to have a mammogram. It’s been two years since the last one. She and I agree that, having had breast cancer in 2006 and breezed through a mastectomy, and being fit and healthy overall, my particular situation suggests the potential benefits — catch another cancer early, gain another good decade or so of life — outweigh the risks.  This is what the whole thing is about: every woman is different, every woman should be allowed to decide, with her doctor, on screening and preventive care. The Mikulski amendment will insure that can happen, whatever one’s age and circumstances.

The first Republican proposal, offered by Senator John McCain of Arizona, would strip the bill of more than $450 billion of proposed savings in Medicare. The savings would curb the growth of Medicare payments to hospitals, nursing homes, health maintenance organizations and other providers of care.

‘The cuts are not attainable,’ Mr. McCain said. ‘And if they were, it would mean a direct curtailment and reduction in the benefits we have promised to senior citizens.’

Senators said that debate on the bill, which embodies President Obama’s top domestic priority, would last for several weeks and perhaps continue into January. A vote on Ms. Mikulski’s amendment has not been scheduled but could come Wednesday.

The health care bill would require most Americans to carry insurance. It would subsidize coverage for people with moderate incomes, expand Medicaid and create a government insurance plan, which would compete with private insurers. The House passed a similar bill last month.

Ms. Mikulski’s proposal was prompted, in part, by the recent furor over new recommendations from a federal task force that breast cancer screenings begin later for many women.

The Senate majority leader, Harry Reid, Democrat of Nevada, hailed Ms. Mikulski’s proposal, saying: ‘The decision whether or when to get a mammogram should be left up to the patient and the doctor. That decision should not be made by some bureaucrat, a member of Congress or someone they’ve never met.’

As health costs and insurance premiums rise, Mr. Reid said, ‘more women are skipping screenings for cervical and breast cancer, and doctor visits that can catch problems like postpartum depression and domestic violence.’

Votes on the Mikulski amendment will show whether Republicans “truly want to improve this bill or just want to play games, stall,” Mr. Reid said.

Ms. Mikulski said her proposal would ‘shrink or eliminate the high cost of co-payments and deductibles’ for women who receive screenings for cancer, heart disease, diabetes and other conditions.

Senator Kay Bailey Hutchison, Republican of Texas, criticized the proposal, saying it would ‘allow yet another government agency to interfere in the relationship between a woman and her doctor.’

No, Senator Hutchison, the government isn’t interfering in my relationship with my doctor, nor will it do so by insuring other women’s choices and coverage.

Republicans argued that the bill would be paid for on the backs of older Americans.

‘We are receiving incredible and overwhelming response from seniors all over America,’ Mr. McCain said. ‘They paid all their working lives into the Medicare trust fund, and now they’re in danger of having $483 billion cut out of it.’

Mr. McCain’s proposal would effectively cripple the bill, because Democrats are relying on savings in Medicare to help offset the cost of providing coverage to more than 30 million people who are now uninsured.

This senior would like to add a word to that “overwhelming response” Mr. McCain reports. I paid all my working life into Medicare (which, by the way, was not exactly a gift to America from the Republican party) and I want a decent health bill more than I want every penny of my Medicare coverage protected.

A lot of us have come to terms with the fact that the health bill we may get is a long way from the health bill we so fervently wanted. We are still hoping that something survives the attempts to sink it at any cost.

Senators Pitch to Women and Elderly on Health Bill – NYTimes.com.

New Cancer Guidelines: One Good Message

News about changing guidelines for cervical and breast cancer screening have some women cheering, a lot of women fuming, and most women feeling confused. Or betrayed, or mistreated or worse.

There is one universal message in it all: every woman has to be her own advocate.

For most of us, that is no big deal. We’ve known for a long time that no two of us (and surely no four collections of breast tissue or no two histories of sexual activity) are alike, and most of us have gotten used to asking a lot of questions. It’s unfortunate that so many changes have been announced at almost the same time, and especially that the issue has become politicized.

New York Times health writer Denise Grady summed up the latest developments, and the issues that have caused confusion and anger in a November 20 article:

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.

The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.

Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”

She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”

Dr. Iglesia said the argument for changing Pap screening was more compelling than that for cutting back on mammography — which the obstetricians’ group has staunchly opposed — because there is more potential for harm from the overuse of Pap tests. The reason is that young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone. But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix and lead to problems later when a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean.

Still, the new recommendations for Pap tests are likely to feed a political debate in Washington over health care overhaul proposals. The mammogram advice led some Republicans to predict that such recommendations would lead to rationing.

It boils down to this: every woman will need to pay close attention to her own health care. That is bad news for the less educated, the less aggressive, and those with less access to care, and not particularly good news for many older women who grew up with “The doctor knows best” excuse for not paying attention.But it’s good news for those of us, particularly older women, who have questioned what sometimes seemed too-frequent testing and screening.

Asking questions just got more respectable.

Guidelines Push Back Age for Cervical Cancer Tests – NYTimes.com.