Click on the American Cancer Society's link below for statistics.
Prevention is working.
Get screened.
http://www.cancer.org/research/infographicgallery/mammography-statistics
Mary-Jo Murphy, MS, RN, CDE, certified diabetes educator |
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After my yearly mammogram, today, the staff at the radiology department presented me with a pink rose, a lollipop and a smile. Click on the American Cancer Society's link below for statistics. Prevention is working. Get screened. http://www.cancer.org/research/infographicgallery/mammography-statistics
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What is being done to get the word out about the HPV vaccine? And how is the message being received?
The medical community and health officials promote vaccines as the greatest achievement in modern medicine, yet a growing fear still exists over vaccine side effects. A certain amount of skepticism is normal, but once relevant data is presented, why does the skepticism persist? Resistance to the HPV vaccine has some of its origins in a mistrust of the relationship between the medical community and the pharmaceutical industry. Critics assume someone must be gaining financially. Also, news reports and information on the Internet are designed to pique interest not clarify cause and effect vs. correlation. Denial is a human defense that is less available to members of the medical and public health communities. Someone who has never seen polio sees no need for the vaccine. A Ventura California Public Health nurse recalled when she was a child, there was a boy in her neighborhood who was paralyzed by polio. She reminds resistant parents of diseases that exist, even though most people would rather not think of them. HPV related cancers fall into that unseen group. The same nurse reports that acceptance of the vaccine was slow at first, because initially, “There was a lot of misinformation out there.” It can be difficult for the parent of a 13 year-old girl to imagine the day when the child will be sexually active. Recently, a mother refused the vaccine. “If she’s a virgin until she gets married, my husband doesn’t think she’ll need it.” the nurse pointed out that perhaps the girl’s husband wouldn’t be. The child got the vaccine. A Pediatric Nurse Practitioner in Southern California strongly recommends the vaccine. “I’m all about prevention and alleviating suffering.” She approaches the parents with direct, easy-to-understand language. “After your child’s exposed, the horse is out of the barn. You won’t know until it’s too late.” “It prevents cancer,” she tells them. She reminds the parents that the onset of cervical cancer affects the child bearing years. She mentions penile cancer, anal and even references Michael Douglas’ recent oral cancer. Neither nurse reported any serious side effects beyond dizziness and local muscle soreness. The Nurse Practitioner says that 30% of her teenagers want the vaccine. "The resistance of the others has more to do with injection phobia than fear of adverse effects." The mother of two teenage boys living in South Carolina told me that her decision to vaccinate was directly related to her trust in her pediatrician. She added that her 15 and 17 year-olds knew more about the vaccine than she did. The mother of an 8 year-old girl who lives outside of Sau Paulo, Brazil, credited her government and their public service campaign for her knowledge of the importance of the vaccine. She says that in Brazil the vaccine will soon be covered, but at this time for girls only. Another mother of an 11 year-old girl living in Los Angeles explained her acceptance of the vaccine this way. “You can read things online, but the parent need someone they trust.” In her case her “older, conservative pediatrician” explained, “it’s a vaccine to prevent cancer. That’s a no brainer.” Public Health campaigns affect acceptance, but those who provide direct care should not underestimate their influence. Awareness is spreading, but it is the one-on-one interaction that can be a countervailing force against scare tactics and cynicism. Prevention requires information, affordability, but above all trust. Mary-Jo Murphy, MS, RN, CDE
cartoon art by Craig Rohlfing
When my son was small we were shopping at a hardware store. In the rear of the store, a buck’s head was mounted on the wall. My horrified four-year old asked, “Mommy, what’s that?” Always one to believe simple truths are less confusing, I replied, “It’s an elk.” “How did it get there?” “Someone shot it, sweetie.” “Oh,” he said. Later, as we returned to our car, he asked if we could walk around to the back of the building. “Why?” I asked. “To see the back end of it.” I have told that story many times. But once, at a dinner party, I couldn’t retrieve the name of the store. I don’t mean a specific name. I couldn’t remember what those types of stores are called! This was years ago. Forgetting words was a new experience. After a long embarrassing pause, I began a description. “You know, those stores with hammers and screwdrivers…” “Hardware store?” someone offered. “Yes.” Relieved I resumed my story. Since my chemo, I forget words regularly. When I can’t pull up a word, hardware store is my default utterance. My oncologist seems unconcerned about my brain glitches. He says they are common after chemo, as is the fogginess and fatigue that make it impossible to resume my energizer bunny persona. Friends, who have never had chemo, confide that their memory isn’t what it used to be. As we age, memory lapses are normal – forgetting names or where you left your glasses, missing an appointment or having trouble remembering the details of a conversation. But, in my cancer support group, this memory thing has a name - chemo brain. Before treatment, I’d never heard of it. I had heard of the hippocampus, the region of the brain involved in the formation and retrieval of memories. I was curious how normal brain aging differs from chemo brain. So I attended a presentation by speech pathologists Carol Superfine, M.A., C.C.C. and Jeannette Nagai, M.A., C.C.C. They described these frequently experienced post-chemo experiences: · Being unusually disorganized · Difficulty: concentrating, finding the right word, learning new skills and multitasking · Fatigue, Mental fogginess · Short attention span · Short-term memory problems · Taking longer than usual to complete routine tasks · Trouble with verbal memory, such as remembering a conversation · Trouble with visual memory, such as recalling an image or list of words They termed these symptoms "mild cognitive impairment." Usually the changes are very subtle, and others around us may not even notice. But we’re aware differences in our thinking. Doctors have known for a long time that radiation therapy to the brain can cause trouble with thinking and memory. But now, they are learning that chemotherapy is linked to some of the same problems. Though the brain usually recovers over time, it’s important to know that the vague, distressing mental changes are not imagined. Chemo brain is real! Two major studies are being conducted in Australia by oncologist Janette Vardy, MD. Her studies include people with breast cancer and colorectal cancer. The researcher has found that those with cancer who never received chemotherapy didn’t experience any brain changes. Those who had received chemotherapy did. To try to understand better what is happening, the researchers tested the central nervous systems of experimental animals, Dr. Noble’s team found that chemotherapy interferes with the cell division in the hippocampus. (Remember what that is?) The cells needed for memory don’t reproduce normally. They also learned that the myelin, the nerve’s insulation can be damaged, causing cognitive problems. Early research by Jame Abraham, MD, director of the Comprehensive Breast Cancer Program at West Virginia University’s Mary Babb Randolph Cancer Center shows differences in the white matter in the front part of the brain in women who had received chemotherapy—differences that correlate with their slower speed in processing information. These changes do not appear to be caused by depression or anxiety. The last time I walked purposefully into my office and stood wondering what I was doing there, I thought, “Wow! This chemo brain is really annoying.” But then I remembered, so was my cancer. So how do we deal with the inconvenient and sometimes aggravating aftermath of our changed bodies and minds? How do we cope with the new normal? Here’s another story I just remembered. I think it’s easier to put things away – right away, rather than leave them lying around until later. The other day, I needed to tell my son to put something back where it belonged. “Could you put this away?” I pointed at the offending object. I guess I was sounding a little bossy, because he shot back, “What’s this?” Again I pointed, this time laughing, “I’m trying to think of the word. Would you put it away, anyway? Please.” Here are a few suggestions on how to cope with day to day living: · Share these changes in you with the people you love. They’ll be much more accommodating · Talk with your cancer team. Write down your questions and bring them to your visit · Relax. It helps you remember · Have routines · Write it down · Move. Exercise increases the circulation to your brain · Wait. Sometimes, your mind needs time to reboot · Get enough rest and sleep. Naps can bring back alertness · Eat healthfully, especially vegetables · Give yourself permission to focus on one thing at a time · Consider some time for meditation or yoga · Don’t rush. Give yourself enough time · Look for patterns that may help you figure out what affects your memory. Then, don't plan important tasks or events when your memory problems are worse · Exercise your brain. Do or learn something new · Don’t be hard on yourself. Acceptance will help you put your new thinking into perspective · Describe it. If you lose a word, a name, ask for help. · Don’t forget to laugh at yourself · Don’t forget the Hardware Store Helpful information and materials may be obtained from the American Cancer Society at 1-800-227-2345 or check out their Web site, www.cancer.org.
cartoon by Craig Rohlfing
BACK TO THE DOCTOR We all need feedback, an accountability partner. You might have felt inspired as you read about Bob, who lost over 50 pounds and is still at it. Bob moved his BMI from 35 to 25. In other words from obese to normal. Bob was motivated. His doctor warned him that he was going to get diabetes. How did the doctor know? Numbers – Bob’s weight and his blood sugar’s upward creep. Fear is a short-term motivator. For success we need intention. When Bob left the doctor’s office, he was determined to try, though he wasn’t convinced that his weight wasn’t just his inherited body type. To recap, in case you haven’t read his interview in earlier blogs, Bob’s a therapist, and because he understands behavior, he knew he needed feedback – some reality check outside himself. Change needs a plan. His was to go to Weight Watchers. He was willing, but he wasn’t drawn to it. He’s a busy guy, and he’d rather spend his free time golfing than going to meetings. Then, he happened upon a product, a Nike Band, which gave him feedback on how much he was taking in and how much he was burning. It was as if he was wearing his accountability partner on his wrist. Another thing in Bob’s favor is that he’s computer savvy, so he utilized the Nike site to compare his progress to others his age. He could have succeeded by using other means, but the fact is he found something that worked, and he’s still doing it. He’s still on course more than six months later. I’m not someone who pushes products or programs. You can burn calories dancing alone in your kitchen or walking your dogs, just as you can at a gym. But, if you find something that motivates you, helps you stick with your goal and the principles behind it are legitimate, embrace it. Don’t misunderstand. I am not endorsing the latest miracle product. Ads for coffee beans, berries, grapefruit, WHATEVER, put me in a bad mood. I hate seeing people shell out hard-earned money for quick fixes. Anything that strains your budget while offering to turn your life around in 28 days is suspect in my penny-wise world. Losing weight is like getting out of debt. Just as you can’t borrow your way out of debt, you can’t buy your way out of excess inches. One part of Bob’s journey, not covered in the interview, involved his 6-month follow-up visit with his doctor – the one who threatened him with diabetes. Here’s what happened. His doctor looked at Bob’s lab results and read the numbers, which were now normal. His doc didn’t jump up and congratulate him. He didn’t seem amazed. He didn’t even ask Bob how he did it. Strange! Bob looks like a different person. Maybe the doctor needs glasses. Or here’s another possible explanation – Physicians are numbers people. Just like a financial planner, they watch figures go up and down. Doctors aren’t behavioral change specialists. What most of them want to know is where you are in terms of your numbers. Bob has another theory. “My doctor’s seen this before in other patients. He doesn’t believe it’s going to last.” Could be. And Bob thinks it will be fun to prove him wrong. Driving on the freeway the other day I saw a billboard that read: “He’s off to college. It’s too late to talk about alcohol.” How true! We parents have our chance to speak and be listened to beforeour kids hit puberty. After that, we’re out; it’s their peers.
So what in our medical mind allows us to process the yucky subject of a vaccine to prevent a STD? How do you look into the eyes of your prepubescent son or daughter and explain that they, as well as over 50% their friends could someday be infected with a virus that causes: oral cancer, cervical cancer, penile cancer and anal cancer? How do you explain the need for this vaccine when 11-year-old boys think that girls have “cooties” and girls their age think that boys are “gross.”? How about telling them that the vaccine they are receiving prevents cancer caused by a virus? Now, you may have to explain what cancer is, maybe even what a virus is. I suppose it’s possible that an 11 year old will press for details as to how the virus is transmitted. Good. In that case you, and not their peers, get to be the one to explain. Remember though, it’s always good to start simple and only answer the question asked. I’m reminded of the story of a child who inquired, “Mom, where did I come from?” Figuring the time had come, she took a deep breath and explained the birds and bees in great detail. The kid looked confused. “No, I mean; one of my friends said he was from Chicago. I was just wondering where I came from.” PART 3.
Interview with Bob Renard So what about exercise? My exercise pattern is more a part of my daily routine. I have made it a priority to walk more every day. Since lightening my load, my knees have become more steady. I recall a day when I was walking, when I decided to jog a little just to see. Suddenly, I realized that I could jog again without feeling stress and fear. I realized that for a while now, I had been uncomfortable jogging or running, so to get across the street before a car gets too close. I thought my body was telling me I was just getting too old to run or jog. Really it was telling me that I was endangering myself to run with all those pounds on me. I was not steady anymore running. Now, that I am lighter, I can jog comfortably for long stretches of time without fear and without pain later. So I play golf two to three times a week and then walk in the neighborhood or at the YMCA. I take the dogs for a walk nearly every day. How do you feel? Honestly, I only notice feeling better or different when I put my awareness on something specific, like being able to jog or the needle on the scale pointing to a lower number than the day before, ore having to trim inches form my belts and re-punch holes so they will hold up my pants or seeing my toes when I look down. Otherwise, I tend not to notice the changes going on. This is probably an echo of my longstanding avoidance of my body and the ensuing denial that helped numb me out. Do you ever feel like quitting? Nope. Not so far. I think since I have been successful and for such and extended period of time now, nearly six months now, I have faith in myself. I not longer feel hopeless about my weight. Historically, I felt hopeless, so I would give up or give in without really noticing. Now, I am noticing something else – the sweet taste of success…better than food…even better than lobster and cake! What do you know about habit formation? Being reinforced or rewarded for a behavior that feels satisfying, increases safety or reduces pain or fear of experiencing pain. This is the start. Self-protection is the goal of all habits. Then our mind sets up shop and repeats the behavior[s] over and over and soon without knowing it, our mind sucks in so often that our brain learns and so 'consolidates' a memory that is then practiced and re-experienced so often now, that our brain is changed. See the short video on neuroplasticity at: http://www.youtube.com/watch?v=rTPks7XQbSw&list=UU2LRgxZVAJ3aJuazBBsINRQ&index=12 What insight’s have you gained? The most important thing that I learned and hope to continue to learn is that behaviors may be hopeless or at least can lead to situations that we judge to be hopeless, but we are not HOPELESS. By doing something new or doing something different, that our mind can change our brain. Literally, we can rewrite the brain. We can change the structure of our brain and that this change in structure means we can change our mind for the better! PART 2.
Interview with Bob Renard It (the fuel band) has no real power over me. It has become my reminder, my buddy, the object of my self-awareness of what I am eating, how much I am exercising and a daily practice of up loading my fuel band data to the Nike site has replaced what I would have gotten from Weight Watchers. So no meetings, and instead, I can use the support of friends and some family through social media (Facebook allows for the posting of my progress from the Nike site to my timeline) and so net no loss of time. I exercise more and watch my calorie intake as it relates to how many calories I am burning based on my Fuel Band’s ability to track this along with how many steps I have taken and so how much “fuel” I have generated in that day, which I set as a personal goal to hit 3000 fuel units or more a day. The Nike site keeps my numbers, awards special goal like “Best Sunday” or “Best Tuesday Ever” and a digital celebration or awards banner. It allows me to compare myself to others my age or all the people uploading for their fuel bands. So it is rewarding and educational too. These three factors have supported me through the initial phases of losing weight and now have become part of my daily life for a s long as I require them to be. It feels good to do the steps, so I do them freely and with joy…similar to Twelve Steps in this regard. The reason I lost the weight is I learned that I was not hopeless. Have you been eating a special diet? Some diet that continues to eat healthy but NOW to just plain EAT LESS food. Just because it’s good or healthy or even both IT IS JUST FOOD! Nothing more. If I continue to remember that food is only nutrition, not a reward or punishment, then it is easier for me to JUST eat, not turn food into something more than it is intended to be. Interview with Bob Renard How much weight have you lost? Well, if you go back 3 years, I weighed 249 at a doctor’s visit, so then lost about 10 and over the next two years riding the diet roller coaster. I lost 20,then gained it back. Lost 15 then gained it back. At my last doctor visit in December 2012, he said, “the good news is you are still where you were last year; the bad news is you’re still where you were last year.” He went on to tell me he thought I was looking at type 2 diabetes in the next two years if I did not lose 20 pounds. That got my attention. Other weight loss attempts? Since December, I have lost about 40 pounds. (since this interview, Bob has lost another 10) My wife points out that is a fifth of my weight. I weighed 196 on my home scale this morning. At the YMCA, with clothes on, I weighed 202. I am now losing steadily and waiting to see where I stabilize, instead of setting an arbitrary goal. Actually, I did set a goal in December to get down to 212, the number I can remember being before my weight began to rise. I recall wearing size 38 to 40 pants back then, so I thought it a good goal Now, I am so happy to have exceeded it. What is different now? A few things have made the difference. First, I did not want to have diabetes. That warning from the doctor was a shock, and it woke me up. Second, since I eat essentially healthy foods, and so I am careful, I had lulled myself into the mistaken belief that my weight problem was not my responsibility. I did not eat super-sized cheeseburgers, fries and milk shakes; I did not have dessert, and haven’t had daily bowls of chips and dip. The “calories in and calories out” solution that my doctor recommended, seemed my only last resort, so I planned on the agreed upon treatment of joining Weight Watchers in January. There I would get support, weekly weigh-ins, food guidance, etc. It would mean losing free time, but I was willing, to improve my health. Notice, I was thinking it was about health – it was, and that was a good thing. But to be honest, I did not really believe I could lose weight; deep down, I felt hopeless on that account. I have been fat for as long as I can remember. I see pictures of me when younger than 10 years old being a normal looking kid, BUT that was then and this is now. It was never really going to happen for me now…again…too late. But at least, I would show my wife and my doctor that I had really tried…they would believe me, that I was just normally “overweight,” “Scotch-Irish" and "raised by my mom,” etc. I was just going to be who I was, even if I got diabetes. Bob's new "buddy." So then, the third ingredient showed up in the mail. My nephew and his wife work at Nike Corporation and they gave us these Nike Fuel Bands...some sort of fancy digital watches. WELL, it turned out to be a blessing and a life changing event. In his book, The Total Money Makeover, Dave Ramsey tells us that if we don’t tell money what to do it will go out. He suggests that we need intention when it comes to our finances – that financial health is 20% knowledge and 80% behavior! As a person, who has handed out information based on my own knowledge of the subject of weight loss, I have been impressed that most people admit, “I know what to, but I just don’t do it.” The knowledge – behavior disconnect keeps us stuck. It encourages us to look for the next new thing that will allow us to be thinner, fitter and happier. Mark Twain said, “Be careful about reading health books. You may die of a misprint.” Every day I get one or two applications in the mail for a new credit card, and almost as frequently I see a story on the Internet about health changes that have taken place without effort. The next miracle promises an easy path to forever success, and it usually involves an expensive product. Food is like money. If you don’t tell it what to do, it will still do something. In the case of money, it will go out. In the case of food, it will come in. The other thing that is like money is exercise. If you don’t budget money, you find yourself not making any progress toward getting rid of your debt. If you don’t budget time for exercise, you find that you have none for what you know you “should do.” Mr. Ramsey spends a good deal of his time busting myths. Health advice is replete with those things too. And some of the myths we tell ourselves – I can’t run anymore, because I’m too old. No matter what I do, I can’t lose this weight. I’m big boned. That’s just how I’m built. Ramsey says if you want to be rich, get your advice from rich people. Hmmm. Could that be true of our health goals too? Should we observe the people who are doing it right but are not selling it? The thin person that you see indulging in a sugary, whipped-creamed delight or downing a greasy burger, doesn’t eat that way three to six times a day, seven days a week. They don’t! The person who finishes a marathon didn’t start training a week ago. They’ve been at it for at least six months, usually longer. Myths have to do with lies or some secret. There are many ways to lose weight, to get into shape, but the only way to stick with it, to insure success is to go slowly and never stop. That’s not a secret. Over time, your goals might move and change. You might begin with 10 pounds or 10 minutes, but when you achieve it, you might think, “I did that. Maybe I can do more.” Positive change builds on itself. Ramsey suggests an exercise that most of us would find uncomfortable – paying for things with real money – not credit cards. Hundred dollar bills! He says it makes what goes out real. I suggest writing down what you eat or how many minutes you exercise. Make it real. You might be surprised. And get an accountability partner. A friend of mine who lost 40 pounds in about ten weeks (a fifth of his body weight) used a Nike Fuel Band to chart his daily progress. Some people go to Weight Watchers or sign onto a computerized tracking system at their gym. Some people write it in a notebook. There is no one-way –only proven principles. It’s not magic. It’s not about information. Most of us know about fruits and vegetables and about movement. It’s about in and out. It’s about intention and hope. |
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