Thursday, February 9, 2012

Our Cancer Journey - Week 8

Kathy finished Cycle 3 of Adriamycin/Cytoxan, has weathered the most difficult treatment symptoms, had a positive rebound of her blood cell counts, and continued to receive an outpouring of support from the community.

Per the screen print above from BIDMC's web-based Online Medical Record, her neutrophil count increased from 3610 to 5660, ensuring she can fight infection.   Neutrophils are significantly affected by chemotherapeutic agents but Neulasta, a bone marrow stimulant, prevents cancer patients from the neutropenic nadirs that once caused multi-day hospitalizations requiring antibiotics.

Dr. Robin Schoenthaler, a Radiation Oncologist in the MGH Department of Radiation Oncology at Emerson Hospital and Director of Medical Education  at Emerson wrote to me with very helpful advice for husbands and families supporting breast cancer patients:
"I am a radiation oncologist at MGH specializing in the treatment of women with breast cancer and I have been following your blog (from which I heard about that very cool I-phone charger; thank you very much!) for some time.  My heart goes out to you and your wife.  I hope that things go as swimmingly as possible for you during and after the acute phase of treatment.

I have many many thoughts about what you have written; but yesterday's column which touched on the issues of 'causality' rang a real bell for me in three areas.

First off, it may interest you to know that, as far as I can find,  there are no good studies that absolutely link breast cancer (or any cancer) with stress.  Studies looking at extreme stress (eg war, famine, rape) have not shown a clear-cut link with the later development of cancers.  Studies looking at day-to-day stressors have been negative, and studies evaluating severe stressors (recent divorce, death of loved one) are extremely mixed -- some show perhaps a small link and some actually show that severe stressors are associated with a LOWER rate of breast cancer (eg the Women's Health Initiative).  This stuff is terribly hard to tease out so all we can say at the present time is that while there MAY be a link, and although there are hypothetical reasons to be concerned about a link, thus far many good studies do NOT show an absolute connection between being under stress and then getting breast cancer.

This may well be because 'cancer' is such a heterogenous disease, and it may also be related to the fact that cancers grow at such different rates, so that it's nearly impossible to say that a defined 'stressor' (and who can say exactly what stress is -- for some people it's their mother-in-law!) is linked to a very slow-growing breast cancer (or a fast one) or a lightning-fast lymphoma.  It's just too hard to connect the dots.

The second idea I would like to convey to you is that your search for a cause -- wondering if it's paints, or stress, or radicals (or for other women: fertility treatments, or living under power lines, or pesticides) is a specifically AMERICAN response to disease, or more fundamentally, why bad things happen to good people.  If you and your wife lived in India, you would probably think this disease occured because of something harmful you did in a past life prior to this reincarnation (karma, etc).  If you lived in Mexico, you might well think your wife was bound to suffer this way so she could offer it up and then sit at the right hand of Mary in heaven.

But here in America, we always, always, think it's something we did.  We think we are the cause.  We ALWAYS think we are the cause, and if only we had done x or y or z maybe this wouldn't have happened.  We like to think we are in control, us Americans (especially the engineers and computer people amongst us, despite the fact Mother Nature that is constantly showing us who rules.

I do think this is an important thing to think about -- maybe it wasn't environmental, maybe it had nothing to do with behavior, maybe it was just stone cold bad luck.  I think it changes the way one approaches disease sometimes and I offer it to you as a possibility.

The third thing I want to say to you is that you are really being a model Husband/Caretaker, and my hat is off to you and to all such wonderful men.  I call men like you 'Purse Holders' and in fact I wrote an essay in the Globe about them a couple of years ago.  If you care to read it you can find it here.

I send you my very best regards and wishes, and if you would like to further discuss these or any other breast-cancer-related issues or questions, please consider me your go-to person."

Thanks Robin, your support is much appreciated.  And you're right, since treating breast cancer is a partnership, all aspects of treatment including the driving, the listening, and the purse carrying are a shared responsibility.

On Sunday, I must fly to China to fulfill a promise I made a year ago to assist with healthcare IT design in Shanghai and Hong Kong.   My absence is timed for those treatment days when Kathy is at her best and her energy has returned.   I'll be back before the symptoms of Cycle 4 begin.    I'll write my post next week during the first time we've been apart overnight since her diagnosis in December.   As we travel the treatment path together, the experience of caring for Kathy long distance will bring new emotions.

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