...perchance to dream

Well, we had one heck of a birthday week end. T. says it was one of his best ever, which makes me feel very pleased, indeed.

We really did have a lot of fun with friends and family, great food and some (too much?) very nice wine. It really was a lovely, lovely week end during which I rarely thought about cancer.

My only regret is that I forgot to take pictures.

But it did take me a while to sleep it off. I napped after a family brunch on Sunday, slept all morning on Monday and went to bed early both nights.

Yesterday was a chemo and Herceptin day. My new personal protocol (which seems to prevent the side-effects I was experiencing) involves being pumped full of Demerol and Gravol (to avoid nausea from the Demerol). The resulting high is far from unpleasant but it did knock me out in short order (not a bad thing since the Herceptin is administered very slowly and they keep me for an hour-long observation period). I also took a nap in the evening and went to bed for good at around 9:30.

And of course, I spent today in my pajamas.

On another note, I'm reading a fascinating book: Bitter Chocolate, Investigating the Dark Side of the World's most Seductive Sweet, by Carol Off (2006, Random House Canada).

Somewhat ironically, as I read about the history of chocolate (and cocoa) and the cruelty and inequalities inherent in its production, I found myself developing an overwhelming craving. I eventually had to go downstairs for a handful (or several) of chocolate chips.

This has led me to the following conclusions:

1. My stomach must not be too unhappy if I can eat chocolate.
2. I am extremely susceptible to suggestion.
3. I need to ask someone to bring me some fair trade chocolate, so I can stop feeling so guilty.

Medicare Advantage Payments to Insurers Will Be Cut

The State Children's Health Insurance Program (S-CHIP) needs to be reauthorized by the Congress. That will cost $13 to $15 billion over the next five years--something I detailed in an earlier post.Compounding the S-CHIP budget dilemma, Medicare physicians are scheduled to have their fee payments cut by 10% on January 1, 2008.When the last Congress reversed the scheduled 5% fee cut for 2007, in

The Individual Health Insurance Market Isn't Ready for Primetime

Julie Appleby has an article on the front page of Monday's USAToday covering an issue I dealt with in an earlier post--insurers using post-claim underwriting to rescind people's health insurance policies.President Bush's health plan proposal would encourage consumers to buy their own health insurance. The President, and many others, believe that giving individuals more control over their health

It's the Cost of Health Care Stupid!!!

We have seen a number of new health care proposals--many I recently cited in a post.My old friend and health care policy mentor, Henry Simmons, who is President of the National Coalition on Health Care, recently released a statement on President Bush's health care proposal.One of the key points he made is that any health reform proposal must be comprehensive and able to slow the growth in health

Is the Bush Health Plan Tilted Too Far In Favor of Health Savings Accounts (HSAs?)

Chris Lee has an article in today's Washington Post that raises an important question.Has President Bush gone too far in tilting his new health care proposal in favor of health savings accounts (HSAs)?The President would level the health insurance tax preference playing field for consumers whether they get their health insurance at their place of employment or buy it in the individual

he's 40

Come Rain or Come Shine

Long road, dark night, nothing but headlights
But I'll see some bright lights when I get home to you
Framed in your doorway with your arms open wide
I'll hold you in my arms, enfold you inside

And I want to tell you
Come rain or come shine
That I'll always be your love
If you'll always be mine

Sometimes I wonder what you see in me
Is it someone you're wishing or hoping I'll be?
Sometimes I wonder, I can't help myself
Will your love go someplace with somebody else?

And I want to tell you
Come rain or come shine
That I'll always be your love
If you'll always be mine

Sometimes you wonder what I see in you
Just picture the sun on an ocean of blue
Just picture that ocean, so deep and so wide
Feel the sun on the water, feel the pull of the tide

And I want to tell you
Come rain or come shine
That I'll always be your love
If you'll always be mine.

David Francey, 1989, from The Skating Rink.

moving in the right direction

My oncologist says that my gastrointestinal issues are nothing to worry about. Accordingly, I have told my inner hypochondriac to stand down.

He also said that my liver functions are now normal (repeating himself for emphasis and to make sure I grasped the import of this).

He told me that last Friday's ultrasound revealed that the fluid buildup in my liver is now gone, which is the reason that my abdomen no longer seems to be as swollen (a quick physical exam confirmed this. My abdomen is no longer hard, one side of my liver is normal and the other is much less swollen than it was). He called it a "dramatic improvement."

What the ultrasound did not reveal was any sign that my tumours are shrinking. I do feel a bit disappointed but it is early days yet, and all other signs are that the treatment is working.

I'm pleased.

As Maria said in the comments, "it really is a fight," but, for the moment, the forces of good seem to have the upper hand.

Health Savings Accounts (HSAs) and The Massachusetts Plan--Two Great Experiments

In the wake of the President Bush's new health plan, much has been said about whether we should move to reform the health care system by building upon the traditional employer-based system (preferred by most Dems) or move to a system more controlled by individuals (preferred by most Republicans and the President).Democrats claim the President's plan would wreck the employer-based system--

The Bush Health Care Plan and U.S. Health Care Reform

It’s a new day in the health care debate. Reform is breaking out everywhere.2007 is shaping up to be the “Year of the Possible” with notable health care reform proposals coming from a number of places almost at once:The new Democratic Congress is setting an ambitious health care agenda as they look to first reauthorize the very successful Medicaid State Children’s Health Insurance Program (

gut feeling

I feel pretty lousy this evening. A few months ago, I would have chalked it up to a virus. I feel nauseated, bloated, I have heartburn and other intestinal issues. This all started yesterday afternoon and has gradually worsened.

It's probably nothing but I no longer have the confidence to feel that a cramp is just a cramp, nothing more.

Hopefully, I'll wake up tomorrow feeling much better.

I see the oncologist tomorrow afternoon. I'm also hoping that he has my ultrasound results and that our optimism has been well placed.

I'll let you know.

is your workplace making you sick?

Australian Broadcasting Corp. closes office over breast cancer risk

Last Updated: Thursday, December 21, 2006 | 9:35 AM ET

Australian Broadcasting Corporation

The Australian Broadcasting Corporation is pulling out of its Brisbane offices because of what it calls a significant atypical spike in the incidence of breast cancer among staff.

Staff will be moved off site within days after an independent investigation confirmed an incidence of breast cancer among them is up to 11 times higher than for the wider community.

Since 1995, 10 women have developed the disease while working on the site.

ABC managing director Mark Scott has promised counselling and other support, including funding for medical tests, for anyone who may be affected by a high rate of cancer at the Brisbane studios.

Sydney University public health Prof. Bruce Armstrong's investigation has not found a direct cause of the cancer cluster, despite extensive testing.

The decision to remove staff from the Toowong studios was made as soon as Armstrong's report was delivered, Scott said.

Continue Article

"We are undertaking immediate moves to relocate the ABC offices and facilities here from this site at Toowong to other premises around Brisbane," he said.

"This process is starting today immediately and will take place in coming weeks, and we expect that by the end of January, we will have cleared most of this site."

The radio and television newsrooms have already been cleared.

One of the women who suffered from breast cancer while working for ABC News, Lisa Backhouse, said she is relieved about the decision to shut down the site.

"I would like to say to management, 'Thank you also for acting, but it's a shame it it wasn't done earlier,'" she said.

"It's a real pity it wasn't and it's a shame it took another person getting sick."

Queensland Premier Peter Beattie said the state government will help the ABC find a new Brisbane site.

More on the Bush Health Plan

My good friend Bill Boyles of Health Market Survey offers these comments regarding the President's upcoming health proposal (my own post is below this one):New Bush Proposal Takes Intriguing ApproachAfter six years of offering the same old thing, President Bush Tuesday will propose a creative new health reform that is drawing support from both sides of the political spectrum and could be taken

New Bush Health Plan Proposal to Be Announced in State of the Union Address

President Bush is about to announce an interesting health care proposal that would cap the tax benefits on the most generous health benefit plans––often held by higher paid executives and some labor unions and use the revenue to cut the number of uninsured.Individuals, whether they got their health insurance from work or paid for it themselves, would get a standard deduction of $7,500 for an

seen this?

Makes me excited and angry at the same time.

Long-used drug shows new promise for cancer

Therapy prescribed for metabolic disorder now found to shrink tumours in lab rats

ANDRÉ PICARD

From Wednesday's Globe and Mail

Imagine, if you will, a drug that shrinks cancer cells and can even make tumours disappear. A couple of spoonfuls a day of powder in a glass of water is all you need.

There are no nasty side effects like nausea and hair loss, and no damage to internal organs such as with traditional chemotherapy. And it costs only about $2 a dose.

Too good to be true?

Not according to a Canadian researcher who stumbled upon the potentially new anti-cancer agent called dichloroacetate, or DCA, a drug long used to treat rare metabolic disorders.

"This is one of the most exciting results I've ever had," said Evangelos Michelakis, an associate professor of medicine at the University of Alberta in Edmonton.

"But I can't be overenthusiastic until it works in a human being."

In a paper published in today's edition of the medical journal Cancer Cell, Dr. Michelakis and a group of researchers from the U of A and the University of Ottawa, report on how they were able to use DCA to shrink human lung-, breast- and brain-cancer tumours in both lab rats and in a test tube.

While this type of research in laboratory animals does not generally generate a lot of enthusiasm, in this case the findings are creating a stir because DCA has actually been used safely in humans for decades -- in treating rare inherited metabolic disorders such as lactic acidosis, not cancer.

"One of the big concerns about drugs is that they can harm people but we already know this drug is safe. It doesn't even affect normal cells," Dr. Michelakis said.

The research challenges one of the fundamental premises of cancer biology, that mitochondria (the energy producing units of cells) are permanently damaged by cancer.

What Dr. Michelakis and his team found is that while mitochondrial function is suppressed, it can be revived with DCA, which makes the cancer cells susceptible to dying. (Most cancers become resistant to standard chemotherapy by suppressing mitochondrial function.)

In other words, the drug works by revving up the engines of normal cells, allowing them to work normally and driving cancer cells to commit suicide.

"This is the holy grail of cancer therapeutics -- how to kill the cancer cells and spare normal cells," Dr. Michelakis said.

Dario Altieri, a professor in the department of cancer biology at the University of Massachusetts Medical School in Worcester, Mass., said the research is "exciting" and that DCA has a lot of potential.

Dr. Altieri said DCA needs to move quickly from the lab into human testing. But he cautioned that there is a real possibility that will not happen, largely for economic reasons.

There is no longer a patent on DCA, meaning it is not owned by any one company. As a result, there is little chance of making a large profit, even if the drug works remarkably well, and hence no incentive for pharmaceutical companies to invest in research.

Dr. Michelakis acknowledged this is a real practical problem, but he expressed hope that public funding bodies like the Canadian Institutes for Health Research (which funded the lab study) will step in.

"Nobody is going to make a billion dollars from this drug," Dr. Michelakis said. "But maybe it will help a lot of people with cancer."

SCHIP Reauthorization--Will Medicare HMOs Pay for Some of It????

In the post below, I reviewed the need to reauthorize the very successful State Children's Health Insurance Program (S-CHIP).The Congress will have a real challenge coming up with the needed money--$13 billion to $15 billion. Finding the money will be hard because of the House Democrat's pledge to fully fund any spending--their "pay-as-you-go" policy.Where will the money come from?First, the

Back to "Regular Order"--The House Medicare Part D Drug Bill and SCHIP Reauthorization

The debate over the House Medicare drug negotiation bill is now moving over to the Senate.My post from last Friday (next post below) still reflects what I am seeing on this issue. The Senate will move a drug bill on "regular order" which means we will see the standard committee hearings and process that could lead to floor action later in the spring or summer. The House Medicare Part D drug

pajamas again

Yesterday was a chemo day, so, of course, today was spent in my pajamas. All things considered, I am doing well (I was really sick last night but woke up - at eleven - this morning feeling tired but only a little queasy).

No Herceptin this time, only chemo.

My white blood cells, and in particular the infection fighting neutrophils have rebounded really well (my count yesterday was seven. I have no idea what this means, except that I was at zero when I was in the hospital and two a couple of weeks ago).

My echocardiogram showed that my heart is now functioning at fifty-eight per cent effciency. This is back to what it was before I was diagnosed with cancer (a little better in fact), when I was in really good shape. I can breathe easier, now, knowing I won't be yanked off the Herceptin (or forced to take heart medication).

I think this bodes well for my ultrasound on Friday. These things happen in three's, no?

By next week, I hope to tell you all the story of my incredible shrinking tumours.

the marvellous mundane

At around 11:00 this morning, my little family piled into the station wagon and set off to run some errands. We went to the comic book store (for my oldest son to spend a gift certificate. He and his father would have happily spent the whole day in the place) and then out for Vietnamese noodle soup (we were delighted to find our favourite 'pho' soup in the middle of big box store land).

Fortified, D. (my three and a half year old) and I went grocery shopping (at a grocery store with little cars built into the carts, so D. could ride around in front and 'drive'), while my spouse and older son went to buy a new router for our network (ours having gone belly-up the day before). They met us before we were done and in time to help with the last bit of shopping.

Finally, we went to Canadian Tire. While my spouse and little D. went in to buy skates, S. read comic books in the car while I returned a call to my parents (I was almost shocked into hanging up - my parents have acquired an answering machine. They are so thrilled with it that they are letting it pick up all incoming calls, even though it means they're on the hook for calling us back).

After the errands were done and we were home, I read D. a story while my spouse put the groceries away. Next I went for a walk with my friend H. and my dog, J. (we stopped for coffee and again for cat food). My spouse and the boys went skating on a neighbourhood pond.

When I got home from the walk, a little chilled (and with the boys still out), I treated myself to a long hot jasmine-scented bath and emerged feeling like I'd had a massage. Then I cleaned out the kitchen while de-frosting dinner (frozen chicken, frozen french fries and frozen veggies, washed down with a freezing cold beer).

Does this all sound incredibly boring? I loved every minute of it. It seems that I have come to embrace the mundane, to revel in my ability to do normal things. And to feel that I've accomplished something.

I turned the chemo corner yesterday, feeling energetic and healthy. My next treatment is on Tuesday. I am savouring these few days when I feel like myself, eating, exercising, playing with my kids and even buying groceries on a Sunday afternoon.

if i knew then...

I should have taken out life insurance when I was healthy.

My spouse and I were in the process of applying (had even gone through the physical exams) when I found my lump. I really, really wish we had acted sooner.

Grassley and Baucus Key to Any Drug Negotiation Compromise

In earlier posts, I have made the point that the House bill to require the federal government to negotiate Part D prescription drug prices will not pass the Senate.Developments in recent days have confirmed that opinion for me. The ranking Republican on the Senate Finance committee, Chuck Grassley, has said he would lead a filibuster of the House bill on the Senate floor and has said he is

The House Part D Drug Negoatiation Debate is Heating Up!

I was quoted in the Washington Post today reiterating my concern that the House Part D drug negoatiation bill is a hollow political charade on the part of the Dems:"The federal government can get lower prices, but only if it's willing to exclude a certain number of drugs from the formulary," said Robert Laszewski, a nonpartisan health policy consultant in Washington. "And that's a huge political

so far so good

I had Herceptin yesterday, along with the Vinorelbine (the chemo I'm on). It's been more than twenty-four hours and I have not had a reaction to the Herceptin, nor am I running a fever.

The doctors had said that my reactions would probably diminish over time. To help matters along, they pumped me full of Demerol before treatment (I've never taken a heavy duty narcotic before when I wasn't in serious pain. What a trip!), along with Gravol. I quickly became very stoned and very sleepy. They went on to give me the Herceptin very slowly (over ninety minutes) and then to keep me for an hour's observation.

It was a long day, but it was worth it. No chills, no shakes, no fever (I didn't write about this, but I landed in emergency the day after my last Herceptin treatment. Nothing like sitting in a waiting room full of coughing, puking people while your immune system is depressed...) . I'm pretty tired and a little green around the gills but I've been able to read and sleep today.

It's a pretty gruelling routine I'm on, in terms of the frequency of treatment, but the side effects (she says, crossing her fingers) seem to be less intense than what I experienced during the first go-round (before the metastasis). If I can eat a little, sleep and read, everything is a little more bearable.

And I still have hair.

Health Care Trend Falling

According to a CMS report published in the latest issue of Health Affairs, health care spending increased 6.9% in 2005--the third consecutive year it has fallen.Given that medical cost trend, as reported by the health plan industry, fell again in 2006, I fully expect CMS to report a 2006 trend rate of around 6.5% when they do their calculation again next year. And, given that trend looks to be

Good for the Governor of California!!!!

Governor Schwarzenegger’s new health plan proposal is full of controversy.It puts a provider tax on doctors and hospitals (which the docs have predictably already attacked), it hits HMO profits by putting a 15% cap on expenses and profits (WellPoint is currently operating on about a 20% expense and profit margin), and it mandates that both individuals, and employers with more than 10 employees,

More on the Democratic Part D Drug Negotiation Debate

A friend in big pharma responded to my earlier post on Part D disagreeing with me that the Democratic proposal is not a threat to the drug industry.He made two points:The Dem bill does not prevent the government from requiring each and every plan to prior authorize a medicine for which it is unable to negotiate an "acceptable" price. They see such restrictions as possible because this would not

the trip of a lifetime or a really dumb idea?

Or something in between, perhaps?

Twenty-four hours of driving, two children, in between cancer treatments. This is what my spouse and I are seriously considering, as an alternative to flying to Florida to visit granparents (or as an alternative to not going anywhere at all).

On the plus side:

• Even with two nights in a hotel and the cost of gas, it would be considerably cheaper than flying four of us to Florida in February/March.
• We would avoid all the hassles of air travel, including the risks of exacerbating my lymphedema.
  
• We wouldn't have to rent a car once we're down there.
• It would be a great way to see parts of the US that we've never seen before.
• Road trips can be full of fun surprises.
  

On the negative side:

• It is a lot of driving, especially with two young (8 and 3 years old) kids in the back seat.
• Even if we left earlier and came back later, our actual time under the Florida sun would be shortened.
• We would need to travel pretty soon after chemo (but not too close to Herceptin) in order to make it worthwhile. I may still be a little green around the gills.
• Road trips can be full of unpleasant surprises.
  

A grave mistake or a fund adventure? I really need your input, my friends.

a song for sunday

This is a song I sing to my youngest son most nights. It was written by Fred Small. On Friday, I dug out an old cd that has a cover of this song, performed by Roy Bailey. I played it that evening in the car on the way to visit the Toronto grandparents. He was thrilled.

I used to play this song long before my kids were born, belting out the words (only a little off-key), imagining myself playing it for my kids one day.

For the record, the young D., lovingly known as 'the tyrant', doesn't like the first verse. I always have to start with the chorus.

Everything Possible

We have cleared off the table, the leftovers saved,
Washed the dishes and put them away
I have told you a story and tucked you in tight
At the end of your knockabout day
As the moon sets its sails to carry you to sleep
Over the midnight sea
I will sing you a song no one sang to me
May it keep you good company.

You can be anybody you want to be,
You can love whomever you will
You can travel any country where your heart leads
And know I will love you still
You can live by yourself, you can gather friends around,
You can choose one special one
And the only measure of your words and your deeds
Will be the love you leave behind when you're done.

There are girls who grow up strong and bold
There are boys quiet and kind
Some race on ahead, some follow behind
Some go in their own way and time
Some women love women, some men love men
Some raise children, some never do
You can dream all the day never reaching the end
Of everything possible for you.

Don't be rattled by names, by taunts, by games
But seek out spirits true
If you give your friends the best part of yourself
They will give the same back to you.

You can be anybody you want to be,
You can love whomever you will
You can travel any country where your heart leads
And know I will love you still
You can live by yourself, you can gather friends around,
You can choose one special one
And the only measure of your words and your deeds
Will be the love you leave behind when you're done.

HMO Stocks Fall on Medicare Advantage Worries---What Took So Long?

HMOs that play in the Medicare Advantage world fell on Wall Street last week on worries that the Democrat Congress has the power to end the industry's generous payments.Well, what took so long?Of course the Medicare Advantage payments are going to fall when the Democrats get around to the budget this fall.For the complete story on why you can see my earlier post on this.

Bravo Kaiser Permanente!--As the Insurance Industry Defends Screwing its Customers

I have always had the greatest respect for Kaiser Permanente (KP) and the way it has always conducted itself--in its operations and in the policy debate.That confidence was reaffirmed this week when KP announced that it is working with the California Insurance Commissioner to craft new guidelines for an insurer's ability to cancel, or rescind, insurance coverage when the applicant made

The Democrats' Hollow Part D Proposal

The House Democrats have announced the form their Part D prescription drug legislation will take.Throughout the 2006 campaign, they had pledged to lower senior prescription drug prices by requiring the federal government to negotiate directly with the drug companies--something the 2003 Medicare Act specifically prohibited. The Democrats went further saying that these negotiations would make it

a hole in my memory

I went for an echo-cardiogram yesterday at one of the local hospitals, one that only does testing and day surgery.

My mother-in-law took me to a CT scan at the same hospital on December 21. I remember discussing with her how quiet this hospital was and how much it had changed since my son was born there in 1998 (when the hospital was less specialized).

When the technician asked, I told him I had been for an echo before, at the General Hospital (the one where most of my other tests have taken place and where the cancer centre is located) but I couldn't tell him when. He looked me up on the computer. I did go for an echo, on December 4, at that very hospital and he had been the technician who did it.

I remember none of it. The waiting room, reception, testing room, the test itself or even the hospital, none of it seemed remotely familiar to me. I know that my friend K. took me to the echo, but only because she returned my grey sweater a couple of weeks ago. I had noticed it was missing but have no recollection of leaving it in her car.

I vaguely remember driving with K. and mentioning that I was on morphine (which could be partially the cause of the hole in my memory) but nothing else. And, yes, I was on some heavy duty drugs but, mostly, I think it was the shock of hearing about and dealing with the diagnosis of metastasis and everything it means.

The human brain is really quite unfathomable.

More Trouble for Humana's Part D Program

Boston's mayor has been sharply critical of Humana for raising his city's Part D premiums by 130%. Get in line Mr. Mayor, they've done it to millions of seniors who bought their plans!Joe Paduda, in his Blog "Managed Care Matters" has a post today that hits the nail right on the head.You can read more about how Humana got itself into this position in an earlier post I did on the subject of Part D

looking up

I had an appointment with the doctor who works with my oncologist today (they call her a GPO). I adore Dr. B.. Today she was all smiles.

She says that it's her feeling, and that of Dr. G., my oncologist, that I am having these intense reactions to Herceptin because it's working. She says that they've seen these signs before when the treatment has been effective and although the evidence is purely anecdotal, they are feeling very optimistic.

And so am I. Cautiously optimistic but optimistic all the same.

Consider the following:

1-The swelling in my liver has decreased somewhat dramatically. As recently as Christmas day, I looked and felt like I had swallowed a watermelon. Both sides of my belly now look the same (which means like a woman who has had two kids and has never done a ton of ab work) and I can do up my pants. I can also go for walks (and I have been) without feeling like my insides are all mushed together.

2-I have not needed a pain-killer stronger than extra-strength Tylenol since boxing day. Less than two weeks ago, I was on morphine.

3-My most recent blood test revealed that my liver functions have improved greatly since my diagnosis of metastasis.

It was nice to leave an oncology appointment with a smile on my face.

I did have an echo-cardiogram again today (more on that tomorrow) the results of which may determine when I am next treated with Herceptin. The next session is scheduled for January 9 but the docs are concerned about the toll Herceptin might be taking on my heart, given the damage that has already been caused by Adriamycin (the 'red-devil' chemo drug that made me lose my hair).

I hope that I am given the green light to proceed (along with a couple of new drugs in the mix to reduce the intensity of my reactions), as I am, of course, keen to keep attacking my tumours (I've been visualizing the chemo and Herceptin blasting the little bastards).

Dr. B. told me that she's ordering a new ultrasound to see what my liver looks like now that I've had a few treatments. She seems pretty confident that we'll see a marked improvement.

The New Congress––Sniping or Civility?

Jerry Ford's funeral took place in our capital city today. I will admit to always being a fan.He gets an unfair rap for not doing a lot during his administration. But just getting our country back on track in the wake of Watergate was a major accomplishment in itself. Let's also not forget that he was the President who signed ERISA into law--something that was a major bipartisan

Health Care Middlemen––Don't Forget Value!

Friday's Wall Street Journal ran the last of a series on health care "middlemen."The theme was about people taking big money out of the already incredibly expensive health care system but questioning whether they leave a commensurate value.The series included:"As Patients, Doctors Feel the Pinch, Insurer's CEO Makes a Billion," April 18."Selling Generic Drugs by Mail Turns Into Lucrative Business