Anniversary

" As anyone who has been close to someone that has committed suicide knows, there is no other pain like that felt after the incident. " ~ Peter Green

Ten years ago today, my dad grabbed a shotgun and went to a neighbor's house. He knocked on the door and asked the neighbor if he could borrow a bullet to kill a snake. My father took the bullet, walked out into the front yard and made the decision.

The Tale of Jasper Bottomhugger, Further Adventures in Crazy Land

"I believe that our Heavenly Father invented man because he was disappointed in the monkey." ~ Mark Twain

(Names have been changed to protect the innocent primates.)

Owner of Crazy Land and his wife, The Gatherer, have been friends of mine for over 30 years. Owner was friends with Hubby when they were in high school and I was introduced to him just as he started dating The Gatherer.

The Gatherer's father (before his recent death) was a successful businessman. One of his hobbies was hunting for wild mushrooms every year during a brief period of time in a specific place after heavy rain. This earns him the nickname of Mushroom Hunter. He didn't even eat them after he spent hours wandering around in the brush looking for them. Hunter gave them away, as did Owner, who always went along for the search. It was the thrill of the hunt that captivated the Hunter.

Mushroom Hunter and his wife, Patience (who's still living), acquired a Capuchin monkey about ten years ago. When he came to live with them, Jasper Bottomhugger (hereafter referred to as J.B.), was just a baby. His new "parents" stocked up on Huggies, baby powder, wipes and immediately ordered some outfits specially made for him from a lady in Abilene. I understand he looked fabulous in them.

Eventually, Hunter and Patience abandoned the Huggies when they noticed the diapers were chafing J.B.'s tiny monkey butt. I'm not sure how the potty training went, but I'm assuming they eventually mastered it. I'm certain Owner would have told me had it been a continuing issue. After a while, the outfits weren't as important, either, because J.B. began acquiring more expensive trinkets.

His first big gift from Hunter and Patience was a Jeep Cherokee. J.B. was allowed to play in the Cherokee whenever his monkey mind was so inclined. When Hunter and Patience took J.B. on his frequent trips to Dairy Queen, they always went in Jasper's Jeep. Unfortunately, DQ was one of the only restaurants they could take J.B. for a snack or dinner out. The Health Department is so picky about allowing monkeys in eating establishments.

During his formative years, the hours between 2:00 p.m. and 4:00 p.m. were reserved for J.B. bonding. Mushroom Hunter left his lucrative business for family time. No one, including their two daughters, were allowed to call and interrupt the primate love fest.

J.B. still lives with Patience and, no doubt, misses The Hunter terribly. Since the Mushroom Hunter died, Owner doesn't spend much time at the family farm. Hunter, along with Owner, were the silver hairs in his life. They were his role models. Sometimes I feel a little sad for him. Then I remember Patience's dedication to J.B.'s happiness and his many amenities, some of which involved massive additions to the family farm. I'm sure he's fine.

There are plenty more Jasper Bottomhugger stories to explore. They belong to the chronicle of Crazy Land. Stay tuned.

Making Treatment Decisions: Resources for Caregivers

Please go to National Coalition for Cancer Survivorship for much more information on breast and other types of cancer.

Making Difficult Treatment Decisions

Treatment decisions by you, the caregiver, may be necessary in the event the person with cancer is not able to make them for him- or herself. The patient and caregivers should discuss this situation, and take steps to assure that the person with cancer receives treatment on his or her own terms. One way that is both legal and effective is for the patient to complete an advance directive to express his or her wishes. This approach makes one's wishes clear — and this can be of great importance to caregivers. There are two components to an advance directive, and a person should have both in place when facing any serious illness.

The living will is a message from the person whose will it is to health care providers in regard to the kind of care that is and is not wanted if the patient can no longer make his or her decisions personally. The topics usually covered in a living will include directives about artificial feeding, use of a respirator if a person cannot breathe on his or her own, and whether or not the patient wishes to have cardiopulmonary resuscitation (CPR) if his or her heart stops. No one must respond to every question in a standardized living will format; if a question is not answered, then the health care provider will make those decisions. Also one can add more information detailing what is and is not wanted, directly on the forms. Many living will standard forms are vague, and so it is up to the person involved to add the details that make it appropriate for his or her care, as is wanted.

A more "user-friendly" version of a living will can be found in a document called Five Wishes, created by Aging with Dignity and legal in most states. This document is clearly written and allows a person to make wishes known in understandable language. To obtain a copy, go to www.agingwithdignity.org and follow the instructions there.

The durable power of attorney for health care designates another person to act as the named individual’s representative in making medical decisions for a person if that person cannot make them. It is simpler than a living will, in that it usually just states that if the named person is unable to make his or her own health care decisions, another person, named in the document, is authorized to do so. This document does not have a list of the kinds of care an individual does and does not want. The person chosen to represent the named individual you choose to have your health care power of attorney should be someone who is trusted and who will honor the wishes of the person giving the power of attorney.

For more detailed information on making wishes known, see Thinking Through Your Wishes on this site.

Other sources of help and information include:

• Family and Medical Leave Act (FMLA) — Passed in 1993, FMLA requires businesses and organizations with 50 or more employees to grant leave without pay for a variety of reasons including caregiving of family members, including parents. If you have been employed at least 12 months by the employer or at least 1,250 hours during the previous 12 months, you are entitled to a total of 12 workweeks of unpaid leave during any one year to care for a family member (parent, spouse, child only), as well as for other reasons, such as the birth of a child, your own health problems or adoption. FMLA may also be applicable to your loved one, once regular sick leave has been exhausted during the course of cancer treatment. Note that the 12 weeks of leave does not have to be taken all at once, but can be used as needed. For more information, see your employer's human resources office and the Department of Labor's website. Also see the extensive and helpful information on the website of the National Partnership for Women and Families.

• For detailed information about cancer survivors' rights as employees, see Your Employment Rights on this site.

• National Family Caregiver Support Program — Enacted in 2001 as part of the Older Americans Act, this program calls for states, working with area agencies on aging, to have basic services such as information services, counseling, and respite care available for family caregivers caring for the elderly and older caregivers caring for young children. Special assistance is provided for people with greatest economic and social needs, and those caring for individuals with mental disabilities. In some instances, these services may be available to caregivers of people with cancer, if other criteria are met. To find out if you may qualify, contact your local Administration on Aging office; look for numbers in the "government" section of the phone book, or ask the hospital social worker for help in contacting these offices.

• The Older Americans Act - helps frail and disabled people 60 or older to remain independent. Covers home care aides, escorts, meal delivery, shopping, etc. Contact your local area agency on aging for information and referrals — look under county or city government headings. Or, call the hotline run by the U. S. Administration on Aging at 1-800-677-1116. This helpful referral service is also available online at www.eldercare.gov.

• Medicaid: Medicaid, a joint state-federal program for low-income people, is, like Medicare, coordinated by the Centers for Medicare and Medicaid (CMS). Medicaid coverage varies from state to state, but usually includes some amount of coverage for nursing, aides, equipment and supplies. Get information from your community's welfare office, state department of health, and on the Internet at www.cms.hss.gov/Medicaid.

More important information from Breast Cancer.org

"I knew I had a problem for a couple of years—something wasn't quite right—a disfiguration. I had a pre-employment physical and the doctor said, 'You ought to go see your personal physician.' What happened is that the breast cancer had metastasized to my hip, so I had to have a hip replacement. They found out that the cause of that was breast cancer. That's why I say, 'Don't put off what seems to be minor." If you have any suspicion that something is abnormal, don't hesitate—go do something about it. — Larry, living with metastatic male breast cancer

Male Breast Cancer

Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2005, when 211,400 women were diagnosed with breast cancer in the United States, 1,690 men were diagnosed with the disease.

You may be thinking: Men don't have breasts, so how can they get breast cancer? The truth is that boys and girls, men and women all have breast tissue. The various hormones in girls' and women's bodies stimulate the breast tissue to grow into full breasts. Boys' and men's bodies normally don't make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Still, you may have seen boys and men with medium-sized or big breasts. Usually these breasts are just mounds of fat. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.

Because breast cancer in men is rare, few cases are available to study. Most studies of men with breast cancer are very small. But when a number of these small studies are grouped together, we can learn more from them.

The Risk Factors for Male Breast Cancer

It's important to understand the risk factors for male breast cancer—particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.

A number of factors can increase a man's risk of getting breast cancer:

• Growing older: This is the biggest factor. Just as is the case for women, risk increases as age increases. The median age of men diagnosed with breast cancer is about 67. This means that half the men who are diagnosed are over 67, and half are under.
• High estrogen levels: Breast cell growth—both normal and abnormal—is stimulated by the presence of estrogen. Men can have high estrogen levels as a result of:
  • Taking hormonal medicines.
  • Being overweight, which increases the production of estrogen.
  • Having been exposed to estrogens in the environment (such as estrogen and other hormones fed to fatten up beef cattle, or the breakdown products of the pesticide DDT, which can mimic the effects of estrogen in the body).
  • Being heavy users of alcohol, which can limit the liver's ability to regulate blood estrogen levels.
  • Having liver disease, which usually leads to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer.
• Klinefelter syndrome: Men with Klinefelter syndrome have lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). Therefore, they have a higher risk of developing gynecomastia (breast tissue growth that is non-cancerous) and breast cancer. Klinefelter syndrome is a condition present at birth that affects about 1 in 1,000 men. Normally men have a single X and single Y chromosome. Men with Klinefelter syndrome have more than one X chromosome (sometimes as many as four). Symptoms of Klinefelter syndrome include having longer legs, a higher voice, and a thinner beard than average men; having smaller than normal testicles; and being infertile (unable to produce sperm).
• A strong family history of breast cancer or genetic alterations: Family history can increase the risk of breast cancer in men—particularly if other men in the family have had breast cancer. The risk is also higher if there is a proven breast cancer gene abnormality in the family. Men who inherit abnormal BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer. This risk is approximately 6% over a man's lifetime. That's about 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. Still, the majority of male breast cancers happen in men who have no family history of breast cancer and no inherited gene abnormality.
• Radiation exposure: Having radiation therapy to the chest before age 30, and particularly during adolescence, may increase the risk of developing breast cancer. This has been seen in young people receiving radiation to treat Hodgkin's disease. (This does NOT include radiation therapy to treat breast cancer.)

  Symptoms of Male Breast Cancer

  One study found that male breast cancer is on the rise, with a 25% increase over the 25 years from 1973 to 1988. But it's still rare. It's unclear whether the reported rise means the disease is slowly becoming more common, or whether men better understand the symptoms and report their symptoms, leading to diagnoses that might have been missed in the past.

  If you notice any persistent changes to your breasts, you should contact your doctor. Here are some signs to watch for:

• a lump felt in the breast
• nipple pain
• an inverted nipple
• nipple discharge (clear or bloody)
• sores on the nipple and areola (the small ring of color around the center of the nipple)
• enlarged lymph nodes under the arm

It's important to note that enlargement of both breasts (not just on one side) is usually NOT cancer. The medical term for this is gynecomastia. Sometimes the breasts can become quite large. Non-cancer-related enlargement of the breasts can be caused by medications, heavy alcohol use, weight gain, or marijuana use.

A small study about male breast cancer found that the average time between first symptom and diagnosis was 19 months, or over a year and a half. That's a very long time! This is probably because people don't expect breast cancer to happen to men, so there is little to no early detection.

Earlier diagnosis could make a life-saving difference. With more research and more public awareness, men will learn that—just like women—they need to go to their doctor right away if they detect any persistent changes to their breasts.

Better and Worse

"The most authentic thing about us is our capacity to create, to overcome, to endure, to transform, to love and to be greater than our suffering." ~ Ben Okri

Better today. I took a nap yesterday and got 6 hours of sleep last night. It's stopped raining, the sun is shining. Though it's certainly not as frigid as my photograph would indicate, it feels that cold to me. I think the temperature is somewhere around 45 degrees. Anything under 60 degrees is cold to me.

We had sad news yesterday in Crazy Land. Crazy Employee's mom died of a heart attack Friday night. My co-worker and her youngest daughter were visiting her mom for the weekend. They'd had dinner together, along with some other family members in town for the Rose Festival weekend. I hate to refer to her as "Crazy Employee" under these circumstances, but that's the name I always use. She was really close to her mom and I know these are terrible days for her. Please say a prayer or keep a good thought for her and her family.

I wonder if my long-term sleep deprivation is related to the anniversary of my dad's death. That occurred to me a couple of weeks ago, but we're inching up to that black day, so I guess I'll find out soon. This morning I was thinking about the months and months when not a thought passed through my head. The mind was still. The only thing I had to focus on was the most immense pain I've ever experienced. An hour could seem like six. I was stuck, waiting for the pain to become more bearable. I had to wait a very, very long time.

I didn't mean to veer off into sadness and, as a matter of fact, I thought of an entertaining cluster of Crazy Land stories to share. The sunlight shining through my windows reminded me of that time. For the moment, I'm flooded with memories.

It must be time to work on my database. I'll try to get back to Crazy Land nonsense a little later today when I'm more settled.

Here's the Kaleidoscope Link

Kaleidoscope Fun

No Sleep Kaleidoscope Fun

"There will be sleeping enough in the grave." ~ Benjamin Franklin

I'm still not sleeping through the night. I woke up at 3:00 this morning and never went back to sleep. Since all of this began about three weeks ago, I've been able to get a normal amount of sleep over the weekends, but this weekend was different. On Friday night, I slept 7 1/2 hours, but Saturday night brought only four hours of sleep. I have no idea what's causing this.

There's a cold front blowing through today. I woke up this morning to the sound of rain. The temperature is dropping and the wind has picked up speed. I hate winter.

I'd love to say more, but the brain is barely functioning. In lieu of content, I offer the following link where you can build your own online kaleidoscope. Go there. It's amazingly fun.
Kaleidoscope Fun

You May Be Able To Help Us Learn More About Cancer

News about an American Cancer Society study from breastcancer.org
U.S. cancer group launches mass cancer study

WASHINGTON (Reuters) - The American Cancer Society said it was looking for half a million volunteers willing to let researchers watch them for the next 20 years to see if they get cancer.

The aim is to match similar big studies in Europe and Asia that are looking on a large scale for the environmental and lifestyle factors that cause cancer, the second-leading cause of death in the United States after heart disease.

"This type of study involves hundreds of thousands of people, with diverse backgrounds, followed for many years, with collection of biological specimens and assessments of dietary, lifestyle and environmental exposures," Eugenia Calle, managing director of analytic epidemiology at the American Cancer Society, said in a statement.

"It also requires active follow-up to discover if and when study participants develop cancer."

The group will recruit men and women between the ages of 30 and 65 who have never been diagnosed with cancer. They will give blood to be tested and answer questionnaires at various times over the next 20 years.

Similar big studies have confirmed the link between cigarette smoking and lung cancer, shown that obesity increases the risk of several cancers, and linked aspirin use to a lower death rate from colon cancer.

They have also found evidence that defied conventional wisdom, such as the Women's Health Initiative study that found hormone replacement therapy actually raises the risk of breast cancer, stroke and heart attack.