10 December 2008

Psychological Waterboarding

Panic off. Instead of relying on rumors, Owner has turned up some reliable sources regarding the financial health of our clients.

That noise you hear is me laughing insanely and beating my head against the wall.

I won't get fooled again. No matter what the annual salary hit I'll take, I've had enough. In the meantime, cackle cackle whack whack.

09 December 2008

Poison Pen Letter

Owner is back from his sick bed and maniacally focused on sending the business into the proverbial trash can.

Today, I'm angry. Golf Pro and his father, a stockholder, are planning to suck up one of the clients the Pro has carefully cultivated over the years by neglecting. By the way, this is Pro's only client and one that existed prior to his employment. Pro foolishly believes this one client will provide him with the exorbitant lifestyle he's come to wallow in. In the words of Bob Dylan, it's a hard rain gonna fall.

Mr. Moneybags will no longer command his 6-figure income, nor will he have Crazy Land to purchase his vehicle. Owner is completely incapable of getting a job. Once we shut Crazy Land down, collecting outstanding debt will become vexing. However, Land's debtors will inside on being paid. Where will all the money come from to support Owner's grown children, his massive credit card debt and to support his own lavish lifestyle?

I'm at least realistic about the changes Crazy Land's demise will have on my life. I have not grown accustomed to unrealistic pay rates. (See previous post.) I have breast cancer. Money is not my highest priority.

I'm angry about injustice, I'm angry about stupidity and greed. Relentless impending doom, when it's not yet warranted, irritates me.

By all means, shut it down. Let's all try to find our way. Before the end, though, several people will need to clear their schedules for a final interview with Ggirl. You cannot imagine the fear and trembling that can evoke.

04 December 2008

I'm Not Home Yet

12.4.08

I threw away my prosthesis Monday night and moved my wigs off of my dresser. I don't know why it's taken so long, nor do I know why there are still things I can't look at and can't get rid of.

I have several tote bags in my bedroom that I've used in the 3 years I've shuttled back and forth between here and M.D. Anderson. They're filled with insurance forms, bills, magazines, puzzle books...the stuff that accumulates while you wait. Waiting is an art in which I've become well versed.

I can't make myself go through it. I try now and then, but that chemo nausea returns like a ghost to remind me of how bad it's been.

I also carry a small notebook with me that includes, among other things, several pages detailing the physical reactions I had to chemotherapy. I agreed to participate in a study that required I keep track. I can't tear those pages out.

I remind myself that I've been through a lot. I got rid of the prosthesis, I moved my wigs. It's a journey of reconciliation. I'm not home yet.

03 December 2008

Rules For Living In Crazy Land

Rule Number One for Living in Crazy Land: Let go of ego and resentment.

Rule Number Two: Remember that everyone here is suffering because of their own inability to let go of ego.

There's no need for anger or fantasies of sabotage. That self-indulgence merely leads me farther down the road into the Crazy Land wilderness where dysfunction flourishes. I don't do dysfunctional. I guess that would be Rule Number Three.

When I'm grounded in reality, I'm always free to offer compassion. And to be entertained.

01 December 2008

Jingling Bling

Thanksgiving being (thankfully) over, the Festal Pig has returned to plague Crazy Land with jingly bling.

We have a minimal staff today--Golf Pro (wonder of wonders!), Mr. Moneybags, The Information Superhighway, IT Boy, Moneybags' daughter, Morose Owner and, of course, yours truly, the Festal Pig. Were it not for the constant jingle jingle of my bracelet, Crazy Land would be utterly grim.

Though it gave renewed temporary hope to Owner, virtually all of our citizens have accepted the inevitable demise of Crazy Land. Owner, the Founder and Caretaker of Crazy Land, is determined to see the company crumble. As far as he's concerned, it already has. His pessimism is living proof to the theory of self-fulfilling prophecy. Owner is depressed and gloomy. He's already destitute. The worst has already happened.

On the Pig front, I recently gained starling new information regarding salaries here and it's given me new impetus to seek a new, more fulfilling Crazy Land. Yes, boys and girls, it's out there. I will most assuredly find it and settle into a new, dysfunctional country of ego maniacs and eccentrics.

It turns out that Golf Pro isn't the only one who's raking in the cash. Looks like I'm last in line for the gravy train. If we weren't already halfway under water, I might be tempted to sabotage my victories in developing a more efficient analytical database. Mr. Moneybags would have to revisit the cost of building a new version. Reality can be a cruel and pricey teacher. We're two steps into the quicksand, though, and I'm not sure it's worth the trouble required to commit software vandalism.

I console myself with the knowledge that job offers for the wildly overpaid with similar big bucks will be mighty slim. I know none of these comforting thoughts falls into the holiday spirit mode. I make up for it in jingle, though. If my jingly bling irritates my fellow workers, all the better.

Jingle jingle, you buttwads.

25 November 2008

Dream Catcher

I dream of everyone on the planet having enough food to eat, shelter from the elements and hope for the future. I dream of peace among all people.

In Which Hubby Gets A Job

Hubby has a job--an actual get-up-in-the-morning, get-paid-regularly job. I found the job listing online one day when it dawned on me that the Texas Legislature will be convening in January. I remembered that they always need proofreaders. Hubby is one of the best proofreaders I've ever known. He's had a series of eight interviews, most of them running about ninety minutes. Today they called and offered employment. I'll bet you can hear my sigh of relief.

Best yet, it's a job where they value the contribution Hubby can make. It has to make him feel much, much better about himself. Of course, I hope he'll make some contacts or prove himself invaluable to the team, which continues on even when the Legislature folds up its tent and goes home.

Crazy Land takes an enormous toll on me. Owner announces every day (usually more than once a day) that we're closing down any minute. I'm not crazy or stupid, I see the instability of world markets and the long, steady decline of computer-related products. Nonetheless, having Owner essentially beat us over the head with dire predictions leaves us all in a state of almost unbearable anxiety.

There was yet another emergency shareholder meeting yesterday, during which Owner handed out articles proclaiming the end of the computer world as we know it. I have no idea why he would do that. We're not losing money (not yet, anyway). We have projects in the works and new purchase orders. Let's by all means shut the company down right now.

I'm very busy still and it cuts into my own job search time. Owner will be out of the office tomorrow. I expect a quiet day, so I hope to make some progress then.

For right now, though, I can relax a tiny bit, maybe enough for my colon to stop hurting. IBS pain started several weeks ago, due to my high anxiety level. In the grand scheme of things, it's a minor annoyance. The pain is nonexistent compared to the level of hurt I've endured during the past three years. Still. It would be nice to experience pain-free for a while.

Hubby's job starts in two weeks. If I weren't such a solitary creature, I'd throw a party for him.

21 November 2008

Owner Meltdown

Even Crazy Land has its moments. I was unaccountably in high spirits today and spread cheer around the office. My mood improved when seafood lunch was provided for all by aforementioned Crazy Land. God knows I deserve it. Well, we probably all do, except for Golf Pro. Golf Pro, of course, was not here. Though Owner would say he's working hard, the rest of us know he's working hard on a beer by now.

It's been a deadly week, with Owner having a mental meltdown all over me. I'm empathic, you know, so all lost souls and lunatics naturally gravitate to me. When they leave, my mind and body have absorbed whatever manifestation of nuttiness they carry with them. Owner was having a panic attack, quit taking tranquilizers two weeks ago, has stopped taking thyroid medication and, on that day, hadn't eaten anything by mid-afternoon. After his endless monologue, he felt much better. Me, not so much.

Mr. Moneybags is looking for another job. He can't take it anymore. What a weenie. I've withstood the onslaught of Crazy Land for around 15 years now (but who's counting).

Let's see, does that make me stupider or stronger?

17 November 2008

Golf Pro's Crisis

Hubby's looking for a job; I'm looking for a job. The entire world is looking for a job. While looking, while working, I'm obsessed with the multitude of Senate and House hearings and subcommittee hearings. I've learned a lot, enough to enrage me. Rage, however, doesn't result in employment potential. Oddly enough, when detailing my professional goals, wreaking vengeance on the architects of our global crisis most likely will result in no calls. Such a pity. I do spiteful so well.

Here in Crazy Land, we thrive on anxiety. Golf Pro, who is overpaid beyond belief, visits the accounting department, demanding to know what the future holds. He has a family, you know. None of the rest of us have any responsibilities. We'd all love to know what the future holds. Hello. There is great uncertainty in life, especially these days.

Now for a little background on Golf Pro. He came to work here about a year after I did. He was useless then and hasn't felt the need to branch out in the 15 or so years he's employed at Crazy Land. He was supposed to be a salesman, but he has yet to make one single sale...ever.

His value to the company, I believe, lies in the fact that his step-father is a minority shareholder in the company. Isn't that fabulous? That's exactly the kind of qualifications needed to get and keep a key position in any company. He's better paid than any of us, short of Mr. Moneybags (don't get me started) and the President. We hate him.

Without exception, we all hate him. He had a brief fling of "pal-ship" with Mr. Moneybags, but it didn't take long for Bags to figure out just how staggeringly lazy and incompetent the Pro is. Loathsome and he came dangerously close to fisticuffs several years ago. I harbor secret fantasies that it came to fruition. Though Pro is considerably younger, he is the Pillsbury Dough Boy and Loathsome could have kicked his pudgy butt in a matter of moments. Let me be absolutely clear here. Even after my five surgeries, three rounds of chemo and seven weeks of radiation in three years, even I could kick is ass. Right now.

Crazy Land. The fun never ends. Anyone have a voodoo doll? Office (and field) staff might be willing to contribute to a fund to get one.

11 November 2008

Golf Pro: The Reason I Don't Own Firearms

I just found out how much Golf Pro makes (note that I did not say "earns"). One of the many reasons why it's best that I don't own firearms.

Golf Pro works, on average, 10 hours a week and makes more money than anyone other than Mr. Moneybags.

As Bob Dylan said, though, "It's a hard rain gonna fall" if Crazy Land goes away. What does a 47 year old man do who hasn't ever worked? If you asked Golf Pro to define the word "work," he wouldn't be able to do it. He has absolutely no marketable skills, but he does have attitude in abundance. Golf Pro is an executive and demands that he be treated as such. Well, he's smart enough not to expect it from me.

I'm going to resume deep breathing and imagine myself contemplating the universe from the comfort of a hotel room in Santa Fe. Ahhh. Much better.

06 November 2008

Wading Through High Waters

It took a while to slog through my dad's anniversary. Actually, I think I'm still wading through some sadness.

Hubby and I are on speaking terms again. He's been more helpful than usual, so I'm thinking that, at least for the time being, we're on almost the same page. Being on the same page is a bit much to ask, but having him on a quarter of the page I'm on is a huge improvement.

Crazy Land has been chewing up all of my discretionary, write in my blog time. While IT Boy was on his honeymoon, I was the only recourse for Loathsome when his email went berserk. He stalked into my office and asked me if I had a computer. That is so Loathsome. I made him cut to the chase and tell me what was happening. You can't imagine what a huge task it was to just get the basic facts out of him. I was exhausted before I began.

I spent two days working on his computer, then I abandoned all hope. I set his email up on another computer so Loathsome could function while we waited for the return of IT Boy. A week into using that computer, it stopped running the accounting software. Of course, everybody blamed Loathsome for the troubles.

IT Boy got back this past Monday and devoted three days to Loathsome's email. I understand that, as of yesterday afternoon, virtual memory has been restored and it's stopped shutting itself down or freezing up. I had correctly pinpointed the problem and I take some pride in the fact that IT Boy wasn't able to waltz in and fix the problem immediately.

Yesterday I invited my Crazy Land cohorts to join me for a belated birthday celebration/thank you party. Two days after issuing the invitation, I suddenly remembered that I've had several birthday parties when no one showed up. Yes, it was a sad, sad childhood. Nothing like setting yourself up to be hurt and disappointed...again.

Everyone but Golf Pro showed up, though, and I was able to thank everyone for helping me get through three years of breast cancer hell. It was actually better that Golf Pro was MIA. Everyone is even more furious at him than usual.

I'm so happy to have 15 minutes to keep track of what's going on, even if it's on a very minimal basis. I have to try to find a way to work this into my days, which continue to be far too busy. I'm inventive. I'll just put me on my daily schedule.

24 October 2008

My Cancer Was A Gift

My Cancer Was A Gift

Indeed it was.

Alone In the Ice and Snow

Hubby and I are at an impasse today. Last night, I lost patience with him when I told him I was having therapy today and he seemed to be exasperated with the endless nature of my medical/psychological needs.

I told him that I resent the fact that he contributes so little to our relationship. He doesn't work, he doesn't do anything around the house except wash the dishes and clean (the inside of) the bathtub. (I have made him responsible for walking and feeding the dogs. He does a middling job of both.) I told him that I'm so resentful, in fat, that it's affecting our intimate relationship. I told him I feel burdened by his lethargy...or whatever. I said that I feel more like his mother than his wife.

I demanded that he tell me what he does with the 8 hours a day I'm at work. I mean, really. Couldn't he just sweep the floor? Dust? Something? He admitted that he wastes a lot of time, but then implied that's just the way he is. I'd love to waste time. I don't have time to waste time.

Well, needless to say, he was very hurt and probably very angry. He disappeared upstairs, came back down a couple of times to deal with the dogs and went directly back up. I didn't like that reaction. It made me angry.

Great timing. Now I will probably have to spend the weekend in silence. Hubby tends to use the Freeze Out (passive-aggressive) response to conflict. Tomorrow is the anniversary of my dad's suicide. Excellent timing on my part.

Today I'm tired and sad. I'm not good at recognizing it, but if I had to bet, I'd say I'm probably really anxious. I feel so alone. The Superhighway says that our respective husbands use guilt to control us. My mom says that, too. I'm sure Therapist will agree.

They're all correct, of course. That doesn't make me less unhappy. Worse yet, I feel shamed by my neediness. Of course, I might not feel so needy if tomorrow were a different day, not an anniversary.

I'm certain that I'll try to ease the tension between us. I wish I wouldn't. I wish he would try to see things from my point of view. I wish, I wish, I wish.... Things are what they are, though.

Boy, do I need therapy.

Tomorrow


Tomorrow.


From Survivors of Suicide

Helping A Survivor Heal

Historian Arnold Toynbee once wrote, "There are always two parties to a death; the person who dies and the survivors who are bereaved." Unfortunately, many survivors of suicide suffer alone and in silence. The silence that surrounds them often complicates the healing that comes from being encouraged to mourn.

Because of the social stigma surrounding suicide, survivors feel the pain of the loss, yet may not know how, or where, or if, they should express it. Yet, the only way to heal is to mourn. Just like other bereaved persons grieving the loss of someone loved, suicide survivors need to talk, to cry, sometimes to scream, in order to heal.

As a result of fear and misunderstanding, survivors of suicide deaths are often left with a feeling of abandonment at a time when they desperately need unconditional support and understanding. Without a doubt, suicide survivors suffer in a variety of ways: one, because they need to mourn the loss of someone who has died; two, because they have experienced a sudden, typically unexpected traumatic death; and three, because they are often shunned by a society unwilling to enter into the pain of their grief.

How Can You Help?
A friend or family member has experienced the death of someone loved from suicide. You want to help, but you are not sure how to go about it. This page will guide you in ways to turn your cares and concerns into positive action.

Accept The Intensity Of The Grief
Grief following a suicide is always complex. Survivors don't "get over it." Instead, with support and understanding they can come to reconcile themselves to its reality. Don't be surprised by the intensity of their feelings. Sometimes, when they least suspect it, they may be overwhelmed by feelings of grief. Accept that survivors may be struggling with explosive emotions, guilt, fear and shame, well beyond the limits experienced in other types of deaths. Be patient, compassionate and understanding.

Listen With Your Heart
Assisting suicide survivors means you must break down the terribly costly silence. Helping begins with your ability to be an active listener. Your physical presence and desire to listen without judgment are critical helping tools. Willingness to listen is the best way to offer help to someone who needs to talk.

Thoughts and feelings inside the survivor may be frightening and difficult to acknowledge. Don't worry so much about what you will say. Just concentrate on the words that are being shared with you.

Your friend may relate the same story about the death over and over again. Listen attentively each time. Realize this repetition is part of your friend's healing process. Simply listen and understand. And, remember, you don't have to have the answer.

Avoid Simplistic Explanations and Clichés
Words, particularly clichés, can be extremely painful for a suicide survivor. Clichés are trite comments often intended to diminish the loss by providing simple solutions to difficult realities. Comments like, "You are holding up so well," "Time will heal all wounds," "Think of what you still have to be thankful for" or "You have to be strong for others" are not constructive. Instead, they hurt and make a friend's journey through grief more difficult.

Be certain to avoid passing judgment or providing simplistic explanations of the suicide. Don't make the mistake of saying the person who suicided was "out of his or her mind." Informing a survivor that someone they loved was "crazy or insane" typically only complicates the situation. Suicide survivors need help in coming to their own search for understanding of what has happened. In the end, their personal search for meaning and understanding of the death is what is really important.

Be Compassionate
Give your friend permission to express his or her feelings without fear of criticism. Learn from your friend. Don't instruct or set explanations about how he or she should respond. Never say "I know just how you feel." You don't. Think about your helping role as someone who "walks with," not "behind" or "in front of" the one who is bereaved.

Familiarize yourself with the wide spectrum of emotions that many survivors of suicide experience. Allow your friend to experience all the hurt, sorrow and pain that he or she is feeling at the time. And recognize tears are a natural and appropriate expression of the pain associated with the loss.

Respect The Need To Grieve
Often ignored in their grief are the parents, brothers, sisters, grandparents, aunts, uncles, spouses and children of persons who have suicided. Why? Because of the nature of the death, it is sometimes kept a secret. If the death cannot be talked about openly, the wounds of grief will go unhealed.

As a caring friend, you may be the only one willing to be with the survivors. Your physical presence and permissive listening create a foundation for the healing process. Allow the survivors to talk, but don't push them. Sometimes you may get a cue to back off and wait. If you get a signal that this is what is needed, let them know you are ready to listen if, and when, they want to share their thoughts and feelings.

Understand The Uniqueness Of Suicide Grief
Keep in mind that the grief of suicide survivors is unique. No one will respond to the death of someone loved in exactly the same way. While it may be possible to talk about similar phases shared by survivors, everyone is different and shaped by experiences in his or her life.

Because the grief experience is unique, be patient. The process of grief takes a long time, so allow your friend to process the grief at his or her own pace. Don't criticize what is inappropriate behavior. Remember the death of someone to suicide is a shattering experience. As a result of this death, your friend's life is under reconstruction.

Be Aware Of Holidays And Anniversaries
Survivors of suicide may have a difficult time during special occasions like holidays and anniversaries. These events emphasize the absence of the person who has died. Respect the pain as a natural expression of the grief process. Learn from it. And, most importantly, never try to take the hurt away.

Use the name of the person who has died when talking to survivors. Hearing the name can be comforting and it confirms that you have not forgotten this important person who was so much a part of their lives.

Be Aware Of Support Groups
Support groups are one of the best ways to help survivors of suicide. In a group, survivors can connect with other people who share the commonality of the experience. They are allowed and encouraged to tell their stories as much, and as often, as they like. You may be able to help survivors locate such a group. This practical effort on your part will be appreciated. (See Directory of SOS Support Groups on main page)

Respect Faith And Spirituality
If you allow them, a survivor will "teach you" about their feelings regarding faith and spirituality. If faith is part of their lives, let them express it in ways that seem appropriate. If they are mad at God, encourage them to talk about it. Remember, having anger at God speaks of having a relationship with God. Don't be a judge, be a loving friend.

Survivors may also need to explore how religion may have complicated their grief. They may have been taught that persons who take their own lives are doomed to hell. Your task is not to explain theology, but to listen and learn. Whatever the situation, your presence and desire to listen without judging are critical helping tools.

Work Together As Helpers
Friends and family who experience the death of someone to suicide must no longer suffer alone and in silence. As helpers, you need to join with other caring persons to provide support and acceptance for survivors who need to grieve in healthy ways.

To experience grief is the result of having loved. Suicide survivors must be guaranteed this necessity. While the above guidelines on this page will be helpful, it is important to recognize that helping a suicide survivor heal will not be an easy task. You may have to give more concern, time and love than you ever knew you had. But this effort will be more than worth it.

ABOUT THE AUTHOR
Dr. Alan D. Wolfelt is a noted author, educator and practicing thanatologist. He serves as Director of the Center for Loss and Life Transition in Fort Collins, Colorado and is on the faculty at the University of Colorado Medical School in the Department of Family Medicine.
As a leading authority in the field of thanatology, Dr. Wolfelt is known internationally for his outstanding work in the areas of adult and childhood grief. Among his publications are the books, Death and Grief; A Guide For Clergy, Helping Children Cope With Grief and Interpersonal Skills Training: A Handbook for Funeral Home Staffs. In addition, he is the editor of the "Children and Grief" department of Bereavement magazine and is a regular contributor to the journal Thanatos.

21 October 2008

Breast Cancer Information Resources

A (not complete) list of Internet resources on breast cancer. Inclusion in this list does not necessarily imply a recommendation.

Detailed Breast Cancer Risk
GE Health Care
Breastcancer.org
Cancer.com
Discovery Health
Revolution Health
National Coalition for Cancer Survivorship
Planet Cancer
ICON Magazine
National Cancer Iinstitute
Susan G. Komen Foundation
National Breast Cancer Foundation
Medline Plus: A Service of the U.S. National Library of Medicine and the National Institutes
of Health

Breastcancer.net
WebMD
MedicineNet.com
Mayo Clinic
M.D. Anderson
National Cancer Institute
American Cancer Society
Healthline
Oncolink: Abramson Cancer Center of the University Pennsylvania
Doctors' Guide to Breast Cancer Information and Resources
Centers for Disease Control and Prevention

I am sorely tempted to (compulsively) alphabetize these, but I've been interrupted by my computer challenged co-worker and now it's time to leave. More tomorrow, perhaps a brief intro to these.

Understanding Suicide: Common Elements

From Survivors of Suicide

(Note from Ggirl: Please pay special attention to element #10.)

Understanding Suicide - Common Elements

No single explanation can account for all self-destructive behavior. Edwin Shneidman, a clinical psychologist who is a leading authority on suicide, described ten characteristics that are commonly associated with completed suicide. Schneidman's list includes features that occur most frequently and may help us understand many cases of suicide.

1. The common purpose of suicide is to seek a solution.
Suicide is not a pointless or random act. To people who think about ending their own lives, suicide represents an answer to an otherwise insoluble problem or a way out of some unbearable dilemma. It is a choice that is somehow preferable to another set of dreaded circumstances, emotional distress, or disability, which the person fears more than death.
Attraction to suicide as a potential solution may be increased by a family history of similar behavior. If someone else whom the person admired or cared for has committed suicide, then the person is more likely to do so.

2. The common goal of suicide is cessation of consciousness.
People who commit suicide seek the end of the conscious experience, which to them has become an endless stream of distressing thoughts with which they are preoccupied. Suicide offers oblivion.

3. The common stimulus (or information input) in suicide is intolerable psychological pain.
Excruciating negative emotions - including shame, guilt, anger, fear, and sadness - frequently serve as the foundation for self-destructive behavior. These emotions may arise from any number of sources.

4. The common stressor in suicide is frustrated psychological needs.
People with high standards and expectations are especially vulnerable to ideas of suicide when progress toward these goals is suddenly frustrated. People who attribute failure or disappointment to their own shortcomings may come to view themselves as worthless, incompetent or unlovable. Family turmoil is an especially important source of frustration to adolescents. Occupational and interpersonal difficulties frequently precipitate suicide among adults. For example, rates of suicide increase during periods of high unemployment (Yang et al.,1992).

5. The common emotion in suicide is hopelessness-helplessness.
A pervasive sense of hopelessness, defined in terms of pessimistic expectations about the future, is even more important than other forms of negative emotion, such as anger and depression, in predicting suicidal behavior (Weishaar & Beck, 1992). The suicidal person is convinced that absolutely nothing can be done to improve his or her situation; no one else can help.

6. The common internal attitude in suicide is ambivalence.
Most people who contemplate suicide, including those who eventually kill themselves, have ambivalent feelings about this decision. They are sincere in their desire to die, but they simultaneously wish that they could find another way out of their dilemma.

7. The common cognitive state in suicide is constriction.
Suicidal thoughts and plans are frequently associated with a rigid and narrow pattern of cognitive activity that is comparable to tunnel vision. The suicidal person is temporarily unable or unwilling to engage in effective problem-solving behaviors and may see his or her options in extreme, all or nothing terms. As Shneidman points out, slogans such as "death before dishonor" may have a certain emotional appeal, but they do not provide a sensible basis for making decisions about how to lead your life.

8. The common action in suicide is escape.
Suicide provides a definitive way to escape from intolerable circumstances, which include painful self-awareness (Baumeister, 1990).

9. The common interpersonal act in suicide is communication of intention.
One of the most harmful myths about suicide is the notion that people who really want to kill themselves don't talk about it. Most people who commit suicide have told other people about their plans. Many have made previous suicidal gestures. Schneidman estimates that in at least 80 percent of completed suicides, the people provide verbal or behavioral clues that indicate clearly their lethal intentions.

10. The common consistency in suicide is with life-long coping patterns. During crisis that precipitate suicidal thoughts, people generally employ the same response patterns that they have used throughout their lives. For example, people who have refused to ask for help in the past are likely to persist in that pattern, increasing their sense of isolation.

SOURCE: Thomas F. Oltmanns, Robert E. Emery
University of Virginia

Loathsome, A Unique Brand of Distraction

This is the second day in a row that I've devoted almost entirely to Loathsome's computer. IT Boy is on his two-week honeymoon, which leaves us without any computer support.

Surprise. I am not IT Ggirl. Error message said not enough virtual memory. I created more virtual memory. I cleaned up the disk and eliminated hundreds of files. Then error message said Microsoft Outlook should be reinstalled because a .dll file is missing. I'm not reinstalling anything, Loathsome. It seems to me that there are systemic problems.

As I tried to understand and work through the many problems, Loathsome required a blow-by-blow explanation of what I was doing and why. Kill me, please. I might as well be speaking Swahili. Loathsome is relentless, as if by telling him, he might be prepared to deal with future problems himself. He's either deluded or he's trying to impress me with his commitment to grasping the workings of Microsoft Windows. Not impressed, as you might imagine.

Up side? Not much time to think about suicide. The baffling thing is that this year is so unbearably sad for me. I've spent at least the last five years being enraged at my father. Even aside from the suicide, I have plenty to be angry about. Most people have trouble understanding how I could have any emotional connection with him at all after he made my life a slow motion, eternal train wreck.

Again, the universe has offered up Loathsome as a distraction. I'm moderately happy to take it.

four days

20 October 2008

Comcast Pink ribbon


Watch a wide array of informative, entertaining and inspiration programs from Lifetime Television, Parents TV, Discovery Health, Showtime and Exercise TV with medical direction sand original content provided by Breastcancer.org.

To help raise awareness and provide important information about breast cancer, Comcast partnered with Breastcancer.org and several cable networks to launch The Pink Ribbon Campaign, an original video-on-demand and online initiative bringing together educational and inspirational content for all women and their loved ones.

The Pink Ribbon Campaign presents dozens of programs about prevention, detection, treatment and living with breast cancer as well as discussion forums, health and fitness advice and relevant news clips.

Throughout the entire month of October, Comcast customers with On Demand service will have free access to programs that will encourage and inspire women who are fighting or have survived breast cancer, including episodes of HBO's Sex and the City, Showtime's The L Word, celebrity bios from Bio Channel and Lifetime original movies, such as Living Proof, starring Harry Connick, Jr.

In addition, there are dozens of programs in categories including:

Pink Originals
Original, exclusive programming created specifically for the Pink Ribbon campaign by Lifetime and Parents TV. Topics including how to talk to children about cancer, and what to expect from diagnosis, treatment and recovery are also covered.

Meet the Doctors

New and original content produced by Comcast, in partnership with the University of Pennsylvania Abramson Cancer Center, provides an overview of risk factors, importance of knowing family history and tips on how to detect and defeat cancer.

Prevention-Healing
Programs from Discovery Health and Exercise TV provide in-depth information about prevention, including how to perform a breast self-exam.

TV and Movies
Special segments from TLC, Style Network and Lifetime provide advice for patients and survivors from demonstrations on how to wear a scarf to tips on boosting confidence and self-esteem.

Pink Ribbon Online

Fancast.com will feature most of the programs available On Demand, including episodes of The L Word, Whose Wedding Is It Anyway, One Tree Hill and profiles of celebrities who have battled breast cancer from Bio Channel. Additional content including videos in The Fan, links to relevant news articles and discussion forums is available at http://comcast.net/pinkribbon.

Suicide: National Statistics

From the American Foundation for Suicide Prevention

(Note from ggirl: From my extensive reading about suicide, I've learned that people who wish to kill themselves badly enough will find a way. It's impossible to watch someone 24 hours a day, guarding them from their own demons. Furthermore, hospitalization is by no means a sure thing. My own father was hospitalized several weeks before he shot himself. Some statistics cite a precipitous upswing in suicides immediately following hospitalization.

We must do whatever we can to prevent the suicide of the people we love (or those we don't), but my point is that it is never our fault that someone else succeeds in checking out. There's always plenty of guilt over the survivors' sense of responsibility for not stopping it. If you've lost someone to self homicide, please check into groups like Survivors of Suicide where you can get support from those who walk in your shoes.)


Facts and Figures

National Statistics


General

  • Over 32,000 people in the United States die by suicide every year.
  • In 2005 (latest available data), there were 32,637 reported suicide deaths.
  • Suicide is fourth leading cause of death for adults between the ages of 18 and 65 years in the U.S., with approximately 26,500 suicides.
  • Currently, suicide is the 11th leading cause of death in the United States.
  • A person dies by suicide about every 16 minutes in the United States. An attempt is estimated to be made once every minute.
  • Ninety percent of all people who die by suicide have a diagnosable psychiatric disorder at the time of their death.
  • There are four male suicides for every female suicide, but twice as many females as males attempt suicide.
  • Every day, approximately 80 Americans take their own life, and 1,500 more attempt to do so.

Youth

  • Suicide is the fifth leading cause of death among those 5-14 years old.
  • Suicide is the third leading cause of death among those 15-24 years old.
  • Between the mid-1950s and the late 1970s, the suicide rate among U.S. males aged 15-24 more than tripled (from 6.3 per 100,000 in 1955 to 21.3 in 1977). Among females aged 15-24, the rate more than doubled during this period (from 2.0 to 5.2). The youth suicide rate generally leveled off during the 1980s and early 1990s, and since the mid-1990s has been steadily decreasing.
  • Among young people aged 10-14 years, the rate has doubled in the last two decades.
  • Between 1980-1996, the suicide rate for African-American males aged 15-19 has also doubled.
  • Risk factors for suicide among the young include suicidal thoughts, psychiatric disorders (such as depression, impulsive aggressive behavior, bipolar disorder, certain anxiety disorders), drug and/or alcohol abuse and previous suicide attempts, with the risk increased if there is situational stress and access to firearms.

Older People

  • The suicide rates for men rise with age, most significantly after age 65.
  • The rate of suicide in men 65+ is seven times that of females who are 65+.
  • The suicide rates for women peak between the ages of 45-54 years old, and again after age 75.
  • About 60 percent of elderly patients who take their own lives see their primary care physician within a few months of their death.
  • Six to 9 percent of older Americans who are in a primary care setting suffer from major depression.
  • More than 30 percent of patients suffering from major depression report suicidal ideation.
  • Risk factors for suicide among the elderly include: a previous attempt, the presence of a mental illness, the presence of a physical illness, social isolation (some studies have shown this is especially so in older males who are recently widowed) and access to means, such as the availability of firearms in the home.

Depression

  • Over 60 percent of all people who die by suicide suffer from major depression. If one includes alcoholics who are depressed, this figure rises to over 75 percent.
  • Depression affects nearly 10 percent of Americans ages 18 and over in a given year, or more than 19 million people.
  • More Americans suffer from depression than coronary heart disease (12 million), cancer (10 million) and HIV/AIDS (1 million).
  • About 15 percent of the population will suffer from clinical depression at some time during their lifetime. Thirty percent of all clinically depressed patients attempt suicide; half of them ultimately die by suicide.
  • Depression is among the most treatable of psychiatric illnesses. Between 80 percent and 90 percent of people with depression respond positively to treatment, and almost all patients gain some relief from their symptoms. But first, depression has to be recognized.

Alcohol and Suicide

  • Ninety-six percent of alcoholics who die by suicide continue their substance abuse up to the end of their lives.
  • Alcoholism is a factor in about 30 percent of all completed suicides.
  • Approximately 7 percent of those with alcohol dependence will die by suicide.

Firearms and Suicide

  • Although most gun owners reportedly keep a firearm in their home for "protection" or "self defense," 83 percent of gun-related deaths in these homes are the result of a suicide, often by someone other than the gun owner.
  • Firearms are used in more suicides than homicides.
  • Death by firearms is the fastest growing method of suicide.
  • Firearms account for 52 percent of all suicides.

Medical Illness and Suicide

  • Patients who desire an early death during a serious or terminal illness are usually suffering from a treatable depressive condition.
  • People with AIDS have a suicide risk up to 20 times that of the general population.

Studies indicate that the best way to prevent suicide is through the early recognition and treatment of depression and other psychiatric illnesses.

Figures from the National Center for Health Statistics for the year 2005.

Remembering the Dragon

Perhaps all the dragons in our lives are but princes that are waiting to see us act just once with beauty and courage. Perhaps everything terrible is in its deepest essence, something helpless that needs our love.
-Rainer Maria Rilke

5 days

17 October 2008

Can Breast Cancer Be Prevented?


From the American Cancer Society

There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage.

Lowering your risk: You can lower your risk of breast cancer by changing those risk factors that can be changed. If you limit alcohol use, exercise regularly, and keep a healthy weight, you are decreasing your risk of getting breast cancer. Women who choose to breast-feed for at least several months may also reduce their breast cancer risk.

Not using post-menopausal hormone therapy (PHT) if you don't need it can also help you avoid raising your risk.

Finding breast cancer early: It is also important for women to follow the American Cancer Society's guidelines for finding breast cancer early. (See the section, "How is breast cancer found?")

For women who are or may be at increased risk

If you have a higher risk for breast cancer there may be some things you can do to reduce your chances of getting breast cancer. Before deciding which, if any, of these may be right for you, talk with your doctor.

Genetic testing: There are tests that can tell if a woman has certain changed (mutated) genes linked to breast cancer. With this information, women can then take steps to reduce their risk. Recently the U.S. Preventive Services Task Force made recommendations for genetic testing. They suggest that only women with a strong family history be evaluated for genetic testing for BRCA mutations. This group is only about 2% of adult women in the United States.

If you are thinking about genetic testing, you should talk to a genetic counselor, nurse, or doctor qualified to explain the results of these tests. It is very important that you know what genetic testing can and can't tell you, and to carefully weigh the benefits and risks of testing before these tests are done. Testing is expensive and may not be covered by some health insurance plans. For more information, see our document, Genetic Testing: What You Need to Know.

Breast cancer chemoprevention: Chemoprevention is the use of drugs to reduce the risk of cancer. Many drugs have been studied for use in lowering breast cancer risk. The drug tamoxifen has already been used for many years as a treatment for some types of breast cancer. Studies have shown that women at high risk for breast cancer are less likely to get the disease if they take tamoxifen. Another drug, raloxifene, has been approved to help reduce breast cancer risk in women past menopause who are at high risk for breast cancer. Other drugs are also being studied.

Preventive surgery for women with very high breast cancer risk: For the few women who have a very high risk for breast cancer, preventive surgery such as bilateral (double) mastectomy may be an option.

Preventive (prophylactic) double (bilateral) mastectomy: For some who are at very high risk for breast cancer, this surgery (a double mastectomy) may be an option. In this operation both breasts are removed before there is any known breast cancer. While this operation removes nearly all of the breast tissue, a small amount remains. So although this operation greatly reduces the risk of breast cancer, the disease can still start in the breast tissue that remains after surgery. To date, this has been a rare problem.

The reasons for thinking about this type of surgery need to be very strong. There is no way to know ahead of time whether this surgery will benefit a particular woman. A second opinion is strongly recommended before making a decision to have this type of surgery.

Preventive ovary removal (prophylactic oophorectomy): Women with a certain gene change (BRCA mutation) who have their ovaries removed may reduce their risk of breast cancer by half or more. This is because taking out the ovaries removes the main sources of estrogen in the body.

Although this document is not about ovarian cancer, it is important that women with this gene change also know that they also have a high risk of getting ovarian cancer. Most doctors recommend that these women have their ovaries removed after they are done having children.

16 October 2008

Stages of Breast Cancer


From breastcancer.org

Stages of Breast Cancer. Cancer stage is based on the size of the tumor, whether the cancer is invasive or non-invasive, whether lymph nodes are involved, and whether the cancer has spread beyond the breast.

The purpose of the staging system is to help organize the different factors and some of the personality features of the cancer into categories, in order to:

  • best understand your prognosis (the most likely outcome of the disease)
  • guide treatment decisions (together with other parts of your pathology report), since clinical studies of breast cancer treatments that you and your doctor will consider are partly organized by the staging system
  • provide a common way to describe the extent of breast cancer for doctors and nurses all over the world, so that results of your treatment can be compared and understood

Stage 0

Stage 0 is used to describe non-invasive breast cancers, such as DCIS and LCIS. In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal tissue.

Stage I

Stage I describes invasive breast cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which:

  • the tumor measures up to 2 centimeters, AND
  • no lymph nodes are involved

Stage II

Stage II is divided into subcategories known as IIA and IIB.

Stage IIA describes invasive breast cancer in which:

  • no tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm), OR
  • the tumor measures 2 centimeters or less and has spread to the axillary lymph nodes, OR
  • the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes

Stage IIB describes invasive breast cancer in which:

  • the tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes, OR
  • the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes

Stage III

Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.

Stage IIIA describes invasive breast cancer in which either:

  • no tumor is found in the breast. Cancer is found in axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone, OR
  • the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures, OR
  • the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures

Stage IIIB describes invasive breast cancer in which:

  • the tumor may be any size and has spread to the chest wall and/or skin of the breast AND
  • may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone
  • Inflammatory breast cancer is considered at least stage IIIB.

Stage IIIC describes invasive breast cancer in which:

  • there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast, AND
  • the cancer has spread to lymph nodes above or below the collarbone, AND
  • the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone

Stage IV

Stage IV describes invasive breast cancer in which:

  • the cancer has spread to other organs of the body -- usually the lungs, liver, bone, or brain

"Metastatic at presentation" means that the breast cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.

Additional staging information

You may also hear terms such as "early" or "earlier" stage, "later," or "advanced" stage breast cancer. Although these terms are not medically precise (they may be used differently by different doctors), here is a general idea of how they apply to the official staging system:

Early stage

  • Stage 0
  • Stage I
  • Stage II
  • Some stage III

Later or advanced stage

  • Other stage III
  • Stage IV

Doctors use a staging system to determine how far a cancer has spread. The most common system is the TNM staging system. You may hear the cancer described by three characteristics:

  • size (T stands for tumor)
  • lymph node involvement (N stands for node)
  • whether it has metastasized (M stands for metastasis)

The T (size) category describes the original (primary) tumor:

  • TX means the tumor can't be measured or found.
  • T0 means there isn't any evidence of the primary tumor.
  • Tis means the cancer is "in situ" (the tumor has not started growing into the breast tissue).
  • The numbers T1-T4 describe the size and/or how much the cancer has grown into the breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.

The N (node involvement) category describes whether or not the cancer has reached nearby lymph nodes:

  • NX means the nearby lymph nodes can't be measured or found.
  • N0 means nearby lymph nodes do not contain cancer.
  • The numbers N1-N3 describe the size, location, and/or the number of lymph nodes involved. The higher the N number, the more the lymph nodes are involved.

The M (metastasis) category tells whether there are distant metastases (whether the cancer has spread to other parts of body):

  • MX means metastasis can't be measured or found.
  • M0 means there are no distant metastases.
  • M1 means that distant metastases were found.

Once the pathologist knows your T, N, and M characteristics, they are combined in a process called stage grouping, and an overall stage is assigned.

For example, a T1, N0, M0 breast cancer would mean that the primary breast tumor:

  • is less than 2 centimeters across (T1)
  • does not have lymph node involvement (N0)
  • has not spread to distant parts of the body (M0)

This cancer would be grouped as a stage I cancer.

Log On 60%


Mr. Moneybags called on the intercom to tell me he was going to shut the server down and reset it.

Two minutes later, someone knocked on my door. Guess who? Loathsome.

"What did your computer do this morning?"

"You mean what's it doing now?"

Loathsome looks confused now that I've posed that question. Try again.

"What's the problem with it?"

It was doing things he'd never seen before and wouldn't allow him to log on. I suggested that he wait a few minutes until Bags reset the server and try again.

"No, that's not it. I've already done that three times, " he said.

I tried to explain why he should try one more time. Sometimes Loathsome gets this look on his face that's part confusion, part frustration, part dumb suffering. If he were a horse, I'd shoot him to end his misery. Instead, I proceeded to his office. I restarted and it got stuck. We did this four times and finally I restartedt in safe mode. At least that way Loathsome could look at his email and surf the net for whatever hugely important tasks must be accomplished today.

I went back to my office and finished up some work on my computer, then went to make some copies in the foyer in our suite of offices. While I was copying, I noticed Loathsome's shadow like carrion ready to lunch on dead meat. Dead meat. That would be me.

"Did you get an email from me?"

I had no idea.

"I don't know. Why?"

"It's not working," he said. I was about to go back to his office when Moneybags appeared at the printer right next to the copier I was using. Bags told Loathsome to log on again.

"Huh?" The famous Loathsome response to everyone, generally repeated 3 times before you can move on to the next sentence.

Moneybags said, "Log on again. Log on again."

Loathsome looked at me like I was his life line. "All the way?"

No, I did not tell him to log on 60%, but you know I wanted to.


Nine days.

15 October 2008

Anniversary

Ten days until the 11th anniversary of my father's suicide.

Grief never ends.

Chemo Brain

From breastcancer.org

“Chemo brain” or “chemo fog” are terms used for thinking and memory difficulty that some associate with chemotherapy treatment. While some research suggests a link between chemotherapy and problems with thinking and memory, findings are not yet consistent and more studies need to be done. What we do know is that for many breast cancer patients, “chemo brain” is a very real issue. You may not remember where you put your keys or why you went to the store, or you may simply not be able to think of the right word. Join us to find out how other aspects of treatment can affect your cognitive abilities, learn ways to improve your mental skills, get the latest research on chemo brain, and more.


Join us tomorrow night between 7:00 p.m. and 8:30 p.m (EDT)* for this month's Ask-the-Expert Online Conference: Managing Chemo Brain. Christina Meyers, Ph.D., A.B.P.P. and George Sledge, M.D. will answer your questions about how long memory issues can last, what you can do to keep your brain active including tips to sharpen your memory, and more.


Christina Meyers, Ph.D., A.B.P.P. is a board certified neuropsychologist. She created the Neuropsychology Service in the newly formed Department of Neuro-Oncology at M.D. Anderson Cancer Center in 1984.


George Sledge, M.D. is the Ballvé-Lantero Professor of Oncology at Indiana University at Indianapolis, where he co-directs Indiana University Simon Cancer Center's Breast Cancer Program.


If you'd like to ask a question for our MANAGING CHEMO BRAIN conference, but will not be able to join the conference tomorrow night, you can submit your question now.


We'll answer as many questions as we can during the conference. A conference transcript will be posted at Breastcancer.org by October 22, 2008.


To join the conference, visit Breastcancer.org any time between 7:00 p.m. and 8:30 p.m. EDT* tomorrow night and click on the "Join Conference" button. It’s easy to participate; no special software is required. The live conference will appear in text on your screen.


Visit the Ask-the-Expert Online Conference page for more details.

10 October 2008

Reprieve

Owner came into my office yesterday morning and delivered a rambling recitation of the reasons why Crazy Land was being terminated with extreme prejudice. They were perfectly understandable in this rough and tumble economic environment. Unfortunately, at least some of the information upon which the decision was made was purely speculative. Rumors.

Furthermore, Owner's children were now going to face the brutal realities of making one's own way in the world. They still receive economic support even though they are in their mid to late twenties. So they need to get with that program in 24 hours? It seemed unlikely to me.

An emergency shareholders' meeting was called for 10:00 a.m. yesterday. Owner can't merely decide for himself whether to shut down the Land of Crazy. After five hours of discussion, they emerged with a renewed commitment to growing the Land.

So here we are, walking in quicksand just like every other business in the world. Sooner or later, the money hemorrhage will end if things don't improve. Most of the corporate employees were blissfully unaware of the looming joblessness sitting right outside their offices. As for me, I developed some action items and tried to come to terms with the prospect of no health insurance. Cancer patients aren't generally welcomed by insurers or, if they're invited into the fold, it comes with a price tag I certainly can't afford.

Having gotten a reprieve from the proverbial ax, I'm looking for a new Crazy Land in which to settle. Trust me, if it's an insane work environment, I will inevitably find it and be sucked in to a black hole of psychodrama and inefficiency. I've learned from history, but I feel certain that I'm nonetheless doomed to repeat it.

On the up side, new entertainment awaits.

Screening for Breast Cancer

From the National Cancer Institute

Screening

Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early.

Your doctor may suggest the following screening tests for breast cancer:

You should ask your doctor about when to start and how often to check for breast cancer.

Screening Mammogram

To find breast cancer early, NCI recommends that:

  • Women in their 40s and older should have mammograms every 1 to 2 years. A mammogram is a picture of the breast made with x-rays.
  • Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.

Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.

If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present. (The "Diagnosis" section has more information on biopsy.)

Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:

  • A mammogram may miss some cancers. (The result is called a "false negative.")
  • A mammogram may show things that turn out not to be cancer. (The result is called a "false positive.")
  • Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.

Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.

Clinical Breast Exam

During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.

Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.

Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.

A thorough clinical breast exam may take about 10 minutes.

Breast Self-Exam

You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period.

You should contact your health care provider if you notice any unusual changes in your breasts.

Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.

You may want to ask the doctor the following questions about screening:

  • Which tests do you recommend for me? Why?
  • Do the tests hurt? Are there any risks?
  • How much do mammograms cost? Will my health insurance pay for them?
  • How soon after the mammogram will I learn the results?
  • If the results show a problem, how will you learn if I have cancer?

08 October 2008

Risk Factors

From the National Cancer Institute.

Risk Factors

No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.

Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for breast cancer:

  • Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause.
  • Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
  • Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
  • Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
  • Gene changes: Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2, and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes. NCI offers publications on gene testing.
  • Reproductive and menstrual history:
    • The older a woman is when she has her first child, the greater her chance of breast cancer.
    • Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
    • Women who went through menopause after age 55 are at an increased risk of breast cancer.
    • Women who never had children are at an increased risk of breast cancer.
    • Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer.
    • Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.
  • Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.
  • Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
  • Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer.
  • Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.
  • Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.
  • Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
  • Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.

Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.

Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.

But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.

If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.