Saturday, December 16, 2017

Feel Like I'm Back Twenty Steps

Finally I am feeling better and my post surgery recovery seems almost complete. The signs are there because I actually felt able to bring in the empty trash barrels and recycling bins (put everything in the big barrel and wheel it down the driveway). This is the first time since early October I have felt up to that. My husband even noticed.

I was all set to go to the gym this week for the first time in months but I woke up Monday with a temperature (101.5) and thought I had the flu. It wasn't the flu. It wasn't an ear infection. It was just your basic run of the mill cold. It set me back - I postponed everything from this week to next week and am still dragging around some.

However, I do now feel better but feel horribly out of shape. I lost weight after sitting around for a couple of months and now have a fatter gut. I get tired easily - probably because:
I'm out of shape
I'm recovering from surgery
I'm out of shape
I'm getting over a cold
I'm out of shape
I've sat on my butt for more than 10 weeks
I'm out of shape

But now my goal is to work on getting back in shape. I really need to.

When I was diagnosed with RA and fibromyalgia, I was very pleased at the fact that I had been working out regularly and was in relatively good shape and was better off than many others when diagnosed. Now I feel twenty steps back from where I was. I am not in shape now. It will be ten times harder to get back in shape than without RA and fibromyalgia.

So Monday I go to PT for the second to last time. Tuesday I go to the gym for the first time in 2.5 months. Then with any luck, I will be back to regular gym visits and work on slowly getting back in shape. The key word is 'slowly' but I'll work on getting back those 20 steps.....

Friday, December 15, 2017

Clinical Trial Exclusions

A recent SEER report looked at the incidence of  previous cancer diagnoses in newly diagnosed patients. An average of 18% of newly diagnosed cancer patients have previously been diagnosed with cancer. (25% of  patients over the age of 65 and 11% of those under 65.)  All these people will also probably exempted from any clinical trials for their new cancer because of their previous cancer.

"The investigators concluded: “A substantial proportion of patients diagnosed with incident cancer in the United States have survived a prior cancer. These patients may be excluded from clinical trials and underrepresented in observational research, and little is known about their treatment and survivorship needs. Understanding the nature and impact of prior cancer is critical to improving clinical trial accrual and generalizability, disease outcomes, and patient experience.”"

I am in this group with two cancers before the age of 50. I have never participated in a clinical trial. Why? Because my previous cancer always exempts me.

While I understand that clinical trials try to keep their participants as homogeneous as possible to prove product safety. However, the problem is it excludes a lot of people. Why should my medical history bar me from potentially benefiting from a clinical trial medication? And why can't I help future medical care by participating in a clinical trial? And its not just me, its the other 18% of the population which already has had cancer and has been diagnosed with another one.

I just took a peek at a few trials over on clinicaltrials.gov and easily found some with exclusions that include:
  • Prior cancer diagnosis or chemotherapy treatment.
  • Active autoimmune disorder.
Here I would not be accepted because of my two cancer diagnoses, chemotherapy, and active RA. (This can make me feel like no one loves me.... and I could get a complex here.)

I think it is time that clinical trails reflect the population - we are aging, we have medical histories, 18% of us have lived through cancer. 18% of clinical trials should include patients with a history of cancer. We live through cancer but we can't participate. Not fair to us nor to future patients who might benefit from our medical histories.

Thursday, December 14, 2017

Tumor Evolution

It turns out that tumors do evolve. And the result of the evolution is that sometimes the cancer treatment stops working.

"A new study by researchers at Huntsman Cancer Institute (HCI) at the University of Utah observed how breast cancer tumors evolve over time and demonstrated how changes within tumors may contribute to the process by which cancers no longer respond to treatment. Further, the research identifies that some of these changes may be shared across certain treatment-resistant breast cancers."

The problem in examining tumors is getting samples because that is that can be invasive. You can't really say to a woman with breast cancer 'be sure to stop by for your yearly tumor biopsy'. They really do not want to keep the tumor around if they don't have to. So they had to be unique, which also meant a very small study size:

"For this study, Werner and her collaborators were able to trace the timeline of treatment of four breast cancer patients, over the course of between two to fifteen years for the patients analyzed. In a unique collaboration between several researchers and medical oncologists, samples of cancerous tissues were collected from breast cancer patients during their regular course of treatment. The tissue samples were then sequenced to study how the samples changed over time and how the tumors responded to each treatment. Using these data, the researchers were able to assess how changes in the tumor coincided with when the patient's cancer stopped responding to treatment."

Four patients is a very small study. However what can be learned from this study can lead to new research. Due to the invasiveness of tumor access, I can't see how tumor access is going to ever be much easier. With most patients, tumors are removed as soon as possible. I guess if there is a recurrence, presto you get a new tumor to biopsy - but if its not the same tumor does it count? Or sometimes tumors are not removed right away because chemo is used to shrink them..... But what do I know? I am a mere patient who is rambling on here.

"The ultimate goal for the researchers is to understand what is happening in a patient's tumor in as close to real time as possible, to predict what will happen next, and to adjust treatment accordingly.

Two new clinical trials set to start early next year at HCI and City of Hope will build on this research. Werner says "ultimately we want to actually predict what is really going to work best for your tumor during the course of your disease. While we're not ready to apply this to standard patient treatment now, with this work we are one step closer to doing that."

So if this tiny study is going to result in more research, I am all for it. You have to start some where and I find it fascinating that this area is one to be explored. I never really considered tumor evolution but if you think about it, tumors must acquire new characteristics as they grow in size. I'm ready to learn more and wait for more results.

Wednesday, December 13, 2017

Friendships

This has come up time and again but for some reason I have seen it more often in my Facebook feed in the last few weeks. Friendships - they come and go. We make friends and we lose friends. Some friends we lose when we change and move on - maybe we used to work together, live next door to each other, go to school together, or some other commonality which held us together but doesn't any more.

Other times we opt to lose our friends when they appear to have changed. The point is from your perception you don't really want them as a friend any more. For instance, if you had a friend and they did something unethical/illegal wouldn't you be uncomfortable with their friendship? I don't know anyone who did anything illegal but can think of a several instances where two different friends made me very uncomfortable with their ethical choices.

Or what if you think your friend is developing emotional issues and they refuse to take care of themselves, to take any advice on it, and do not consider themselves to have any emotional problems. An example is that if you had a friend who became a hoarder, what would you do? What can you do? Hoarding is characteristic which is telling us something more is going on with them emotionally. They need help but if they are in denial over their situation, what can you do?

What if you think your friend is just using you? I had a friend and, I kid you not, for a couple of years she used to call me to see how the traffic was before she drove home from work. Her rationale was that I was home and could look it up on the TV for her. I finally resorted to telling her, for several months, that I have no idea, the TV isn't on, before she finally figured this out. Um, you have the internet don't you?

Then there are the people who are chronically late, for everything. All the time. They can't get anywhere on time. Being late happens to everyone - a flat tire, etc - but not every single time. And late by an hour or more. It is incredibly rude to be late. It says 'I am way more important than anyone else so everyone can just wait for me'. Did you ever try to get a group of people together for lunch at 12 and have one call at 5 til to say they just woke up and will be there in an hour? (I just wonder how people like that keep their jobs because if they can't do anything on time, can they ever meet a work deadline?)

Finally, another part of friendships is what if you have changed? That is certainly the case with me. I have changed significantly over the last decade. My health has been greatly altered and I no longer have the same coping skills I did before. I don't have the patience or the physical ability to wait for people. Nor can I cope with anyone else's emotional issues. I have plenty of my own these days. It upsets me that I don't have the physical and emotional bandwidth I used to and I work on coping with that.

I also realize that I can no longer do a lot of the things I used to do - like hike, go out to dinner, stay up late, etc - so the friends I used to see at those events I no longer do see. But I would be happy to see them if things worked out and I was physically able to attend.

As my life has changed my friends have changed. It can be sad to lose friends but sometimes its necessary to lose them.

Tuesday, December 12, 2017

Breast Cancer the Socially Acceptable Cancer

A breast cancer diagnosis is no fun. Actually any cancer diagnosis is no fun. We all know that. But maybe because of all the 'awareness', it is now more socially acceptable than other forms of cancer. Isn't that just weird? I think so.

Meanwhile, a woman in New Zealand was diagnosed with stage IV lung cancer and she wonders if breast cancer would be better because of the stigma surrounding smoking and lung cancer.

I think lung cancer is the only cancer which is regarded as 'self inflicted'.  Face it, as normal human beings we associate lung cancer with smoking. But not all smokers get lung cancer and not all lung cancer patients were smokers. I think we look at lung cancer patients, even us former smokers, as people who have done it to themselves. They smoked and they got the lung cancer they 'deserved'.

The problem then is with the original cancer stigma, all cancer patients can feel isolated and alone. Which is no fun. But lung cancer with its added stigma makes it even worse. How to find the best support when you don't have the 'in' cancer?

First of all breast cancer patients seem to be all around us but lung cancer patients are fewer and harder to find. Then its got this additional stigma. I think all cancers should be equally treated with the same resources available for all.

Monday, December 11, 2017

That Lingering Risk Thingy

I can't say how much this just aggravates me. You get breast cancer. You get treatment and then they say we will see you once a year. You are NED (No Evidence Of Disease) for now. If you are hormone receptor positive (ER+/PR+) you get to take a little pill (tamoxifen or aromatase inhibitors) that should help you stay that way.

But there is always that lingering risk of recurrence. That's the one thing none of us want. A new study which looked at data from 88 different clinical trials over more than 20 years found that the risk of recurrence lingers after the AIs are ended.

"Researchers from the Early Breast Cancer Trialists' Collaborative Group analyzed data from 88 clinical trials involving 62,923 women with ER-positive breast cancer. The patients all received endocrine therapy for five years and were free of cancer when they stopped therapy.

Over the next 15 years, however, a steady number of these women saw their cancer spread throughout the body, as late as 20 years after the initial diagnosis.

"Even though these women remained free of recurrence in the first five years, the risk of having their cancer recur elsewhere (for example in the bone, liver or lung) from years five to 20 remained constant," says senior study author Daniel F. Hayes, M.D., Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Comprehensive Cancer Center.

The risk of recurrence was directly tied to the original cancer's size and characteristics, and to the number of lymph nodes that were cancerous.

Among patients who were recurrence-free when they stopped taking endocrine therapy after five years, the highest risk of recurrence was for those with originally large tumors and cancer that had spread to four or more lymph nodes. These women had a 40 percent risk of a distant cancer recurrence over the next 15 years. Women with small, low-grade cancers and no spread to the lymph nodes had a much lower 10 percent risk of cancer spreading distantly during the following 15 years."

Isn't this comforting? On my part, I had a relatively small, moderately aggressive, and one positive lymph node. So that must put me in between the 10 and 40% risk of recurrence. Also, I am on the schedule for AIs for up to ten years. Maybe I will ask if I can continue them? But being on AIs only lowers your risk of recurrence, does not remove your risk of recurrence.

However, I do put a lot of credibility into this study as it reanalyzed data from so many studies. This is the kind of research that is the 'more research that was needed'. This just aggravates me that in this day and age, we still do not have a cure.

There goes my warm fuzzy feeling for the day. And you wonder why I deal with stress, depression, and anxiety.

Sunday, December 10, 2017

Personalizing Personalized Medicine

What is personalization? Its making things for the individual. This is seen all the time online. If you visit Amazon's website and search for toothpicks, you will start seeing ads for toothpicks popping up all the time. Until you search for something else.... Amazon's site is responding to your needs by reminding you about your recent search - meeting your needs.

Personalizing personalized medicine means not doing the same thing over and over again, and taking into account patient's individual needs. However, we talk about personalized medicine and then discuss starting mammogram screening for all women at age 40. Where is the personalized part of that? Its just changing the requirement for insurance companies. And no mention of who pays for the additional screenings.

Take this opinion for example, from Dr Montijo on Clinical Advisor:

"I am often concerned about articles summarizing screening mammography data. Without fail, organizations that materially benefit most from performing mammography conclude and advocate more frequent and earlier screening mammography. Organizations composed of primary care or with minimal material benefit conclude that a more conservative screening program and more personalization, such as shared decision making, has the greatest net benefit. The cost alone, from the most aggressive screening design to the most conservative design, is in the billions of dollars. No tradeoff analysis of alternative uses of such cost is entertained."

Again, just because we can, doesn't mean we should all the time.

"Mammography started in the early 1950s with a study from HIP of New York, among others. The use of screening mammography increased precipitously during the ensuing decades typical of new technology, often for assumed or wished for benefits. A major industry was born. As happens with most new technologies, finding the optimal use or non-use takes time but almost always perseveres past the optimal benefit point or in some cases full retirement."

I am not saying mammography does not have its benefits. It does. Some women should start screenings early. Maybe in their 20s - I had a benign lump at 23 and have had annual mammograms since. My breast cancer was found at age 45. And another benign lump appeared at age 46. I am someone who needed mammograms starting young. But this does not apply to everyone. 

In my opinion, anyone who is BRCA positive or has a family history of breast cancer should have annual screenings start at age 25 even. That should not be a discussion, but should be a standard for those women. I am sure there are other cases like this where mammograms should start early.

This is a basic idea to start a personalization discussion with an individual patient. But a global requirement for everyone doesn't help. Mammograms have a financial cost but also the cost of missed time at work for the patient to go to the appointment as well as emotional stress for the patient.

We need much more personalization if we are to make any progress in this area.

Friday, December 8, 2017

I'm Tired

I'm watching the new season of Top Chef so I can say I got myself in the weeds for rest this week. I think the term of being in the weeds is a restaurant kitchen term. It started when I had a two day craft show last weekend, followed by houseguests all week. They were my cousins and I was glad to see them. But I didn't get enough rest.

Today I'm staying in bed and resting. For tomorrow's craft show and a friend's party. And making brownies for the party.

But in the meantime, I am lying in bed as long as I can today.

Monday, December 4, 2017

Waiting for Cancer Research

After 12 years (how the heck did that happen?) of breast cancer coping, I have actually seen some cancer research go from new or in clinical trials to become standard of care. This includes length of hormonal treatment for breast cancer patients. But it does not include many, many others.

Some cancer 'breakthroughs' are still in trials, or have vanished because they didn't work. They provide us cancer people with instant elation at the possibilities it hints at, followed by deflation as we realize it is years or decades in the future.

An example of this is this news that at UVA they are working to find a way to stop triple negative breast cancer, which is aggressive and harder to treat than other types of breast cancer. Here's the elation:

"So-called “triple-negative” breast cancer is a particularly aggressive and difficult-to-treat form. It accounts for only about 10 percent of breast cancer cases, but is responsible for about 25 percent of breast cancer fatalities.

Triple-negative breast cancer earns its name because, unlike other breast cancer subtypes, its cells test negative for estrogen and progesterone receptors, as well as for a gene called HER2. Therefore, it cannot respond to therapies that inhibit cancer-growing signals that come from estrogen, progesterone and HER2. The only treatment options for triple-negative breast cancer are surgery, radiation therapy and chemotherapy, each of which cause difficult side effects and rarely lead to remission.

Triple-negative breast cancer is also highly variable from patient to patient and even among tumor cells of a single patient, making it difficult to understand and treat. Other breast cancer subtypes are homogeneous, more predictable and treatable.

University of Virginia researchers are working to study this variability and find an end-around method to stop triple-negative breast cancer, by seeking out unknown or little-understood routes toward shutting down uncoordinated growth."

Followed by the deflation:

“We’re still early in this investigation, but it may be a step in the right direction for getting a handle on ways to target this very difficult to treat breast cancer subtype.”

So how many years do we have to wait for this 'step in the right direction' to lead to something that is routinely available?  Will my friends with triple negative still be here to benefit from it or will it be here too late for them? 

Friday, December 1, 2017

Post Surgery Recovery

Its exactly 8 weeks and one day since my knee surgery that made me rest more for longer than I have had to in many years. I was told 4-5 months of rehab for my meniscus repair. Now I am at the end of month two and realize I still have many more weeks of rehab in front of me.

The first month I was not allowed to drive so I sat around and gained back the ten pounds I had just lost. I got a lot of reading and knitting done and binge watched way too much TV. The cats liked me to be home and sit around a lot so they got attention. I had to postpone many doctor appointments. The only thing I did get to do was go to physical therapy twice a week.

In the second month, I was allowed to drive and do more things. I started going out of the house and going to all the postponed doctor appointments as well as the grocery store, library, etc, as well as PT. This meant as I resumed my normal activities I hit the exhaustion plateau more frequently. I got out of shape (and fat) while sitting around for a month.

In addition, as I am doing more, I am making my knee hurt. Every PT session starts with ten minutes on the bike to get started. Yesterday, at minute 6 my knee started hurting so I had to move on to other tortures prematurely. The therapists told me its because I have been exerting myself that my knee is telling me that its not quite ready for everything I am putting it through quite yet.

At the beginning of the third month, I am seeing the end of PT. Three more visits to go before I return to the gym. I think the only reason I am ending PT so soon is because the gym I go to (for dilapidated people) is run by physical therapists and I will revise my workout with one of them before any exercise.

But at least I can look forward to going to the gym. The gym is where I spent nearly two hours three days a week. I chat with lots of different people there as well as get in a good workout. Its a big event for me - both the exercise and the socializing. I can't wait.

I just hope my knee is up to it. I realize that I can't just hop back into an hour of cardio followed by 45 minutes or more of stretching, weights, and resistance exercises. But I am getting frustrated with the amount of effort it takes me to do much along with the length of recovery required afterwards. Also, its the wrong season to sit around with an ice pack on my knee....

I am recovering. If I have come this far in two months, I should be able to get back in shape in another two.... I hope?

Thursday, November 30, 2017

Not My Story To Tell

One important issue when you have cancer or anything else 'yucky' is that well meaning friends and relatives often take it upon themselves to retell your story, with embellishments, to others. Its not their story to tell.

As the patient, you have the right to decide who to tell, what to tell, and when to tell about your ailment. This is one of the big reasons I have a blog. I get to funnel the information and tell what I want after I have a chance to digest it, when I want to tell it.

You might have noticed I do not write about other's health challenges. I might mention someone but I don't tell their story. Its not my story to tell. Its theirs.

This is an important point to remember. You are not entitled to retell all the details of someone else's medical misadventure. Its okay to tell people that someone is coping with their ailment. If the patient has consented, you can tell others how they are doing. But you don't get to tell the blow by blow story of it. And even if they have consented, you are not their PR agent spilling all.

Patient, Yuckyailment, is the one who gets to decide who gets told what amount of information. Being sick is a private matter. So get your nose out of it.

Wednesday, November 29, 2017

Supporting Your Friends Through Your Cancer

Say what? You know that line 'don't my your problems, my problems'? This is clearly the case here. Yes, sometimes your friends want emotional support because of your illness.

One of my closest friends mostly vanished from my life during my treatment. Yes she has a very busy schedule and she had a small child at that time. Her mother was also very ill. But I missed her emotional support during that time.
Currently and in the past, we would talk at least once a week and get together once a month. But during that treatment time period, I didn't talk to her for months. I had other friends but I missed her. Later one of our mutual friends told me she had a very hard time dealing with my diagnosis. So maybe it was better we did not talk as often.

I am not blaming her at all. I had enough going on dealing with my diagnosis and treatment that I couldn't have coped with anything else. Today's 'Ask Amy' column rang a bell for me:

"Dear Amy: I’ve recently been diagnosed with breast cancer and have focused my emotional bandwidth on my family, my health and curing my cancer. I have a huge support system that includes family and friends. One of my close friends is having trouble coming to terms with my diagnosis, as well as my not taking her up on her offers of help (yet).

"This friend called a few nights ago sobbing and looking to me to help her feel better about my diagnosis and my long-term prospects. My diagnosis isn’t as good as it could be, but it’s also not as bad as it could be. I did my best to help her understand, and then changed the subject.

I’d really rather not be calming down my friends when inside I’m losing my mind with the slow pace of health care and juggling my appointments and treatments.

Is there a gentle and polite way to explain the “grief circles” to her that’s nonconfrontational? I could really use some help, as I have months and months of work concentrating on my health ahead. I’d like to kindly and gently explain to my friend that I cannot be the person making her feel better about my illness.
Your suggestions?  —Not Dead in California

"Dear Not Dead: “Grief circles,” otherwise known as “ring theory” conceptualizes the important idea that, when dealing with tough or tragic times, it is important for the person at the center of the circle (that’s you) to preserve her strength by only dealing with the person most intimately involved in her care — this might be a spouse, family member, or friend. Other relationships arrange outward in concentric rings. This is called the “kvetching order.” 

The person at the center of the ring (you) can say anything (complain, cry, howl at the moon) to those in outer rings, but those in outer rings should limit their own needs, fears, and statements and focus only on being helpful. No unsolicited advice, no raging at the injustice of it all, no demands for comfort or constant updates. 

Honestly, this seems so logical that it should not need to be spelled out, but understand that ring theory is mainly for you — to give you permission to react the way you want to during a time when you need to preserve your strength (and “emotional bandwidth”). In short, you are not supposed to be worrying about how to be gentle and polite, comforting your friend through your crisis.

You could say, “I understand that this is hard for you, but I can’t help you through this. I’ve got too much on my plate. I hope you understand.” Encourage her to contact someone else in an outer ring when she is upset."

I can honestly understand that some people fall apart when people they care about get a nasty medical diagnosis. I think that is what happened with my friend. Our diminished communication was her way of coping. We are now closer friends than ever.

Tuesday, November 28, 2017

Cancer Friends

For the past two days I have spent time with different cancer friends. I call them cancer friends because I met them all through cancer situations - one group from my old support group and two others I met at different cancer retreats.

What was the gist of all our conversations? Our health and our numbers of ailments. We all have ailments we are coping with. Some of us have new or potential ailments which bring us concern. Some of the ailments are side effects of our cancer treatments. We do not all have cancer concerns right now but that always lurk in the background. And we all know it will never go away.

We shared test results, doctor opinions, traded doctor referrals, and shared our concerns. We tell our medical concerns that we may not have yet shared elsewhere. Our ailments are not all cancer related  We got bolstered through our conversations. They were like mini support groups.

This is the benefit from cancer friends. Cancer is not something to do alone. You need cancer friends to get through it. Then they become life long friends.

I'm having lunch with another cancer friend next week to look forward to. More emotional support for both of us.

Sunday, November 26, 2017

More Not Blogging

I have been very busy the last few day weeks. Now that I can drive, I have been driving and going places and thus wearing myself out and making my knee hurt. I had Thanksgiving prep for food and house guests and dinner for 14. I also have had some doctor appointments that were postponed from when I couldn't drive. I still have lots more appointments for the same reason as well as PT for my knee.

So now that I am getting back to normal I have things on my mind for blogging topics. They will not get all the coverage due  because I have been a slacker for my reasons above.
  • I have pondered the issue of losing friends and making new friends. In the past year, I have lost two friends. Mostly because of my actions because I could no longer with their actions at attitudes. When you part ways with long time friends I think the holidays make you notice their absence more. I think I am still comfortable with their absence in my life. The stress they caused me no longer bothers me. I can't miss friends when I would get so aggravated in trying to get together and getting together. I'm glad I'm done but I still feel some regrets - some because I waited so long to take actions.
  • This 'gentleman', and I use the term loosely, really pissed me off.

    If you have MS, or PTSD after serving in the military, or even breast cancer, this a$$hole thinks we are 'undesirable'. Why? Because he is against having a marijuana dispensary in his neighborhood, which is one of the nicest in Boston.
  • My health is may be telling me new things that I am not ready to discuss. Which aggravates me more. Only four appointments this week, plus two PT trips. I'll discuss later, maybe. But I am really aggravated. I am not allowed to have more ailments than I already do.
That's all for now. But you get the idea. I survived Thanksgiving and it actually went very well. Iam now looking at Christmas and hope it doesn't stress me as much again.



Thursday, November 23, 2017

Celebrate the Holiday, Without the Cancer Advice

Over on Cure Magazine, Martha Carlson, who is living with metastatic breast cancer, provides a bit of advice on how to enjoy the holiday, even when confronted by the unwanted offers of 'advice' from the 'helpful' friends and family you see at family gatherings. 

Everyone knows this type of people. They think they know more than you do about how to treat your disease, because:
  • They read something about it once
  • They saw something about it on TV or online
  • They are smarter than you and just know these things that your poor brain cells could never have found on your own
  • They know someone who had a similar ailment a long time ago and their treatment must be better.
  • They are positive alternative medicine will cure you instantly and you should not waste your time on traditional medicine.
After living with metastatic breast cancer for three years, she has this advice:

"Listen first.  I try to remind myself that she believes what she’s saying, thinks it’s something I’ve never heard before, wants to save my life, and, most importantly, doesn’t know any better. I listen first, at least to a few sentences.

Don’t apologize. I do my best to not say “I’m sorry, but…” If I must be blunt, I simply say that I'm following the advice of medical professionals I trust.

Lead with a fact. I’ve got several at my disposal, and which one I use depends on the conversation. 

Follow with a fact. The other common view I hear is about the value of alternative treatments, both to avoid cancer and to treat it. For breast cancer, people who chose alternative treatments were more than five times as likely to die within five years than those who chose conventional treatment.” If that doesn’t give someone pause, nothing will.

Give a little. I will often talk about my own experience with things like meditation, qi gong, exercise and healthy eating to remind the other person that we don't have to argue in stark opposition.

Be kind, not silent. Say something like, “It’s hard to confront illnesses that could end our lives. I try to be both optimistic and realistic with this disease.”

Change the subject. I try to preemptively control the conversation by asking for specifics about his kids, his retirement, his house—anything other than his health or my own.

Hold up a mirror. As is true in dating, most people would rather talk about themselves."

There is a lot more over at Cure Magazine to read. But I think you get the point. I am about to sit down with a large meal for 14 people and will cross my fingers that I don't get stuck on the topic of my health. I don't allow politics at the dinner table because I would rather talk to people about how they are doing than the latest presidential tweet. Maybe I'll just take another bite of food so I can't reply with my mouth full.

Happy Thanksgiving all!