Pigeons were out in abundance at San Francisco’s Union Square on Thanksgiving weekend. Herb Caen called them feathered rodents. That’s the thing I miss most in the San Francisco Chronicle, Caen’s column. With his tidbits, political jibes, and assorted oddities, he made every reader feel like a city insider. Caen was known to favor three-dot journalism. I have to say the three dot business is a handy way for putting random thoughts on paper . . .

Random thought #1 . . . Other things I miss are the holiday windows on Union Square. It used to be worth a trip into the city just to see them. There were magical animated wonderlands. There’d be kittens and puppies either vying for attention or hiding from view. The merchants didn’t even try this year. Their windows were filled with merchandise: evening gowns, jewelry, perfumes. There was nothing to evoke the season’s magic for the children. Nothing to delight the child in all of us. It left me feeling sad.

Sodden thought . . . Next Monday, Pearl Harbor Day, I start my chemotherapy treatments for breast cancer. I assume the one word is comprised of two: chemicals and therapy. The night before the first session, I’m required to take five steroid pills so the body doesn’t swell like a balloon. For five consecutive days afterward, there will be shots to keep up the white blood cell count. It’s obvious that chemotherapy is toxic to the system . . . Doesn’t sound very therapeutic to me.

I’m sure whoever first said, “The cure is worse than the disease,” had cancer treatment in mind. It’s all very brutal for the body and distressing to the soul. I can’t help but think that, if more men got breast cancer, a cure would be closer at hand. At least they’d find a way to deliver treatments that wouldn’t cause the recipients to lose their hair. Talk about adding insult to injury.

Radiation treatment follows chemotherapy for me. Only two weeks ago, Jeanne Rizzo, president and CEO of the Breast Cancer Fund, mentioned at a public forum that a less risky method is needed to screen for breast cancer because x-ray radiation is carcinogenic. Why, then, is the body bombarded with radiation in an attempt to keep the cancer from recurring? I don’t get it . . .

There is plenty I’m not “getting” today. That’s what makes this a three-dot day . . .

The holiday season is upon us and with it comes the opportunity to see the San Francisco Ballet’s stunning production of The Nutcracker. When I see the television ads for it, I think back to the local ballet school I attended as a child in Germany. We put on The Nutcracker every year. Not that I had much talent. My mother, who attended Tanzschule Bier, a feeder school to the prestigious Wiesbaden Ballet in Germany, was the real ballerina. She danced with Tanzschule Bier as a young girl, before World War II destroyed everything.

In my novel, The Still Voice, the main character Sophia dances in The Nutcracker. Afterward, her mother Brigitte and sister Petra join her backstage. I thought I’d share that scene from the book today, in keeping with the season.

Tanzschule Bier prided itself on its Nutcracker ballet. Preparation for the Christmas holiday favorite began with new choreography, exacting rehearsals, and embellishment to an already lavish set. Sophia had practiced nonstop over the past three months and arrived at the studio well prepared for their one December opening.

The Biers were in a dither. Herr Bier had choreographed The Nutcracker’s “Waltz of the Snowflakes” for four girls. His wife had rehearsed it that way. This afternoon, hours before their opening performance, the lead snowflake had called in sick.

Thrust into first position, Sophia was full of confidence with one breath and tremulous with the next. While the couple revised the choreography for a trio of girls, she warmed up for the evening’s recital. When the new arrangement was in place, the wife led them through the steps until she was satisfied.

After Frau Bier had gone, Sophia ran through the routine alone. Clad in her practice leotard, her hair pulled back in a chignon, she imagined herself as delicate as the bone china cups in the Hettlage store window.

“Five, six, seven, eight.” She slowed to count out a difficult step, watching her feet in the mirror as they swept deliberately across the hardwood floor. When she had it, she resumed dancing to the phrases flitting through her head, then started for the dressing room.

On her way, she stopped to peek through the curtain. The house was starting to fill up. Unable to spot her family in the commotion, she closed the curtain and left to put on her makeup.

She was dabbing on blush when a gasp from the audience told her the performance had begun. She smiled at the reaction. Local craftsmen had carved a sumptuous and colorful set for the opening Christmas Eve scene. The company had hoped it would delight.

Sophia rocked her shoulders in time to the merry overture. When the downbeat for the march sounded, she hummed along: “Tum tata tum tum tum tum tum . . . tum tata tum tum tum tum tum . . . la da, la da, la da da . . .”

“Soph . . .”

Fellow snowflakes Steffi and Monika, the Biers’ daughter, appeared at her elbow. Could she go through the new steps with them one more time?

They rehearsed until the “Departure of the Guests,” then changed into their stiff, silver-and-white tutus. Monika helped Sophia pin her tiara in place. Then, hands and backs arched, they waited in the wings for their music.

Like wind-driven flurries, the trio whirled downstage. Oversized, tinseled flakes shimmered from above, reflecting the blues and purples of the spotlights. Fluffy theater snow swirled beneath their feet.

Sophia tilted forward on her right foot, on pointe, while extending her right arm upward. She stretched her left leg and left arm behind her. In this, the arabesque position, her body created a long, fluid line.

Using her arms for momentum, she executed a series of pirouettes. She was careful to focus, stage right, on one spot—and to snap her head quickly back to the spot as she completed each turn—so as not to become dizzy.

She spiraled and twirled in time to the music, weaving in and out of patterns with the onstage ensemble, like a splinter of ice in flight.

A subtle change in tempo brought out the principal dancers. The snowflakes guided them offstage to the Kingdom of Sweets. The curtain came down behind the players. Sophia was breathlessly in heaven.

When the second act began, she was beguiled by Tchaikovsky’s music for the “Arabian Dance” and his soaring composition for the “Waltz of Flowers.” Enthralled, she watched the performance from backstage.

When the last strains of the “Sugar Plum Fairy” pas de deux (dance for two) had dissipated, Sophia hurried onstage with the rest of the company. She held hands with the corps, blinked in the lights, and bowed. There were four curtain calls, flowers for the prima ballerina, and a standing ovation.

Sophia thought of the great companies of Europe, which often included youngsters. The famous Fanny Elssler was twelve when she became a professional. Marie Sallé debuted in London at age nine. There were the three “Baby Ballerinas” of the Ballet Russe de Monte Carlo, who’d reached stardom at the ages of thirteen through fifteen. Dared she hope to be in their company?

She was changing in the dressing room when the ballet mistress came in, followed by Brigitte and Petra.

“The performance was just beautiful,” gushed Petra. “The dancers. The costumes. The sets. Of course, the music is always wonderful.”

“You were so graceful,” said Brigitte. “My daughter, the ballerina.”

“There were several who were exceptional,” said Frau Bier, diplomatically. “But,” she said in a half-whisper, “Sophia is one I will recommend to the Wiesbaden Ballet.”

“Oh, wow,” beamed Sophia.

“Don’t get a swelled head,” said her mama. “You still have to help me clean house on Saturday.”

I asked family and friends for guest blogs, as I thought voices other than mine would be refreshing in this space. My sister Deborah is my first guest blogger. Here is what she had to say:

When my sister Juli wanted me to guest blog on her site regarding her cancer experience, I at first thought it would be interesting. Now I feel like a ghoul participating in her illness. However, most people with blogs who have cancer are all about themselves. It’s kind of nice that my sister is interested in the family point of view. I have had numerous surgeries (not for cancer) and I kept telling her that it was only sleep. Juli told me that, before her lumpectomy, she had panic attacks about being attacked with knives. The surgery and pain meds. are the best part. Recovery is what sucks. My sister has never had surgery so she was very scared.

When I called our mom on October 9, 2009 and she said Juli had cancer, I did not want to believe it. I dropped the phone at work and cried and cried. My boss had me go into a quiet room to regain my composure. I was able to work the rest of the day. A friend from work said “Sorry for your loss.” I told him no one died. Actually I said, “My sister has cancer. No one died, you idiot!”

October 26, 2009

When I went to see Juli in recovery, her first words were, “Do I look like shit?” She did, but I said she just had a procedure. Juli cried and I held her hand. She said, “Why’d it come. I didn’t do anything.” I told her Dad had cancer. She reminded me that our dad smoked. He didn’t have lung cancer. But in Juli’s medicated state, her answer justified her meaning at the time. She was hungry and asked for food. The nurse brought graham crackers and apple juice. When Juli became nauseous, the nurse took the food away. Juli kept saying, “They took the food awayyyyy.” She reminded me of the kittens I rescue and nurse back to health. I wanted to wrap her in a blanket and make her feel safe, but that was a dumb idea. Juli is a grown person not a little cat. I noticed the word “Yes” on her breast. I guess that is where the incision was made. I told Juli, “Hey, biker tattoo.” I don’t think she caught the humor at the time.

Juli was going to have Thanksgiving this year. I know she is not strong enough for that so I am putting together a nice turkey dinner. We will meet at our parents’ house, which is closer for Juli. I just have to keep Mom out of the kitchen. I want to present a nice meal, which means an excuse for getting my hair and nails done also. You can’t present a lovely feast without looking lovely. I told my sister that when she figures out what treatment she will have, I can take her to the beauty college for a facial and massage. The students do very good work as it is part of their grading. We just need to wait to see how Juli will feel from day to day.

The sad part is Juli and I did not start to spend more time together until we got older. The last time we did something fun was window shopping and lunching in Sonoma. When I got up at the restaurant, I spilled water on her pants. They were white and she worried about them staining. That spill seems so trivial now. We still had a good day. I remember taking the ferry to the San Francisco ferry building with all of the shops. We window shopped and enjoyed the stores with their funky tchotchkes. The best time is when we saw the Bonesetter’s Daughter opera together. I never thought my favorite author, Amy Tan, would have an opera. Juli and I had such a beautiful day at the premier. I’m looking forward to more adventures with Juli. I hope she realizes that the strongest medicine is the will to survive. If she refuses to give in, she can beat this.

I love you, Juli.

Deb

Doctors are testing everyone for vitamin D. It’s the latest thing and, apparently, we are all deficient. My husband, our neighbors, me, none of us has enough. We can get it from the sun, of course. But according to the nutritionist with my HMO, the sun has to be high in the sky for that to work. Peeking-through-the-clouds winter sun doesn’t count.

I asked the nutritionist about food sources of vitamin D. Here are a few: Cod liver oil, whole eggs, mackerel, milk (fortified with D), mushrooms, salmon, and tuna fish.

Too little vitamin D is thought to be a contributing cause of cancer. Though sometimes, it seems like that’s said about everything “under the sun.”

My original intent in seeing the nutritionist was to get some ideas to help withstand the treatments for cancer. While I was there I picked up some tips for better living overall.

We talked about fatty foods. In general, plant fat is better for people than that from meats. And we shouldn’t have trans or hydrogenated fats. Sources of good fat are unsalted nuts, olive oil, and avocados. Since fats can decrease the efficient function of the immune system, the nutritionist suggested less butter, cheese, and sausage. Julia Child would have cried; she loved all three!

One thing Julia Child would have adored: Five to nine servings of fruit and vegetables a day are recommended. I don’t know anyone who can stop to eat that often during a given day. But I got the point. Eat more fruit. Eat more vegetables.

There was the usual admonition to consume less sugar. It is cumulative in the body, and one should have under 12 grams (three teaspoons) a day, including what is consumed in food. Corn syrup and high fructose corn syrups are also bad. The recommended daily sodium intake was up to 2300 milligrams a day. This sounds like plenty, until one realizes that a teaspoon of salt holds 2400 milligrams.

There was the recommendation to eat more whole grains, brown rice, and sweet potatoes (the latter are full of vitamin A and beta carotene).

Red meat once a week is all right, so long as it’s lean. And while everyone is enjoying their turkey this Thursday, we should remember to eat the white breast meat as the dark meat found in the legs and thighs is fatty. That works for me.

Last night I attended a community forum sponsored by the National Institute of Environmental Health Sciences (NIEHS) and the Bay Area Breast Cancer and the Environment Research Center (BCERC). The event was held in Sausalito, CA. What I learned can be found at the very tip of a monumental iceberg of research information. I thought I’d share the more interesting findings here.

Keynote speaker Dr. Linda Birnbaum, director of the NIEHS and the National Toxicology Program, spoke of the environmental triggers of breast cancer. She noted that it is a “major killer of U.S. women, and it’s an equal opportunity killer.” Contributors to breast cancer, she said, are obesity, stress, environmental toxins, and exposure to such chemicals as PCBs, dioxins, and BPA.*

Other factors being studied as possible causes of breast cancer include:

• Chemicals used in beauty salons.
• Exposure to diesel fumes.
• Endocrine disruptors, which influence estrogen production. These disruptors can be found in plastics and in cosmetics.
• Synthetic estrogens.
• Flame retardants, which are used in everything from furniture to computers.
• Certain pesticides.
• Exposure to truck exhaust.

Dr. Birnbaum, and six distinguished panelists who joined her on the dais, addressed a wide range of possible causes of breast cancer. They did note that it is difficult to pinpoint any one cause because there are a number of different types of the disease. Panelist Jeanne Rizzo, president and CEO of the Breast Cancer Fund, noted that radiation is a carcinogen. For that reason, and others, mammography is not the best way to screen women. According to Rizzo, a less risky, non-invasive method of screening is needed.

Interestingly, it takes twenty to thirty years for breast cancer to develop in women. This is why one study is now following girls in puberty. Researchers want to know what “environmental factors contribute to early puberty and which exposures that occur in puberty may increase breast cancer later in life.” Parents are urged to encourage their daughters to maintain a healthy weight, exercise, and avoid using plastic products where possible. (Source: Puberty, Breast Cancer, and the Environment. A report from the BCERC.)

After the formal presentations, I approached panelist Janice Barlow, executive director of the Zero Breast Cancer organization. I wanted to know whether Marin County’s water supply is being studied, because the incidence of breast cancer is so high in Marin. She told me a study expected to be released in the spring of 2010 has identified five neighborhoods in the county with uncommonly high numbers of women with breast cancer. And yes, the San Francisco Bay Area water supply is of interest because of the prevalence of serpentine rock over which our water flows. Serpentine rock contains cadmium and asbestos, known carcinogens.

For more information on this forum and breast cancer research, go to: http://bayarea.bcerc.org/ and http://zerobreastcancer.org/.

*1. PCBs--PolyChlorinated Biphenyls, a mixture of up to 209 chlorinated chemicals. Although PCBs are no longer produced in the U.S., PCBs are still found in the environment. The manufacture of PCBs was stopped in the U.S. in 1977 because of evidence they build up in the environment and can cause harmful health effects. (Source: http://www.medterms.com/script/main/art.asp?articlekey=19548)

2. Dioxins--Dioxins are environmental pollutants. They have the dubious distinction of belonging to the “dirty dozen”—a group of dangerous chemicals known as persistent organic pollutants. Dioxins are of concern because of their highly toxic potential. Experiments have shown they affect a number of organs and systems. (Source: http://www.who.int/mediacentre/factsheets/fs225/en/index.html)

3. BPA--Bisphenol A is commonly abbreviated as BPA. As the building block of polycarbonate plastic and a component of epoxy resins, BPA is used in thousands of consumer products, including food packaging. Research suggests that BPA exposure may contribute to the epidemic of breast cancer now and in the future. BPA exposure has been shown to interfere with chemotherapy treatment for breast cancer. (Source: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.2638145/k.1E45/Chemical_Fact_Sheet_Bisphenol_A.htm)

Sometimes we wonder where our donated dollar goes. Is it used wisely? Does most of it go to administration or does a healthy chunk go toward research? I can only speak for my little corner of the world, but I would like to put in a nice word for a program offered by the American Cancer Society (ACS).

The national program is called “Look Good . . . Feel Better.” The ACS bills it as a public service for cancer patients, “helping them cope with the appearance-related side effects of treatment.” I don’t have those issues yet. But according to the doctors, chemotherapy patients often lose their hair after the second treatment. When my hair falls out in clumps toward the end of this December, and the eyebrows and eyelashes begin to disappear, I believe I’ll be very glad I attended today’s seminar in Marin County, California.

The session was presented in two parts: Wigs, turbans, and hats for the newly bald, and make-up and skin care for the chemo patient’s suddenly over-sensitive skin. Both appealed to a woman’s vanity. But there was a lot of practical advice as well.

I had no idea that the skin becomes so sensitive to sun with chemotherapy that plenty of people can’t stand to be outdoors (even in winter sun) without being covered up or using creams to block the rays. Moisturizers, in general, were recommended because the skin dries out. Drinking lots of water to stay hydrated during the chemo months was also advised. I didn’t know that a sun block with SPF-15 is better for the skin as it is lower in chemicals. And I didn’t know that synthetic wigs can be cut, styled, and thinned. Now I do.

The ACS provided a goodie bag with lots of nice creams and make-up products. They also offered wigs, scarves, hats, pajamas and robes free of charge.

The ACS offers telephone-based education programs, a support network, and programs on nutrition and on managing cancer-related fatigue. Complimentary or reduced-rate lodging for patients traveling more than fifty miles to treatments is offered, too.

An especially valuable service provided by the ACS has to do with transportation. Volunteer drivers donate their time to take patients to appointments and return them home. This is a lifeline for people who become so fatigued with various treatments they cannot drive themselves. Imagine having to drive to radiation treatment five-days-a-week for six weeks and feeling too weak to do so. Even when friends and family offer their help, there are times when they can’t be there.

I have no affiliation with the American Cancer Society. Based on my experience today, I think they are doing a world of good. Their phone number is 1-800-ACS-2345. It operates twenty four hours a day.

The other night my husband said, “Sometimes, when I’m in another part of the house, I hear you cry. It makes me feel sad because I don’t know what hurts. And I don’t know what to do.”

Naturally, hearing him tell me that made the tears flow all the more. It was such a beautiful thing for him to say.

How do I tell him that the tears are not so much about what hurts? There is still some pain remaining from my cancer surgery. It stems from the area under the left arm where the lymph nodes were removed. As I work to regain full mobility in the arm, pain shoots from the inner elbow to the shoulder. But that gets better every day. It’s not why I cry.

How do I tell him that it’s more about fear of the unknown? What will the chemicals used in chemotherapy do to the good cells in my body? Will there be permanent damage? How sick will I be? Will the radiation treatments that follow shrivel the targeted body part like a prune? The recommended five-year hormone treatments sound lethal. Will they give me uterine cancer or osteoporosis?

How to let him know it’s about loss of control? It’s about giving up half a year of one’s life to fight a disease, then changing one’s lifestyle forever to keep it in check.

How to tell him it’s about feeling like an alien on the planet? Marked. A leper.

How to tell him? Instead, I blurted out, “I don’t want to lose my hair.”

His response was as I’d expected. “It will grow back.”

Yes, of course. It will.

The number thirteen is lucky in Germany. Being of German-Italian ancestry, I’d hoped this past Friday the thirteenth would bring some good news from my HMO’s oncologist. In short, I was hoping he’d recommend radiation treatment only following my breast cancer surgery. No such luck. Chemotherapy and radiation are both on the list.

I learned that oncologists use a software program called “Adjuvant! Online” to help them with their recommendations. The program, combined with a patient’s history, pathology slides, blood work, and mammography film, are the main tools employed. But let’s face it. When a pathologist grades a tumor as highly aggressive (grade 3) chemotherapy is going to be in the mix.

My tumor received a grade of 3, and my case seemed fairly straightforward. So I was beginning to question the need for a second opinion. Then this line in the paperwork given me by the oncologist caught my eye: The need for chemotherapy among women with hormone receptor-positive, node-negative breast cancer is controversial . . . That is my profile.

I went to the www.uptodate.com internet site (from which the oncologist had printed the papers he’d handed me) and learned that whether or not to recommend chemo for women with my profile is a major area of controversy. The benefits, according to studies conducted by the National Cancer Institute (NCI), are small.

What the NCI studies do recommend is hormone therapy. My oncologist recommends it, too. There are two standard types. One blocks estrogen in the body from telling cells to grow. The other inhibits the body’s estrogen production. The problem? One recommended drug can lead to blood clots and uterine cancer. Potential side effects from the other include arthritis and osteoporosis.

I am glad I’ve stuck with my decision to get a second opinion. But I can’t shake the feeling I’ll come away from it more muddled than ever. This whole business of selecting the proper treatment is a gamble. Anyone for a game of Russian roulette?

I’ve been trying to decode the pathology report from last month’s breast cancer surgery. Given to me in advance of this Friday’s oncology appointment, I know the experts will go over it with me in detail. Already I’ve found some things I need to bring up. I like to engage in anticipatory worrying.

I understand the part about “no tumor seen in sentinel lymph nodes #1, #2, #3, #4 left axilla.” This is the most fantastic news. No cancer in the lymph nodes. But what does it mean when a node is “hot not blue?” Or what about the node that’s hot and blue? Then there’s one that’s “not hot not blue.” It’s all very mysterious.

I wonder, too, if I should be worrying about this note on the report: “Middle of tissue fell out with processing.” Did they lose something important? I gave up some body parts I was busy using during that surgery. I hope they didn’t misplace them.

There are two bits on the report that look quite serious:
--The removed tumor was grade three. According to Dr. Susan Love’s Breast Book, left on my doorstep by a generous friend, tumors are usually graded 1, 2, 3. The higher the grade, the more aggressive the tumor.
--From the looks of it, at least a portion of the tumor was comprised of comedo cells. Those sound nasty. They are cells that are stuffing the breast duct and are more aggressive.

What does all this say for the future? Oncologists base the treatments they recommend on these reports along with attendant slides, x-rays, and blood work. The forms of treatment, radiation and chemotherapy, are not to be taken lightly. Neither are the drug therapies recommended for the ensuing five years. Somehow, as helpful as Dr. Love’s book is, I cannot read much of it without becoming nauseous.

I’ve decided to give up my decoder ring for the rest of the week. It’s time to have some fun before this illness wraps me completely in its tentacles.

It’s one month to the day since I was diagnosed with breast cancer. I have two surgeries behind me and treatments ahead of me. The shock and trauma to the body and psyche remain fresh.

Details from Friday, October ninth stand out in sharp relief. I was sitting in the chair I’m in now, typing on the same computer, waiting for the results of my biopsy. I remember looking at the clock at 9:50 a.m. “Please let them call me in the afternoon,” I thought. “If they call then, it’s benign. The morning calls will be to people needing appointments for surgery.”

At 10:05 the hospital was on the telephone. “We have your results. The slide came back from pathology marked ‘IDC.’ You have invasive ductal carcinoma.” I wrote down the details of my appointment with the surgeon. I hung up the telephone and let out what would be the first of several primal screams.

The irony of being diagnosed during “Breast Cancer Awareness Month" was not lost on me. There were many coincidences that day. My husband happened to be working from home (a rarity) before keeping an appointment with his own physician. I called him with my news just as he was walking into his doctor’s office. I learned later that my husband’s blood pressure shot so high that his physician did not proceed with a scheduled physical. “This might not be the best day to do this,” said his doctor. “Let’s talk about what’s going on at home.”

There was another irony. I’d skipped my mammogram screening the previous year and thought I might wait until the spring of 2010. I felt fine. Life was good. Why put my upper body through torture? My husband and my primary care physician both harped on me to get a checkup. I went to please them.

When the radiologist called after my initial screening, she had to browbeat me to come back. (I thought she was seeing a benign area on the x-ray that had been discovered years before.) I could almost feel her hopping up and down on the other end of the phone. This did not bode well. So, I went back for another mammogram, an ultrasound, and a biopsy.

The people who browbeat me into getting a mammogram saved my life. Maybe there’s a woman you care about who is tempted to skip her yearly screening. Please don’t let her do it.

The HMO that I belong to is being very thorough. So am I. Between the two of us, my post-cancer life will be well researched.

There are appointments to be kept and lists to be made. My surgeon wants to check her work. The HMO’s oncologist will recommend a course of treatment. (His opinion will be one of three.) The nutritionist will recommend a diet to be followed during treatment and beyond.

Meeting with the nutritionist was my idea. There are so many urban legends, and myths, about substances that cause or feed a body’s cancer that I’d like an expert to help me sift through them.

Among the urban legends is an email currently in circulation and entitled: “Cancer Update From John Hopkins.” When I read the email sent by a friend, I thought, “Shoot me now.” According to the report I could not drink tea or coffee, take sugar, or eat chocolate. Milk, according to the list, was out. So was red meat. Then a red flag went up. The institution’s name was misspelled. It is called Johns Hopkins, with an “s” after the word John.

I went to the Johns Hopkins internet site and found that the “cancer update” is a hoax. So I’ve taken the liberty of copying some of the institution’s real recommendations here:*

“While there is such a thing as tumors that produce mucus, the mucus made by a tumor does not result from drinking milk. And eating less meat, while a good choice for cancer prevention, does not free up enzymes to attack cancer cells, explains cancer prevention and control expert Elizabeth Platz.

“Moderation is key, says Platz. As part of a balanced diet, sugar, salt, milk, coffee, tea, meat, and chocolate—the foods the ‘Update’ calls into question—are all safe choices, she says. The real concern with many of these, particularly sugar, is that it adds calories to a diet and can lead to obesity, and obesity is a major risk factor for cancer. A balanced nutritious diet, healthy weight, physical activity, and avoiding alcoholic drinks may prevent as many as 1/3 of all cancers. Platz recommends eating at least five servings of fruits and vegetables per day and limiting red and processed meats, like hot dogs.

“Several Johns Hopkins experts participated in the World Cancer Research Fund - American Institute for Cancer Research report Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, published in November 2007, which is considered by cancer prevention experts to be an authoritative source of information on diet, physical activity and cancer. Their recommendations for cancer prevention and for good health in general are:
1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat).
4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
7. Limit consumption of salty foods and foods processed with salt (sodium).
8. Don't use supplements to protect against cancer.”

*This is the link to the Johns Hopkins site: http://www.hopkinskimmelcancercenter.org/index.cfm/cID/1684/mpage/item.cfm/itemID/1016

I will never forget my father’s eyes when he came home after colon cancer surgery. Chocolate brown with long dark lashes, they were saucer huge. But it wasn’t so much the size of his eyes as it was the look in them. It was haunting. I asked him once whether he’d noticed. “No,” he said. But others noticed, too.

“Where else will the cancer spread?” his eyes seemed to say. “How bad will the treatment be? Will family and friends treat me differently?”

His fearful eyes made me want to hug him, though my father is not the hugging kind. Instead, I watched a tape my brother once made. Old and grainy images of our family, some dating to the 1950s, flitted across the screen. There were plenty of holiday gatherings, good food and drink on the table. Smiling relatives were in abundance. There were images of me as a four-year-old getting a ride on my father’s shoulders. Daddy’s girl.

I spoke with my father this morning about my upcoming oncology appointment. “Everyone’s cancer is different,” he said. “Listen to what they tell you. Ask good questions. Once you decide on a course of treatment, follow it to the letter. Bring a good book to read if they recommend chemotherapy. You’ll be sitting there quite a while.”

Thanks Dad. And thank you for letting me ride on your shoulders.

I’m convinced the second day after a surgery is the worst. The relief that the surgery is over has dissipated. The mind races with things to do and places to go. The body is unwilling to cooperate. In short, it’s a down day.

I recently read an interview with author Barbara Ehrenreich in the San Francisco Chronicle. Diagnosed with breast cancer ten years ago, she became angry at “exhortations to be positive . . . because it will make you better. It was either smile or die.”

According to the article, Ehrenreich realized that “positive thinking was more widespread than she’d imagined. It was not only touted as a force against breast cancer, along with cheerful pink ribbons and stuffed bears, it was fundamental in our self-image and national character.”

Ehrenreich has written a book called Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. It explores what Ehrenreich calls America’s happiness industry, which she believes is partly responsible for everything, writes her interviewer, from “our slide into war to the economic crisis.”

I have not met Ms. Ehrenreich, nor have I read her book. Already, I love this woman. No one is cheerful every hour of every day. It’s not natural. And I agree that constantly promoting positive thinking can be counterproductive.

For example, I worked for a time in the marketing department of a software company. From gatherings in its conference rooms to lunching in break rooms to one-on-one meetings, cheerleading for the company and its products was not only encouraged, no other outlook was tolerated. The atmosphere was not healthy. Personnel problems could not be addressed because they often were not acknowledged. The marketing department would tout new product features in company brochures while software engineers were expunging those very features because they did not work. How positive is that?

A positive attitude can go a long way toward bettering one’s health and even growing our economy. But I do agree with Ehrenreich that “relentless positive thinking is something from which we must be weaned.”

Bringing Julia Child’s book My Life in France with me into surgery yesterday was probably not the brightest thing I’ve ever done. Her descriptions of France are wonderful; her detailed recollection of meals eaten in the 1940s is astonishing. However, instructed as I was to eat and drink nothing before my operation, I grew lightheaded when I came to the passage about sole à la normande. She calls it “a poem of poached and flavored sole fillets surrounded by oysters and mussels.” Yum!

I was having my second surgery for breast cancer in eight days. The first one removed the tumor. This second operation was to create a larger margin around the tumor site to prevent the recurrence of cancer. As the scheduled time for my operation stretched from 1:30 p.m. to 3:00 and finally 5:20, I had visions of crêpes flambées and tasty fromages flitting through my head.

Mind you, lying around on a gurney awaiting surgery for four hours is not all peaches and cream. I howled when the nurse inserting the IV couldn’t find a vein. (It took three tries, and wow did it burn.) She took my face in her hands when I burst into tears. “It’s okay to cry,” she said while she held me.

“Why so many of us?” I sobbed. “Why does it happen?”

“The good news,” she said, “is they’re getting closer to a cure.”

We discussed that for a while. Both of us were angry, knowing that too many research programs exist to perpetuate employment for scientists. There is too much scrambling for grants and duplication of effort when there should be more focus on a cure. One in eight women worldwide will have breast cancer. Every thirteen minutes a woman will die because of it.

The nurse and I both noted something else. Of the thirteen women I’ve spoken to about their own experiences, eleven have been stricken in the left breast. The nurse, one who travels “on assignment” throughout the country, has noticed the same. “Why,” she said, “is it always on the left?”

Nobody can say. And wouldn’t you know it, I’ve come to that portion of Julia’s book where she describes roasting a full-breasted duck with minced shallots and wine. How’s that for an ending to today’s blog?