Why I could not let maureen shave my head- I am a Jew

I could not initially fiqure out my resistance to letting her shave my head and get rid of all the hair completely. Did I think I was better than all the other cancer patients who do this? Was I being vain? I could not understand it at first but little by little it came to me about the rituals performed as women arrived at concentration camps. I could not let my head be shaved. I am not dying. I am not a prisoner. I am a free American Jewish woman who is being treated for breast cancer.

Upon arrival, Jews were forced to shave their heads clean of hair, this was later used for mattresses, boots, socks, and other clothing. To facilitate easy recognition of any escapees from the camps. They also cut off their hair to humiliate them.

"Mr Blatt only survived Sobibor because he was selected as a so-called "work-Jew". Instead of being murdered upon arrival, he was chosen to shave the heads of women in a barrack room before they were dispatched to the gas chambers next door. The women's hair would ultimately be sent to Germany and turned into blankets for U-Boat crews."

It is Monday January 25, 2016 after our first Blizzard of the Season

This treatment was not too bad- No pain and very little nauseousness. Must be somewhat related to new  drug doctor gave me to take the following 3 days after treatment. Which is mentioned below.  Nancy's energy psychic healing could also still be working.

After getting house in order and eating well and sleeping and  doing body care. Weekend was uneventful. Watched movies and looked up stuff for cruise on ipad.  Lots of help with shoveling thanks to Madison, Brian and Janet.  I got to feed all the birds and sit by the window with my kitties watching them feast. Now getting ready to go to work. Took a little nap before my shower. 

Looking forward to next weekend as many of the extended family that could not come this weekend should be coming for a visit next weekend. Did make sure all my credit cards are paid. Most everything else is automatic debt. Still need to go through all the paper accumulated on my desk though. Maybe tonight. Also need to fix a few broken things in the house. 

so all is well with me. hope all of you made out well also.

Talk more soon. 

Lots of love,

Nancy

Dexamethasone

What this drug is used for:

• As an anti-inflammatory medication.  Dexamethasone relieves inflammation in various parts of the body.  It is used specifically to decrease swelling (edema), associated with tumors of the spine and brain, and to treat eye inflammation.
• To treat or prevent allergic reactions.
• As treatment of certain kinds of autoimmune diseases, skin conditions, asthma and other lung conditions.
• As treatment for a variety of cancers, such as leukemia, lymphoma, and multiple myeloma.  
• To treat nausea and vomiting associated with some chemotherapy drugs.
• Used to stimulate appetite in cancer patients with severe appetite problems. 
• Also used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids produced by the adrenal glands).

Note:  If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful.
How this drug is given:

• This medication may be given to you in many forms. In a pill form, it is available in a variety of tablet sizes.  If you are on a daily dose of dexamethasone (usually less than 10 mg), and you miss a dose, take the dose as soon as you remember. If you are on high doses of dexamethasone (20 mg or 40 mg per day for 4 days out of the month), and you miss your dose, contact your healthcare provider. You may be instructed to repeat the missed dose, and continue the medication.
• Take pills with food or after meals
• This medication may also be given by infusion into a vein (intravenously or IV)
• Dexamethasone eye drops are given to treat or prevent many eye conditions. The eye drops are most commonly given to patients with leukemia or lymphoma, to prevent inflammation of the eyes (conjunctivitis), if you are receiving high dose chemotherapy (usually Cytarabine [Ara-C]). The eye drops are given every six hours, in both eyes, and for at least 48 hours after the chemotherapy has completed.  Do not stop taking these eye drops unless directed by your healthcare provider. 
• You may be given dexamethasone as a lotion (topical) to treat skin disorders. 
• The amount of dexamethasone you will receive depends on many factors, including your general health or other health problems, and the reason you are receiving this drug.  Your doctor will determine your dosage and schedule.

Body care and life is a BIG job with lots of work

Well Guys and Gals- It has been snowing- 11 years ago we had a blizzard too and Madison had her Bat mitzvah. It was another unpleasant experience. But today she cleared the driveway and sidewalk nearest to the house and cleared off all the cars. Not an easy chore for her. Hard physical labor while cold it not her cup of tea. So now she is napping. I put a down comforter on her bed today and she is all cozy. Janet did the back path to her house for me. 

I just took a warm bath and covered my "toy " with a plastic bag so it would not get wet--- It should torture me in about an hour or so.  My house is finally in order (bills are next)

I am ready to rest after I finish my body care. Your know our human bodies require a lot of work to be properly maintained and cared for- Brush teeth, rinse mouth Floss teeth, shape and pluck eyebrows, moisture face in the morning, moisturize face in the evening, keep hands and feet properly moisture too. Cut toenails, cut and shape fingernails, Lotion on body. Take vitamins, keep up with routine blood work. Get enough sun to process Vitamin D but not too much to get skin cancer. Once a year in stirrups, once a year Mammography, every 5 years colonoscopy. Yearly dental X-rays, teeth cleaned. Drink water, get enough sleep and rest. Exercise daily if possible and at least 3 times a week. Strengthen your core. Do cardio. Keep muscles mass good. Lower body fat ratio. Avoid sugar, Avoid bad fats. Eat good fats. No preservatives or GMOs. Stick with natural like God and Mother nature made- Nutrient dense. Fruits and Vegetables. Nothing white. Get enough berries, use high quality extra virgin olive oil. Wash hair but not too often. Uses conditioner. Do not pull just fluff. Cleanse face. Tone face. Use sunscreen that won't clog pores. OMG- I think I want to retire just so I can keep up with my bodily functions- did I mention to make sure I am eliminating daily. Juicing is good, Fiber is good- don't drink juice though from the store full of sugar. Cows milk is out. Almond milk is in- Get unsweetened. Drink green tea.   

And go to work; meet your friends for dinner. Keep a clean and organized home, Cook daily and especially on weekends- Food shop at more than one store. Empty the trash. Make sure house smells good. Feed the cats- empty cat litter. Play with cats so they know they are loved. Send out birthday cards. Call friends and chat to keep up with them. Tell family you love them. Plan and go on vacation. Do weekend getaways. Make time to visit with friends and family even when not a holiday. Be involved with book clubs or volunteer and be part of professional and social groups. Attend services for religious purposes. Sit and spend time with adult children and listen. Validate them and listen so more. Do not offer suggestions unless asked. Stay informed with politics especially with national and local elections.  Know your geography. Learn to use the Internet and all that it entails. Clean out your inbox almost daily before you get overwhelmed. Do that at home and at work. Return all phone calls. Make sure you get some "me" time alone. Have a good cry. 

Moments of reflection, the evening of chemo #2 and night and sweet dreams

Busy evening. I have preparing for the storm. No not the snow silly. The pain, being uncomfortable and a little suffering. This time is expected to possibly be a little worse. More type of side effects with greater intensively. I would have liked to have read "For Dummies: How to Prepare to have Chemotherapy Treatment for Breast Cancer ". 

So tonight I have been preparing to not be available to function for a few days and nights. I had to go through my food cabinets and make room for real food in my kitchen. I reorganized my pantry which meant I needed to make room elsewhere near the kitchen for stuff.  It is important to get extremely organized before getting sick. The world outside of me needs to be easy accessible to me. Almost planning to be temporarily disabled. Or maybe it is the same you do before you go on a long vacation. Getting your home organized, make your return as pleasant as possible. Take of bills in advance. Change all the linens. Figure out how to handle,trash, mail etc. I did not plan well to experience temporary disability. Wow. What a great concept. "This too shall pass".

It would have been lovely if once upon a time I knew that my despair and panic would fall into the category of "this too shall pass". It would have been wonderful if I could have know "this too shall pass" when the only route out of my suffering was to go away. Exit. Escape. Leave. I must find a way. I cannot take more of this. How the hell can I do this. I was alone in my head with all my emotions. Very dangerous place for anyone to be. 

My experience with cancer has been greatly influenced by my experience with my clinical depression. Sad that this great outlook that I am sharing, was built on the heart and soul of my depression. What a horrible way to develop such a positive attitude. In that light, my experience with Phil and his addiction helped prepare me too. Everything I learned in 12 step programs changed my life for the better for my entire life. Totally changed the trajectory of my life. God loved me so much he sent a wonderful man who was also an addict who wanted to be with me very badly for some unknown never disclosed reason. ( I was.... well, let's say,  when Phil meet me, I was - very attractive and very needy and FUN, of course).  A "Wicked" combination. 

If I did not know better. I would say that maybe everything in life happens for a reason even when we have no clue of what that could possibly be. We take what we are given and do our best and then let go. I  believe my friends and family aka, guys and gals, that is simply what faith is. Faith is the willingness to embrace acceptance that not one single human being is running the whole big show, it is, in fact, beyond any one of us, there is no safety and we are free to chose to surrender to a higher power without proof and complete understanding of those mysteries. YEP--- sounds like faith to me.

You are deeply loved by your creator and me.

Always, with an open heart,

Nancy

It's here

Two things I have been waiting for- my new chemotherapy concoction and the first snowfall. At 10:15 am today I will see my delightful Dr. Gor and show her the little sores on my head. I am taking my ipad and some books.  They will try out my port for the first time too. 

I am prepared for both snow and chemo. For the snow- I filled up  both of my cars with gas. I have food in the house. I ran the dishwasher and will do the same with doing all my laundry this morning.I am preparing to be sick. When I get home- I will make a big pot of tea so I will have ice tea for the week.  I have plenty of bird food and cat food. I even bought a new shovel. Beth picked up some rock salt for me too.

I will miss shoveling the snow. I love going out in the dark night when all is quiet and slowing shoveling my driveway. The good news is that we have more cars this year. So with my new car (2008 Camry)  in the driveway and the one Madison (2002 Highlander) drives too, there will be less driveway to shovel but I also always shovel a path over to Janet's. I have never seen Madison shovel. But this weekend will be different. She will do it this snowfall.  My neighbor actually has a snowblower but he does not like me so he has never done either of my sidewalks. I wonder if he knew I was getting chemotherapy for Cancer if he would help me this year.? I am confident that all my family would say-"Not a chance".

Today I am aware of what I will likely experience. I know I will have pain and suffering. I will be nausea and have loose stools. Also, I want to give some credit to a former chemo patients who received Neulasta.  She was correct when she reminded me that she warned me about the shot. She said It will feel like I got run over by a Mack truck. and I said she did not use the word PAIN. She thought she was being very clear. I learned I am very literal. I do not know what that meant. I needed specific. "Your bones will hurt and you wont be able to get comfortable." So technically I was warned. I was too dense to get it. Or too naive or maybe both. I did call the company and they did say that since the shot is now pre-package- that could not give me less. I would have to go back on Monday to get a shot to get less. This place no longer does that. My doctor tried to convince that my pain was likely from the chemo and not the shot. (The doctor was right!- I had no pain from the shot the 2nd time- it was part of my allergic reaction tot the "T" (vodka in my first formula) So this will be the true test as my cocktail has changed for  TC to AC. Is the pain from the shot or was it from the "T".?

So I have prepared for the pain this time by planning on working with Nancy Patterson tomorrow evening- God willing I will be able to get to her house for a session with her for taking away the pain.  I can always do it over the phone if the weather is too bad for Madison to drive me there. 

I have not be able to focus on my paper work again- sorting thru the bills is my least favorite grown up thing to do and when I am stressed, I let it go and just hope most of it is on automatic. Today when I get home, I will try to do it before I feel sick and tired. That part reminds of when I stopped doing it when I got sick from depression. This is different though because I can do it I just do not want to. It is a PIA.   "Pain In the Ass"

People are telling me I have a good shape head

I realized that some of you get nervous if I have not written in awhile- But I am really ok- just not too much to report- I have been working on writing a blog article  for my friend and colleague Rachel Prunchno. She and I are both connected by experiences with mental illness which I hate that term- we have nothing is out bodies called "mental"- It is a brain disorder. And getting the right kind of help for a loved with a brain disorder is not an easy task and learning not to be ashamed of having a relative with a illness in their brain is also very challenging. Rachel wrote a wonderful book called "Surrounded by Madness"  http://surroundedbymadness.net/

The kicker in the pants is that all the acceptable brain disorders are given to the neurologists (Parkinson, Multiple Sclerosis, Epilepsy, Dementia)  and all the unacceptable ones are given to psychiatrists ( Depression, Anxiety,  Schizophrenia, Delirium, Impulse disorders ) and a whole different kind of insurance system to care for them.  It is plain wrong.

People are telling me I have a good shape head- Almost 90% bald- Crew cut did the trick to tolerate the experience- My next treatment is Friday- Talk more after that.

Hugs and kisses.

Nancy M. Alterman

interesting article about new targeted cancer therapies in yesterday newspaper

Marie McCullough, STAFF WRITER

POSTED: Sunday, January 17, 2016, 8:51 AM

When President Obama announced his "precision medicine" initiative a year ago, the White House spotlighted Emily Whitehead as an example of patients who have already benefited from an approach most people have never heard of. The central Pennsylvania girl, now 10, was near death in 2012 when researchers at Children's Hospital of Philadelphia engineered her own immune system's T cells to recognize and attack her leukemia cells.

Though Emily's therapy was custom made, it didn't take into account individual differences in her genetic makeup, lifestyle, or environment - which is how the president's initiative and the National Institutes of Health define precision medicine.

Little wonder, then, that there is confusion over just what this phrase means.

"The definition of precision medicine is in the eye of the beholder," acknowledged Children's Hospital oncologist Stephan Grupp, who treated Emily.  "For me, precision medicine is about trying to go after a tumor a lot more specifically. Chemotherapy is as imprecise as it gets - somewhere between a bomb and a shotgun."

Grupp will be a speaker at Cancer Precision Medicine, Big Ideas in Research, Treatment and Prevention, a half-day public conference Thursday presented by The Inquirer and the American Association for Cancer Research. Directors of six Pennsylvania cancer centers will offer their perspectives on the promise of precision cancer medicine and answer / questions from the audience.

Despite its name, precision medicine covers a lot of imprecise ground. In that regard, it is much like an earlier incarnation, so-called personalized medicine - a field that even has a five-year-old scholarly journal. Considerable vagueness and hype surround these concepts and terminology. Still, precision medicine is emblematic of a revolution underway in health care, particularly oncology. The transformation reflects the convergence of three things: molecular technologies that can decipher and manipulate basic cellular interactions; the advent of rapid, lower-cost DNA sequencing methods; and computer platforms that can crunch vast amounts of data.  "Precision medicine addresses the unique characteristics of patients at the level of their genes and metabolism in a way that hasn't been done historically in medicine," said Lankenau Institute president and CEO George C. Prendergast, who will be a panelist at the conference.

Of course, some types of genetic assessment are already standard in modern health care. Think of prenatal testing for Down syndrome, and newborn testing for inherited disorders such as cystic fibrosis and sickle cell disease. But only in oncology have both diagnosis and treatment become increasingly personalized and precise.

Why cancer instead of, say, diabetes or heart disease?   "A lot of conceptual and molecular advances were pioneered in cancer," Prendergast said. "The genetic revolution has had the most influence in cancer."

More than other diseases, cancer is the result of cumulative, continual genetic defects that turn the body's own cells into rogues and then keep the immune system from killing them.   Conventional oncology weapons that cut out or kill cancer cells - surgery, chemotherapy, and radiation - are effective, but they involve collateral damage to healthy tissue. And when cancer metastasizes, such blunt weapons can't stop it.

The mid-1970s brought several breakthroughs in the search for ways to marshal the immune system against cancer. Scientists discovered interleukin 2, which has direct effects on disease-fighting T cells. They also developed monoclonal antibodies, genetically engineered proteins that target an identifying marker, or antigen, on tumor cells, then deliver a deadly blow. Today, "targeted" therapies such as Avastin and Gleevec - drugs that disrupt specific molecules involved in the growth and spread of cancer - have become the backbone of oncology. More than 50 such drugs have been approved, with sales rising from 11 percent of the global oncology market in 2003 to 48 percent in 2014, according to the market research firm IMS Health. And although targeted drugs are not yet available for most patients, these medicines accounted for the majority of the 45 new cancer drugs launched between 2010 and 2014, IMS found.

Increasingly, such therapies are approved for use with molecular diagnostic tests to identify patients who have the relevant target. Although that adds to the complexity and cost of treatment,  it also offers reprieves to patients like Albert Snite, 67, of Philadelphia.

Last January, when the retired Common Pleas Court judge was diagnosed with lung cancer that had spread to his brain, his genetic tests at the University of Pennsylvania found no targetable mutation. He was treated with radiation and chemotherapy.  But over the summer, researchers announced the discovery of a new target - a mutation involved in malignant-  cell migration and invasion - for crizotinib, a metastatic lung cancer drug  approved in 2013. Shortly afterward, as Snite's lung tumor progressed, his doctors reviewed his test results and realized he had the newly identified mutation.  "I started crizotinib in September. I had one scan after six weeks. My lungs looked significantly better. And I feel good! It is truly amazing," Snite said, adding that another scan this  month was unchanged.

Even targeted therapies are not magic bullets. Patients who respond - and not all do - often see their cancers develop resistance. The good news, however, is that efforts to harness the immune system in novel ways are yielding successes. Witness patients like Emily Whitehead, who remains cancer-free.  Three main "immunotherapy" approaches have worked to varying degrees - and with varying toxic side effects:  Bioengineered T cells: T cells, the soldiers of the immune system, are removed from the patient's own blood, genetically rigged to recognize and attack a cancer cell antigen, the  grown into the billions and put back in the patient. Penn, CHOP, the National Cancer Institute, and other centers have achieved high rates of long-lasting remissions of certain blood cancers, but this approach has yet to work for solid-tumor cancers. Penn's therapy often has severe but manageable toxicity. Because of the complexity and cost of this approach, it won't be widely used, some experts believe.

Therapeutic vaccines: Unlike preventive vaccines, which preset the immune system to recognize and kill infectious invaders, treatment vaccines are designed to provoke a

heightened immune response to cancer cell antigens. In 2010, Provenge for prostate cancer became the only approved therapeutic vaccine, but it was costly to customize and barely effective; maker Dendreon filed for bankruptcy last year. Still, this technique is improving. For example, two Penn scientists - Yvonne Paterson and David B. Weiner - each developed  novel vaccine technology that separate biotech firms have licensed and are using in clinical trials for cervical and other cancers.

Overcome immune tolerance: Instead of directly revving up the immune response, this approach interferes with one of cancer's main defenses - its ability to evade and suppress the immune system. Since 2011, three "checkpoint inhibitors" have been approved for advanced melanoma and lung and kidney cancers. These drugs and even newer versions are being tested in cancers of the pancreas, colon, brain, and other organs. Prendergast, at Lankenau, has been a leader in research of an enzyme pathway called IDO (for indoleamine 2,3-dioxygenase) that cancer uses not only to escape immune detection, but to attract a blood supply and metastasize."The field has stressed how to activate the immune system," Prendergast said. "In the last 10 years, we realized the tumor is standing on the brakes of the immune system. We have to  take off the brakes. That was one of the shocks of my career."    Some people have immune systems that are inherently superior at unmasking and managing dangerous cells. That's why most smokers don't get lung cancer and many old men have   prostate cancer that will never harm them.  "The problem is not that there are rogue cells in the body, but that the body is mismanaging them," Prendergast said.

Figuring out why is part of precision medicine.    "You can match a blood transfusion to a blood type - that was an important discovery," Obama said a year ago. "What if matching a cancer cure to our genetic code was just as easy, just as standard?