Christina Bach, MSW, LCSW, OSW-C

Another month – Another Awareness Cause! (This time, our pets!)

Did you know that November is National Pet Cancer Awareness month? I am a “pet parent” to three amazing dogs, two of whom do therapy work with me. Before I worked in “human” oncology, I was privileged to work with many of the outstanding veterinary oncologists at the Ryan Veterinary Hospital of the University of Pennsylvania. I had no clue about cancer and pets before I started working in Veterinary social work, except that my first family dog, Shadow, died suddenly when a tumor “burst” in his liver. I was 12 and back then there really was not a lot of education about cancer in companion animals, let alone about treatment options.

Flash forward to 2012. Let’s look as some facts about cancer and pets

• Did you know that cats and dogs receive chemotherapy and radiation? They receive many of the same drugs that humans do.
• Cancer accounts for nearly 50% of all disease related pet deaths each year (Veterinary Oncology and Hematology Center).
• Dogs get cancer at roughly the same rate as humans (AVMA.org).
• One in four dogs will die of cancer (Morrisanimalfoundation.org).
• Cancer risk increases with age in both cats and dogs.
• Pets get cancers like lymphoma, melanoma and sarcomas, just like humans!

What’s striking about this information? Cancer is remarkably similar in its incidence and treatment between humans and companion animals. However there is one BIG difference, most pet parents in the United States do not have pet insurance. The cost of chemotherapy and radiation for a dog or cat can be upwards of $5000 (sometimes even more)!

One of the best things I ever did was purchase pet insurance for my three fur kids. The peace of mind that this coverage gives me, should I ever have to face a cancer diagnosis and treatment for one of the dogs, is wonderful. Most pet health insurance plans have coverage for cancer treatment and some even cover complimentary therapies like acupuncture. For more information about pet health insurance check out this article with links to the providers (Pet insurance providers). Be sure to do your homework and ask specific questions. For example:

• Do you cover pre-existing conditions?
• Do you have a maximum dollar amount you will pay for the lifetime of a pet?
• Do you cover chemotherapy, radiation and diagnostic tests for cancer?
• Do you cover complimentary therapy like acupuncture or physical therapy?

Another important difference with pet health insurance is that you are still expected to pay for the cost of the veterinary care and then submit a claim, for which you are reimbursed. You can also expect your quote to depend on important factors like your pets age and breed.

Increase your awareness of cancer in pets

The Veterinary Cancer Society has published the following list of signs and symptoms to be aware of with your animals.

• Abnormal swellings that persist or continue to grow
• Sores that do not heal
• Weight loss
• Loss of appetite
• Bleeding or discharge from any body opening
• Offensive odor
• Difficulty eating or swallowing
• Hesitation to exercise or loss of stamina
• Persistent lameness or stiffness
• Difficulty breathing, urinating, or defecating (American Veterinary Medical Association)

If you are concerned about symptoms your animal may be having, take them to your Veterinarian as soon as possible. I always err on the side of caution with my animals. I know that I have to act as their voice as well as their decision maker. This is a tough position to be in as a caregiver of a pet with cancer. Just as with human cancers, earlier diagnosis and treatment CAN make a difference. Take care of yourselves and Fluffy. Our pets are enormous supports, especially when going through a life threatening illness; but they also need our support too.

Learn more about cancer in companion animals on OncoLink’s Veterinary Oncology section.

Rodney Warner, JD

A couple days ago, while driving to work, I saw it on the road. I was at an intersection, waiting for the light to turn green. It rained the previous night and the road was wet. The cigarette butt rolled silently on the damp road, blown by the wind. I guessed someone had to have a cigarette while they drove to work and threw it out the window when they were done with it. Blue grey smoked curled up from the butt. I tried to crush it with my tires after the light changed.

In college, one night after drinking too much, I think I smoked half a cigarette. One of my uncles smoked himself to death. He died while I was in high school, of cancer. He was told he had to stop smoking. I’m not sure he ever did.

Tobacco is a history changing plant. It’s believed native Americans cultivated it as far back as 6000 BC. It spread to Europe after Europeans came to the New World. The young American government used it as collateral for French loans used to finance the Revolationary War. When you think of slavery in the U.S., you probably think of cotton. More slaves worked on tobacco plantations, than cotton plantations, until the invention of the cotton gin.

Tobacco’s death toll is astounding. Worldwide, an estimated five million deaths per year are tobacco related, or about 10% of all adult deaths. To put that in perspective, five million is about the population of Los Angeles and San Diego combined or slightly less than the population of Colorado. In the U.S nearly 20% of all deaths are tobacco related, or about 443,000 Americans a year. That’s just less than the population of Kansas City. A study commissioned by the world’s largest tobacco company, Philip Morris, estimates that the average American smoker loses 5.23 years from his/her life due to smoking.

It’s been estimated that one billion people will suffer tobacco related deaths in the 21st century, with a mere 100 million tobacco related deaths in the 20th century.

Long term illness isn’t the only threat. In 2008, an estimated 680 Americans died in cigarette smoking related fires. The world’s worst forest fire (in China in 1987, which left 300 dead and 5,000 homeless) was caused by smoking.

You might also think lung cancer when you think of tobacco use. Smokers are ten to twenty times more likely to get, or die from, lung cancer, compared to non-smokers. But tobacco use has been linked to 14 different kinds of cancer.

It should come as no surprise that tobacco is big business. The World Health Organization estimates that about 5.5 trillion cigarettes a year are manufactured world wide, a third of them being smoked in China. In 2008, the world’s top two tobacco companies, Philip Morris and British American Tobacco, had $114 billion in revenues. That’s all well and good for their stock holders, not so good for everyone else. For example, in 1999, 6% of the nation’s total health care spending, or about $76 billion, was to treat tobacco related illnesses. It’s been estimated that, in 2001, smokers took off nearly twice as many sick days from work, compared to non-smokers.

We are creatures of habit, and smoking isn’t the only bad habit that causes disease and death. But, can death and destruction be more attractively packaged and sold as tobacco can? Will we ever stop buying it?

Editor’s note: Learn more about the tobacco crisis: Did You Know…The Facts About Smoking and the Worldwide Crisis it has Caused? Ready to quit? Get started on OncoLink. Want to know more about cancer risk? Create your What’s My Risk? profile.

Rodney Warner, JD

She was desperate. I remember she was a middle aged woman with dark hair. I think she was still wearing a coat long after the rest of us took ours off.

I was attending a blood cancer support group at Gilda’s Club Delaware Valley. We had an unusually good turn out that night. I can vaguely remember about ten of us being there, including my friend, Jay, and the group facilitator, Kelly.

I don’t know how she got to the meeting, or who convinced her to come. She wasn’t comfortable, despite being in Gilda’s homelike environs and surrounded by people dealing with blood cancer, in one form or another, one stage or another, past or present.

She told us her story. I remember her talking about fevers so high, she couldn’t sleep in her bed. She slept on her dining room floor. She told us about how much time she had to take off from work, and how that was causing her problems. She talked about seeing doctors, getting a cancer diagnosis and being told there was no treatment for what she had and the disease was going to kill her.

She told us she couldn’t have cancer and this couldn’t be happening to her. One reason was that she had too many things to do. At one point in the meeting, I asked her to repeat what kind of cancer she had because it seemed unusual to me that there was no treatment at all for what she had. She just stared at me, not saying a word. It was like if the name of the cancer came out of her mouth, it would give the cancer more reality, more power over her life.

Several of us suggested she get a second opinion and even gave her names of specific doctors to see. Many of us, myself included, had been wrongly told we were helpless cases. We all tried to be supportive and comforting, but I felt this woman was not really fully grounded in reality. There are times in our lives when we need a warm cup of tea to settle us down and other times when we need cold water thrown in our face to wake us up. The meeting was coming to a close, so I told her what no one else had that night. I told her until she recognizes she has a problem, it’ll never get better. Running away from a problem doesn’t make it go away.

I never saw the woman again. I don’t know if she’s alive or dead. Maybe she was right, maybe she was misdiagnosed and really didn’t have cancer.

I would guess everyone diagnosed with cancer was in denial, to some degree, at one point or another. Before my diagnosis, for nearly two years, I had very high fevers, like clockwork, every three months. I was in my 30’s and otherwise in good health. It wasn’t until I became utterly exhausted (along with other symptoms) did it occur to me there might be something seriously wrong with me. Before that point, why didn’t I stop to think, it’s not normal for a person to be like this, I really need to stop and have someone check this out! Was I in denial, or just being a moron, I don’t know.

How many of us diagnosed at late stages (like I was) could’ve, or should’ve, been diagnosed much sooner, and treated with far fewer problems and side effects and with greater success, if not for the powerful spell that denial can have over us? We get so much comfort from our efforts to organize our lives, the fact something might come along and throw our lives into chaos, and possibly kill us at an age far younger than we ever imagined, can be so terrifying that’s it’s too scary to even think about.

But we have to think about it. If not, for those unwilling or unable to recognize and prepare for the coming storm, whose official cause of death was cancer, how many were actually killed by denial?

Karen Wagner, MS, RD

Is there a “best diet” or are there “best foods”? These terms are used a lot on magazines and on short news segments and are often based on recent research into certain chemicals found in foods. It is difficult however to put into more relevant terms what the terms “best foods” mean. When people ask me, “What are the best foods”, I think they mean “What is the combination of foods that will assure me the very lowest risk possible of ever getting cancer, or lowest possible risk of a recurrence?” The truth is, even with all the exciting research that goes on in the area, I just don’t know. I don’t really have a comprehensive way to rank foods over one another. Is broccoli better than walnuts? Broccoli does have more Vitamin C and a particular chemical called indole-3-carbinol which is often studied for breast cancer prevention, but walnuts have protein, omega-3 fats and a chemical called resveratrol, which also may fight breast cancer, but in a different way. Are onions more potent at fighting cancer than garlic? If someone doesn’t like green leafy vegetables or beans, is there some other way for that person to get the known benefits from these foods. Is drinking one soda bad? What about one soda every day?

The bottom line is that the scientific community knows some very specific things, such as how certain detoxifying systems in the body are affected by particular chemicals in broccoli, and we know some very general things, such as eating lots of fruits and vegetables seems to help reduce someone’s risk for developing certain cancers. The area in the middle however, is very great. So far, the best advice I’ve seen is from Micheal Pollan: “Eat food, not too much, mostly from plants.” As an added step, you can see how many different kinds of plants you are eating in a day, or a week. I may not know if broccoli is better than walnuts, but I know they both have chemicals that have been shown to be healthy. Instead of trying to figure out which is better, I recommend including them both, along with many other fruits, vegetables, beans, whole grains and nuts. That way, when the next “best food” comes along, you’ll already be eating it!
There is a certain amount of tug of war in nutrition as it relates to cancer. On the one hand there are frequent “discoveries” of chemicals founds in foods that seem to be helpful in “fighting” cancer. Often the chemical in question is just one of many found in a particular plant and it is studied in isolation. This information is very exciting, and often provides support for the general recommendation to “Eat more fruits, vegetables, beans, nuts and whole grains”. On the other hand, these discoveries can lead to confusion about what exactly to do with this information. Exactly how much broccoli should someone every day? What about turmeric, green tea, blueberries, walnuts, red wine, spinach, apples, onion, oregano? What about the even more exotic foods that are not often a part of our diets such as acai, noni, goji, or miyake mushrooms? Will people really benefit from taking these foods as powders or supplements?

Is there a “best diet” or are there “best foods”? These terms are used a lot on magazines and on short news segments and are often based on recent research into certain chemicals found in foods. It is difficult however to put into more relevant terms what the terms “best foods” mean. When people ask me, “What are the best foods”, I think they mean “What is the combination of foods that will assure me the very lowest risk possible of ever getting cancer, or lowest possible risk of a recurrence?” The truth is, even with all the exciting research that goes on in the area, I just don’t know. I don’t really have a comprehensive way to rank foods over one another. Is broccoli better than walnuts? Broccoli does have more Vitamin C and a particular chemical called indole-3-carbinol which is often studied for breast cancer prevention, but walnuts have protein, omega-3 fats and a chemical called resveratrol, which also may fight breast cancer, but in a different way. Are onions more potent at fighting cancer than garlic? If someone doesn’t like green leafy vegetables or beans, is there some other way for that person to get the known benefits from these foods. Is drinking one soda bad? What about one soda every day?

The bottom line is that the scientific community knows some very specific things, such as how certain detoxifying systems in the body are affected by particular chemicals in broccoli, and we know some very general things, such as eating lots of fruits and vegetables seems to help reduce someone’s risk for developing certain cancers. The area in the middle however, is very great. So far, the best advice I’ve seen is from Micheal Pollan: “Eat food, not too much, mostly from plants.” As an added step, you can see how many different kinds of plants you are eating in a day, or a week. I may not know if broccoli is better than walnuts, but I know they both have chemicals that have been shown to be healthy. Instead of trying to figure out which is better, I recommend including them both, along with many other fruits, vegetables, beans, whole grains and nuts. That way, when the next “best food” comes along, you’ll already be eating it!

Carolyn Vachani, RN, MSN, AOCN

Flu vaccine information is everywhere you turn these days, from the supermarket to the news. Every year around this time, questions about flu vaccination start popping up in cancer clinics. Many people with cancer may be wondering how they can best prevent getting sick, and if they should be vaccinated against the flu. Here are the facts…

According to Neil Fishman, MD, associate professor of Infectious Diseases and director of Healthcare Epidemiology and Infection Control at The University of Pennsylvania, all immunosuppressed individuals should receive influenza vaccination (a single shot now includes both “seasonal” strains and the H1N1 strain). People currently undergoing treatment for cancer and those who are in remission should be vaccinated, as both of these groups are at higher risk for developing complications from influenza infection. These patients should receive only the injected vaccine, since the inhaled form contains live viruses. It would be best to receive the vaccine when they are the least immunosuppressed in order to guarantee a maximal response. This means that they should not receive the vaccine during their nadir (the time when blood counts are at their lowest, typically 7-14 days after treatment). Talk with your healthcare team about the best time for you to get vaccinated.

Dr. Fishman also advises that people with cancer (particularly those on therapy or post-transplant) also get a pneumovax vaccine. This vaccine helps to prevent a common strain of bacteria that can cause pneumonia as well as other serious infections. The CDC recommends pneumovax for adults over 65, for smokers and for “people with certain health problems” – this includes health problems or treatments that weaken the immune system. People with cancer may require a second dose of pneumovax, given 5 years after the first. Patients should discuss their need for re-vaccination with their healthcare team.

Remember, while receiving cancer treatment, you are at an increased risk of getting infections, including colds and the flu, particularly when your blood counts are low. What precautions should you take as a patient receiving cancer therapy? Most importantly, wash your hands often- it is the easiest, most effective way to prevent the spread of infection. Keep hand sanitizer in your bag, desk, car or anywhere you may not be able to access a sink for handwashing. Avoid touching your eyes, nose and mouth- that is how germs get in. It is perfectly acceptable not to shake hands or to ask people who are sick (or have sick people in their household) not to visit you. Ask any visitors to wash their hands upon arrival and, whenever possible, avoid places with crowds of people, particularly when your blood counts are at their lowest. Have other members of your household get vaccinated as well; you don’t want them bringing these infections into your house where it will be harder to avoid.

Still, even the best handwashers get sick sometimes, so don’t blame yourself if you do. Get plenty of rest, drink plenty of fluids, and help to prevent the spread of the flu to others by staying home when you are sick.

You can learn a lot more about cancer and the flu through the CDC webpage on this topic.

Now roll up your sleeve – this won’t hurt a bit!

Carolyn Vachani, RN, MSN, AOCN

Flu vaccine information is everywhere you turn these days, from the supermarket to the news.  Many people with cancer may be wondering how they can best prevent getting sick and if they should be vaccinated against the flu, both seasonal and H1N1 (often called Swine flu).  Here’s the facts…

According to Neil Fishman, MD, associate professor of Infectious Disease and director of Healthcare Epidemiology and Infection Control at The University of Pennsylvania, all immunosuppressed individuals should receive the influenza vaccines (both seasonal and H1N1).  This includes people receiving cancer treatment. These patients should only receive the injected vaccines and not the inhaled forms of the vaccines, which use a live virus.  It would be best to time the vaccine to when they are the least immunosuppressed in order to guarantee maximal response.  So, they should not receive the vaccine during their nadir (the time when blood counts are at their lowest, typically 7-14 days after treatment).  Talk with your healthcare team about the best time for you to get vaccinated.  You can receive both the seasonal flu and H1N1 vaccines at the same time.

Dr. Fishman stresses that the novel H1N1 influenza virus is not any more dangerous than seasonal influenza at this point. It is no more deadly, but we need to take the same precautions we take for seasonal influenza.

Remember, while receiving cancer treatment, you are at an increased risk of getting infections, including colds and flus, particularly when your blood counts are low.  What precautions should you take as a patient receiving cancer therapy?  Most importantly, wash your hands often- it is the easiest, most effective way to prevent the spread of infections.  Keep hand sanitizer in your bag, desk, car or anywhere you may not be able to access a sink for handwashing.  Avoid touching your eyes, nose and mouth- that’s how germs get in.  It is perfectly acceptable to not shake hands or ask people who are sick (or have sick people in their household) to not visit you.  Ask any visitors to wash their hands upon arrival and, whenever possible, avoid places with crowds of people, particularly when your blood counts are at their lowest.  Have other members of your household get vaccinated as well- you don’t want them bringing these infections into your house where it will be harder to avoid.

Even the best handwashers get sick, so don’t blame yourself if you do.  Get plenty of rest and fluids and help prevent the spread of the flu to others by staying home when you are sick.

Now roll up your sleeve- this won’t hurt a bit!

Also see Ask the Experts: Exposure to People After Vaccines.

Rodney Warner, JD

This is a musical blog, so I hope you have some time.  Click on the links and enjoy some great music.

I’m a big Lyle Lovett fan.   He’s a great song writer whose songs bend several musical genres: country, blues, gospel, rock.  He often tours with his Large Band, a 16 piece Texas swing band (Lyle’s from Texas…That’s right, you’re not from Texas…).  I’ve seen him perform with, and without, his Large Band in places big and small.

One of Lovett’s more recent works is It’s Not Big It’s Large.  Though his songs aren’t about cancer survivors (as far as I know), there are a couple that just grab me by the heart.  One is I Will Rise Up, and the chorus is…

And I will rise up, and I will rise up,
Though I be a dead man, I said yes and amen.
And I will stand tall, and I will stand tall,
Until I meet my end, until I meet my end.

Whenever I hear these words, I think about all the cancer survivors who are terminally ill, living day by day, doing their best to live with dignity and independence for as long as they can.

Another song is Don’t Cry a Tear For Me.  Whether it’s about someone leaving a relationship, or dying, I don’t know, but when I hear it, all I can think about is my brother.  Bart would want us to remember him by all the good times we had with him, and all the good things he did, not about what he went through before he died.

Warren Zevon died of lung cancer.   His song My Shit’s Fucked Up is about his cancer experience, written in a way that only he could write it.  I think he speaks for many of us, especially those us unafraid of using four letter words.

Zevon’s last album was The Wind, which was made when it was clear his lung cancer would soon kill him.  He sang a version of Knockin’ on Heaven’s Door, which has a whole new depth when sung by someone who knows he’s dying.

The album ends with Keep Me in Your Heart.  On an internet bulletin board, I’d communicated with a woman whose 21 year old son died after a battle with Hodgkin’s lymphoma.  I posted the lyrics.  She had them read at his funeral.

I’ll try to be more upbeat next blog.

Karen Wagner, MS, RD

At least once a week, if not more, I find myself in the strange position of trying to convince someone to eat more sugar. It is not that I think that everyone should eat more sugar, it’s not that I think sugar is healthy, but the information regarding sugar and cancer gets so distorted by fear and misunderstanding that sometimes, me, a dietitian, gets put in the counter-intuitive position of encouraging someone to eat more sugar.

By the time someone has come into see a doctor in the cancer center, he or she has already received a lot of information from a lot of people. One of the things that people sometimes hear is that sugar feeds cancer.

It should be stated, first of all, that every cell in our body uses sugar for fuel, our brain cells, our immune cells, our blood cells and our muscles. Sugar breaks down easily and provides a lot of energy quickly. Almost all of the cells in our body will use sugar, specifically glucose, even if there are other energy sources in the blood stream, such as fat. Furthermore, our cells can not tell if the glucose that is in the blood stream is from a jelly bean, or from brown rice, each sugar molecule looks the same to our cells.

Cancer cells are our own cells that have mutated and they do use the same fuel source that our healthy cells use. Cancer cells do typically use up more fuel than regular cells, but they too, can not distinguish the source of sugar molecules in the blood stream. This may sound scary, but a number of recent reviews have come out in the past couple of years that do NOT show any relationship between a person’s cancer risk and a person’s sugar consumption. Of the studies that have shown any indication that sugar consumption and carbohydrate intake may influence cancer risk, the increased risk was small. These studies often look at whole diets and often follow people for a long time and I think should provide some comfort for all of us. They indicate that sugar consumption, by it itself, does not seem to effect a person’s risk for getting cancer.

These studies are about people before they get cancer, what about people going through treatment? The main thing we know about nutrition and people going through their cancer treatments is that people who can maintain their weight within about 10 % of their pre-diagnosis weight seem to do better overall. They feel better, they are able to get the full course of treatment planned by the doctor, they have fewer side effects and they have a better long term survival rate. Again, it does not seem to matter what kind of foods people ate, as long as they maintain their weight.

Of course, I am a dietitian. I personally would love it if everyone who goes through cancer treatment could also eat a low sugar, low fat, high fiber, high fruit and vegetable diet. I have absolutely no data to prove that this would be helpful or beneficial, but I just like for people to eat their fruits and veggies. However, what I really want is for the people I work with to get the most from their cancer treatments and to feel as well as they can throughout the process. Because of this, I often encourage people to eat more sugar, or at least, nourishing foods that also contain sugar, especially when someone is limited in what he or she can tolerate. Puddings, cheesecakes, pumpkin pie, smoothies or milkshakes, cookies and milk are often easy for people to eat during treatment, can help people maintain their weight and do provide needed protein and calories.

Sometimes it’s a tough job convincing someone to eat ice cream.

At least once a week, if not more, I find myself in the strange position of trying to convince someone to eat more sugar. It is not that I think that everyone should eat more sugar, it’s not that I think sugar is healthy, but the information regarding sugar and cancer gets so distorted by fear and misunderstanding that sometimes, me, a dietitian, gets put in the counter-intuitive position of encouraging someone to eat more sugar.

By the time someone has come into see a doctor in the cancer center, he or she has already received a lot of information from a lot of people. One of the things that people sometimes hear is that sugar feeds cancer.

It should be stated, first of all, that every cell in our body uses sugar for fuel, our brain cells, our immune cells, our blood cells and our muscles. Sugar breaks down easily and provides a lot of energy quickly. Almost all of the cells in our body will use sugar, specifically glucose, even if there are other energy sources in the blood stream, such as fat. Furthermore, our cells can not tell if the glucose that is in the blood stream is from a jelly bean, or from brown rice, each sugar molecule looks the same to our cells.

Cancer cells are our own cells that have mutated and they do use the same fuel source that our healthy cells use. Cancer cells do typically use up more fuel than regular cells, but they too, can not distinguish the source of sugar molecules in the blood stream. This may sound scary, but a number of recent reviews have come out in the past couple of years that do NOT show any relationship between a person’s cancer risk and a person’s sugar consumption. Of the studies that have shown any indication that sugar consumption and carbohydrate intake may influence cancer risk, the increased risk was small. These studies often look at whole diets and often follow people for a long time and I think should provide some comfort for all of us. They indicate that sugar consumption, by it itself, does not seem to effect a person’s risk for getting cancer.

These studies are about people before they get cancer, what about people going through treatment? The main thing we know about nutrition and people going through their cancer treatments is that people who can maintain their weight within about 10 % of their pre-diagnosis weight seem to do better overall. They feel better, they are able to get the full course of treatment planned by the doctor, they have fewer side effects and they have a better long term survival rate. Again, it does not seem to matter what kind of foods people ate, as long as they maintain their weight.

Of course, I am a dietitian. I personally would love it if everyone who goes through cancer treatment could also eat a low sugar, low fat, high fiber, high fruit and vegetable diet. I have absolutely no data to prove that this would be helpful or beneficial, but I just like for people to eat their fruits and veggies. However, what I really want is for the people I work with to get the most from their cancer treatments and to feel as well as they can throughout the process. Because of this, I often encourage people to eat more sugar, or at least, nourishing foods that also contain sugar, especially when someone is limited in what he or she can tolerate. Puddings, cheesecakes, pumpkin pie, smoothies or milkshakes, cookies and milk are often easy for people to eat during treatment, can help people maintain their weight and do provide needed protein and calories.

Sometimes it’s a tough job convincing someone to eat ice cream.

Rodney Warner, Esq

I loved Christmas. What boy didn’t? Especially a greedy little urchin like me, who measured Christmases by the size of the pile of gifts I’d get, and whether or not I got all the G.I. Joe paraphernalia I asked for. It wasn’t a spiritually uplifting, get together with loved ones, Jesus our savior is born kind of thing. Christmas was all about the toys. A week off from school was pretty cool, too.

Later, I learned to dread Christmas. It scared the shit out of me.

In December 1998, six months after my daughter Kaitlin was born, I had my first fever. It was a whopper, 103 and change. I didn’t feel well, then body shaking, teeth chattering, chills. For the next two years, like clockwork, every three months or so, I’d get a raging fever and night sweats.

In the Fall of 2000, my body shut down. The coughing, itching and fevers wouldn’t stop. I went to see a chest specialist. He ordered every test in the book and a full body CT scan. He told me I may have cancer, probably some kind of lymphoma, given my symptoms and the fact the lymph glands in my abdomen were the size of hand grenades. I was 34 years old.

My parents joined me, my wife and daughter for Thanksgiving. The biopsy surgery was scheduled for early the next day. There didn’t seem much to be thankful for.

Christmas No. 1

A lymph gland in my chest was taken out and biopsied. It was Hodgkin’s lymphoma. I started Stanford V treatment, I think the second week of December. I had twelve straight weeks of chemo.

Kaitlin, my daughter, was clueless about my illness. She was a cute little kid, enjoying her second Christmas. It was an all day affair. Open something, play with it, open something, play with it…

I was scared, but hopeful, that Christmas. Yes, I was diagnosed at the most advanced stage of the disease, but I had a really good doctor, and I was tolerating treatment pretty well. After the chemo, radiation was next. My radiation doctor and I reviewed the latest CT scan. “Your tumors responded beautifully,” he told me. I felt great. Three and a half weeks of radiation to put the nails in the cancer’s coffin.

Christmas No. 2

In October 2001, I had my six month check up after radiation was done. I had a dry cough that wouldn’t go away, but otherwise, I felt fine. After a chest x-ray, my oncologist told me he thought the cancer had returned to my lungs, and left the room. Maybe that’s how he learned to deliver bad news. Let me deal with it myself. He re-emerged and we talked about what to do next. More chemo and an autologous stem cell transplant.

Again, the second week of December, more chemo. “Salvage” chemo, like your body is trying to be salvaged. A more sexy name is “de-bulking” chemo. This isn’t namby pamby out patient chemo. This was ICE, inpatient, constant drip for 72 hours. I did well with Stanford V. ICE kicked my ass.

I got a couple weeks off. My second round was scheduled the last week of the month, the week after Christmas. Yes, another Christmas with cancer. Another Christmas spent trying not to think about dying, or having a daughter grow up without me. A Christmas without hair. To be honest, I don’t remember much about that Christmas. It was the three of us, Kaitlin had fun, my wife and I tried to live for the moment. Another long Christmas for my daughter. Open something, play with it, open something, play with it….

My fears seemed to be coming true. Being treated for cancer is bad enough, but there’s always that fear that if it does clear up, it’ll come back. For me, that’s just what happened. But, I was still a father and a husband. It was Christmas, and I did my best to get in the seasonal spirit.

The next week, another 72 hours of ICE, nausea, exhaustion and general, all around misery. One thing I’ve learned about cancer treatment, if you can tolerate misery, you’re more than half way home.

That wasn’t enough misery. Two rounds of ICE only got half the job done. Went to another hospital for the transplant, had another miserable round of inpatient chemo (this time, DI-CE) which seemed to clear up the tumors. I moved onto getting blood stem cells removed, high does chemo (six straight days of chemo), then getting my stem cells put back. It wasn’t as bad as I’d feared, but it was pretty awful, like a month long hangover. The process was like going on a month long bender with none of the benefits.

But I was back in remission. That’s all that mattered. I tried to keep positive thoughts.

Christmas No. 3

I got the call in early December 2002. I was at work. The transplant coordinator gave me the latest CT scan results. Three tumors were in my liver. I was shocked. I had no symptoms. It also looked like I was running out of time. As far as I was concerned, this was no longer an uphill battle, I was facing a cliff.

Afterwards, I remember looking at myself in the mirror and thinking, this is how a dying man looks. I am dying of cancer, and this is how I look. Visions of being bed ridden, with fevers, night sweats, coughing and itchy skin utterly out of control ran through my head. I started planning my funeral.

My doctor told me my last hope for a cure was an allogeneic bone marrow transplant. I’d undergo chemo to (hopefully) get into remission and bone marrow from a donor (hopefully one that’s related) would be infused. That new marrow would produce a new immune system, which is supposed to kill off any remaining cancer cells. The new immune system could also attack my healthy tissue, too. Immune systems attack foreign things lurking in the body. If it comes from someone else, your whole body is foreign. It’s my understanding that an allogeneic bone marrow transplant is the riskiest kind of medical procedure you could have. That why only those of us facing certain death undergo it.

Christmas was not fun for me. We bought a video camera, so Kaitlin would have some video of me, her departed father. She was four at the time. I didn’t think she’d remember me if I died. Dads are supposed to have fantasies about their daughter graduating college, getting married, having kids of her own. I didn’t think I’d be around to see her get through elementary school.

January was the time of second opinions (and also of my 37^th birthday). One was, “There’s no easy way to tell you this, so I’ll just come out and say it. You’ll never get rid of this disease.” That is the easy way to say it. This doctor could’ve told me, this disease will kill you and there’s nothing you can do about it. He told me he’d never had a patient cured with an allogeneic bone marrow transplant. The second, second opinion was that the transplant may cure me, but no one could really say what my chances were. He estimated, without a transplant, I’d be dead in a year.

Kids don’t learn by what you tell them. You teach them by what you do and how you act. I figured, if I couldn’t teach Kaitlin by how I lived, I’d teach her by how I died. If I was going down, I was going down swinging. I had more chemo, got into remission number three in March 2003. My brother and sister were tested to see if they were a good match to donate bone marrow. My sister was, my brother was not. I had the transplant in May 2003.

Christmas No. 4

November 2003 was time for a follow up CT/PET scan. Once again, the end of the year, the time for bad news, pain, fear, dread and sometimes, terror. The time when death seemed to be just over my shoulder. Winter was the time for cancer. My original diagnosis and my two relapses were discovered in November or December. Here I was, all over again, in November, waiting for news. Insanity is doing the same thing over and over but expecting a different result. I’d been treated for cancer over and over, but it came back over and over. Why would this time be any different?

After the scan, my wife and I sat in my doctor’s waiting room. I was shaking and crying, convinced more bad news was coming. After all, it was November, and Christmas was just around the corner. Only this time, there would be no second or third chances. This was going to be the bad news that ended all bad news.

There was no bad news. No signs of cancer, and the blood tests showed my new immune system was hard at work, especially in my liver, where the last tumors were found. Christmas 2003 was like breathing fresh air again. I didn’t seem to have a care in the world. I started thinking I was really going to beat cancer, maybe even grow old, and help my daughter grow up. I’ve been in remission since March 2003.

Brother Bart

Thankfully, he wasn’t my bone marrow donor, because he was diagnosed with multiple myeloma in June 2004. He had two more Christmases with his wife, three sons, friends and family. Shortly after Thanksgiving 2006, his wife called, saying Bart had weeks to live. He died in early December, at the age of 46. His wake and funeral were about ten days before Christmas. 2006 was my first Christmas without my brother. Because Bart’s not here, cancer is with us every Christmas.

Karen Wagner, MS, RD

I love news stories about "super foods". Even if these stories can sometimes be confusing, I welcome almost any opportunity to talk about healthy foods! Super foods often get their designation in the media because they contain some newly discovered chemical, often called a phytochemical that may be helpful in preventing heart disease, diabetes or cancer. In recent years broccoli, blueberries, pomegranates, red grapes, garlic, walnuts and even chocolate have earned "super food" designation. However, the list of foods that contain phytochemicals is quite extensive and to me, almost anything that comes from a plant can be seen as a "super food". It seems that when scientists look at almost any plant food, from the rather mundane apples, oranges, nuts and beans to exotic spices and berries they find some phytochemical that fights inflammation, or that can help
our immune systems destroy cancer cells. Often they find many phytochemicals and have to pick out just one to study. This process can lead to confusion too, as the phytochemicals associated with certain "super foods" appear as supplements that sometimes claim to have the health benefits hyped up in the news stories, while in reality the research is much less straightforward.

As an example, I recently attended a conference put on by the American Institute for Cancer Research (www.aicr.org), and one of the many fascinating speakers at the conference was Dr Pezzuto, who was one of the authors of an exciting study about a phytochemical called resveratrol. Resevratrol is just one of the phytochemicals in red grapes and red wine that is being studied for its effects on variety of conditions from Alzheimer’s disease to cancer. However, one of his points at this latest talk was that resveratrol was only one of 1628 phytochemicals that have currently been identified in red grapes. One-thousand-six-hundred and twenty eight, just in red grapes! Reseveratrol is exciting, but what about the other 1627 phytochemicals? Does resveratrol work better when combined with some of these other phytochemicals? Do our bodies process the resveratrol
differently when all of these compounds are combined? These were questions that Dr. Pezzuto himself acknowledged that we may never know for sure and one of the reasons that, at the moment, we don’t have enough evidence for recommending resveratrol supplements.

Our current methods of researching phytochemicals have often relied on picking out one compound from hundreds or even thousands that have been found in a particular plant, and then we study that one compound in isolation. We study it in cell cultures, we study it in animals. After years of this we begin to study it in people. However, even before the initial results are published, supplement makers have introduced these products onto shelves, which leaves doctors, nurses, and dietitians in a bit of a quandary. We may be familiar with the studies that have been done in laboratories, but we just don’t know for sure how supplements will interact with medications, or how large doses of isolated phytochemicals will affect people.

At this point, I do not know for sure whether or not I or you or anyone else should take a resveratrol supplement, but I’m happy to tell you to eat plant foods that contain resveratrol. Besides red wine and grapes 70 other plant foods have been identified that contain resveratrol, including many berries, plums, peanuts, and pine nuts. Plus when you eat these foods you increase your consumption of the thousands of other phytochemicals that are in those foods. The best way to take phytochemicals appears to be in their "original packaging", that is fruits, vegetables, nuts, beans and whole grains.

So, even though the media stories about super foods can miss the underlying nuances of research and can cause confusion, I still welcome the opportunity to think and talk about "super foods" and why including these foods in our diet can be helpful. I just embrace a much wider definition of what can constitute a super food. Almost all plants foods, especially ones that are minimally processed such as fresh or frozen fruits, vegetables, whole grains, beans and nuts have health benefits. In addition to that, these foods are delicious!

For recipes and more ideas for increasing plant foods in your diet, please visit www.aicr.org.

Please note that I am not recommending drinking lots of red wine. Please talk with your doctor or other health care professional about appropriate amounts of alcohol consumption, including red wine.

I love news stories about "super foods". Even if these stories can sometimes be confusing, I welcome almost any opportunity to talk about healthy foods! Super foods often get their designation in the media because they contain some newly discovered chemical, often called a phytochemical that may be helpful in preventing heart disease, diabetes or cancer. In recent years broccoli, blueberries, pomegranates, red grapes, garlic, walnuts and even chocolate have earned "super food" designation. However, the list of foods that contain phytochemicals is quite extensive and to me, almost anything that comes from a plant can be seen as a "super food". It seems that when scientists look at almost any plant food, from the rather mundane apples, oranges, nuts and beans to exotic spices and berries they find some phytochemical that fights inflammation, or that can help
our immune systems destroy cancer cells. Often they find many phytochemicals and have to pick out just one to study. This process can lead to confusion too, as the phytochemicals associated with certain "super foods" appear as supplements that sometimes claim to have the health benefits hyped up in the news stories, while in reality the research is much less straightforward.

As an example, I recently attended a conference put on by the American Institute for Cancer Research (www.aicr.org), and one of the many fascinating speakers at the conference was Dr Pezzuto, who was one of the authors of an exciting study about a phytochemical called resveratrol. Resevratrol is just one of the phytochemicals in red grapes and red wine that is being studied for its effects on variety of conditions from Alzheimer’s disease to cancer. However, one of his points at this latest talk was that resveratrol was only one of 1628 phytochemicals that have currently been identified in red grapes. One-thousand-six-hundred and twenty eight, just in red grapes! Reseveratrol is exciting, but what about the other 1627 phytochemicals? Does resveratrol work better when combined with some of these other phytochemicals? Do our bodies process the resveratrol
differently when all of these compounds are combined? These were questions that Dr. Pezzuto himself acknowledged that we may never know for sure and one of the reasons that, at the moment, we don’t have enough evidence for recommending resveratrol supplements.

Our current methods of researching phytochemicals have often relied on picking out one compound from hundreds or even thousands that have been found in a particular plant, and then we study that one compound in isolation. We study it in cell cultures, we study it in animals. After years of this we begin to study it in people. However, even before the initial results are published, supplement makers have introduced these products onto shelves, which leaves doctors, nurses, and dietitians in a bit of a quandary. We may be familiar with the studies that have been done in laboratories, but we just don’t know for sure how supplements will interact with medications, or how large doses of isolated phytochemicals will affect people.

At this point, I do not know for sure whether or not I or you or anyone else should take a resveratrol supplement, but I’m happy to tell you to eat plant foods that contain resveratrol. Besides red wine and grapes 70 other plant foods have been identified that contain resveratrol, including many berries, plums, peanuts, and pine nuts. Plus when you eat these foods you increase your consumption of the thousands of other phytochemicals that are in those foods. The best way to take phytochemicals appears to be in their "original packaging", that is fruits, vegetables, nuts, beans and whole grains.

So, even though the media stories about super foods can miss the underlying nuances of research and can cause confusion, I still welcome the opportunity to think and talk about "super foods" and why including these foods in our diet can be helpful. I just embrace a much wider definition of what can constitute a super food. Almost all plants foods, especially ones that are minimally processed such as fresh or frozen fruits, vegetables, whole grains, beans and nuts have health benefits. In addition to that, these foods are delicious!

For recipes and more ideas for increasing plant foods in your diet, please visit www.aicr.org.

Please note that I am not recommending drinking lots of red wine. Please talk with your doctor or other health care professional about appropriate amounts of alcohol consumption, including red wine.