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Archive for December, 2009

We must rethink a system that disproportionately rewards medical testing and procedures rather than thorough and complete histories and physical exams.

On Being a Difficult Patient

Rarely do difficult patients get to weigh in on why they are “difficult”—and rarely do doctors get to explain to difficult patients why it’s difficult to care for them. In the first of these essays, patient Michelle Mayer, a research professor in North Carolina with a chronic autoimmune system disease, tells why she eventually became a difficult patient, and how it helped her get the doctoring she needs.

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What do you think about the new recommendations on mammograms and self-exams? 

The recommendation of the U.S. Preventive Services Task Force (USPSTF) is that women over 50 should have an annual mammogram. Previously, it was women over 40.  We used to be told to do monthly self-exams. The panel is not recommending self-exams.

What do you think? Will you continue to do a monthly self-exam? 

“The net effect of the new guidelines is that screening would begin too late and its effects would be too little. We would save money, but lose lives,” says Stephen Feig, MD, professor of radiology at the University of California at Irvine and president-elect of the American Society of Breast Imaging.

Breast Guidelines Wipe Out Years of Progress

(A group of breast cancer experts) say the guidelines would represent a major setback, wiping out decades of progress.

“Deaths from breast cancer have dropped by 30% since 1990, when mammography screening beginning at age 40 became more widespread,” says Daniel B. Kopans, MD, professor of radiology at Harvard Medical School.

He says the task force relied on studies with methodology flaws that underestimated the benefits of mammography.

“Numerous [well-designed] studies have proven the benefits of annual mammograms beginning at age 40,” Kopans says.

“The guidelines tell women in their 40s that they can go back to the 1950s when they had to wait until a tumor was too large to ignore, and then go to the doctor when there was no longer any chance of a cure,” Kopans says.

Breast Screens’ Benefits Outweigh Risks

Feig also took issue with USPSTF’s reasoning that for younger women, annual mammograms carry a risk of harm, chiefly anxiety and false positives, that could outweigh their benefits.

“Think of a smoke detector. Do you want it to go off only when the house is half burned down or put up with the fact that it will sometimes go off when there is smoke in the kitchen?

“You’re going to have some false positives, if you detect cancer early,” when it is most curable, Feig says.

Source

Of course, the recommendations were for women who had not had breast cancer. Women who have had breast cancer should follow the recommendations of their doctor.

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The Spirited Walker: Fitness Walking for Clarity, Balance, and Spiritual Connection, by Carolyn Scott Kortge, gives me guidance about walking and breathing. Kortge was a presenter and a workshop leader at the Life Beyond Cancer Retreat at Miraval when I attended two years ago. I’m not a fitness walker, but I turn to Kortge’s book for help and inspiration. Walking might be the one best thing that I can do to improve my health, reduce my risk of recurrence, and increase my sense of well-being.

This morning, I re-read the chapter, Breathwork for Walkers, which explains how controlling the pace and depth of breathing can increase our stamina and help us relax by tapping into “a channel of energy that reaches deep into the body instead of ending in gasps at the neck.”  When we breathe right, “fears disappear. Breath spreads through the body like a soothing breeze.” 

When I returned from six weeks of radiation treatment and felt fear and panic intrude into my day, I grabbed a jacket and headed out the back door to walk it off. Sometimes I drove into town and walked the sidewalks around the lake or the fishing pond. Or I drove up to the farm, left my car, and headed down the gravel county road, sometimes veering off on a pivot road into the middle of a field, then back to the car.  Once I didn’t want to worry about calculating how far I could go before needing to turn back so I called a relative and said I was walking as far as I could, then I would call them to pick me up. 

Sometimes I walked and counted my breath. Sometimes I counted my steps or followed other of Kortge’s directions. Sometimes I walked counterclockwise around the walking path and prayed, then realized I was meeting serious fitness walkers going the other directions, knees and elbows pumping high.

I went through a time this year when I didn’t feel well and I was depressed and I didn’t walk.  I believe if I had walked during that time, I would have been better much sooner, both physically and emotionally.  Walking and breathing fills us with a life force. Kortge discusses that connection between between breath and spirit or life.

 The Latin word spiritus means both breath and spirit. The Sanskrit language speaks of prana, the life force carried in the breath. English places spirit at the essential core of life in the words inspire and expire. . . . The power of deep rhythmic breathing to enhance physical, mental, and spiritual well-being forms the foundation of many ancient spiritual and healing practices. . . Breath links the inner and outer worlds, unifying action and intention. It guides us across the communication gaps that develop when mind and body are separate. . . .By developing awareness of the breath, we become better listeners for the physical information we receive from our own bodies.”

 

As a cancer survivor who is constantly learning how to be vigilant for signs of a recurrence without being anxious over every physical change, I can use all the help I can get to become a better listener for the information I receive from my body. Walking and breathing are not just good for me, but may help me learn a new way of being a survivor.  I’m going to re-read Kortge’s book.

And I am going to walk somewhere, somehow, each day, whether it is on a treadmill when the weather is bad, through the fields in the sunshine, down a gravel road, up the sidewalks in town, down a fence row, or up and down the stairs in my house.

This morning when I went outdoors,  there was a dusting of snow on the ground. The pheasants came out of the newly harvested cornfield and flew up into the tops of the trees.  I took a photo of them against the pale morning light.

Later, I saw them hurrying past my house, headed for a wheatfield.

On The Walking Path to Survival – more on Carolyn Scott Kortge

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