Thanksgiving Holidays

Sunday, November 30, 2014

I can't believe the four-day holiday is almost at an end.  This is the first time in years that I haven't traveled to celebrate Thanksgiving and I've enjoyed having more time to be at home although I also miss my immediate family and A's family.

We weren't alone by any means and drove just slightly north to celebrate the holiday with my extended family.  Growing up far away from the family center, we celebrated holidays with our small immediate family.  It's kind of fun to pull up to my grandmother's and have the driveway piled up with cars.

Adam made barbecued green beans and I made the sweet potatoes.  Everything about Thanksgiving was pretty standard.  Everyone else headed off to the movies and I hung behind with my grandma, knitting and chatting.

The day after Thanksgiving was, of course, dominated by Nebraska football.  The game against Iowa was definitely too close for comfort.  My bloodsugars even reflected the intensity of my emotions. After almost perfect bloodsugars throughout the entire Thanksgiving holiday, you can see the bloodsugar spike that happened as Nebraska began mounting its come-from-behind victory.  You can see a screen shot of 12 hours of bloodsugars on my CGM.  Almost perfect until the middle of the third quarter when it began to look like Nebraska had a shot.  So funny to have such a compelling visual of how sports fandom can affect the body!

Saturday, A and I hit the lots to start looking for a new car for him.  Right now we're struggling to balance practicality, affordability, and fun.  It'll be interesting to see where we end up.  We have a few more cars to look at, but A seems particularly interested in the Mini-Cooper.  When I look at that car, I see the next ten years and no space for carseats, but A has been through a lot and deserves something fun, so we'll see.

In the backdrop of all of this, Houston has been beautiful, producing just slightly cold, perfect fall-like weather for the holiday.  This is the view outside our windows.  You probably can't tell, but there is a little swan on the edge of the water.  This is my home.

Org. Series #8 Wrapping Paper

Tuesday, November 25, 2014

Wrapping paper can be a total mess.  I can't tell you how many feet of paper I've had to toss in the trash because they got crumpled in the closet somewhere.  This year I finally broke down and bought a wrapping paper organizer!  The organizer I picked is this one from The Container Store and that occurred because I happened to see it there while purchasing wrapping paper, but there are many other cheaper options at Target and Wal-Mart and the like.  Such a lifesaver!

New Vitamin D Update

Monday, November 24, 2014

I have written several times about studies suggesting low Vitamin D is related to the most prominent causes of death.  About an hour ago the NYTimes just released this story, which reports on a Danish study that determined low Vitamin D is casually linked to earlier death.  According to the study, low Vitamin D levels increase the risk of cancer by 40%.

Changing up my approach to exercise

Sunday, November 23, 2014

At my last doctor's appointment, my doctor and I set a goal of losing six pounds by my appointment in February.  I had gained weight from my previous appointment in spite of the fact that I had reached of level of physical fitness and consistency that I hadn't seen in years.  It is likely that part (or maybe all) of the weight-gain may have happened during the stressful time while A was inpatient and recovering from intensive cancer treatment and friends were bringing us decadent, comfort-food meals, but even if that's true, I realized I needed a more effective fitness routine.

The old approach consisted of running three days per week and hot vinyasa yoga two to three days per week.  This type of workout routine worked wonders for my vital signs.  My previously slightly-high blood pressure plummeted.  We measured it once on a stressful day in the hospital and my blood pressure clocked in at 106/65.  My resting heart-rate dropped into the 50s.  But, while it is clear that my heart had strengthened, the cardio-based approach wasn't torching fat.

After some extensive research, I've changed things up just a bit.  Instead of running three days per week, I'm running once and doing 2 HIIT workouts from Fitness Blender (a fabulous site with free full-length HIIT workouts that require no equipment), I'm still doing hot power yoga about twice per week, I'm playing tennis once a week and have added one day per week of weightlifting with my husband at the gym.  The reasons for making these particular changes are mixed.  Adding tennis, for example, had nothing to do with improving my fitness routine and everything to do with happening to rediscover a game I love.  I decreased my running and added HIIT after reading up on making the change.  The impression I got from the articles I read was that you should consider adding in HIIT into a workout if your blood pressure is good and your resting heart rate is below 60.  HIIT stresses your body in different ways than cardio, depleting your oxygen stores and burning carbohydrates.  The hype behind interval training is that it kickstarts your metabolism and causes you to continue burning calories long after the workout has finished.  While HIIT seemed like a debatable change, the need for weightlifting seemed pretty obvious.  Almost every fitness expert recommends a balance of weightlifting and cardio because increased muscle mass changes the amount of calories your body burns.  Fitness experts would probably recommend weightlifting twice a week, but I have not yet developed a great love of weightlifting and I think it's more important to have a workout schedule I love than the perfect, ideal workout combination.

I am paying for the changes to my workout in terms of my ability to run.  It's not as easy to run one day per week as it was to run three and that has meant it's a bit more challenging each time I do run. I was able to ignore all of my feelings about my decreased running ability on my running day today because the weather was beautiful.  Running felt beautiful.  I ran with my arms outstretched.  Houston is perfect this time of year.

Two years

Friday, November 21, 2014

Judge Kopf married A and I two years ago in Lincoln.  I love the memory because it felt so authentic.  I felt a little bit nervous that morning unlike on the day of our wedding celebration.  And the moment felt much more the way marriage feels.  But A hates the memory and he's entitled.  He was very sick.  Rushing out to puke outside the courtroom kind of sick.  Skipping our planned dinner celebration and returning immediately to the hospital kind of sick.  Thankfully, that day did not approximate, for him, the way marriage feels.

We are not specifically celebrating our anniversary today.  We are celebrating our lives and marriage in the way that we do every day.  We are meeting up after work at the gym to start a weight-lifting routine.  I need to begin weight-lifting to improve my health and A is just barely able to begin the process of recovering from his last super-round of chemo.  After the gym, I will try making a new sweet potato recipe and that will be lovely.

Although I won't be drawing too much attention to today, it is a marker that focuses my view on time and all of the changes that have occurred as time has passed.  What a difference two years makes!  Looking back, I'm very proud of the way we handled our first two years of marriage.

Leaving Nebraska

Thursday, November 20, 2014

I have as much home-state pride as the next girl.  I don't know that it's so different from every other place in the way all of those "You know you're from Nebraska if . . . " articles seem to suggest.  Whenever I read those, by the time I get to the end, I know the author is struggling because she ran out of unique things to say after hitting the fifth or sixth item on the list.  I don't live in Nebraska anymore, but I don't think there will ever be a time in my life where I hate having to say that I don't live in Nebraska anymore.

It's not that I am urging my husband to move back home.  He had a fabulous job opportunity in Houston and he loves his job here.  I also love that he is being treated for leukemia at one of the best hospitals in the country.  My extended family is here and I know that my folks are planning to leave the cold and windy plains when it's time for them to retire.  Sometimes I marvel at the city as I drive my car into downtown Houston.  It amazes me that my coworkers can pick a new place to try for happy hour every month and it's always great and always within walking distance of work.  There is a meetup group that does everything.  It isn't that I'm unhappy here in Houston or that I don't think this move, and my husband finding a job he loves, was in our best interests.

I just miss Nebraska.

Lanny Fuller wrote on a blog entry going viral that "Out here, people aren't afraid of feeling small."  As an attorney, this may be what I miss most about home.

When I graduated from Duke Law School and returned home to Nebraska, it felt like I could finally breathe again.  No, I'm not one of those people who hated every minute of law school, I loved it, but I did feel guilty every time I took a shower that was a little bit too long because I knew I could have been using that extra time to study.  Back in Nebraska, I took a comparatively low-paying job as a government-attorney.  And I did good work, but I also left the office in time to make dinner and I worked from the hospital sometimes while my husband was receiving chemotherapy.

In Nebraska, nobody wanted to hear about my resume, they wanted to hear about my family.  Nobody pressured me about my career goals, they wanted to know if I was happy, if my life felt balanced, which colors I was considering for my wedding.  They knew I would figure everything out in time, or if I continued to work for the government my entire life, that would be wonderful because it was challenging, important work and being satisfied with the work you do is more important than being rich or well-known.  You can be rich in so many ways.  I knew about my boss's kids' soccer tournaments and my co-worker's exercise routines.  As I worked steady hours, but wasn't plotting toward some grandiose future, I spent time in the hospital with my husband as we fought cancer and nobody judged me for spending all of my after-hours time in that way.

We are programmed to mimic our peers to some extent.  The influence, at least for me, cannot be escaped entirely.  In Nebraska, everyone approved of my steady job and family focus and I split my efforts between improving my legal skills and giving to my family.  I did not spend my evenings networking.  And I never felt inadequate.

The big city in Texas is not the same.  I moved into a similar job in Houston, but people wonder when I'm going to finally be ready to transition to a job at a law firm.  And then I start wondering and questioning.  I wonder if my small life is enough.  Am I wasting my brains?  My education?  The doubt creeps in here in a way it never did back home.  Out there, people aren't afraid of being small.  It's harder here.

Study suggests milk is unhelpful and potentially harmful for adults

Tuesday, November 18, 2014

I've become a bit jaded by health studies and health advice over the years.  It seems almost every old adage has been dismantled, but this one shocked me even more than the first time I heard that fruit could be considered unhealthy.  (For what it's worth, I still think fruit is healthy.  I acknowledge the sugar, but it comes with so much fiber and antioxidants, and I have to believe that variety is still the spice of life.)  Anyway, today we have a new study claiming to dismantle everything your mother ever told you about drinking milk.

I skimmed the article and have only skimmed the studies, so I have more research to do to be qualified to really discuss these findings, but some of my initial reactions are that the causality linking milk to early death is non-existent and I'm not sure it's even worth mentioning the correlation.  Also, while the statement that most Americans are not (known to be) vitamin-D deficient might be true, I've written several times about vitamin D, including here, and here, because a substantial percentage of Americans are vitamin-D deficient and the current thinking suggests that is no minor deal.  Finally, even today's article concludes that milk in moderation is fine--well okay--was drinking milk to an excess even a major problem?

Even with my slightly skeptical response to the alleged harm, it's certainly interesting to know that milk doesn't seem to have the protective qualities I thought it did.  For, now I'm staying put.  I don't drink enough milk that this new article will alter my behavior and who knows when this study will be overturned by the next.  Still, interesting.

Exercising and Gaining Weight

Wednesday, November 12, 2014

Just last night I was reflecting with my mother about the lack of any weight loss benefit in spite of a substantial overhaul of my exercise regime.  Everyone says it must be muscle, I was explaining to her, but it doesn't seem like muscle.  If I had just gained muscle, I would expect to eventually be losing weight, but I'm not.

Almost as if it read my mind, today the New York Times published a story on exercising and gaining weight in which the Times reported on a study of women who undertook a new exercise regime under supervision and were told not to change anything about their eating habits.  Some women lost weight, but a substantial number of women gained weight, which suggests that, at least for some, exercising causes an unintentional increase in calorie intake that is not offset by the calories burned.

Before making observations about weight loss, though, I want to point out that fitness ability is more important than weight in terms of achieving health benefits, so it would not be advisable to avoid starting an exercise program out of fear that you'll gain weight.  But, a few takeaways from this study:

1. The old adage that diet causes you to lose weight and exercise doesn't really do anything may not be true.  It may be that exercise doesn't work because people are likely to increase their food intake without realizing it when they start an exercise regime, but if they held their caloric intake steady, they actually would lose weight.

2.  Exercise is not a cure-all, so it's important to track what you eat even if you're exercising regularly.

Pumpkin Cream Cheese Bread Thank-Yous

Sunday, November 9, 2014

The idea of trying to figure out how to thank everyone who has helped us this past month has been overwhelming just because so many people brought a meal or arranged delivery.  To be clear, I don't think that everyone dealing with an illness should expend tons of effort to thank those helping them out.  The last thing your friends want is for you to be sweating over the stove while your loved one is lying on the floor of the bathroom alone in agony.  But, since I found myself with the opportunity to make some time to thank people, I spent some time trying to determine how.

I haven't quite figured out what to do for everyone, but I did take a big step towards thanking the folks at work.  I settled upon this pumpkin cream cheese bread recipe.  The benefits of doing something like making bread are enormous.  First, I was able to double the recipe and bake two loaves at a time and I could bake all of the loaves in succession.  Second, as I repeated the same steps over and over, I got faster and better and actually making the loaves.  Third, these loaves are easy to stack and easy to transport.  And this recipe is the perfect combination of seasonal and sweet without being a straight dessert.

A few tips and tricks with this recipe: 1. Put the cream cheese layer close to the bottom rather than the top.  Because the pumpkin mixture is heavier than the cream cheese mixture, whenever I set the pumpkin in the cream cheese moved around.  Having the cream cheese closer to the bottom made it much easier to actually close the bread.  2. 48 minutes was way too short for my oven.  I started the loaves at an hour and added an additional 15 minutes onto that for some of them.

I had some burlap sitting around and that proved to be a nice touch at the end.  I also spiced up the envelopes of the thank you notes with metallic puff paint because "why not?"

A practical guide to dealing with a cancer diagnosis #1

Friday, November 7, 2014

[In an attempt to capture everything I've conveyed about caregiving in the cancer context, I broke the process down into five categories: 1) the medical, 2) the financial, 3) the logistical, 4) the social, and 5) the emotional.  I tried to write about all five in one post, but never could finish it up, so I'm going to post these in a series.  This post focuses on the medical and financial aspects.]

Treatment for leukemia is a long process.  We just celebrated (okay, we didn't really celebrate) the two-year mark, and we have another six months to go on chemo.   The downside is that it's a LONG process, the upshot is that I have learned a lot about how to handle it all in the past two years.  Does this mean I'll handle it well this time?  Who knows, every round comes with its own surprises.  I think my odds of success have been increasing, though.

The following is a practical guide for caregivers prepping to go through it.  It is not scientific, it is based on my own experience:

The Medical:
1. I am constantly amazed by two things when it comes to cancer treatment: the first is the amazing scientific advances--what humans have learned about our cells and how to change it is truly amazing.  Many days I am in awe of the medical establishment.  Equally amazing is the lack of detail-orientedness at every cancer center we've been--and we've been to some of the best.  From missed lab tests to attempting to administer a flu shot to an allergic patient, a clearly marked allergic patient.  You have to be your own advocate and you have to hold your treatment providers to the plan they intended to execute.  If you aren't on your game, the game-plan will not be executed properly.  My best advice is to contact LiveStrong and get their big patient binder.  Open up the calendar and write down every test any doctor mentions and the date it's supposed to occur.  Write down all the medicines prescribed.  Write down all of the discussed contingency plans and options.  Keep the binder with you anytime you walk into a hospital and don't be afraid to question your provider when the game-plan you hear on Thursday doesn't match what you were told Wednesday.  These are big treatment centers and the providers are treating lots of patients.  They need to be reminded about the specifics of your loved-one's disease.

2. Understand your treatment plan.  Oncologists walk faster than any category of human beings I've ever seen.  They pop into the room and never take their eyes of the doorway.  It's like they just dined and ditched and are about to be caught.  Call the oncologist back into the room, tell them to slow down while you think a minute, and ask them your entire list of questions.  Make sure you understand what they told you and make sure it makes sense to you.  There is no reward here for taking the path of least resistance.

3.  Get a second opinion.  This applies more toward the beginning and at any major decision-branch in the treatment.  It's a pain.  It feels impossible to travel while your loved-one is so sick.  But, cancer is life and death.  Every doctor we've met has found something important that the others missed.

4.  Try to get your loved-one to be honest about the side-effects they're experiencing.  The doctors and pharmacists will come in with a chemo calendar and tell you it's a standardized plan, but chemo regimens are not one-size fits all.  It'll get adjusted over time.  The doctors are balancing different risks and so it's important that they know your loved-one had acute chest pain--they need to test for that pulmonary embolism and the answer to that test matters.

5. Making decisions about treatment: One of the most terrifying parts of A's experience was when the doctor told us he didn't have any advice as to whether or not A should receive a bone marrow transplant.  The doctor basically said, well, I don't know what's going to work best--it's an option that comes with certain risks.  But, in our case he didn't have a recommendation.  "The transplant team was equally split," he said.  In another conversation he added, "the hospital makes a lot of money from transplants" without any further explanation or comment.  That's one thing to be aware of--the hospitals and the doctors have interests and in borderline cases your treatment providers may or may not consider those.  Knowing that doesn't help you much.  My best advice is to try to seek second opinions from folks outside of the hospital who will do the actual procedure to make sure they have no skin in the game.  Also, ask social workers and folks from cancer support groups to connect you with others who have had to make the same decision and find out how they made their choice.

The Financial:
1. There is some sticker shock associated with cancer treatment.  The last thing I wanted at the end of a long day working and then at the hospital was to come home to my empty apartment and open medical bills.  It has to be done.  Know that you will not make it through cancer treatment without a mistake.  Familiarize yourself with the details of your plan and get used to calling your insurance company.  I've heard that in cases like cancer, you can request to have one person consistently handle your case.  Given the amount of run around you're probably going to get, I might set that up.

2. Even after you know the details of your insurance plan, stay on top of it.  This was something that I delegated to my mother during A's initial diagnosis, but we've taken it over as time has progressed.  If you can delegate this aspect of care to someone, I'd absolutely do it.  I guarantee that you will not make it through your cancer treatment without billing errors that you'll want to challenge.  You may be able to set up one contact at your insurance company, which can be very helpful as every time I call the insurance company they contradict whatever they said the last time I called.  Watch out for pre-authorization problems--you don't want to be trying to get pre-approval at 4 p.m. on a Friday for something your loved one needs done immediately, you'll spend the whole weekend beating yourself up about your inevitable failure and it's unlikely you'll get it solved first thing Monday.

3. Accept that you are going to spend than whatever the out-of-pocket max is on your plan and start trying to incorporate that into your budget.

4. If you have a diagnosis like leukemia, you automatically qualify for social security disability benefits, but it takes a long time for the paperwork to set in.  Get that started immediately if your loved-one will not be able to work during treatment.  With respect to work, see if there is any way your loved one can work from home, work from the hospital--the longer they can stay employed the better.

5.  If your loved one cannot work and takes disability, start looking into your health insurance options pretty quickly.  If they lose coverage, they should be able to be on your plan, but you have a tight window to obtain coverage.  That coverage may be ticking away while you're in the hospital and your employer isn't going to be incentivized to bend rules to add a cancer-patient into their group.  Talk with social workers about all of the options available if you're on disability.  Don't delay on this.  Note that some of these insurance changes may need to be made well before you ever see a bill.

6. Cancer takes a heavy financial toll on almost everyone.  It's normal to feel overwhelmed.  If you're feeling crushed under the weight of the medical bills, talk to a social worker at the hospital about different resources out there.  Sometimes hospitals will work to charge you less for treatment and social workers can also direct you to resources.  The American Cancer Society and other groups will pay utility bills, rent, and all kinds of bills for cancer patients who are struggling to make ends meet in the face of the millions of dollars in medical bills.