Risks

Every day we take risks, we drive, we invest in the stock market, we apply for jobs, risky business life is eh?

The vernacular of medical oncology is risk. Local radiation is a treatment to reduce the risk of recurrence of the cancer in the breast Chemotherapy helps to reduce the risk of recurrence of cancer in other parts of the body, it also helps to improve 10 year survival rates. Hormonal therapy reduces risks in similar fashion if the tumor feeds off female hormones.

We know about the benefits of these therapies thanks to clinical trials that have randomized, quantified, stratified up the yinyang.

I think one of the hardest tasks of an oncologist is communicating the risk reduction of treatment to a patient. It's essential that the woman with breast cancer understands her options and understands the benefits of such options, but when the data is so complex, when the benefits are blurred, effectively communicating the concept of risk is crucial to ensure shared decision-making.

So far I've only discussed the risks reduced by treatments for breast cancer. To make things more tangled for treating breast cancer, there are also risks associated with the very same treatments that help fight the tumor. Radiating vital organs, Heart failure caused by adriamycin, uterine cancer from tamoxifen, you have the potential of getting ANOTHER cancer from an anti-cancer treatment. How dumbfounding! So here comes the second layer of risks and benefits for treating cancer. The oncologist and the patient have to weigh the benefits of treatment with the additional risks taken on due to such treatment. Here's a question, if someone told you that you could take a drug for 6 months, lose your hair, feel sick all the time, lose feeling in your fingers, have no energy, and this drug would improve reduce your risk of recurrence of cancer by 10%. But, this same drug comes with a risk of heart failure, say 4%. Getting complicated yet?

The tertiary level of complication is the basis of all of these numbers, where did all these numbers come from anyways? We know the answer: clinical trials. But the deeper questions are, what types of patients were on the trials? Were they your age? Were they your ethnicity? Were their tumors similiar to your tumors? Where they node-positive patients? Node-negative patients? How far along did they start the treatment? Did they take anything to prevent breast cancer in the first place? How successful was the local resection? What other treatments did they have? Talk about opening Pandora's Box...

Given this uncertainty, how are oncologists (or patients my gosh) supposed to make sense of all of this? That's my question, I still haven't figured out the answer. For oncologists, I know that years of training, of questioning and contributing to the medical literature, of immersing themselves in the controversies and successes of medical oncology, and treating a lot of patients can help. For patients, I think it comes down to the realization that at a certain point, you have to trust your physician's judgment, you have to believe in the efficacy of your treatment, and you have to have a lot of hope.

Cancer sucks

I haven't unloaded much about my experiences at the Breast Care Center. I like simplicity, and nothing about cancer or the breast care center is simple, I do have two simple conclusions I'd like to share. Maybe I'll have more eloquent reflections later.

1. The physicians, nurses, and staff at the breast care center are incredibly caring, passionate, hardworking people who go above and beyond the call of duty.

2. Cancer SUCKS.

Puffin' Presidio

So, today was my first time running in the Presidio. My new nickname for it is the Puffin' Presidio, since all I seemed to do the whole run was huff and puff.There were so many hills!!! My calves were so tight as I made it up the last one. These hills were monsters, long, steep hills that had no end in sight. We actually ran more than a mile straight up hill. Owieeee. Luckily, Meredith and Eugene had my back, and we really did beat those hills into the ground. Not only were there hills, but this was a long run, we ran for 75 minutes, that's one of my longest runs ever. We'll see tomorrow who really won, us or the Puffin' Presidio.

The thing about this run that I really liked was that it was an adventure. We got a little turned around (read: I got lost and dragged E and M with me), but we ended up at Chrissy Field, the sun was shining on the city, the bay was gorgeous strewn with dozens of kayakers, the Golden Gate was as overwhelming as it always is, and Angel Island looked like a playground just calling from the east. There were so many people out running, biking, walking, and with Mez and Eugene singing shooop, at 47 minutes into our run I was just so happy that we decided to go on our adventure. Yes, I endured pain, yes my ego was hurt when I had to start walking up that last bit of the hill (there was sand!), but it was awesome!

"Hills hills hills, yeah they kills kills kills, but I don't need pills, pills pills pills, cuz I can fight my own hills, hills hills hills."

Running blog

I've been running on a fairly regular basis now since January 1st of this year. I've even kept up my training log! I had some down time in February with a vacation and being sick, but now I'm back in full throttle. Even though I was a track and field athlete in college, I frankly didn't do much running except for summer and fall workouts, at least running over 800m at one time! So it's been fun to change things up and really focus my energies into running. I really do miss the throws and the jumps, but I've been having a ton of fun coaching the MacCanDo athletes in these events. My knees and back aren't really made for the field events, I wish they were or I would still be training!!! For now, running is my main sport. Since I've now done it fairly consistently over the past 3 months, I figured I would start blogging about my efforts on a bit more regular basis.

For now, I am very fortunate to live by a track and the amazing Golden Gate Park, AND to have wonderful running partners in Meredith and Eugene. They have really helped to spark my interest and excitement in running and have given me a lot of motivation to keep going and extending my distances. Thanks for being great running partners guys!