Because Of Your Medical History....

Once you get cancer or any other 'nasty' medical ailment, this little phrase follows you for the rest of your life 'because of your medical history...'. If you have this phrase following you around, you are lucky when you are not sent for more tests or additional follow appointments start filling your calendar.

As a child I was not the one (sister) who had ear infections non-stop or the one (brother) that went running around into and over and under things resulting into many minor injuries requiring stitches, etc. I was the reasonably healthy one, except for a few colds here and there.

Boom, at age 19, I was diagnosed with thyroid cancer and that magic little phrase started following me around. I never had a normal doctor appointment. Even if it wasn't discussed, that cancer history was still lurking in the air between the doctor and I.

It followed me for decades. Until I added another cancer diagnosis and then it followed even closer. And was probably written like this 'because of your medical history...'. Two cancer diagnoses before fifty and all the red flags start jumping up to the doctors. Do you have a genetic abnormality? Did you wade in toxic waste as a child or live next to a smelly factory? It didn't matter why, all it meant was I went to more doctor appointments than anyone I know.

Since then with a bad back (three different places), rheumatoid, and fibromyalgia, now my pet phrase is written like this 'because of your medical history...'. It is right on my heels every day. I now need my medical history to the point that I don't even dare to go to another hospital. It would take too much time to explain my ailments, allergies, and medications to any emergency room triage person. No, I can't print out a list to take with me because it changes too often.

So that little phrase has gone from an annoyance to a necessity. Damn. I wish I was healthy.

Screening Recommendations Based on Doctor Personal Experiences

Recently in JAMA, "...a research letter... explores how social interactions with friends, family and colleagues who have been diagnosed with breast cancer may affect a physician’s recommendations to patients."

What it found was that a doctor's personal experiences impact what they recommend for their patients. They did not necessarily follow the current guidelines. 

"Physicians familiar with someone with a poor prognosis who was not diagnosed via screening were much more likely to recommend routine checks for women between 40 and 44 years old and those over 75."

“Describing a woman whose breast cancer was not diagnosed by screening mammogram and who had a poor prognosis was associated with increased odds of recommending routine screening to patients within the designated younger and older age groups for which guidelines no longer support routine, universal screening,” Pollack et al. wrote." 

In my personal experience, my rheumatologist has been very hesitant to prescribe a biologic, such as Humira or Enbrel, for my rheumatoid arthritis. It is standard not to prescribe them to anyone who has been diagnosed with any cancer in the past five years because there is a TNF (Tumor Necrosing Factor) in them. 

Although I am more than ten years out from breast cancer and over 30 years out from thyroid cancer that translates to two cancer diagnoses before the age of 50. So she has been very hesitant. She even has conferred with my oncologist on this. Finally she has prescribed me Orencia which I have just started.

And the truth came out. At a recent appointment she told me that she had a patient who had had cancer and was over five years out from her diagnosis. My rheumatologist put her on a biologic for her RA and then she had a cancer recurrence. Who knows if the two were connected but that has had an impact on my rheumatologist. And she doesn't want to have this happen to any more of her patients.

“Our results suggest that helping clinicians reflect on how their experiences influence their current screening patterns may be an important approach to improve adherence to revised breast cancer screening guidelines.”

From a patient's point of view, I want impartial treatment for all my ailments. But there is so my crossover and overlap between them that discussions are often required. Due to my medical history, I have 'received' more screenings (a/k/a medical misadventures) than anyone else I know. I want the doctors to bend the guidelines to help me as best as possible.

Clinical Trial Exclusions

A recent SEER report looked at the incidence of  previous cancer diagnoses in newly diagnosed patients. An average of 18% of newly diagnosed cancer patients have previously been diagnosed with cancer. (25% of  patients over the age of 65 and 11% of those under 65.)  All these people will also probably exempted from any clinical trials for their new cancer because of their previous cancer.

"The investigators concluded: “A substantial proportion of patients diagnosed with incident cancer in the United States have survived a prior cancer. These patients may be excluded from clinical trials and underrepresented in observational research, and little is known about their treatment and survivorship needs. Understanding the nature and impact of prior cancer is critical to improving clinical trial accrual and generalizability, disease outcomes, and patient experience.”"
I am in this group with two cancers before the age of 50. I have never participated in a clinical trial. Why? Because my previous cancer always exempts me.

While I understand that clinical trials try to keep their participants as homogeneous as possible to prove product safety. However, the problem is it excludes a lot of people. Why should my medical history bar me from potentially benefiting from a clinical trial medication? And why can't I help future medical care by participating in a clinical trial? And its not just me, its the other 18% of the population which already has had cancer and has been diagnosed with another one.

I just took a peek at a few trials over on clinicaltrials.gov and easily found some with exclusions that include:

• Prior cancer diagnosis or chemotherapy treatment.
• Active autoimmune disorder.

Here I would not be accepted because of my two cancer diagnoses, chemotherapy, and active RA. (This can make me feel like no one loves me.... and I could get a complex here.)

I think it is time that clinical trails reflect the population - we are aging, we have medical histories, 18% of us have lived through cancer. 18% of clinical trials should include patients with a history of cancer. We live through cancer but we can't participate. Not fair to us nor to future patients who might benefit from our medical histories.

Vanessa Bayer

I can tell you I am not Vanessa Bayer's biggest fan, because I honestly do not stay up until midnight to watch the show (waaaayyyy past my bedtime). But I am suddenly a hug fan of her openness regarding her leukemia diagnosis.

I was getting my hair cut this week and had a chance to catch up on the latest magazines, including People. 

"When Vanessa Bayer was just freshman in high school, she was diagnosed with leukemia. While the news was a shock for her and her family, Bayer says her cancer battle ultimately led her to a career in comedy.

“I wasn’t really that scared,” Bayer says in the latest issue of PEOPLE. “My dad is a really funny guy, and we would make jokes about my leukemia. When my friends would come over we would joke about it too. It’s sort of messed up out of context, but it put everybody at ease. Being sick is the reason I went into comedy.”"

She went from being a Make-A-Wish kid to a career in comedy and she's still here. 

Also, I really want to say that I am so happy to hear about another person who had cancer while young and is being very open about it. I think that the world is a better place if people do not keep their illnesses quiet. There is nothing wrong with talking about your medical ailments. And you probably are a lot healthier if you do talk about your medical issues. 

But anyway, I am now one of her biggest fans.

The big reveal

I have worked at my  job for almost 6.5 years and am leaving in five weeks. Well I will work remotely one day a week and come in once a month until my replacement is found. Which I assume will take until spring.

I have made friends at work as I have been there so long. They make fun of  my health regularly. And they only know half of it. Yesterday's joke was that I have more ailments than all the patients on the first floor of the local hospital combined. We laugh about it. They wonder how I can laugh about it and I say I have to laugh about it because I really do not have any other choices.

But they really do not know all about my health. They know I have a bad back, fibromyalgia, and rheumatoid arthritis. They do not know about cancer and all the rest. I have decided what I will do when I am done working there is I will give two of my co-workers a link to my blog so they can keep in touch and follow along with the rest of the disasters in my health (unless I miraculously get cured).

In the past, I have never shared my medical crap with my co-workers. I have always felt it doesn't belong in the workplace and I might some day want a reference for another job. At this point, I am retiring and hope to apply for disability social security. I don't plan on needing another job reference because I don't think I can continue to work at all.

So finally I can reveal my medical history to anyone I want to with out fearing any impact on my professional life. I mean who wants to hire someone as unhealthy as me?

New Guidelines for Life after Cancer

The Spring issue of Cure Magazine has an article on the new guidelines for life after cancer from the National Comprehensive Cancer Network. Sometimes I just want to say 'its about time'.

The article provides a nice overview and is a worthy read. But I do feel it is way late. Why does the medical profession feel so vertical? In the days of personalized medicine, isn't the patient's entire body supposed to be of concern? Each specialist only seems to deal with their little focus and not that of the entire patient.

A cancer diagnosis is not the same as a chicken pox diagnosis and leaves a life long impact. The new guidelines show a new way of thinking. If no one asks about it, how will it become known as an issue?

'To develop the new guidelines, the NCCN engaged experts in oncology from throughout the country. During the course of a year, they split into working groups—one for pain, for example, another for sleep issues—and reviewed the scientific literature on how to assess survivors’ problems and intervene in a meaningful way. Focus areas included:

• Anxiety and depression
• Cognitive dysfunction
• Exercise
• Fatigue
• Immunizations and prevention of infections
• Pain
• Sexual dysfunction
• Sleep disorders

The guidelines were then developed to give oncologists, primary care doctors, nurses, social workers and other healthcare providers an easy-to-follow structure. At the first level, providers might consider asking a few simple questions.

To check for anxiety and depression, for example, the provider might ask:

• Do you often feel nervous or do you worry?
• Do you often feel sad or depressed?
• Have you lost interest in things you used to enjoy?'

It seems almost too logical and clearly in the category of "why didn't we think of this before?"

There is a lot of reliance on the primary care physician who is supposed to care about the whole patient. At this point, I see my primary care annually and see all the specialists more frequently. While they focus on their part, its only when I get to my PCP, that my whole body and being gets discussed. And last year due to scheduling issues, I saw her nurse practitioner, who is nice, but not the same. I do like having my annual physical with my PCP.

But back to the new guidelines. I think its time for me to start making a list of my issues that relate to the focus areas to make sure I am prepared for my appointment... In July.

Your medical records

In recent years, medical records have become more and more available to the patient. Some medical facilities make them available on line. Others offer them at the end of each doctor visit.

I have tried to read translate my medical records. It is not as easy as you think. If it says 'patient denies... '  that just means you said you didn't have whatever they asked you about. They are also full of vague 'doctorisms' that are not as clear to the average patient. That is fine by me.

They are full of the doctor's opinion about what is going on with me. This means they are full of the thoughts and opinions of people who went ot medical school to unravel my medical mysteries. They could probably write theses on my medical uniqueness at this point. And my unique ways - for instance if I find a 'something' its guaranteed to be a 'nothing'. But if a test finds 'something'  its guaranteed to be a 'bad thing'.

But I digress.

A medical record is a pile of doctor notes, test results, procedures, diagnoses, treatment plans, and professional medical opinions.

There is the thought process that patients should find out whats in their medical records. I agree with this. I do get copies of test results. I have been known to ask what is in my records and disagree with it.

But I am not sure I think I should be able to edit my medical record as if it was a Wiki. A medical record should stand as the medical professionals' version of me. It is sort of a reference list of my medical history (blah, blah, blah) and should be what it is and nothing else.

I could add a separate list of information which becomes the patient's side of it. I mean if the doctor said I seemed to tolerate a procedure well. I could happily record in my version that I was uncomfortable and basically it was a very sucky experience. From the doctor's point of view, I might have been uncomfortable but it wasn't a walk in the park as most medical adventures are.

I am an advocate for my health but I also respect that medical professionals went to school for their training and are working with in their professional detachment to keep the emotions out of it. I am full of emotions about me.

Which reminds me, next week I need to go pick up copies of my latest test results to make sure I keep up with  my latest.

Sharing information

Today's topic for Wego Health Blog month is choosing what information to share.

When I was diagnosed with thyroid cancer, cancer was the big C, I was young, and cancer was the killer. I quickly learned that the word cancer made people frequently run away from me. I grew to like 'selective sharing' and only sharing with those I felt were in on the 'need to know'. I didn't tell long term friends for sometimes decades.

At my second diagnosis, I said to myself, the heck with this, I am going to be a bit more open about my cancer and now am comfortable living a life that includes the word 'cancer'. This isn't to say I introduce myself to total strangers as someone who has been diagnosed with cancer. But there are times when I do openly talk about it.

I have two part time jobs. One of them is at a local cancer support organization. There I am quite open with that group as its full of people who have had cancer or who treat people with cancer. I think most of them are fairly aware of my medical background.

At my other job, they all think I know so much about cancer and its treatment because of my job at the cancer center. They do not know about my cancer, they just think I am incredibly unhealthy with a bad back, fibromyalgia, RA, tennis elbow, bad ankle, and more. They laugh at all my doctor appointments and tease me about my ailments. Sometimes I was tempted to tell them about it but then one day one of my coworkers said that every time she hears the word 'cancer', she just assumes that the person is done for. That was it. I no longer considered that as an option.

So how do I decide where to draw the line. I do not broadcast my ailments. I also don't feel the need to keep everyone, including family members, updated with minute by minute updates on the latest ailment and treatments. Sometimes I am more open about things than others. It really depends on the ailment, who the conversation is with.

If my medical issues do not impact the situation, I leave them out. If my medical issues do impact the situation, I may bring it up. If I am asked if I want to go to a museum, I will probably decline. If pushed I might tell them I simply can't stand around like that to enjoy the time.

The level of detail that I share is usually very little. However if a friend calls me up and asks about a specific medical procedure that I have had the privilege of undergoing because they are going to have the procedure, I am happy to share all sorts of details including pain level, hospital stays, recovery, questions they should ask their doctor, etc.

So maybe I still live by the 'selective sharing' on a 'need to know basis'. Maybe I haven't changed as much as I thought.

How would you answer the question?

Someone asked about this on one of the many cancer boards I am on recently, post cancer how do you answer the question: "Do you have any significant health issues?" Let us pretend this is not a doctor's office where we would launch into a twenty minute spiel that includes multiple surgeries, treatment protocols, on going side effects, latest tests and their results, current prognosis, medical facilities used, and current medication list. If someone really needs to know my medical history I need a sheet or two of lined paper, not two scrawny little lines to write in tiny print.

But what if you wanted to go bungee jumping, sky diving, or something which required a medical release? Do you say 'I had cancer and am mostly fine except for a touch of lymphedema'? (Note: my back would preclude me from any of these activities myself.) Or do you say nothing because you are no longer in treatment?

My personal feeling is that if my medical history is going to make a difference I might tell them about the majority of my medical adventures. Is it important for anyone to know I had my gall bladder out four years ago?  Only to my doctor or a surgeon looking to cut into other parts of me.

I will never use the word 'survivor' to describe myself except in the context of  'surviving millions of medical adventures'.  But I could be persuaded to write 'I had cancer twice'. Then I get weird looks and lots of questions and people tend to tell me their medical history. And then we get to have a big discussion about health ailments.

So I guess I would be more inclined to keep my mouth shut about my medical history.

Better late than never

Last winter I was approached by Tory Zellick, the author of "The Medical Day Planner" asking me to review it and then make it available to people at the Center where I work. I said I would because I had plenty of time. The book didn't show up when promised and my life got VERY busy for several months. In the midst of all that the book showed up and as I was busy I put it aside - like every non essential thing in my life. It got lost in a pile of books to deal with.

Finally I rediscovered it and said to myself "oh crap I did say I would review it didn't I?" Then yesterday Ann, over at But Doctor I Hate Pink reviewed it and started a contest for a copy of it. I started to feel like a slacker and the guilt piled on. So here is my review:

One word: wonderful. One request: everyone should be issued one of these at birth.

Seriously. I looked at it and said why don't I have these records of my entire life? I have chemo brain and have no idea. But if I had had this book issued at birth and kept it up to date I would have known.
It makes me want to go back and put in all the information I have on my medical adventures - but I think I might need a second or third copy before running out of space.

My mother used to keep a file on each of us children full of useful things like birth certificates, doctor notes, immunization records, and report cards. I have no idea where my folder is now. I may have it or she may still. I have kept diligent records over the last five years of every medical expense (for tax purposes), appointments, and medications. I have a folder which is labeled "Current Medical" that has my recent test results. I know who all my doctors are and how to reach them - most of them conveniently are at the same hospital where my patient number will unlock the piles of information on me.

I could have used one for my husband as well. He doesn't remember his medical ailments and what he has done either. He did have some medical adventures a few years ago that could have been very nasty but ended up with good results. I wish we had written all that down then as well. Actually he doesn't know it but he has a little section in each of my medical appointment and expenses list so I can track that part of his as well.

But back to the book, unless you are perfectly healthy go buy a copy. If you have never had any ailment - even the common cold - you don't need it. But since we all have had the common cold we all need it. Get a copy for your spouse and each child as well.

It is conveniently broken out into useful sections - patient information, phone book, medication appointments, treatment, procedure history, test and scan history, hospitalizations, notes, and day planner. I'm not sure if a one year day planner will be helpful to me but all the other sections are incredibly logical and useful. Some things would be written in pencil to be erased and updated but others could be indelibly etched in ink.

So what are you waiting for? Go buy a copy!

So whats your medical history?

Do you even know your medical history? Could you write it down and give it to your doctor? I know the doctors always ask if you have had or if there is any family history of about twenty different things at one point or another when you first start seeing them. But then do they ever ask again? No.

But you should tell them about significant health issues periodically. It is recommended this is done every five years.

I am impatient. I tell my doctors more often. Every time I have aches and joint pain, I tell them how my mother has rheumatoid. Every time we talk about my bones and osteopenia, I tell them about the osteoporosis my mother, aunts, and grandmother had.

If there is no medical history of a diagnosis in your family, it doesn't mean you can't get it. But if there is a medical history of something, you may be more likely to get it.

Actually, I think anytime a family member member is diagnosed with anything more than the common cold, you should mention it to your doctor on your next visit. It adds to the big picture of how you are doing. If a family member is diagnosed with a significant something... like that little thing called cancer... it adds a huge amount of stress on you. So speak up and tell your doctor. Stress is a nasty thing that can cause you to grind your teeth, prevent sleeping, and cause depression and other issues.

In the meantime, go home, sit down and write your family medical history down. Then go back and update it as needed over the years. Give a copy to family members as well.

Things change, but they don't really

Last night I was lying in bed listening (with a tiny bit of insomnia) to the heavy rain come down and realized that I wasn't concerned that the roof might leak. This is a significant change, there were a few years where I would dread every forecasted rain storm and even make a point not to be home in case the roof did leak.

When we bought the house in early 2005, we knew we needed a new roof. We had some ice dam issues that first year which caused some ceiling damage too. We had the roof replaced in the summer of 2005. On New Year's Day 2006, I was working in my office upstairs and heard a drip. The roof was leaking in my office. We found a new roofer who would come that day and did some repairs. A few trips by the roofer and several hundred dollars later, we no longer had any drips but I had learned to hate rain. It would stress me out. What if the roof leaked again? We couldn't keep spending money on the roof, we had to pay for other things - a furnace, driveway paving, etc. I was stressed for every storm.

Last night I was not stressed by the rain and I started thinking. I knew the roof could leak at any time. This does happen sometimes. Roofs do leak - during hurricanes, or when big debris lands on them, or with ice dams, not just in regular rainstorms. But I wasn't concerned.

Last week I had my annual mammogram and physical and I wasn't stressed about cancer issues. I was stressed about other health issues on my never ending list of new medical issues. Have things changed? Not really. Just because I was not stressed about cancer cooties, doesn't mean the concern they may reappear has disappeared. It never really does.

After my first cancer diagnosis, I learned to despise the words 'but with your medical history we need to be sure...' Every little medical blip put me to the front of the cancer line. Eventually, my stress settled down and I wouldn't be as concerned about every issue. Then another cancer diagnosis, totally unrelated but very stressful, came along and I returned to the front of the cancer line for everything.

With two cancer diagnoses and three years of waiting for a clean mammogram, my stress level is finally settling down. Maybe my breast cancer is not going to come back but 'with my medical history, they always need to be sure'.

So last week, I wasn't as concerned that they might find cancer cooties related to my breast cancer as it has not been as problematic in the past year. In fact I passed last year's mammogram and with a second clean one this year, I was feeling pretty comfortable with it and wasn't freaking out that they might find something else during it.

Its the other cancer issues that cause me stress but that doctor isn't until July. I have another thyroid ultrasound in July to see if they can figure out what is the 'detectable but too small to biopsy' thing is that is hanging out where my thyroid used to be. So I think I have just deferred my stress for a different doctor appointment.

I can still stress about my mysteriously caused heart rate issues but that doesn't look like cancer. It could be caused by my thyroid levels being messed up but it doesn't look like cancer. I'll have my echocardiogram in a few weeks and learn more then. I'll save more stress for then.

So things did change, the roof didn't leak and my mammogram was clean and I wasn't stressed. I have learned that I can always find something new to stress about with my health. And with 'my medical history, they need to be sure'.

Where am I, what am I doing, how am I feeling?

Its time to break from the analysis of news and other random thoughts and talk about me again. I am approaching the season of 'all the check ups' again. I am just ignoring them - as my inner three year old handles it the best if I do. I have lots of doctor appointments in the next month or so.

I will see my radiation oncologist for a check up - she is actually very nice and is quick to recommend tests or other follow ups. She is Russian and shows up for her appointments in a white medical jacket over a funky outfit with outrageous shoes - usually high heels.

I will see the knee surgeon to find out what damage I inflicted on my formerly good knee while falling this winter. It only hurts when it gets twisted or I decide to do something complicated like climb stairs.

I will see my new primary care for an annual check up where we can discuss the woeful state of my body and how I feel as healthy as a horse (on its way to the glue factory at times). We can talk high blood pressure, headaches, fatigue, chemobrain, back pain, exercise, and more.

I will see my back pain doctor to talk pain and how I have been exercising at a gym and my new meds seem to be helping but standing around ever or walking on the beach have become very difficult.

I will see my therapist and meds therapist to make sure my sanity is still here. I will have a mammogram, bone scan, more blood work, and probably some knee bending tests. Otherwise, I am normal.

Otherwise, I am doing fine. Work is keeping me busy but not too busy. I recently enacted the self rule of no work on weekends or evenings unless mandatory. I get to the gym three times a week and have started going for walks again since the ice age has melted away.

We might even get away for a few days to enjoy some spring time. So I guess life is okay these days.

Mammograms aren't as useful after breast cancer

Well, yip-diddy-doo-dah! After breast cancer treatment, they send you on your way in your life and tell you, 'be vigilant, follow up with your doctors, and get regular mammograms'. Now they say 'mammograms are not as useful after breast cancer - they are less effective/less sensitive. The study (of course another study) recommends ultrasounds, MRIs and possibly the new 3D mammograms which were just approved by the FDA.

Thank you for confusing me and stressing me out some more (I am supposed to reduce the stress in my life). I do know where I go for treatment, first of all if you have any previous history, you get the specialized super duper digital mammograms as opposed to the regular digital mammograms. And if there is any question, you get sent for an ultrasound right then and there. But an MRI as well? I'll have to ask both my doctors and my insurance company.

I know I have blogged about this before but the continued new studies and medical advances, while they show progress and advances, they also have a niggling way of tugging at the back of your mind - what if the treatment I got was proved to be ineffective or even harmful?

I know we have learned in the past centuries that leeches and blood letting is not necessarily the best treatment for the flu. Or that while bottles of a snake oil salesman's opiates sold in the 18th and 19th centuries will certainly make you feel better but wont due much for curing you as well. More recent treatments, such as treatment for lymphoma involving radiation to the chest has cured one ailment but resulted in breast cancer decades later in many of those treated. These were the best standard of care at the time.

But as medical science progresses, will any of the treatments that I have received turn out to be ineffective or have caused long term harm to my body? I just have to stop holding my breath and go about my life and hope for the best. Because there is no way of knowing what will be learned in the future.

1000 character medical description

Computerized medical records are the way of the future. Oh goody. now we are dependent on technicians limiting what doctors can say about us and making them fill in forms etc. What if we don't fit in a form?

This doctor was trying to describe his patient's health and was stuck with 1000 characters. Could I be described in 1000 characters? I just went over to MS Word and started typing to describe myself. I got up to 300 characters pretty darn fast. Never mind talking in medical jargon about my health crap. And all of my health issues which are still in paper records in a vault some place.

But if a doctor is prepping me for surgery or making a treatment recommendation, there should be no limitations on what (s)he is writing. I want a full description and complete details. My red blood count runs low because of chemo so it is not an indicator of other problems. My blood pressure runs low so if it gets to a normal level, it might be considered on the high side.

Think about you and your health, shouldn't a doctor have lots of space to describe you?

A programmer who sets a limitation on a doctor's assessment or treatment has no medical training. I understand the need for computer fields that are the same for each patient and the whole point of computerization is to have standardization, etc. But the human body is a mystery and medical science can not be limited by computer fields or number of characters.

Computerized records might be a good idea but I think we need to work out the kinks.

Being a horse or a zebra

The other day I had a discussion with my therapist about whether I am turning into a hypochondriac and over reacting every time there is something wrong. Do I let the little things (headache, cough, etc) become big things? Should I ignore them or when should I call the doctor? Can I ignore them or should I call the doctor?

The medical profession is also partly to blame as once you have a cancer or other bad diagnosis, they are quick to put you on the fast track for more tests for what otherwise would be minor issue. Once you get a little tag in your file that says 'cancer' or something else nasty, they send you down the little path of tests. Which, yes, you can refuse, but then invitation counts more than the action. (Just like with party invitations you become part of the in-group.)

My therapist made the analogy that in medical school, doctors are trained to look for the zebras in the herds of horses. To most doctors, I am clearly a zebra.

People talk about going back to a new normal after a cancer diagnosis but I was never an adult without a cancer diagnosis. I was 19 the first time so I have spent all my adult life being fast tracked by doctors looking at a zebra. My therapist actually has also had breast cancer but she was an adult when she had it. I think she is somewhere in her 50s and I think she had breast cancer in the past ten years. (I don't know exactly because we talk about me, not her as I am the patient.) She has been an adult before and after cancer so she has a sense of what I am missing.

The question becomes, as my therapist summed it up, as a zebra how many stripes do I want to have? I would prefer to have none and blend in with the horses but am not sure that its possible.

Jobs and health issues relating to working ability

If you have a medical condition, does it impact your ability to do your job? Well, yes it could. Perhaps you injured your back and can no longer perform a job that requires standing or lifting objects. What if you have a chronic condition (note: cancer is treated as a chronic disease these days)? But your brain still works and can you still contribute to the company. Would you/should you tell your potential employer of your limitations due to your medical history? No, absolutely not unless they need to know. If it in anyway impacts your ability to perform your job that is different than if you have a condition that is under control.

A case in point are the recent stories on Steve Jobs. He had a form of pancreatic cancer a few years back and recently had experienced a significant weight loss. The news headlines rang out - his cancer is back, he's going to die. Apple stock tanked. Then did he have a heart attack? Stock really tanked. The media was ready to bury him before he died. Did he perform his job in the past year? As far as I can tell he did. Also, a company is more than just one person. One person cannot be identified as a company. Someday he is going to die (sorry but true, life is a terminal condition and this will happen to all of us). However, he's not dead yet. He's still working. And the company is still going strong.

This is just one example of the millions out there fear and discrimination in the work place and other relationships. Just because someone at one time had an illness, it doesn't mean they will drop dead on you. Or that they are contagious. Or that the brain doesn't work (okay, I will admit chemo brain can be limiting). But they still are who they are and should be treated as such. Don't turn your back on these people, treat them as you would normally. I know it isn't my place to speak for Steve Jobs or Apple Computer but my point is this isn't such a rare form of bias as you might think. It happens all the time.

Okay, that was my soap box rant for the day. Maybe because I have a cold I am being extra crabby. Or the fact that I am trying to type and the (15 lb) cat insists on helping by sitting on my lap. Yesterday I worked all afternoon. Today, I am going to work from home and see how I feel. I may just stay home (as was recommended by my husband) but I have not decided yet (should I start listening to my husband now?).