Wednesday, August 26, 2015

Survivor

This blog is called "Bryson O'Rourke Wedding," so let's begin with acknowledging the 8th anniversary of that event, two days ago.

See the video posted below, too. The audio isn't great, but that's us!

I called this post "Survivor" because I was going to write about something else: how this week is the 5th anniversary of Kate finding the lump. Five years is the standard for cancer "survivor."

From the Canadian Cancer Society website:

Relative survival looks at how likely people with cancer are to survive after their diagnosis compared to people in the general population who do not have cancer, but who share similar characteristics (such as age and sex).

In Canada, a 5-year relative survival is reported for breast cancer. The 5-year relative survival for all stages of breast cancer is 88%. This means that, on average, women diagnosed with breast cancer are 88% as likely to live 5 years (or more) after their diagnosis as women in the general population.

You know what that means to me right now? Absolutely nothing.

Kate lived 21 months after finding the lump. Twenty months after the official diagnosis.

Wedding anniversary. Cancer anniversary. Survivor milestone. What a week.

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p.s. Walk/jog today. Three miles in 35.37 minutes. Not my fastest, which was 34.37, but I've been on vacation and haven't done a "run" in two weeks. Rehab ends on Sept 9. Then a new phase begins, again. I've got an app and I'm recording all of my food intake. Fascinating. More on that another time.

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Sunday, July 26, 2015

My Hero

This video is from 2011. Kate had recently had a left mastectomy, which had been preceded by 16 weeks of chemotherapy. She had been prescribed tamoxifen. She was about to endure 25 days of radiation therapy.

She kicked at the darkness, making it bleed daylight. When I feel tired and pouty, I think of Kate in her boxing gloves, slamming the bag.

My hero.

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Video by Ansley. I copied it off Facebook.

Thanks, man.

Thursday, July 23, 2015

Big Fat Sigh

Big Fat Surprise? No.

Read this instead. Fat is Still Bad for You.

Heard the BFS author interviewed on CBC this morning, an episode of the Current from last winter.

Holy bad advice. Holy bad journalism.

Quotation from the necessary rebuttal (linked to above):

The problem with focusing on fat, or on any one nutrient, as a diet strategy is that it distracts us from what is really important, says Dr. David Katz, director of the Yale University Prevention Research Centre and president of the American College of Lifestyle Medicine.

He says that when Keys and others initially recommended a low-fat diet, what they meant was eat less fatty food and more fruits, vegetables, whole grains, beans and lentils.

These are all nutritious foods that also happen to be low in fat. But that was not what happened.

"We just invented low-fat junk food," Katz told me.

As consumers sought out low-fat alternatives to their favorite snacks, companies simply took out the fat and added more sugar. Thus they were able to preserve the taste while still being able to label their food fat-free, which was a brilliant marketing strategy.

The public ate it up — literally and never ate those healthy fruits and vegetables.

Consequently, the low-fat diet, as it was being practised in North America, was not associated with any health benefits.

That doesn't surprise Katz. He says that if you invent new ways to eat badly, your health won't improve.

The new movement to redeem fat was fuelled by a 2014 study in the Annals of Internal Medicine.

This review of 32 studies is often cited as proof that saturated fats are good for you.
However, that is not what the study actually showed, says Katz.

The study found no difference between high-fat and high-sugar diets when it came to cardiovascular disease.  

But that does not mean that saturated fat is good for you, says Katz. "Whether it was low-sugar, high-fat or high-sugar, low-fat, the rates of heart disease were basically the same and really high. Everybody lost."

You can cut the fat and eat badly, just like you can cut carbs and eat badly.

"There's a simple shortcut that's even better," Katz says. That's eating wholesome foods — things like fruits, vegetables, nuts, seeds, lentils and fish — in sensible combinations.

If your diet is mainly made up of good stuff, Katz says, you can't get it wrong, because then there is no room for the bad stuff.

And junk food like low-fat potato chips, just like low-carb brownies, are the bad stuff.

Saturday, July 11, 2015

Dietician

This week I saw the dietician at the Toronto Rehabilitation Institute.

In my program, we do exercise every Wednesday (and during the week at home), and we also have lectures on various topics related to cardiac health.

This is the number one question people ask me: Have they told you to change your diet?

I always say, No.

They haven't told me to do anything.  Except, take your meds as prescribed. Don't over-do the exercise.

But we have had a couple lectures led by the dietician: food and cholesterol, food labels, fiber and plant food.

I wanted to have a 1:1 talk with her, so I booked it and this week I did.

To prepare, I did a food diary for three days, and she reviewed them, but I wasn't expecting much from that. I am reasonably aware of what I'm eating and decently self-conscious about it. I wanted to ask her a number of things.

One, a question about cholesterol. I'm taking meds to drive down my cholesterol. I've been taking them for 10 years. It's been driven down. It's been driven down for a decade. Why do I need to pay attention to what I eat? I had one doctor tell me I didn't, so I didn't. I ate reasonably well, but I wasn't obsessive about it.

The result? My cholesterol has not been high, and yet my cardiac disease still progressed to the point where I required invasive surgery. I told the dietician that perhaps I'm a victim of my genes. She said genetics isn't destiny. I'm not so sure. (I think it was for Kate.)

In any case, what was the dietician's answer? Essentially, doctors measure different things. It's true that taking the meds will drive down the cholesterol, and I can eat whatever and it will still be driven down. But there are other reasons to eat well. Well, that, I said, is what I want to talk about. She had mentioned inflammation in one of the lectures. I wanted to know more about that.

Low grade, chronic inflammation over an extended period can have bad effects, she said. Then she asked me about stress. Do you have stress in your life?

Ah, well. So I told her. The last five years have been stress on top on stress on top of stress. I told her that Kate and I had done the Mindfulness Meditation 8-week class. In that case, she said, you might want to look into "intuitive eating."

I'd told her that I didn't really want a diet plan. I wanted to be able to open the fridge and just eat something, but what to have in the fridge? Stuff that you can mix and match and make whatever you're feeling like. I don't want a cooking schedule that's overly planned.

Intuitive eating? That sounds perfect.

At the rehab center, they push the Mediterranean diet, which is anti-inflammatory generally.

But she also pointed me to the Brazilian food guide (pdf), which was re-designed a few years ago.

She mentioned a food pyramid that sorted food by the amount of processing involved. I haven't been able to find a good image of that, but here are some link to stories about what's happening in Brazil:
 Here's an overview from the UN.

Oh, I wish Kate were here to discuss this with. I believe I noted earlier that the one thing she didn't do during the cancer period was visit a dietician. I think she didn't because she didn't want to be told she'd been eating wrong, as if diet had given her cancer. Also, she loved food. She loved her food. It gave her such pleasure, and she didn't want to be told she'd been "doing it wrong." (That's my belief, because she had no enthusiasm for arranging any such meeting.)

I don't feel like I've been eating wrong all of these years, but I have a better idea now of how I can eat better. There is certainly nothing bad about that, and much potential good.

Have they told me to change my diet? No. But they've given me some ideas how to improve it.

Now, about the children ....

Wednesday, July 1, 2015

Self-sustainability

Michael said to me that when he met me, I was working valiantly towards self-sustainability, doing work I did not find fulfilling, and trying to provide for my kids single-handedly, perpetual motion and positivity. - Kate, Sept 9, 2011

For some reason, I expected it to be a painless experience. But (here's a shock) as it turns out, the pain followed from Toronto, and laid claim to parts of me in the same fashion, regardless of my global positioning. I think I had expected it to be done by now, somehow, tidied up. To not interfere with my plans, my vacation. Indignation, frankly, that it is not over yet. But this is the old Kate talking, the one who looked for fast, expedient solutions to problems. Well this one is not a clear cut do-the-right thing fixer upper. - Kate, Sept 5, 2011

The dead move around in time, it seems to me. At different times, different Kates talk to me. Right now it's the Kate of Sept 2011. About six months past her surgery (as I am now). Trying to negotiate the turn back to health. Struggling with ongoing pain, expectations of others, expectations of herself.

The ongoing pain was a sign, of course, that not all was well. That it was all about to get much worse.

But in September 2011 we didn't know that, and we were trying to cope with getting back to "normal." Kids back to school. Vacation over. The future beckoning. The day-to-day simply hard.

The conversation Kate mentions in the Sept 9 post, I remember well. Like many of our conversations it happened on our front porch. She so fervently wanted to be well. She wanted to feel strong and get "back" to our life, to work, to routine. But various pains remained. Most notoriously, I think, in her lower back, a pain no one would explain to her until January 2012. It was cancer in the T1 vertebrae.

I remember telling Kate about my memories of meeting her. She was a dervish. So strong, so powerful, so full of action and determination, dreams, hopes, desires. I often think of that woman still. The one I feel so in love with, so attracted to her, so happy to attach my life to hers. I tried to tell her life did not need to be a perpetual struggle. It shouldn't be. Now, she should rest and focus on being well, and later we would make our life the best it could be. The way we had wanted it to be, right from the start. If there was pain, then it was a signal to rest, not a signal to lower the shoulder and plow through. Now, stop. Later, we will act.

This is advice I have tried to remind myself of, many times in the past three years, but especially in the past six months. Life should not be framed by pain. One needs to have the courage necessary to make the changes, to live the best life. Kate and I never got to have that next conversation. About what was the life we wanted to have, after cancer. Now I am asking myself questions about the life I want to have, after heart surgery. And I think of Kate in this moment, Sept 2011.

No, it's not a clear cut do-the-right-thing fixer upper. It's something else entirely.

Sunday, June 28, 2015

Written on the Body

Written on the Body is a novel by Jeanette Winterson. It's also the title of a blog post by Kate, January 29, 2012.

Kate's post was a well of rage about what cancer was doing to her. She had written a post earlier (June 9, 2011), which included a photograph of her mastectomy scar. That post radiated pain, but also hope. She was marked, then, but getting better.

I have two big scars from triple by-pass surgery now almost seven months ago. When I think about where I am now, I can't help but think about where Kate was then. Her surgery was hard. She had a breast removed. It was horrible, but it was also a dramatic end, we hoped, to the cancer within.

It wasn't to be. A little over six months later, she found a new lump. The timing between her surgery and her new lump, is about the timing for me right now between my surgery and today.

Today I did my walk/jog rehab exercise. Three miles in 40 minutes, 31 seconds. Three minutes walking, one minute jogging. Repeat. All of that is going very well. What if tomorrow I had a heart attack? What if I had eight months to live?

In late 2011, Kate met with the palliative care team at Princess Margaret Hospital. She went with her brother. I didn't go. Later, she told me the doctor had said the oncologist had known for a long time that she wasn't going to make it. Would she rather have known that, or had her "summer of bliss"?

Kate was unequivocal. She would rather have known.

Me, I'm not sure. I'm glad we had that time to try and forget about cancer. To try to live without cancer. To try to recapture our "before time." The three weeks we had at the cottage in August 2011 were such a blessing.

My heart disease is written on my body, permanently. I am on new meds and making lifestyle changes. Much more exercise. Much more fiber. On these scales, I'm doing well. Life is good.

My grief, my sadness, is much harder. It hasn't left a physical mark, but it is still the major force shaping my sense of self. I still want to live within my marriage, and I experience the loss of my partner in crime virtually in every hour of every day. I am perpetually asking myself: How can I move on? I must move on, I can't move on.

“I can't go on, I'll go on” (Beckett, The Unnameables).

I thought I would be past this point by now. The feeling of being "trapped" isn't as bad as it once was. Either I am much more comfortable with my predicament, or some shift has occurred. Likely bits of both.

After Kate died, a friend of mine who'd lost his wife to breast cancer a decade earlier told me that, eventually, "All you will remember will be the happy times." I'm not there yet, but that is part of the shift that's happening. I know how hard she fought to recover from her surgery, from her chemotherapy, from her blasts of radiation and the drug treatments and just the shock of having cancer. Cancer! Holy fuck!

Oh, we tried to stay passionate about life, and we were, but the end was devastating, and the journey often lonely. When I think about our marriage, I think of many things, but there were moments of sheer panic and pain, where it was just the two of us, and now it's just me. Or is it? She is not here, but neither, I think, is she gone.

I find myself saying, hey, Kate, remember this, remember that. Remember when we went to that place, and those people were talking about folks at work fucking the dog, abusing their workplace insurance, and how they said, oh, no, we're not talking about you, Kate, other people, you know. By the way, when are you going back to work, anyway? Remember how incensed we were, coming home? Remember how I kept trying to change the subject, and they kept bringing it back to so and so, and so and so, and such and such. It was just simple and horrible, and I said, never, never, never was I going back there, and I haven't, and I won't. Assholes, they were, and you and I are the only two who know that story, and why should I still care? Because some things are right, and some things are wrong. And on that, there is no compromise. Not ready, and no reason, to make nice.

On other things, the future remains an evolving mystery. Unwritten. Unknowable.

Which is the way, uh huh, uh huh, I like it.