Tuesday, July 31, 2012


I've spent the day cleaning up after a backyard camp out/sleepover/birthday party for my daughter (burnt marshmallow on the driveway, etc.) and napping (the girls needed our air mattresses, so I slept with just a sleeping bag -- on a rock, a stump, and a root, probing various parts of me throughout a sleepless night).

And while I've been away from the computer, there have been a couple of Lympho-Bob-related items in the news:

With that, it's back to the Olympics.

Sunday, July 29, 2012

More Olympics

Well, the Olympics Opening Ceremony was as odd as promised. Very British, very weird, kind of cool -- that seems to be the consensus. I thought the whole torch lighting was kind of neat, with all of the leaves coming together, but that's probably because I was exhausted by that point and anything would look neat. And Bob Costas didn't disappoint -- just as smart-ass-y as I had hoped.

I have been a little surprised, though, that there haven't been more cancer stories when NBC cuts away from the action to give us a human interest piece. Goodness knows there's enough human interest and drama on the court/field/water without having to break away for a short piece on some tragedy. And goodness knows there are plenty of human interest stories that involve cancer-less tragedies. But cancer is The King, isn't it? When you really want to hit them in the Kleenex, you break out some cancer, you know?

Anyway, Uptight Citizens Brigade put together a nice bit of satire called "NBC's Sad Olympics" that covers just this topic. Enjoy. (Especially the anonymous commenter who posted a couple of days ago to a 2008 Lympho Bob post called "More Cancer Humor."  Sorry to hear about your diagnosis, friend. I hope this helps a little. Good luck. And keep laughing.)

Friday, July 27, 2012

Olympics and Cancer

Ah, the Olympics Opening Ceremony is only a few hours away, and I can't wait. Apparently, rumor has it that the ceremony will feature, among other things, 70 goats, a forty-foot tall Lord Voldemorte, and Queen Elizabeth. Which sounds like the beginning of a sick joke. I can't wait to see if it's all actually true.

But, more important than all of that is that cancer is well-represented. Some of the cancer-related stories this year (I expect Bob Costas will give us more detail in his usual metaphors-as-thick-as-clotted-cream manner):

  • U.S. swimmer Eric Shanteau will compete in the 100 meter breaststroke. This is his second Olympics; a few days before the 2008 trials, he was diagnosed with testicular cancer. He held off treatment for two months, competing in the trials and the Olympics, and then had surgery six days after he got back from China. Skip all of the Lochte vs. Phelps stuff and cheer for the cancer survivor instead.
  • Petr Koukal, who is on the Czech badminton team, is also a testicular cancer survivor. He'll carry the flag for the Czech team during the opening ceremony. Watch for him and cheer. (Likely your only chance, since badminton is probably going to be shown at 3:00am.)
  • Scottish runner Lynsey Sharp does not have cancer, but she worked last week to try to raise 10 million pounds sterling for a cancer charity. Cheer for her when she runs in the 800 meters.
  • And cheer on the U.S. men's volleyball team for helping make a wish come true. They took off from Disneyland with a 15 year old boy named Tim Vorenkamp, who was competing in the USA Volleyball Boys Junior National Championship division two years ago when he was diagnosed with cancer.  Tim gets to hang with the team in London, thanks to the Make A Wish Foundation. (And he's one of a bunch of kids going to the Olympics because of Make a A Wish.)
Some great stories, especially those that involve athletes who don't give up on their dreams. Truly inspiring.

Anjoy Paul McCartney singing to all those goats tonight.

Wednesday, July 25, 2012

The Problem of Scanxiety

The New York Times had a nice piece a couple of days ago on Scanxiety -- the anxiety that comes from waiting for test results (like scans). The article focuses especially on laws (and voluntary practices) involving access for patients to check their own lab and scan results.

This has some good and bad parts.

The good is that patients don't have to wait for doctors to deliver the results. That's often where the scanxiety comes from  -- having a doctor say, "We should have results in three or four days," and then waiting by the phone on day three, day four, day five, calling the office and not getting a response, etc. Very frustrating. Being able to go online to find one's own results would be a big help, especially if a law required those results to be available within a certain number of days. I'm all for patient empowerment.

On the other hand, knowledge can be a dangerous thing. Having a lot of information, but not the skills to interpret it, can cause even more anxiety. A quick, hypothetical example: a newly diagnosed Follicular Lymphoma patient gets results that say he has stage 4 grade 1 fNHL. Everybody knows what stage 4 cancer means, right? Except with lymphoma, because it is a systemic cancer, stage 4 is usually as treatable as stage 2, because the Bendamustine or whatever is going to go to all of those places that cancer might exist, anyway. In other words, the treatment will hit all of the nodes, plus the liver and spleen, and other places, whether there are cancer cells present or not.

But a newly diagnosed patient won't know that. So they wait hours (maybe even days) for a doctor to call back and explain and answer questions. Double the anxiety, because of the misinformation.

I think of these online results as kind of like online college classes. Very helpful for many people in many situations, but sometimes you need to speak one-on-one, face-to-face, with a teacher, someone who can not only answer your questions, but adapt to what he or she sees in your body language, tone of voice, etc. ("Yes, I understand" seems straightforward in a student's email, but can have a hundred different meanings face-to-face.)

So, ideally, a patient will get results online and then have access to further information to help interpret. That would, hopefully, be a doctor or nurse who knows what it all means. But maybe a reliable web site (though there's no guarantee of reliability, or of a site understanding the potential complexity of a diagnosis). Maybe even a nice online support group (though, again, it could take hours or days for a reliable response; at the very least, you're likely to get some anxiety-reducing sympathy, anyway, from support group members).

So overall, I think I'm good with accessible, online results. It will likely take some time before the system is perfected, which means lots of anxiety in the meantime. But I think patient empowerment wins in the end.

Monday, July 23, 2012

Quality of Life

Psychology Today published a piece last week called "Does Your Oncologist Care about Your Quality of Life?"  The answer seems to be, in general, that No, most oncologists don't care -- at least not as much as they care about lengthening a patient's life.

The researchers asked oncologists about several scenarios involving treatment choices that produced differences in quality of life and length of life, and for the most part, doctors came out as valuing an increase of length. Which isn't surprising; what doctor would routinely say to a patient, "I could give you five years, but I'm going to recommend three really happy months"? For that matter, what patient, when faced with the choice -- at least at initial treatment decision -- won't take more time?

Of course, part of the problem with the study is that they never really define "quality of life," at least not in the report they provide of it. What does that mean? Side effects that are horrible, but only temporary (like hair loss or neuropathy)? Or something debilitating, like permanent heart damage that results in a sedentary life?  Or something worse?

I would imagine it would depend on a patient's circumstances, too. An 85 year old is obviously going to make different choices than a 30 year old, and one would hope that a doctor would take those factors into consideration.

I guess the real issue here is about communication, as the article's last sentence sums up: "If you ever face an illness forcing you to decide between living long or prospering, make sure it is your values that rule the day, not your doctor’s." The choices are ultimately ours, as patients, not our doctors'. I think I'm fortunate to have an oncologist who values quality of life -- sometimes even more than I do. There have been times when I have suggested a treatment, and it resulted in conversations about its downside, short- and long-term. His philosophy is "Do no harm," and he seems to understand that harm encompasses both the physical and emotional.

Of course, not everyone is so lucky to have an oncologist like mine. And that's where communication comes in -- and maybe a second opinion as well.

Saturday, July 21, 2012

Bendamustine at ASCO (Again)

I know, I've written about this several times in the last 6 weeks, but it's worth putting out there one more time, because it's become even more clear how significant it is.

At this year's ASCO conference, German researchers showed updated results for their long-term study of Bendamustine + Rituxan vs. CHOP + Rituxan for first treatment of Follicular NHL patients. B+R results in longer progression-free survival with much less toxicity, when compared to CHOP + R. It's a big deal.

This was discussed once again in The ASCO Post, earlier this month.

When you read the piece linked above, be sure to click on the Figure on the left, too, for some cautions. Still no change in overall survival, and the results have not yet been published (and thus not yet peer-reviewed by other lymphoma experts). But that doesn't mean we can't get excited about it anyway. Even if this is the fifth time you've heard about it....

Thursday, July 19, 2012

The ACA and You

The furor over the Affordable care Act has died down slightly, though I'm still seeing the occasional Facebook post or email with some rumor, or politicization, or misrepresentation. I don't think that's going away, though it will probably stay on simmer until we get closer to the election.

But that small bit of "down time" provides a good opportunity for people to step back and think carefully about what is in the ACA law -- the good and the bad. (And, as most of you know, I think the good parts have to do with things like pre-existing conditions and other matters that pertain to cancer patients.)

In that spirit of finding out as much as we can about the good and the bad, I'm offering a link to an article by the always awesome Betsy de Parry, lymphoma advocate, home builder, TV host, and writer. Her most recent Candid Cancer column is called "Beyond Politics: The Affordable Care Act, Your Doctor and You."

It features an interview with the heads of two hospitals: Dr. Ora Pescovitz, CEO of the University of Michigan Health System, and Rob Casalou, CEO of the St. Joseph Mercy and Livingston Hospitals. Betsy's reasoning for interviewing these two subjects is that they are on the front lines, and as heads of hospitals, they will have a perspective that is broader than any single entity (patient, doctor, or politician). They are less concerned (if at all concerned) with how this will affect the November election, and more concerned with how it will affect patients, doctors, and quality of care.

It's a very interesting interview, and while the two admit that there are some questions that they just cannot answer yet, there are other insights that they offer that they seem pretty sure about. A few excerpts:
  • "Dr. Pescovitz: One of the big things that the ACA emphasizes is quality of care — are doctors and their teams doing everything for patients that we know is proven to work and that can keep people healthy? And, it's tying payment to performance on quality measures and patient satisfaction. This is a big change for our industry and, quite frankly, one that is a long time coming."
  • "Q. Serious illnesses such as cancer may require periodic, long term or lifelong treatment. Is there anything in the law that will prevent our doctors from treating us at any time in the course of our illnesses?
    Mr. Casalou: I don't see anything in this law that will prevent or withhold appropriate care to patients."
  • "Dr. Pescovitz: The ACA is already funding a wide range of research that compares medical treatment options and gives us valuable information on what works and what doesn't."
  •  "Q. There is speculation that the ACA is driving doctors who are currently practicing out of medicine and that it will drive the best and the brightest young people to professions other than medicine, which, of course, will mean fewer doctors to treat more people. Are you seeing any evidence of this?
    Dr. Pescovitz: ...I don't think the ACA is driving people away from medicine. It would be premature to draw such a conclusion. Actually, more young people are applying to medical school than ever before — 7,000 more nationwide last year compared with a decade ago!"
Clearly, I have a very particular intetest in the ACA as a cancer patient. I am also someone with a stable job and very good health insurance (for which I am infinitely thankful), which also narrows my perspective. But, as I said a few weeks ago, I'm also someone who has seen several people die because they lost their insurance -- that probably colors my perspective most of all.

So while this one interview won't answer all of the questions that people have about the ACA, I hope it serves as one more piece in peoples' ongoing education. I'll say it again: there's just too much at stake for this law to be repealled outright. Change it, make it better, but don't take away the gift that has been given to cancer patients.

(And I'll say this again, too: thanks for another great article, Betsy.)

Tuesday, July 17, 2012

Multi-Drug Approach

Folks, I think it's going to be some quick posts this week. Just too much going on. (In a good way.)

So today's quickie is about an article in the prestigious journal Nature that suggests what cancer treatments will probably look like in the future: a multi-drug approach (rather than a single, targeted drug) that will aim to manage cancer (not cure it). I'm not even linking to the Nature article itself, but rather to a press release from Harvard, where the Nature author works.

It's an interesting concept, and it's related to the way HIV has been handled: no single drug was found to work for more than a short time, so a "cocktail" of drugs is used now to manage the disease. The HIV virus was just too complex and smart to hit with one drug.

Cancer is even smarter, I would guess. It has certainly proven to be so far.

This -- if it turns out to be true -- is going to require a very different mindset, from both patients and doctors. We all want to hear the "Cured" word, but living in this state of "Management" will require some emotional strength.

Of course, those of us who have been watching and waiting already know how to deal with this mental feat of being able to exist in that state of limbo. My biggest bit of advice, for those of you who might one day find yourself in that situation: it takes a good six months to get used to it.

My second piece of advice: live your life. There's no sense in stopping yourself from doing the things you can do, physically, because of what might happen someday.

Sunday, July 15, 2012

Disney Politics

No, this isn't a post about Disney doing something political.

We're in the Silly Season now, with primaries over, but the conventions still weeks away, so I thought I'd get in the spirit and link to this slide show of Politicians Who Look Like Disney Cartoon Characters.

Pretty funny.

And bipartisan.

Friday, July 13, 2012


Suleika Jaouad, the young woman who writes the New York Times column Life, Interrupted, offered a new installment yesterday called "Am I a Cancer Survivor?" She brings up an interesting question, one without easy answers.

Jaouad is about three months out from a bone marrow transplant. She was at a Rally for Life, when all survivors were invited on stage, and then on to the track for a Survivors Lap. She hesitated about whether to step forward.

An understandable problem: she doesn't feel like a survivor, given where she is in her cancer journey (I don't think I like that phrase, but I can't think of another way to put it right now). She thinks taking on the label Survivor feels like she's saying it's been conquered. I've been told the same thing -- the Magical Five Year Mark means survivorship.

 But, as a friend points out to her, anyone who ever had cancer and is still around is a survivor, no matter how long it's been since they heard the words -- ten years or ten minutes. As the friend said to her, "blunty," "A cancer survivor would be someone who a) has cancer and b) is not dead." This fits the definition of "Survivor" offered by the National Cancer Survivors Day organizers.

And it's the one I believe in, too. I've heard plenty of objections, and I'd never force a label on any current or post-treatment cancer patient (see how I avoided the word there?), but for me, anyone who has heard those words form a doctor has already earned the badge. They deserve something to commemorate their service. (And I could write 10,000 words on the whole "war" metaphor for cancer, too. Maybe another blog entry some other time.)

And I know just how Jaouad feels, from a slightly different perspective. She's been through a very aggressive treatment, and doesn't feel like she's a survivor. I spent two years without having any treatment at all, and sometimes questioned just how much "surviving" I'd done. Even after the relatively benign treatment of Rituxan, I'd sometimes compare myself to people who had been through much harsher stuff, and wonder if I could be in the same category.

But there's an emotional component to cancer, one that's there no matter how many treatments, or what kind, or when. And that's really what survivorship is all about: dealing with the day-to-day emotional and mental struggles, as well as the physical ones. The scars can be just as deep, the pain just as intense.

So I say Jaouad is a survivor. Because she got out of bed this morning.

Wednesday, July 11, 2012

Cool Gene Sequencing Story

The New York Times recently ran a series of three stories on gene sequencing, and how it may help to solve the cancer puzzle. The first in the series is called "In Treatment for Leukemia, Glimpses of the Future." The other two articles are linked at the top of the page for that article.

What I like most about the series is the personal stories -- including one about a leukemia researcher who is diagnosed with aggressive leukemia, and becomes a guinea pig of sorts for the kind of gene sequencing research that the articles highlight. Basically, what's involved is taking a sample of the tumor's DNA and a sample of non-cancerous DNA from the same patient, doing a full accounting of the genetic code for each, and then comparing them. To give you a sense of how big a task that is,  the second article says that the genetic code amounts to about three billion symbols, made up of four letters (A, T, G, and C). Put all 3 billion of those in book form, and "they would fill a medium-sized elementary school’s library." That's for the cancer cell. That's another 3 billion to be analyzed for the normal cell.

Obviously, there are some computers involved here.

Once abnormalities are identified (there's a difference in the patterns of the two cells), then a targeted treatment can be attempted. (This assumes that there are genetic differences between similar cancers; in other words, while two Follicular NHL cells might look alike, they were caused by two different genetic mutations).

Anyway, it's all fascinating, and pretty accessible. The NYT reporter was interviewed on the NPR radio show Here & Now. Also accessible, the interview provides a little more depth about the topic.

As good an introduction to the genome/cancer link as you're likely to find.

Saturday, July 7, 2012

American Girl

The nice folks at American Girl have announced that they will be developing a bald American Girl doll. This is a big deal.

You can find a little more information at the AG Doll Hospital site, and then clicking on the "Dolls Without Hair" link.

This is related, I think, to a controversy from last January involving bald Barbie Dolls. Some people had set up a Facebook page asking Mattel to create a bald Barbie for girls going through chemotherapy, or who have alopecia (hair loss) for other reasons.  The site took off when a couple of news outlets wrote about it, and then really took off when a blogger for the American Cancer Society wrote a blog entry criticizing the Bald Barbie Facebook page, saying the dolls would scare small girls who would worry that they might get cancer. The blogger argued that childhood cancer is actually very rare -- more rare than lightening strikes, which is, according to the blog post, "why we don’t see advocates calling for lightning strike dolls."

This statement enraged parents of children with cancer, who thought the blogger, and by extension, the ACS, were downplaying the seriousness of childhood cancer. They offered further evidence in the amount of funding that the ACS devotes to childhood cancers (less than 1%). They flooded the ACS blog and Facebook page with questions, comments, and demands that the blogger (who is also their chief public relations officer (yikes)) be fired. The ACS apologized, but mishandled the entire situation after that, erasing critical Facebook comments, refusing to respond to inquiries about the amount of money they donate to childhood cancer, and just generally showing that they have no idea how social media works. (It basically requires being open to conversation with readers. It's not that tough.)

Anyway, the ACS lost on this one. All around.
  • The blogger is still employed, but does not blog for ACS anymore.
  • The Bald Barbie facebook page has 157,000 Likes.
  • Parents are still angry. They still regularly post Facebook comments about ACS's lack of commitment to childhood cancer, even if the Facebook post has nothing to do with childhood cancer.
  • In March, Mattel announced that they would make a "friend of Barbie" who is bald, to be sent directly to children's cancer wards.
  • In April, MGA announced they would be making a "True Hope" line of dolls: three bald Bratz dolls, three bald Moxie Girlz dolls, and one bald Moxie Boyz doll.
  • And now, at the end of June, Mattel again announced a bald doll, the American Girl doll.
The ACS blew it.

More importantly, lots of other companies didn't. The American Girl doll without hair will be available on its own; in addition, previously purchased customized dolls can be given a replacement head without the hair.

In some ways, this whole thing seems trivial. It's only a doll, after all. But the whole point of the bald Barbie, in the first place, was to question ideas about beauty, in an effort to help girls feel better about themselves. That's worth a lot. And it's nice to see that someone gets it.

Thursday, July 5, 2012

Another Race

I ran a road race yesterday. I choked -- literally. But it was a good race, overall.


The race was the  Thirsty Irish Runners Four on the Fourth. It was a benefit race, part of the "Rally for Sally," named for a young girl with osteosarcoma, a bone cancer. The proceeds from the race go to research on that disease at Dana-Farber Cancer Institute.

I found the race on a website that lists upcoming running races all over the country. The site listed this one as a 5k. This is my distance -- 3.1 miles. I looked at the results from last year's race, just to get a sense of how well I'd do. It was clear that I would do very well, given the times from last year. These were my people: The Old. The Fat. The Possibly Cancerous. My typical 5k time would put me in the top third of this field.

Of course, last week, when I went to the official web site and looked at the course map, I saw that this was not a 5k. It was a 4 miler. (Hence the name, "Four on the Fourth.") The results from last year instead indicated that I would be very much near the end of this field. It was not a happy discovery. I ran a four miler on my own last week to see what my time would be. It was 42 minutes and 18 seconds. Not bad, considering my recent asthma and foot problems, but it confirmed that I'd definitely be near the back of the pack at the end of the race.


The race was conducted under the worst possible conditions. It rained. A lot. By the end of the race, I think I had an extra 5 pounds of water in my clothes. Also, it was a course full of hills; I don't think we went more than 100 yards without hitting another hill. And downhills are no better than uphills -- they're murder on the quadricepts and knees, if you don't force yourself to slow down.

The rain had started even before the race began, and it conveniently got worse just as the race director gave us instructions. The starting line was at the bottom of a hill, so we for forced to immediately go uphill. Never a good way to start. The first mile was rolling hills, up and down, up and down. But it gave me a chance to check out my competition. I always like to pick out a few people that I think I can beat. It gives me some incentive for later on. After a half mile, I settled into a pace (as best I could going over hills), and then I found three candidates for my little game of "Who Can I Beat?" A guy in a leg brace. A guy wearing a green Kevin Garnett shirt who ran on his toes. And a guy carrying an umbrella. Not exactly Olympians, but that was OK -- I'm careful to set goals that I think I can reach. The psychological benefit of passing and beating someone is more important than who I beat, even if it's a guy carrying an umbrella.

(He never actually opened the umbrella; he just ran with it, closed, in his hand. But I really like the image of chasing after a guy with an open umbrella, carrying that much more wind resistance and beating me anyway.)

I felt great for the first mile. Legs and lungs were all holding up. I was with a pretty large pack, and it didn't seem like the leaders were all that much ahead of us. The first mile marker had a water stop. I had planned on skipping it, since I was soaked by rain and not much up for water, but I saw little kids handing out the water cups, so I felt like I should take some and make them happy. Big cups, too -- 12 ounces. Very unusual.

The bad part about this water stop was that it was at the top of a long hill. So I was breathing hard when I grabbed my water. I was also going pretty slow, so I didn't use the usual technique of squeezing the paper cup into a spout and pouring it slowly into the side of my mouth. Instead, I just took a big gulp.

Big mistake. Because it was the top of a hill, and I was breathing hard. As I sucked in a lungful of air, I followed it by sucking in a mouthful of water, too. I choked a little bit, coughed a few times, and then sucked in the water that was sitting at the top of my windpipe.

Very scary -- I couldn't breath for a couple of seconds. It's a horrible feeling. I stopped and bent over, finally catching my breath again, and coughing out whatever was still in my lungs. As I stood bent over, I watched my pack run past me. Knee Brace. Umbrella Boy. Only Kevin Garnett, who had stopped for water, was still within reach by the time I recovered. I'd be seeing his back for the next three miles.


From here, it was just another series of hills. Horrible, rain soaked hills. My lungs were not happy, after their little trauma. I avoided the water stops and pushed on.

At about 2.5 miles, we turned a corner and the race marshall directing us told us to be careful. We found out why pretty quickly -- we were running up a long dirt road, now a small waterfall of mud. I ran for about 20 yards, and then I did something I'd never done before in a race -- I walked. I've always had a policy of never stopping. It's a cancer thing. I've always felt like it was kind of symbolic -- never quit. But on this muddy hill, I looked up at the people ahead of me, and I decided that my goal was not going to be to break my 42:18 training time; it was going to be to just finish this damn race. So I walked. And, rationally, it was the right thing to do. It was safer, for one thing, but also probably conserved enough energy to finish. Plus, it's a proven racing strategy.

So I was a little disappointed, but I got over it. After that hill, we had a short stretch of flat running, and I managed to find a little bit of a rhythm. There was a large group of spectators at the last water stop (at the 3.5 mile mark) cheering us, which is always nice for a lift, especially at the end of a race. Still had one more long hill to go up, but I figured there was likely a downhill after that, so I had something to look forward to.

Indeed, the last quarter mile or so was a downhill. As I said, downhills still aren't very fun, but I'll take them over uphills, especially at the end of the race. I could see the finish line from the top of the hill, and there were maybe 5 or 6 runners ahead of me, including the guy in the Kevin Garnett shirt, who was about 20 feet ahead of me. He and I had been about 20 feet from one another the whole race, and as much as I was struggling, he looked like he was struggling even more. I thought to myself, Wow, this guy deserves to beat me. He's been pushing for the last three and seven-eighths of a mile. Good for him.

But then I thought, Forget him. I've got a little left in the tank, and I'm heading downhill. I put out whatever I had left, and passed him. And then I just kept going. Hard. Because that's the best way to finish a race.

That's me in the photo below. Those black shorts were royal blue when I started, before they were soaked by rain. And that guy in the picture (not the 12 year old right behind me, the guy in the green shirt to the right of the traffic cop) -- that's the Kevin Garnett guy. I had started out my final kick 20 feet behind him. That's how fast I was going. (And how slow he was going.)

I finished in 42 minutes and 40 seconds. Not too bad considering the hills, the heavy rain, and the lung full of water.

My shoes were still not dry 12 hours later.


There's at least one lesson in every race, and this one had several:

1) Don't gulp the water.
2) Don't run in the rain.
3) Don't run four-milers anymore.
4) It's OK to slow down and walk sometimes. That's a cancer lesson as much as a running lesson. Because slowing down doesn't mean you've lost; it means you're still in the race. 

Monday, July 2, 2012

Things I Wish I Was Told

Jeff Tomczek wrote a nice piece a couple of days ago called "The Things I Wish I Were Told When I Was Diagnosed with Cancer."

It's a familiar list to anyone who's been diagnosed; that's not a criticism -- some of us only realize the familiarity after we've read it.

A few that I particularly like:

"You will be determined to have more energy than you do."  I've been fortunate to have had only Rituxan, which knocked me out for about a day or two. But I've certainly known cancer patients who have had stronger treatments, and tried to do more than they could. Tomczek says that you change, and you should embrace this. I think that's good advice, whether or not you had an aggressive treatment.

"Your doctors and nurses will become a source of comfort." I admire health professionals who go into oncology, because almost all of them are wonderful people who deal with some much bad stuff all day. I admire their being able to come to work every day. Of course, if you're a smart ass like me, you challenge your doctor by quoting from medical journals that you know he probably hasn't had time to read yet. Also, you chuckle at how he gets a little embarrassed when he needs to give you a physical exam. These, too, are comforting.

"You will inspire others. It will feel weird." Yes, you may become a role model. Your determination and strength will cause people to say, "I don't think I could do it." And you will smile and touch their hand and say, "Yes...you could." But really you are thinking, "Please, don't let this be the start of a story about someone you know who died from the same cancer." You will change the subject quickly.

For those of us who have already been diagnosed, it might be too late to take this advice. But we can certainly pass it along to others, with our understanding.