A Chemotherapy Fashion Show

Author Sue Ann Bowling in July 2009

I’ve always been too lazy to do anything to my hair that requires upkeep, so I’ve just gone from brown to gray without ever trying blond, red, black or frosting. But at this point in my chemotherapy I have a few strands of (mostly white) hair combed over a pink scalp, and I thought, “Why not try out a different appearance?” The local cancer center has all kinds of wigs and turbans available, so I spent a morning trying them on. Most were totally unstyled, and I tried them on only for length and color. Most – how can I put it? – just weren’t me. I used  Photo Booth on my laptop to record some of the results.

In self defense, the photo at the left gives a little better idea of how I look when I’m not undergoing chemotherapy and when the photo is taken by a professional rather than by my computer! (Not to mention when my nose and my forehead are not skinned, and whatever the laptop photos are doing to my skin tone.)

I should mention that all of these photos have been lightened and warmed in color to compensate for the lighting.

Almost. This one came out in second pace.

But when it came right down to it, I liked the highlighted one better. It still needs styling.

North Pole Weather 8/12/13

The sun rose this morning at 5:29; and it will set 16 hours 51 minutes later, at 10:20 this evening. Solar height at noon is now below 40°, we are still losing almost 7 minutes a day, and in a few days we will start having nautical night (sun more than 12° below the horizon) again.

We’re still running warm and dry for the season, with 3 more 80 degree days since last week, and only a trace of rain. Tuesday and Wednesday might hit 80 again, but mid-70’s are still pretty warm for this time of year in Alaska. I really hope we get more precipitation than the isolated showers predicted; I’m tired of smoke.

Those lilies not badly stunted by the lack of water early on are opening, the zucchini is growing faster than I can eat it, and the mint is running riot in the raised bed, thanks to my hauling the hose around. This is increasingly difficult; my balance has deteriorated until I don’t dare water without a cane.

No pictures of me this week; the volunteer at the cancer center wasn’t there Friday. I need to go in again for labs today, so maybe today. My sister thinks I should go for red hair. I’m going to have little enough of my own by the end of the week!

Update 2:30 pm: My hematocrit and cell count have changed enough I won’t have to have a transfusion, and the volunteer at the support center was in so I spent the time between blood draw and results trying on wigs. Red and blond just didn’t work with my skin tone, but I now have a highlighted brown that I rather like. I took my laptop and photographed several I tried, so I’ll have a “chemotherapy fashion snow” on the blog Thursday..

Cancer, Chemo and Quilts

The chemo seems to be following the same pattern as last time. Maybe I can at least count on it to stay consistent.

Friday is infusion day. All five hours of it. Not so bad, if boring.

Saturday I feel fairly well, but my basal insulin goes crazy, up to twice normal. My balance is getting shaky, but I feel well enough to spend a few hours at the fair, with the aid of a rolling walker. Took in the quilt show, but the horse show grounds were too rough to handle.

Sunday the need for basal insulin crashes – 90% normal. By 7 I’m ready for bed, and I sleep until 9 Monday morning, and crash again after breakfast.

Not that I have an appetite, but I drag myself out of bed for an unwanted snack and nausea meds by 1. Joints and feet hurt. If I continue to follow the pattern of the last round, my insulin needs will rise again Monday, but I won’t feel like getting out of bed until Thursday. I did get dressed this morning, though — it has not rained, the forecast is close to 80 today, and I have to water.

Anyway, here are a couple of quilts from the show.

North Pole Weather 8/5/13

The sun rose this morning at 5:06 am, and will set 17 hours and almost 40 minutes later, at 10:45 this evening. We’re still losing a little more than 6 minutes a day, but the noon altitude is starting to decline faster – it will be down below 42° today. Civil twilight (sun more than 6° below the horizon) has been back for about a week, though we still have no nautical twilight.

It’s been a warm summer after our cold spring, and while not a record, so far we’re in second place to 2004. We have, however, set a new record for the number of days with temperatures of 80°F or warmer during the summer: 31 as of Thursday, August 1. Friday and Saturday were also above 80°, though it now appears to be cooling off with some showers expected. I hope so; things badly need water and I’m not going to be feeling up to watering for the next few days. In spite of the heat, blooming is behind last year; none of the lilies have opened yet and the delphiniums are just coming into full bloom.

ADA kerchief

My favorite (though very old) gardening hat

This one was purchased for a boating trip. Looks nice, but not as comfortable.

The pre-meds knocked me out when I intended to try wigs while in for chemo Friday, so I don’t have any pictures of wigs. I am including a few with the head coverings I have, and one of me au natural

Current appearance without head covering.

(though I expect it will be very temporary, both in terms of what hair I have left right now and of the overall loss.) It might even come back curly.

Other Uses of DNA

A schematic of a DNA molecule. (Public Domain image from Wikimedia commons.)

So far I’ve been talking strictly about my results from the genographic project. This project is aimed at clarifying the history of the human species, but this is far from the only way human DNA sequencing is used.

Genographics focuses on mutations that are relatively old and allow us to track the spread of the human species around the planet. There are two other commercial DNA testing services that use a similar method of testing but are focused on slightly different uses. All use y-chromosome and mitochondrial DNA as well as the 22 sets of autosomal chromosomes, and all look for mutations specific to specific groups. But Ancestry.com uses a set of relatively recent mutation that are most useful for finding recent relatives, while 23and me puts more emphasis on testing for genes know to be associated with health conditions. All three are useful adjuncts to conventional genealogical research, especially for those who have hit a “road block” with a known ancestor of unknown background.

But genealogy is far from the only use of DNA analysis. At the other extreme of price and usefulness is whole genome sequencing, where all 23 pairs of chromosomes are sequenced, letter by letter. This is expensive and rarely done, though the price is dropping fast. We are still talking thousands if not tens of thousands of dollars, not something to do for curiosity alone! However, such sequencing may be useful in finding an abnormal gene in a person with a health problem that cannot be pinpointed, and through knowing what the normal gene does even leading to a cure.

A far more common approach to health studies using DNA is based on the fact that many diseases are closely associated with specific genes. Finding such genes may aid in diagnosis, or (if the genes are found in prospective parents) may lead to counseling about the advisability of having children.

I’m running into this right now. There are a couple of variants of the BRCA gene that lead to an increased chance of breast and/or ovarian cancer, especially in relatively young women. I’ve had breast cancer, though at an age where it’s common. My recent (like this month) ovarian cancer has no obvious relationship to that breast cancer, from which I appear to have recovered, and the ovarian cancer was caught early enough (stage 1) that the chemotherapy I’ve been prescribed is mostly precautionary. But could I have a general susceptibility to this class of cancer? If so, would it be worthwhile removing my remaining breast tissue?  This is why genetic counseling should accompany or even precede this type of testing.

Finally, there are all kinds of forensic genetic tests. Like the genealogical tests, these are generally incomplete and depend on markers—regions where the DNA is known to vary markedly among people. I am no expert in these tests, but they have cleared more than one person on death row.

Blogathon Blues

I knew when I signed up for the blogathon it would present problems, particularly since I had registered for the Kachemak Bay Writer’s Conference June 14-18 and I was getting a late start on the garden. I was not expecting to:

Cambridge brick sidewalks. These are in better repair than those where I fell. tripping on an asphalt patch that was actually a curb.

(1) sprain my wrist when I tripped and fell on a Cambridge sidewalk a week ago, or

(2) have a Doctor’s appointment made Monday to talk about what I thought was a minor but annoying problem balloon over two days into a projected operation in Anchorage, 350 miles away.

I normally blog four days a week: Monday (Alaska weather), Wednesday (quotation contexts), Friday (Jarn’s Journal ) and Sunday (snippets from my writing.) I thought I’d fill in Saturdays with my genealogy from Genographics, and  Tuesdays and Thursdays with my experiences at the conference and in self publishing. Well, I’ve had to cancel the conference (I’ll be in surgery when it opens, and the surgery has nothing to do with my fall in Cambridge.)

I don’t know yet if I’ll have WiFi in the hospital, but the Wednesday and Sunday posts for June are already scheduled. I hope to get next week’s and Jarn’s Journal through the end of the month written and scheduled before I fly to Anchorage Tuesday. Beyond that? I have just had my collection of old slides digitized and I have lots of other photos from the Corning Glass Museum, so you may be treated to a lot of pictures on Tuesdays and Thursdays. But I’m still going to try for a post a day.

Vitamin D

I know. You’re supposed to get your vitamins and minerals from your food, rather than pills.

But ….

I live in Alaska. The only time I can get really fresh produce is in summer, from my own garden and the farmers’ market. The rest (most) of the year I have to get “fresh” produce that has traveled a loooong way, or frozen food. Being lazy (and suspecting that the frozen stuff may actually be more nutritious than the “fresh” food by the time it gets here) I all too often stick a frozen dinner in the microwave. I doubt seriously that I am getting all the vitamins and minerals I need in my food, so I take a variety of supplements.

Some are subject to a good deal of controversy; some, like Vitamin A, can actually be toxic in large quantities. But I got a surprise on one recently: Vitamin D.

Vitamin D is one that most people can make for themselves if they get enough sunshine on bare skin. Without sunblock. There are foods that have Vitamin D naturally, notably fish and the marine mammals that eat them. This is why the native population, eating a subsistence diet, can survive in Alaska. Believe me, we don’t get much sun on bare skin. Even at the height of summer the sun doesn’t get very high in the sky — about 45°, where I live.

I figured this out years ago. Problem was, at that time vitamin D as a supplement by itself was extremely hard to find. Most often it was combined with vitamin A, as in cod liver oil. Since I eat a lot of carrots I get plenty of vitamin A, and I didn’t want to risk toxicity by taking more — but you wouldn’t believe how hard it was to find vitamin D by itself in those days. I finally found one store that carried it — and it went out of business. Then GNC opened a branch in Fairbanks, and I was able to get vitamin D from them. But the recommended dose was still just enough to prevent rickets.

Now all at once, or so it seems to me, vitamin D is being touted as a miracle pill, needed by the body for a lot of things never heard of in my day. I just knew I wasn’t getting much sunlight, and the light skin of people who’d lived many generations in northern climates was hard to make sense of unless vitamin D was pretty important. But I was still a little worried that my 2000 units a day (possible now without a handful of pills) might be too much.

Apparently it’s not.

Last week I went to the cancer doctor for a follow-up on my breast cancer. The check-up went fine, but he’s had me on Femara for about 4 years now. Apparently one of the possible side effects is reducing bone density, so I got a bone density scan and a blood test of vitamin D (important in keeping bone strong) as part of the check-up. I’ve been taking 2000 units of vitamin D a day for several years now, so I thought my blood vitamin D would be normal to high.

The bone density was a little low, but no lower than it was two years ago. Vitamin D — would you believe at the lowest end of normal? I was actually advised to increase my dose to 4000 units a day, and keep up the calcium supplements and the yogurt and cottage cheese that are a normal part of my diet. So this seems to be a supplement that is needed. Especially for us older folks.

Diet Sleuth: A Useful Meal Planning Tool

Last Thursday’s lunch

One of the problems in carbohydrate counting is figuring out how many grams of carbohydrate are in any given meal. I explained last week how I weigh my food whenever possible. But to get from that to the number of grams of carbohydrate, protein and fat are in a meal, I use a program called Diet Sleuth. This is a program designed for Mac, though a Windows version is available. There are things that have me screaming at it, but I’d have a much harder time controlling my diabetes without it.

The first figure is the main window, with my lunch for last Wednesday selected. (To enlarge the image, click on it.) Double clicking on a food brings up a window to add the food to a meal, with a variety of

Entry window for adding a food not in the database

serving sizes or number of grams. I use grams to enter except for the cherries. Since they are pretty uniform in size and one cherry is one of the portion sizes given, I just fill in the number of cherries (10 in this case) and let the program calculate the grams.

The program comes with a large database of foods, based on the USDA database of nutrients. It also has a number of prepared foods, including frozen dinners, fast foods, and snacks. You can easily add any packaged food with a nutrition label. The second figure shows the window for adding a food, filled in.

You can also add recipes. This is particularly useful when you make a large quantity of something and freeze it in serving-size portions. The cookie recipe shown comes up per cookie, but it’s impossible to make every cookie the same, so I go by grams when I’m actually eating one. The only ingredient not in the

Florentine cookies, showing window for adding a recipe.

included food database was the candied orange peel, which I added from the package. (By the way, these cookies store very well in the freezer, and I’ll probably make a larger batch next Christmas when candied orange peel is again available. But I rarely eat more than one at a time.)

Problems? Loss of data when I change versions or upgrade my operating system! This is a real problem with added food items and recipes. (It is also the reason I do not guarantee that the version shown is the latest.) There is also a minor bug that puts the “duplicate” button in the middle of the expanded data entry window instead of at the bottom with the other buttons, but I didn’t even know that one existed until I was trying to capture the windows for this blog.

There is another problem that comes up with using any nutrition database: all fruits of the same kind, for instance, are not equal. Take an apple, for instance. Apples vary enormously in sweetness and carbohydrate content per gram. They also vary a great deal by size, if you want to use the “per apple” option rather than per gram. The sizes given don’t often agree with what’s available in the supermarket. That can be addressed by using grams, but the sweetness cannot. Neither can bones in meat.

All in all I’d recommend it as an excellent meal planning tool. You can even use it to keep track of your weight. Just don’t count on it for saving your recipes!

It’s Award Time Again

I received two awards last week: The Kreativ Blogger from Chris Kelworth at the Kelworth Files, and the Liebster from Cindy Brown at Everyday Underwear. I’m a bit conflicted about these awards. On the one hand, I appreciate receiving them, and I have no problem thanking the bloggers and linking back to them. On the other hand, both are the type that say “pass it on to x number of other bloggers”, and I know too much about exponential functions not to be aware that this is another version of chain letters, Ponzi schemes, population growth, or the failure to recognize limits in economic theory. (Yes, they all depend on exponentials, or rather on most people not understanding how exponentials work.)

I am not going to post another chart showing how many iterations of these awards it would take to reach the entire population of the world. I’ve already done that for awards passed on to five, seven, and eleven other blogs. And I’m going to follow my own advice on the Liebster: since this is the second time I received it, I’m not passing it on.

The Kreativ is also a “Pass it on to seven others” award. I will confine myself to passing it on to one which I really like, but I will follow the other conditions. The first, thank and link back to the awarding blog, as I’ve done above.

2. Answer the seven questions or alternatives. (I’ll provide some alternatives.)

3. Provide 10 random factoids about yourself.

4. Pass on to 7 others? Nope. See above on exponentials. I will, however, pass it on to one I like, and leave it to her to pass it on to seven if she wishes.

The Seven Questions:

1. What’s your favorite song? My alternative, Who are your favorite vocal artists? That one I can answer: Sarah Brightman and Andrea Bocceli.

2. What’s your favorite dessert? Unfair to ask a diabetic, but now and then I have a chocolate cocoanut crème brulee from Wolf Run. My alternative, What’s your favorite comfort food?

3. What do you do when you’re upset? My alternative: what sort of thing upsets you? Actually I don’t get upset easily now that I’m retired—except about politics and the way the world is going, which when you really think about it ought to upset anyone.

4. What is your favorite pet? I’ll have to use past tense, because when my last Sheltie died of old age I reluctantly decided that at my age and with poor balance, I really shouldn’t try to replace him. But the one that really was my heart dog was my first, Derry. He was a singleton Sheltie who I really think never figured out that he was a dog, and there’s a post about him in his puppy days on my Sheltie site. He was my first tracking dog, had titles in three activities in two countries, and I really ought to write more about him. My alternative: what do you look for in a pet?

5. Which do you prefer, black or white? The alternative given was do you prefer white or wheat bread? I’ll go a step farther in my alternative, and say what kind of bread do you prefer? Not white or wheat bought in the store! When I eat bread, it’s what I bake myself in the bread machine – apricot-almond and ricotta cheese being my two top favorites. Or Brioche bread. Blue corn bread with sunflower seeds and ancient seed bread are pretty good, too. Maybe I should post some recipes?

6. What is your biggest fear? Blindness. At the time of my retirement, diabetic retinopathy had left me blind in one eye, and the treatments had left my other eye such that I see a straight line as wavy. It seems to be fixed now except for limited peripheral vision, but I’m still worried. The alternate given was name one of your strong points or special skills.

7. What is your attitude mostly? I’d have to say laid back, I guess. Definitely not outgoing or sociable, I’m quite happy to be left alone, and downright uncomfortable in a crowd—though that’s partly due to my vision. The alternative given was Do you think it is better to help people or leave them alone?

Finally, 10 random factoids:

1. I can’t find shoes that fit.

2. I am perfectly happy living by myself. I’ve lived by myself since my second year of college.

3. However, there are times a third hand would be useful.

4. I remember (vaguely) the election of Truman.

5. When I went to junior high, girls had to take a semester of sewing and one of cooking. Boys had to take shop. I envied the boys. In retrospect, shop would have been more useful. I didn’t learn anything in sewing or cooking I hadn’t already learned from my mother.

6. I’ve lived in Alaska for almost 50 years.

7. My first home computer was a KayPro running CP/M and relying on two (literally) floppy discs, one for system and program and one for files.

8. I learned to code FORTRAN on punched cards long before the KayPro. Dropping a deck of 1000 cards was a disaster!

9. I live on a dirt road, with my own well and septic system.

10. I wish I had a dog that would alert to low blood sugar. Which leads into the one blog I plan to pass the Kreativ award on to: Sarah at Animals Help Heal. I love her post about seeing eye horses.

Meals with Diabetes

It would really be nice just to eat what I want, or even just to eat what was good for me. But when you’re using an insulin pump with carbohydrate counting, things are never that simple.

The scale was tared for the weight of the pan; only the asparagus is weighed. This is only 6 grams of carbohydrate; asparagus is not a high-carbohydrate food.

Carbohydrate counting is a relatively complex way to handle the interplay between food and insulin. The simplest way, which is what the doctors started me on 40 years ago, was a rigid diet (the diabetic exchange diet) and an equally rigid schedule of insulin shots. It worked all right during the honeymoon phase, but few people stick to it, and by 10 years ago it wasn’t working. Even when I tried counting carbohydrates to get a more accurate food intake, the intake being dictated by my doctor, I still had problems. Sometimes I would go into shock at the most unexpected times (including while eating); at other times I would go high for no apparent reason.

It wasn’t until I got an insulin pump that I learned the most important lesson of carbohydrate counting: you adjust your insulin to what you are eating, your measured blood sugar at mealtime, and how your body reacts. Some doctors are still not comfortable with this.

The standard method of carbohydrate counting just counts the grams of carbohydrate in a meal, leaving the fat and protein to themselves except for avoiding too much fat and making sure there is enough protein. This works as long as each meal contains about the same balance of fat, carbohydrate and protein. When this balance varies, it’s better to use a complex formula that includes all three, as all eventually show up as glucose in the blood. One formula I’ve seen is grams of carbohydrate plus half the grams of protein plus one-fourth the grams of fat. I use grams of carbohydrate plus half the grams of protein, unless fat makes up more than 40% of the meal. (Not often.)

But how do you get those grams?

If you’re eating prepared food you read the nutrition label. These are actually available online for many national restaurant chains, though it means going online before you go out to eat, or order it sent. (It may also shock you at the amount of fat present.) If you are eating out other than at a national chain, you have to guess – and check your blood sugar often after eating. If you are cooking with fresh food at home, you need to weigh everything and refer to some kind of list, such as the one put out by the FDA, which has nutritional information for all kinds of foods. (The FDA list is available as an iPhone app, and there are may other food listings of this sort online.) Needless to say, this greatly slows down the process of preparing a meal, which is why I tend to rely rather heavily on frozen meals – reading the nutrition labels before I buy!

As to how to weigh food, the ideal is a gram scale, usually digital and battery-powered. Mine’s almost worn out from use, but it’s an essential part of food preparation for me.

As to getting all those weights into a meal, I use a computer program called Diet Sleuth, though it means running back and forth between the kitchen and the computer room to enter the foods I’m going to eat. Next week I’ll describe how it works.