Impossible is a matter of opinion, it is not a fact.

Mission: Earth, Voyage to the Home Planet

Mission: Earth, Voyage to the Home Planet (Photo credit: Wikipedia)

A long time ago someone asked me if I thought I could fly to the moon.  “Yes” I said without stopping to give it any consideration.  “But that’s ridiculous” the person doing the asking then stated, “of course you can’t fly to the moon!”  Blessed with equal measures of resourcefulness and stubbornness, I continued to declare my ability to reach the moon in spite of the arguments thrown at me. The conversation went something like this:

Person A: You cannot fly to the moon.

Me: Yes I can.

Person A: Don’t be silly, you haven’t got a spaceship.

Me: You’re right, I don’t. I would have to get one.

Person A: You can’t just get a space ship!

Me: If I needed a spaceship badly enough I’d get one.

Person A: Spaceships cost money. You don’t have that much money.

Me: I know, if I needed a space ship badly enough I’d have to find a way to raise the money. You know I could do that if I had to.

Person A (slightly grudgingly): Ok, I know if you had to you’d find a way to get the money for a spaceship. But you can’t just go out and buy them and even if you could, you don’t know how to fly anything. You don’t like flying and you’re certainly no astronaut.

Me: If I couldn’t buy a spaceship and I really needed one, I’d have to learn how to build one myself. If I had to I could build a spaceship.

Person A: Hmm. Maybe. But you still don’t like flying and you’re no astronaut.

Me: You’re right, I don’t like flying but I could learn. If I’m going to learn to fly I may as well do some astronaut training too. I like to learn.

Person A: But you know deep down that its just not possible. You can’t fly to the moon because its impossible for people like us to do things like that.

Me: It would be difficult, but it’s not impossible. If I had to fly to the moon I would. I’d find a way to make the money, build the space ship, learn to fly and complete astronaut training. I don’t doubt it would be hard, but in no way is it impossible.

Person A: You’d fail. Crash or something. It’s definitely not possible.

Me: I might fail – I might build a dodgy rocket or crash into some space debris or navigate the wrong course and end up heading into the sun. Still doesn’t mean it’s impossible though – it would just mean I was a rubbish spaceship builder who needed to improve her map reading skills.

Person A: Oh for goodness sakes! YOU are impossible.

——————-

Maybe I am a little impossible. The easiest option when posed with a seemingly impossible situation (do you think you can fly to the moon?) is to shrug and say no. The question goes away, all the thinking about how to make it happen goes away and with it, the possibility goes away.

The trouble is, I don’t believe many things are truly impossible. They might be difficult – like climbing Everest or walking to the North Pole or dealing with cancer – but very few are completely out of the question. The most successful people have often overcome the most daunting obstacles, they aren’t prisoners of circumstance, they don’t blame their childhood, education or social setting for the situations they have to face and they don’t lie down and give in. They persist, retain a positive attitude and keep going no matter what gets thrown at them. They recognise that impossible is an opinion, not a fact and that a positive attitude in spite of tricky circumstances can lead to brilliant outcomes.

As Dr John Maxwell says “your attitude colours every aspect of your life. It is like the mind’s paintbrush.”   My minds paintbrush is like a rainbow, it rarely bows to gloomy greyness or melancholy black. I think having a positive attitude really makes a difference, not only in what I’m willing to take on or overcome but also in the kinds of people I attract into my life and the depth of friendship we develop. I wonder if its true that people who can find a way through almost any situation attract others who do likewise?

When your next obstacle comes along (as it surely will because our lives are shaped by them) what colour will you put on your minds paintbrush?

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A crash course in genetics and genome sequencing

My son is in the second year of a Biomedical Science degree and one of his elected modules is applied genetics.  For many years this subject has fascinated me but most of my knowledge stems from my love of science, a love that began 30 years ago.

I seem to remember my first encounter with genetics involved Gregor Mendel’s pea studies, the dominant or recessive genes associated with blue or brown eyes, ear lobes and rolling tongues. My ability to recall the details has been impaired by a variety of useless and useful information I’ve attempted to force into my brain since leaving school.  I followed a different educational path, into computing and technology, so never reached the point of applied genetics.  I think I’d have enjoyed applied genetics had I chosen to follow that path.

My more recent research extends to a specific field of study – attempting to understand how four previous generations of women in my family succumbed to breast cancer when the BRCA genes are not present in our blood lines.  Fortuitously I had the chance to take a crash course in applied genetics and genome sequencing whilst helping to review my son’s latest project over the weekend.  The subject is just as fascinating as I remember and the body of knowledge has moved on significantly.

I discovered that there are perhaps 50 or more genes involved in breast cancer but at  present aside from BRCA our knowledge about their actions and interactions is somewhat limited.  We simply don’t understand enough about how each of the 50 genes contributes to increased risk or how they might combine to spark the development of breast cancer, recurrences or metastasis. The level of complexity involved in assessing how genes change, mutate, are switched on or off is phenomenal.  So today I agreed to become a media volunteer for Breakthrough Breast Cancer.  It’s a charity I’ve supported for more than 20 years through payroll giving and they have a strong focus on research.  Breakthrough’s mission is “dedicated to saving lives by finding the causes of breast cancer, improving detection, diagnosis, treatment and services.”  I’m happy to be helping them – whilst great progress has been made in the diagnosis and treatment of breast cancer far too many women (and some men) continue to die of this disease each year.

I’m hopeful that by understanding the genetics of breast cancer, our scientists will also unlock the secrets of a wider number of cancers and reveal the anomalies encoded in our DNA that cause other forms of illness too.  Knowledge really is power when it comes to health,  genetics and tackling disease.

 

Ding dong the witch is dead….

Which old witch? The Wicked witch!

No, that’s the wrong song. But it’s kind of fitting because FEC is over and I’m half way through chemo.  Another day to praise and be grateful!  The nausea is manageable although it does cause me to feel like Oscar the Grouch now and again.  The continual low-level headache is all but a minor distraction. With luck both will be gone in three days. The cherry coloured hue to my skin from head to chest is due to dexamethasone, a corticosteroid.  I look like I’ve been mistaken for a crustacean and part-boiled.  My face feels hot too, like someone snuck in during the night and stuffed me head first in a pan of hot water!  I know as soon as I stop taking dex, also in 3 days, I’ll be back to translucent creamy white again, it’s very weird.

So what’s next?

I’m scheduled for an echocardiogram at 8am on 15th November. I was obviously a very wicked witch in a previous life as this means a 6am awakening in the slightly-tired-after-chemo period.  Echo is an ultrasound scan of my heart and it’s done for three reasons:

  • to check FEC hasn’t damaged anything; the epirubicin and cyclophosphamide in FEC can damage the heart muscle.
  • to ensure my heart is in good overall condition for herceptin; herceptin is known to induce congestive heart failure.
  • to assess my baseline left ventricular ejection fraction. (Pumping of blood via the aortic valve into the systemic cardiac system – an essential function).

This is an important test and funnily enough I’m very attached to my heart for physical and sentimental reasons. I need it for a long while yet so I want it to stay in good shape.  I realised today that my head, my heart and my legs are the last remaining vestiges that no-one has examined, operated on or stuck needles into. (Some might say having my head examined would be a good thing and I do wonder about it myself from time to time).  Following the echo, my legs and head are all that’s left in my medical Demilitarised Zone; I’d like them to remain tamper-proof.

I return to the oncologist on 22nd November. This is when I’ll know if my heart is as powerful as I hope. We’ll also review the FEC process (I will tell him I’m glad it’s over) and we’ll discuss the switch-over to Taxotere plus granulocyte colony stimulating factor (GCSF) and extra dexamethasone complete with fetching shade of beetroot red skin. I need to start thinking about what topic I’ll make him laugh about on this visit, no doubt it will be something to do with vampires!  I’m not sure if he’s aware the chemo nurses have already discussed some of Taxotere’s challenges with me – they had to explain why I need to start taking corticosteroids a day in advance of every infusion.

Taxotere is a tough chemo drug and very hard on the bone marrow amongst other things. As a result, GCSF injections – what fun, more sharp pointy things coming up soon – see Granulocyte Colony-Stimulating Factor (G-CSF) Prevents Common Chemotherapy Complication) are used to force the bone marrow to produce more white blood cells in order to avoid neutropenia or neutropenic sepsis – more info here Neutropenic fever a complication of cancer treatment.   GCSF is an injection into the tummy fat…. and I can’t believe I’m saying this but I wish I’d retained a little more of mine!

Taxotere can also cause severe infusion reactions so alongside the corticosteroids, antihistamine drugs will also be included in my new gourmet drugs menu. An infusion reaction is a medical emergency and I anticipate it falls into the possibly scary category of life events.  I told the chemo nurses they’re far too busy for that kind of nonsense and three of them dealing with a reaction is far too much attention for my liking so please can we arrange for me not to react. It’s worth a try :-).

As ever, cancer and it’s treatment is a balancing act of risk and reward.

Herceptin won’t start with my first Tax because it too can induce life threatening infusion reactions. Once again I anticipate this could be potentially scary and thus is a situation to be avoided if at all possible.  If they infuse Tax and Herceptin together first time around and a reaction occurs, it’s difficult to decipher which drug prompted the ensuing chaos. This is not a good idea because it’s then almost impossible to know how to fix the problem.

Having worked in technology for a very long time, this is an issue I’m all too familiar with and do everything possible to avoid. Too many live or uncontrolled system changes lead to a crash; no-one knows for sure which change is the culprit and a drawn out process of needle-in-haystack trial and error then follows in order to get things up and running again.   Trial and error isn’t great when you’re faced with a system outage;  it’s bloody annoying and your customers get very upset. So does your CTO – me!  But it’s likely to be catastrophic when dealing with a potential human outage so I think we’ll stick with Tax first and introduce herceptin later.

Of course before any chemo can happen I have to get more bloods done. This momentous occasion falls on 26th November and I hope the counts will all hold up. So far my red count has been knocked a little, platelets went down by around 100 but have almost recovered to their starting point. White blood cells and neutrophils haven’t been so lucky. Both are around half of my original baseline but they remain marginally above the ‘delay chemo’ cut-off point. I read that manuka honey can help – I’m not sure if it’s true but it tastes good on porridge so I’ll give it a go.

It’s fair to say I’ve always been more impressed by the power of my mind than the aesthetics of my body, which is in essence a large logistics organisation for my little blob of grey matter.  But credit where credit is due, logistics are also essential and this 177cm frame is doing a damned good job in the risk vs. rewards cancer game to date so its power is not to be underestimated.

Well done body. Brain says thank you for all your efforts and please keep up the good work!

Credit: heather-fenoughty.com

 

The subtle repercussions of unnecessary stress

This is a breast cancer specific post so may not appeal to everyone, but as so many people get touched by this disease it’s probably worth five minutes of your time.  Even if you’re not directly affected, your near or dear ones may be. It’s an indiscriminate condition so it affects girls in their teens as well ladies over 70 and any one in between. (It also affects men).

Recent research suggests stress induces breast cancer metastasis (spread) to the bones; this is more often the cause of breast cancer deaths than the initial tumour itself.  (http://www.sciencedaily.com/releases/2012/07/120717183344.htm). Studies  conducted in mice indicate activation of the ‘flight or fight’ response makes bones vulnerable to breast cancer mets.  By looking at the outcomes of women who suffered stress or depression following treatment, researchers identified they also had shorter survival times – stress and depression activate the sympathetic nervous system.  The emerging good news is that it seems beta-blockers, cheap drugs used to treat blood pressure problems, can help prevent bone mets. Let’s hope this proves to be true in human studies as well as the mice models.

The researchers suggest efforts to reduce stress and depression in patients with cancer may have unacknowledged benefits for metastasis prevention.  So until the positive effects of beta-blockers are proven, here’s the thing.  When people are faced with a cancer diagnosis it’s an extremely stressful situation, one of the most stressful anyone is ever likely to face.  Once you get over the initial shock there’s a whole plethora of further investigations, surgeries or therapies to contend with. It’s a lot to take onboard and for a while it turns your whole life (and the lives of anyone close to you) upside down.

During cancer diagnosis, treatment and follow-up, anything that can remain constant – college, relationships, work, family – helps reduce stress, offering the individual some stability in a world where they’ll face a great deal of uncertainty for a protracted period of time.   So I find it sad to report that in many instances, these constants are also swept away and often for no good reason.  In talking with friends who’ve been on this journey, I’ve been surprised and dismayed to hear how many of them have been abandoned by people they considered good friends, prevented from continuing their studies or disadvantaged by their employers. Some have even been made to feel a nuisance or burden by their own family members, finding themselves cast aside in their hour of greatest need. Every one of these situations causes extra stress. Every one of them could be avoided.

We can speculate about the causes of this bizarre behaviour (it’s the 21st Century, we are supposed to be civilised) but it would appear it stems from the same roots as the majority of bizarre human behaviour.

  • False assumptions about cancer:  similar to the false assumptions that sometimes get made about black people. Many of my best friends are black and get misjudged solely on their appearance – it never ceases to amaze me.
  • False assumptions about how a person with cancer might change: similar to the doubting comments that sometimes get made about pregnant women – are they committed to anything other than the child?  Still happens.
  • False assumptions about what a person surviving cancer will want or be capable of:  like suggestions that sometimes get made about older people – can they cope, are they up to it. Still happens too.
  • False assumptions that cancer is the persons fault so they’re using it as an excuse: similar to the way parents sometimes think children make excuses to stay off school or avoid their homework. Most people don’t make excuses about cancer, it’s not their fault, they aren’t being lazy or burdensome.

So many of these stereotypical assumptions lead to prejudice and persecution.  But it  strikes me that by 2012 we really ought to have a handle on this.  We ought to be able to appreciate each others differences whether its skin colour, age, physical state, cancer or any other attribute that differentiates one group of people from another.  It’s kind of sad that we still need laws to protect some groups from others and whilst the law in Europe and many other parts of the world is meant to prevent disadvantage – in education, when accessing services or at work –  it seems some people are still willing to flout it. And if bonds of blood aren’t strong enough to prevent family members neglecting a brother, sister, wife or child with cancer then what hope can the law possibly offer?    We’ve seen claims for asbestos exposure, corporate manslaughter, disability discrimination and PTSD. Recently a grandmother was sued by her family for falling downstairs while carrying her baby granddaughter who was left severely disabled…. will we see respondeat superior or vicarious liability claims for stress induced breast cancer mets at some point in future too?  Draco dormiens nunquam titillandus.  But law isn’t really the answer. If only common sense weren’t so uncommon, if a little bit of compassion, dare I say it standing in the other (often disadvantaged) persons shoes for a while could be offered, then these situations need never arise.  Sadly it seems some people still have a lot of work to do when it comes to developing these most simple, yet fundamental, human traits.