Monday, November 21, 2016

Cancer Advocacy Update

My friend Beth has been denied the chemotherapy drugs her doctor is recommending she get to treat her metastatic breast cancer. Her insurance company, +Blue Cross and Blue Shield Service Benefit Plan doesn't think she should have them. They did a cost-benefit analysis, apparently, and decided Beth's life wasn't worth it. I think that about sums it up.

I am angry, and you should be too.

***
Supermoon over DC
Photo by Stan Mouser

I flew to DC last week and spent all day Thursday at a policy roundtable to discuss the future of cancer policy post-election. What happens to the Patient Protection and Affordable Care Act (ACA/Obamacare)? Will Vice President Biden's Cancer Moonshot still get funded? Is Paul Ryan going to be successful in privatizing Medicare? Will the Medicaid expansion go away?

Mostly, I listened, because there were some serious wonks on those panels, women and men who've spent their entire careers focused on healthcare policy and how to improve the system. I also asked a few questions. 

Deep into a discussion on "high-risk pools" and the need to draw in "young immortals" to decrease overall insurance costs, I raised my hand. 

"Hi. I was one of those 'young immortals' until I was diagnosed with metastatic breast cancer at age 32. Metastatic cancer in young people is on the rise, but people are also living longer with cancer. Cancer is expensive. What about lifetime and annual limits, which are currently prohibited under the Affordable Care Act?"

To which the response was, essentially, "Your life matters. I'm sorry for your experience. But trade-offs will have to be made."

Trade-offs. This is what we're up against, folks.

***

Here is what I learned, although nearly every speaker admitted we are all trying to read tea leaves at this point. No one really knows what a Trump administration is going to look like, but we do know that the Republican Congress of the last several years has voted to repeal the ACA more than 60 times

One panelist likened it to a dog who finally caught the car. The question is what does the dog do now? 

  1. Repeal and replace was just a campaign slogan. The general consensus was there is not currently any republican agreement on what to replace the ACA with. So there will be efforts to repeal, possibly with a phasing in of something else down the road. There are legislative tricks up those republican sleeves, including a way to repeal without the requisite sixty-vote majority typically needed in the Senate. Get poised to hear budget reconciliation a lot. And if you don't currently have insurance coverage and think you might want it, APPLY FOR COVERAGE NOW. Keep current on your payments. Those with existing coverage may be grandfathered in to new legislation, if and when new legislation is introduced.
  2. Medicare (and Medicaid) as we know it is at risk. Speaker of the House Paul Ryan has repeatedly made it clear he wants to overhaul Medicare (likely to privatize it, similar to what happened with our prison system. That didn't work out so well.) Another panelist said she'd be shocked if this happens in the same year as a repeal of Obamacare, but it's still at risk. While many panelists cautioned that republicans gut Medicare -- and potentially alienate the AARP crowd -- at their peril, Paul Ryan and company seem determined to move on this one. And if the ACA is repealed, so goes the Medicaid expansion. 
  3. Cancer Moonshot funding is a concern. Congressional appropriations for fiscal year 2017 are at a stand-still because of the election (with another continuing resolution expected before December 9th), and didn't include specific funding for the moonshot anyway. At least one advocacy organization is urging its followers to reach out to Congress and demand a vote on NIH funding this year, rather than flatline the funding at 2016 levels. Another opportunity for funding the moonshot is the 21st Century Cures Act, which increases funds in exchange for decreasing regulations at the FDA. But prospects for that legislation during this lame-duck session are murky. I feel like I'm giving you answers straight out of a Magic 8 Ball: reply hazy try again. 
  4. Speaking of the Moonshot, MATCH Trials have begun. These clinical trials aim to analyze patients' tumors for genetic abnormalities for which we already have targeted therapies. We might have data from these trials in as soon as one year. The current acting director of the National Cancer Institutes is planning on staying on in this administration as long as possible. Typically, it takes new presidents about a year to replace these appointees.
  5. Advocacy is more important than ever. Every speaker mentioned it. We need to tell our stories and show that we are more than just a cost in the cost-benefit analyses that Congress and insurance companies are doing. We need to talk about why the Affordable Care Act is important (protections against prohibiting coverage for pre-existing conditions and bans on annual and lifetime coverage limits are my two gems). Is the ACA important to you? TELL YOUR STORY HERE. And write, email, or tweet Congress to tell them your concerns. 
***

After a full day of policy information that was admittedly bleak, I went with a representative from MetaVivor to meet a friend on Capitol Hill. We talked about how her office can help us in the cancer community. We have allies on the Hill who understand how expensive treatment is, who know women (and men) are dying by the hundreds every day, and who want to keep the protections that have been in place for several years now. They (and I) also understand the current system isn't perfect, but we don't believe the answer is cutting off protections and coverage for millions of people. 

People like my friend Beth cannot afford gaps in insurance, let alone insurance that isn't working for them and denying treatments. Another friend told me she would stop treatment rather than bankrupt her family, if she lost her access to Medicare. My friends are having to think about making the choice to die or pay their bills.

We have work to do.

Monday, November 14, 2016

What Can We Do Now?

Well, that didn't go as I had hoped. I am still troubled by Republican plans to gut the Affordable Care Act, phase out Medicare, and -- in all likelihood -- reduce spending on cancer research. But those are not my only concerns, not by a long shot.

Maybe I should give you some background on me. 

I think I mentioned way back at the beginning of this blog that I grew up an Army brat. I can't find the reference, but trust me on this. It happened. My family moved, on average, every two years. 

I went to three different high schools, two of which were majority minority. Having lived on military bases -- which were very racially diverse, maybe still are -- until late in middle school, I didn't think much of it. I took that diversity for granted.

Here's a page from my yearbook in 1995, the second high school I attended. Don't ask me what I was thinking with that hair. But you see the faces of my classmates? This is the bubble I grew up in. We also had the benefit of not much socioeconomic adversity, since most of our parents were in the military. 

Growing up, I took acceptance of our differences for granted. For years, I naively assumed that racism was pretty much gone in this country because I didn't see much of it in my early life. I lived in Korea and Alabama twice and Florida -- and because us kids were mostly getting along (except for that tiff between the Puerto Rican students and Mexican students at my high school in Orlando that one time), I wrongly assumed adults were mostly okay with each other, too.

Even as I witnessed with horror the killing of Trayvon Martin, Terence Crutcher, and SO MANY others, it didn't dawn on me that racism was still prevalent enough in this country to elect Donald Trump. I still held out hope that we would collectively stand up against an openly racist and inflammatory candidate. 

I'm not sure that military diversity bubble was the most productive for my worldview, since it meant that I was surprised and gutted by this year's election. I am heartened only by the fact that more of the electorate voted for kindness and inclusion, but that doesn't change the outcome.

I was blind, but now I see. 

I still don't understand or begin to make excuses for the 53% of white women who voted for Trump. If you are one of them, can you please explain your decision to me in a way that doesn't belittle Hillary? I can wholly understand how reasonable people could not like Hillary's policies, but to choose a man who would "grab 'em by the pu**y" to represent women's interests? Our daughters'? Did you hate Hillary that much? Can you not see past the end of your noses? Are you -- my neighbors -- really supremacists? I'm trying to understand, and I just don't.

So what now? What can we do to keep hope alive in this country? SNL this week helped. If you're one of the few people who haven't seen it yet, Kate McKinnon's rendition of Leonard Cohen's iconic song is beautiful: 



"I'm not giving up, and neither should you."

And A Tribe Called Quest has always been one of my favorites.



In that vein, I'd like to point you to a few women- and minority-run businesses that are doing good things, mostly in the breast cancer space, but not exclusively. (Note: I don't know how all of these people voted, but their work is impressive enough for me to put it here.)

1. The Brobe by Allison Schickel: I wished I'd had one of these when I had my bilateral mastectomy nearly five years ago. The material is incredible, it has a built-in bra and internal pockets for drains. I do have one to give away. If you're interested, please leave a comment and I'll send it your way. It's black, size large, and comes with some jewelry from...

2. Kendra Scott, who donated $100,000 to...

3. MetaVivor.org, which is committed to funding metastatic cancer research.

4. HealinComfort by Cherie Mathews: similar to the Brobe, above, but meant to be worn out of the house, too. I think I used safety pins to keep my drainage bags hooked to the inside of my zip-up sweatshirt. But I had Chris to help me with fastenings, and this shirt would have been so much easier.

5. Tigerlily Foundation: helping young and underserved women get through cancer.

6. Shay Sharpe's Pink Wishes: granting wishes to terminal breast cancer patients.

7. PAL Experiences: opening up new worlds for children living with autism.

8. Kerry Burki: a catalyst for positive change in our world.

9. Lara Agnew: my talented friend who reveals the beauty in our world.

10. Farmyard: local CSA serving Phoenix

11. AnaOno Intimates: beautiful lingerie by and for breast cancer survivors.

12. HulaBelle Swimwear: bathing suits for women who've had breast cancer.

13. Cat & Owl Co.: fun games to play with your young children that also teach them math concepts. Quinn LOVES these games.

14. Brim Papery: cards, mugs, and paper products that make great gifts.

15. Emily McDowell Studio: best known in my circles for the "Please let me be the first to punch the next person who tells you everything happens for a reason" card.

Also, here is a list of organizations that need our help right now.

This week, my family and I have also donated to Planned Parenthood, contributed to the ACLU, and I'm going to find ways to give back to my community, here in still red Arizona, that don't simply involve writing a check or canvassing in neighborhoods that apparently turned out to vote for Hillary in much larger numbers than my own. What will you do?

Monday, November 7, 2016

Get Out And Vote

I wasn't sure I was going to write about this election on my breast cancer blog. I mean, what does politics have to do with cancer or healthcare? Quite a bit, actually.
My dear friend Beth is currently in a fight for her life because her insurance company, a federally-run group, has denied the combination therapy that her DOCTOR recommends she have to treat her metastatic breast cancer. You see, the drugs are not FDA-approved for use in this way, even though trials have shown 93% efficacy in the treated population. Beth has taken her fight to social media, and as a community, we are stepping up in the hopes that +Blue Cross and Blue Shield Service Benefit Plan will hear our voices and #SaveBeth.

It's gross, really, that an insurance company can say no to life-saving drugs.

Here's how it's supposed to work: 1) Patient pays for insurance 2) Patient gets sick 3) Insurance pays for treatment. THAT'S WHY WE HAVE INSURANCE. It's why we PAY for it.

Insurance denials by federal insurers are a policy issue. FDA approvals are a policy issue. Cancer research and how much money gets funneled into research on metastases (not nearly enough, only about 7%) is a policy issue. Policy gets set, for the most part, in Washington, DC. And for cancer patients and survivors, those issues are vitally important.

It is literally about life and death.

I cried tears of relief last year when the Supreme Court ruled in favor of the Affordable Care Act's protections on coverage for those with a pre-existing condition. I didn't know then what I know now about my health: namely, that I was likely never metastatic. But I still will always have had cancer. It is part of my story now, and prior to this monumental ruling, insurance carriers could flat out refuse to cover me.

I have my insurance through Chris. It has been wonderful insurance, covering most of our costs over the past five-and-a-half years, which have included a c-section, a bilateral mastectomy, nearly EIGHTY infusions of chemo or targeted chemotherapy, several biopsies, five weeks of radiation, more scans than I can count, and reconstruction. I have no idea how much all of that has cost, but my guess is Chris and I couldn't afford it out-of-pocket. 


The thing is, our insurance is tied to his job. I think his job is secure, but surprises happen in life. [UNDERSTATEMENT OF FOREVER] If something happened to Chris, would I be eligible for insurance coverage? The Supreme Court says yes. But Republicans have vowed to overturn the law that protects this coverage. I'm not okay with that uncertainty.

Republicans have also promised to defund Planned Parenthood, which provides free cancer screenings for underserved populations. DEFUNDING THAT CARE IS NOT OKAY. Women of color are already at such a disadvantage when it comes to healthcare. Struggling populations don't need one more hurdle standing in the way of their survival.

A republican congress has also drastically cut spending on science over the last decade, and would likely continue to do so. Science is how we get research. It's how we move toward therapies that keep patients like my friend Beth alive long-term. So she can watch her young kids grow up. So she can continue to advocate for other patients living with this dreadful disease. So we can end cancer as we know it.

But this election isn't just about me. It isn't just about cancer. And it isn't just about democrats versus republicans and who promises what.

It's also about the most qualified candidate in my lifetime to run for office, going up against an unprepared clown who seems to think our constitution is a joke and derides nearly every group of people imaginable: women, disabled people, Hispanics, Muslims, Jews, blacks, even those in his own political party. I honestly don't understand the appeal.



This election is about the tone we will set for our country for at least the next four years, but possibly a generation or more. Our kids are paying attention. Quinn tells me I should be president, but short of that, he doesn't understand why a mean person, a bully, would even have a chance. Quinn is in kindergarten and understands that's not how we get ahead in this country. Those are not the morals we defend. We are better than that.

As one of my favorite bloggers put it:

I'm begging you:  please go vote, and please vote with best intention.  I suspect that I don't have to convince you that this man is a demagogue -- I can't imagine you'd be visiting Chookooloonks if you agreed with his stance.  However, if you're eligible to vote in the United States, I beg of you to do so.  Vote early, if you can; if you can't, then on Tuesday, November 8th, please find your way to the polls, despite the weather, despite the lines, despite how busy you might be.  And as you vote, please be mindful:  please don't throw away your vote, and please don't vote for this person simply because you're loyal to his party.   He's a dangerous, unkind, mean man, and he doesn't deserve your vote just because he conveniently chose a major political party to hang his platform on.

There are so many important issues facing our country. Healthcare, the future of our treatment of cancer, and the first amendment are just a few important ones to me. I'll probably lose a few readers because of this post, but it's important. I can't keep silent on it, not this year, not this election. 

Please remember to vote tomorrow. Our lives depend on it.

Monday, October 24, 2016

My Tribe Will Understand My Memory Issues

I can’t thank this community enough for your support after my last post. I have cried reading through your comments and emails, Facebook messages and texts. I was scared to share this part of my story. I was worried about what it would mean for my identity (because once you put it on the Internet there’s no going back). I was afraid about what it might mean to break ties with a community that’s become a second home.

I shouldn’t have worried. This is my tribe, and its members are not victims who cry foul when another gets good news. Instead, I mostly heard: this is a miracle, and we love you. One friend said, "We are not kicking you out just because you lucked out!"

I love you all right back.

I still had cancer. I still experienced nearly five years of metastatic cancer. Now I just have different appointments and different doctors to figure out what the best path forward is for me. I’ve got more pain and sometimes even miss the damn steroids. I’ve got similar levels of fatigue (apparently it wasn’t just the chemo). My chemobrain might be slowly retreating, but it’s been replaced by an anxious fear that perhaps none of my doctors know what they’re talking about.

I still feel scatter-brained most days.

And Chris occasionally makes fun of me, but keeping track of it all, then and still: the appointments, kindergarten volunteering, and now, also, a job search, is not something I can seem to manage on my phone. Calendars don’t sync, I fumble with my thumbs when trying to enter new appointments into my device at the end of one doctor’s visit and get frustrated, and inevitably ask for a print out of my follow up visits anyway.

I know. I sound like a dinosaur.

I prefer paper. I prefer a hardcover book, too, although I recognize the convenience of my Kindle for travel. But for my calendar? For keeping track of my life? It’s a spiral-bound monthly planner all the way. My 2016 one has photos of Quinn interspersed throughout, and I'll probably hold onto it forever for that. And because this year has been something else, amiright?

The cover of my 2016 planner. Photo taken by Jodi Lynn Wall, April 2015

A few weeks ago, a woman reached out to me to share her breast cancer story, and to ask if I’d be interested in trying out some of the products she’d designed for the company she works for, Erin Condren. You might have heard of them?

Would I like some paper and pens and organizing pockets and even a journal, too? Yes, please! Sign me up. In ink.

{photo source: www.erincondren.com}

And then I learned that a portion a full FIFTY PERCENT of the proceeds of these products would be donated to the Pink Lotus Foundation, which aims to provide treatments for underserved communities. To help women who don’t have the means or insurance to help themselves when they’re diagnosed with breast cancer. See, corporate America? There IS a way to do Pinktober correctly!

***

Side note: do you know how much DISPARITY exists in breast cancer survival rates? That African American women are more likely to die of the disease, and that women of color are less likely to be given information about reconstruction options? That death rates are falling overall for breast cancer, but not nearly as quickly for women of color?

This is why I’ve walked the Avon Walk these past 5 years, with my team raising more than $100,000 to help underserved communities (and provide money for research). It is a cause near and dear to my heart because I have been fortunate, and I hope I don’t take a dollar of that for granted.

Do you remember my SIX THOUSAND DOLLAR shot? One shot. That I received probably fifteen times for just the cost of my copays.

Cancer is expensive. Treatment is expensive, transportation to/from doctor's offices is costly, and taking time off work to receive and recover from treatment isn't a viable option for many, many women. That's where organizations like the Pink Lotus Foundation and Avon come into play. I will support them as long as I'm able.

***

Last week, I went in to have my thyroid checked, because I’ve gained an unusual amount of weight since stopping treatment. My thyroid appears fine, but my joints all ache. I’ve got an MRI of my knee today, and tomorrow an ultrasound of my right armpit for a painful lymph node (or possibly just the spot where my implant is sewn into scar tissue).

I missed the third presidential debate to be on a flight to Houston to attend a metastatic breast cancer conference as a patient advocate. From what I understand, SNL did a fine job of summarizing the two candidates. I'm going to order my "Nasty Woman" coffee mug as soon as I'm done writing this.

Before my flight to Texas, I helped Quinn's class of 27 kindergarteners plant beet and carrot seeds in their class garden. Friday was a school book fair, this weekend we had two birthday parties, a soccer game, and ASU's homecoming. Tomorrow is our 8th wedding anniversary. I can’t keep track of all that in my head! Pre-chemo, I might have been able to, but now I rely on writing everything down.

And I never do sponsored posts here. I don’t even know if this counts as one. But I did receive some free products, and I am vouching for their awesomeness, so here is my disclaimer. Also, send some love to our tribe member Sam if you get a chance. She’s doing good work, and keeping me a little less scatter-brained in the process.

Monday, October 3, 2016

An Announcement

Last Friday, Quinn's class had pajama day and an ice cream party to celebrate the number of "class compliments" they've received since kindergarten started eight weeks ago. He has grown up so much these past couple of months. He's made new friends and started to find his way at a big, new school with big, new rules. He is learning to read, playing soccer now, and asking for time with his friends more and more. Our dynamic is shifting, and I'm trying to breathe my way through it.

But after school last Friday, he went to the bathroom, then walked around the house in his pajama top and underwear, sending me straight back to his toddler years when he refused to wear pants at home. A glance at his thighs alone had me in tears before I knew what hit me: a nostalgia for what wasn't, for something we'd missed, for a past I can't change.

I spent that evening watching old videos of Quinn: swimming, opening Christmas presents, on our way to adopt our first dog (the one that ended up biting him in the face), telling me I was his best best friend forever. I am a puddle of emotions. How is he five and a half? Again, I borrow from my friend talking about losing her mom: "Two years ago today my sweet mama bear was diagnosed with ALS. Two years. Two years. Two of the longest years of my life. Two of the shortest years of my life. Time bends and twists and deceives the eye and heart and mind. Time, you weirdo contortionist." Time is a weirdo contortionist.


What might it be like to raise a child and not have the fear of cancer looming over you every moment? How might those early years have been different? How might today?

This is one of the hardest posts I've ever written.

***

You guys know I haven't written here much lately, and I haven't posted a health update in months. I know you've noticed. Some of you have asked, and I've been vague.

I haven't known where to start. I've wanted to be certain, as certain as one can be when talking about one's health, anyway.

Chris always tells me to start with my elbow.

A skin biopsy at the beginning of the year led to questions about my cancer staging. My oncologist wanted to take me off chemo based on the results, which came back as something called sarcoidosis. I wasn't ready to let go of my chemo safety net. Not because of a pea-sized thing on my freaking elbow.

Then I had a scan in March that lit up like a Christmas tree: in my chest wall, my abdomen, my left lung, my spine, the list goes on. I walked out of my oncologist's office as he was handing me the radiology report. Fuck this, I thought. How does anyone deal with cancer progression? How does one face their spouse after news like that, without exposing every fear simmering under the surface? You just hope your partner is a little stronger than you in those moments. Because one of you must steer the ship, and after reading "likely for metastatic disease" in about five different places, I was in no position to steer anything. Afterward, you hope that your partner will take you out for a drink even though it's the middle of the day.

He does, bless him.

Over the next couple of weeks I underwent a slew of tests to determine what was happening in my body. A spine MRI and a pelvic ultrasound were both "unremarkable" despite showing activity on my PET scan. A lung biopsy left me with a partially collapsed lung and a twelve hour hospital visit, but the results were benign: a granuloma with characteristics of sarcoidosis.

Not cancer. Not this time, at least.


I went for a second opinion at the Mayo Clinic. What the fuck? was my basic question to the oncologist there. "If this is metastatic breast cancer, it's the strangest case of it I've ever seen," he told me, after reviewing my scans from the last four and a half years. "We don't tend to see recurrence after a pathological complete response like you had, not with Her-2+ disease."

Where had he been the last several years of my life?

***

Sarcoidosis is an autoimmune disease that causes inflammation -- typically seen in the lungs, skin, and lymphatic system. They don't know what causes it. Bernie Mac died from complications of it, but it's usually not fatal. While it sometimes goes into remission on its own, the treatment for sarcoidosis is steroids.

Like the ones I'd received with every single chemo infusion over the past fifty-four months.


Three doctors agreed on a course of action: take a break from treatment and re-scan in three months. Those months were a series of panic, panic, Xanax. Like a bad game of duck-duck-goose.

And then my three month scan came at the start of the summer. It was clear as a bell. Clean as a whistle. The radiology report suggested a "complete response to interim treatment," except there hadn't been any interim treatment.

Metastatic cancer doesn't clear up on its own.

I cried big tears in my oncologist's office, part relief, part are you fucking kidding me, part hope that any one of my doctors knew what they were talking about. "I hope those are happy tears," he said. "It's not every day someone gets a miracle like this. This is better than winning the lottery."

To which I say: yes, mostly. I imagine it's also like being wrongfully imprisoned and then released after nearly five years and told to go be happy. I am happy, but this news has required a lot of processing. Like, a shit ton of therapy. I'm still processing. I'm still a puddle of emotions every time I catch a sunset. Or a glimpse of Quinn's thighs.

***

As the news -- that my so-called metastases have always likely been sarcoidosis -- sinks in and starts to seem more real, I have continued to advocate (albeit a little more quietly) on behalf of the MBC community. But it has come to a point where I feel like in order to amplify my voice and those of my friends living with mets, I needed to be able to do so in a way that upheld my integrity, that allowed me to be my most authentic self.

I haven't been restaged, but if I had to guess based on the size of my original tumor and the number of lymph nodes removed during my surgery, I was probably Stage 3A. I don't know if I'll ever know. As one new friend recently put it, "I will always consider you a Stage 4 survivor." But I am no longer considered a metastatic breast cancer patient.

While I have superb insight on what it feels to be one, I feel it is only fair to withdraw myself from Pfizer's Story Half Told campaign, which aims to shed light on the lives of women living with metastatic breast cancer. Pfizer's team has been more than patient with me on the timing of this announcement. But I know that October will be a big push for the campaign and the stories of the women involved. I could not honorably continue as a face of MBC after learning the news I've learned this summer. In no way do I want to distract from my friends who are facing this disease day in and day out.

I will continue to do whatever I can to bring awareness to the men and women living with MBC, to advocate for more research funding, and to bring hope to people that there is life after a terrible diagnosis. In some cases, the details of that diagnosis may even be a terrible mistake. If my story isn't a plug for second (and third) opinions, I don't know what is.

To the few of you who've shared these past few months with me in silence, thank you for holding space for me to grow into this new reality, and for supporting our family as we learn what it means to start over. To the rest of you who have been such a godsend of strength to us these past five years, thanks for standing by us as we adjust to life after cancer.

I always wanted to be an outlier, I just never imagined it would be in this way. Here's to more sunsets. Here's to the ultimate mulligan. Here's to hope. Here's to first grade...and beyond.