Kitty Corner: Toxoplasmosis – Update, Feline Seizures & Human Precautions

UNEXPECTED UPDATE ON YESTERDAY’S POST


FRESH STEP® CAT LITTER TOXOPLASMOSIS WARNING:

We would like to remind our customers, especially pregnant women and immunosuppressed persons, that cat feces can sometimes transmit a disease called toxoplasmosis.* Therefore, always remember to wash hands thoroughly after handling used cat litter. For further information, consult your doctor. Unused cat litter poses no toxoplasmosis threat.

Mister C_Portrait_Lightened_2013_JBowman *Toxoplasmosis, an illness characterized by cold or flu-like symptoms, can be transmitted by cat feces. It is especially serious in pregnant women because it can cause birth defects. Immunosuppressed persons may also be susceptible to toxoplasmosis.

May 5, 2015 – Tuesday

I was not expecting to update yesterday’s post on my cat’s toxoplasmosis for quite some time. But this morning at about 8:00, Mister C had his third seizure—or at least the third I have witnessed. And if this had been a typical day, I would have missed this one. But I had trouble sleeping last night and got up hours earlier than normal today. And that’s when it happened.

This seizure was not as bad as the first and not as easy as the second (of those I observed). This time, although the seizure itself lasted less than 60 seconds, for a few minutes afterward C seemed to want to walk around in slow circles, following his own tail. Otherwise, he recovered fairly quickly with no residual effects in hearing, sight, orientation, or appetite. As noted yesterday, the vet said we should monitor C over the coming months. But considering that this seizure was a bit more severe than the last, and especially because I have no way of knowing whether he has seized when I haven’t seen him, I aborted the monitoring plan.

I called the vet, and he readily agreed to start C on phenobarbital, which he will have to take this for the rest of his life. So I went and picked up the pills, not needing to take C with me—no need to put him through that.

Mister C's Phenobarbital Setup_2015-05-05 (1)The green label on the blue pill bottle says “BLOOD WORK REQUIRED BEFORE NEXT REFILL.” The vet said that it may take four to six weeks to build up the needed level of medication in the brain, so we will do a blood test next month to see whether the dosage needs to be adjusted. We started with a low dose of 15 mg (1/4 grain) tablets, which are scored—and very small. Fortunately, I have a pill cutter that slices through the pill when it is placed properly in the trough. The photo shows the remaining half of this evening’s initial dose sitting in the cutter’s blue tray. He’ll get the other half in the morning.

As I learned during C’s thyroid treatment last summer and his antibiotic treatment last month, getting foreign objects (pills) into a cat isn’t one of life’s easier tasks. But this is important medicine, so I pulled out my mortar and pestle, which did a fine and quick job of pulverizing the half-tab. This was easy to mix in with his wet food. The problem is that he gets dry food for breakfast. However, he loves milk and cries for it when he sees me making my tea, so I think I’ll try sprinkling the powder in his “tea” tomorrow morning.

My dearest hope is that I will not see any more seizures. They are quite upsetting, and it is heart-wrenching to see a beloved pet in the control of what seems to be a malevolent force. However, the vet warned that because we are starting on a low dose that may not achieve the desired therapeutic level at the outset, I could still witness more seizures until the medication is stabilized.

But for tonight, I think I can rest more easily knowing we have C under good care.

As for the little man himself, he is sleeping peacefully, quite unaware that he is ill.

Final Cautionary Note

At the beginning of today’s post, I repeated the Fresh Step warning about the potential for certain vulnerable humans to contract toxoplasmosis from handling used cat litter, especially if it has been soiled for three or more days. At risk are pregnant women and immunosuppressed people. Of course, I have a less than zero-percent chance of becoming pregnant following my hysterectomy for endometrial adenocarcinoma,* but as a cancer survivor I may (or may not) be immunocompromised. I had internal radiation and no chemotherapy, so I probably am not at any particular risk. Nevertheless, I urge pregnant women and anyone with a compromised immune system to be particularly careful caring for pets who venture outdoors and who may get into who-knows-what kind of mischief.


*For more on my story, see the Uterine (Endometrial) Cancer–My Story & More page.

Kitty Corner: Toxoplasmosis – Feline Seizures & Human Precautions


FRESH STEP® CAT LITTER TOXOPLASMOSIS WARNING:

We would like to remind our customers, especially pregnant women and immunosuppressed persons, that cat feces can sometimes transmit a disease called toxoplasmosis.* Therefore, always remember to wash hands thoroughly after handling used cat litter. For further information, consult your doctor. Unused cat litter poses no toxoplasmosis threat.

Mister C_Portrait_Lightened_2013_JBowman *Toxoplasmosis, an illness characterized by cold or flu-like symptoms, can be transmitted by cat feces. It is especially serious in pregnant women because it can cause birth defects. Immunosuppressed persons may also be susceptible to toxoplasmosis.

March 10, 2015 – Tuesday

With winter still hanging on, MISTER C and I were having a quiet afternoon at home. “C” was cap-napping on top of the love seat, sound asleep on his favorite cushion right in the middle, where on a good day he can be straddled by two loving humans. My husband was away, so he had the love seat to himself while I was reading on the sofa.

Engrossed in my story, it took a second or two for me to register that C had suddenly jumped up and started running around in frenzied circles on the living room carpet, just beyond the love seat where I couldn’t see him. When I got up to see what he was chasing (ick)—or, worse, what was chasing him (ugh)—I found him on his side, convulsing and foaming at the mouth. Feeling powerless, I had no idea what to do. Instinctively, I bent down and put my hand on his side to let him know I was there, even though I was otherwise useless. Fortunately, the seizure stopped within about a minute. But he was dazed and couldn’t stand up. In that semi-dreamlike state that kicks in during emergencies—the one that protects us from our emotions  while still allowing us to take action—I called the vet’s office. They told me to bring him right in.

During the exam, C’s pupils were dilated and nonreactive to light or the approach of a finger, so it looked as if he couldn’t see. He also didn’t seem to be able to hear because he didn’t react to loud clapping. The vet held him so that his back legs dangled over the metal exam table to see whether one side or the other was affected by a possible stroke. But when C scrabbled to try to gain purchase on the table, both legs were working. He still couldn’t stand on his own once he was up.

I petted him the whole time and talked softly to him to let him, even though he couldn’t hear, to let him know that his pet parent was there and seeing to it that he got good care. But I needed support as well. With my husband traveling, I was terrified that I would have to make the “big decision” on my own.

The vet shaved C’s neck in the same spot where he had had his partial thyroidectomy last year (see the August 19, 2014 post) to take blood samples. The battery of tests would check his remaining thyroid gland function, his general health, and also whether he had picked up one or more infections—some of which could be fatal (such as leukemia or AIDS) and/or could have been in his system for years, causing slow damage. Despite the lack of paralysis, the vet said he could also have had a stroke. I was, of course, worried and alarmed, because that “big decision” might still have to be made after we got the test results. The vet gave him an injection of cortisone to reduce brain inflammation, and he also gave him a shot of phenobarbital to prevent additional seizures.

I brought him home just over an hour after the seizure, expecting him to be dazed and unresponsive. To my happy amazement, though, as soon as I opened his carrier he pranced right out of it as if nothing had happened. He could see and hear and was walking without difficulty, not at all disoriented. He knew where he was and certainly recognized the hand that feeds him. It was close to his dinnertime, and he started crying for food, which he gobbled up. He also had the strength to jump back up onto his favorite cushion.

Here, a few hours after his seizure, Mister C is looking up at his cushion, ready to return to normal. Post-Trauma Normalcy_2015-03-10He might seem a little depressed, but this expression is quite normal when I ask him to do something—including look into the camera to have his picture taken. 

This was all very weird, but I was grateful I was here when it happened so I could get him prompt care. The vet said that seizures in cats are rare and are always caused by a problem (whereas in dogs, they can be hereditary). The fact that he had serious neurological symptoms and was fine about an hour later was surprising. But the vet said there was no telling whether or when he might have another seizure, so I would have to keep a close eye on him.

March 13, 2015 – Friday

After our ordeal on Tuesday, Mister C continued to be fine. As far as I could tell, he was completely back to normal. Although we were supposed to get the blood work results on Wednesday, we didn’t get them until Friday—all except one titer, which was sent to the University of Colorado for analysis of possible infection. All of the other tests were negative. So, after a terrible fright, a visit to the vet, hundreds of dollars worth of blood tests, and careful monitoring, all the vet could say (before getting the final test result) is that he probably had had a TIA (transient ischemic attack), or mini stroke. In the meantime, while waiting for the final result, the vet advised me to give him 1/4 of a low-dose aspirin twice a week.

Not allowed to go out while waiting for the final blood test results, Mister C is looking wistfully out on the deck and backyard, his former (occasional) stomping grounds, although he is essentially an indoor cat.Pensive & Wistful_2015-03-13

 

March 18, 2015 – Wednesday

A week and a day after the seizure, I finally received the last blood test result on my little buddy. It showed that he has toxoplasmosis. In this test, two immunoglobulins are analyzed, IgM suggesting recent infection, and IgG suggesting chronic infection. The former was negative, but the latter was positive. This means that sometime within the past few years, the little mister got hold of a rodent—or, as I shudder to remember, a baby rabbit—that was carrying the Toxoplasma gondii protozoa. This common parasite affects the nervous system and thus seemed to explain Mister C’s seizure. So we stopped the aspirin and started the antibiotic Antirobe (clindamycin hydrochloride) 75 mg twice a day for a month.

The vet said that humans who handle cat feces that has been sitting in a litter box for three or more days, or who eat plants from gardens where the feces has been parked, can become infected and will need antibiotic treatment. As stated at the top of this post, toxoplasmosis is especially dangerous for pregnant women or women who may become pregnant, as well as for immunosuppressed people. So good feline-human hygiene is necessary to prevent cross-contamination.

April 18, 2015 – Saturday

A month later, having completed his course of antibiotic treatment on Friday, April 17, Mister C was doing well and showed no signs of impairment. The next afternoon, however, again while sleeping peacefully on his favorite cushion, he suddenly jumped up, ran around in circles, and fell to his side in another convulsion.

This time my husband was home, and we both stayed with him during the minute or so that the seizure lasted. It was Saturday, and the vet’s office was closed. I called the emergency number and was told I would have to take him to an animal clinic several towns away. But when we checked little mister, we saw that he had recovered very quickly, and within minutes he showed no signs of deafness, blindness, or weakness. So we decided to wait it out and contact the vet on Monday.

Here’s the little guy asleep post second seizure in his favorite place behind my shoulder.

Post-Trauma Normalcy 2_Cropped_2015-04-18

I told the vet I was afraid that toxoplasmosis had not been the cause of Mister C’s seizures or that the antibiotic hadn’t worked. At C’s age of almost 15, I said I was not inclined to put him through a lot of difficult and expensive tests. But the vet said this latest seizure didn’t mean a failure of diagnosis or treatment. The antibiotic can’t undo old neurologic damage, but it will halt progress of the disease. These protozoa cause severe neurological damage and dysfunction, and it is possible that he will have more seizures. The vet said that if he has more than one seizure a month, or if the seizures become severe, we can consider putting him on phenobarbital, which is inexpensive and has few side effects other than temporary lethargy, although in some cases it affects the liver. His advice, though, was to just monitor him for the foreseeable future.

May 4, 2015 – Monday

Now that we are into spring and experiencing some lovely days, it is heartbreaking to see my little guy staring out the deck door or gravitating toward any open window for a breath of fresh air. He still thinks of himself as a wild man, although he had only a few misadventures in the past (including two baby bunny attacks, for which he is now paying). Most of the time, we didn’t ask questions about his escapades.

Mister C_Wistful_Cropped & Outlined_2015-05-04

Sadly, though, the fear of his picking up another infection—or worse, having a seizure outside where we can’t find him—means he will need to adjust to a window-peering version of experiencing nature.

Our job is to keep him safe and as healthy as possible for the rest of his days, which we are happy he is spending with us.

What happens on February 3rd?

It's always February 2nd - ThisIsAuthentic.com

If, like me, you are a fan of redemption movies—and of Bill Murray—then yesterday you tuned into AMC and watched Groundhog Day . . . again . . . and again . . . and again.


My favorite part of the movie is near the end, when Phil (also the groundhog’s name) Connors finally gets it and starts living—and giving—in the ever-present moment. He hasn’t yet escaped the time warp he’s found himself in; but he has accepted his fate and lives a perfect day that only infinite re-dos and learning the ultimate lesson could make possible. And yet . . .

What is a “perfect” day? The message of the film is that this Scrooge-like guy learns about becoming his best self through genuine interest in and compassion for others—all with a comic and romantic twist (not unlike Bill’s other redemption movie, Scrooged). His reward for a lesson well learned on February 2nd? February 3rd.

But on the other side of the screen, we don’t get infinite re-dos. We need to learn as we go through time, not when we’re stuck in an endless loop. So how do we learn to live a “perfect” day on February 3rd after learning the lessons of our own February 2nd?

My personal February 2nd, so to speak, was in 2014. At this time last year, I was in the middle of my vaginal radiation treatments (brachytherapy) following a total hysterectomy for uterine cancer on December 13, 2013. And I was still in the “glow” of having survived a brush with fatality and having learned my lesson that all moments of life—even my life, which I have not always valued—are precious, if not eternal.

Or are they? This is a topic for another day, but perhaps all moments of time exist somewhere, in some treasure vault that we can revisit . . . and revisit . . . and revisit—if we learn the combination or find the key. George's Secret Key

But what if we can’t unlock all of the secrets of the universe? (Who knows—maybe it’s only one secret.) These thoughts took me back to part of the lyrics of the 1967 song by the Youngbloods, “Get Together,” which I always thought held the deepest human secret:

You hold the key to love and fear
All in your trembling hand
Just one key unlocks them both
It’s there at you command

20150203_103012 (2)In an awesome and happy coincidence, a quick search for the lyrics took me to the February 3, 2015, post on the Huffington Post blog, “The Third Metric,” where the song is featured today: “Daily Meditation: Get Together.” Such coincidences seem to point to a cosmic connection, one that I don’t understand. Yet these occurrences whisper to me that perhaps we do hold a key that unlocks the secrets to at least our private universe.

In the afterglow of that “Whew! Narrow escape” feeling post-op and post-radiation last year, I am still figuring out how to incorporate the lessons of my February 2nd into February 3rd—my reward for having survived. Learning how to do this will require me to be awake, aware, and appreciative in all the days that follow until I run out of them.

On this February 3rd, as I see welcome sunlight turning ice into crystals on the bare limbs outside my window, I guess it is enough for me to realize that aftermaths and interims are just as important as great events. Or maybe they are the great events. Life is still happening in an amazing way even when we can’t quite feel the miracle of it after the emergency or major event has melted into the rest of our experience.

Life transitions often feel shallow, muddy, confusing, unfocused, unimportant. But without the respite from urgency that we experience during exciting or traumatic times, we wouldn’t have the chance to dive deeper into our own being. These times spent in semi-mist may actually be mystical. Change is creative. So transition isn’t really a dark place to be feared or avoided, but a space offering a chance to learn and become your own next great thing. As earth transits around the sun, transition is how we experience time . . . and all the times of our lives.

Alone in my personal space, I will celebrate February 3rd, knowing that the ice crystals will become leaf buds . . . in time. I hope you will have a quietly wonderful February 3rd, too.

20150203_112402 

Serenity – Could it be yours, no matter what?

Tian Tan Buddha_Cheri Lucas Rowlands on WP_2015-01-16

“Serenity” by Cheri Lucas Rowlands, WordPress Staff Member

Mid-January already! So much to write, so much not written. But I am being patient on the path as I sort through my list and take my to-dos all the way to dones.


While I gather my thoughts, I thought you would like to hear from someone who is showing great grace under health pressure. Elizabeth Gilbert, author of Eat, Pray, Love and The Signature of All Things (signed copies are available through her Two Buttons online shop), posted an update on Facebook the other day (1/14/15) about having to cancel a trip to India to take care of herself—take a look: “Trust the Timing of Your Life.” She was planning to attend a literary festival in Jaipur, a city I have visited.

Not only did the title of Elizabeth’s Facebook post arrest me—because I can so relate to her message on several levels, having canceled my own trip to India last year to take care of myself (story here)—but today I saw this lovely image of Buddha by WordPress staff member Cheri Lucas Rowlands, taken on her recent trip to Hong Kong, where she visited Ngong Ping on Lantau Island. I thought of Elizabeth as soon as I saw Cheri’s post today.

No doubt Elizabeth Gilbert would approve, and love, this image. She has quite a wonderful marble statue of Buddha outside her Frenchtown, New Jersey shop, Two Buttons (that’s me with the Buddha below), which contains troves of treasures from Asia, as well as signed copies of her books. And it’s right in my own backyard. I have visited the shop several times and brought home a few lovely items. My husband, who is from Mumbai (Bombay) and travels throughout Asia frequently,* was also very impressed and heartened by the authentic collection of mostly handcrafted objects from his favorite parts of the world.

Two Buttons Buddha & Me_2014-10-10

Last summer, I also had the pleasure of hearing Elizabeth speak during our Hunterdon County, NJ, tricentennial celebration (check the calendar for August 9, 2014). Now that we know the title of her next book, Big Magic: Creative Living Beyond Fear, due out in September, I think she was giving us not only a glimpse into her creative process, but a peek into her near future. She gave an inspiring, heartwarming, magical-yet-down-to-earth talk, adjectives that describe Elizabeth herself. Soon after, I read and very much enjoyed The Signature of All Things.

You can follow Elizabeth on any of her many social media sites. Do so—it’s worth bathing in the glow of her life, even when she is facing challenges. Her brand of serene joy leaps off of each page. And if you’ve ever had the delightful experience of hearing Elizabeth speak, you, too, will believe in magic.

Oh, yes—and read her books.


*In fact, he is leaving on Sunday, 1/18/16, for India, Sri Lanka, and Nepal. I opted to wait until the next trip to accompany him to India—more about this later.

 Also posted on Ellipsis Editing’s “The Art of Writing” Blog 

Happy New Year 2015

Happy New Year_2014-15

Wishing you all abundant health, happiness, and a refreshed approach to life in the new year.


We will be exploring many topics in 2015 as the blog is updated and improved, bringing you stories and information to enhance your journey toward living the life you desire—both as a healthcare consumer and as a person connected to so many others who are glad you are in their lives—and also on their healthcare teams.

Best wishes to everyone around the world as we begin a new trip around the sun.

Thank you for being a Patient Path reader.

Pamela Bond Contractor

 

Important Announcement: A Heartless Hoax Exposed

I am very upset_cropped  Dear Readers,

Several times on this blog I have mentioned Emily, a young woman posting as “SeeGirlLive,” who said she was dying of both uterine and colon cancer. I followed her story for more than a year and was often brought to tears from sheer heart-wrenching compassion for her plight. 

To my shock and dismay, on Saturday, December 27, 2014 I discovered that “Emily” is not a real person and that her various blogs and social media were fake. As of now, they have all been deactivated, including her Tumblr blog “Living Life Loudly,” which was her most recent and now final site.

For information on the outing of “Emily”—who, unbelievably, appears to be a medical student at Morehouse College in Georgia—please see Warrior Eli Hoax Group – Emily Wilson. They report that her medical school ethics council has been informed of her cyber-crime activities (which include two separate fabricated tales about death by cancer that I know of). 

Words cannot express how betrayed the online community feels. We have been keeping vigil over a dying girl who does not exist except in the imagination of a very misguided and apparently mentally ill individual who has perpetrated a cruel and heartless cyber-crime. (It appears that this young woman is suffering from Münchausen by Internet.)

My apologies for unwittingly contributing to this hoax. Be assured that everything else I write on this blog is real and verifiable, and I will report any developments. A silver lining: At least my consciousness has been raised about Lynch Syndrome, a devastating familial cancer disease, from “Emily’s” posts. More people need to become aware of this devastating health problem. 

The Patient Path is committed to keeping you informed and safe as part of the Internet community seeking reliable information and support. Please come back soon for more actual stories intended to support you on your journey to enhanced health and well-being.

Best wishes to all for the new year,

Pamela

 

My Friend’s Story – Leukemia: In Memoriam on Her Birthday–Two Last Cups of Tea

Reposted from December 6, 2013.


 SANDRA CRESPY KLINE

 12-6-52 — 9-27-10

I met Sandee Crespy when we were both seven years old. We were in the same second-grade class at Ziegler Elementary School in Northeast Philadelphia. Although we had almost distinctly opposite personalities and, on the surface, not much in common, we nevertheless went through four schools together—after Ziegler it was Fels Junior High, Lincoln High, and La Salle College (now University), all in Philly. Our early careers also took roughly parallel paths—she was a legal secretary, I was a medical secretary. I was a bridesmaid at her wedding when she married her high school sweetheart, Mitch Kline, and she was the matron of honor at my wedding when I married my second husband, Farok Contractor, on December 7, 2003. After we graduated college—it took her 18 years of night school, me 11—she went on to become a CPA, and I became an editor-writer. Eighteen years may seem like a long time to go to college, but she and Mitch had three amazing children (Alyssa [Malka], Evan, and Jeffrey) while she also pursued her career and studied—and, of course, socialized with her many friends. (My son, Matt, was born about a year after I finally graduated while working full-time, so I had it a bit easier.)

This synopsis tells you very little about how and why we managed to retain a friendship over 50 years. To give you some idea of that relationship, you can read a brief remembrance I wrote about us in 2012 as an exercise for my writing group: An American Friendship—Associated Memory. In that mini-memoir, you’ll see that I mentioned my recently found sister, Vicki Sue, who was reunited with her maternal family 50 years after we were separated (read her story here). However, the connection is very important because just about a year after we found Vicki Sue, we lost Sandee to her deadly battle with leukemia. But not before the two of them had the chance to meet the previous October. Although Sandee had two lovely sisters, Ronnie and Jackie, you might have thought she’d found another one of her own. (She also had two brothers—Scott, who is doing well, and Mark, who died very young of bone cancer.) Of everyone I knew, she was the most thrilled that Vicki Sue had re-entered our lives—particularly because Vicki had been raised Jewish!

Sandee’s Jewish background was one of the things that had attracted me about her the most when we were young. She came from a big family—Ashkenazy on her mother’s side, Sephardic on her father’s. This mix of Russian and Spanish ancestry may be one of the primary reasons a bone-marrow donor could not be found to save Sandee’s life, despite her myriad of relatives on both sides. But my larger point is that I used to love going to Sandee’s house when we were kids because of all the people—all the life and love—I found there. My family is small and had an unhappier history, so I often took refuge in hers.

In October 2009, my family had its first reunion gathering to honor our finding Vicki Sue. This has evolved into an annual Oktoberfest celebration. But on this first occasion, Sandee joined us—you can see the joy on her face, drinking her last cup of tea in my home:

Sandee Holding Her Cup_October 2009

Sandee and I did share one final cup of tea—at her home in January 2010. She had recently returned from a trip to Israel, where she and Mitch had been visiting their daughter and her family, and thought she’d contracted some sort of bug. Each afternoon she developed a high fever and became very sleepy, so much so that she had to stop working. One snowy January afternoon, I went to see her and took with me a collection of unusual chocolate teas that someone had given me as a gift that I’d never opened. We cracked open the little canisters that day and enjoyed a cup of chocolate tea together. Although she didn’t drink out of “her” cup, which is at my house, looking at that cup brings back these powerful memories of those two last cups of tea we shared:

Sandee's Cup_30%

I didn’t see Sandee again until August 15, 2010, just weeks before she passed. It wasn’t that I didn’t try—I emailed and called her family repeatedly trying to set up a time to visit. But she became sicker and weaker over the ensuing months and was in and out of hospitals, including Johns Hopkins—where our friend Sue and I went for our last girl-thing that August day. The three of us used to get together for our annual fall combined birthday dinner (my day is September 24, Sue’s is November 24, and Sandee’s, of course, was December 6). The last time I spoke with Sandee on the phone it was just a couple of days before my birthday, but she was too ill and too weak to realize it. On September 27, 2010, we got the word from her family that she’d passed away at the local hospital, which was her choice. She was surrounded by her loving family.

Her daughter, Malka, called me and asked me to be one of the pallbearers at her mother’s funeral. I’ve never before or since carried a burden that was so light in my hands and so heavy on my heart.

Click the heart image to read about its significance.

Sandee's Heart

Rest peacefully and as joyfully as you lived, my friend.

See more in Sandee’s memory here.

* * *

PLEASE SUPPORT THE EFFORT TO ERADICATE BLOOD CANCERS

Leukemia & Lymphoma Society Logo

MITCH’S LEUKEMIA & LYMPHOMA SOCIETY

TEAM IN TRAINING FUNDRAISING PAGE


My Friend’s Story – Leukemia: Rosh Hashanah & Remembrance

Rosh Hashanah Happy Jewish New Year to Old Friends & New Family

September 24 was the first day of Rosh Hashanah this year, which ends at sundown tonight. As noted in my 9/24/14 post, it was also my 62nd birthday—the first adult birthday I have been truly grateful for.

Sadly, my childhood friend, Sandee, did not live to see her 62nd birthday. As detailed in my previous posts about her, as well as in the story of finding my sister after 50 years, Sandee and I met when we were seven—just at the time I “lost” my baby sister. My Sister’s Story – Adoption & Reunion had a happy ending. My Friend’s Story – Leukemia did not.

Sandee died four years ago tomorrow, on September 27, 2010 (at age 57) of an insidious blood cancer— just after Rosh Hashanah had started that year. And just one year after my sister came back into our lives. No one was more gleeful about that event than Sandee—especially when she learned that my sister had been raised Jewish! 🙂

But Sandee’s story is only partially tragic. She lived joyously, and one of her sisters told us that, as she lay dying, Sandee said that she had loved her life. She was truly blessed and gave everyone who knew her big dollops of her happy life energy.

One of the proofs of the gift that was Sandee is her legacy of four beautiful grandchildren. Just yesterday, right in the middle of the new year, I received this card from her daughter in Israel:

Sandee & Mitch's Grandchildren

As hard as it is to mourn the passing of my childhood friend, it is easy to rejoice in the part of her that lives on through her and her husband, Mitch’s, children and grandchildren.

Happy New Year 2014 to my Jewish friends and family. May you know as much joy as Sandee did during her shortened life on earth. And may you leave as wonderful and inspiring a legacy as she did.


Please also visit Mitch’s Leukemia & Lymphoma Society Fund-Raising Page.

My Story – Osteopenia: What’s bone loss got to do with uterine cancer?

 Sample Bone Density Image_L1-L4_Norland   Sample Bone Density Image_Left Femoral Neck_Norland

DEXA (Dual Energy X-ray Absorptiometry) Scan

In the August 13, 2014 post, I discussed the second colposcopy and repeat Pap test I’d had the day before. My doctor, concerned about my ongoing vaginal discharge and previous Pap result showing abnormal glandular cells of undetermined significance (AGUS), said he might put me on an estrogen blocker if the repeat Pap also came back abnormal. But before he would prescribe a medication, he wanted me to have a DEXA (dual energy X-ray absorptiometry) scan to check my bone density. It was only after the visit that I realized I didn’t quite grasp the connection between the two. . . .


Bone Density Test & Results

I already knew from a previous DEXA scan a few years ago that I had osteopenia, or bone weakness, which is typical for a post-menopausal woman. So it was with a “just another to-do on my list” attitude that I went to my local mammography center to have a repeat bone-density scan done on August 25.

This painless, noninvasive test takes about 20 minutes or so and is nothing to be nervous about—you’re not even confined in a tube as you are with an MRI. The basic test setup for the phase 1 screening of the lumbar spine (L1–L4) requires that you drape your lower legs over a block with your knees bent and your back flat on the table, as shown in the photo below. (My scan was done using a Norland [CooperSurgical] DXA Bone Densitometer). The scanner passes over your body while you lie still, and the technologist monitors the results right next to you.

For the phase 2 screening of the top of the left thigh (left femoral neck), the under-knee support is removed, and your left leg is positioned inside a sling with your left foot turned slightly inward. (Only one thigh is scanned because it is assumed that an otherwise healthy woman will have the same results in both legs—sort of like blood pressure readings done on only one arm.)

When I was finished, the technologist printed out the preliminary (unread) results, which are based on comparisons with other women in a younger age group and also in the same age group. They looked very much like this:

Sample Bone Density Results_Sydney

Sample Bone Density Analysis

An accompanying sheet explained that the results include values called the T-score (which compares your results with those of a young, healthy population) and the Z-score (which compares your results with those in an age- and gender-matched reference population). The T-score is evaluated according to criteria established by the World Health Organization (WHO):

  • a score of –1 or above (0 to +4) is normal (adequate bone density)
  • a score between –1 and –2.5 indicates osteopenia (reduced bone density)
  • a score below –02.5 indicates osteoporosis (severely reduced bone density).

A disclaimer reads: “Although very useful, this test is not the sole determinant of bone health” and goes on to list other risk factors, such as family history, nutrition, physical activity, and others.

t-score_image

Osteoporosis was defined by the World Health Organization in 1994 as a T-score that is 2½ standard deviations below the mean or LOWER THAN -2.5.

My results: Lumbar spine (L1–L4)—T-score = –0.96, Z-score = –0.32. Left thigh (femoral neck)—T-score = –2.02, Z-score = –0.30. “Impression: Osteopenia. Patient is at medium risk for fracture.” In other words, osteopenia, as defined by WHO, “is 10% to 25% below peak adult bone mass, or a T-score between –1.0 and –2.5 standard deviations below normal. Having a T-score between –1.0 and –2.5 is not ’pre-osteoporosis,’ but it is very important for people with low bone density to develop a good plan to prevent bone loss and osteoporosis.”

bone_density_chart

A T-score of -1.0 to -2.5 signifies osteopenia, meaning below-normal bone density without full-blown osteoporosis. This stage of bone loss is the precursor to osteoporosis.

The radiologist’s report recommended weight-bearing exercises, calcium, and vitamin D supplements. My doctor’s office subsequently called and said I should be taking 1,200–1,500 mg of calcium per day and at least 800 international units (IU) of D3, although my family doctor had previously recommended 2,000 IU. (Vitamin D for bone health is usually sold as vitamin D3, or cholecalciferol, a metabolite of vitamin D that helps your bones absorb calcium; see the resources below.) The doctors did not recommend any bone-health medications at this point.

Bone Scan Results & Uterine Cancer Follow-up

While waiting for the Pap test and DEXA scan results last month, I sought out more information on estrogen blockers in case my doctor decided to prescribe one to reduce my risk of recurrent cancer following my hysterectomy and radiation treatments (vaginal brachytherapy) last winter. A quick Internet search at the time led me to assume that my doctor would most likely prescribe anastrozole (Arimidex) or tamoxifen (Nolvadex), drugs that are often used to treat breast cancer. The thought of taking a “cancer” drug didn’t appeal to me because of side (and psychological) effects; but then I was still concerned that a second Pap report might show abnormal results.

However, as discussed in the August 21, 2014 post, the follow-up Pap was normal (whew). Nevertheless, I still did a little more poking around the Internet to see what I could find out about estrogen blockers. I also wanted to understand the relationship of these drugs to bone loss after I received my DEXA scan results showing osteopenia. What I discovered was that the biochemistry of the drugs used to treat or prevent recurring cancer and those used to treat bone loss is fairly technical and confusing. At that point, I concluded that I could not be sure that my original assumption of what my doctor would probably have prescribed was correct.

Briefly, anastrozole (Arimidex), a nonsteroidal drug approved for treating breast cancer after surgery, as well as metastasis in both pre- and post-menopausal women, works by inhibiting the aromatase enzyme. This enzyme is involved in synthesizing estrogen and can therefore increase the severity of breast cancer—and, of course, uterine and other gynecologic cancers—if left unchecked. However, bone weakness has been associated with anastrozole use, and women who switched to this drug after taking tamoxifen for two years reported twice as many fractures as those who continued to take tamoxifen.

Tamoxifen (Nolvadex or a different brand), which is on WHO’s List of Essential Medicines, inhibits estrogen production in breast tissue, acting as an estrogen antagonist. In other tissues, such as the endometrium (lining of the uterus), however, it behaves as an estrogen agonist (a chemical that binds to a receptor and activates it to produce a biological response). Tamoxifen’s tissue-selective behavior directly led to the concept of selective estrogen-receptor modulators (SERMs), and by the time I read this I started getting lost in the science—especially because I no longer have a uterus. But it was still interesting to read that, unlike anastrozole, a beneficial side effect of tamoxifen is that it prevents bone loss.

Blockers, Bones, Birthdays . . . & Babes

The next time I see my doctor, which is not until November, I plan to ask him about the relationship between prescribing an estrogen blocker and getting a DEXA scan to ascertain the presence of bone loss. At the time of my last visit, he jumped from one subject—estrogen blockers—to another—DEXA scan—without explaining the connection. A number of thoughts have gone through my mind since that time, especially after doing some research. I strongly recommend that readers start with the resources listed below to learn more—and then discuss the use of estrogen blockers and/or treatments for osteopenia or osteoporosis with their doctor before making any therapeutic decisions.

In the meantime, I am taking advantage of the nice weather to do a little more walking and have increased my calcium intake as I continue to take my D3. Degenerative changes in the body are inevitable, and as I approach my 62nd birthday next week I am mindful that I need to learn to age gracefully. After all . . . after all the cancer treatments and so much else . . . the point is that I am still getting older.

This is the first birthday in years that I have not actually minded.

For more information about my uterine cancer story, click here.


Take a look at some of the people I’m keeping company with on Pinterest.

Dame Judy Quote

Damn right, Dame Judi .


Resources

American Bone Health – How We Diagnose Osteoporosis—Understanding the Bone Density T-score 

BoneDensitomers.com – About Bone Densitometry

4BoneHealth.org – Expert Insights on Osteoporosis (Also see WHO below)

– World Health Organization – WHO Criteria for Diagnosis of Osteoporosis

LiveStrong.com – Do You Need Vitamin D3 When Taking Calcium?

Mayo Clinic

– Bone Density Test

– Osteoporosis

– Osteoporosis Treatment: Medications Can Help

National Institutes of Health Office of Dietary Supplements – Vitamin D Fact Sheet for Consumers

National Osteoporosis Foundation – Get the Facts on Calcium and Vitamin D

University Health News (UHN) Daily – Bone Density Chart: Understand Your Bone Density Scores –T-Score Bone Density Chart

UpToDate.com – Patient Education: Osteoporosis Prevention and Treatment (Beyond the Basics)

VeryWell.com – Orthopedics

– Osteopenia – What You Need to Know

– Overview of Osteoporosis

Vitamin D Council – What is vitamin D?

WebMD – Osteoporosis Health Center

–DEXA Scan (Dual X-ray Absorptiometry) to Measure Bone Health

– Osteopenia Directory

– Osteoporosis Health Center

– Picking the Right Osteoporosis Medicine for You

Wikipedia

– Anastrozole (Arimidex)

 Estradiol

– Selective estrogen-receptor modulator (SERM)

– Tamoxifen (Nolvadex)

– Vitamin D

– Cholecalciferol (Vitamin D3)

World Health Organization (WHO) – Model Lists of Essential Medicines (Also see 4BoneHealth.org above)