It's not all just heaving over a beige plastic bucket, wishing that I wasn't retasting the shoarma I ate 5 hours ago.
Since April 3, Day 1 of Cycle 1 (D1C1), I:
- saw Ojos de Brujos at Paradiso (D5C1)
- had a drink at the AmstelHaven and then a tea at the Amstel Hotel (D8C1)
- went to an Chinese Hot Pot Dinner Party (D17C1)
- ate Dutch food with my mother and brother at Moeder's restaurant where, after 10 minutes of avid searching, we finally located the framed photo of my mother that we donated the last time she visited Amsterdam about a year ago (D20C1)
- walked all over town decked out in orange on Queen's Day (D7C2)
- danced during my friend Joel's Drum & Bass DJ set at Greenhouse Effect and then attempted to banter with very drunk Dutchmen at my first ever houseboat party (D7C2)
- went for a drive to Oude Kerk for a super-delicious brunch of chicken club sandwich and Dutch appeltaart with whipped cream, followed by a walk around Amsterdamse Bos (D10C2)
- attended a dinner cooked by my friend Sandrine, who is a fabulous French cook and hostess (D16C2)
- picnicked in Saphartipark, where alas -- a @#%&ing dog peed on my bicycle (D17C2)
- biked to the Hole in the Wall pub for a friend's birthday drinks, watched Yankee Come Home at Boom Chicago, and then went back to the pub to catch up on the results of 2009's Eurovision song contest (D2C3)
- saw one of the most amazing taiko drum groups in the world, Yamato, perform at the Carre (D4C3)
- drank a mint tea at the Blue Teahouse and then played ping pong at OT301 (D5C3)
- went to a barbeque and then played a Mario driving game on the Wii (D6C3)
- saw the always-educational-and-inspiring annual World Press Photo exhibit (D10C3)
- biked 45 minutes each way to see Star Trek in IMAX (D10C3)
Promisingly, I'm getting out of the apartment more with each cycle!
Also, I restarted my lapsed membership to the public library and have started biking there every weekend to borrow DVDs. So far, I've watched the whole first season of 30 Rock, Shortbus, Mamma Mia, Darjeeling Express, In Her Shoes, Step Up, and Fletch (again). This in addition to: The Changeling, Australia, Mystery Alaska, Legends of the Fall (again), and Finding Nemo (again).
I also tried meditation a few times, following a Gaiam DVD I borrowed from my friend Sarah.
Also thanks to Sarah, who's a voracious reader and shares my taste in books, I read the first two books of the Twilight Series, The Time Traveler's Wife, Water for Elephants, and a Short History of Tractors in Ukrainian.
Now I'm reading a Renate Dorrestein book in Dutch I bought on Queen's Day for 50 euro cents as well as Brilliant Orange: the Neurotic Genius of Dutch Football, which I bought using a gift certificate I got from my friend Marta for my birthday.
I've had four visitors from the States.
My mom brought me Wii Fit and got me hooked on sudokus. In return, I made her watch Tokyo Zombie, which is probably the only non-Oscar-nominated movie that my mom has ever watched. I think I got the better end of the deal.
My brother Eric somehow managed to stuff Wii Rock Band, which includes a drum set and guitar, into his suitcases and lug them over here from California. So I'm learning how to play the drums and guitar now, or at least distinguish primary colors from one another under pressure.
My friend Lois gave me a book called 'The Healing Power of Chocolate' and brought me dark-chocolate covered pistachios from Trader Joe's, which prompted a whole series of emails with my nutritionist friend and eventually resulted in my sampling different brands and formulations of dark chocolate on a regular basis (so far Toblerone is coming out ahead).
I'm proud to say that I introduced my brother Ed to the diabolical genius of Joss Whedon. We watched the entire season of Firefly while he was here. I also introduced him to moth.org and This American Life. We both learned how to play Odin's Ravens together, but he won easily. While I like board games more, he seems to be better at them; so unfair!
Looking back, I guess I managed to still do a lot during my first three chemo cycles. And the list didn't even include the approximately 30 hours a week I've been working from home! Not too bad for someone with a serious illness. Although I have to admit that I've had more mandatory free time than usual, due to the fact that most of the Dutch holidays come one after the other in April and May, instead of being spread out through the year. Besides Easter weekend and Queen's Day, we had two days off last week for Ascension Day. In a normal year, I'd be spending these long weekends traveling.
This coming weekend is Pinksteren weekend, and every single one of my friends will be out of town. In fact, most of them will be away on the same sailing trip visiting the islands in the north of Holland, a trip that I wanted to do but in the end I had to back out because, at the time that they were organizing the trip, there were too many uncertainties about how I would react to my chemo treatments. Trapped on a boat, there was too much risk that I could get an infection and not find my way to a hospital or that I would be already be horribly nauseous. So I'll have to entertain myself, which is not usually so hard to do.
These two days (Days 11 and 12) are usually the best days of my chemo cycle. I've been meaning to go to the supermarket for a few days, so I've been forced to get creative in the kitchen, without my usual stockpile of favorite foods. Then it was pouring rain all day, and I was getting obsessive about my current work project, so I thought maybe I would skip the trip again. But finally the sun came out, and in Holland these days it doesn't get dark until past 10pm, and happily I confirmed online that my nearest Albert Heijn would be open 'til 10. I was so excited in the supermarket about having fresh produce again, I was actually humming to myself, and I had to remind myself that I only live less than 5 minutes away by bike; there was no need to buy 15 different fruits and vegetables! As I was cycling home with my treasures, the thought popped into my head spontaneously that I am really so lucky and happy just to be alive. Every extra day that I'm on this earth is another chance to appreciate all the amazing things life has to offer, whether it's big or small. In the past 24 hours: my first taste of cherries this summer, thunder and rain drumming against my window while I snuggle into my warm bed, the view of the sun setting over the canals and old houses of Amsterdam, chatting with my neighbors, feeling the stretch of my limbs and the wind on my face as I biked.
Monday, May 25, 2009
Stephen Jay Gould, Marijuana, and Statistics are Not Destiny
I'd read some essays by Stephen Jay Gould when I was in college. I never knew he was a cancer survivor. This from Wikipedia:
"In July 1982, Gould was diagnosed with abdominal mesothelioma. He later published a column in Discover magazine, titled The Median Isn't the Message, in which he discusses his discovery that mesothelioma patients had only a median lifespan of eight months after diagnosis. He then describes the research he uncovered behind this number, and his relief upon the realization that statistics are not destiny. After his diagnosis and receiving an experimental treatment, Gould continued to live for nearly twenty years. His column became a source of comfort for many cancer patients."
"It was during his bout with abdominal mesothelioma that Gould became a user of marijuana to alleviate the nausea associated with his cancer treatments. Although Gould maintained, "I am something of a Puritan" with respect to any substances that would alter or dull his mental state—not drinking alcohol or using drugs in a recreational sense—he attributed value to the medicinal use of marijuana in helping him to face the painful side effects of his treatment and keep a more positive attitude (Grinspoon 1993). Ultimately, he recognized an important role to the maintenance of spirit through adversity, and that use of marijuana had an important effect on this aspect of his treatments, though he disliked the mental blurring."
"Stephen Jay Gould died May 20, 2002, from a metastatic adenocarcinoma of the lung (a form of lung cancer, which had spread to his brain). This cancer was completely unrelated to his abdominal mesothelioma, from which he had fully recovered almost twenty years earlier."
"In July 1982, Gould was diagnosed with abdominal mesothelioma. He later published a column in Discover magazine, titled The Median Isn't the Message, in which he discusses his discovery that mesothelioma patients had only a median lifespan of eight months after diagnosis. He then describes the research he uncovered behind this number, and his relief upon the realization that statistics are not destiny. After his diagnosis and receiving an experimental treatment, Gould continued to live for nearly twenty years. His column became a source of comfort for many cancer patients."
"It was during his bout with abdominal mesothelioma that Gould became a user of marijuana to alleviate the nausea associated with his cancer treatments. Although Gould maintained, "I am something of a Puritan" with respect to any substances that would alter or dull his mental state—not drinking alcohol or using drugs in a recreational sense—he attributed value to the medicinal use of marijuana in helping him to face the painful side effects of his treatment and keep a more positive attitude (Grinspoon 1993). Ultimately, he recognized an important role to the maintenance of spirit through adversity, and that use of marijuana had an important effect on this aspect of his treatments, though he disliked the mental blurring."
"Stephen Jay Gould died May 20, 2002, from a metastatic adenocarcinoma of the lung (a form of lung cancer, which had spread to his brain). This cancer was completely unrelated to his abdominal mesothelioma, from which he had fully recovered almost twenty years earlier."
Friday, May 22, 2009
Treatment Against Nausea
Here's the advice I've collected on the internet against GERD so far:
Avoid anything carbonated or effervescent. [Note: There is a lot of contradictory information out there about carbonation. My doctor recommended that I try original Coke. But both days that I actually drank a Coke (Day 1 and Day 7), I vomited. I've also been recommended to drink ginger ale and ginger beer for nausea.]
Eat bland food.
Avoid dairy products, sugar, fat, and spices.
Prop up the head of the bed 6 inches, or sleep in a recliner.
Cut HALF a banana, mash it, and eat it, chewing slowly.
Sip room temperature water to dilute the acid.
Wear loose-fitting clothes.
Avoid lying down for 3 hours after a meal.
Avoid citrus fruits such as oranges, lemons, grapefruits, tomatoes, and cranberries.
Avoid caffeine in all forms.
Don’t overeat.
Yesterday, I had eaten a late lunch of Dutch pancakes with bacon, apple, and syrup along with a Coca-Cola. We then biked to a cafe outside of town where I shared an apple pie with whipped cream and a Bitter Lemon. At dinner, I had a mango juice and shoarma smothered with a mix of garlic sauce, hot sauce, and mild salsa. At the bar afterwards, I had a bottle of cranberry juice.
In other words, I had broken almost every rule above and am now paying the price. When I came home, I felt awful. I vomited around 2am, and again around 4am, and didn't feel better even after that, though I had nothing left in my stomach to eject. I spent almost all day today collapsed on the couch marathoning 30 Rock episodes, it's almost midnight, and I still feel nauseous. I'm actually afraid to lie down.
I feel like I'm Bill Murray in Groundhog Day, doomed to repeat the same day again and again, until I figure out how to do it right. Now I am in Cycle 3 of 8 and I've figure out how to manage or eliminate constipation, mouth sores, neuropathy, and hair loss. But I'm still struggling with nausea and vomiting.
So far, I've tried all of the following, with no noticeable improvement and some uncomfortable side effects:
Granisetron (Kytril), only prescribed for the first 3 days and hasn't stopped me from vomiting on the first day of each cycle
Zantac (H2-receptor antagonist)
Maalox (antacid)
Pantecta (a PPI), strong side effect of heart palpitations
metoclopramide, strong side effect of dizziness and drowsiness
sativa marijuana, strong side effect of dizziness
original Coke
ginger beer
HCl Plus
My doctor thinks the problem is GERD. For a brief while, I thought the problem was not enough stomach acid. But now I'm wondering whether the problem is dyspepsia -- simple indigestion. I don't have heartburn and only once in a while do I taste stomach acid in my throat, but that's always due to burping. Burping is my biggest symptom and that seems to be caused primarily by excess gas in the stomach, not a weakness of the muscle that separates the stomach from the esophagus.
According to Wikipedia, clinical trials show that antacids and H2-receptor antagonists like Zantac have little to no effectiveness against dyspepsia when compared to placebo. Also very interestingly, metoclopramide, which my doctor prescribed, has also been shown to be ineffective.
The same Wiki article stated that a herbal remedy called Iberogast and PPIs have been proven to work. So next I'll try the Iberogast and ask my doctor to prescribe another PPI besides Pantecta.
* * * * * * * * * * * * * * * * * * *
UPDATE: well, I tried the Iberogast. A little bottle sells here for about 15 euros, and I'm supposed to take 20 drops three times a day. The taste is somewhat awful, and I didn't notice a difference after taking it once. I stopped taking it, because the burping has gotten somewhat more tolerable now that I'm on Day 11 of this cycle. I saw today that another blogger (Carrie's NHL Blog) wrote that nausea wasn't a big problem for her: "Zofran, Compazine and Ativan work great and, when I just need a little something, I take 500 mg – 1000 mg of ginger." So I plan to do some further investigation of this option before my next consult.
Avoid anything carbonated or effervescent. [Note: There is a lot of contradictory information out there about carbonation. My doctor recommended that I try original Coke. But both days that I actually drank a Coke (Day 1 and Day 7), I vomited. I've also been recommended to drink ginger ale and ginger beer for nausea.]
Eat bland food.
Avoid dairy products, sugar, fat, and spices.
Prop up the head of the bed 6 inches, or sleep in a recliner.
Cut HALF a banana, mash it, and eat it, chewing slowly.
Sip room temperature water to dilute the acid.
Wear loose-fitting clothes.
Avoid lying down for 3 hours after a meal.
Avoid citrus fruits such as oranges, lemons, grapefruits, tomatoes, and cranberries.
Avoid caffeine in all forms.
Don’t overeat.
Yesterday, I had eaten a late lunch of Dutch pancakes with bacon, apple, and syrup along with a Coca-Cola. We then biked to a cafe outside of town where I shared an apple pie with whipped cream and a Bitter Lemon. At dinner, I had a mango juice and shoarma smothered with a mix of garlic sauce, hot sauce, and mild salsa. At the bar afterwards, I had a bottle of cranberry juice.
In other words, I had broken almost every rule above and am now paying the price. When I came home, I felt awful. I vomited around 2am, and again around 4am, and didn't feel better even after that, though I had nothing left in my stomach to eject. I spent almost all day today collapsed on the couch marathoning 30 Rock episodes, it's almost midnight, and I still feel nauseous. I'm actually afraid to lie down.
I feel like I'm Bill Murray in Groundhog Day, doomed to repeat the same day again and again, until I figure out how to do it right. Now I am in Cycle 3 of 8 and I've figure out how to manage or eliminate constipation, mouth sores, neuropathy, and hair loss. But I'm still struggling with nausea and vomiting.
So far, I've tried all of the following, with no noticeable improvement and some uncomfortable side effects:
Granisetron (Kytril), only prescribed for the first 3 days and hasn't stopped me from vomiting on the first day of each cycle
Zantac (H2-receptor antagonist)
Maalox (antacid)
Pantecta (a PPI), strong side effect of heart palpitations
metoclopramide, strong side effect of dizziness and drowsiness
sativa marijuana, strong side effect of dizziness
original Coke
ginger beer
HCl Plus
My doctor thinks the problem is GERD. For a brief while, I thought the problem was not enough stomach acid. But now I'm wondering whether the problem is dyspepsia -- simple indigestion. I don't have heartburn and only once in a while do I taste stomach acid in my throat, but that's always due to burping. Burping is my biggest symptom and that seems to be caused primarily by excess gas in the stomach, not a weakness of the muscle that separates the stomach from the esophagus.
According to Wikipedia, clinical trials show that antacids and H2-receptor antagonists like Zantac have little to no effectiveness against dyspepsia when compared to placebo. Also very interestingly, metoclopramide, which my doctor prescribed, has also been shown to be ineffective.
The same Wiki article stated that a herbal remedy called Iberogast and PPIs have been proven to work. So next I'll try the Iberogast and ask my doctor to prescribe another PPI besides Pantecta.
* * * * * * * * * * * * * * * * * * *
UPDATE: well, I tried the Iberogast. A little bottle sells here for about 15 euros, and I'm supposed to take 20 drops three times a day. The taste is somewhat awful, and I didn't notice a difference after taking it once. I stopped taking it, because the burping has gotten somewhat more tolerable now that I'm on Day 11 of this cycle. I saw today that another blogger (Carrie's NHL Blog) wrote that nausea wasn't a big problem for her: "Zofran, Compazine and Ativan work great and, when I just need a little something, I take 500 mg – 1000 mg of ginger." So I plan to do some further investigation of this option before my next consult.
Day-by-Day Breakdown, Chemo Cycle III
Day 1: vomiting approximately 8 hours after leaving the hospital
Day 2: nausea in the morning, fatigue, slight cough, hyperactivity leading to sleeplessness (side effect of prednisolon), very slight neuropathy in my right thumb
Day 3: same as Day 2
Day 4: same as Day 2 plus extreme dizziness and drowsiness after taking metoclopramide in the morning
Day 5-6: same as Day 2 plus burping (note that the only anti-nausea meds I took on these days was Maalox)
Day 7: same as Day 2 plus heavy burping, vomited twice in the middle of the night (note that I made the mistake of eating shoarma with hot sauce and ran out of Maalox)
Day 8: same as Day 2 plus burping and nausea (took 2 Zantac pills)
Day 9: nausea, burping, fatigue, slight cough
Day 10: nausea, burping, fatigue
Day 11: burping
Day 12: burping
I really need to find a good solution for the nausea and burping!
Day 2: nausea in the morning, fatigue, slight cough, hyperactivity leading to sleeplessness (side effect of prednisolon), very slight neuropathy in my right thumb
Day 3: same as Day 2
Day 4: same as Day 2 plus extreme dizziness and drowsiness after taking metoclopramide in the morning
Day 5-6: same as Day 2 plus burping (note that the only anti-nausea meds I took on these days was Maalox)
Day 7: same as Day 2 plus heavy burping, vomited twice in the middle of the night (note that I made the mistake of eating shoarma with hot sauce and ran out of Maalox)
Day 8: same as Day 2 plus burping and nausea (took 2 Zantac pills)
Day 9: nausea, burping, fatigue, slight cough
Day 10: nausea, burping, fatigue
Day 11: burping
Day 12: burping
I really need to find a good solution for the nausea and burping!
Monday, May 11, 2009
Treatment Against Peripheral Neuropathy
Two weeks ago, I experienced a little bit of peripheral neuropathy (tingling in hands and feet, fingernails and toenails turning black). My right thumb seemed to suffer the worst and alternated throughout the days between numbness and tingling.
I read that it's best to address neuropathic symptoms as soon as they are noticed; otherwise, more serious side effects can develop. But there is not so much information available on the web on how exactly to go about tackling the problem.
Other survivors have highly recommended taking 10 grams of glutamine daily, acupuncture, and (to a far lesser extent) professional massage or acupressure. Unfortunately, alternative treatments are not covered by my insurance policy. In some ways, this is a relief for me, because then I'd have to mount a campaign to persuade my not-so-holistically inclined doctor to refer me to one of these specialists. I don't think I have the energy for that.
In the meantime, as this particular side effect is not too bad at the moment, I tried self-massaging my hands several times a day using a combination of techniques from these videos:
Self-Massage for Hands
Ten Step Hand Reflexology Self-Treatment
Note that the Expert Village series also includes self-massage for the neck, tired eyes, bottom of feet and heels, feet in high heels, after-meal relief, arms, back, and lower back. Also, if self-massage doesn't appeal, one website recommended asking a partner or friend to learn massage and have them perform it on you (one way to test whether they really mean what they say when they say: "let me know if there's anything I can do!"). I quite liked that idea, but the nice thing about self-massage is that I can do it every day, several times a day, whenever I want.
The hand self-massaging feels good (I do it almost subconsciously now, when I'm waiting in line at the pharmacy, for example), but didn't produce any noticeable reduction of my existing neuropathic symptoms.
But yesterday, I massaged my entire body using a powerful electric massager I bought years ago from Sharper Image, focusing on the palm of my hand and all around my thumb. This not only provided instant relief, but even hours later, my thumb neuropathy has virtually disappeared.
I've also noticed recently that if I wear warm mittens and socks to bed, I don't wake up with tingling in my feet or hands. It makes sense to me that the blood should circulate better if it's kept warm, so I might try wearing my mittens around the house as well.
It could be that the neuropathic symptoms are simply waning as more days pass after my last chemo treatment. I'll have to see whether these techniques will continue to work when I plunge into Chemo Round 3, which begins next Friday.
* * * * * * * * * * * *
UPDATE: now it's Day 8 of my third chemo cycle, and I have (so far) less neuropathy than I did during Cycle 2 at the same time point. I use my massager on both hands and arms whenever I feel tingling in my right thumb, so approximately 2-3 times a day. So far, I haven't developed neuropathy anywhere else.
I read that it's best to address neuropathic symptoms as soon as they are noticed; otherwise, more serious side effects can develop. But there is not so much information available on the web on how exactly to go about tackling the problem.
Other survivors have highly recommended taking 10 grams of glutamine daily, acupuncture, and (to a far lesser extent) professional massage or acupressure. Unfortunately, alternative treatments are not covered by my insurance policy. In some ways, this is a relief for me, because then I'd have to mount a campaign to persuade my not-so-holistically inclined doctor to refer me to one of these specialists. I don't think I have the energy for that.
In the meantime, as this particular side effect is not too bad at the moment, I tried self-massaging my hands several times a day using a combination of techniques from these videos:
Self-Massage for Hands
Ten Step Hand Reflexology Self-Treatment
Note that the Expert Village series also includes self-massage for the neck, tired eyes, bottom of feet and heels, feet in high heels, after-meal relief, arms, back, and lower back. Also, if self-massage doesn't appeal, one website recommended asking a partner or friend to learn massage and have them perform it on you (one way to test whether they really mean what they say when they say: "let me know if there's anything I can do!"). I quite liked that idea, but the nice thing about self-massage is that I can do it every day, several times a day, whenever I want.
The hand self-massaging feels good (I do it almost subconsciously now, when I'm waiting in line at the pharmacy, for example), but didn't produce any noticeable reduction of my existing neuropathic symptoms.
But yesterday, I massaged my entire body using a powerful electric massager I bought years ago from Sharper Image, focusing on the palm of my hand and all around my thumb. This not only provided instant relief, but even hours later, my thumb neuropathy has virtually disappeared.
I've also noticed recently that if I wear warm mittens and socks to bed, I don't wake up with tingling in my feet or hands. It makes sense to me that the blood should circulate better if it's kept warm, so I might try wearing my mittens around the house as well.
It could be that the neuropathic symptoms are simply waning as more days pass after my last chemo treatment. I'll have to see whether these techniques will continue to work when I plunge into Chemo Round 3, which begins next Friday.
* * * * * * * * * * * *
UPDATE: now it's Day 8 of my third chemo cycle, and I have (so far) less neuropathy than I did during Cycle 2 at the same time point. I use my massager on both hands and arms whenever I feel tingling in my right thumb, so approximately 2-3 times a day. So far, I haven't developed neuropathy anywhere else.
Treatment Against Cough
I've had this @#$%ing cold since the week of March 1.
I can't get rid of it, because every time it's about to go away, I enter into the phase of my chemo cycle where my white blood cell count heads south and then of course my cold viruses figure the parents are out of the house and it's time to PARTY!
As I figure that I'm going to end up with terrible cold symptoms every 3 weeks until September, I've been doing my best to alleviate the cough and congestion via these techinques, gathered primarily from web research:
1) alternating peppermint tea with a tea made from ginger, lemon, honey, and a couple of shakes of cayenne pepper
2) a few drops of eucalyptus oil in a steaming hot shower
3) wearing a hat, gloves, and socks around the apartment
4) dosing with Nyquil (though I'm going to switch to prescription codeine as soon as I can) at night so that I can quiet the cough enough to sleep
5) drinking liters of water and barley tea
* * * * * * * * * * * * * * * * * * *
UPDATE: it's now Day 10 of Cycle 3 -- no more cough!!! It's a miracle! I'm now just crossing my fingers that it won't come back on Day 13, which is when my cough usually got much worse during my first two cycles.
I can't get rid of it, because every time it's about to go away, I enter into the phase of my chemo cycle where my white blood cell count heads south and then of course my cold viruses figure the parents are out of the house and it's time to PARTY!
As I figure that I'm going to end up with terrible cold symptoms every 3 weeks until September, I've been doing my best to alleviate the cough and congestion via these techinques, gathered primarily from web research:
1) alternating peppermint tea with a tea made from ginger, lemon, honey, and a couple of shakes of cayenne pepper
2) a few drops of eucalyptus oil in a steaming hot shower
3) wearing a hat, gloves, and socks around the apartment
4) dosing with Nyquil (though I'm going to switch to prescription codeine as soon as I can) at night so that I can quiet the cough enough to sleep
5) drinking liters of water and barley tea
* * * * * * * * * * * * * * * * * * *
UPDATE: it's now Day 10 of Cycle 3 -- no more cough!!! It's a miracle! I'm now just crossing my fingers that it won't come back on Day 13, which is when my cough usually got much worse during my first two cycles.
Thursday, May 7, 2009
The Silver Linings
Despite the fact that I'm voluntarily streaming poison into my body every three weeks, in some ways, I feel healthier than I have in years. I have greatly improved my diet. I sleep more. I am less stressed because I have fewer urgent projects on my plate, and I don't have to go into the office.
I've learned a lot about my body and how to take care of it, that will be useful to me, and maybe also to my friends and family, after my treatment is finished.
I learned that I'm tougher and more disciplined than I thought. In a short period of time, I was able to give up coffee and alcohol, as well as drastically cut down on sugar.
I learned how deeply my friends, family, and even colleagues care about me.
I have reconnected and have gotten closer to some friends as a result.
I've gotten extra 1-1 time with my mother and my brothers, that wouldn't have happened otherwise.
I'm more empathetic when I hear about the troubles of others, whether it's a death in the family or a health problem.
I've learned a lot about my body and how to take care of it, that will be useful to me, and maybe also to my friends and family, after my treatment is finished.
I learned that I'm tougher and more disciplined than I thought. In a short period of time, I was able to give up coffee and alcohol, as well as drastically cut down on sugar.
I learned how deeply my friends, family, and even colleagues care about me.
I have reconnected and have gotten closer to some friends as a result.
I've gotten extra 1-1 time with my mother and my brothers, that wouldn't have happened otherwise.
I'm more empathetic when I hear about the troubles of others, whether it's a death in the family or a health problem.
Wednesday, May 6, 2009
Day of Chemo Checklist
The first time I did chemo, I had to stay in the inpatient clinic, where I shared a room with 3 other chemo patients -- all much older than me, 2 of whom were staying in the hospital for a few days.
After my first chemo treatment showed that I had no allergic reactions to any of the chemo drugs, I was allowed to switch to the dagbehandling (day treatment) clinic, which was a large room equipped with about 10 blue dental chairs. Other patients came and went in a manner that indicated this was routine for them. One brought cake to share with everyone else in the room, a nice gesture, though sweet foods are supposed to increase nausea so I turned it down. One woman was hairless, pigmentless, and kept perfectly still for three hours with her eyes closed. She seemed to be dead already. The guy sitting next to me still had a full head of salt-and-pepper hair and enough energy to entertain three visitors. Again, I was by far the youngest person in the room.
For my next chemo session, I want to bring:
* an engrossing book
* noise-cancelling earphones
* my IPOD with the latest moth.org and This American Life episodes loaded
* my laptop and a good DVD
* two fresh bagels
* peanut butter
* some fruit
* ginger candy
* a big bottle of water
* ginger ale
* sea-bands
After my first chemo treatment showed that I had no allergic reactions to any of the chemo drugs, I was allowed to switch to the dagbehandling (day treatment) clinic, which was a large room equipped with about 10 blue dental chairs. Other patients came and went in a manner that indicated this was routine for them. One brought cake to share with everyone else in the room, a nice gesture, though sweet foods are supposed to increase nausea so I turned it down. One woman was hairless, pigmentless, and kept perfectly still for three hours with her eyes closed. She seemed to be dead already. The guy sitting next to me still had a full head of salt-and-pepper hair and enough energy to entertain three visitors. Again, I was by far the youngest person in the room.
For my next chemo session, I want to bring:
* an engrossing book
* noise-cancelling earphones
* my IPOD with the latest moth.org and This American Life episodes loaded
* my laptop and a good DVD
* two fresh bagels
* peanut butter
* some fruit
* ginger candy
* a big bottle of water
* ginger ale
* sea-bands
Tuesday, May 5, 2009
Chemo Procrastination?
I've read about 'chemo brain' and 'chemo fog', but is there such a thing as 'chemo procrastination'? Even when I have the energy and the time, I keep ignoring everything unless it's related to an urgent work project or management of my cancer treatment. I'm especially obsessed with the latter. I'll spend hours on the internet reading cancer-related blogs, instead of spending the 5 minutes needed to scan my income statement so that my accountant can finally finish my soon-to-be-overdue tax return.
I have to-do lists scattered all over my apartment, with not a thing on them done.
I have to-do lists scattered all over my apartment, with not a thing on them done.
Vitamin D
I'm taking 1000 mg of Vitamin D daily because Suzanne (my nutrition guru), who generally favors eating real food over popping supplements, says that it has been consistently associated with better cancer treatment outcomes. In fact, she takes the same supplement herself and thinks that almost everyone should.
Her article explaining the whys and hows of Vitamin D much better than I ever could is here: Vitamin D, Wonder Nutrient
The importance of Vitamin D supplementation is definitely not recognized in Holland. At the Bio Markt (the Dutch version of Whole Foods), there are floor-to-ceiling shelves of vitamins in alphabetical order. Vitamin C can claim almost a whole shelf to itself. But there is a gap between Vitamin C and Vitamin E, a dark hollow space that seems to say: no, we didn't misshelve D, we just don't think you should take it.
At Etos (the Dutch version of Long's or CVS), I could only find Vitamin D in combination with calcium. Three of these tablets a day would provide 750 mg of calcium and 7.5 mg of Vitamin D. But the recommended dose of Vitamin D is at least 1000 mg!
After mentioning this to Suzanne, she sent me a link to her source of Vitamin D. I ended up ordering 1000 mg Vitamin D gelcaps very cheaply (180 gelcaps for about 9 dollars, including shipping) via iherb.com and having them shipped to my brother, who will be flying here next week.
This whole experience has started me thinking that Vitamin D misinformation could be one of the biggest public health problems that should be addressed. If I were to accept everything that Suzanne wrote in her article, there are a number of things that should be changed:
1) Vitamin D supplementation should be included as part of chemotherapy treatment, if not already taken.
2) Vitamin D in higher doses should be made readily available wherever vitamins are sold.
3) The general public should be encouraged to swallow Vitamin D daily, especially in the north, through general media campaigns.
4) Certain high-risk populations (African-Americans living in Europe for example) should be targeted through tailored media campaigns.
5) Vitamin D supplementation should be taught in schools (at what age should it begin?)
It seems to me that there is a real need for a grass-roots campaign to increase the visibility of Vitamin D (perhaps following the trajectory of the successful campaign to increase calcium supplementation in adult women), but I'm not sure that I have the time or energy to launch it.
Her article explaining the whys and hows of Vitamin D much better than I ever could is here: Vitamin D, Wonder Nutrient
The importance of Vitamin D supplementation is definitely not recognized in Holland. At the Bio Markt (the Dutch version of Whole Foods), there are floor-to-ceiling shelves of vitamins in alphabetical order. Vitamin C can claim almost a whole shelf to itself. But there is a gap between Vitamin C and Vitamin E, a dark hollow space that seems to say: no, we didn't misshelve D, we just don't think you should take it.
At Etos (the Dutch version of Long's or CVS), I could only find Vitamin D in combination with calcium. Three of these tablets a day would provide 750 mg of calcium and 7.5 mg of Vitamin D. But the recommended dose of Vitamin D is at least 1000 mg!
After mentioning this to Suzanne, she sent me a link to her source of Vitamin D. I ended up ordering 1000 mg Vitamin D gelcaps very cheaply (180 gelcaps for about 9 dollars, including shipping) via iherb.com and having them shipped to my brother, who will be flying here next week.
This whole experience has started me thinking that Vitamin D misinformation could be one of the biggest public health problems that should be addressed. If I were to accept everything that Suzanne wrote in her article, there are a number of things that should be changed:
1) Vitamin D supplementation should be included as part of chemotherapy treatment, if not already taken.
2) Vitamin D in higher doses should be made readily available wherever vitamins are sold.
3) The general public should be encouraged to swallow Vitamin D daily, especially in the north, through general media campaigns.
4) Certain high-risk populations (African-Americans living in Europe for example) should be targeted through tailored media campaigns.
5) Vitamin D supplementation should be taught in schools (at what age should it begin?)
It seems to me that there is a real need for a grass-roots campaign to increase the visibility of Vitamin D (perhaps following the trajectory of the successful campaign to increase calcium supplementation in adult women), but I'm not sure that I have the time or energy to launch it.
Treatment Against Burping
The burping and belching is still driving me mad. During Cycle 1, after spending all day googling on the search terms "burping", "belching", or "gas" plus "chemo" and "cancer", I didn't come up with much of anything useful, except a few community forum posts that indicated that I wasn't the only one who was perplexed by this not-often-mentioned side effect of chemotherapy.
On one thread, someone posted that he noticed that his mother burped continuously during her treatment period and was curious as to why, which provoked indignant responses like: "your mother has cancer and you're worried about burping?!" To this I would reply, it's hard to feel normal when your body does things it doesn't normally do. Plus, as I mentioned in an earlier post, the burping makes nausea worse.
My brother suggested over-the-counter Maalox, but that didn't work. Then I told my doctor, and he prescribed a powerful proton pump inhibitor called Pantecta (pantoprazole) to use in combination with the anti-emetics during Cycle 2. That didn't work either. In fact, I'm 90% sure it caused me to have severe heart palpitations (listed as a possible side effect for < 2% of the population), because I didn't have heart palpitations during Cycle 1, and they stopped almost immediately after I stopped taking Pantecta.
Then, I happened to be reading an website article on improving digestion and stumbled upon a few sentences about hypochlorhydria:
"Low stomach acid (hypochlorhydria) is common, especially in older people since as we age, we make less stomach acid. Research suggests that as many as half of the people over 60 years old have hypochlorhydria. A variety of factors can inhibit sufficient stomach acid production including the pathogenic bacteria, Helicobacter pylori, and frequent use of antacids. Hypochlorhydria is also associated with many diseases, such as asthma, celiac sprue, hepatitis, rheumatoid arthritis, osteoporosis, and diabetes mellitus. Signs of hypochlorhydria include a sense of fullness after eating, bloating, excessive belching, indigestion, multiple food allergies, undigested food in the stool, and peeling and cracked fingernails."
Bingo! I had almost every symptom listed to some degree.
After further investigation on the net, I discovered:
1) Hypochlorhydria is often misdiagnosed by doctors who almost always jump to the conclusion that antacids should be prescribed, which would only make the problem worse!
2) Burping can be a serious problem because it's a sign that the body is not capable of breaking food down into its component nutrients; you can eat all you want and still be starving and undernourished. I felt especially frustrated when reading this, because I had been spending so much time researching nutrition and preparing healthy food to eat, only to learn that most of it is just being flushed down the toilet!
3) Hypochlorhydria is a well-known side effect of proton pump inhibitors. After still more research, I discovered that proton pump inhibitors are recommended to mitigate some of the side effects of CHOP chemotherapy. But as far as I know, I hadn't been taking any proton pump inhibitors except for Pantecta, which I only took after I already experienced burping.
More detective work revealed that it is possible to self-diagnose hypochlorhydia by performing a challenge test with hydrochloric acid. In fact, the challenge test would also determine the appropriate treatment dosage for my level of stomach acid deficiency. Perfect.
The local Bio-Markt (Holland's version of Whole Foods Market) didn't have any hydrochloric acid in stock, but they offered to order HCl Plus by Biotics Research for me. This is a combination pill of HCl, pepsin (to simulate the body to produce HCl naturally), and Vitamin B12 (because persons with low stomach acid are always deficient in B12).
I still haven't tried the challenge test yet, but I plan to do it soon. It would be amazing to have this mystery solved!
***********
It's now a few days later and I've started taking HCl with every meal, but frankly: I can't tell whether it's working. I just read on the internet that one person took many pills, didn't feel any burning, but later got tested for stomach acid and found out that his level was normal. I don't feel any burning when I take one pill; I'm still burping, but I'm afraid to take more and end up with a self-created ulcer. So on Wednesday when I go in for my next consult, I'll see whether I can persuade my doctor to check my stomach acid level. I am now afraid to take anything for fear that my problem will worsen, but I'd really like to make these side effects go away for good.
On one thread, someone posted that he noticed that his mother burped continuously during her treatment period and was curious as to why, which provoked indignant responses like: "your mother has cancer and you're worried about burping?!" To this I would reply, it's hard to feel normal when your body does things it doesn't normally do. Plus, as I mentioned in an earlier post, the burping makes nausea worse.
My brother suggested over-the-counter Maalox, but that didn't work. Then I told my doctor, and he prescribed a powerful proton pump inhibitor called Pantecta (pantoprazole) to use in combination with the anti-emetics during Cycle 2. That didn't work either. In fact, I'm 90% sure it caused me to have severe heart palpitations (listed as a possible side effect for < 2% of the population), because I didn't have heart palpitations during Cycle 1, and they stopped almost immediately after I stopped taking Pantecta.
Then, I happened to be reading an website article on improving digestion and stumbled upon a few sentences about hypochlorhydria:
"Low stomach acid (hypochlorhydria) is common, especially in older people since as we age, we make less stomach acid. Research suggests that as many as half of the people over 60 years old have hypochlorhydria. A variety of factors can inhibit sufficient stomach acid production including the pathogenic bacteria, Helicobacter pylori, and frequent use of antacids. Hypochlorhydria is also associated with many diseases, such as asthma, celiac sprue, hepatitis, rheumatoid arthritis, osteoporosis, and diabetes mellitus. Signs of hypochlorhydria include a sense of fullness after eating, bloating, excessive belching, indigestion, multiple food allergies, undigested food in the stool, and peeling and cracked fingernails."
Bingo! I had almost every symptom listed to some degree.
After further investigation on the net, I discovered:
1) Hypochlorhydria is often misdiagnosed by doctors who almost always jump to the conclusion that antacids should be prescribed, which would only make the problem worse!
2) Burping can be a serious problem because it's a sign that the body is not capable of breaking food down into its component nutrients; you can eat all you want and still be starving and undernourished. I felt especially frustrated when reading this, because I had been spending so much time researching nutrition and preparing healthy food to eat, only to learn that most of it is just being flushed down the toilet!
3) Hypochlorhydria is a well-known side effect of proton pump inhibitors. After still more research, I discovered that proton pump inhibitors are recommended to mitigate some of the side effects of CHOP chemotherapy. But as far as I know, I hadn't been taking any proton pump inhibitors except for Pantecta, which I only took after I already experienced burping.
More detective work revealed that it is possible to self-diagnose hypochlorhydia by performing a challenge test with hydrochloric acid. In fact, the challenge test would also determine the appropriate treatment dosage for my level of stomach acid deficiency. Perfect.
The local Bio-Markt (Holland's version of Whole Foods Market) didn't have any hydrochloric acid in stock, but they offered to order HCl Plus by Biotics Research for me. This is a combination pill of HCl, pepsin (to simulate the body to produce HCl naturally), and Vitamin B12 (because persons with low stomach acid are always deficient in B12).
I still haven't tried the challenge test yet, but I plan to do it soon. It would be amazing to have this mystery solved!
***********
It's now a few days later and I've started taking HCl with every meal, but frankly: I can't tell whether it's working. I just read on the internet that one person took many pills, didn't feel any burning, but later got tested for stomach acid and found out that his level was normal. I don't feel any burning when I take one pill; I'm still burping, but I'm afraid to take more and end up with a self-created ulcer. So on Wednesday when I go in for my next consult, I'll see whether I can persuade my doctor to check my stomach acid level. I am now afraid to take anything for fear that my problem will worsen, but I'd really like to make these side effects go away for good.
Treatment Against Nausea
Nausea's usually one of the worst side effects of chemo, although it seems to affect everyone to a different degree and some not at all. I read that younger women are typically more affected.
The good news is that an array of powerful medications are available for fighting nausea, so if one combination doesn't work, then others can be tried until the right one is found. But in addition to that, there are a lot of other natural ways to fight nausea:
1) Sea bands, which use acupressure and can be found in any drug store in the U.S. I did indeed notice a difference when I put these on, but not enough to give up my anti-emetics.
2) Ginger: candied or raw or cut up into tea with some lemon & honey or in ginger beer (make sure the ingredients list real ginger, rather than ginger flavoring)
3) Marijuana: the indica variety (as opposed to sativa) is supposed to work wonders against nausea, appetite, and vomiting. A friend of a friend, who found the side effects of anti-nausea medications too debilitating, smoked 30-45 minutes before every chemo treatment and as often as needed afterwards. I tried smoking a few tokes around Day 10 after my first chemotherapy, but I didn't like the feeling of lightheadness and dizziness that went along with being high. It reminded me too much of my first few days after chemo.
4) Eating: eat many small meals per day instead of three large meals, eat bland foods, chew slowly, drink lots of water
5) Eating, Part II: make sure you eat, even if you have no interest in eating. Otherwise, the nausea will just get worse.
6) Pills: if the pill taste increases the nausea, try crushing them in food (usually meds that are not slow-release meds may be crushed) or enclosing them in gelcaps you can buy at the pharmacy.
I'm still looking for my nausea magic bullet. I still feel extremely nauseous and vomit-prone on Day 1 of chemo and then progressively less nauseous until Day 10. But my anti-nausea drug regimen -- taking granisetron (kytrol) during Days 1-3 and metoclopram preventively from Days 4-7 -- in addition to following the tips above, have helped a lot.
The good news is that an array of powerful medications are available for fighting nausea, so if one combination doesn't work, then others can be tried until the right one is found. But in addition to that, there are a lot of other natural ways to fight nausea:
1) Sea bands, which use acupressure and can be found in any drug store in the U.S. I did indeed notice a difference when I put these on, but not enough to give up my anti-emetics.
2) Ginger: candied or raw or cut up into tea with some lemon & honey or in ginger beer (make sure the ingredients list real ginger, rather than ginger flavoring)
3) Marijuana: the indica variety (as opposed to sativa) is supposed to work wonders against nausea, appetite, and vomiting. A friend of a friend, who found the side effects of anti-nausea medications too debilitating, smoked 30-45 minutes before every chemo treatment and as often as needed afterwards. I tried smoking a few tokes around Day 10 after my first chemotherapy, but I didn't like the feeling of lightheadness and dizziness that went along with being high. It reminded me too much of my first few days after chemo.
4) Eating: eat many small meals per day instead of three large meals, eat bland foods, chew slowly, drink lots of water
5) Eating, Part II: make sure you eat, even if you have no interest in eating. Otherwise, the nausea will just get worse.
6) Pills: if the pill taste increases the nausea, try crushing them in food (usually meds that are not slow-release meds may be crushed) or enclosing them in gelcaps you can buy at the pharmacy.
I'm still looking for my nausea magic bullet. I still feel extremely nauseous and vomit-prone on Day 1 of chemo and then progressively less nauseous until Day 10. But my anti-nausea drug regimen -- taking granisetron (kytrol) during Days 1-3 and metoclopram preventively from Days 4-7 -- in addition to following the tips above, have helped a lot.
Treatment Against Mouth Sores
I don't have to avoid citrus fruit or rinse my mouth with salt water anymore. I've figured out how to self-treat mouth sores.
Besides rinsing my mouth after every meal, brushing my tongue and where the gums meet the teeth once a day, flossing and using water pic once in a while, and using wooden toothsticks to massage the gums between the teeth every night, I've also started to massage my gums with the pads of my fingers. Not just the gum area around the teeth, but my entire mouth. It only takes a few seconds a day and it really works!
Besides rinsing my mouth after every meal, brushing my tongue and where the gums meet the teeth once a day, flossing and using water pic once in a while, and using wooden toothsticks to massage the gums between the teeth every night, I've also started to massage my gums with the pads of my fingers. Not just the gum area around the teeth, but my entire mouth. It only takes a few seconds a day and it really works!
Monday, May 4, 2009
Day-by-Day Breakdown, Chemo Cycle II
Day 1: extreme nausea (made some mistakes such as not taking my granisetron in time because it was not available at my pharmacy and not bringing enough food to chemo so that when I finally ate, I ate too fast and I ate everything on the sandwich, including the cheese), dizziness, and fatigue
Day 2: nausea in the morning, fatigue, slight cough, hyperactivity leading to sleeplessness (side effect of prednisolon), slight neuropathy, more hair loss
Day 3: slight nausea in the morning, slight cough, hyperactivity, a lot of hair loss in the shower, breakthrough pain
Day 4: slight nausea, heart palpitations, breakthrough pain
Day 5: same as Day 4
Day 6: same as Day 4
Day 7 (Queen's Day): slight nausea, heart palpitations, some breakthrough pain, fatigue, strange taste in saliva
Day 8 (took only Pantecta against nausea today): slight nausea, burping, very strong heart palpitations, slight cough, some neuropathy, some night sweats, toes black, thumbnails turning black, stiff/sore right leg, stiff right arm
Day 9 (took only metoclopram against nausea today): same as Day 8 but with only slight heart palpitations
Day 10 (took no medications against nausea today, started yoga/meditation/self-massage for hands): burping, congestion, slight cough, some neuropathy, toes black, thumbnails turning black
Day 11: same as Day 10 but with a bit more energy, actually one of the best days I've had since diagnosis
Day 12: same as Day 10 but with much stronger cough and congestion (I'm guessing that my dip period begins on Day 12)
Day 13: same as Day 10 but with much stronger cough and congestion (I'm guessing that my dip period begins on Day 12). I also accidentally cut myself on Day 12. It's was a tiny cut that would have ordinarily closed in an hour, but today it's still bleeding like a fresh cut. I put Bacitracin and a bandaid on it, to prevent infection, but the bleeding would probably indicate a low platelet count.
This chemo cycle seems to be better against nausea, though I have hopes that I won't vomit at all during Round 3, and I still feel queasy from time to time. I'm concerned about the atrial fibrillations. Even though they don't seem to be considered a serious side effect, I have this sensation that I need to take deep breaths to prevent myself from having a heart attack. I'm also concerned about the breakthrough pain; does it mean that the cancer is still fighting back?
I've had this cold since the week of March 1 -- thus, for more than two months. I am betting now that I'll have it for the entire course of chemotherapy.
Day 2: nausea in the morning, fatigue, slight cough, hyperactivity leading to sleeplessness (side effect of prednisolon), slight neuropathy, more hair loss
Day 3: slight nausea in the morning, slight cough, hyperactivity, a lot of hair loss in the shower, breakthrough pain
Day 4: slight nausea, heart palpitations, breakthrough pain
Day 5: same as Day 4
Day 6: same as Day 4
Day 7 (Queen's Day): slight nausea, heart palpitations, some breakthrough pain, fatigue, strange taste in saliva
Day 8 (took only Pantecta against nausea today): slight nausea, burping, very strong heart palpitations, slight cough, some neuropathy, some night sweats, toes black, thumbnails turning black, stiff/sore right leg, stiff right arm
Day 9 (took only metoclopram against nausea today): same as Day 8 but with only slight heart palpitations
Day 10 (took no medications against nausea today, started yoga/meditation/self-massage for hands): burping, congestion, slight cough, some neuropathy, toes black, thumbnails turning black
Day 11: same as Day 10 but with a bit more energy, actually one of the best days I've had since diagnosis
Day 12: same as Day 10 but with much stronger cough and congestion (I'm guessing that my dip period begins on Day 12)
Day 13: same as Day 10 but with much stronger cough and congestion (I'm guessing that my dip period begins on Day 12). I also accidentally cut myself on Day 12. It's was a tiny cut that would have ordinarily closed in an hour, but today it's still bleeding like a fresh cut. I put Bacitracin and a bandaid on it, to prevent infection, but the bleeding would probably indicate a low platelet count.
This chemo cycle seems to be better against nausea, though I have hopes that I won't vomit at all during Round 3, and I still feel queasy from time to time. I'm concerned about the atrial fibrillations. Even though they don't seem to be considered a serious side effect, I have this sensation that I need to take deep breaths to prevent myself from having a heart attack. I'm also concerned about the breakthrough pain; does it mean that the cancer is still fighting back?
I've had this cold since the week of March 1 -- thus, for more than two months. I am betting now that I'll have it for the entire course of chemotherapy.
Viva Amsterdam!
Okay, non-Dutch cancer patients. Prepare to be jealous.
I had my arbo doctor appointment this morning.
A few weeks ago, a letter arrived in the post, written in Dutch, requesting that I meet with the arbo doctor and notify my company if I cannot attend. Then a woman from Human Resources called me to ask if I received the letter. I asked her what it was all about, because we have nothing like this in the States.
Apparently, by law, all employees who are absent from work for more than 5 days meet with an arbo doctor. I didn't need to bring or prepare anything for the meeting, and Human Resources insisted that I take a taxi to the meeting and back.
I asked a long term resident about the arbo doctor and she said not to worry; the company is absolutely not checking up on me. In fact, the arbo doctor will typically take sides with the patient over the company. They are there to ensure that the employee is not overworked during his/her illness and to ease the transition back to work. Sometimes they insist, for example, that an employee on maternity leave only work half-days for the first week they are back in the office.
The arbo doctor asked me a few questions about my diagnosis, treatment, and its side effects. He also explained that I could not legally lose my job for up to two years. The first year, I would continue to receive 100% of my salary. The second year, I would receive 70%. The doctor showed me the form he was completing to send to my company, which legally could not mention my diagnosis or specific side effects; mostly it just stated that I had been working approximately 20 hours a week due to problems with fatigue and concentration, resulting from my treatment. He was careful to tell me that stating this number in the letter was by no means binding me to work 20 hours a week. Also as required by law, we will continue to meet every 6 weeks by telephone or email throughout my treatment.
Wow. While I've never been sick for more than 5 days in the U.S., I'm pretty sure that's not how it works there. My former company combined sick and vacation days, and we had 20 days in total. I know I had short-term and long-term disability benefits, but I never bothered to look at the fine print, so I have no idea whether it is anywhere near as simple or comprehensive as the Dutch system.
My cousin just sent me a link to an article in the New York Times that goes on quite a bit about the 52% tax rate in the Netherlands. The article mentions some of the benefits citizens get as a result, but not this one. I am feeling truly thankful that I am here at this moment...and also a little bit guilty, as I don't even pay the 52% tax rate. As an expat, I get a big tax break called the 30% ruling, which means that I don't get taxed on the first 30% of my income. Oh well: one doesn't turn down free money!
I had my arbo doctor appointment this morning.
A few weeks ago, a letter arrived in the post, written in Dutch, requesting that I meet with the arbo doctor and notify my company if I cannot attend. Then a woman from Human Resources called me to ask if I received the letter. I asked her what it was all about, because we have nothing like this in the States.
Apparently, by law, all employees who are absent from work for more than 5 days meet with an arbo doctor. I didn't need to bring or prepare anything for the meeting, and Human Resources insisted that I take a taxi to the meeting and back.
I asked a long term resident about the arbo doctor and she said not to worry; the company is absolutely not checking up on me. In fact, the arbo doctor will typically take sides with the patient over the company. They are there to ensure that the employee is not overworked during his/her illness and to ease the transition back to work. Sometimes they insist, for example, that an employee on maternity leave only work half-days for the first week they are back in the office.
The arbo doctor asked me a few questions about my diagnosis, treatment, and its side effects. He also explained that I could not legally lose my job for up to two years. The first year, I would continue to receive 100% of my salary. The second year, I would receive 70%. The doctor showed me the form he was completing to send to my company, which legally could not mention my diagnosis or specific side effects; mostly it just stated that I had been working approximately 20 hours a week due to problems with fatigue and concentration, resulting from my treatment. He was careful to tell me that stating this number in the letter was by no means binding me to work 20 hours a week. Also as required by law, we will continue to meet every 6 weeks by telephone or email throughout my treatment.
Wow. While I've never been sick for more than 5 days in the U.S., I'm pretty sure that's not how it works there. My former company combined sick and vacation days, and we had 20 days in total. I know I had short-term and long-term disability benefits, but I never bothered to look at the fine print, so I have no idea whether it is anywhere near as simple or comprehensive as the Dutch system.
My cousin just sent me a link to an article in the New York Times that goes on quite a bit about the 52% tax rate in the Netherlands. The article mentions some of the benefits citizens get as a result, but not this one. I am feeling truly thankful that I am here at this moment...and also a little bit guilty, as I don't even pay the 52% tax rate. As an expat, I get a big tax break called the 30% ruling, which means that I don't get taxed on the first 30% of my income. Oh well: one doesn't turn down free money!
Sunday, May 3, 2009
Marinated Cucumber Recipe
For some reason, vinegary things seem to go down well. And cucumbers are on the list of the world's healthiest foods. This is my mom's recipe:
1. Wash cucumber well and slice as thin as you can.
2. If you have time, soak the slices in salty water for > 1/2 hour. If you are in a hurry, sprinkle the slices with a little salt, let sit 5-10 minutes, and rinse the salt off.
4. Squeeze out the water.
5. Add sugar, vinegar, and sesame oil to taste. You can also add garlic sesame seeds and/or a little soy sauce.
You can eat this immediately or you can keep it in the fridge. You can do the same thing to asparagus after you cook it in salty boiled water for 5-8 minutes and cool it off naturally or in cold water.
1. Wash cucumber well and slice as thin as you can.
2. If you have time, soak the slices in salty water for > 1/2 hour. If you are in a hurry, sprinkle the slices with a little salt, let sit 5-10 minutes, and rinse the salt off.
4. Squeeze out the water.
5. Add sugar, vinegar, and sesame oil to taste. You can also add garlic sesame seeds and/or a little soy sauce.
You can eat this immediately or you can keep it in the fridge. You can do the same thing to asparagus after you cook it in salty boiled water for 5-8 minutes and cool it off naturally or in cold water.
Subscribe to:
Posts (Atom)
Posts
