The plight of not having insurance or adequate insurance is not a situation many people can understand unless they have actually been there. That feeling of knowing a broken wrist could set you back financially or that a doctor's visit will eat up your monthly budget is a terrible one. Cynthia Campbell knows the feeling all too well. Campbell is battling stage IV cancer and will lose her temporary insurance policy as of July 20.

Temporary insurance policies are handy when you are in between jobs or waiting for a newer, better policy to take effect. But temporary policies to not smile upon too many claims and can often be hard to renew, as in Campbell's situation.

Currently Campbell is interviewing for several nursing positions that will provide full coverage if she is hired. Although she needs to rest and will require additional care for her cancer, it could be her only chance for adequate health coverage.

OK, we all know young women get breast cancer. But the way some talk about the pair -- young women and the deadly disease -- it would seem finding a young one living with this type of cancer is like locating that needle in a haystack. Many a young woman -- like me -- have heard doctors and nurses and technicians and family and friends remark, "you are too young for the disease," and then dismiss cancer suspicions as needless worry.

The median age for women diagnosed with breast cancer is 65. But think about this fact, published in the Spring/Summer edition of Beyond: Live & Thrive After Breast Cancer.

More than 240,000 women in the United States age 40 and under are living with breast cancer. Each year in this country, more than 14,000 women 40 years old and younger are diagnosed with breast cancer, says Boston oncologist Ann Partridge, M.D., of the Dana-Farber Cancer Institute.

That's a lot of young women. That's a lot of breast cancer. And yet, mammograms still are not recommended for women under the age of 40.

Luanne Austin says chemotherapy is not all it's cracked up to be. She doesn't mean it's cracked up to be something really great but is far from such a thing. She means it's cracked up to be something pretty horrible but is really not all that bad.

Austin says the day her doctor announced she would receive chemotherapy was almost as bad as the day she learned she had breast cancer. That's because she had heard nothing but bad things about the treatment. She expected to be laying in bed with her life in the balance -- nauseated, vomiting, sick -- as the "cure" killed her.

All expectations aside, Austin decided to tackle chemotherapy with a positive attitude. This may seem a daunting task -- turning a dreaded chemotherapy protocol into a not-so-bad experience -- but Austin mastered the task. And here are seven of her positive thoughts about a treatment that is not all it's cracked up to be.

• Austin talked to people who had traveled journeys similar to hers. What she learned is that many women continued working through treatment. Some suffered very few side effects. One woman even told Austin her experience was super. Austin was inspired by the positive women she tracked down. And now she inspires others.
  

• Austin did some reading. She learned that chemotherapy drugs target quickly-dividing cells, like cancer cells, red and white blood cells, blood platelets, and digestive tract cells. Learning about the process helped her realize chemotherapy was intended to make her well, not make her suffer.

• Austin learned how to support her body through treatment. She came to understand that the best chance of surviving breast cancer comes from conventional medicine -- surgery, chemotherapy, radiation -- but that alternative treatments can complement the traditional approach. She recommends the book Breast Cancer: Beyond Convention and considers her pursuit of a healthy diet, exercise, supplements, and a good night's sleep some of her most helpful chemotherapy add-ons.

• When Austin felt weak, tired, and just plain zoned out, she retreated to her bed with a good book and a cup of tea. Instead of considering it a setback, she called this downtime a good excuse to spend hours reading.

• Austin found relief from her nurses. They were terrific, she recalls, and professional and friendly and respectful too. Getting to know her medical crew -- and receiving hugs from them at the end of her treatment -- confirmed chemotherapy has some good points.

• For Austin, God -- who carried her through her whole journey -- was instrumental in her positive outlook. She felt lifted up and carried, she says.

• And then there's love -- pure and simple love from her husband and family members -- that allows her to conclude that chemotherapy is not so bad. "I'd have to say chemotherapy hasn't been all that bad," she says. "Not bad at all."
  

I've had the little book, with its glossy plaid cover, ever since it was released in 1991. I was 21 years old and already a fan of well-crafted, powerful words. So it was no surprise I picked up Life's Little Instruction Book: 511 suggestions, observations, and reminders on how to live a happy and rewarding life. And it's no surprise I have kept it with me for all these years, allowing it a lifetime membership on my bookshelf, where I can swiftly pluck it from its spot when I need a little inspiration.

Now in a worn, faded, and tattered state, this book is still one of my favorites. Its words are timeless, its messages are meaningful -- even more so now that I am 36 years ago. Now a college graduate, a one-time working professional, a wife, a mom, a writer, and a breast cancer survivor, the reflections printed in this book speak to me more clearly than ever before.

Here are seven of my current favorites from Life's Little Instruction Book -- written by H. Jackson Brown, Jr. for his college-bound son at a time when he had no idea the road map he provided for his child would come to serve so many others.

• Always have something beautiful in sight, even if it's just a daisy in a jelly glass.

• Don't forget, a person's greatest emotional need is to feel appreciated.

• Choose work that is in harmony with your values.

• Don't be intimidated by doctors and nurses. Even when you're in the hospital, it's still your body.

• Don't use time or words carelessly. Neither can be retrieved.

• Live so that when your children think of fairness, caring, and integrity, they think of you.

• Keep it simple.
  

Women with ovulation disorders -- and related infertility problems -- have a lower risk of developing breast cancer, according to a study of more than 116,000 women.

Researchers from the Harvard School of Public Health in Boston studied data from the Nurses' Health Study II and evaluated female nurses aged 25 to 42, tracking them every two years beginning in 1989 and ending in 2001.

Results of the study, reported in the Archives of Internal Medicine, revealed 1,357 diagnosed cases of invasive breast cancer. Overall, women with ovulation disorders had a 25 percent less chance of developing this disease than those without the disorder.

Also detected was an even lower risk of breast cancer for women who experienced induced ovulation for treatment of infertility. This is potentially great news -- pending more research, of course -- for women worried about breast cancer implications of infertility treatment.

Luis Carranza is just eight years old. And he is just a few years -- or perhaps a few months -- away from dying as a result of a weakened immune system due to aggressive treatment for leukemia. The same treatment that at one time brought remission for this boy also attacked his central nervous system, caused seizures, brought on terminal and irreversible brain damage, and eventually sent him into a vegetative state. Luis has traveled a rough road -- and so has his mother who illegally slipped him across the Mexican border into the United States in hopes of treatment to save her young son's life.

Guadalupe Carranza did find salvation for her son in a Texas hospital and for more than one year, Luis received chemotherapy and radiation -- and loads of love from staff and volunteers who helped care for him. Guadalupe was not always there for her son, though, because after locating helpful health care and social services, she was deported to Mexico. She tried to return on many occasions and even received assistance from doctors, nurses, social workers, and attorneys who worked to find a legal way to unite Guadalupe and Luis. But not until Luis fell into a coma did efforts pay off.

After negotiation with border and consulate officials, Guadalupe was granted a humanitarian parole visa and legally crossed into the United States on May 8. The visa allowed her 60 days -- but officials agreed to let her stay until Luis passes away. And so she stays -- by her son's bedside where he rests peacefully in a place that gave him a chance at life. A chance his mother says he never would have had in Mexico.

I was in the emergency room the other night with my three-year-old who was experiencing a mysterious leg pain that resulted from a bad case of strep throat. It wasn't serious enough to warrant swift movement from the waiting room to an actual room and we sat in a holding pattern with a crowd of other patients, some of whom were still waiting after Danny had been treated and released. I was told patients are served in the order in which they arrive but also according to the seriousness of their complaints -- which takes me back to the night I was in the ER with a fever, headache, sore throat, and sore gums. The night I was given a mask and was immediately escorted from the waiting room to a private room where doctors and nurses treated me for neutropenia -- a condition caused by chemotherapy and marked by a drop in neutrophil levels, a condition that puts chemotherapy patients at great risk for infection. This was the second time I went to the hospital for neutropenia. Both times I was admitted and treated for five days.

And so sitting in the ER reminded me about how serious chemotherapy side effects can be. And it makes me want to caution all chemotherapy patients to never dismiss the signs that the body is suffering -- to never tough it out with the hope that a good night's sleep or a few days rest will straighten everything out. Because it may not -- and the end result may be tragic.

All chemotherapy patients should be briefed by their medical teams about when to call for medical assistance. For me, a temperature of 100.4 was the magic call-for-help signal. And twice, I called for help -- once in the middle of the night. But any symptoms , and definitely a combination of symptoms, are cause enough for a simple phone call. So don't delay. Don't excuse warning signs that your body is struggling. Don't second-guess your decision to notify a medical professional about your symptoms. Just call. It could save your life.

The family has asked that they not be identified by name as they grieve the loss of their family member lost to a massive overdose of the chemotherapy drug 5-fluorouracil. Last week, a 43-year-old mother of three, died from a massive chemotherapy drug overdose mistakenly administered by a portable pump used primarily by gastrointestinal, genito-urinary and head and neck cancer patients. The fatal dose of 5-fluorouracil was 24 times what was intended.

According to the report, a nurse programmed the wrong information into the woman's pump. Another nurse checked the pump but failed to notice the error. Four days later, the woman was dead. The Cross Cancer Institute calls this mistake one of the center's worst nightmares but they will not hide the mistake.

While the nurses who made the error are receiving counseling over the mistake they made that led to the mother's death, they will not be disciplined for the error, as the cancer center believes it was not due to negligence. Then what was it due to? There are times when human error cannot be allowed to be made as it can be fatal -- as in this case. There are some professions that require an absolute fail-safe set of procedures and practices that do not allow for human error. A standard of professional excellence in carrying out one's job that this type of incident does not happen -- even once. Because human life can be lost. How do you remedy that error -- right that wrong? I feel for this family, for the children left motherless due to the errors made by two nurses.

According to the woman's oncologist, she had a 75 percent chance of surviving her cancer diagnosis. Tragically, she did not survive treatment. An investigation by the Institute for Safe Medication Practices is underway, and the cancer center states it will implement any changes recommended.

Some campaigns just make me sad. UK's Age Concern, a charity that works to promote the health and welfare of older citizens, has launched a campaign called Hungry To Be Heard because it seems nine of of ten nurses do not have time to make sure elderly patients are getting enough to eat during their stay in the hospital. As a result, over half of the elderly patients are at risk for malnutrition. As hospital patients, if the elderly are malnourished, they simply are not going to recover or heal as quickly; they are at greater risk for post-surgical complications and they suffer a higher rate of death.

And so the countdown begins -- 22 days until my port comes out. On September 15 at 9:00 AM I will report to the basement of Shands Hospital at the University of Florida where I will be doped into a semi-conscious state and wheeled into an operating room. Doctors and nurses will open the skin near my collarbone and while watching their own procedure on a monitor hanging overhead will remove my port and all connected tubing. They will close my skin, leaving an incision that will quickly become a scar -- and a physical reminder of the cancer than once settled into my breast and the drugs that ran through my veins in search of it. It will be my battle scar -- second in importance only to the marks that criss cross my stomach and mark the spot where two big baby boys stretched my skin to unimaginable proportions.

The state of my port has plagued me for some time now -- ever since I knew chemotherapy was fast approaching its end. I have wanted to keep it in place just in case I need it again. And I have wanted to get it out just in case I never need it again. And when it came down to making a decision, I decided taking it out was best. So I can move on. So I can move forward. So I can move away from cancer. I know I'll never move completely away from it -- and that's okay. I don't want to forget my journey. I just want to live beyond its reach. Beyond the port that pops out from under my skin. The port that if needed again, can simply be put back in place.

And so my soul searching -- chronicled in the following two posts -- is over. My port is coming out.

• Wrestling with cancer decisions turns up uncertainty
• A little hand holding eases departure from cancer treatment

Less tends to go wrong for the patient during morning surgery, according to an analysis by Duke University Medical Center researchers, who studied the records of 90,159 surgeries to determine when most surgery patients experienced unexpected adverse events related to their anesthesia. Of these, they found 2,693 cases where error or harm occurred. Patients undergoing surgery in the afternoon most often had more trouble with postoperative pain, nausea and vomiting.

There might be several factors in these time-related problems, including afternoon fatigue among health care providers caused by swings in the circadian rhythms that influence normal biological ups and downs over the course of a day, and hospital work schedules.

US Oncology has launched a new program, OncologyRx Care Advantage, that provides a convenient home delivery service of oral cancer medications to cancer patients in Oregon, Washington, Texas and Virginia.

Not only will they be delivering cancer medications to cancer patients at home, oncology-trained pharmacists and nurses will call the patients to see if they have any questions and to monitor side effects, and in turn, patients can call anytime of the day or night to speak with nurses or pharmacists.

The OncologyRx Care Advantage team will report on a regular basis to the physician so that the physician is aware of how their patient is doing at the time cancer medications are delivered to the home. While this service is limited to Oregon, Washington, Texas and Virginia, the company hopes to expand to all 50 states by 2007.

Double the hormone, double the risk. Or so says one study of older women who take hormone pills. When estrogen and testosterone are combined, women face twice the chance of getting breast cancer, according to a study of more than 70,000 nurses. This type of combination therapy may help with mood, libido, and bone density -- but the possible risk of breast cancer may just outweigh these benefits. These findings, published in Monday's Archives of Internal Medicine, add to the evidence that certain types of hormone supplements -- like estrogen-progestin pills -- increase risk of breast cancer, strokes, and heart attacks in women. Other research points to a link between breast cancer and high natural levels of testosterone.

Women's natural levels of estrogen and testosterone decrease with menopause. Use of supplements has climbed over the past 24 years, perhaps putting more women at more risk. Estrogen-testosterone pills are sold under the brand names Estratest and Estratest H.S. and appear on a Washington-based advocacy group's "Worst Pills" list because of breast cancer risk.

The aftermath of devastation and unimaginable horror when Hurricane Katrina hit New Orleans is still making headline news. The images and reporting coming out of New Orleans in the first days after the hurricane disaster by mainstream and citizen media were disturbing. The government, state and local authorities failing to provide safety for the people of New Orleans are more than one. But the purpose of this post is not about political failings but medical ethics and the possibility that a doctor and two nurses committed the most unthinkable act of choosing to euthanize patients as they waited to be rescued from the flooding after the storm hit.

Memorial Medical Center had been cut off by flooding after the hurricane. Power was out in the 317-bed hospital and the temperatures inside rose over 100 degrees. As it is told, the medical staff did the best they could under extreme circumstances to care for patients as they waited day after day -- four days total -- to be evacuated from the flooded conditions. As they waited, patients died.

Stories started to surface that some of the deaths were decided on by a small group of medical staff. An investigation that followed as to whether there was any truth to the rumors that patients in pain had been euthanized. One doctor and two nurses have now been arrested on charges of second-degree murder. The arrest warrants state the three intentionally killed four patients at Memorial Medical Center.

"We're not calling this euthanasia. We're not calling this mercy killings. This is second-degree murder," said Kris Wartelle, a spokeswoman for Attorney General Charles C. Foti.

Arrests are not convictions, and it is my belief that we should hold judgment. I cannot help but be saddened that human beings were put into such dire straits as the people of New Orleans were during the flooding after the hurricane, or that stories like this could even be true. It appears the Attorney General's office feels they have enough evidence to prove the truth to what were once rumors -- and if proven true in a court of law -- there is no justifiable reason to do what these three are accused of doing. Doctors and nurses have to be trusted to do everything humanly possible to save lives. What are your thoughts about this story?