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Are You Living Life True to Yourself?
Courage is the art of being the only one who knows you're scared to death. ~Harold Wilson
There's a certain comfort and safety in being a part of the crowd, but sometimes in life we have to make a decision; the decision to follow where our heart leads us rather than walking a predetermined (safe) path that isn't truly ours. Sometimes we just have to have the courage to be true to yourself and become our own person, even if it doesn't conform to what others think we should be or do with our life.
While following your heart will give you a much greater chance to find happiness and fulfillment; it will also take courage … sometimes a lot of courage.
The truth is, when you choose to follow your own path, others may question your choices, and in some cases maybe even ridicule you. Maybe they fear being left behind, or having to face the results of their own life choices, or maybe it's just that you are forcing them to redefine the neat little label they've created for who they believe you are.
Choosing to Live Life True to Yourself
- It's your road, and yours alone. Others may walk it with you, but no one can walk it for you. ~Author Unknown
- To be a star, you must shine your own light, follow your own path, and don't worry about the darkness, for that is when the stars shine brightest. ~Author Unknown
- The greatest pleasure in life is doing what others say you cannot do. ~Walter Bagehot
- Often times what sets you apart can feel like a burden – but it's not, it's what makes you great. ~Author Unknown
- Instead of wishing you were someone else, be proud of who you are. You never know who has been looking at you wishing they were you. ~Author Unknown
- I was once afraid of people saying, "Who does she think she is?" Now I have the courage to stand and say, "This is who I am." ~Oprah Winfrey
- Did you just fall? No, I attacked the floor. Backwards? Hey, What can I say, I'm freaking talented! ~Author Unknown
- There are people who put their dreams in a little box and say, Yes, I've got dreams, of course I've got dreams. Then they put the box away and bring it out once in awhile to look in it, and yep, they're still there. These are great dreams, but they never even get out of the box. It takes an uncommon amount of guts to put your dreams on the line, to hold them up and say, How good or how bad am I? That's where courage comes in. ~Erma Louise Bombeck
- Accept no one's definition of your life; define yourself. ~Harvey Fierstein
- I may not (yet) be where I need to be but I thank God that I'm not where I used to be! ~Joyce Meyers
- The more you love your choices, the less you need others to accept them. ~Author Unknown
- Be daring, be different, be impractical, be anything that will assert integrity of purpose and imaginative vision against the play-it-safers, the creatures of the commonplace, the slaves of the ordinary. ~Cecil Beaton
- When someone says "you've changed" it simply means you've stopped living your life their way. ~Author Unknown
- None of us needs instruction in how to recognize what your heart is saying. We do need guidance, however, on how to have the courage to follow those feelings, since they will force us to change our lives in any case. But consider the consequences of not listening to the heart's guidance: depression, confusion, and the wretched feeling that we are not on our life's true path, but viewing it from a distance. ~Caroline Myss
- Remember always that you not only have the right to be an individual, you have the obligation to be one. ~Eleanor Roosevelt
- It takes a lot of courage to release the familiar and seemingly secure, to embrace the new. But there is no real security in what is no longer meaningful. There is more security in the adventurous and exciting, for in movement there is life, and in change there is power. ~Alan Cohen
- People say I'm different, and I assure you that's okay, cause I'm way past tomorrow and they're still stuck in today. ~Author Unknown
- I wish I'd had the courage to live a life true to myself, not the life others expected of me. ~Bonnie Ware, The Top 5 Regrets of the Dying
Every path leads somewhere – the question I want you to ask yourself is this … if you continue down the path your on today will you get where you want to go?
I hope you'll consider contributing to the conversation by leaving a comment and sharing this post with your friends! In fact I'd love to connect with YOU! To follow me on Facebook, Twitter, Google+, etc., just click here.
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Twitter: Mazzastick
permalinkFebruary 14, 2013
Hi Marquita,
Great question to ask. I often take time to reflect on my life to make sure I am headed in the right direction. I usually see if I am producing the results I want to and if not I will make the necessary adjustments.
Justin recently posted..Brain Evolution System Review
Twitter: workingonthego
permalinkFebruary 3, 2013
Hi Marty,
Great article. So true , often for us to really achieve our goals we have to be able to stand back from others and follow our heart. I really like the way you included so many fantastic quotes in this post.
Take care Rosemary
Rosemary recently posted..Social Media in Ireland and Keeping Our Irish Children and Families Safe Online
Sarah Arrow
Twitter: saraharrow
permalinkFebruary 3, 2013
What a great quote to open your post with, and what an inspirational post it is – thank you. My favourite is this one – Did you just fall? No, I attacked the floor. Backwards? Hey, What can I say, I'm freaking talented! ~Author Unknown. What a positive spin on life the person had
February 2, 2013
I love this post! Being true to yourself has been difficult lately especially for people who are not contented with themselves and are always striving to impress everyone. I have experienced this as well. In the end, I realized I was just making a fool of myself and making myself miserable as well.
Sarah Park recently posted..How to Make Money Making Jewelry
Michael Levy
Twitter: mdlevy2004tx
permalinkFebruary 2, 2013
What a nice inspiring post. I sure love your site and all of the positive things you share. Every time I read something I feel good. Thank you for sharing such positive and encouraging quotes Marquita!
Michael Levy recently posted..Isn't it Great to Dream!
Twitter: hollyfulfordjef
permalinkFebruary 2, 2013
What a fantastic article!! I love this. Your quotes are awesome.. My favourite, the one by unknown, that if someone says you've changed, you're simply not living life their way! Love it!! Too many people live according to others, not themselves!! I love it when I can help people past that issue!!
Nick Catricala
Twitter: nickcatricala
permalinkFebruary 2, 2013
Hello Marquita,
I know that I am following my heart and that happen only a few times, but when it hapen, tehre is no mistakes… it is truly what I love to do.
After years of practice, finally I know what I love to do, what I truly love to follow and what I just hate to haha
I remember years a go when I used to get into all kinds of friendships, or jobs or what ever and I knew from the start it would not be great, but for some reason I just went on and guess what? All of them failed, including getting married with the person who I did not like to but went in "because" Yes, I was THAT great haha
Thanks so much for sharing your wisdom.
Nick Catricala recently posted..In Life ___ What Did You Do?
February 1, 2013
Super post Marty!
Wonderful quotes most of then I hadn't heard before all of them I could identify with!
Sadie-Michaela Harris recently posted..GoMoSoLo Support the Peace One Day Corporate Coalition
Chery Schmidt
Twitter: cheryschmidt
permalinkFebruary 1, 2013
HI Marquita, Another Great Post. Be true to yourself, Oh So True, nobody can make those choices for you either you choose to be happy or NOT! I just loved your quotes! I actually copied a few Here is the one I really feel fits me to a T ""I may not (yet) be where I need to be but I thank God that I'm not where I used to be! ~Joyce Meyers"" Thanks for sharing Marquita.. Chery
Chery Schmidt recently posted..Simple CraigsList Strategies For Online Entrepreneurs
Julieanne vanZyl
Twitter: julieannevanzyl
permalinkFebruary 1, 2013
Hi Marquita, I know when I am following my heart when I get a sense of excitement about what I'm doing, not all the time of course, but some of the time. It took me years before I knew that feeling, wouldn't it be great to learn that in secondary school? All young children know it then it's "taken away" from them, I would love it if they could be encouraged to have that feeling again when they're older children. That's probably why teenagers are so rebellious and confused!
Rachel Lavern
Twitter: rachellavern
permalinkFebruary 1, 2013
Hi Marty,
I loved this post! Like me, you are probably always encountering people who are not taking action right now because they do not know what action to take. I always seek to follow my heart's guidance. I believe that when I listen to my heart, I will be led to provide something of value and to be of service to others.
I came across the following passage just this morning:
"Follow your heart and go with your gut.
This is the path to your Soul Purpose.
This is the way toward discovering and Fulfilling your Destiny!
From the Heart to the Soul"
Rachel Lavern recently posted..How to be Personally Empowered
January 31, 2013
Hi Marty,
great encouragement to be the individual that we are.
Wouldn't it be nice if parents and teachers would guide children with this in mind.
I liked the quote you shared: "Remember always that you not only have the right to be an individual, you have the obligation to be one. ~Eleanor Roosevelt"
Thank you so much for sharing this!
Love and Light
Yorinda recently posted..Making Changes and the Limbic Lag
January 31, 2013
I've never seen this one: Did you just fall? No, I attacked the floor. Backwards? Hey, What can I say, I'm freaking talented!
Boy! will I use that one again – with all sorts of other scenarios. Thanks for some really motivating quotes.
Anne recently posted..How To Build Confidence In Positives
January 30, 2013
Walking the dark path is only scary when you have no faith that it will lead to your rightful destination.
Darkness does not confer fear along the way, only lack of knowledge.
Fear is rooted in lack of faith, and courage in the understanding that whatever path we follow, we do not travel alone.
David Merrill 101 recently posted..Keeping Pace With Online Communications
Lydia Brown
Twitter: lydiajbrown
permalinkJanuary 30, 2013
I love finding new quotes Marquita thank you. Your post reminded me of "To Thine Own Self Be True" Polonius ~Shakespeare Play
Lydia Brown recently posted..Eight things you don't know about Lydia Brown
January 30, 2013
Here is a thought that went through my head in reading this today, and this is something -a dilemma- I think of a lot.
Be true to yourself. Live authentically. (I think they are on the same track, yes?) And, the "quote of the day" in the upper right of your blog happened to hit close to the mark of this blog post: "Let the world know you as you are, not as you think you should be."
But this thinking troubles me:
(1) We all have blemishes, faults, weak points don't we? –Things that are not necessarily congruent with the main thrust of our lives; perhaps doubts, "sins," mistakes. Surely it is OK to NOT let the world know those parts of you. What's the point?
(2) Then there is the quandary over "fake it til you make it." This clearly violates "Let the world know you as you are, not as you think you should be." And yet, is it wrong to act confidently (even if I don't feel that way), kind of like- "whistle in the dark"?
Which brings me to the headline quote: "Let the world know you as you are, not as you think you should be." That kind of suggests maybe it IS okay to NOT let the world know you as you are. In fact it takes courage to push on with what you think you should be.
If that sounds a little convoluted, I am just expressing that the "be true to yourself" idea can sometimes run amok of other worthy life advice. What do you think?
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I had some fun coloring her, especially that hair. I'm trying to improve on my shadowing skills and leaving some highlights here and there. Of course, I did have to add stickles to her wings, they just don't seem complete without some sparkle.
We had to do some grocery shopping yesterday, much to my chagrin. Duke wanted to drive me since I have been having trouble with my car. He is a slowwww shopper and it drives me crazy; plus Cody is on spring break, so it was double trouble. Thankfully, they parked it on a bench for most of the trip and let me get to it. I will admit, however, it was nice to have someone to carry it all out, and load/ unload it.

subset: commoncrawl


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When Andrew Tomasello, of Little Silver, N.J. was chosen as an audience member to step on stage with Jimmy Fallon on "Late Night with Jimmy Fallon" in 2010, it was "one of the best days" of his life. Key word: 'was.'
"I can't say that anymore because I beat cancer," he tells me.
In 2012, Andrew, then 20, was living the life of an aspiring politician and broadcast journalist in Washington, D.C. He was elected chairman of the College Republicans at The Catholic University of America, interned at N.J. Gov. Chris Christie's office and had a job lined up at a TV station. Everything was going great until a tumor was diagnosed on his pelvis. It was deemed non-malignant, so he had non-surgical treatment to remove the tumor, and went on with his life.
When the tumor reccurred a year later, it was malignant; and Andrew received a diagnosis of osteosarcoma. That May, Andrew underwent a 10-hour surgery in which two-thirds of his pelvis was removed. "A significant part of the surgery was spent separating the tumor from his nerves so that his leg would not be paralyzed and would function, as well as his bladder and bowel," says Andrew's Orthopedic Surgical Oncologist James Wittig, chief of Orthopedic Oncology at John Theurer Cancer Center in Hackensack, N.J.
Thankfully, Andrew didn't have to undergo amputation. "In Andrew's situation, I was able to save the important nerves, blood vessels and muscles necessary for saving the leg," Wittig says. Andrew had to start treatment almost immediately following the surgery. On July 1, 2013, he had the first of his 19 rounds of chemo. His treatment also included 35 rounds of radiation. He spent the "Big 21" in the hospital due to complications from treatment. "It's ironic because I always knew I would spend my 21st birthday in the hospital sick, but I never thought it would be for chemo," he says.
Andrew spent a couple nights in the hospital for each chemotherapy treatment. During that time, he developed close friendships with his healthcare team, especially his nurses. He often posted photos on his Facebook and Instagram account of times with them.
While Andrew maintained a very optimistic spirit, he had his down times; especially in the beginning. "Yeah, I had cancer, it sucked," he says. He was saddened by having to put his life on hold; his job, school and independence--a common issue young adults with cancer face during treatment. However, the feeling was short lived. "It is hard to see anybody diagnosed with a cancer, let alone such a young man just starting college and getting his life underway," Wittig says. "He approached the entire situation very bravely."
Andrew was officially deemed in remission on April 17. "I'm 100 percent cancer–free, and it's all because of Dr. Wittig," he says. "He's the greatest man on the face of the earth."
It was just as beneficial for Wittig. "Personally, I gain such an incredible amount of fulfillment from taking care of such a brave young person and being presented with one of the largest most challenging limb-sparing surgeries and having a perfect outcome in an immensely positive and grateful patient. I will have the delight to watch Andrew finish college, lead a productive life and grow old with a great quality of life," he says.
On July 29, Andrew was able to have a "cancer-free" birthday. He was thrilled not to just make up for his 21st, but to be able to celebrate more birthdays. He was set to make "22 the new 21" with his hashtag #Andrews22. He admits that he, at first, was in denial about getting older, but now he embraces it.
Can cancer be glamorized?
When Andrew and I discussed the movie "The Fault in Our Stars" (TFIOS) and he says that while it wasn't the perfect portrayal of cancer, it's very eye-opening.
He says the problem with cancer portrayal in today's storytelling is "throwing cancer into the story just for the sake of having cancer," especially with love stories. That can be misleading, he says. TFIOS "wasn't a love story that someone threw in cancer." It's a cancer story from the beginning.
Wittig says that cancer in storytelling gives young patients "courage and positivity." He says it "brings a public awareness about sarcomas and childhood cancers. It shows young adults that they can lead a normal productive life despite being stricken by such a difficult disease and that this can be overcome just like any other obstacle."
TFIOS best relates to Andrew's story and the person he is. He jokingly tells people that he's just like Augustus Waters. They both had the same cancer and prospective. "The only difference is I lived and didn't lose a leg," he says. He also makes subtle jokes, like Waters. Watch this video and see for yourself.
Wittig says one important thing young adult cancer patients can learn from Andrew is "how to make the best of a tough situation."
"There were many times when Andrew was in the hospital receiving chemotherapy and posting Facebook updates with smiling and laughing photos with his nurses," he says.
Andrew offers three bits of advice for young adults battling cancer.
1) It gets better. Just take it one day at a time.
2) You won't see it now, but you'll be a better person in the end.
3) Watch plenty of Netflix.
Jennifer Nassar is the senior editorial intern at CURE magazine. She is a second-year graduate student at the University of North Texas and a 2013 graduate of the University of Mississippi.RELATED POSTS
August is Summer Sun Safety Month, an ideal time to think about the effectiveness of your sun protection habits. Protecting your body from the damaging rays of the sun has always been a serious health issue, but with SPF numbers ranging from two to 100 and new "sunscreen" pills hitting the market, it's surprisingly difficult to understand how much and what type of protection is best. It's important to know the facts so you don't get 'burned' by your sunscreen now and in the future.
For instance, when it comes to sunscreen, more is better. Many people don't slather on enough sunscreen to get the full protective coverage they need. Look for a product labeled "broad spectrum" with an SPF of 30 for the best protection against skin cancer. Apply sunscreen about 30 minutes before sun exposure and use about 1 oz. of sunscreen for the body, which is enough to fill a shot glass. Reapply that same amount every two hours. For a day at the beach or the pool, one person should use about half of an 8 oz. bottle.
I see a lot of patients who think sunscreen with a higher SPF means they can apply less and stay out in the sun longer. That's not true, and SPF numbers can be deceiving. For example, SPF 15 blocks about 93 percent of harmful sun rays, and SPF 30 blocks about 97 percent. Thus, doubling the SPF doesn't necessarily provide that much more protection. I tell my patients that SPF 30 is usually sufficient for most people, and the focus should be on reapplication every two hours or sooner, if you're sweating a lot or in the water.
Keep in mind that no sunscreens are "waterproof." If a lotion is labeled, "water resistant," the FDA now requires manufacturers to designate how long the sunscreen is protective while swimming or sweating.
I also caution patients about using spray-on sunscreen. It's a great option, but it can be difficult to get an even application. Make sure you spray an even coat across your skin, holding the bottle about 4-5 inches from your body. Be careful not to inhale spray sunscreen. When applying it to the head or neck, spray it into your hands first and then rub it onto the face, neck or scalp.
Although researchers are trying to develop a true "sunburn pill," the ones available today are only supplements, not federally approved medications. While they may seem like a safe alternative to sunscreen, there's no real evidence that pills alone offer protection from the sun's rays. Antioxidants in some supplements have shown promise, but before taking them you should talk to your doctor, as they could interact with other medications.
In addition to sunscreen, I advise patients to use other methods to protect themselves from the sun, such as clothing that covers their arms and legs, wide-brimmed hats that protect the face, head and ears, and sunglasses that have 100 percent UV protection. You can also buy clothing that has sun protection in it, called UPF or ultraviolet protection factor. It's also a good idea to avoid midday sun, the time when the sun's rays are the strongest.
By taking action to avoid being burned by your sunscreen this month, you're taking action to protect yourself from skin cancer in the future. Simply knowing your number and the best ways to apply your lotion can reduce serious health risks. The next time you sit in the sun, remember to separate the facts from fiction.
Shannon C. Trotter is a dermatologist at The Ohio State University Comprehensive Cancer Center specializing in skin cancer.RELATED POSTS
On July 9, CURE hosted a Facebook Chat on neuropathy after a cancer diagnosis. We invited Michael Stubblefield, a cancer rehabilitation physician at Memorial Sloan Kettering Cancer Center; Pam Shlemon, executive director of the Foundation for Peripheral Neuropathy; and CURE's editor-at-large Kathy LaTour to answer your questions on neuropathy.
Stubblefield specializes in the identification, evaluation and treatment of neuromuscular, musculoskeletal, pain and functional disorders caused by cancer and cancer treatment. In addition to neuropathy, he also takes care of complications of radiation and surgery as well as of the cancer itself.
You can view the full chat here with a Facebook account.
This was one of the most fast-paced and involved chats we've had to date. Our experts answered most of the questions posed during the chat and a few that were emailed and posted ahead of the chat on the Events page.
Here is a selection of the questions answered during the chat:
Q: CURE magazine Our first question for our panel comes from an earlier email: Pam, what are the main symptoms of neuropathy? Can there be different symptoms for different people?
Pam Shlemon CIPN symptoms usually appear symmetrically in a stocking-glove shaped distribution in the feet and hands. Typical symptoms include numbness, tingling, burning and electric-shock like symptoms or muscle weakness. Affected patients can experience impairments including difficulty in walking, increased risk of falls and weakness and restrictions in fine motor skills such as writing and other manual tasks buttoning your shirt.
Q: Kris Today is Round 12 of 12...The neuropathy (both fingers and feet) didn't come on until the last week or two...Should it go away over time? Is there any kind of exercise/therapy I can do to help get rid of it?
Kathy LaTour, CURE This is one of those questions that is answered with a probably. Doctors don't know who will get neuropathy and they don't know when it will end. The majority of neuropathy resolves over time after treatment ends. I have friends whose neuropathy resolved over a year and some over six months.
Q: Janet I had breast cancer over 11 years ago and one of the chemo drugs I was on was taxatear...I started having neuropathy in my feet, toes, and fingers then. I still have some problems with it today. Does neuropathy still happen years after treatment?
Michael Stubblefield One of the common questions I see asked is if the neuropathy will ever go away. The answer to this depends... Most of the time chemotherapy-induced neuropathy does improve over time. In some cases, however, it never goes away. That being said, there are usually effective medications to treat the pain and tingling that goes along with neuropathy. Weakness can usually be improved with physical therapy. Numbness (the lack of sensation) and other symptoms don't respond to medication.
The most common causes of neuropathy in the cancer setting are chemotherapy and the cancer itself. There are a number of less common causes like paraneoplastic disorders. Paraneoplastic disorders occur when the tumor secretes a hormone or protein that causes problems. For instance, certain types of lung cancer (Small Cell) are known to cause a paraneoplastic peripheral neuropathy by causing the development of an antibody that damages nerves.
Nerve damaging chemotherapies include the taxanes (taxol, paclitaxel), the Vinca alkaloids (vincristine) and the platinum drugs (carboplatin, cisplatin). Other types of chemotherapy such as thalidomide, bortezomib, Epothilones also cause neuropathy. The type of neuropathy caused by the platinum drugs and most other types of chemotherapy can be very different because of the way they affect the nerves. Taxanes and Vinca alkaloids damage the long axon fiber of the nerve and tend to cause a neuropathy that can be painful, or associated with abnormal sensations (paresthesias). Weakness is also a common feature of these medications in severe cases. The platinum drugs damage the cell body of the nerve as opposed to the axon and tend to cause more sensory issues such as pain and sensory loss. Platinum drugs do not usually cause weakness although they can cause problems walking because the sensation nerves are greatly affected.
It is important to determine what the exact cause of symptoms is because the treatment can be very different. For instance, if a patient has tingling in the hands because of carpal tunnel syndrome they might benefit from occupational therapy, hand splints, anti-inflammatory medications, or even surgery.
Q: Bill Is there a difference between neuropathy from diabetes and from chemo? How about Parkinson's?
Pam Shlemon Just the only difference is the causes, the symptoms are typically the same and the treatments are also typically the same. The only difference is the nerves that are effected - small fiber and/or large fiber
Q: Robina Will acupunture help?
Pam Shlemon Not every treatment works for all patients. Patients that I have spoken to who have tried acupunture are mixed. Some patients have found relif and other have not. Treatments for PN are not a "one-size" fits all. It is worth giving it a try - there is something out there for everyone.
Q: Bill Can radiation cause neuropathy?
Michael Stubblefield There is a question about if radiation can cause neuropathy. This is one of my favorite topics. Radiation does NOT cause peripheral neuropathy but it can damage the nerves running through the radiation field. For instance if a patient received radiation for breast cancer years ago they can develop brachial plexopathy which will cause numbness, tingling, weakness, and other symptoms that mimic neuropathy. Similarly focal radiation for things like sarcoma can damage the nerves that go through the field. This is called a mono (meaning one) neuropathy as opposed to a polyneuropathy.
Q: CURE magazine Pam asks: I had SGAP (breast reconstruction surgery) five years ago. I have tingling and numbness above, below and to the sides of the incision. I had no idea that this could happen. How many others have neuropathy from surgery alone? Is there anything that helps?
Michael Stubblefield There is a question on pain in the breasts or arm pit after mastectomy and reconstruction. This is a situation where neuropathic symptoms are NOT caused by peripheral neuropathy. It sounds like you have what I call post-mastectomy reconstruction syndrome (aka, post-mastectomy syndrome). Numbness, tingling, spasms, arm weakness, a feeling of constriction in the chest and a number of other symptoms often result from mastectomy and importantly reconstruction. There are a number of different disorders that make up this syndrome but none are peripheral neuropathy. In this case, it sounds like the small nerves that supply the chest and sometimes back were damaged during the surgery and reconstruction. A number of other issues like restriction of the fascia (connective tissue that binds the muscles and bones) are also contributing. This is not uncommon. One nerve that is often damaged is called the intercostobrachial nerve. It is important to understand that this isn't a surgical complication per se but simply a consequence of the surgery that happens in a small percentage of women.
The treatment varies but physical therapy emphasizing myofascial release is often extremely helpful. Some of the same medications used to treat neuropathy such as duloxetine (Cymbalta), pregabalin (Lyrica), or gabapentin (Neurontin) are also often very useful.
One of the common questions I see asked is if the neuropathy will ever go away. The answer to this depends... Most of the time chemotherapy-induced neuropathy does improve over time. In some cases, however, it never goes away. That being said, there are usually effective medications to treat the pain and tingling that goes along with neuropathy. Weakness can usually be improved with physical therapy. Numbness (the lack of sensation) and other symptoms don't respond to medication.
There are questions about the percentage of patient who get neuropathy from chemotherapy. The answer is that it depends on the type of chemotherapy, the dose, and the way it was delivered as well as the type of patients who get it. While 40% may get neuropathy with certain medications and regimens, it goes away for many of them. Unfortunately not everyone will have the neuropathy go away.
Q: CURE magazine What types of integrative therapies are worth trying for patients with neuropathy?
Pam Shlemon Complementary: While complementary and alternative forms of medicine are often thought of interchangeably, there are differences. Complementary therapies are used together with conventional medicine. This might include a regimen of vitamins, supplements, herbs, and 'natural' substances to be used in conjunction with other medications. Integrative: A total approach to health care, integrative medicine combines conventional and CAM therapies into a treatment plan where there is some high-quality evidence of safety and effectiveness.
Complementary and alternative medicines (CAM) are divided into several broad categories:
• Natural Products: This category is the most popular form of CAM, used by more than 15% of the U.S. population. These include herbal medicines, vitamins, minerals, and products sold over the counter as dietary supplements.
• Mind and Body Medicine: Using mind and body practices that focus on the interactions among the brain, mind, body, and behavior, to affect physical functioning and promote health. Examples are: Meditation, yoga, acupuncture, deep breathing exercises, hypnotherapy, progressive relaxation, and tai chi.
• Manipulative and Body-based Practices: These practices focus primarily of the structures and systems of the body, including bones and joints, soft tissue, and circulatory and lymphatic systems. Spinal manipulation and massage fall into this category.
•Energy medicine is among the most controversial of the CAM therapies. These therapies involve the manipulation of various energy fields to affect health. The most common practices include those involving electromagnetic fields (magnet and light therapy).
Q: Mike Hi Dr Stubblefield, I have RFS and some neuropathy after having HD in 1989. I live in Ireland and was wondering if there are any of your colleagues working in this part of the world.
Michael Stubblefield Unfortunately there are not a lot of doctors who have knowledge and experience with this disorder. While we are training a number of Cancer Rehabilitation Fellows here in the United States, I don't know of physicians in other countries who would be able to deal with the neuromuscular and musculoskeletal complications of HL. Treatment of these conditions requires a team approach from both physicians and therapists. There are doctors who have knowledge of the cardiac, secondary cancer, and other medical effects. These are usually in Survivorship Programs.
Q: Can you reduce your risk?
Pam Shlemon Collaborate with your team and report symptoms you notice during treatment: Dose reduction, rest period, or halt therapy
Medication before or during chemo. Examples: Calcium and Magnesium infusion, new evidence strongly suggests that intravenous calcium and magnesium therapy can attenuate the development of oxaliplatin-induced CIPN, without reducing treatment response. Accumulating data suggest that vitamin E may also attenuate the development of CIPN, but more data regarding its efficacy and safety should be obtained prior to its general use in patients. Other agents that look promising in preliminary studies, but need substantiation: Acetyl-L-carnitine, Alpha lipoic acid, Duloxetine, Glutamine, Glutathione, Oxcarbazepine, Xaliproden, Venlafaxine
Q: Beth I'm 7 yrs post chemo for breast cancer. Had 4 rounds of adriamycin and cytoxin. I've started having burning pain in 1 foot the last couple of months that the Dr says is neuropathy from the chemo. How long after chemo can neuropathy start?
Michael Stubblefield There are a lot of questions on if neuropathy from chemotherapy can come up years later. It is not possible to get neuropathy from chemotherapy years later. Certain medications like the platinum analogs (cisplatin, oxaliplatin, carboplatin) can do what is called "coasting." This means that the medications damage the nerve cell body over time and result in symptoms a few months (not years) later. In these cases, the symptoms usually start during or just after chemotherapy and can progress for 6 or even 9 months before they level off.
When a patient develops neuropathic symptoms years after chemotherapy then it is ALWAYS another disorder that is responsible. Certainly having the nerve previously damaged can contribute to the development of neuropathic symptoms years later because the nerve is weakened but still there must be something else going on for a patient to develop symptoms.
Common things I see causing neuropathic symptoms years later are spinal stenosis or another type of neuropathy such as diabetes, B12 deficiency, CIDP (chronic idiopathic demyelinating polyradiculoneuropathy), etc. It is important to figure out what the cause of these symptoms is because the treatment of neuropathic symptoms varies considerably for all of these disorders. For instance, if neuropathy is caused by B12 deficiency then replacing B12 can make the patient much better.
Kathy LaTour, CURE When I visited with a podiatrist a few months ago, he said he is seeing many more cases of neuropathy that is ideopathic, meaning for no apparent reason. He said the numbers have really increased.
Q: Peter I went through detox after a year and several months from a Stem Cell Transplant for Stage IV non-Hodgkins Lymphoma. My feet hurt so bad that I crawled through my Mother's house. I could no longer watch her cry or being in so much pain. Is this something that you would recommend?
Pam Shlemon Support groups are very beneficial to all PN sufferers. It allows you to hear what other are going through and successful treatments that are working. If you need to find a support group in your area you can contact the Foundation for Peripheral Neuropathy. Many support group bring in speakers such as, physical therapist, neurologists, dietitians, Tai Chi experts and others to educate patients on neuropathy and treatments.
Q: Melva I have neuropathy in feet and fingers I have resigned myself to the fact that it will always be there. Chemo ended 3 yrs ago and I hate to take another drug to fight this. Is there anything besides drugs that will help?
Pam Shlemon Yes, you can try Complimentary & Integrative medicine, acupuncture, massage, biofeedback, Tai Chi
Q: Laurie Can neuropathy affect only one foot, or does it always affect both?
Pam Shlemon It can affect only one foot. I have CIPN from cancer and only affects my one foot
Michael Stubblefield This is not likely to happen with chemotherapy as they usually cause a distal symmetric type of neuropathy. When neuropathic symptoms are asymmetric this almost always means that there is something else going on. For instance if a patient has a pinched nerve in their back from a disk, then this can become symptomatic when they are challenged with neurotoxic chemotherapy. Similarly, if you have carpel tunnel syndrome and then receive a medication like taxol, vincristine, or a platinum drug, it can make your carpel tunnel syndrome worse. I see these types of issues in clinic all the time.
Q: Rick Can you please provide further information on physical therapy?
Michael Stubblefield Physical therapy is excellent for improving strength, gait, and other functional deficits. Occupational therapy is excellent for improving a patient's ability to participate in activities of daily living. It is not as good at improving numbness and tingling. Some modalities like TENS can help improve these sorts of symptoms.
Robb Hi my name is Robb Bolton and I have a nonprofit the offers exercise and wellness programs for Cancer Survivors. We have created a class specific for the symptoms of foot neuropathy. Our program includes exercises for foot strengthening, flexibility, mobility, balance and massage techniques. We have had over 40 participants so far with great success. I am curious if you have heard of any similar programs and if so where? I think we could be on to a potentially great program for foot neuropathy suffers but our nonprofit is small and I need help to research the benefits of our programs and gain support for the medical community. Thanks for any help.
Robb http://cancerfitinc.com/footsteps-forward.html Footsteps Forward cancerfitinc.com exercise program designed to address the symptoms of peripheral neuropathy of the feet and lower extremity.
Q: C McAllister My ?s are similar to some posted already....numb finger, toes, left foot more than right dr. commented they should improve within year...I see many having this same issue, and not improved Have read the current article in CURE....learning to adjust, seem to be what I am going to have to do.... it is disheartening Mine is Breast dancer stage IIIC Had taxol. Oct-Dec 2013 Herceptin began Oct goes through this Sept.
Kathy LaTour, CURE As the oncologist in the article said, it seems that every option seems to work for someone. Don't give up. Go to a neurologist and if they can offer no help, ask them who would be next.
C McAllister I am very disappointed that I was not told that the neuropathy would not clear up totally.... I would have liked being told it would possibly linger .....going into treatment to begin w/ is overwhelming....so much to know/experience/ I had read tons, as I have had others in family w/cancer/all types, my hubby, just before me ! as it is I have come to terms w/ drs. constantly saying ... well everyone is different for everything to do w/side effects of all kinds....I do understand this thought, but feel that they could elaborate a bit more..... it is all sad, sad to me...and the "cheer leading" type comments get to me after awhile!
Michael Stubblefield I agree with Kathy that patients must advocate strongly for themselves. The internet is a wonderful resource. I get 2-3 new patients a week from all over the US who have found me online. There are other specialists who are superb at diagnosing and treating neuropathy. Finding these folks isn't that difficult as they usually have online bios from their medical centers, private practices, or wherever they work.
Q: Sandy Lee What type of doctor is best to work with for neuropathy caused by chemo? Neurologist, Endocrinologist or other?
Michael Stubblefield There are a lot of choices for this. Often a neurologist is the right choice but rehabilitation medicine specialists, pain management specialists, and even your PCP. In general neurologists and rehabilitation medicine specialists (physiatrists) are the best choice. That being said, not everyone has access to all types of physicians depending on where they live.
Michael Stubblefield There must be a lot of frustration for people who have neuropathy but don't know where to go. This is particularly true for survivors in rural areas. If you don't have a neurologist, physiatrist, or pain management specialist who treats neuropathy available, then the task of treating you falls to the physicians you do have available (your internist, primary care physician, oncologist). Often it may be possible to get an opinion at a specialized center (I.e., the University of X) and take those recommendations back to your local physicians to co-manage you. I have a number of patients from all over the country and world that I do this for. The first step is finding the specialist willing to work with your home physicians. Most physicians at academic medical centers are willing to do this.
Pam Shlemon It is imperative that you become your own advocate for your healthcare. One way to find a neurologist that focuses in neuroapthy is to google their interests through their CV, Bios. Typically you find this information at larger academic centers. You can also call the neurologists offices and ask questions to see how knowledgeble they are. To see a list of questions to ask your doctor you can visit our website at www.foundationforpn.org for The Foundation For Peripheral Neuropathy.
Michael Stubblefield While we have spent a lot of time talking about the causes and differential diagnosis of neuropathic symptoms we haven't talked much about treatment. There are several consequences of neuropathy as we have discussed including pain, numbness, weakness, gait disturbance, trouble with activities of daily living (ie dressing).
Each complication may require a different treatment. Ironically pain is often one of the easiest symptoms to treat. The newer medications such as duloxetine (Cymbalta) and gabapentin (Lyrica) can be very effective and there is a recent article in JAMA demonstrating this. The use of this medication is a skill. They often need to be titrated slowly and to high doses. When the nerve stabilizing medications (Cymbalta, Lyrica, Neurontin, etc) do not work or only work partially, then opioids are often needed. The vast majority of my patients have very little pain when the medications are titrated to effective doses over time. The skill comes in getting them on the high doses while minimizing side effects.
CURE magazine Thank you to our guests, Michael Stubblefield and Pam Shlemon. Thank you to Kathy LaTour, CURE, and to all of you, for sharing your story and what you've learned while living with neuropathy. Please feel free to continue to use the Event page to share your story, tips and words of support to each other. Thank you and have a good day!RELATED POSTS
ATTN: Young adult cancer patients or survivors: Here's a chance to have your cancer story featured on curemagazine.com.
Cancer is popular in storytelling today. Movies, such as "The Fault in Our Stars," "50/50," "A Walk to Remember" and more, have been sharing the cancer journeys of young people, particularly love stories during treatment.
Is your story similar to a movie you've seen recently? How has it been different than the media's portrayal of cancer in young adult relationships? We want to share your story and opinion about how the entertainment industry gets cancer – both right and wrong.
Send an email to email@example.com with the following three sections:
1) Story: A brief description of your cancer journey. When did you receive your diagnosis? Are you in remission? If yes, for how long? What physical and emotional struggles are you facing or have faced?
2) Movie: Pick a movie that is similar to your story. How do you relate to it?
3) Entertainment View: What's your opinion of how cancer is portrayed in storytelling today? Do writers need to do more research? Is it portrayed correctly? If it's not convincing, do you find it insulting to cancer patients and survivors?
Send an email to firstname.lastname@example.com, by 12 p.m. Central July 18. Please include your name, city, cancer type, phone number and email. If chosen, Jennifer will contact you to schedule an interview.RELATED POSTS
In 2011, Army veteran Douglas Chase was diagnosed with brain cancer. A few months later, the cancer had spread. Chase and his wife Suzanne, who lived in Acton, Mass., drove to Boston for his treatments. It eventually became too much, and Suzanne decided to apply for care at a nearby Veteran Affairs (VA) hospital to make him more comfortable.
They didn't hear back from the VA hospital administration, and Chase, a Vietnam veteran, died in August 2012. Shortly afterward, Suzanne filed for benefits from the VA to assist with funeral expenses; however, it was denied because Chase wasn't treated at a VA hospital.
No kidding.
Suzanne wanted to "put it all behind" her.
About a week ago, she received a letter from the VA addressed to her late husband. After two years, they offered her husband the opportunity to schedule an appointment. It was requested that he respond quickly.
This story has most Americans shocked; I'm not one of them.
Honestly, I wonder if her husband would've received the proper care and treatment had he'd been able to schedule an appointment right away.
Why do I ask this? My family went through a very similar situation with my grandfather (whom we refer to as Papa), a Korean veteran. Sadly, I never had a chance to meet him.
In 1985, Papa was experiencing back pain, and went to see a doctor at a VA facility. The doctor felt around his back and said it was a muscle sprain. He was given pain medications and a whirlpool jet bath. This went on for two years. In that time, not one X-ray or any additional tests were done.
My grandparents didn't think about going elsewhere for treatment. They trusted that the doctor was telling them the truth. In January 1987, they found out the truth. Papa was having chest pain one night, and my grandmother took him to the emergency room. An X-ray and additional tests were done. After sitting in the waiting room for a couple of hours, my grandmother was allowed to see him. When she walked into his room, he started crying and said, "I'm sorry." Before she could even ask "for what?" the doctor walked in and broke the news to her.
Papa had a large tumor on his kidney that had metastasized to his lungs. "There's nothing we can do," the doctor told them.
Despite what had happened, my grandmother held no anger toward the VA. "I was too busy being scared," she says.
My grandparents still wanted to do "anything and everything" they could to help him. For the next few months, he underwent chemotherapy at a VA hospital, the same system that told him for two years he only had muscle sprains. In July 1987, at age 55, Papa lost what little battle he was able to fight.
I read Chase's story on Wednesday, July 2, 27 years to the day that Papa passed. Some of my family members, particularly my mom, wanted to sue the VA. However, at the time, suing the government wasn't realistic, my grandmother says. "You didn't sue the government."
Currently, there are over 100,000 veterans who have been waiting to schedule an appointment. Some have been waiting for more than three months. What scares me is thinking that some of these people could have something seriously wrong with them requiring and deserving immediate attention.
Thankfully, the Senate passed a bill in June to allow veterans to seek private care. Criminal investigations of the VA's actions are also ongoing.
Another area that concerns me is how the men and women on active duty are receiving medical treatment. Or are they receiving treatment? Those on active duty have a harder time getting care off a military post, if that's what they prefer. If they wish to receive treatment elsewhere, they have to request an "off-post referral." However, these can be hard to obtain.
A friend of mine in the military was denied an off-post referral to see a specialist for severe knee pain. He had to wait a month just to schedule an appointment. Then, he had to wait a month between a MRI and other appointments.
With cancer, time is very fragile. It's very likely that someone with back, knee or stomach pain isn't going to automatically assume they have cancer, unless you work in the industry. It's important that people get in to see their physicians in a timely manner to receive the proper diagnosis.
Something ironic about the letter sent to Suzanne Chase is that it stated that the VA is, "Committed to providing primary care in a timely manner and would greatly appreciate a prompt response. " This failed both my and the Chase family.
OK, now here comes patriotic cliché me.
In my opinion, the men and women in the military, retired or active duty, give and sacrifice more for this country than any of us ever will. It truly saddens me to know the number of veterans who have been on a waiting list for months. This situation can get more difficult for active duty military because there's not much they can do if they're not pleased with the wait or treatment. It's not like they can file a complaint to Uncle Sam. They have to do what they're told.
Just like the military, I think it's only fair that the VA do what they're supposed to do; protect and serve those who protect and serve.
Jennifer Nassar is a graduate student at the University of North Texas. She is a summer intern for CURE magazine.RELATED POSTS
CURE's editor-at-large Kathy LaTour and I met up cancer survivors Diana DeVoe and Debbie Fitzer in Dallas to see "The Fault in Our Stars," based on the book by John Green.
Diana, 44, received a diagnosis of alveolar rhabdomyosarcoma at 18 in 1988. Debbie, 53, received a diagnosis of triple-negative breast cancer about nine years ago at 44. Diana's story was featured in the Fall 2012 issue of CURE. You can read more here.
During the movie, we laughed, and cried and cried. A word of advice for women: Don't wear eye make-up; you will leave the theater with raccoon eyes. Two hours and a few tissues later, we sat down for a causal discussion. During this, I noticed a very coincidental pattern that related Diana's story to the movie trailer.
TRAILER: "This is the truth...doctor's appointments..."
DIANA: She spent her 19th birthday in surgery to have two fingers removed on her left hand. After surgery, she underwent radiation and two years of chemotherapy.
TRAILER: "And worst of all, support groups."
DIANA: There were no support groups at the time of her diagnosis. She wouldn't have attended if there were any. "I didn't talk about cancer," she says.
TRAILER: "I'm in love with you." "I'm a grenade."
DIANA: She often pushed people away. "I didn't get into relationships," she says.
TRAILER: "We are a hot mess." (making love scene when Hazel struggles with her cannula )
DIANA: Being intimate was very hard for her when she wore a wig. "I would have to take it off, and then turn off the lights," she says.
While we agreed it was a beautiful story, the cancer portrayal wasn't convincing. "They didn't seem sick," Debbie says. "She (Hazel) looked way too healthy."
"When I heard that (thyroid cancer), I thought she would be pale, thin and incredibly frail," she says.
When Augustus' cancer, osteosarcoma, returned and spread just about everywhere, he still looked like his "handsome" self, we all agreed.
There was one side effect to Augustus' chemotherapy that was very realistic to Diana.
WARNING: Spoiler alert, okay?
Augustus alerts Hazel to meet him at a gas station where he is parked. She gets there to find him crying and that he has a serious infection from chemo.
"That was gut-wrenching for me," says Diana, who once had an infection from chemo with a temperature of 105 and was hospitalized.
Debbie saw a relation to the financial struggles that can come with cancer.
After a star-struck Hazel receives an email from her favorite author, she approaches her mom about taking a trip to Amsterdam to meet him. Her response, "We don't have the money."
Debbie blamed financial stress for her cancer after she received a diagnosis. "I would constantly ask myself 'Can I work?', 'Can I pay my bills?'" she says.
Diana and Debbie both agreed the discussion of cancer and death in the movie is a reflection of how more "comfortable" society is in acknowledging cancer.
When Debbie was little, her grandmother died from breast cancer. She said she didn't see much of how her grandmother's cancer affected her family because no one talked about it.
"Back then, parents didn't want kids around cancer," she says. "But today, we're more open."
One subject all of us kept going back to was love. Kathy thought the love "was too good to be true." Yes, the love in the movie is "amazing." But can we expect every movie about a cancer patient to be included in a love story? Is this becoming to cliché in the storytelling industry? My question to you: Is it right to use cancer to enhance a love story?
Jennifer Nassar is a graduate student at the University of North Texas. She is a summer intern for CURE magazine.RELATED POSTS
Somewhere along the line of my now long career, I became interested in learning more about the role of religion and spirituality in the care of patients needing palliative care. As other areas in palliative care got better and better, spiritual care remained little studied. Fortunately, since its origins with leaders such as Dame Cicely Saunders and Dr. Balfour Mount, inclusion of a person's spiritual needs has been a core part of the care provided by hospice as well as palliative care.
Indeed, experience suggests that when spiritual care is present, patients and family caregivers alike seem more comfortable as they go through their difficult times.
Spirituality, of course, is a very personal matter, but as doctors we ask our patients lots of personal questions when it is relevant to their case, such as information about their sex life. It is part of caring for the whole person. Clinicians may feel like they are crossing a boundary by raising the subject of religion or spirituality with their patients. Is it their place to raise the issue, or should they simply be prepared to answer questions from, and offer resources to, patients who raise the subject?
Prayer does come up in our interactions with patients. We have the option to call upon the chaplain. The role of the clinician is assessment; so isn't it important then, if facing a crisis, to involve a chaplain or the patient's clergy if the person is in spiritual distress? I think so.
Recently the HealthCare Chaplaincy Network sponsored six landmark studies on this issue. One of them, "Hospital Chaplaincy and Medical Outcomes at the End of Life," conducted by Tracy Balboni and her colleagues at the Dana-Farber Cancer Institute in Boston, focused on the presence and helpfulness of chaplaincy visits for patients with advanced cancer. The research showed how chaplain care influences patient well-being and decision-making for people facing serious illness. Over half (52.4 percent) of the 250 respondents reported not being visited by a chaplain. Of those patients who were visited by chaplains, 88 percent said the chaplaincy visit was helpful.
Researchers also collected qualitative data in response to the question: "Please explain why your time with the chaplain was helpful or not helpful." Several patients said that the chaplain was "comforting," noting that the discussion, support and prayer with the chaplain were helpful. Though this data is still in the process of being collected, some preliminary conclusions indicate that though chaplain visits may not be as frequent as desired, when they do occur, they are generally helpful to patients.
In several of the studies, the benefit of having chaplains available went beyond religious matters to human spirituality even for the non-religious. The implications are that chaplains can help with communication in the service of whole person care that integrates a person's spiritual resources with other resources in their well-being. Spiritual care is central to caring for patients. It should not be ancillary.
Certainly not everyone who is dealing with cancer as a patient or as a survivor is in the hospital where they can meet with a chaplain. There is a new resource where you can find thoughtful and practical spiritual care information, resources and support provided by professional chaplains: ChaplainsOnHand.org. Besides the good content for anyone regardless of religion or beliefs, it enables you to chat with a chaplain by phone or email.
Linda Emanuel is director of the Buehler Center on Aging, Health & Society at Northwestern University Feinberg School of Medicine and and the Buehler professor of Geriatric Medicine. She also holds the title of Senior Vice President for Research & Education, HealthCare Chaplaincy Network.RELATED POSTS
Have you ever participated in a clinical trial?
They're VITAL to getting life-saving drugs on the market, but being a guinea pig is easier said than done.
As I mentioned in my last blog (Searching for NED), my most recent PET scan showed my breast cancer had progressed despite the medications I was taking. Even though my doctors recommended chemotherapy, I enrolled in a phase 3 clinical trial for the hot new PARP-inhibitor drug, BMN-673.
Taking a clinical trial drug expands the very finite list of cancer drugs available to me NOW, and it can also help increase options for patients like me in the future (stage 4, ER-positive, BRCA genetic mutation).
With the start of each new drug regimen, we pray for as much time as possible before progressing on that drug. Because once my cancer outsmarts the medication I am taking – and we know that it will – I have to cross that drug off my list and find a new one. When that happens, I try to ignore the little voice in my head that asks, "How many drugs are left?"
To be honest – I don't know, and I don't want to. Because the louder, more optimistic voice keeps yelling, "I don't need a long list of drugs... I just need ONE good one."
I need one good drug that my cancer can't outsmart. With 2:1 odds of receiving the trial drug, I ended up in the control group. Ironically, I'm receiving the same chemotherapy my doctors recommended in the first place, but so far, eribulin seems to be a "good" chemo with manageable side effects. My biggest physical complaint is a nagging pain in my lower back, but hopefully next week's scan will prove the pain to be a result of picking up 32-pound Henry.
I'll admit, at first I was angry that I wasn't getting the trial drug, but I made peace with it by looking at the bigger picture. I need to do more than just wait for drugs to come down the pipeline, and since I don't have millions to donate to research, I'm offering up my services as a guinea pig. Even if I am in the control group, I'm helping get the job done.
With any luck, PARP-inhibitor BMN-673 will be a wonder drug that hits the FDA fast-track. I'm very optimistic to see if the FDA's new breakthrough program is actually going to help us get drugs to market faster, because the new PARP inhibitors definitely qualify as a breakthrough. Now let's just cross our fingers and pray the drug will work some magic. And maybe cross some toes too....
In the meantime, summer has officially arrived here in Dallas! During the week, I'm juggling babysitters and appointments at the cancer center, but we enjoy our weekends as a family in the backyard. Most Saturdays we fire up the grill, turn on the sprinklers and let Henry run his lawn mower through the mud until he's tired enough to nap!
Carrie Corey was diagnosed with stage 2 breast cancer at age 29 and with a stage 4 recurrence in 2012 at the age of 31. She is a wife and new mom living in Dallas, and will be reporting frequently on her cancer experiences.RELATED POSTS
CURE invited Diane Gambill, PhD, a CURE advisory board member, to share her thoughts on advancements in blood cancers highlighted at the 2014 annual meeting of the American Society of Clinical Oncology.
Several years ago, I heard the early results of a new drug being studied in mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL). The drug (PCI-32765, an inhibitor of Bruton's tyrosine kinase) generated a lot of excitement, but might not have made it to the clinic.
Like the stories behind Viagra and penicillin, the development of PCI-32765 is a classic example of scientists developing a compound for one thing and finding out, almost by accident, that it might be useful for something else. PCI-32765 was developed by a company called Celera engaged in the Human Genome Project as a tool to help find new drugs – not as a potential new drug itself, but the head of Celera resigned after the 2006 completion of sequencing the human genome and progress on their new drug portfolio ground to a halt.
In 2007, Pharmacyclics acquired the intellectual property of Celera including PCI-32765, what was to later become "Imbruvica." PCI-32765 was not among the acquired compounds that was initially pursued; however, it took less than seven years for Imbruvica to enter the clinic for treatment of MCL (2013), and in February 2014, the FDA granted accelerated approval of Imbruvica for patients with previously treated CLL based on a small phase 2 trial that showed an impressive response rate in 48 heavily pretreated patients [NEJM 2013;369:32).
To gain full approval from the FDA, these results need to be confirmed and shown to improve long-term outcomes in phase 3 trials. Seven trials are underway and the preliminary findings of one of them (a trial called RESONATE) were announced at the 2014 annual meeting of the American Society for Clinical Oncology.
The RESONATE trial compared Imbruvica to Arzerra (ofatumumab), another treatment for CLL. Patients with CLL that had relapsed following response to prior treatment or was refractory to treatment were randomized to daily oral Imbruvica or 12 doses of intravenous Arzerra. The goal of the trial was to determine if the 195 patients treated with Imbruvica had longer progression-free survival (PFS) than the 196 patients treated with Arzerra. The trial included patients with poor prognostic characteristics such as bulky disease (about half of the patients) and a third of patients had chromosome 17p deletions.
The majority (86 percent) of patients on the Imbruvica regimen remain on therapy while all but one of the Arzerra patients had completed therapy. Of note, patients who progressed on Arzerra were allowed to cross over to the Imbruvica arm as of August 2013.
The overall response rate was substantially higher for Imbruvica (48 percent) than for Arzerra (4 percent), and the gap was even larger if patients who had a partial response with lymphocytosis were included (63 percent vs. 4 percent). This is consistent with the phase 2 results.
According to the investigators, more than 80 percent of the patients receiving Imbruvica are in remission at one year – more than twice the number expected from standard therapy. More importantly, patients who were treated with Imbruvica had significantly better PFS and overall survival compared with those who were treated with Arzerra. With Imbruvica, the risk of progressive disease or death decreased by 78 percent and 57 percent, respectively. The advantage in overall survival was seen despite patients receiving Imbruvica after progressing on Arzerra.
Probably the most impressive result was that the data was positive in all subgroups, including disease that was refractory to fludarabine or had poor prognostic markers such as 17p deletions, both of which tend to limit the efficacy of traditional therapies.
Both treatments were relatively safe and there were no unexpected toxicities. Diarrhea and mild infection were more common with Imbruvica. Serious infections were similar between the two treatments. Atrial fibrillation (a heart rhythm disorder) was more frequent with Imbruvica (10 patients versus 1 with Arzerra) but caused only treatment discontinuation. Bleeding was also more common with Imbruvica; however, there were no serious events. Infusion reactions and neuropathy were more common with Arzerra. These preliminary results suggest that Imbruvica will achieve full approval; but, final results of this and other phase 3 trials currently underway are needed to see if the impressive results seen in the earlier clinical trials hold up... so look for final data in 2015.RELATED POSTS
CURE invited Diane Gambill, PhD, a CURE advisory board member, to share her thoughts on advancements in lymphoma highlighted at the 2014 annual meeting of the American Society of Clinical Oncology.
Patients 60 years old and younger who have high-risk aggressive lymphoma (diffuse large B-cell lymphoma [DLBCL]) might not need a transplantation according to results of a phase 2 trial announced at the annual meeting of the American Society for Clinical Oncology.
The trial (LNH 2007-3B), presented by the French GELA/LYSA group, assessed 222 patients' response to chemoimmunotherapy, which was evaluated using positron emission tomography (PET) scans after two (PET2) and four (PET4) cycles of treatment. PET scanning results were used to drive the decision to continue chemoimmunotherapy versus autologous stem cell transplantation (ASCT) after four cycles of treatment. Previously, PET2-negative results had been associated with improved outcomes for patients with high-risk DLBCL, so investigators of the trial thought some patients might not need an ASCT.
Patients on the study were randomized to receive chemoimmunotherapy with Rituxan/CHOP14 or Rituxan/ACVBP14. As expected, patients on the Rituxan/ACVBP14 regimen had a higher rate of serious toxicities, notably febrile neutropenia, infection and mucositis than patients on the Rituxan/CHOP14 regimen. Despite the difference in toxicities, the number of patients who withdrew from the trial early was similar between the arms (six on the Rituxan/ACVBP14 regimen and five on the Rituxan/CHOP14).
Based on PET2 and PET4 scan results, there were three different consolidation treatment plans:
• Patients with a PET4-positive result indicated that active disease was present and the patient was taken off study to receive salvage chemotherapy. Fewer patients on the Rituxan/ACVBP14 regimen received salvage therapy than on the Rituxan/CHOP14 regimen (27 percent and 39 percent, respectively). This difference was statistically meaningful and is consistent with the response advantage seen in lower-risk DLBCL.
• Patients with a PET4-negative result, meaning they had a complete response to chemoimmunotherapy, were treated according to their PET2 scan result.
o Patients with PET4-negative but PET2-positive scans were treated with an ASCT, which resulted in a similar number of patients for each regimen: 41 percent for Rituxan/ACVBP versus 33 percent for Rituxan/CHOP.
o Patients who had both PET2- and PET4-negative scans received further chemoimmunotherapy and the numbers were similar for both regimens. Overall, 25 percent of the patients in this study were eligible for this approach, sparing them from ASCT.
So, what does this trial mean for patients in the U.S.?
First, this phase 2 result is intriguing but requires further investigation before it is ready for the clinic. Second, one of the drugs in the ACVBP regimen is not available in the U.S.; however, despite the differences in numbers of patients with PET4-positive scans between the regimens, progression-free survival and overall survival were not statistically different. The investigators suggested that matching the PET response to an appropriate consolidation therapy might be responsible for the similar survival outcomes.
Finally, using PET to assess response to initial therapy is currently the standard for DLBCL; but some worry about the potential risks of PET scans, notably false positives and second malignancies, particularly in a younger population (those 60 years old and younger). In the case of high-risk DLBCL, biopsies are needed to confirm PET-positivity, and the benefits of PET outweigh the risks given the potential for long-term disease control.
The GELA/LYSA investigators have started a phase 3 trial, called GAINED, to confirm these results.RELATED POSTS


text:
Huge new wildlife reserve
Millions of tonnes of earth from the construction of new rail tunnels are being used to create a huge wetland nature reserve in Essex which will be the largest of its kind in Europe.
Nature reserve created in Essex
Work has started on Europe's largest man-made nature reserve, which will eventually be home to tens of thousands of migratory wetland birds.
It's being created using the millions of tonnes of earth from dug out for London's Crossrail project, which will allow rail passengers to journey between Shenfield in Essex, across the capital to Maidenhead in Berkshire.
The project will see Wallasea Island, near Southend, transformed into a massive wetland habitat.
Operation starts building new Essex nature reserveby Kate Prout
The first load of soil has arrived from London at an Essex island to start the creation of Europe's largest coastal nature reserve.
Four and a half million tonnes is being excavated from beneath the capital to create a rail link between Heathrow and Shenfield in Essex and the earth is being used to bolster Wallasea island near Southend to create a haven for hundreds of thousands of birds
Essex coastal reserve to be largest in Europe
Millions of tonnes of earth from the construction of new rail tunnels are being used to create a huge wetland nature reserve in Essex.Read the full story


text:
Mayweather VS Cotto, who wins and why?
Mayweather VS Cotto, who wins and why?
Dec 9 2007, 04:03 AM
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Joined: 10-November 06
Member No.: 5,559
It's early to start talking about this fight, but I think it's safe to say this is the fight to make at Welterweight.I know Mayweather wants a break and he deserves it, but now is the time to make these fights when he's still at peak level.If these two superstars fought it could unify the WBC,WBA & RING Titles which would be something neither man has done.Also, Mayweather wouldn't have to work with Golden Boy on this one either.He could get back at Arum for all the negative things he has said about Floyd.Personally, I think Floyd should take this fight in 2008.It would advance his Legacy even further and it's a fight he can win and look good.Cotto has improved, but so has Mayweather over the years.I think Mayweathers defense and skills would take him to a decision victory.Cotto can be hit often if the right gameplan is put in place.I believe Mayweather is still very quick and has the experience advantage over Cotto.This fight would sell and possibly be an instant classic.
Dec 12 2007, 11:03 AM
Post #2
Choppin Headz Boi!
Group: Team BU
Posts: 22,696
Joined: 16-October 02
Member No.: 19
I totally disagree with this and want to know why everyone keeps bringing up Cotto's great body attack. Mayweather DOESN'T GET HIT cleanly to the body (or anywhere really). Cotto may punish Mayweather's elbows, but not his body. Just like everyone was saying that Hatton was going to punish Mayweather's body... and how many effective body punches did Hatton get in all night? You could count them on 1 hand.
Mayweather is like a Toney or Hopkins in that his opponents simply don't connect clean on him... VERY rarely anyway. And another huge factor that needs to be taken into consideration with ALL of Mayweather's opponents is that they find out very quickly about 1/3 of the way into the fight that his speed/accuracy combo is something they have not had the pleasure of dealing with in the past. Look at how many guys have started out doing decent against Mayweather looking pretty good and then by the middle of the fight they are completely shut down and defensive minded. Mentally that's gotta wreck you every time you are about to jab and you get clocked with a lead right hand that you never have a chance to react to... or you are about to throw a lead right hand yourself and you get iced with a left hook that you never saw coming. You'll see Cotto's punch output drop dramatically around the middle of the fight, meaning he will be landing even fewer punches of the already low percentage of clean shots he landed earlier.
I disagree with Mayweather having to fight such a cautious fight. He has the ability to stay outside and play the lead right hand/left hook game all night with an occasional jab thrown in all night long, OR when the distance closes his defense allows him to evade just about everything clean and he always manages to get his own work in.
Well, Jose Louis Castillo in their first fight was able to get to Floyd's body quite a bit. Although some were low blows and some were inside the clinch but still. You are right, like Hopkins and Toney, it is very difficult to hit Floyd...especially with a headshot. But Cotto is kind of an accurate, heavy-handed puncher and although he has been rocked before, he has a pretty decent chin. He took some bombs from Judah and Sugar Shane. I'm just saying, Cotto will give Floyd a tougher fight then most other people. Him and PWill are the only guys with a shot at Floyd.
And if Floyd's stands in the pocket with Cotto, he will feel the heat.
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Doctor of Physical Therapy
Prestige Speaker Day
October 2013
Prestige Speaker Day at Cleveland State University was inaugurated in 1992 in celebration of Physical Therapy month. It is designed to provide an opportunity for CSU physical therapy students, alumni, and physical therapists in the Greater Cleveland area to interact with an individual who has made a significant impact on the physical therapy profession. In addition, several scholarship awards are given at this event in memory and recognition of well-known local physical therapists. Prestige Speaker Day is also a unique opportunity for students to network with sponsoring organizations and professionals in the community.
The keynote speaker this year is Dianne V. Jewell, PT, DPT, PhD, CCS. Dr. Jewell is founder and CEO of The Rehab Intel Network (Ruther Glen, VA), a consulting company providing project and data management; program development and evaluation; education; and staff development services to practices, organizations and educational institutions dedicated to physical rehabilitation. Dr. Jewell has over 25 years of experience as a physical therapist practicing in acute hospital, inpatient rehabilitation facility, and outpatient settings. Her roles have included clinical team leader, clinical education coordinator and director of quality management. She also developed a physical therapy screening and case management program for a free clinic serving uninsured individuals in Richmond, VA.
2012 Daniel L. Riddle, PT, Ph.D., F.A.P.T.A.
2011 Katherine J. Sullivan, PT, PhD, FAHA
2010 Sue Whitney, PT, PhD, NCS, ATC, FAPTA
2009 Rebecca Craik, PT, PhD, FAPTA
2008 Jonathan Cooperman, PT, DPT, JD, MS
2007 Gail M. Jensen, PT, PhD, FAPTA
2006 Diane B. Jette, PT, PhD
2005 Elizabeth Domholdt, PT, EdD, FAPTA
2004 Barret Dorko, PT
2003 Laurita M. Hack PT, PhD, FAPTA
2002 Ben Massey Jr., PT
2001 Ruth Purtillo, PhD
2000 Bella J. May, PT, EdD
1999 Shirley Sahrman, PT, PhD
1998 Alan M. Jette, PT, PhD
1997 Katherine F. Shephard, PT, PhD
1997 Helen J. Hislop, PT, Phd
1996 Pamela W. Duncan, PT, PhD
1995 Jules Rothstein, PT, PhD
1994 Florence Kendall, PT
1993 Mary McKinney Edmonds, PT, PhD
1992 Marilyn Moffat, PT, PhD


text:
Reviews for Spit It Out LyricsPerformed by Slipknot
By Pages: 1 2 3 4 5 6 7 8 9 10 Next 10 Pages Current page No. 5/ 14
Add Your New Review About The Song
Wow | Reviewer: Anonymous | 5/16/10
All your religious fags out there commenting on this, go do something else with your time. Go pray about your sins or w.e you people do. Religion is to control the masses and look at the little donkeys following along with it.
Not Satanic | Reviewer: Yeah | 5/14/10
I am a agnostic atheist but i have done my fair share of 14 years (age) look up psychosocial by slipknot they say "But no one else can see the preservation of the MARTYR in me" Martyr= Dying for religious beliefs they have never said any thing negative toward christian they may actually be Christian so any hating fag marricones out there if you want satans musito judge take your jesus freak ass to some norwegian black metal they burn churches and say lyrics literally Fuck Jesus hail Satan the chorus might even jus b satans name . So before you try to judge religion reguarding to music do your research its not Satanic metal its simply hardcore/thrash metal no offense to any religion but im 14 and i know this is a dumb conversation i cant even look up lyrics without some dumb fuck making an insult . Let your balls drop kiddies any one who this dont apply to sorry for the profane language grow a pair and grow up!
Respect | Reviewer: Andrew | 5/12/10
It's funny how many people use this review space to judge upon a band on not how high the quality of their music is, but on how they are as people. Though I am not Christian, I think there is a verse in the Bible that says "judge not least ye be judged". In my opinion, if you don't like or don't know anything about a certain people, then give it your respect by not commenting. Also, if you don't know what you are talking about (ie I'M Jesus when talking about satanism)you should really first look up the suggested material before speaking your mind.
Dear I'M Jesus | Reviewer: ray Lewis | 5/12/10
Satanist DONT tourture children and kill innocent animals. if u read their bible/rule book, what ever you want to call it, the first rule is Thou shall not harm children, the 5th rule is thou shall not kill animals without reason, mostly for hunting or self defense. if u werent such a one sided retard you would have atleast looked insted of going by your own belifes. And (if there was a god) he would be forgiving and understanding, unlike you who judge people by there belifes and the type of music they listen to. BTW this is a great song, i just wish though uptight Extremeist bastards didnt have to comment and make everyhting worse
I'M Jesus | Reviewer: Anonymous | 5/8/10
I just want to tell all satanists that torture childs and kill innocent animals for satan that god will get you! noone can stand up to gods powers, and shuld not. god is good and you shuld love him. Now, let us all PRAY for god sake!!
Bye // Jesus
Fucking pathetic | Reviewer: Matthew | 4/28/10
Seriously, you Christians who want to comment on these lyrics saying that Slipknot are demonic or whatever....FUCK OFF!!! you are wasting your time and are just fucking pathetic, now i know not every Christian think this but all of you who are saying this just please piss off and leave it, no one really gives a fuck because in the end ITS JUST MUSIC :)
What The Heck? | Reviewer: Michael | 4/23/10
These reviews are about the songs and the band, not for people who are disrespecting the work that these people put out. If your Christian and don't like this, don't look it up. Hell if you don't like it at all, just dont comment. Let It Be.
Otherwise? Never known the lyrics, but now that I know them? Kickass song
voices | Reviewer: kieran | 4/2/10
if you dont like the song dont listen to it.
you maybe entitled to your opinion but dont tell it to us and also that rule doesn't apply here for you 12 year old fags.
this is a great song i think you should listen to some other music before you start talking crap about this.
u must be retarted | Reviewer: insanity594 | 4/7/10
y the fuck r there always retarted arguments in lyric comments yea slipknot kicks ass but who gives two fucks about maggots...juggalos...or whatever other fucking pussy ass groopie klan ur a part of u think ur fucking hardcore?!?!? y???? cuzz u r one out of a shit-ton of people who listen to a famous band ""fuck all u haters"" FUCK YOU WHAT THE FUCK R U GONNA DO ABOUT IT COCKSUCKERS?!?!?!?!? if u think ur badass cuzz ur part of a group of people that idolize a band then U MUST BE FUCKING RETARTED!!!!!!!!!!! ecverybody idolizes some band!!! being a maggot dosent make u badass it just makes u sound retarted when u get into a fucking "comment war" SO FUCK ALL OF U!!!!!!!!!!!
slipknot | Reviewer: londoner | 4/8/10
slipknot is one of the est hevey metal bands in the wold, and in my opinion, if u dont like slipknot or hevey metal, they why the hell are u lookin up their lyrics??? just to diss em ??? well thats kinda sad dont you think. the lyrics by slipknot, are the same as rap, but just sung in different forms. its a small world out there.
if u dnt like it, y r u here commenting? | Reviewer: Anonymous | 4/5/10
its funny to see all these christians who do not like the music talking about, if u do not like it then y r u even on this page? seems very sterotypicly religous to stick ur nose in somewhere you dnt like and dnt agree with to force your views and beliefs upon ppl, i am not religous, but i can respect the views and beliefs of those who r, but the majority of them do themselfs no favours by playing to the sterotype
I Give in! | Reviewer: Joe | 4/7/10
I'm realy sorry about my shit that I caused. My fab. Song by ct is I'm not Jesus. It says that ct got raped/ abused by a priest, when he was 11-12 savelagy . And that's why the way he is now. In inspires u realy alot. By the way he wrote the song Corey Taylor is a Cristian belivdd it or not ! Also w8 and bleed is great! Ps to to dragonforce fans, zp left!
Well I hope u forgive me!
ffs | Reviewer: metallica lover <3 | 4/2/10
come on people, if you dont like hevey metal bands, why are you googlein them and commentin on their lyrics ? if you dont like hevey metal, dont search it !!! personally, i love slipknot and think they make amazin lyrics that are powerful and meen alot to somne people,
just let people be who they are, and dont try to change some one !
arguments about the lyrics | Reviewer: Michael | 4/2/10
I am a christian and listen to slipknot even though most people think of it as demonic. and if you believe you can't believe in god if you listen to slipknot or any other band like them then that is something you believe. i don't have a problem with you saying anything about the lyrics. in all honesty i ddon't think it calls for people arguing about it.
Erm, that "Joey" kid. | Reviewer: rozejukes | 3/29/10
"chris=an durty phat whore. fuk chris u pobly rape yo mama u bitchbag. u dont need 2 critisize me just cuz im a christian. u slut fag. u r a sick sikc lil' lesbian girl. stay (sic). exept 4 chris! go 2 hell chris"
Please, oh please, learn to spell.
Maybe people would consider taking your criticism as an insult if they could possibly read it.
I doubt I'm the only one when I say your post made NO SENSE to me.
Add Your New Review About The Song
By Pages: 1 2 3 4 5 6 7 8 9 10 Next 10 Pages Current page No. 5/ 14


text:
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Several non-surgical procedures can also be combined with a brow lift or eyelid surgery for enhanced results. BOTOX® Cosmetic treatment is available at our New Jersey center and can reduce the appearance of lines around the eyes and between the eyebrows, while skin resurfacing procedures such as chemical peels and laser skin resurfacing can improve the appearance of the skin around the eyes as well as the entire face. One of our on-staff skin care consultants can advise you on the best non-surgical procedures to address your individual needs.
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If you are ready to learn how Total Eye Area Rejuvenation can brighten your appearance, contact the New Jersey practice of Dr. Brian Glatt to schedule a consultation today. During your consultation, Dr. Glatt will create a customized treatment plan to help you achieve the look you desire.
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text:
Oct. 15, 2012
STILLWATER, Okla. - Oklahoma State football coach Mike Gundy and members of the team visited with the media Monday in Boone Pickens Stadium to talk about this week's game against Iowa State. Some of their comments:
Coach Mike Gundy
Opening Statement
On Iowa State:
On Iowa State's defense:
"They may have the best crew inside and play as well together as anybody that we have in our league. They're experienced. Most of their guys are juniors and seniors and they've played a number of games. The experience and maturity is so important and they've got guys who've played a lot of games and it shows in the results."
On playing the `revenge card':
On the special teams performance against Kansas:
On being a win away from breaking Pat Jones's school record for wins:
Defensive Coordinator Bill Young
On revenge being motivation against Iowa State:
On getting crucial late stops against Kansas and how that builds confidence:
On Josh Lenz's recent play, and how that affects game planning:
On having no more bye weeks:
Offensive Coordinator Todd Monken
On what Iowa State's defense presents:
On whether the revenge factor as motivation is overrated:
On how Saturday's performance at Kansas impacts the offense moving forward:
On how the struggles in the running game affected the offense against Kansas:
Quarterback J.W. Walsh
On what the film from Saturday's game at Kansas showed:
On how the weather impacted the offense:
On preparation in an uncertain quarterback situation:
On how last week's injuries impact the team moving forward:
Offensive Lineman Jonathan Rush
On whether this week's game vs. Iowa State is a "revenge game":
On the offensive line play at Kansas:
On correcting errors from last week:
Linebacker Alex Elkins
On the mindset of the defense coming out to make a defensive stand at the end of the Kansas game:
On playing a close game on the road:
On playing Iowa State this weekend:
Wide Receiver Charlie Moore
On last week's game at Kansas:
On wide receivers being hurt:
On the homecoming experience:
Defensive Tackle James Castleman
On the defense making adjustments for this weekend's game:
On if there is a revenge factor from the Iowa State game last year:
On the 11 a.m. start:
Offensive Lineman Parker Graham
On the OSU quarterback situation:
On the morning kickoff against Iowa State:
On how the team feels coming out of last week's game at Kansas:
Safety Shamiel Gary
On the Iowa State game:
On the close nature of the Kansas game:
On preparing for Iowa State:
Defensive End Tyler Johnson
On the weather delay against Kansas:
On how long it took to bounce back from last year's Iowa State game:
On pulling out a tough win on the road:
Cowboys in the NFL, Preseason
Oklahoma State in Season Openers
Opener Gives Many Cowboys A Taste Of Home
Cowboy Football Against The Elite
Gundy, Cowboys Preview Florida State
Cowboy Football Report, Aug. 20, 2014
Cowboy Football Report, Aug. 19


text:
Emergency Chocolate Stocking Stuffer - Free Printable
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12 Comments
I couldn't agree more ( as you might be able to tell from my blog name). These are awesome! Saw them over at Rook No. 17!
Oh Carol, I howled when I went over and saw your blog name! Perfect!
Adorable! I would love if you could share these at my Pin'Inspiration Party. I admit-I've bought them already done, in the past.
Love this. I pinned it.
Wow! Awesome! Love it! Great printables;-)
Thanks for linking up to Topsy Turvy Tuesdays! I love this idea and I'm featuring this as my treat of the week!
I love this great idea. Consider, if you will, sharing it with my readers at http://sassafrassalvation.blogspot.com/2011/11/although-i-must-say-that-link-response.html. Thanks! Christmas blessings to you……….Kathy
Wonderful idea and excellent printables!
I'm spotlighting your post on my Facebook page today!
Thank you for being a part of making last week's "A Little Birdie Told Me…" at Rook No. 17 so rich in creativity and inspiration! Today's party is in full swing, so please feel welcome to drop by and share your talent.
such a fun idea
I like this blog!
You should take part in a contest for one of the best blogs on the web. I will recommend this site!


text:
- Select an Interest -MARTIAL ARTSSPORT TRAINING
This easy to understand 62-page exercise booklet contains 30 of the most popular upper and lower body Xertube® resistance exercises recommended by top personal trainers and fitness instructor. Basic double-arm and more advanced single-arm Xertube® exercises. Challenge exercise participants of all ages and ability levels.IMPORTANT: One-half of the exercises contained in this exercise guide utilize the Door Attachment product found the "Accessories" subcategory.Click here to purchase Door Attachment.