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PET/CT is a highly sensitive imaging technique used in oncology, cardiology, neurology and in infectious diseases. In this procedure, special equipment combines two procedures: positron emission tomography and computed tomography. By combining them, the doctor can obtain the benefits of both in one procedure. Performed at the same time on the same machine, the two scans create a more complete image than either test offers alone.
In a PET scan, radioactive sugar molecules are injected into the body. The scan shows biologic data about cellular activity.
The CT scanner takes a series of X-rays, which are combined by a computer to create an extremely detailed image of your internal organs or other parts of your body. The scan shows anatomical data.
The PET/CT scan can be performed in Tanner's radiology department or at our outpatient imaging center. It is performed by a radiologist or radiology technologist who specializes in CT scanning and nuclear medicine.
The information the doctor obtains from the two scans—the PET and the CT scan—are very different. However, they are complementary to each other. In cardiology, the PET scan shows areas with increased metabolic activity, while the CT scan shows detailed anatomical locations. A combination of these two images taken together enables a doctor to tell whether the high metabolic activity in an area of your heart is significant. If it is, it tells the doctor exactly where that area is. Sometimes the doctor will repeat the PET/CT to monitor the effect of treatment on a particular disease.
In oncology, a PET/CT scan is used to detect and determine the stage of a tumor—whether the tumor has spread to lymph nodes or other parts of the body—and evaluate the effectiveness of cancer treatments. The PET/CT is also used to guide some types of biopsies (the removal of a small amount of tissue for examination to determine whether cancer is present).
Immediately prior to the scan, a nurse will give you the injection or insert an IV. The IV includes the radioactive sugar and sometimes will include an iodinated dye. During the test, you'll be asked to lie flat with your arms above your head for approximately 35 minutes. If you think you will be unable to do this, please notify the technologist and they may be able to accommodate you.
You should plan for a total of two to three hours for the PET/CT procedure.


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Stroll the Waterfront.
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Miracle Details brings the suds and shine to you! Their mobile auto wash and detail services makes taking care of your car a breeze.
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1130cc, 85bhp, 133mph, Insurance group 13
The BMW R1150GS Adventure is the ultimate round-the-world, do it all motorcycle – as Ewan MacGregor and Charley Boorman proved in their 'Long Way Round' motorcycle adventure. The BMW R1150GS Adventure is a jacked up, kitted out, heavy duty version of the already excellent BMW R1150GS and is the Hummer of the motorcycle world. Awesome in every way…
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What would you recommend for the purpose of photographing of small things?
The price threshold for me is $600.
Hi and welcome.
This is a UK site but have looked at what you want in the US. You may find them cheaper by doing more research, as it just goes over your $600 budget at the moment.
http://www.bhphotovideo.com/c/produc...0mm_f_2_8.html Note: When fitted to the Olympus it becomes a 120mm lens http://www.whatdigitalcamera.com/tec...uivalents.html
And don't forget. Post processing is such an important part of photography and should be used to sharpen and enhance pictures taken with your camera. If you don't have an imaging editor, then use the one in my signature below. There are http://ictpublish.com/pixlr/ to get you started. The most useful is the http://ictpublish.com/pixlr/Videoes/...06_Levels.html and for even more adjustment. The http://ictpublish.com/pixlr/Videoes/...07_Curves.html is a must (it's my favourite all-in-one adjuster). My Resize-Crop-Sharpen tutorial below, will get your pics ready for the internet or whatever
Last edited by Chris Cool; 11-11-12 at 06:19 PM.
thank you very much for your recommendations and tips.
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Honda CBF1000: Nice legs, shame about the boat race… The big Honda CBF1000 is one of the unsung heroes of modern motorcycling. Detuned Blade engine, fabulously easy handling and throttle response and great ergonomics make the Honda CBF1000 hooningly enjoyable, yet novice friendly and a great value all-rounder. It's just a shame the Honda CBF1000 looks so dull.
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Yes, I know Dangerous Seedy Potato Bread is sort of cheating with the letter "D". Today has been a crazy day though! Since our refrigerator stopped functioning a few days ago we've been scampering around the kitchen with bags of ice trying to keep our perishable food from becoming part of a landfill. So far, we have succeeded. A repairman looked at our dead fridge, said it wasn't economical to repair it, and now we are eagerly awaiting a BRAND NEW fridge courtesy of our landlord. Hooray! Our old fridge had issues anyways…
Fast forward to right now. Guess what's inside our oven (yet another appliance teetering on the edge of death)? A monstrous loaf of Dangerous Seedy Potato Bread!!! It wasn't supposed to be dangerously humongous, but maybe the chaos in our kitchen created the perfect rising environment for this particular loaf. The recipe is adapted from a New Zealand cookbook called Muffins, Breads, Biscuits, and Slices. I will share my version of the recipe in a moment.
This is BEFORE baking!
This bread had a crusty exterior and a soft, pillowy interior. It is perfect for dunking in bowls of soup.
Dangerous Seedy Potato Bread
1/2 cup warm water
3 teaspoons active dry yeast
2 teaspoons unrefined sugar
2 1/2 cups whole wheat flour
1 cup unbleached all-purpose flour
1 1/2 teaspoons salt
1 cup warm mashed potato (about 2 small red potatoes)
3/4 cup unsweetened nondairy milk, warmed slightly
1 Tablespoon olive oil
1/3 cup pumpkin seeds
1/3 cup mixed seeds of choice for rolling dough in (I used sesame, poppy, pumpkin – I also added minced dried garlic and minced dried onion)
1. Stir together water, yeast, and sugar in a glass measuring cup. Set aside for about 10 minutes, until frothy.
2. In a large bowl, combine flours, salt, and pumpkin seeds.
3. Add yeast mixture, mashed potato, pumpkin seeds, milk, and olive oil to flour mixture.
4. Knead either by hand or in a stand mixer for about 10 minutes, or until dough is smooth and elastic. You may need to add more flour to keep the dough from getting too sticky.
5. Place dough in a well-oiled bowl and cover with a towel. Place in a warm, draft-free place and allow to rise until doubled in size, about 2 hours.
6. Punch dough down. Line a cookie sheet with parchment or a Silpat and dust with corn meal.
7. Shape dough into an oval, spritz with water, and sprinkle all over with seed mixture. Place on prepared pan. Cut a slit across the top. Place in a warm place to rise for about 45 minutes.
8. Meanwhile, preheat oven to 350 degrees. When dough had risen nicely, place in oven and bake for 30 minutes. Loaf will be golden and will sound hollow when tapped on the bottom. Allow to cool on a cooling rack before slicing.
My dad is visiting this weekend so my posts may thin out until Monday… We'll see! We're going hiking near Mt. Hood tomorrow after a breakfast of pancakes!! Until then, enjoy this gorgeous photo of the Wilson River in Oregon (taken on a recent hike). Goodnight!


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Why and Where Cancer Returns
Taking Control: Your Care and Treatment
Managing the Side Effects of Your Treatment
Your Feelings
Setting Goals
Family and Friends
Looking for Meaning
A Time To Reflect
For more information
Adjusting to the News
Maybe in the back of your mind, you feared that your cancer might return. Now you might be thinking, "How can this be happening to me again? Haven't I been through enough?"
You may be feeling shocked, angry, sad, or scared. Many people have these feelings. But you have something now that you didn't have before - experience. You've lived through cancer once. You know a lot about what to expect and hope for.
Also remember that treatments may have improved since you had your first cancer. New drugs or methods may help with your treatment or in managing side effects. In fact, cancer is now often thought of as a chronic disease, one which people manage for many years.
"When I found out I had cancer again, I just felt numb. It was hard for me to accept the news at first. After a few weeks, though, I started to really look at all my options and things I could do for myself. By doing this, it gave me back some control."
Why and Where Cancer Returns
When cancer comes back, doctors call it a recurrence (or recurrent cancer). Some things you should know are:
- A recurrent cancer starts with cancer cells that the first treatment didn't fully remove or destroy. Some may have been too small to be seen in follow-up. This doesn't mean that the treatment you received was wrong. And it doesn't mean that you did anything wrong, either. It just means that a small number of cancer cells survived the treatment. These cells grew over time into tumors or cancer that your doctor can now detect.
- When cancer comes back, it doesn't always show up in the same part of the body. For example, if you had colon cancer, it may come back in your liver. But the cancer is still called colon cancer. When the original cancer spreads to a new place, it is called a metastasis (meh-TAS-tuh-sis). (See the box below.)
- It is possible to develop a completely new cancer that has nothing to do with your original cancer. But this doesn't happen very often. Recurrences are more common.
Where Cancer Can Return
Doctors define recurrent cancers by where they develop. The different types of recurrence are:
- Local recurrence. This means that the cancer is in the same place as the original cancer or is very close to it.
- Regional recurrence. This is when tumors grow in lymph nodes or tissues near the place of the original cancer.
- Distant recurrence. In these cases, the cancer has spread (metastasized) to organs or tissues far from the place of the original cancer.
Local cancer may be easier to treat than regional or distant cancer. But this can be different for each patient. Talk with your doctor about your options.
Taking Control: Your Care and Treatment
Cancer that returns can affect all parts of your life. You may feel weak and no longer in control. But you don't have to feel that way. You can take part in your care and in making decisions. You can also talk with your health care team and loved ones as you decide about your care. This may help you feel a sense of control and well-being.
Talking With Your Health Care Team
Many people have a treatment team of health providers who work together to help them. This team may include doctors, nurses, oncology social workers, dietitians, or other specialists. Some people don't like to ask about treatment choices or side effects. They think that doctors don't like being questioned. But this is not true. Most doctors want their patients to be involved in their own care. They want patients to discuss concerns with them.
Here are a few topics you may want to discuss with your health care team:
- Pain or Other Symptoms. Be honest and open about how you feel. Tell your doctors if you have pain and where. Tell them what you expect in the way of pain relief. (See Chapter 4 for more about pain and other symptoms.)
- Communication. Some people want to know details about their care. Others prefer to know as little as possible. Some people with cancer want their family members to make most of their decisions. What would you prefer? Decide what you want to know, how much you want to know, and when you've heard enough. Choose what is most comfortable for you. Then tell your doctor and family members. Ask that they follow through with your wishes.
- Family Wishes. Some family members may have trouble dealing with cancer. They don't want to know how far the disease has advanced. Find out from your family members how much they want to know. And be sure to tell your doctors and nurses. Do this as soon as possible. It will help avoid conflicts or distress among your loved ones. (See Family and Friends to read more about talking with your loved ones.)
Other Tips for Talking With Your Health Care Team
- Speak openly about your needs, questions, and concerns. Don't be embarrassed to ask your doctor to repeat or explain something.
- Keep a file or notebook of all the papers and test results that your doctor has given you. Take this file to your visits. Also keep records or a diary of all your visits. List the drugs and tests you have taken. Then you can refer to your records when you need to. Many patients say this is helpful, especially when you meet with a new doctor for the first time.
- Write down your questions before you see your doctors so you will remember them. (See below.)
- Ask a family member or friend to go to the doctor's office with you. They can help you ask questions to get a clear sense of what to expect. This can be an emotional time. You may have trouble focusing on what the doctor says. It may be easier for someone else to take notes. Then you can review them later.
- Ask your doctor if it's okay to tape-record your talks.
- Tell your doctor if you want to get dressed before talking about your results. Wearing a gown or robe is distracting for some patients. They find it harder to focus on what the doctor is saying.
Treatment Choices
There are many treatment choices for recurrent cancer. Your treatment will depend partly on the type of cancer and the treatment you had before. It will also depend on where the cancer has recurred. For example:
- A local recurrence may be best treated by surgery or radiation therapy. This means that the doctor removes the tumor or destroys it with radiation.
- A distant recurrence may need chemotherapy, biological therapy, or radiation therapy. (For more information see the NCI booklets Radiation Therapy and You and Chemotherapy and You.)
It's important to ask your doctor questions about all your treatment choices. You may want to get a second opinion as well. You may also want to ask whether a clinical trial is an option for you.
Should I Get A Second Opinion?
Some patients worry that doctors will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for them.
If you get a second opinion, the doctor may agree with your first doctor's treatment plan. Or the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.
Clinical Trials
Treatment clinical trials are research studies that try to find better ways to treat cancer. Every day, cancer researchers learn more about treatment options from clinical trials.
Each study has rules about who can take part. These rules include the person's age and type of cancer. They also cover earlier treatments and where the cancer has returned.
Clinical trials have both benefits and risks. Your doctor should tell you about them before you make any decisions about taking part.
There are different phases of clinical trials. They include:
- Phase I trials test what dose of a treatment is safe and how it should be given.
- Phase II trials discover how cancer responds to a new drug or treatment.
- Phase III trials compare an accepted cancer treatment (standard treatment) with a new treatment that researchers hope is better.
Taking part in a clinical trial could help you and others who get cancer in the future. But insurance and managed care plans do not always cover the costs. What they cover varies by plan and by study. If you want to learn more about clinical trials, talk with your health care team.
For more information about clinical trials, see NCI's brochure Taking Part in Cancer Treatment Research Studies.
Questions to Ask Your Doctor or Nurse About Treatment Choices
Decide on the most important things you need to ask your doctor or nurse. Some ideas:
- What are my treatment choices?
- Which do you suggest for me?
- How is this treatment the same as or different from my last treatment?
- How successful is the treatment you recommend? Why is it best for me?
- Will I still be able to do things I enjoy with the treatment? Without the treatment?
- How long will I be on this treatment?
- Will I have side effects? If so, how long will they last?
- How can I manage the side effects?
- Will I have to stay in the hospital?
- Is a clinical trial available to me?
- Will I have to pay any costs in a clinical trial?
- If the treatment doesn't work, then what will I do?
Making Your Wishes Known
When cancer returns, the treatment goals may change, or they may be the same as they were for your first cancer. But for many people, it's the second cancer diagnosis that finally prompts them to make their wishes known. Although it can be tough to think about, and maybe even tougher to talk about, having recurrent cancer may prompt you to make certain decisions about what you want done for you if you are unable to speak for yourself.
Everyone should make a will and talk about end-of-life choices with loved ones. This is one of the most important things you can do. Also, think about giving someone you trust some rights to make medical decisions for you. You give these rights through legal documents called advance directives. These papers tell your loved ones and doctors what to do if you can't tell them yourself. They let you decide ahead of time how you want to be treated. These papers may include a living will and a durable power of attorney for health care.
Setting up an advance directive is not the same as giving up. Making such decisions at this time keeps you in control. You are making your wishes known for all to follow. This can help you worry less about the future and live each day to the fullest.
It's hard to talk about these issues. But it often comforts family members to know what you want. And it saves them from having to bring up the subject themselves. You may also gain peace of mind. You are making these hard choices for yourself instead of leaving them to your loved ones.
Make copies of your advance directives. Give them to your family members, your health care team, and your hospital medical records department. That way, everyone will know your decisions.
Legal Papers At-A-Glance
Advance directives
- A living will lets people know what kind of medical care you want if you are unable to speak for yourself.
- A durable power of attorney for health care names a person to make medical decisions for you if you can't make them yourself. This person is called a health care proxy.
Other legal papers that are not part of the advance directives
- A will tells how you want to divide your money and property among your heirs. (Heirs are usually the family members who survive you. You may also name other people as heirs in your will.)
- Power of attorney appoints a person to make financial decisions for you when you can't make them yourself.
Note: You do not always need a lawyer present to fill out these papers. But you may need a notary public. Each state has its own laws about advance directives. Check with your lawyer or social worker about the laws in your state. (For more, see Resources.)
Managing the Side Effects of Your Treatment
You probably already know about ways to manage the side effects of cancer treatment. If so, parts of this section will be a review for you. It outlines some of the support therapies cancer patients have found helpful.
For more information about side effects, see the NCI booklets Radiation Therapy and You and Chemotherapy and You.
Comfort Care
You have a right to comfort care both during and after treatment. This kind of care is often called palliative (PAL-ee-yuh-tiv) care. It includes treating or preventing cancer symptoms and the side effects caused by treatment. Comfort care can also mean getting help with emotional and spiritual problems during and after cancer treatment.
People once thought of palliative care as a way to comfort those dying of cancer. Doctors now offer this care to all cancer patients, beginning when the cancer is diagnosed. You should receive palliative care through treatment, survival, and advanced disease. Your oncologist may be able to help you. But a palliative care specialist may be the best person to treat some problems. Ask your doctor or nurse if there is a specialist you can go to.
Pain Control
Having cancer doesn't always mean that you'll have pain. But if you do, you shouldn't accept pain as normal. Your doctor can control pain with medicines and other treatments. Managing your pain helps you sleep and eat better. It makes it easier to enjoy your family and friends, and to focus on the things you enjoy.
Have regular talks with your health care team about your pain. Let them know what kind of pain it is, where it is, and how bad it is. These talks are important because pain can change throughout your illness. And your pain may show where cancer has returned after remission. Many hospitals have doctors who are experts in treating pain. Tell your doctor if you would like to talk to a pain specialist.
Treatments can be used for all types of pain, including:
- Mild to medium pain
- Medium to very bad pain
- Breakthrough pain
- Tingling and burning pain
- Pain caused by swelling.
There are different ways to take pain medicine, such as:
- By mouth
- Through the skin (with a patch)
- By shots
- Through an I.V. pump.
Your medicine, and how you take it, will depend on the type of pain and its cause. For example, for constant pain you may need a steady dose of medicine over a long period of time. You might use a patch placed on the skin or a slow-release pill.
You may want to keep a pain diary to help you explain your pain to your doctor. In the diary, write down:
- The time of day you had the pain
- What you were doing when you felt the pain
- What it felt like
- Where you felt it.
Your doctor may also ask you some questions about how your pain affects your daily routine (see Controlling Pain: What to Tell Your Doctor). Having your pain managed means that you can focus on living your life and not be distracted by pain.
To learn more, see the NCI booklet Pain Control.
Controlling Pain: What To Tell Your Doctor
When describing pain to your doctor, give as much detail as you can. Your doctor may want to know:
- Where exactly is your pain? Does it move from one spot to another?
- How does the pain feel - dull, sharp, burning?
- How often do you have pain?
- How long does it last?
- Does it occur at a certain time of day - morning, afternoon, night?
- What makes the pain better? What makes it worse?
Using Strong Drugs To Control Pain
People with cancer often need strong medicine to help control their pain. Don't be afraid to ask for pain medicine or for larger doses if you need them. And the drugs will help you stay as comfortable as possible.
People with cancer hardly ever get addicted to these drugs. Sadly, fears of addiction sometimes prevent people from taking medicine for pain. The same fears also prompt family members to encourage loved ones to "hold off" between doses. But people in pain get the most relief when they take their medicines and treatments on a regular schedule.
Other Ways To Treat Pain
Cancer pain is usually treated with medicine and other therapies. But there are also some nondrug treatments. They are types of complementary and alternative medicine (CAM). Many people have found the methods listed below helpful. But talk with your health care team before trying any of them. Make sure they are safe and won't interfere with your cancer treatment.
- Acupuncture is a form of Chinese medicine that stimulates certain points on the body using small needles. It may help treat nausea and control pain. Before using acupuncture, ask your health care team if it is safe for your type of cancer.
- Imagery is imagining scenes, pictures, or experiences to feel calmer or perhaps to help the body to heal.
- Relaxation techniques include deep breathing and exercises to relax your muscles.
- Hypnosis is a state of relaxed and focused attention. One focuses on a certain feeling, idea, or suggestion.
- Biofeedback is the use of a special machine to help the patient learn how to control certain body functions. These are things that we are normally not aware of (such as heart rate).
- Massage therapy brings relaxation and a sense of well-being by the gentle rubbing of different body parts or muscles. Before you try this, you need to check with your doctor. Massage is not recommended for some kinds of cancer.
These methods may also help manage stress. Again, talk to your health care team before using anything new, no matter how safe it may seem. Ask your health care team for more information about where to get these treatments. To learn more, see the NCI booklet Thinking About Complementary and Alternative Medicine.
Fatigue is more than feeling tired. Fatigue is exhaustion - not being able to do even the small things you used to do. A number of things can cause fatigue. Besides cancer treatment, they include anxiety, stress, and changes in your diet or sleeping patterns. If you are having some of these problems, you might want to:
- Tell your doctor or nurse at your next visit. Ask about medicines that can help with fatigue.
- Eat a well-balanced diet
- Plan your days and do only what is important to you
- Take short breaks every day to rest and relax
- Take naps
- Ask others for help.
Nausea and Vomiting
Nausea is feeling sick to your stomach. Vomiting means throwing up. Both can be a problem for cancer patients. Untreated nausea and vomiting can make you feel very tired. They can also make it hard to get treatments or to care for yourself. There are many drugs to help you control nausea and vomiting. Ask your doctor which medicines might work best for you.
You also may want to make these changes to your diet:
- Eat small amounts of food five to six times a day.
- Avoid foods that are sweet, fatty, salty, spicy, or have strong smells. These may make nausea and vomiting worse.
- Have as much liquid as possible. You'll want to keep your body from getting too dry (dehydrated). Broth, ice cream, water, juices, herb teas, and watermelon are good choices.
For some patients, it's hard to eat the foods they normally enjoy. For others, it's hard to eat anything at all. Are you having trouble eating or digesting food? If so, you may want to talk with your doctor about your diet. They may suggest:
- A special diet
- Other ways of getting the nutrition you need
- Tips on eating during treatment
- Seeing a dietitian.
For more information, see the NCI booklet Eating Hints for Cancer Patients.
Sleep Problems
Illness, pain, stress, drugs, and being in the hospital can cause sleep problems. These problems may include:
- Having trouble falling asleep
- Sleeping only for short amounts of time
- Waking up in the middle of the night
- Having trouble getting back to sleep.
To help with your sleep problem, you may want to try:
- Reducing noise, dimming lights, making the room warmer or cooler, and using pillows to support your body
- Dressing in loose, soft clothing
- Going to the bathroom before bed
- Eating a high-protein snack 2 hours before bedtime (such as peanut butter, cheese, nuts, or some sliced chicken or turkey)
- Avoiding caffeine (coffee, tea, cola, hot cocoa)
- Keeping regular sleep hours
- Avoiding naps longer than 15-30 minutes
- Talking with your health care team about drugs to help you sleep.
Physical Therapy
Sometimes people with cancer feel pain in different parts of their body. Others feel weak and tired. And some feel stiffer than they used to. So it can become hard to move different body parts. If you are having any of these problems, your health care team may suggest you see a physical therapist. The therapist may use heat, cold, massage, pressure, or exercises to help you. Physical therapy may reduce tiredness and help your body function better. It may help with strength and balance as well. It also may help with stiffness and other side effects of radiation therapy.
Complementary and Alternative Medicine
Complementary and alternative medicine (CAM) treatment can be helpful for some people. And some CAM treatments are safe, such as those listed in Other Ways to Treat Pain. But you may have read about different diets, vitamins, and herbs for treating your cancer or symptoms. Talk with your health care team before you try anything new. Here's why:
- Some CAM treatments are not proven to work and could actually harm you.
- You may have a dangerous reaction. Or the CAM treatment could interfere with the medicine your doctor has prescribed.
- A "natural" product doesn't mean that it's a safe product.
Seek information about CAM treatments from trusted sources. Federal agencies and nonprofit cancer groups are good sources. You might also want to read the NCI booklet Thinking About Complementary and Alternative Medicine or go to NCI's Office of Complementary and Alternative Medicine (www.cancer.gov/cam).
Your Feelings
People feel so many emotions when they find out that their cancer has come back. Shock, fear, anger, and denial are just a few. The new diagnosis hits them as hard as it did the first time, or even harder.
Regardless of your first reaction, starting cancer treatment again can place even more demands on your mind and spirit. You'll have good days and bad days. So just remember that it's okay to feel a lot of different emotions.
Some of these emotions may be ones you have had at other times in your life. But you may be feeling them more intensely. If you have dealt with them in the past, you may be able to cope with them now, too. If some of the feelings are new, or are so strong that it is hard to get through everyday activities, you may want to ask for help.
There are many people who may be able to help you. These include health psychologists, oncology social workers, other mental health experts, and leaders in your faith or spiritual community. They know many ways to help you cope with your feelings. See Ways You Can Cope for other ideas on how to cope.
Stress is a normal reaction to cancer. After all, you're dealing with a lot: treatment, family, your job, money, and day-to-day living. Sometimes, you may not even notice that you are stressed. But your family and friends probably see a change.
Anything that makes you feel calm or relaxed may help. So try to think of things that relax you and that you enjoy doing. Some people try deep breathing, listening to tapes that have nature sounds, or listening to music. See below for more ideas on how to relieve stress.
While you may be sad or depressed about your cancer recurrence, you do have reasons to feel hopeful. Science has advanced and cancer treatments have improved. So more people are surviving cancer than ever before. Nearly 10 million people who have a history of cancer are alive today.
In other words, cancer is becoming a disease that doctors can manage. To help build your sense of hope:
- Plan your days as you have always done.
- Don't limit the things you like to do just because you have cancer.
- Look for your own reasons to have hope.
Some people see their cancer coming back as a "wake-up call." They may realize the importance of enjoying the little things in life. They go places they've never been. They finish projects they had started but put aside. They spend more time with friends and family. They mend broken relationships.
It may be hard at first, but you can find joy in your life. Take note of what makes you smile. Pay attention to the things you do each day that you enjoy. They can be as simple as drinking your morning coffee, sitting with a pet, or talking to a friend. These small, day-to-day activities can give you comfort and pleasure.
You can also do things that are more meaningful to you. Everyone has special things, both large and small, that bring meaning to their life. For you, it may be visiting a garden in your city or town. It may be praying in a certain chapel. Or it could be playing golf or some other sport that you love. Whatever you choose, embrace the things that bring you joy when you can.
Cancer takes a toll on both your body and your mind. You are coping with so much now. You may feel overwhelmed. Pain and medicines for pain can also make you feel anxious or depressed. And you may be more likely to feel this way if you have had these feelings before.
Here are some signs of anxiety:
- Feeling very tense and nervous
- Racing heartbeat
- Sweating a lot
- Trouble breathing or catching your breath
- Having a lump in your throat or a knot in your stomach
- Feeling fear.
Feeling anxious can be normal. But if it begins to disrupt your daily life, tell a member of your health care team. They can suggest someone for you to talk to. Or they can give you medicines that will help. Some of the nondrug choices for pain may work for your anxiety as well (see above).
It's normal to feel scared and worried. You may be afraid of pain or other side effects, either from the cancer or the treatment. You may worry about looking different as a result of your treatment. You may worry about taking care of your family, paying your bills, and keeping your job. You may be afraid of dying.
It's hard to deal with the fear of so many unknowns. Some people say it helps if you know what to expect in the future. Ask your health care team questions, so you can understand more about your cancer and treatment choices. Also, update your will and other legal papers, if you haven't already done so. Then you won't have to worry about them.
Fear can be overwhelming. Remember that others have felt this way, too. It's okay to ask for help.
Sadness and Depression
Sadness is a normal response to any serious illness. You may feel sad that you have to go through treatment again. You may feel sad that life won't be quite the same from now on.
It's okay to feel blue. You don't need to be upbeat all the time or pretend to be cheerful. Many people say that they want the freedom to just give in to their feelings sometimes. But others say that it helps to look for what is good in life, even in the bad times.
Depression can happen when sadness or despair seems to take over your life. Some of the signs listed on the next page are normal at a time like this. But if they last more than 2 weeks, talk to your doctor. Some symptoms could be due to physical problems. This is why it's important to let your doctor know about them.
Signs of Depression
- Feeling helpless or hopeless, or that life has no meaning
- No interest in family, friends, hobbies, or things you used to enjoy
- Loss of appetite
- Feeling short-tempered and grouchy
- Not being able to get certain thoughts out of your mind
- Crying for long periods of time or many times each day
- Thinking about hurting or killing yourself
- Feeling "wired," having racing thoughts or panic attacks
- Sleep problems, such as not being able to sleep, having nightmares, or sleeping too much.
You may also feel angry or frustrated. It's normal to ask, "Why me?" You may be mad at the cancer, your doctors, or your loved ones. If you are religious, you might even be angry with God. If you feel angry, it's helpful to remember that you don't have to pretend that everything is okay.
Try to figure out why you are angry. Anger sometimes comes from feelings that are hard to show. These might be fear, panic, frustration, worry, or helplessness.
It's not always easy to look at what is causing your anger. But it's healthy to try. Being open and dealing with your anger may help you let go of it. It's also good to know that anger is a form of energy. You can express this energy through exercise, art, or even just hitting the bed with a pillow.
It's normal for some people to wonder whether they did things that caused their cancer to recur. People feel guilty for a number of reasons:
- They worry about how their family and friends feel.
- They envy other people's good health and are ashamed of this feeling.
- They blame themselves for certain lifestyle choices.
- They feel guilty that their first treatment didn't work.
- They wonder if they waited too long to go back to the doctor. Or they fear that they didn't follow the doctor's instructions the right way.
But it's important to remember that the treatment failed you. You didn't fail the treatment. We can't know why cancer returns in some people and not others. So, it's important for you to try to:
- Focus on things worthy of your time and energy.
- Let go of any mistakes you think you may have made.
- Forgive yourself.
You may want to share these feelings with your loved ones. Some people blame themselves for upsetting the people they love or worry that they'll be a burden to others. If you feel this way, take comfort knowing that many family members say that it is an honor and a privilege to care for their loved one. Many consider it a time when they can share experiences and become closer to one another. Others say that caring for someone else makes them take life more seriously and causes them to reevaluate their priorities.
If you don't feel that you can talk openly about these things with your loved ones, getting counseling or joining a support group may also help. Let your health care team know if you would like to talk with someone about your feelings.
You may feel lonely, even when lots of people support and care for you. Here are some common feelings:
- You feel like no one else understands what you're going through, even those you love and care about.
- You feel distant from others. Or you find that your family and friends have a hard time dealing with your cancer.
- You realize that you aren't able to take part in as many events and activities as you used to.
Although it may be harder some days than others, remember that you aren't alone. Continue to do the things you've always done as best you can. If you want to, tell people that you don't want to be alone and that you welcome their visits. More than likely, your loved ones have feelings like yours. They may feel isolated from you and lonely if they are unable to talk with you.
You may feel that this is not happening to you. It's tough to accept that the cancer has come back. Feeling that you need more time to absorb everything is natural. You may need more time to adjust to the news. But this can become a serious problem if it lasts longer than it should. It can keep you from getting the treatment you need or talking about your treatment choices. As time passes, try to keep an open mind. Listen to what others around you suggest for your care.
Ways You Can Cope
Your feelings will come and go, just like they always have. If you have some strategies to deal with them, you have already taken a step in the right direction.
Know that many other people have been where you are. Some do better when they join a support group. It helps them to talk with others who are facing the same challenges. You may prefer to join an online support group. That way you can chat with people from home. Be sure to check the privacy issues before you join.
If support groups don't appeal to you, there are many experts who are trained to give cancer support. These include oncology social workers, psychologists or health psychologists, counselors, or members of your faith or spiritual community. For more information, see the Resources section.
A Word About Support Groups
You may have heard about support groups in your area for people with cancer. They can meet in person, by phone, or over the Internet. They may help you gain new insights into what's happening, get ideas about how to cope, and help you know that you're not alone.
In a support group, people may talk about their feelings and what they have gone through. They may trade advice and try to help others who are dealing with the same kinds of issues. Some people like to go and just listen. Others prefer not to join support groups at all. Some people aren't comfortable with this kind of sharing.
If you feel like you would enjoy outside support such as this, but can't get to a group in your area, try a support group on the Internet. Some people with cancer say that Web sites with support groups have helped them a lot.
Ways You Can Cope
You may be able to continue many of your regular activities, even though some may be more difficult than before. Whatever you do, remember to conserve your strength for the things you really want to do. Don't plan too many things for one day. Also try to stagger them during the day.
Here are some things other people with cancer say have helped them cope. As you can see, even the little things help!
Setting Goals
Cancer treatment can take up a lot of your time and energy. It helps to plan something that takes your mind off the disease each day. Aim for small goals each day, such as:
- Exercising
- Completing tasks you've been wanting to do
- Making phone calls
- Having lunch with a friend
- Reading one chapter of a book or doing a puzzle
- Listening to music or a relaxation tape.
Many people with cancer also set longer-term goals. They say that they do much better if they set goals or look forward to something special. It could be an anniversary, the birth of a child or grandchild, a wedding, a graduation, or a vacation. But if you set a long-term goal, make sure you are realistic about how you will achieve it.
Remember, too, that being flexible is important. You may have to change your plans if your energy level drops. You may have to adjust your goals if the cancer causes new challenges. Whatever your goals, try to spend your time in a way that you enjoy.
Family and Friends
Your loved ones may need time to adjust to the news that your cancer has returned. They need to come to terms with their own feelings. These may include confusion, shock, helplessness, anger, and other feelings.
Let family members and friends know that they can offer comfort just by:
- Being themselves
- Listening and not trying to solve problems
- Being at ease with you.
Knowing that they are able to comfort you may help them cope with their feelings.
Bear in mind that not everyone can handle the return of cancer. Sometimes a friend or family member can't face the idea that you might not get better. Some people may not know what to say or do for you. As a result, relationships may change, but not because of you. They may change because others can't cope with their own feelings and pain. If you can, remind your loved ones that you are still the same person you always were. Let them know if it's all right to ask questions or tell you how they feel. Sometimes just reminding them to be there for you is enough.
It's also okay if you don't feel comfortable talking about your cancer. Some topics are hard to talk about with people you are close to. In this case, you may want to talk with a member of your health care team or a trained counselor. You might want to attend a support group where people meet to share common concerns.
Family Meetings
Some families have trouble expressing their needs to each other. Other families simply do not get along. If you don't feel comfortable talking with family members, ask a member of your health care team to help. You could also ask a social worker or other professional to hold a family meeting. This may help family members feel that they can safely express their feelings. It can also be a time for you and your family to meet with your entire health care team to solve problems and set goals. Although it can be very hard to talk about these things, studies show that cancer care is a smoother process when everyone remains open and talks about the issues.
People Close to You
Often, talking with someone close to you is harder than talking with anyone else. Here's some advice on talking with loved ones during tough times.
Spouses and Partners
- Try as much as you can to keep your relationship as it was before you got sick.
- Talk things over. This may be hard for you or your spouse or partner. If so, ask a counselor or social worker to talk with both of you together.
- Be realistic about demands. Your spouse or partner may feel guilty about your illness. They may feel guilty about any time spent away from you. They also may be under stress due to changing family roles.
- Spend some time apart. Your spouse or partner needs time to address their own needs. If these needs are neglected, your loved one may have less energy and support to give. Remember, you didn't spend 24 hours a day together before you got sick.
- Body changes and emotional concerns may affect your sex life. Talking openly and honestly is key. But if you can't talk about these issues, you might want to talk with a professional. Don't be afraid to seek help or advice if you need it.
Keeping your children's trust is very important at this time. Children can sense when things are wrong. So it's best to be as open as you can about your cancer. They may worry that they did something to cause the cancer. They may be afraid that no one will take care of them. They may also feel that you are not spending as much time with them as you used to. Although you can't protect them from what they might feel, you can prepare them for these feelings.
Some children become clingy. Others get into trouble at school or at home. It helps to keep the lines of communication open. Try to:
- Be honest. Tell them you are sick and that the doctors are working to make you better.
- Let them know that nothing they did or said caused the cancer. And make sure that they know that they can't catch it from you.
- Reassure them that you love them.
- Encourage them to talk about their feelings.
- Tell them it's okay to be upset, angry, or scared.
- Be clear and simple when you talk, since children can focus only briefly. Use words they can understand.
- Let them know they will be taken care of and loved.
- Let them know that it's okay to ask questions. Tell them that you will answer them as honestly as you can. In fact, children who aren't told the truth about an illness can become even more scared. They often depend on their imagination and fears to explain the changes around them.
Teenagers have some of the same needs as those of younger children. They need to hear the truth about an illness. This helps keep them from feeling needless guilt and stress. But be aware that they may try to avoid the subject. They may become angry, act out, or get into trouble as a way of coping. Others simply withdraw. Try to:
- Give them the space they need. This is especially important if you are relying on them more to help with family needs.
- Give them time to deal with their feelings, alone or with friends.
- Let them know that they should still go to school and take part in sports and other fun activities.
If you have trouble explaining your cancer, you might want to ask for help. A close friend, relative, healthcare worker, or trusted coach or teacher could help answer your teenager's questions. Your support group, social worker, or doctor can also help you find a counselor or psychologist.
Adult Children
Your relationship with your adult children may change now that you have cancer again. You may have to rely on them more. And it may be hard for you to ask for support. After all, you may be used to giving support rather than getting it.
Adult children have their concerns, too. They may start to think about their own mortality. They may feel guilt, because of the many demands on them as parents, children, and employees. Some may live far away or have other duties. They may feel bad that they can't spend as much time with you as they would like. Often it helps to:
- Share decision-making with your children.
- Involve them in issues that are important to you. These may include treatment choices, plans for the future, or activities that you want to continue.
- If they aren't able to be there with you, keep them updated on your progress.
- Make the most of the time you have. Share your feelings with them.
Try to reach out to your adult children. Openly sharing your feelings, goals, and wishes will help them adjust. It will also help prevent problems in the future. Remember, just as parents want the best for their children, children want the best for their parents. They want to see your needs met effectively and with compassion. Your children don't want to see you suffer.
Looking for Meaning
At different times in life, it's natural for people to look for meaning in their lives. And many people with recurrent cancer find this search for meaning important. They want to understand their purpose in life. They often reflect on what they have gone through. Some look for a sense of peace or a bond with others. Some seek to forgive themselves or others for past actions. Some look for answers and strength through religion or spirituality.
Being spiritual means different things to different people. It's a very personal issue. Everyone has their own beliefs about the meaning of life. Some people find it through religion or faith. Some find it by teaching or through volunteer work. Others find it in other ways. Having cancer may cause you to think about what you believe - about God, an afterlife, or the connections between living things. This can bring a sense of peace, a lot of questions, or both.
You may have already given a lot of thought to these issues. Still, you might find comfort by exploring more deeply what is meaningful to you. You could do this with someone close to you, a member of your faith or spiritual community, a counselor, or a trusted friend. Or you may find that talking to others at gatherings and services at places of worship is helpful.
Or you may just want to take time for yourself. You may want to reflect on your experiences and relationships. Writing in a journal or reading also helps some people find comfort and meaning. Others find that prayer or meditation helps them.
Many people also find that cancer changes their values. The things you own and your daily duties may seem less important. You may decide to spend more time with loved ones or helping others. You may want to do more things outdoors or learn something new.
A Time To Reflect
This is a hard time in your life. Living with cancer is tough, especially when it has come back. You battled the disease once, and now you must face it again. But you're more experienced this time around.
Use this knowledge to your advantage. Try to remember what you did before to cope. Reflect on what you might have done differently. By looking back in this way, the hope is that you may find new strength. And that this strength can help carry you through each day, and through the coming weeks and months.
Federal Resources
National Cancer Institute
Provides current information on cancer prevention, screening, diagnosis, treatment, genetics, and supportive care. Lists clinical trials and specific cancer topics in NCI's Physician Data Query (PDQ®) database.
Visit: www.cancer.gov
Cancer Information Service
Answers questions about cancer, clinical trials, and cancer-related services and helps users find information on the NCI Web site. Provides NCI printed materials.
Visit: www.cancer.gov/cis
Chat online: Click on "LiveHelp."
Administration on Aging
Provides information, assistance, individual counseling, organization of support groups, caregiver training, respite care, and supplemental services.
Phone: 1-202-619-0724
Visit: www.aoa.gov
Centers for Medicare and Medicaid Services
Provides information for consumers about patient rights, prescription drugs, and health insurance issues, including Medicare and Medicaid.
Visit: www.medicare.gov (for Medicare information)
or www.cms.hhs.gov (other information)
Equal Employment Opportunity Commission
Provides fact sheets about job discrimination, protections under the Americans With Disabilities Act, and employer responsibilities. Coordinates investigations of employment discrimination.
Toll-free: 1-800-669-4000
Visit: www.eeoc.gov
U.S. Department of Labor, Office of Disability Employment Policy
Provides fact sheets on a variety of disability issues, including discrimination, workplace accommodation, and legal rights.
Toll-free: 1-866-ODEP-DOL (633-7365)
Visit: www.dol.gov/odep/
Private/NonProfit Organizations
American Cancer Society
National Cancer Information Center Available to answer questions 24 hours a day, 7 days a week.
Toll-free: 1-800-ACS-2345 (1-800-227-2345)
Visit: www.cancer.org
Offers free support, information, financial assistance, and practical help to people with cancer and their loved ones.
Toll-free: 1-800-813-HOPE (1-800-813-4673)
Visit: www.cancercare.org
Cancer Support Community
Cancer Support Community is a national organization that provides support groups, stress reduction and cancer education workshops, nutrition guidance, exercise sessions, and social events.
Toll-free: 1-888-793-WELL (1-888-793-9355)
Visit: www.cancersupportcommunity.org
Kids Konnected
Offers education and support for children who have a parent with cancer or who have lost a parent to cancer.
Toll-free: 1-800-899-2866
Visit: www.kidskonnected.org
National Coalition for Cancer Survivorship
Provides information on cancer support, employment, financial and legal issues, advocacy, and related issues.
Phone: 1-877-NCCS YES (1-877-622-7937)
Visit: www.canceradvocacy.org
National Employment Lawyers Association
Can help find a lawyer experienced in job discrimination cases.
Phone: 1-415-296-7629
Visit: www.nela.org
NeedyMeds - Indigent Patient Programs
Lists medicine assistance programs available from drug companies. NOTE: Usually patients cannot apply directly to these programs. Ask your doctor, nurse, or social worker to contact them.
Visit: www.needymeds.com
Patient Advocate Foundation
Offers education, legal counseling, and referrals concerning managed care, insurance, financial issues, job discrimination, and debt crisis matters.
Toll-free: 1-800-532-5274
Visit: www.patientadvocate.org
* For a complete list of resources, see NCI's database, National Organizations That Offer Services to People With Cancer and Their Families. Or call 1-800-4-CANCER (1-800-422-6237) to ask for it.
For more information
The following free booklets may be helpful if your loved one is receiving cancer treatment:
- Chemotherapy and You: A Guide to Self-Help During Cancer Treatments
- Coping with Advanced Cancer
- Eating Hints for Cancer Patients
- If You Have Cancer: What You Should Know About Clinical Trials
- Pain Control: A Guide for People With Cancer and Their Families
- Radiation Therapy and You: A Guide to Self-Help During Cancer Treatments
- Taking Time: Support for People With Cancer
- Thinking About Complementary and Alternative Medicine: A Guide for People With Cancer
- When Cancer Returns
These booklets are available from the National Cancer Institute (NCI.) To learn more about the specific type of cancer you have or to request any of these booklets, visit NCI's Web site (www.cancer.gov). You can also call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) to speak with an information specialist.


text:
Latest update : 2012-12-03
Vaira Vike-Freiberga, former Latvian president
Four years after being forced to request a bailout and seeing its GDP shrink by 24 per cent, Latvia has become the EU's fastest-growing economy. Is this proof that stringent austerity policies work? What can Spain and Greece learn from the Latvian model? Christophe Robeet speaks to Vaira Vike-Freiberga, a former Latvian president.


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Welcome to our live coverage of politics from the national capital. All times in AEDST. You can follow us on Twitter @murpharoo @mearesy @ellinghausen
6.20pm: Well folks.
Seasons greetings. Wear fluffy slippers when you kick the cat. Don't give up on politics, even if that seems hard sometimes. Use the summer break to recharge and prepare for a year next year that's going to make 2012 look like a teddy bear's picnic.
We on The Pulse Live have so many people to thank.
First, and most importantly the audience. What a bunch of legends you are.
We are very grateful to Mark Baker, who supported this project from the beginning with huge enthusiasm. More recently to Tom Allard, who runs our operation in Canberra. Thanks Tom.
To the crew on The National Times, Ori Guererra and Fergus Shiel in Melbourne, and Michael O'Reilly in Sydney. Special thanks to Gabe Hooton, who moderates our comments.
To our homepage folks in Sydney and Melbourne, and the video team. Thank you.
To Carlos Monterio, who has solved so many technical problems for us. We salute you.
To our colleagues in Canberra in the Age and Herald bureaux. Saints. (We are looking at you Damien Bright!)
To the politicians and staff we deal with every day. Politics has embraced The Pulse Live, even when we are annoying and obnoxious, and we are incredibly grateful.
Our US election team of special correspondents - Kath Cummins, Mark Textor, Andrew Leigh, Josh Frydenberg, Mary Cannane and William Powers (and Nate Silver, who didn't know he was floating our boat) and of course to Nick O'Malley and Paul McGeogh.
The Pulse Live wouldn't happen without Andrew Meares and Alex Ellinghausen and Chris Hammer, my colleagues, co-conspirators and friends.
Thank you so very much.
Have a Merry Christmas and a Happy New Year.
6.09pm: Pulsers in Canberra might want to come along tomorrow to the Walkley's Conference at the National Film and Sound Archive.
Andrew and I will be participating in a panel on digital journalism.
We'll be yapping about The Pulse. Come, say hello.
6.07pm: So there it is.
6.03pm: The feedback from The Pulse Live audience is overwhelming.
The political moment of the year?
By popular acclaim.
The Prime Minister's misogyny speech.
5.51pm: Liberal Senator Cory Bernardi.
Impossible to do a red carpet without genuflecting to future marriages with the family cat.
5.43pm: Speaking of what she said.
Andrew Meares went down a few moments ago to take the pulse of the Prime Minister.
What she said. Today, you wouldn't dare countenance any other view.
5.35pm: The What She Said Award - to Workplace Minister Bill Shorten.
Mr Shorten agreed whole heartedly with his leader, Ms Gillard, even though he had no idea what he was agreeing with.
It really was magnificent. This remix by the Young Liberals.
5.26pm: The Age's wonderful Tony Wright has done a rapid file on Question Time.
The Bruiser and the Bloodnut.
As cage fights go - and this was an event built to the proportions of a massacre in pre-fight publicity - it was a pretty bloodless affair.
In the absence of a knock-out, it had to be decided on points, and the challenger, Bruiser Abbott, having talked big before the bout, failed to get the nod. He just couldn't find his killer punch.
Bloodnut Gillard walked away with not much more than a barked knuckle, spitting out her mouthguard and hollering ''he's got nothin'! Nothin'!''
5.18pm: Independent Bob Katter has moved on to his attempt (telegraphed yesterday) to scuttle the Gillard Government's Murray Darling Basin reforms.
The BobKat is in the chamber, shouting wildly.
Why are those orchards dead?
(I don't know Bob. I don't know.)
National Bruce Scott, in the Speaker's chair, chastises Mr Katter mildly. Could you please return to your substantive motion?
Now the vineyards are dead.
5.13pm: Great audience feedback on the awards - thanks a bunch.
A number nominated NSW Independent MP Tony Windsor's moment from this year where he blasted Mr Abbott on climate change. The only thing you wouldn't do to get the job was sell your arse.
(Mr Abbott has always denied saying this to Mr Windsor.)
We'll award the off-the-long-run moment to Tony Windsor.
5.05pm: Mr Abbott has released the terms of reference for the judicial inquiry he wants on slush-gate.
The parameters of the inquiry are as follows:
An independent inquiry to inquire into and report on:
- The incorporation of the Australian Workers' Union Workplace Reform Association Inc. ("the Association") in 1992, and in particular whether misleading statements were made to the Corporate Affairs Commission of Western Australia in relation to the constitution, objects and purposes of the Association.
- The conduct and activities of the Association and of its officers.
- The operation of all bank accounts held in the name of the Association or operated on behalf of the Association or its office bearers, and in particular the payment from such bank accounts of monies for unlawful or improper purposes and the subsequent use of such monies.
- The circumstances surrounding the purchase of the property at 1/85 Kerr Street, Fitzroy, Victoria, in 1993 and in particular the financing of the transaction.
- The preparation, execution and use of a Power of Attorney granted by Ralph Blewitt to Bruce Wilson.
- The source of monies used to finance renovations to the property at 36 St Phillips Street, Abbotsford, Victoria, in 1994 and 1995.
- The sale of the property at 1/85 Kerr Street, Fitzroy in February 1996, and the application of the proceeds of that sale.
- Any other matters incidental to these terms of reference.
4.57pm: Last day of parliament. People want to talk to me. Confounding! Don't they know I have to file every ten minutes!
More awards shortly.
4.33pm: The Prime Minister ends her valedictory by noting she's looking forward to the contest in 2013.
Politicians. Who can fathom them?
4.20pm: The Prime Minister is on her feet delivering her Christmas valedictory.
It's a nice speech, as these speeches always are. Ms Gillard chokes up briefly as she remembers her father, who died earlier this year.
We'll listen as they talk, but we want to pop back to our own Pulse Live Awards for a bit.
We want to doff our caps to Sam, Tony Abbott's advancer and fluoro enabler.
A vital role.
To Sam Jackson-Hope. The cheery valet award for 2012.
3.43pm: The political year was destined to end this way: these two leaders are now so defined by their conflict, their mutual antipathy, this rolling cycle of contention, that it is impossible to imagine them doing anything else in the last Question Time than glowering across the dispatch box, waiting to see who blinked first.
Mr Abbott is always looking for the twist in the tale; the knock-out blow.
Ms Gillard rises in these big moments. She's absolutely fixed and resolute in a fight. Determined not to yield.
Draining and diminishing and corrosive at one level, this dynamic - but fascinating at another.
3.38pm: We missed the tail end of Question Time just then. It's done.
But you didn't miss much, truth told. Having opened with drama and moment and tactical flourish, it just ground towards the end.
Ms Gillard determined to take it home, and the end the political year on her feet, defiant.
3.37pm: There's Question Time in a shot.
Right there.
Bless Andrew Meares.
3.34pm: Apologies. I didn't go to sleep. We just lost live publishing capacity for about twenty minutes.
Fingers crossed, we are back in business now.
3.01pm: Ms Bishop wants to know if documents were witnessed properly in accordance with requirements set out under the law.
The Prime Minister:
In terms of the question before the chair, I have answered about how I witnessed documents as a lawyer - and there is the nature of sleaze and smear - that what you do is you come in and you just try and engage in these broad brush statements.
As the Deputy Leader of the Opposition well knows, working as a lawyer, you witness hundreds and hundreds indeed thousands of documents across a legal career.
Now anybody can engage in this sleaze and smear. I could stand here and say the Deputy Leader of the Opposition never properly witnessed a document during her legal career, not once, not ever.
2.49pm: Liberal deputy leader Julie Bishop now.
My question is to the Prime Minister. I remind the Prime Minister of her confession to Slater & Gordon in her exit interview of conduct which appears to be in breach of the WA ..
Labor's Mark Dreyfus is on his feet objecting to the use of the word confession.
Speaker Burke wants the question rephrased.
Ms Bishop changes confession to statement.
Ms Gillard:
Isn't it interesting that the leader of the Opposition had fifteen minutes to make an allegation out and didn't go to these matters that the deputy leader raises.
There she is with sections of the legislation, waving them around, pretending again to be Miss Marple.
She's needing to make sure she doesn't run into a television camera in Parliament House because she the doesn't want to front up to (her) lack of honesty about her dealings with Ralph Blewitt.
2.40pm: Back into normal questions now.
Three questions from Mr Abbott on slush-gate.
They are all essentially the same question. How can the Prime Minister persist in claiming that she had nothing to do with the incorporation of the AWU association, when the exit interview shows clearly that she argued the case to the Corporate Affairs Commission, she argued the case for its incorporation.
Ms Gillard says stop misrepresenting words on a page. There's no evidence for your contention. Put up or shut up.
2.25pm: Here is the Prime Minister.
Mr Abbott went out this morning and accused me of commiting a crime, she says.
A crime.
Has Mr Abbott produced any evidence that I've committed a crime?
Now, there is a problem with all of this for the Leader of the Opposition. We've seen this movie before. When leaders of the Opposition overreach and go out and falsely accuse a Prime Minister of committing a crime, we have seen this movie before.
And if he wants to see how the movie ends, turn round and look at the member for Wentworth, because we saw in the Godwin Grech affair what happens to a Leader of the Opposition who accuses a Prime Minister of a crime and cannot back it up.
Ms Gillard goes through what the Slater & Gordon transcript says. She says it confirms she wrote to the relevant authority to say the AWU association was not a trade union.
Well, whatever view people take of the facts of this matter, I've never heard anybody contend that the association is a trade union. Saying it's not a trade union is a simple matter of fact, a simple matter of fact.
The leader of the Opposition is now handcuffed to an allegation against me that I committed a crime, and he is handcuffed to the fact that he does not have any evidence of that.
Now, a decent man, a decent man would apologise for this ... a decent man would recognise that he has gone too far, that he has made an error, that he has relied on a false report, that he cannot prove what is being said.
2.19pm: Mr Abbott wants a judicial inquiry, and has the terms of reference on hand. (Almost like he came prepared!)
So I say to the Prime Minister and to members opposite - let's get to the bottom of this. Let's have the bottom of this.
Let's have the judicial inquiry. Let's have the judicial inquiry that Mr Ian Cambridge, the then national secretary of the Australian Workers Union, was calling for at the time and has been calling for ever since.
Mr Abbott asks MPs opposite to consider Ms Gillard's moral claim to the leadership.
So the question for members sitting behind the Prime Minister today - is she a fit and proper person to hold the prime ministership of our country? That is the question that they need to ask themselves. Madam Speaker, they can shout all they like today, but that is a question that will play on their consciences over the next couple of months, until this Parliament comes back.
Madam Speaker, the Prime Minister has clearly been preparing for this moment.
I think we know what we can expect from the Prime Minister. We can expect more of the bluff and the verbal intimidation that she has practised throughout her career.
I have this piece of advice for the Prime Minister - this is not about gender.
This is about character and, Prime Minister, you have failed the character test.
2.12pm: Mr Abbott is deliberately keeping his tone of voice measured.
He's not shouting. He's speaking quite slowly.
She knew all along that this was a slush fund - a slush fund for the re-election of union officials.
She was party to the creation of a slush fund, on her own admission in her exit interview with Slater & Gordon. Madam Speaker, this whole exercise was a sham to facilitiate a fraud.
And the Prime Minister's involvement in it was this - she gave the advice, she made the representations that enabled the association to be incorporated that facilitied the fraud.
Now, at the very least this is conduct unbecoming. It's unbecoming of a legal partner. It is unbecoming of a future Prime Minister of this country.
Mr Abbott says he'd be prepared to give the Prime Minister the benefit of the doubt.
The problem is that where we have had the opportunity to test the Prime Minister's assertions against the documents, against the record, her assertions have turned out to be gravely lacking in truth and in substance.
So the charge, Madam Speaker, is that the Prime Minister has been at the very least a dodgy and unethical lawyer. She's been an incompetent and an untrustworthy Prime Minister, as has been demonstrated abundantly by the evasions and the obfuscations that we have so consistently seen from this Prime Minister in the Parliament this week.
2.09pm: The Opposition has taken up the invitation to have this suspension debate.
Mr Abbott is on his feet.
Ms Gillard had three clients at Slater & Gordon.
Her boyfriend, his self-confessed bagman and their union.
If there was nothing wrong here, if there was nothing to hide here, why did the Prime Minister never open a file?
2.05pm: The Prime Minister is suspending the standing orders.
(Attack being the best form of defence apparently.)
It also forces Mr Abbott into the frontline attack.
Speaker I move that so much of standing and sessional orders be suspended as would allow the leader of the Opposition to address the House for a period of fifteen minutes to substantiate his claim that the Prime Minister has breached the laws of WA or if he cannot do so, to unreservedly apologise.
That following the leader of the Opposition's address, the Prime Minister be given fifteen minutes to reply. Speaker, Australians are rightly sick of sleaze and smear.
1.56pm: The pokies package, amended, is belting through its final votes now.
Here are the cross benchers voting with the government.
And here comes the Prime Minister for Question Time.
1.46pm: The lack of certainty about what the Prime Minister actually said to the WA Corporate Affairs Commission concerning the AWU association won't stop an outbreak of aggressive simplicity in Question Time in about ten minutes time.
I think that's a safe prediction.
Tune in.
Last time this parliamentary year - the hour of slug-fest, it cometh.
1.37pm: Climate Change Minister Greg Combet is on Sky television.
Mr Combet says writing to the Western Australian corporate affairs commission to advise that body that the AWU association was not a trade union is not vouching for anything.
What is the allegation of wrong doing here? Can anyone really say?
1.20pm: Here is the relevant section from the new bit of the Slater & Gordon transcript that has surfaced in the newspaper reports today.
This excerpt is sourced from The Australian newspaper, which also reported the development. You can view the section of the original source document here.
This interview is between Slater & Gordon senior partner Peter Gordon and Ms Gillard, then a salaried partner at the firm.
Peter Gordon: And last Monday I think you gave to Paul Mulvaney a follow-up which demonstrates that Slater & Gordon had drafted model rules for, for that, had submitted those rules to the relevant Western Australian government authority, that there'd been a letter from the authority suggesting that it might be a trade union and therefore ineligible for incorporation under that legislation, and that we had prepared a response submitted on Wilson's instructions to that authority suggesting in fact it wasn't a trade union and arguing the case for its incorporation. My recollection is that all of that happened in or about mid-1992. Is that right?
Julia Gillard: I wouldn't want to be held to the dates without looking at the file, but whatever the dates the file shows are the right dates, so ...
Peter Gordon: Yes. And to the extent that work was done on that file in relation to that it was done by you?
Julia Gillard: That's right.
So, this information suggests Ms Gillard told the WA Commission that the association Mr Wilson was seeking to have incorporated was not a trade union.
We don't have the letter she wrote.
We don't know how she framed this argument.
12.48pm: Here's the latest news wrap on the AWU slush fund and what all our protagonists are saying about it from breaking news reporters Judith Ireland and Jonathan Swan.
12.32pm: So where does that leave us on the substance of this slush fund saga?
A spokesperson for the Prime Minister is now effectively accepting that Ms Gillard wrote to the WA Commissioner regarding the AWU association.
When she was asked about this in parliament earlier this week - did she write to the WA Commissioner effectively vouching for the association - Ms Gillard replied thus:
The claim has been made but no correspondence has ever been produced.
12.27pm: More from the Prime Minister's spokesman.
The Opposition's central claim goes to the Prime Minister's knowledge of alleged fraud. The unredacted transcript shows those claims to be empty and false. It is worth restating that any correspondence in this matter would have been received or sent in Julia Gillard's capacity as a lawyer acting on instructions. As the Prime Minister has noted, the application to incorporate the Association was lodged by its office bearer, Mr Ralph Blewitt.
The decision to incorporate the Association was made by the WA Commissioner of Corporate Affairs. The Prime Minister has not done anything wrong. No evidence has been produced that she did anything wrong. The only misleading statements in this matter have been made by Julie Bishop when she denied multiple contact with Ralph Blewitt, and denied she'd made accusations against the Prime Minister she had made several hours earlier; and by Tony Abbott this morning.
Tony Abbott this morning accused the Prime Minister of misleading the West Australian Corporate Affairs Commission, and of breaking the law. These assertions are completely unsupported by the evidence. The unredacted transcript says only that the Prime Minister stated that the Association was not a trade union – a fact that is clearly true. Tony Abbott needs to produce evidence to support his unsubstantiated claim, or follow his Deputy into a humiliating backdown. Today, Tony Abbott and Christopher Pyne made serious claims against the Prime Minister with no evidence. This is exactly the same thing that killed Malcolm Turnbull's career.
12.20pm: The Prime Minister has this morning written to the chief executive of Fairfax Media, Greg Hywood, concerning Mark Baker's news reports on the AWU slush fund this morning.
In her letter to Mr Hywood, the Prime Minister says the reports are false and misleading to readers.
There are also comments from a spokesperson.
Concerning the letter to the WA Corporate Affairs Commissioner referenced this morning, the response is: So, the Prime Minister wrote to the WA Commissioner? So what? She did what lawyers do. Act on instruction. Provide legal advice. So, the Prime Minister can't remember writing one letter from 20 years ago. So what? Lawyers write thousands of letters in their careers. And what does the transcript show? That the PM said the association wasn't a union. So what? It obviously wasn't. In fact, the unredacted transcript backs up what the Prime Minister has been saying. The transcript supports the Prime Minister's account that she had nothing to do with the Association once it was incorporated. The transcript also supports the Prime Minister's account that she didn't have anything to do with setting up bank accounts operated by the Association.
Noon: Merry Christmas from the Abbott clan.
11.43am: Once he was the Attorney-General. Then he supported Kevin Rudd too enthusiastically.
Now, Robert McClelland is a humble Labor backbencher from the NSW Right. Mr McClelland is delivering a little hymn of praise in the House of Representatives right now about clubs, and the positive role they play in communities. Mr McClelland is making his contribution in the pokies debate.
Clubs have always been worried about problem gambling he says. It would be wrong to suggest otherwise.
11.30am: To guide your thinking on the big moments, Andrew Meares has produced a wonderful gallery of the political year for 2012.
Click on the image of the Prime Minister to view the best of Andrew and Alex Ellinghausen.
11.16am: We'll come back to the awards over the course of today.
Let's get our heads back in the game. Here's some vision of your elected representatives on the doors: to resign, or not to resign.
Don't forget to turn off your auto-refresh if you want to review these videos.
10.59am: Also very popular in the 'what-the' stakes.
That sprint from the chamber by Tony Abbott and Christopher Pyne to negate the vote of Craig Thomson.
Congratulations to Mr Abbott and Mr Pyne - inaugural winners of the Usain Bolt award.
Run, Abbott, run, Abbott, run run run.
10.47am: I've asked the Twitters to chime in on big political moments for 2012.
Some great suggestions coming through.
Labor man Craig Emerson's completely birko Whyalla wipe out moment is rating well.
This moment never gets old.
Ladies and gentlemen, and blog watchers, our first Pulse Live Award for 2012 goes to Craig Emerson - for services to the Australian music industry.
It's a long way to the shop if you want a sausage roll.
10.31am: Perhaps we could re-enact the procession as a mark of respect?
10.23am: Last sitting days.
They can go off with a bang.
The Gillard Government on the final sitting day for 2011 popped Liberal defector Peter Slipper into the Speaker's chair. That was last year's shazam.
Mr Slipper has of course moved on from that lofty position. One Liberal wag suggests today is a Slipperversary.
10.15am: Treasurer Wayne Swan has been stopped by the cameras on the parliamentary forecourt.
Should the Prime Minister resign? That's absolutely ridiculous, Mr Swan says. Voters want their parliament to focus on policy issues - schools, the NDIS - not smear.
10.07am: Green MP Adam Bandt.
Less than thrilled. We sense some hard bargaining in play here on the pokies package (see our post at 9.30am).
Tasmanian Independent Andrew Wilkie (left) Mr Bandt (centre) Labor's Joel Fitzgibbon (right.)
9.56am: The last day.
Turkeys with all the trimmings.
Make sure you get amongst it.
Comment below, or hit Twitter and break out our hashtag #thepulselive
9.51am: The bollocking the Prime Minister gave me yesterday was this big.
Labor's Steve Gibbons - in big trouble yesterday for Tweeting that the Opposition leader was a douche bag and the deputy Opposition leader was a narcissistic bimbo - has a laff in the chamber with crossbencher Craig Thomson.
9.47am: And here's the morning news wrap on the AWU.
Mr Pyne declares the Prime Minister must go.
9.44am: While they argue amongst themselves, here's the Prime Minister introducing the NDIS legislation.
9.39am: Procedural skirmishes are underway in the House.
The Opposition is trying to suspend the standing orders to bring on consideration of shadow immigration spokesman Scott Morrison's private members bill to restore temporary protection visas.
So far that's proved unsuccessful.
9.30am: The Gillard Government's pokies reforms are another significant moving part today.
The New South Wales Right is restive, and the package is still in the balance.
I'll let Richard Willingham bring you up to speed:
- The government's poker machine reforms remain in the balance after key independents moved towards further softening of the proposed rollout of plans to give punters the option of presetting how much they are willing to lose.
- The government's bill would require venues with more than 20 machines to have voluntary pre-commitment on all its machines from 2016, with smaller venues given longer.
- Amendments already circulated by independent Tony Windsor push the deadlines for compliance back by a year.
- But members of the NSW Right lead by Chief Government Whip Joel Fitzgibbon have put pressure on both the government and the crossbenchers to extend the transition period to two years.
- Labor sources last night believed that it had the support of Mr Windsor, Craig Thomson, Rob Oakeshott and Peter Slipper, but it would need another crossbench vote: either Andrew Wilkie or the Greens' Adam Bandt.
- The demands of the group left Mr Wilkie and the Greens with the decision of supporting the further dilution or sinking pokies reform completely.
9.20am: Little bit of history in this lovely chamber shot from Alex Ellinghausen.
The Prime Minister is at the dispatch box. Six Coalition MPs watch on as the NDIS is introduced.
9.15am: The Prime Minister, on the NDIS.
Few actions in public life give me greater pleasure than introducing the National Disability Insurance Scheme Bill does today.
The scheme to be established by this bill will transform the lives of people with disability, their families and carers. For the first time they will have their needs met in a way that truly supports them to live with choice and dignity.
It will bring an end to the tragedy of services denied or delayed and instead offer people with disability the care and support they need over their lifetimes.
9.07am: The manager of Opposition business Christopher Pyne has gone to the doors of parliament to urge the Prime Minister to resign.
Her position is untenable, he says.
The Prime Minister is ignoring Mr Pyne - and is now in the House introducing legislation for the national disability insurance scheme.
It's an important day for people with disabilities and their carers.
8.58am: Opposition leader Tony Abbott was up and about early.
Given this new information on the AWU slush find saga, the Labor Party needed to be searching its soul today. The Prime Minister had made false representations to the West Australian corporate affairs commission - and this would appear to be in breach of the law.
This has always been about the judgment, character and integrity of the Prime Minister. Mr Abbott said it's impossible for this government to deal with systemic trade union malfeasance when senior figures are participants in the process.
8.50am: Here's the Prime Minister, arriving to face the music.
Andrew Meares was down kerbside with his camera.
8.40am: We've opened at a screaming pace.
Just when you fancied the momentum was going out of the Slater & Gordon/AWU saga, fresh material.
Mark Baker in Fairfax newspapers this morning:
Prime Minister Julia Gillard enabled the incorporation of a union slush fund from which her boyfriend later stole hundreds of thousands of dollars by formally denying to authorities that it was a trade union organisation.
A newly released document confirms that a letter Ms Gillard wrote to the WA Corporate Affairs Commission in mid-1992 rejected the commission's assertion that the Australian Workplace Reform Association was ineligible for incorporation because of its union links.
The document also confirms that Ms Gillard, then a salaried partner with Slater & Gordon, drafted the rules for the association - without opening a formal file, without consulting the senior partners and without taking advice from expert lawyers within the firm.
The revelations contradict Ms Gillard's claims at media conferences and in Parliament that she played a limited role in the formation of the association, from which Mr Wilson and his crony, Ralph Blewitt, later misappropriated more than $400,000.
A smoking gun, says the Opposition.
Ms Gillard has been asked all this week if she vouched for the AWU association with the West Australian corporate affairs commission.
The Prime Minister has danced around this point.
8.30am: The only peaceful moment we are going to get today, so I'm going with it.
Welcome to the finale for 2012.