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Radiation Treatment After Breast Cancer: Not Optional

The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to?AskLisa@Sunnybrook.ca

The Question:?I have a friend who has just had a lumpectomy and sentinel lymph node biopsy for a small invasive lobular breast cancer. She has not yet met with the surgeon for her final report but knows that radiation to her breast will be one of the next steps in her treatment. She is quite reluctant to have radiation treatment and wonders about the risk of recurrence if she does not have radiation. Can you refer us to information that would help her with this decision ? like what the likelihood of recurrence is without radiation and the long-term effects of radiation? She would like to have time to review this information before meeting with the radiation oncologist.

The Answer:?Cancer treatment is an area where strict adherence to the rules is paramount if you want to ensure the best possible outcome ? in this case, cure is the aim so we should ensure not failing our goal ?. Radiation treatment after lumpectomy is not an option but part of a package. There is a risk of the cancer returning if you do not undergo it.?

?Many patients ask, if they can choose receiving radiation or not,? said Jean-Philippe Pignol, a radiation oncologist at Sunnybrook and professor of radiation oncology at University of Toronto. And in this case, ?cancer treatment is not like choosing options when you buy a car. It is more a black or white thing and not receiving the appropriate treatment is a serious decision.??

Cancer patients such as your friend ? who have undergone breast-conserving surgery ? require radiation treatment. That?s because no matter how good a surgeon is at removing the tumor and surrounding tissue, there is always chance a couple of cancer cells ? invisible to the naked eye ? were missed.?

Perhaps the easiest way of looking at it is to look at how much risk your friend is willing to accept. Without radiation treatment, the risk of the breast cancer recurring in five years is up to 30 per cent. In other words, the odds are almost one in three that the cancer will return in five years if she does not undergo radiation. When breast cancer returns, it is metastatic half of the time, which means it has spread to surrounding tissue, organs or bones, making cure impossible. The goals of care at that point will be lengthening survival as long as possible.

Compare that to patients who undergo radiation following breast cancer: their risk of recurrence over five years is about five per cent. In other words, they have a one in 20 chance of the cancer returning over five years. After five years, patients are often considered cured of the disease and if cancer returns after that period of time it is considered a new primary.

Theoretically, your friend is onto something: 70% of the patients may not recur after limited surgery there are likely breast cancer patients who do not require radiation whose survival would not be impacted but as of today, oncologists have no way of determining who these patients are.

?It?s rare that they would say maybe no radiation is necessary,? said Dr. Pignol.

There is no question radiation therapy represents a significant burden in terms of time and psychic energy: typically, patients are required to come every day, five days a week up to five weeks.

?Daily radiation is very disruptive,? said Dr. Pignol in an interview. ?It has a great impact on patients? lives and nobody is very pleased to go every day at a cancer center. It can be extremely draining, physically and psychologically.?

There are other side effects of radiation besides boredom, including burning on the skin ? roughly 30 per cent of patients will experience it, but this side effect disappears typically after a week or two.?

There have also been concerns that those who have radiation to the left breast may have a higher chance of coronary artery disease and myocardial infarction than those whose right breast is irradiated.?

But according to Dr. Pignol, this seems untrue today as technological advances ? in the form of CT scans ? helps doctors better see what they are actually treating.

Though there is an additional radiation exposure, the chance of developing a secondary cancer due to the radiation treatment is almost undetectable.

Recognizing the arduous length of time for radiation treatment is a barrier to patients across Canada ? especially those in remote areas who must travel to urban centers ? doctors are studying ways to provide it in a compressed, shortened period of time. Even today, some patients can obtain radiation at certain Canadian centers over several weeks.

?We?re working on solutions,? said Dr. Pignol. ?And since we cannot select who should receive radiation and those who should not, the best thing to do is to simplify the radiation treatment and make it more patient friendly.?

To that end, doctors are looking to see if they can compress that five-week radiation treatment, to shorter periods, including treatment in a single session using implanted radioactive seeds or delivery of radiation during surgery.

Lisa Priest is Sunnybrook's Manager of Community Engagement & Patient Navigation. Her blog?Personal Health Navigator?provides advice and answers questions from patients and their families, relying heavily on medical and health experts. ?Her blog is reprinted on healthydebate.ca with the kind permission of?Sunnybrook Health Sciences Centre. ?Send questions to?AskLisa@sunnybrook.ca.

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Source: http://healthydebate.ca/2013/01/topic/managing-chronic-diseases/radiation-treatment-after-breast-cancer-not-optional

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Re: bought Dragon speech recognition software...got Family Tree ...

Sorry, Linda, hubby has been very busy at work and we have both been battling the flu. We haven't done anything yet with Dragon or FTM.

I suggest you just google Dragon and get their 800 number. I spent almost a half hour on the phone with customer service before deciding to purchase. They went over all the plan options and we designed what was good for hubby and I. The final cost was $168.

Source: http://boards.ancestry.co.uk/topics.software.famtreemaker/9292.1.1.1/mb.ashx

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Tips To Find The Buyer's Real Estate Agent | Siben & Siben Long ...

There are a lot of safe ways to invest in the real estate market, but you need to be careful because there are even more ways that you could make a bad investment. This article is packed with practical advice on all aspects of shopping for real estate. Do not risk your hard-earned money by purchasing a property that is priced unfairly.

Before you finalize an offer on a house, arrange for an inspection of the property. You do not want to be stuck with a house that needs major renovations. Not only can this cost you a lot of money, it could force you to make other living arrangements until the home is fixed.

TIP! Before purchasing a home, you should check your listed sex offender registry and see if there are any registered sex offenders living in the neighborhood. Although sex offender registries are available to the public, real estate agents are under no obligation to disclose information to potential buyers about registered sex offenders in the neighborhood.

When you are looking for a home to purchase, ignore the decor. Smart sellers hide their house?s flaws with decorative items, so you need to learn how to look past the decor and analyze a home based on its architecture and structural condition. If you base your buying decisions on only the home?s decor, you could pay for it later because you failed to see a large structural problem.

Become familiar with the type of homes in your targeted neighborhood. The ?best? house in the neighborhood may not be ideal for you. If you do, your own home?s value will be reduced because of the lower value of other homes in the area.

TIP! Never buy a home that has fireplaces in rooms other than the living room. It can be difficult to keep up with fireplaces, especially if you don?t use them.

Make sure you have an emergency fund set aside for extra costs that arise while purchasing property. Buyers typically figure out their closing costs by totaling the down payment, any points that they pay to the lender, and all real estate taxes after they are prorated. However, most of the time, extra things are included in closing costs, such as improvement bonds, school taxes, and other specific items related to the area.

Measure any home that you are think of buying before making an offer. Make sure your home?s square feet is listed correctly on the public record. If these numbers do not match up closely, you should not buy the property or go to the proper authority to have it fixed.

When in the market to purchase a new home, always consider your long-term situation. Even if you don?t currently have any children, if you are planning on living in the home for an extended period of time and the possibility of starting a family during those years cannot be ruled out, you should consider researching schools in the neighborhood to see if they will be satisfactory should you have any children down the road.

TIP! It is essential to hire a trustworthy real estate agent. The Better Business Bureau is a great resource, along with a number of other Internet resources.

Before renting a property, know who is responsible for landscaping, upkeep on shared structures, pest control, and maintenance. Some landlords can require you to clean the garden or to pay someone to do it. Other places have this included in the monthly payments.

In matters of real estate, poor decisions can eventually cost you a great deal of money. You could even wind up losing the property you?ve purchased. But, if you follow the advice here you can lower those odds. All you must do now is take advantage of your new knowledge.

Visit us at http://www.sibensiben.com

Source: http://www.sibensiben.com/long-island-injury-lawyer-blog/real-estate-law/tips-to-find-the-buyers-real-estate-agent

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Video: Post-Show Thoughts: After the Fiscal Cliff

Previewing the Next Big Fight

Also Sunday: The battle lines for the next fight were already being drawn before the members of the 113th Congress were sworn into office. Can Washington tackle the tough issues ahead, like raising the country's debt limit, in such a politically charged environment?? Plus: Turmoil in the Republican party as even members of the party's leadership split their votes on the final deal. Has Speaker Boehner's power diminished in the wake of this bruising fight? Joining us: Freshman Senator from Maine Angus King (I-ME), former Speaker of the House Newt Gingrich (R-GA), Chair of the House Democratic Caucus Rep. Xavier Becerra (D-CA), former head of HP and Vice Chair of the NRSC Carly Fiorina, and Washington Post columnist E.J. Dionne.

Source: http://www.msnbc.msn.com/id/3032608/vp/50378894#50378894

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erazer-lenovo-gaming-pc - Lenovo Blogs

?Why don?t you guys make something for the serious gamers?? We?ve heard that one a lot over the years. Well, guess what?? We?re tossing our hat into the gamer lounge. This year at CES, we?re bringing hardcore gamers exactly what they?ve been craving?we?re getting in the game with the Erazer X700, a high-performance desktop with high storage capacity that extreme gamers will love. ? ?

?This isn?t some machine for n00bs?Erazer is a serious gamer?s dream. It?s the first Lenovo PC to give you powerful OneKey? overclocking performance at the click of a button, while the system simultaneously protects the processor from overheating during intense game play. The Lenovo Cooling System uses a liquid coolant to keep internal temperatures at optimal levels.? Gamers can now get extreme performance out of their PC without worrying about overheating or shutdowns.

?Erazer touts AMD Eyefinity technology, which allows you to simultaneously connect up to six monitors for a truly panoramic display.? It also comes equipped with the latest Intel? Core i7 Extreme processor and can be fitted with an option 7.1 channel surround sound support with Dolby Advanced Audio.

?As Lenovo grows, we continue to make smart acquisitions in the market and this product is the perfect example of how those acquisitions turn into amazing products.? Born from our acquisition of Medion, Erazer utilizes their expertise and their know-how in the gaming space to deliver the optimal gaming machine.

?Other Specs:

???????? Memory: Up to 16GB DDR3

???????? Video Graphics: Dual graphics support ? NVIDIA? SLI; up to dual NVIDIA? GeForce? GTX660 1.5GB or ATI CrossFireX?; up to dual AMD Radeon? HD 8950 3GB graphics

???????? Hard Disk Drive: 2TB (High-end); 2*1TB Raid0 (Low-End); tool-free expandability of up to 4TB of storage space, including 2 hot-swap external drive bays that allow plugging in of additional storage without powering off the PC

???????? Connectors: USB2.0; USB3.0; HDMI (TBD); 9in1 card reader supporting SDXC format

??Lenovo is on your side, gamers.

?

Source: http://blog.lenovo.com/products/erazer-lenovo-gaming-pc

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Report: Son of US Sen. Rand Paul arrested

CHARLOTTE, N.C. (AP) ? U.S. Sen. Rand Paul's son reportedly was charged with underage drinking and disorderly conduct on a flight from Kentucky to North Carolina.

The Charlotte Observer reports http://bit.ly/13cI8me 19-year-old William Hilton Paul was arrested Saturday morning at Charlotte Douglas International Airport.

The newspaper quoted Charlotte-Mecklenburg Police Lt. Blake Hollar as saying it's possible Paul was served alcohol on the flight from Lexington, Ky., to Charlotte.

When the plane landed shortly before 11 a.m., the son of the Republican senator from Kentucky and grandson of former presidential candidate Ron Paul was charged with consuming beer/wine underage, disorderly conduct and being intoxicated and disruptive.

In a brief statement, Senator Paul's office said "as many parents with teenagers would understand," the family requested their privacy be respected "in a situation such as this."

Source: http://news.yahoo.com/report-son-us-sen-rand-paul-arrested-030159882.html

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BMX Legacy Project ? Ride UK BMX

This is an awesome project. It?s aimed at the race aspect of BMX but we definitely felt we needed to shout about this one. Anything that is going to fire up the next generation of BMXers is a positive, Access Sport hit us up with the full details;

BMX Legacy Project

? PRO-ACTIVE London Project of the Year 2012
? London Youth Games Community Partner of the Year

What is the BMX Legacy Project?

Access Sport?s BMX Legacy Project was launched in February 2011 and has created five new model BMX clubs and built five new BMX tracks in the Olympic host boroughs. These new clubs will feed into the Olympic BMX track that is due to open to the public in early 2014.

Access Sport has used its unique model of club development to work intensively over two years to develop each club into a sustainable, ?new model? community sports club.

The project has been delivered with the support of the Greater London Authority, British Cycling, Lee Valley Regional Park Authority and five Olympic host boroughs (Greenwich, Hackney, Newham, Tower Hamlets and Waltham Forest).

What is the need for this project?

When construction of the multi-million pound BMX facility began at the Olympic Park in Stratford there was not a single BMX club or track in any of the 5 host boroughs.

BMX is one of the fastest growing sports in the UK, and following the interest generated by the London 2012 Olympics it is getting more popular. BMX can provide a unique tool to engage disadvantaged young people in cycling that can lead to a lifelong commitment to sport, recreation and travel.

Sustainable sports clubs have an exceptional ability to act as a hub for the communities in which they operate ? forging links between local organisations such as schools and youth services with grass-roots sport.

Where are we now?

Over the first two years of the BMX Legacy Project Access Sport has worked with the 5 Olympic host boroughs of Greenwich, Hackney, Newham, Tower Hamlets and Waltham Forest to create:
? 5 ?New Model Clubs? established
? 5 new BMX tracks built
? Over 4200 people engaged in BMX in less than 2 years
? 205 new regular participants
? 380 regular outreach participants e.g. schools
? 1166 young people have been engaged at the clubs
? 31 new coaches trained
? 160 volunteers engaged
? London BMX Forum ? a democratic voice for local volunteers
? Worldwide media attention including TV in Japan, Brazil & Norway
? New competition structures created, including:
? BMX in the London Youth Games for first time ever & becoming a point-scoring sport in 2013
? First London BMX time-trail league
? Corporate organisation support
? GlaxoSmithKline, Barclaycard, adidas, Chain Reaction Cycles

?Before the construction of this BMX track, the park was almost exclusively used by drug users. Now, in contrast, the park is full of thriving young people, who are using the BMX track and improving their health and fitness.?

John Gillman, the Mayor of Greenwich

?Access Sport have been absolutely brilliant, they?ve basically helped me set up the club in the right way. They?ve got people qualified; supplied the most amazing equipment and given great advice?

Simon Hall, Club Leader

?Partnering with Access Sport to run a BMX workshop in the school for 6 weeks was a brilliant intervention not only for its use as a carrot to deal with poor behaviour but for the fact that the pupils also had the opportunity to learn new skills taught by expert riders. The coaching was led by Simon Hall and Kit Rackham and both were a big hit with the pupils for their charm and personality. Below are two case studies of the impact of the workshop:

Kymani Welsh ? A Year 8 pupil with Behavioural Emotional and Social Disorder (BESD) who was at the brink of permanent exclusion attended a few sessions and his behaviour was reported to improve rapidly.

Jordi Sansu ? A Year 7 pupil with a history of disruptiveness in the classroom was able to concentrate better and made progress in his final academic assessments.?

Patrick Iberi , Nurture Group Teacher/ Coordinator, Cardinal Pole PRU

For further information about the BMX Legacy Project visit www.accesssport.org.uk/bmxlegacy or contact the team on 0207 993 9883?or bmx@accesssport.co.uk

BMX Legacy Project

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Source: http://rideukbmx.mpora.com/news/bmx-legacy-project.html

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Tax deal leaves Republican party as divided and angry as ever

BOSTON (AP) ? The Republican Party seems as divided and angry as ever.

Infighting has penetrated the highest levels of the House GOP leadership. Long-standing geographic tensions have increased, pitting endangered Northeastern Republicans against their colleagues from other parts of the country. Enraged tea party leaders are threatening to knock off dozens of Republicans who supported a measure that raised taxes on the nation's highest earners.

"People are mad as hell. I'm right there with them," Amy Kremer, chairman of the Tea Party Express, said late last week, declaring that she has "no confidence" in the party her members typically support. Her remarks came after GOP lawmakers agreed to higher taxes but no broad spending cuts as part of a deal to avert the "fiscal cliff."

"Anybody that voted 'yes' in the House should be concerned" about primary challenges in 2014, she said.

At the same time, one of the GOP's most popular voices, New Jersey Gov. Chris Christie, blasted his party's "toxic internal politics" after House Republicans initially declined to approve disaster relief for victims of Superstorm Sandy. He said it was "disgusting to watch" their actions and he faulted the GOP's most powerful elected official, House Speaker John Boehner, R-Ohio.

The GOP's internal struggles to figure out what it wants to be were painfully exposed after Mitt Romney's loss to President Barack Obama on Nov. 6, but they have exploded in recent days. The fallout could extend well beyond the party's ability to win policy battles on Capitol Hill. It could hamper Republicans as they examine how to regroup and attract new voters after a disheartening election season.

To a greater degree than the Democrats, the Republican Party has struggled with internal divisions for the past few years. But these latest clashes have seemed especially public and vicious.

"It's disappointing to see infighting in the party," said Ryan Williams, a Republican operative and former Romney aide. "It doesn't make us look like we're in a position to challenge the president and hold him accountable to the promises he made."

What's largely causing the dissension? A lack of a clear GOP leader with a single vision for the party.

Republicans haven't had a consistent standard-bearer since President George W. Bush left office in 2008 with the nation on the edge of a financial collapse. His departure, along with widespread economic concerns, gave rise to a tea party movement that infused the GOP's conservative base with energy. The tea party is credited with broad Republican gains in the 2010 congressional elections, but it's also blamed for the rising tension between the pragmatic and ideological wings of the party ? discord that festers still.

It was much the same for Democrats in the late 1980s before Bill Clinton emerged to win the White House and shift his party to the political center.

2012 presidential nominee Romney never fully captured the hearts of his party's most passionate voters. But his tenure atop the party was short-lived; since Election Day, he's disappeared from the political world.

Those Republican leaders who remain engaged ? Christie, Boehner, Senate Minority Leader Mitch McConnell of Kentucky and Republican National Committee Chairman Reince Priebus ? are showing little sign of coming together.

Those on the GOP's deep bench of potential 2016 presidential contenders, including Florida Sen. Marco Rubio, Wisconsin Rep. Paul Ryan, and Louisiana Gov. Bobby Jindal, have begun staking out their own, sometimes conflicting ideas for the party.

Over the short term at least, the party's divisions probably will continue to be exposed.

Obama has outlined a second-term agenda focused on immigration and gun control; those are issues that would test Republican solidarity even in good times. Deep splits already exist between Republican pragmatists and the conservative base, who oppose any restrictions on guns or allowances for illegal immigrants.

It's unclear whether Obama can exploit the GOP fissures or whether the Republican dysfunction will hamper him. With Boehner unable to control his fractured caucus, the White House is left wondering how to deal with the House on any divisive issue.

Fiscal issues aren't going away, with lawmakers were agree on a broad deficit-reduction package. The federal government reached its borrowing limit last week, so Congress has about two months or three months to raise the debt ceiling or risk a default on federal debt. Massive defense and domestic spending cuts are set to take effect in late February. By late March, the current spending plan will end, raising the possibility of a government shutdown.

Frustrated conservative activists and GOP insiders hope that the continued focus on fiscal matters will help unite the factions as the party pushes for deep spending cuts. That fight also may highlight Democratic divisions because the party's liberal wing vehemently opposes any changes to Social Security or Medicare

"Whenever you lose the White House, the party's going to have ups and downs," said Republican strategist Ron Kaufman. "My guess is when the spending issues come up again, the Democrats' warts will start to show as well."

The GOP's fissures go beyond positions on issues. They also are geographical.

Once a strong voice in the party, moderate Republicans across the Northeast are nearly extinct. Many of those who remain were frustrated in recent days when Boehner temporarily blocked a vote on a disaster relief bill.

Rep. Peter King, R-N.Y., said campaign donors in the Northeast who give the GOP after the slight "should have their head examined."

Boehner, who just won a second term as speaker, quickly scheduled a vote on a narrower measure for Friday after the new Congress convened, and it rushed out a $9.7 billion measure to help pay flood insurance claims.

Weary Republican strategists are trying to be hopeful about the GOP's path ahead, and liken the current situation to party's struggles after Obama's 2008 election. At the time, some pundits questioned the viability of the Republican Party. But it came roaring back two years later, thanks largely to the tea party.

"If we have learned anything from the fiscal cliff fiasco, conservatives discovered we need to stand firm, and stand together, on our principles from beginning to end," said Republican strategist Alice Stewart. "It's frustrating to see the GOP drop the ball and turn a position of true compromise into total surrender. The Democrats succeeded in their strategy of divide and conquer."

___

Associated Press writers Ken Thomas and Ben Feller in Washington contributed to this report.

Source: http://news.yahoo.com/republican-party-seems-divided-angry-ever-140632093--election.html

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