One person’s struggle does not discount or supersede another’s, that’s true. We live our own reality whether it involves bombs or failing grades, sickness or unfortunate hairstyles. It can be important, however, to consider the circumstances of others when trying to make sense of our own. Sometimes, that makes us appreciate the smallness of our suffering, or ways that we can improve the lot of another. Which brings me to Terry Fox.
 
I dealt with a lot of teenagers when I had my family practice, and also had two teens of my own. They can be self-centred and infuriating, impulsive, emotional, angry and unresponsive. What was different about 18-year-old Terry Fox? As most people know, he had just lost a leg, arguably one of the most traumatic cancer-related events that could happen to an active teen. He decided not just to raise money for cancer, not just to run despite his prosthesis, but to run a marathon a day all the way across Canada. [Here, as a parent, I wonder what I would have said. Probably something like “Hey honey, why don’t we aim for success here? Why not run one marathon, and go from there?” Worrying about failure and the impact that would have.] According to Wikipedia, his mother did discourage him at the start. Instead of listening, Terry ran 143 marathons, from Newfoundland to Thunder Bay. I thought about him a lot, as I went through my surgeries and treatment. I’m sure he had his grumpy days like anyone else, but his actions spoke loudly to me. There may be no hierarchy of suffering, but there are certainly those who endure with inspirational humility, grace, and selflessness.
 
I’m reminded, when I want to hide and give up on humanity, of those who supported me through my setback. Of Terry and his ability to see the big picture despite his own trauma. Of the protesters willing to give their lives for what they believe in. I’m reminded to continue small acts of kindness, bigger ones when and where I can. To believe that most humans are intrinsically good and act accordingly. To honour all levels of suffering, to listen, offer courage and support.
 
In this way, imagine what we can accomplish together.

I'm sure you've noticed that toilet paper no longer comes in "rolls." It comes in double rolls! And triple rolls! All advertised in large excited lettering, with things like 12 double rolls=24 rolls! Or six triple rolls=18! As if we should be over the moon about these fabulous hygienic options. The only problem is that if you look closely, some of the "double" rolls have 142 sheets per roll, and others have 186 or 224. Packages come anywhere from 6-30 rolls, "double" or "triple," and the consumer is then left to do the math to figure out how much we are actually paying per roll (or per sheet, if you want to get technical). Admittedly, it's not difficult math, and unlike the warnings of past math teachers, we DO actually all carry a calculator everywhere we go now. The point is, why should buying toilet paper require a calculator? I feel like the confusion is deliberate, so people will just grab whatever seems like a good deal. Add trying to buy Canadian-only products into the mix, and I could spend the day in the toilet paper aisle while the Earth slowly falls apart around me. Why make things more complicated than they need to be?
         Moving on to flat-rate chicken. Which, in fact, does seem to simplify things: packages of chicken thighs and breasts, all labelled at the same price: $9 or $12 or whatever. Why are grocery stores doing this? The range in weight for a single price was anywhere from 700gm to 1.2 kg, with the 1.2 kg obviously being a much better deal...40% more chicken for the price! In the past, I'm pretty sure I just grabbed one without looking at the weight; maybe that's why they do it, in which case stupid me, but also, just list the price by the weight PLEASE. 
          I realize I am very fortunate to be able to buy both toilet paper and chicken. I found out recently that charities handing out food cannot give expired items, even if they are in cans. Since I never even knew cans had expiry dates on them, I've definitely eaten some expired soup and tomato sauce! Dried pasta? Unopened cereal? Salt? At a recent charity food collection, we had an entire table of these items and more, food we could not use. And yet, I just heard on CBC about the rise of discount grocery stores that use surplus, expired or near-expired food, to reduce costs. There's also the "Too Good to Go" labelling (a company in Denmark) that simply suggests Look-Smell-Taste rather than throwing something out just because it's past its best before or expiration date. If we want to bring down costs and reduce waste, we need to do anything possible to avoid throwing out usable food items.
         Now, looping back to all the insane things happening around the world: I can't do any "big things" to protect Greenland, or prevent wars. What I can do (we can do!) is pay attention to small details, like prices, food waste, item sources, packaging, and the many day-to-day decisions that, when  multiplied by thousands or millions of people, can make a huge difference (look at our impact on US tourism!). There's so much more I could be doing at the local & individual level, so I'll keep working on that. Do you have suggestions? 
And manufacturers and grocery stores: please, just simplify the process for everyone. There's enough going on as it is.

Similarly, every charity in existence seems to be asking for money right now. It’s the season of giving, I get it and I give, but the sheer number gets very overwhelming. All of them feel important in one way or another. In addition to cash, there’s the food bank needing nonperishables, the warming centre needing coats, Adopt-a-Senior needing gifts for elderly shut-ins and nursing home residents, multiple services needing children’s toys, charities looking for socks and tampons and baby formula.
 
I can’t solve the problems of a society in which there’s ever-increasing needs and perpetually inadequate funding. I do, however, have a Big Idea for children’s sports.
 
My idea came during the baseball playoffs as I learned about the unbelievable wages earned by some of the major players. Shohei Ohtani is the top earner, making $70 million annually. Annually! In the NBA the top wage is $59.6 million/year, and in the NHL $14 million/year, which seems paltry by comparison but is a massive amount of money, more than anyone could ever actually need. I understand the market forces at play and the arguments about short careers and potential injuries and teams bidding for players and blah blah blah. Most of these top athletes are also making a lot of money through endorsements. Well invested, a single year of their salary could cover them for life.
 
My Big idea is to cap all professional athletes at $10 million annually. I’m sure this idea will be hugely unpopular among said professionals and their team owners and managers, especially  teams raking in billions, because what I propose is that along with this salary cap in all sports, at least part of the leftover money should be reinvested into children’s sports programs. Imagine if Shohei was capped at $10 million: that would leave $60 million annually to fund developing sports. And that is only one player on one team! Naturally, pro sports are businesses, and players are often called “products.” Having better products is good for sales and the bottom line. But would our professional sports franchises really fall apart if they had salary caps? I highly doubt it; the NHL has survived so far. Meanwhile our kids could have partially or fully funded opportunities to develop their own skills, rather than spending their time (or more accurately, their parents’ time) schlepping pepperettes. Surely, we should at least consider change. Am I the only one feeling the imbalance of funding makes no sense? Let’s have a conversation. Reply in the comments, or on Facebook at Karen Lea Armstrong-Author.

And the pain—the pain was bad at the beginning and lasted a long time. I had to drastically alter my diet so that liquid stool would not pour out and cause dehydration. I, who loved all the healthy, high-fibre foods many people hate (vegetables with skins, kale, seeds, whole grains) had to eat only pureed soups and white bread and potatoes. I paid for cheating with extra bag-emptying bathroom trips at night, or significant fluid loss.
 
I named you right away, and that helped a bit. You were like a child I had to manage, a personality I had to soothe. Bilbo didn’t like that food. Bilbo was up three times last night. Having no sphincter at the stoma site, gas would make noise, sometimes at inopportune times; Thanks for your opinion, Bilbo, we’d say. If I had to excuse myself to empty the bag of gas or stool, I’d say I need to deal with Bilbo for a minute. Somehow, this personification helped me and those around me.
 
Having you, Bilbo, confirmed the kindness of people, something important to recall in these uncertain times. Friends and family made soups and breads, cored and peeled tomatoes so I could eat their sauce, pureed strawberries and strained the seeds, left out the onions. My husband even peeled grapes for me. Gradually, I was able to increase my diet and learn which foods would cause excessive gas or output, and people adapted their drop offs and menus.
 
But despite all that adjustment, you were maddeningly unpredictable. I’d plan my shower or flange*** change after fasting, to avoid a mess, and just as I was all clean you’d eject stool all over the shower (or floor, or a white towel). You’d come to life just as I was sticking on a new, fresh flange. You’d be full of liquid –for which I was not prepared– during the night, and whoosh all over the toilet and floor as I tried to empty the bag in the dark. And you smelled so bad! Stool universally stinks, of course, but your odour was next level. Don’t eat fish, said my handouts, don’t eat eggs. Avoid onions, garlic, spices, and gas-producing vegetables. A), ridiculous. B), honestly, it didn’t seem to matter. I found a “stoma bag deodorizer” which helped somewhat, but let’s just say I will not miss the constant air fresheners and scented candles, nor the need to close the bathroom door even when not in use, and leave the room whenever I had to express air from the bag.
 
I had a couple of young patients in my former medical practice with permanent ileostomies. They never complained; their surgeries had been for uncontrollable ulcerative colitis or Crohn’s disease, which caused constant pain and bleeding. Great, I remember thinking, when they got their colon-removal surgeries. Finally, their symptoms will settle. I never stopped to think what it would be like to deal with a stoma at sixteen, or twenty: body image is so very important,  sexuality is developing, poop is a taboo topic and friends recoil at words like “anus” or “rectum.” I ache for them now. I want to go back twenty years and take their hands and talk about the impact on their lives. I want to say I’m sorry, I didn’t understand. The pain, the expense, the embarrassment, the social impact, the stink, the activity avoidance, the diet limitations.
I just didn’t understand.
 
At the time, I was fine living snugly within my ignorance, as we all generally are (we don’t know what we don’t know). But if I must find a silver lining, it would be the near-vertical learning curve and new level of understanding I’ve developed.

Now, I’m facing surgery to have you reversed and go back to using my colon (I’m lucky enough to still have one), which has been on vacation for eight months. The large bowel won’t kick back in right away, which means I will likely be incontinent for a couple of weeks, and after that more prone to urgency and accidents. Such fun!
 
I’ll admit that even though you sometimes irritated my skin, caused poop explosions, or woke me multiple times in the night, I’ve become used to you and might even miss some aspects (eg. absolutely no constipation!). Overall, however, I’m not sad to see you go. I look forward to sleeping on my stomach, swimming without fear of equipment breakdown (hopefully I won’t need a swim diaper!), wearing clothes I don’t have to negotiate around the bag, and having my body functions tucked back inside. We women are not used to dangling external bits.
 
Thank you for your service, Bilbo Baggins.
You taught me a lot, but let’s not keep in touch.

 
 *with apologies to JRR Tolkien
**ileostomy: a surgically-created attachment of small bowel to skin, to allow fecal contents to skip the large bowel, rectum and anus.
***flange: the component of an ileostomy bag which attaches to the skin, allowing the stoma to empty stool contents into a bag. Also called a wafer.

Why do we ring the bell at the end of chemotherapy treatment?
According to the MD Anderson Cancer Centre website, it’s because of US Navy admiral Irve Le Moyne, who in 1996 completed his cancer radiation therapy. On the final day, he brought a bell to ring, because in the navy, bellringing indicated the end of a difficult journey, or the accomplishment of a particularly arduous task. He donated his bell to the MD Anderson Cancer Centre and a tradition was born. Or at least that’s how the MACC tells the story.
 
Maybe I should not have been surprised at my own response. I recall my father-in-law wondering aloud why people cry at weddings; his brother, in true brotherly fashion, said “Well Dave, it’s called emotion.”  I expected to feel nothing but happiness finishing treatment. Instead, it was as if something opened up inside me, that I’d been holding tightly closed like a sweater against a cold wind. I didn’t cry a lot during the six months of chemo, instead counting on self-affirmations like this treatment will heal me and I can do hard things and strong and calm. There were very dark and sad days but I didn’t want to bring others down with me. I think the tears were all those I’d held back since diagnosis and surgery and through the treatment; they signified that I made it, I actually made it. A lot of people told me they cried watching the video; I’d much rather have shouted “F**k cancer!” and pumped my fist in the air and had everyone feeling inspired and celebratory. But sometimes, circumstances are bigger than us.
 
When my husband and I were in Italy, many years ago, we went to see the famous Duomo, a very old and beautiful domed cathedral in Firenze (Florence). When we arrived, they were just locking the doors, closing up for the day. Seeing our disappointment, the worker said “why don’t you climb the bell tower?”
We decided to do so, climbing what felt like a million serpentine steps, which got smaller and shallower as we ascended. The view at the top was incredible. We were so glad we’d taken on the task, when suddenly the entire tower vibrated. It was six o’clock, and the enormous bell was ringing. Immediately, church bells across the city also began ringing. It was a cacophony of bells, surrounding us as we took in the gorgeous view, and it was also our anniversary, so it was easy to pretend the bells were just for us.
 
I tell this story because that Italian bell ringing episode was filled with joy and awe and gratitude, all the things I expected to feel ringing the oncology bell. And even though the moment at the hospital did not go as I expected, all those wonderful emotions were also there under my tears; I’ve found and embraced them now. Arduous task accomplished. Time to move forward to new adventures.

I’m not normally a big risk taker, but I’m also not usually one to picture all the worst possible outcomes of every scenario. Recently, we tried to plan a shortened version of our usual two-week cottage vacation, accommodating my chemo schedule, and I was immediately overwhelmed:
-what if I can’t enjoy the lake? I have cold neuropathy due to my chemo, I have the ileostomy bag. Water activities are a huge part of the cottage.
-what if my ostomy bag detaches when we are in a rustic setting with no flush toilet?
-what if I can’t manage the walking that usually is no problem for me?
-what if I’m nauseous and tired and can’t enjoy the family time?
And so on. And so on. I acknowledge both the privilege of having a cottage and the insanity of my concerns. My husband and I discussed all of the above and decided to try.
          Well. Everything went so smoothly, I feel like an idiot for ever worrying. The lake was an amazing 78 degrees, swimming pool warm, and I had no problem tolerating the temperature even for prolonged periods. My husband found me some high-waisted swim shorts that covered the ostomy bag and held it against my body, and my online ileostomy group suggested some Sure Seals to keep the flange in place—both worked wonderfully. I swam, bobbed in waves, played water volleyball, and used my paddleboard. My in laws gave up their usual cottage so that I would have privacy, a place to rest, and access to the electric toilet. My brother-in-law did the vast majority of the cooking. My energy was pretty good and I limited my activity as needed, even asking for help (they all know I HATE asking for help!) lifting the paddleboard.
          Thank goodness I didn’t give in to all those worries and abandon the trip. Getting out of town, spending time with friends and family provided the perfect distraction from side effects and self-doubt. The “worst case scenarios” were pretty benign and should not have caused such ridiculous stress. I blame the Chemotherapy Multiverse, because one of the (few) “benefits” of a cancer diagnosis is that you can blame it for everything.
          Moving forward, I want to turn my what ifs into why nots. Why not try, and see what happens? Why not? Just because I’ve temporarily lost control of my health, I don’t want to become a scared little mouse. Not when I have a roaring dragon inside me who fears nothing. Maybe the next universe will be the one that releases that dragon and whatever magic she contains. Now THAT would be a Multiverse worth seeing.

1. Premium nap: this is the good one, the Porsche of naps. In bed, under the covers, maybe even in pyjamas if you’re really committed. Earplugs, eye mask, fan, phone in a separate room, no alarm. The crème de la crème of napping.
 
2. Couch or chair nap: almost premium, depending on the couch/chair, number of pillows, and quality of available blankets. Easily interrupted and often short, but a quality nap experience. May occur unexpectedly while reading.
 
3. “I’ll put the kids to bed” nap: you lie down with your young child “just for a minute” and wake up 30/60/90 minutes later. Satisfying but can interfere with accomplishing anything in your evening.
 
4. Library/Study nap: back when we used textbooks, I’d sometimes rest my forehead on one while I was studying and take a quick forty winks. What do young people use now as a study-nap pillow? A laptop? Seems much riskier to drool on.
 
5. Movie nap: that long boring section that has soft beautiful music and is cinematically gorgeous (think Moonlight) can also be deadly if you’re feeling tired. Our movie theatre now has the “luxury recliners” which make action and loud noise even more important to avoid movie napping (although at some times of our lives, the $14 feels well worth it for a good nap).
 
6. Car nap: NOT WHILE YOU ARE DRIVING (Chevy Chase in National Lampoon’s vacation), but A) as the driver, you get that intense wave of sleepiness, pull over, and instantly fall asleep. Even a few minutes works well. B) as passenger: do as much napping as you like. As with Trains and Airplanes, the trip goes much faster if you can actually sleep (not one of my personal skills). Remember, as a child, lying down in the back seat, or the back of the station wagon? Side note: if you have small cranky children and your spouse is driving, your prolonged car nap may cause some marital discord.
 
7. Beach nap: self-explanatory and often occurring on vacation, thus a very helpful and guilt-free nap. Don’t forget to use sunscreen and assign someone to watch the kids.
 
8. Eyes-wide-open nap: lectures, meetings, even boring conversations with acquaintances can assist with this type of nap. Watch out for questions.
 
9. Yoga nap: Surely I’m not the only one to fall asleep during shivasana, but I’ve never heard anyone else wake themselves up snoring!
 
10. Couples’ “nap”: Come on. We all know what you’re really doing.
 
Final note: yes, napping can interfere with your sleep at night, so restrict to 30-60 minutes, unless you are on shift work, have small children, are training for an Ironman race, or are on chemotherapy, in which case you’ll probably be fine despite your nap.
 
 

Cosmetic, or non-essential use, of pesticides, is defined as the “use of pest-control products to improve appearance of non-agricultural green spaces.” Dandelions, while perhaps not visually appealing to everyone, do not cause any actual harm, and may in fact have health benefits. Pesticides, on the other hand, have many known or putative negative health impacts, which are not justified simply for the appearance of a lush green lawn.
 
The Canadian Association of Physicians for the Environment (CAPE) has been actively trying to reduce cosmetic pesticide use for years.  On their website they cite many scientific articles(246 articles over 19 years published in peer-reviewed clinical journals, plus a report from the PEI Chief Public Health office with 350 peer-reviewed studies over 11 years).  Both groups found that pesticide use (multiple types) is associated with development of cancers of the brain, prostate, kidney, blood (leukemia), and Non-Hodgkin’s lymphoma.  Non-organochlorine pesticides may cause adverse reproductive outcomes including low birth weight, neural tube defects, and diaphragm defects. Exposure of infants, children or pregnant women to organophosphates, biocides, and fungicides was associated with increased asthma and wheezing in children up to age 6.
 
The emphasis on pregnant women, infants and children is significant: the chemicals have a particularly negative effect on the developing fetus. Infants and children have higher exposures due to crawling/playing on the ground, ingestion of dirt, higher body surface area, reduced ability to process chemicals, and increased exposure to household dust (up to 76% of post-herbicide exposure is related to house dust from pesticides tracked indoors; exposure to this contaminated dust can be 100 times greater in children than adults). Who knew?
 
Admittedly, a soft, perfect lawn is much more inviting.  Lying on your back looking at cloud patterns is much less appealing when you are lying on a thistle.  A golfer is definitely not going to get a straight putt on a big cluster of plantain.
 
We tried to maintain our lawn pesticide-free using every method: overseeding, longer grass, aerating seasonally. One summer, our bored teenager spent hours pulling dandelions in the front yard; in a day she cleared the entire half yard, and the next day–the NEXT DAY –the lawn was yellow with dandelions again.  It brought to mind the hydra of Greek mythology, where 2 heads sprout when you chop off one, or Game of Thrones, expending massive energy to wipe out all the White Walkers only to have them all rise up and start staggering back. We threw up our hands and surrendered.  We waved a white flag of dandelion fluff.
 
But we did not spray.  Not even those “natural” sprays which are apparently made of  microbials, “plant-incorporated protectants” (whatever that means), or iron; while those have not been associated with cancers, the long term health effects of exposure are currently unknown, so the Canadian Cancer Society suggests elimination of all cosmetic pesticides.  Also, consider the effects, known or unknown, of pesticides on our natural world: has anyone read Silent Spring? Written by Rachel Carson in 1962?  (Hint: nature good, pesticides bad).
 
Perhaps, as stated by the Canadian Cancer Society, we must “increase our tolerance for imperfection” to have a world less dependent on chemical pesticides. 
These things, of course, take time; in the meantime, come by and check out our dandelions.  Pick some if you want, make dandelion tea or wine, make a dandelion salad! We have plenty to share. PLENTY.
 
Your body, as well as the children, birds, animals, and insects of our world will thank you.
 

Age 55 is not considered an early-onset rectal cancer, but it certainly feels young, and not just to me. People say things like “but you’re so young,” or “but you’re so healthy!” knowing that I am a runner and triathlete, that I eat well, don’t smoke, and keep a healthy weight. There’s no family history. Why, then, is this happening to me? (And side point: If I was not young and lifestyle conscious, would it then be “fair” to have cancer?)
          When people say things like “it must have been your stressful job,” it makes me feel I have caused my own illness. We know that stress can cause health problems. On the other hand, lots of people have stressful work, and physicians are in fact a bit less likely to develop cancer than others, due perhaps to recognition of early signs, or generally healthy lifestyles. Many of my patients had hugely stressful lives, living with financial instability, addictions, abuse, heavy caregiving roles, and lack of control in their lives. Most of them did not develop cancer despite overwhelming stress.
          Did I manifest my rectal cancer? Was it the way I boldly microwaved food in plastic containers, even after we’d been told to only use glass or ceramics, saying “hey, you have to die of something”? Was it my response to the “pink” breast cancer campaign, where I said of course breast cancer deserves research, but what about all the other cancers? “What about the poor people with bum cancer?” I said to my kids, fifteen years ago (true story). Was it the way I endorsed Ezekiel J. Emanuel’s 2014 article in the Atlantic, “Why I hope to die at 75?” Was it the way my medical colleagues and I would joke that we needed “just a touch of cancer” so that we could take a week off and rest?
          Maybe my illness was due those things, but more likely it was not. Most likely of all, a genetic mutation occurred, that we may find but never explain. One that I certainly did not personally manifest.
          Thinking positively, taking deliberate steps toward a goal, having self-confidence and self-awareness and gratitude are all good things, and likely do make future achievements possible. But sometimes things don’t work out, or bad things happen. Unless we deliberately self-sabotage, that’s not some kind of reverse/negative manifestation: it’s just life.
Imperfect, undulating life.

For the uninitiated, an ileostomy is a way for the small bowel to empty through an opening in the skin (as opposed to a colostomy, which is the same thing with the large bowel). I had surgery to remove my rectal cancer, and they were able to reattach the bowel to the rectum, but I needed to give the area a chance to rest and heal. So, now I have the temporary ileostomy which drains into—you guessed it—a plastic bag on the outside of my abdomen. To avoid odour, I need to change the bag every couple of days, and although it’s possible to rinse the bags out and reuse, there’s a bit of an ick factor there. When it’s time to change the two-piece flange (the part stuck to my skin) and bag, the entire thing goes into yet another plastic bag for the garbage. I wear medical gloves to do these changes (more plastic, or at least polymers), since I’m not too skilled yet and otherwise end up with poop on my hands.
 
I’m aware of the irony here: the person trying to reduce plastic use, now relying on plastic every day. There really aren’t any other “environmentally friendly” options for an ileostomate. Some colostomy users are able to control their stool output by flushing the stoma intermittently during the day, but small bowel output is much more constant, and higher volume.
 
The dilemma reminds me of the disposable-versus-cloth diaper decisions I had to make when the kids were small. The message: disposable diapers are bad! They take hundreds of years to break down! I made the effort to use bulky, inconvenient cloth diapers and realized quickly that trying to wash and dry them was using hot water, chemicals, electricity, and a lot of time. I compromised by using one cloth diaper per day…for a while.
 
Have you ever felt thwarted in your efforts to do something for the environment? I’m thinking about the time we cleaned up garbage at the side of the highway, only to have someone drive by and fling a coffee cup out their window. I’m thinking of the vegetable garden I attempted in our backyard, which failed completely due to excessive shade (runty, cork-sized carrots, a green pepper the size of my thumbnail). I’m thinking of that time I rode my bike to work and it was stolen even though I could see it from the window.
 
At this point, I don’t think anyone will begrudge my newly increased plastic use. I’m not giving up on environmental causes, but I’m also embracing Kant: “the only thing that is good without qualification is the good will.”
Seriously, I’m trying.