YOUR BODY makes glucose, a kind of sugar, from the foods you eat. This glucose travels through the bloodstream for immediate use as “fuel”, or is stored in the liver for future use. When there is a build-up of glucose in the blood, the pancreas sends out a hormone, insulin. It is the action of insulin that enables glucose to move from the bloodstream into the body’s cells, which then use the glucose as a source of energy. Diabetes results when, for one reason or another, there is a breakdown in this process and glucose accumulates in the blood. In other words, diabetes signifies the body’s inability to use glucose (sugar) as fuel in the normal way. When diabetes sets in before age 30, it is generally because the pancreas is producing a deficient amount of insulin — or none at all —Because me body mistakenly destroys the cells in the pancreas that secrete insulin. There are no oral drugs for this type of diabetes which usually starts abruptly. It always needs to be treated by supplying the missing hormone through injections of insulin. Even one day without insulin can bring on the risk of diabetic coma and death. This type of diabetes is known as Insulin-Dependent Diabetes (IDD), or juvenile-onset diabetes, or Type I diabetes.When diabetes occurs in adults over age 40, it is often because they are genetically pre-disposed to develop it (A family-history search could uncover close relatives who have or had it). Peoplewith adult-onset diabetes typically produce sufficient amounts of insulin in the pancreas. Bat the hormone has lost its ability to effectively move glucose out of the blood and into the cells, resulting in a condition known as insulin resistance. In effect, the cells resist the action of insulin, causing sugar levels to accumulate in the blood.This results in what is known as adult-onset diabetes or Non-Insulin-Dependent Diabetes (NIDD) — so called because, except in a small proportion of diabetics and in certain emergency situations, it does not need to be treated with insulin. 90 per cent of diabetics have the Type II form of the disease.*61\332\2*
For breast cancer that has recurred within the initially treated breast, an aggressive type of surgery is usually performed. If the earlier surgery was a lumpectomy or partial mastectomy, a complete mastectomy may now be required. Once the tumor and surrounding tissues have been removed, the tumor will be evaluated for the presence of estrogen and progesterone receptors. The decision to use chemotherapy, radiation, or hormone therapy will be based on the size and location of the tumor, nodal involvement, the presence or absence of receptors, and the prior use of chemotherapy drugs. For tumors considered to place the patient at high risk of recurrence, or when conservative surgery is performed, radiation is used subsequently to decrease the risk of another recurrence. As discussed earlier, for patients who have estrogen or progesterone receptors in their primary breast tumors, tamoxifen or another hormonal agent may be prescribed to control or prevent further tumor recurrence. Chemotherapy is also considered, depending on the kind of chemotherapy the patient received initially and how well she responded at that time.If the breast cancer has spread to a single site outside the breast, treatment depends largely on where the tumor is located. If the recurrence is in an area that is surgically operable and the tumor impairs the patient’s normal functioning, then the tumor may be surgically removed. For tumors of the bone or other tumors that are not readily operable, radiation may be used to reduce tumor size and alleviate symptoms.Chemotherapy is typically given to patients with rapidly progressing or receptor-negative breast cancer that has spread beyond the breast. At one time it was believed that patients with disseminated breast cancer had little chance of long-term response to chemotherapy. Drugs were given primarily to moderate the symptoms of the disease. Today we know that by using different chemotherapeutic combinations an improved quality of life can be achieved in at least 60 percent of these patients.Most beginning drug therapies will include either methotrexate or adriamycin. Once a patient no longer benefits from the first protocol, she may be given a different course of drugs. Typically, a patient responds to the initial course for 6 to 12 months. When she stops reacting to any of the conventional drug combinations, the patient may elect to take a new and untested drug or combination of drugs that seems promising. Some of these agents have had encouraging results in patients with advanced breast cancer.A patient with estrogen-receptor-positive breast cancer that has metastasized may be offered tamoxifen therapy before chemotherapy. Response to tamoxifen in patients with bone or soft-tissue metastasis is very good, and remission can last more than 12 months. Unfortunately, while response to tamoxifen may be as high as 75 percent in some groups, virtually all patients will eventually develop tamoxifen resistance and no longer respond. Once tamoxifen therapy fails to be effective, other hormonal agents such as aminoglutethimide, halotestin, megestrol, and leuprolide are available. As with tamoxifen, patients may initially respond satisfactorily, but eventually they develop resistance to all endocrine agents as well.*38\320\2*
Relabeling means redefining a troubling situation so that it seems more benign. Relabeling is related to thinking positively: any situation, no matter how bad, contains the possibility for something good. The idea is to focus on the possibilities for good and define the situation in those terms. “If I approach it with the right attitude,” says Steven, “I can see the blessings.” Call something a challenge rather than a struggle, a preference rather than a need, an opportunity rather than a problem, caring rather than dependency. People who have to quit work say they are not losing their usefulness but gaining freedom and opportunity: the chance to volunteer, to read certain books, to learn to paint, to teach, learn a language, put together models, and especially, spend more time with the people they love. Helen knows that even though HIV infection is not curable, it is treatable, and seeing the disease as treatable, she says, “does a lot for me.” Dean, who has lived a long time with the virus and has weathered several serious illnesses, defines himself not as a sick person but as a survivor, a winner: “I’ve survived a lot of illnesses, and some even the doctors thought I wouldn’t,” he says. “So even if I die, I’ll still feel I’ve won.”*241\191\2*