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A Year Ago Today

Monday, December 26, 2011
Today is the one year anniversary of James’ death. I’ve tried to let the day unfold naturally, to let it be what it will be, but the circumstances and the aftermath of his death are still as surreal as they were a year ago.

I remember every detail of that day: the sound of the screen door as our neighbor stepped onto our porch and the anguished look on his face. His countenance delivered his message before he’d even said a word, and I remember feeling sorry for him that he was the one to bring me this news. Since then, I've run the gamut from numb to an eerie calm, punctuated by anger and depression over losing this special man, along with feeling the same anguish and crushing disappointment James felt the weekend he died.<PREVIEWEND>

There have been times this last year I thought the same disappointment would kill me, too. While his congenital heart problem would have eventually killed him, all of his doctors agreed the events of that last weekend most certainly hastened his death. On top of everything else James saw and heard that weekend, his daughter-in-law's words were further confirmation, and it was all more than he could take. I now understand when people say you can die of a broken heart.

Not a day goes by I don't tell James how much I miss him, how much I love him. I talk to him a lot, especially in the car. On my daily drive into town, I start by talking to God, thanking Him for the blessings He’s bestowed on me and my family, for His gift of grace, for walking beside me this last year and for sending James into my life. Sometimes I tell James about his “winter trees,” the cluster of oaks he loved because of their stick-like silhouettes against the late afternoon winter sky.

James had a special humor, a way of making even the most mundane things fun and interesting. He had an appreciation for all things living, for the way the birds made nests in the trees and the almost serendipitous effort it took to make bluebonnets bloom in the Spring. Nothing delighted him more than spending the day raising the skirts on an oak tree, cutting away dead limbs until an unnoticed tree became a thing of beauty. He could read animal tracks in the dirt and knew whether it was a big cat, a buck or a doe, or if it was running or walking and how much it weighed. He taught me the names of every grass and plant in Texas and long before anyone else, he recognized subtle signs that his beloved trees were beginning to suffer from the drought.

When James was alive I used to pray, twice a day, that God would wrap His protective light and love around James Daniel Coffee and keep him safe and free from all harm and return him safely to the Little House. God did that. He took James to work and back and kept him safe on the freeways, safe from all physical harm and illness, but I now think my prayers fell short. I should have asked God to keep James safe while he was here on the ranch, because it was here that James died.

The other night I sat outside and watched the moon rise. I could see glimpses of the far path James liked to walk and jog on, and I imagined him walking there and waving to me. I waved back and shouted, "I love you," and for a moment, I could almost see him waving back.

"Talk big," I hollered. My voice carried across the canyon. "I can't hear you."

In the moments before dusk melded into dark, I imagined him standing there, waving back. I wondered if some kind of parallel universe might somehow unfold between us. What if this time, every night, I could catch what I thought was a faint glimpse of James? Would it be enough to sustain me, and for how long?

I’ve driven to that side of the canyon, but someday I need to again resume my walks on this familiar path, to make my way to where he died. The Little Blue Stem and the other native grasses have now grown up to where they cover the road James cut, but no amount of tall grasses can hide the fact that under those trees is where his soul left his body, and that he'll never stand there, again, waving to me. 

My prayers have changed since James died. I now pray that all is well with James Daniel Coffee's soul, that he's with God and that he knows how much I love him.

"Thank you for loving me, James. Other than God and His precious Son, you are the best thing that's ever happened to me."

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The Year's Top 10 and More

Sunday, December 18, 2011
As the end of each year draws to a close, the news media publishes their Top 10 lists of the most important, most newsworthy, the most beautiful, the best movies.... The lists go on and on. While they are mildly interesting and usually remind me of events and people I’ve already forgotten, most of the things on these lists don’t matter a whit in the grand scheme of things.<PREVIEWEND>

For most of us, our families’ and friends’ health and well being is what matters; whether we have a job or enough money to keep our house and pay the taxes; whether we're good parents; whether we have the right words to comfort someone who’s dying or has lost someone dear to them, and whether our country is headed in the right direction. For me, I find myself thinking about so many of you who are fighting cancer, missing loved ones and coping with the blows life throws you. You, and so many others, are my top 10 and more. Daily, I lift each of you up in prayer.

In no particular order:
1. Christine S: Fighting recurrence of breast cancer and participating in a clinical trial.
2. Jacqueline J: Recovering from extensive complications from reconstruction surgery.
3. Lisa P: Breast cancer survivor & grieving the loss of her son.
4. Cindy TC: Her precious husband died Christmas Eve, last year.
5. Jan H: Two-time breast cancer survivor & recently separated from her husband.
6. Bonnie C: Her husband died early this year.
7. Ann L: Has gone through breast cancer alone.
8. Norma M: In hospice care.
9. Ruth G: Her cancer is Stage IV.
10. Linda H: Battling a long-term, incapacitating and undiagnosed immune problem.
11. June McD: In treatment for Parkinson’s.
12. Cheryl R: In hospice care & I can’t reach her.
13. Gayle H: Bravely participating in a clinical trial to treat her breast cancer.
14. Deb T: Has battled depression and recurrence of her breast cancer.
15. Marie O’C: Lost her unborn child and her mother.
16. Anna R: Living with metastatic breast cancer.
17. Glenn M: Recently diagnosed with three separate cancers.
18. Joanie F: In hospice care.
19. Norm H: Stage IV cancer.
20. Philippa K-D: Breast cancer survivor & advocate, recovering from back surgery.
21. Lee C: One of the strongest, wisest women I know.
22. Single working mothers everywhere.
23. Loving, faithful husbands and fathers.
24. Those who’ve been diagnosed with cancer.
25. Those who’ve lost loved ones.
26. Every member of my church.
27. The United States of America.

28. Role models of every age and sex.


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Help for Vaginal Dryness

Sunday, December 11, 2011
It’s no surprise that Diane Keaton’s and Jack Nicholson’s film, Something’s Gotta Give, resonated with women of a certain age. The movie portrayed a 50-60ish woman who, after having sex for the first time in a while, was ecstatic to discover she wasn’t “closed for business.” Women who are involuntarily closed for business are not having intercourse. More than likely they've had their ovaries removed, are post menopausal, have had chemotherapy or are taking estrogen blockers like Arimidex. For many women, estrogen can restore their sex lives. If you can’t take estrogen, however, there may be several things you can do, but before we go there, let's talk about the relationship between estrogen and sex.<PREVIEWEND>

Without estrogen, the vagina atrophies: It becomes shorter, narrower, dryer and has less elasticity, plus the walls of the vagina can tear easily, and sex can be extremely painful. The vagina may also be more prone to infections. A lack of estrogen can also contribute to a waning libido as can stress, having a baby and some medications. If you have vaginal problems or a low sex drive, you should first see your gynecologist to make sure nothing else is going on.

Last week I took Dr Susan Love to lunch, and we talked about estrogen and women who've had breast cancer. She was quick to point out that research on decreasing vaginal dryness has only been done on women who've not had breast cancer. Those studies found that estrogen creams appear to have a higher absorption than the low-dose Estring or Vagifem. If you've had breast cancer and your doctor approves you for estrogen, talk to him or her about prescribing Estring or Vagifem. Also, be aware that bioidentical hormones are still hormones, so don’t let anyone tell you they’re safer or better for you because they’re not.

If you can’t or don’t want to take hormones, Andrea Bradford, Ph.D. psychologist and instructor of Gynecologic Oncology at MD Anderson suggests using a combination of techniques. For starters, use a vaginal moisturizer several times a week and a lubricant each time you have sex. Check the labels on non hormonal over-the-counter products and avoid those with alcohol, propylene glycol and parabens. For some women, personal lubricants that are oil or silicon-based can cause more friction and therefore more pain, and lubricants with glycerin are known to promote yeast infections, so water-based products are preferable. My favorites are Replens Single-Use Disposable Applicators and Wet Naturals Barely Bare. This particular Replens and Barely Bare may be harder to find, but you can purchase them at the RETAIL THERAPY store on You may also want to read my blog, Breast Cancer, Vaginal Dryness and Sex for more information about lubricants and exactly where and how to apply them.

You might also want to find a specialist who treats painful intercourse and vaginal dryness. They may suggest a set of vaginal dilators that, over time and with lubricants, can stretch your vagina, plus you can order them online. The specialist will probably have you start with the smallest dilator you can comfortably fit into your vagina. Try to progress to a new size each week with the understanding that each new size will be uncomfortable. Take it slow.

Changes in self-image due to breast cancer and the natural aging process make some women less comfortable with their bodies. One of the biggest factors in a post menopausal woman’s sex life is her relationship with her partner and whether she’s comfortable talking explicitly about what works and what doesn’t work to get her aroused. Most women require more than hugging and kissing. They need direct stimulation to the genitals and more than they needed before menopause. Perhaps we should rename “foreplay” to “men-o-pause.” Men, oh pause here, longer!


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What Your Oncologist Doesn't Tell You About Sex

Sunday, December 04, 2011

Libido and/or lack of libido was a major topic of conversation at the recent Life Beyond Cancer Foundation’s Retreat in Austin, Texas. Many of the women there were angry at their oncologists for not telling them about the side effects breast cancer treatment might have on their sex life. While we know a diagnosis of breast cancer may result in the loss of our breasts, few of us know we may also lose our sexuality. As one of the women at the Retreat asked, “Why didn’t my oncologist warn me that after cancer treatment, I would no longer have any desire for sex? I do it for my husband, and I know he wants more sex, but since menopause, it’s painful, and I’m just not interested anymore. Why didn’t my oncologist tell me that?”<PREVIEWEND>

Many oncologists tell their estrogen positive breast cancer patients that cancer treatment may push them into premature menopause--hot flashes, night sweats and weight gain--but they fail to tell us menopause may cause our vaginal tissues to become dry and paper thin. As a result, our vaginal opening may atrophy and become smaller, and our tissues become less pliable which results in painful penetration by our sex partner. What’s worse, we feel guilty that we’re not interested and don’t want sex like we used to, and we worry our partners may look elsewhere to satisfy their needs. Could menopausal libidos and painful sex be a contributing factor as to why some men have historically taken up with younger and juicier women?

If we deconstruct the word “menopause,” we get “men-o-pause,” which implies we’ve reached a point in life where we’ve pushed men, and perhaps sex, to the sidelines. Our mothers’ generation suffered through menopause and any resulting lack of sexual desire in silence, but we are not our mothers. We’re not prepared to go through the rest of our lives as female eunuchs. We’re not only conscious of the effect our lack of libido may have on our sex partner, but we miss our sexuality. We’re not afraid to say that we like sex; we like pleasing our partners, and we like having orgasms. Sex feels good, and it’s fun! What a dirty trick that just at the time when our children have left the nest, and we have more time and money to travel and enjoy our partner, mother nature saddles us with men-o-pause.

For years men have made it clear they want to remain sexually active until the day they die. Whats more, their sexuality is often more important than whether they survive their cancers or not, as exemplified by one of James’ ski buddies, who was diagnosed with prostrate cancer and chose not to receive any treatment. In other words, he chose his sexual health and a shorter survival as opposed to living longer with the very real possibility of sexual impotency and/or incontinence.

Trust me, I’m more than OK with the fact that men can sire children ad nauseum while my days of having babies are behind me, but I’m not OK with the fact that I don’t have a good sexual libido/self-moisturizing alternative except for hormone replacement therapy. Before James died, I decided to look into solving this problem. I spent countless months talking to gynecologists, oncologists, researching alternatives to estrogen and meeting with prominent chemists around the country. Just when I caught a glimmer of hope, a way to moisturize my dry and withered vaginal tissues, the Food and Drug Administration (FDA) stepped in and crushed my bubble.

Because the FDA defines a personal internal moisturizer as “intended to affect the structure or function of the body,” such a product must go through the FDA. Unless I was willing to spend years and years and millions and millions of dollars taking my product through clinical trials, it would never be anything more than a fantasy... and not one of the sexual ilk. If I didn't go through the FDA, no reputable laboratory in the country would develop and/or manufacture such a product and if I somehow found one, here or abroad, the FDA could slap us with an injunction, shut us down and sue us for all the tea and orgasms in China.

So for now, we must make do with less than perfect herbal and over-the-counter remedies while we take a page from our male counterparts and raise our voices until we have a safer solution than hormone replacement to our problem.

PS: You didn’t really think I was going to leave it at that, did you? Next week, we’ll talk about some practical things you can do to help the situation.

PPS: To all of you who emailed and called, asking about Goldie, I thank you for your kind wishes and prayers. I’m over the moon to report she seems to have gotten rid of the incredible, mind-boggling amount of lace she consumed, but it wasn't easy. We'll leave it at that. From now on, I’m going to put her in the bathroom when I leave the house and take away all the towels and bathmats and soap. Goldie girl will only get a bare tile floor and a stainless steel bowl full of water until I feel like I can trust her again, but then again, hello! She's a dog! That's what they do... Oy vey!

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