I talked to the nurse at my gynecologic oncologist's office this week, specifically we discussed that I have been having just a general feeling of fatigue and I was seeking an explanation for why I am feeling this way.  As we talked, the answer to my question became so evident to me.  Sometimes, as much as I want to ignore it and pretend like I can just push through everything like normal, I need to slow down and remember that I do have cancer.  Speaking with my nurse, who doesn't even see my day-to-day life, she was able to rattle off a list of things I had completed in the last month that would make the most healthy person I know tired.  That was without her even knowing that I am actively doing other things on top of the things she was able to list.

If you know me personally, you know that I don't really slow down.  I push through and get things done that I want and/or need to get done.  You also know that it is really no good to try and tell me to do something differently, slow down, or change my plans.  When I have my mind set on something, I am going to do it.

I think that sometimes, because I don't look sick, people forget that I have cancer.  Or maybe forget is a poor choice of words.  I think it is easier for people to compartmentalize it and see me as healthy.  It is easier for me to forget that I need to take time to myself.  When I had a nephrostomy tube coming from my back you can be sure I never "forgot" I had cancer.  It is easier to put the cancer aside when I look healthy.  I don't want to see myself as sick.  I don't want to be sick.  I want to go back to my life as if it is all normal.  It is not normal.  It will never be normal again.

I have been debating writing about this for a while.  I don't want to change the way people look at me.  I don't want you to question if you should invite me out.  I don't want you to stop yourself from asking for my help with something.  I don't want you to see my differently.  I don't want to be different.  I don't want you to handle me like I am fragile and going to break.  I don't want you to feel like you need to take care of me.  

So, you might be wondering, what do I need?  I just need you to be there.  I need you to understand that if I can't do something, it isn't you personally.  I need you to include me in things, even if I end up not being able to make it.  I need you to understand, sometimes I just have to go home and rest.  I need you to trust that I will work to not overcommit myself and I will tell you when I just am not up to doing something.  I need you to help me make the world a fabulous place for my son, who has to see the worst parts of cancer.  Most of all, sometimes I just need a minute to breathe.

This week I had to make an unplanned visit to my gynecologic oncologist.  If you are grossed out by medical information, now would be the time to stop reading.  I was having increased blood in my bowel movements.  I mentioned it to my nurse and she had me come in right away.  Apparently it is a symptom which can be caused by Avastin.  That is the hardest part about treatments.  Each treatment, even a treatments that doesn't make you overtly sick, brings along its own potential side effects.

I saw the nurse practitioner and she hoped since I wasn't exhibiting any other urgent concerns I could move forward with my Avastin treatment, scheduled for next week.  They got me scheduled to see a GI specialist, add that to the list of doctors I never thought I'd have to see, for President's Day.

Well, I received a phone call Friday that changed our plans.  My gyn-onc wants me to postpone next week's Avastin treatment.  The concern is, if the GI doctor were to need to do a procedure I would need to be off Avastin for 28 days before that procedure could take place.  You see, Avastin can make it harder for your body to heal, more side effects.  So, I will be postponing this week's planned treatment until I can see the GI doctor on February 15th.  I don't like it, and  I expressed this to the nurse practitioner I was talking to over the phone.  She said she understood but they really felt that we needed to hold this treatment so when I see GI I would have been off Avastin for 28 days and if something more serious were happening and they needed to do a procedure I wouldn't have a waiting period.  They also mentioned that my kidneys could use a break.  Too much rationale and science for me to dispute.  That doesn't make it easier though.

It is difficult mentally to have to miss a treatment.  The Avastin is suppose to be stopping the cancer from spreading and/or growing.  When I have to miss a treatment all I think about is what could be happening inside my body during this missed treatment.  What could be happening?  It is scary and mentally taxing. 

I am honored to be the featured blog post on Cervivor this week.  While co-hosting Cervivor School Hoosier and attending Cervivor School South I was able to witness some amazing things during Cervical Cancer Awareness Month.

Check out the post here, on Cervivor, to hear about these experiences.  

The United Nations Secretary-General Ban Ki-moon released a message in support of World Cancer Day.  One specific portion of his message really resonated with me, and helped guide today's blog post:

I would like to start out by noting, I am discussing the developing word as low to middle income countries.  According to the WHO, of the 270,000 cervical cancer related deaths annually world wide, 85% of the deaths occur in the developing world.  The state of healthcare in these countries varies widely.  However, it is all subpar to any of the healthcare systems in the developed countries, specifically the United States.  Healthcare in the middle income countries is more developed than the healthcare in the low income countries.  In many instances, there is zero healthcare available in the low income countries.  According to the WHO, globally, in 2012, there were nearly a billion women between 30 and 49 years old, most of whom have never been screened even once in their life.  Take that in for a moment, these women have never been screened.  It is no wonder women are dying at such high rates!

There are three major barriers to effective healthcare related to cervical cancer in developing countries - 

• Lack of money - for many communities in developing countries the lack of financial resources is the primary barrier to healthcare.  Global health organizations can help to minimize healthcare costs, however the lack of financial stability remains a major barrier to healthcare.
• Lack of education - in the developing countries there is much poverty and a lack of basic education.  People who live in poverty typically aren't provided education about when, why, and where to even access basic healthcare.  Another area of concern is the lack of basic public health education.  This lack of education can lead to a negative stigma and increased spread of disease.
• Lack of resources - in the United States there are experts all over the country who are trained doctors able to perform annual well woman exams, there are also ample experts able to analyze data collected from Pap tests and provide accurate results for treatment.  This is simply not the case in the developing world.  There are not enough trained individuals to perform the needed exams and read the analyze the needed information.  There are, obviously, also not enough trained professionals able to treat any precancerous lesions which could be found during regular exams.  The lack of resources is a major barrier to having adequate healthcare in these developing countries.

Cervivor is on a mission to eradicate cervical cancer!  Cervivor is an organization built around the principles of being informed, empowered, and alive. Cervivor is a community, a learning tool, an advocacy resource, and an online retreat for healing, connecting and thriving.  We at Cervivor want women dealing with HPV or cervical cancer to know they are not alone. We are a circle of friends, a circle of support and a circle of hope. Our network of survivors and their friends are all part of this circle – offering support for those who have received a diagnosis, education to those who want to learn how to protect themselves from cervical cancer, and advocacy to everyone who wants to help us stamp out this disease once and for all. Visit Cervivor to learn how you can get involved.  

Another organization which is on a mission has a goal to minimize the barriers and reduce the global burden of cervical cancer.  The Global Coalition against Cervical Cancer (GC3) provides expert analysis with best fit sustainable solutions to reduce the global burden of cervical cancer
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The World Cancer Day initiative also has several suggestions for how you can get involved to help minimize the impact of cancer.  All of these principles can be applied to reducing the global impact of cervical cancer.

Infographic provided by GC3 shows the yearly global cervical cancer burden of the US compared to India and Africa.  As you can see from this graphic the rate of disease incidence and fatalities increases as the income and development level decreases.

I had the honor of meeting Clara Griffin of GC3 in Charleston at Cervivor School South.  She helped shed some light on what conditions are like in low and middle income developing countries.  I felt like seeing is believing in this case and I reached out to see if she could share some photographs with me which really show what women's healthcare is like in these other countries.  She first told me that these pictures are all based in middle income countries.  Can you guess why?  The answer, in my opinion, is devastating.  The low income countries do not have facilities so there is nothing to have a picture of!  Imagine that.  You are having unusual symptoms, things don't seem right, and there isn't even a place to go.

Looking at these pictures, think about your doctors offices, hospitals, and medical facilities.  Can you imagine walking into any of these facilities pictured below and receiving adequate healthcare?  When Clara sent me these pictures she noted that there is an open box of pathology (pap smears) slides with a bag of food trash next to it; these are actual results waiting to be analyzed!  Boxes of papers that are, in fact, the filing system for the lab; imagine if that is how your files were stored. There are jars of swabs not only open to the air but the collection end is up where it can not only collect other material but someone might grab or touch it; how accurate do you think those test results will be?  When I looked at these pictures I noticed many things.  There is mold on the walls in a medical facility and on the walls of a diagnostic room.  These are real pictures, of what the healthcare conditions are like globally right now.

I encourage you to fully embrace the purpose of #WCD, and take a chance to reflect on what you can do, make a pledge, and take action.  Specific examples of what you can do include:  make healthy lifestyle choices, understand that early detection saves lives, ask for support, support others, take control of your cancer journey, love and be loved, be yourself, return to work, share your story, and/or speak out.  Please click on #WCD for examples of each of these items and guidance for how it can apply to you.

Want to be involved in a larger way?  There are many ideas on the #WCD page to help you get involved on a grander scale!