Thursday, April 28, 2016

Get ready for possible side effects of chemotherapy

Ask questions and work with your health care team to prepare for chemotherapy so that you know what side effects to expect and how to manage them.
Chemotherapy works by killing rapidly dividing cancer cells. As it wipes out cancer cells, though, chemotherapy can also destroy fast-growing healthy cells. This may cause you to experience side effects.

Lower blood cell production

Your bone marrow's ability to make blood cells might decrease.
  • Anemia. You may not have enough healthy red blood cells to carry oxygen to your tissues, which can leave you feeling tired or short of breath.
  • Bleeding. You may not have enough platelets — a blood cell that plays an important role in forming blood clots — to help prevent bleeding when you're injured.
  • Infections. You may make fewer white blood cells, which protect your body from infections. An elevated body temperature may be the earliest sign of an infection.

Gastrointestinal symptoms

The lining of your stomach and intestines could become damaged.
  • Diarrhea. Your body's ability to absorb nutrients from food and get rid of waste might be affected.
  • Nausea and vomiting. Damage to your stomach and intestinal lining can also cause nausea and vomiting.
  • Constipation. Though less common, constipation also can be a side effect of chemotherapy.

Skin and hair symptoms

Chemotherapy targets rapidly growing cells, including healthy cells in your hair and inside your mouth.
  • Hair loss. This happens most often on the scalp but your eyebrows and eyelashes may thin, too. Fortunately, hair loss is almost always temporary.
  • Mouth sores. Damage to the cells in your mouth can create sores that make it difficult to eat and drink.

Whole-body effects

Chemotherapy drugs go through your bloodstream and can affect your whole body. That can cause symptoms such as fatigue. Feeling tired or having little energy is a common side effect of many types of chemotherapy.

Work with your health care team

Consider preparing a list of questions about side effects to ask your health care team so that you can get ready for chemotherapy.
Here are some questions you can ask:
  • What side effects are most common with the drugs I'm receiving?
  • How do these compare with the side effects of other treatments?
  • What can I do to prepare for these side effects?
  • What can I do to decrease the chances that I'll have them?
  • What side effects are dangerous and should prompt a call or visit to the clinic?
  • May I call you anytime if I have these side effects? What phone number should I use?
After you start treatment, it's important to tell your health care team about all the side effects you experience. The earlier they know, the more likely they can prevent side effects from becoming more-serious problems.

Tastes change during cancer treatment: Try more vegetables

By Sheryl M. Ness, R.N. April 21, 2012
I love spring weather! Warmer, longer days, flowers blooming, green leaves on the trees, and fresh, seasonal vegetables in the markets.
A few weeks back, we talked about the benefits of a Mediterranean diet, which is rich in fresh vegetables. This spring, find new ways to incorporate fresh vegetables into your diet; and make the changes last all year.
One of my favorite ways is to make a salad. Include crisp, leafy greens, asparagus (steamed, grilled or roasted), spring onions, and radishes. Add protein by including white beans, garbanzo beans or lean roasted turkey. Finish the salad with a simple dressing made with olive oil, lemon juice and balsamic vinegar, and you have a tasty creation.
During and after treatment for cancer; your tastes can change. I've heard from many people that they prefer vegetables over meat especially during this time. A nice protein option is to make an omelet or frittata. There are many recipes available for this idea.
I especially like to include sautéed onions, zucchini and asparagus or broccoli with 2-3 eggs (or simply egg whites) along with new potatoes with the skins still on them. Use olive oil in the pan to sauté your vegetables and this will keep the fat content healthy. If you love toast along with this dish, choose whole grain bread.
For dessert, mix vanilla or plain yogurt with fresh strawberries, blueberries or bananas. Add a few nuts on the top, or a little granola and your sweet tooth will be satisfied.
I know many of you have other great thoughts for incorporating healthy vegetables and fruits into our diets. Share your ideas and suggestions on the blog.
Follow me on Twitter at @SherylNess1. Join the discussion at#livingwithcancer.

Follow on Twitter: @SherylNess1

Monday, April 18, 2016

A Recently Revealed Protein Structure Creates New Opportunities for Cancer Research and Drug Design

By Eva Kiesler 
on Thursday, May 30, 2013
Pictured: Three-dimensional structure of the protein mTOR
In an eagerly awaited study, Memorial Sloan Kettering researchers report on the molecular structure of mTOR, a protein commonly mutated in cancer.
For the first time, structural biologists at Memorial Sloan Kettering have revealed the molecular structure of mTOR, a protein known to be involved in many types of cancer.
The findings, obtained using a method known as x-ray crystallography, provide important insights about how the protein functions. The information may also be used to speed the development of new cancer drugs that act on mTOR.
Three-dimensional renderings of a major portion of mTOR were published in the journal Nature on May 9. In an accompanying commentary, scientists who were not involved in the research observed that the “stunning structure” has been eagerly awaited.
We asked the senior author of the study, Structural Biology Program Chair Nikola P. Pavletich, to tell us more about the findings and their potential value.

What is mTOR, and why are cancer researchers paying close attention to it?

Before a normal cell divides, it senses whether it has enough energy, nutrients, and other factors to grow. The mTOR protein plays a key role in this sensor system by helping the cell receive and respond to a number of external signals.
When growth conditions are favorable, mTOR sets off a cellular process called the mTOR pathway, inducing the cell to grow in size and ultimately causing it to split into two cells.
In many cancers, mutations result in a hyperactive mTOR pathway. As a result, cells may divide excessively and spur the formation of tumors.
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How may the structure of mTOR inform cancer research?

Scientists have a fairly good understanding of what signals trigger the mTOR pathway, and how these signals may lead to cancer when the pathway is malfunctioning. In fact, there are hundreds of drugs in development that work by inhibiting the function of mTOR.
But until now, we haven’t fully understood how the protein is regulated at the molecular level – how it is tickled to act.
Once you solve a protein’s structure – in essence, creating a three-dimensional map showing where all its atoms are – you gain much deeper understanding of how the protein works and how its function could be manipulated with drugs.
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What challenges did you have to overcome in obtaining the structure?

In x-ray crystallography, you need to produce a protein in large amounts while making it assume its natural shape, and then coax the protein into forming crystals in which all its atoms can be analyzed. In our case, obtaining a crystal wasn’t trivial — partly because mTOR is a huge and complex protein. The only way we could make it fold properly was by producing it in human cells.
Human cells are more difficult to work with than bacteria or insect cells, which are conventionally used for this purpose. A turning point in our research was figuring out how to make human cells produce mTOR in sufficient amounts.
Another challenge was to determine the biochemical conditions needed to work with mTOR in the lab. The way we think of it, it’s learning how to keep the protein happy outside of the cell.
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What type of information did the structure reveal?

Like many other cancer-associated proteins, mTOR belongs to a protein type called kinases. We were surprised to learn that the mechanism that controls mTOR activity is different from that of most other kinases and essentially unknown for this type of protein.
By studying the structure of mTOR, we gained a better understanding of how the protein is controlled in normal cells and how it is hyperactivated in cancer.
In addition, we were able to analyze the structure of the mTOR protein bound to drugs that inhibit it. The information we gained could be used to speed the development of these drugs, which hold great promise for cancer treatment.
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Could you tell us more about how your findings could help scientists improve upon existing, investigational drugs?

The mTOR-inhibiting drugs that currently are being developed have been discovered though a process of trial and error, which means their specificity and efficacy may not be the best possible.
Knowing what the protein looks like in detail, it is now possible to purposely optimize these drug molecules, a concept known as rational drug design. In the future, we are likely to see new mTOR inhibitors that perform even better than existing drugs — controlling cancer more effectively while minimizing the risk of side effects.

License to Build: New Theory of Cancer Puts Metabolism at Center

By Matthew Tontonoz
on Tuesday, January 12, 2016
Montage of beer, reproducing cells, and building blocks

Scientists have known for 100 years that cancer cells metabolize nutrients in a unique way, though they haven’t understood why. In a new paper, MSK researchers reconsider the evidence and offer an unorthodox explanation, turning some commonsense wisdom on its head.
  • Normal cells in the body do not take up nutrients without the appropriate growth signals.
  • Cancer cells acquire mutations that allow them to take up nutrients autonomously.
  • This altered metabolism may lie at the heart of cancer.
  • Targeting cancer metabolism opens up new avenues for treatment.
Long before Louis Pasteur became famous for proving that diseases were caused by germs, he worked in a beer factory. His job: finding a way to make beer from sugar, hops, and yeast without having the yeast take over the vat, gunking up the beer.
He failed.
Turns out yeast are very good at converting sugar into more yeast, and nothing Pasteur did could change that — which is why today, most beer is filtered.
This long-familiar fact about beer making is inspiring some unconventional thinking about cancer. In apaper published today in Cell Metabolism, Memorial Sloan Kettering President and CEO Craig Thompsonand postdoctoral fellow Natasha Pavlova argue that cancer cells take up and use nutrients much like yeast in a vat of sugar, reproducing with wild abandon. Further, they claim that it’s this altered metabolism of nutrients — rather than any quirk of a disordered cell cycle — that lies at the heart of cancer.  
“All of the information that drives the cell cycle — drives cell growth — comes from cells recognizing that they have adequate nutrients,” says Dr. Thompson.
If he’s right, then much of what we think we know about cancer is wrong.     

The Challenges of Living Together

For Dr. Thompson and his colleagues, the problem of cancer is intimately tied up with another biological question: how living things evolved from single-celled organisms, such as yeast, to multicellular organisms like fish, birds, and biologists.
“The fundamental thing that allows us to live as a collaborative multicellular organism — a society of cells — is that every cell agrees it will not take up and utilize the shared resources available to the body except on its instruction from other cells,” says Dr. Thompson.
In this view, cancer results when cells stop playing by the food rules. Through mutations, they develop the capacity to acquire nutrients autonomously. After that, it’s every cell for itself.
Through mutations, cancer cells develop the capacity to acquire nutrients autonomously.
The easiest way to see this, Dr. Thompson says, is to consider what happens when a person gets a yeast infection in the blood, a common problem on hospital wards where people are often immunocompromised. The yeast find their way from the bloodstream to the liver — a nutrient smorgasbord — and grow out of control.
“Metastatic cancers do the same thing,” he explains. “They act just like yeast, and that’s why the liver is the most common site of metastasis.”
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Revisiting Cancer’s Hallmarks

Craig Thompson and Natasha Pavlova.

Drs. Thompson and Pavlova named their paper “The Emerging Hallmarks of Cancer Metabolism” in homage to a famous article called “The Hallmarks of Cancer,” published in 2000 by Douglas Hanahan of UCSF and Robert Weinberg of MIT.
In that article — required reading for every cancer biologist — the authors describe six features, or hallmarks, of cancer that they believe characterize the disease, including things like activated growth factor signaling and evasion of cell death. Not included on the list is anything having to do with altered metabolism, the subject of the new paper.
Metabolism did later receive attention from these authors, but even then it was accorded a secondary status.
“The repeated refrain from traditional biochemists is that altered metabolism is merely an indirect phenomenon in cancer, a secondary effect of cancer cells gaining signals to survive and proliferate,” Dr. Thompson says. “The heretical part of our argument is that we’ve gotten all of this wrong.”
In support of their view, Drs. Thompson and Pavlova point out that many cancer-causing genes, or oncogenes, have direct effects on metabolism. For example, the oncogenes AKT and RAS directly increase glucose consumption by cells. Other cancer-associated genes, such as MYC and Rb, boost uptake of amino acids, another important nutrient.
Oncogenes do not simply transmit instructions for a cell to survive, grow, and divide, but in fact directly control nutrient uptake and utilization.
Natasha Pavlova
Natasha Pavlovacancer biologist
“It is becoming increasingly clear that oncogenes do not simply transmit instructions for a cell to survive, grow, and divide, but in fact directly control nutrient uptake and utilization,” says Dr. Pavlova, a postdoctoral fellow in the Thompson lab and the paper’s first author.
This “metabolic reprogramming” has long-term consequences for the cell, she says, transforming it from one that obeys the instructions of its neighbors to one that seeks only to feed and reproduce itself. 
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Rediscovering Metabolism

Kidney cancer cells growing in culture.

The new theory helps to make sense of a long-standing cancer conundrum. Scientists have known since the 1920s that cancer cells take up much more glucose than normal cells (which, incidentally, is the basis for PET scans). However, cancer cells don’t process this sugar in the same way normal cells do.
Typically, cells burn sugar in their mitochondria to make ATP, which they use to power chemical reactions. (Recall from your high school biology class that mitochondria are the cell’s “power plants.”) Cancer cells, on the other hand, use the less efficient process of glycolysis, which produces fewer molecules of ATP and leaves much of the glucose energy untapped. (Yeast do this too; it’s called fermentation.)
This fact has perplexed biologists over the years, since cancer cells presumably have a great need for energy. “For a hundred years, we’ve thought that the whole problem of life was gaining a battery supply,” Dr. Thompson says. “We weren’t thinking about the problem of how you actually make two of something.”
For a hundred years, we've thought that the whole problem of life was gaining a battery supply.
Craig B. Thompson
Craig B. Thompsoncancer biologist
To make two (and four and eight) of themselves, cancer cells need more than just energy; they need building materials — sugar to construct DNA and lipids to make membranes, for example. Shunting nutrients from the power plant to the assembly line, therefore, makes perfect sense.
The effects of cancer metabolism do not end there. Metabolic products also affect gene expression, which shapes a cell’s identity. Cancer cells even pump out metabolic products that trick neighboring normal cells into helping them proliferate and spread.
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New Treatment Options

If correct, Drs. Thompson and Pavlova’s new theory suggests that targeting altered metabolism could be an effective approach to cancer treatment. Drugs not previously thought of in the context of cancer — such as the diabetes drug metformin — might become useful in the fight against the disease. We might even find that many existing cancer drugs, including certain targeted therapies, achieve their effects by affecting a cell’s access to nutrients, in contrast to current theories of how they work.
The study of cancer metabolism is more than a century old, but these recent discoveries are revitalizing interest in the subject. Asked if he thinks the time will come when altered metabolism will be seen as a full-fledged cancer hallmark, Dr. Thompson is bullish: “I actually don’t think it’s a hallmark of cancer,” he says. “I think it’s the root cause.”
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Craig Thompson is supported by grants from the NIH and NCI, and is a founder of Agios Pharmaceuticals. Natasha Pavlova is supported by the Terri Brodeur Breast Cancer Foundation.

Saturday, April 9, 2016

How a dermatologist protects her skin from the sun

Saira George, M.D., knows the importance of taking care of her skin. “Sun protection should be a regular part of your day, just like brushing your teeth,” she says.
Saira George, M.D.
Saira George, M.D., knows the importance of taking care of her skin. George is a dermatologist at MD Anderson in Sugar Land.
“As dermatologists, we see the effect of sun damage in our clinics every day,” she says.  “I think most people now realize that too much sun can cause skin cancer. But they may not realize just how much of what they thought was 'normal' aging of the skin – wrinkles, sun spots, loss of elasticity – is actually sun damage.  And that’s something you can minimize.”
Here are some of the advice George offers to help protect your skin from the sun.
Make sun protection a simple part of your daily routine
Since the effects of sun damage are cumulative, doing something to protect your skin on a daily basis can add up to big benefits down the road.  
“For a regular work day, I keep it simple and apply a daily moisturizer with sunscreen under my makeup every morning,” George says.
Factor in the sun if you're going to be outdoors
If she’s going to spend extended time in the sun, like outdoors at a soccer game or by the pool, George applies a dedicated sunscreen.  
“I hear a lot of people say they don’t like sunscreen because they remember ones they tried in the past that felt greasy, smelled funny or stung their eyes,” George says. “But nowadays with all the different options available, there is a sunscreen for everyone. It’s a lot easier to find one that you like and will use.”  
She recommends wearing a sunscreen that is broad-spectrum (meaning, it protects against UV-A and UV-B rays), has an SPF 30 or higher and is water resistant.   
“It doesn’t have to be fancy. I use a drugstore brand,” she says.  
For sunscreen to work as intended, though, it has to be applied correctly. 
“Most of us don’t put on nearly enough sunscreen or reapply it enough,” she says. “I’ve certainly been guilty of that.” 
She recommends applying sunscreen 30 minutes before heading outside and reapplying it every two hours.
“Apply enough to get a nice even layer that you can massage in. Some rules of thumb are that an average sized person would need a nickel sized dollop for just the face and a full shot-glass (1 ounce) to cover their entire body,” George says.   
Have a complete sun protection plan
“Sunscreen should just be part of what you do when you’re out in the sun,” George says. “What you wear or where you will be outside can be as, or even more, important as far as sun protection goes.” 
When she’s going to be outdoors, she wears a wide-brimmed hat and sunglasses. If she’s heading to the beach or pool, George wears a sun shirt or rash guard.   
“Clothing offers excellent, easy sun protection. And don’t forget to seek shade," George says. "If I’m hanging out outdoors, I look for a spot under a tree, umbrella or shade structure.”   
Plan ahead
George also tries to limit her time spent outside between 10 a.m. and 4 p.m. That’s when the sun’s ultraviolet radiation is strongest, especially during the summer. If she plans to do yard work or take her three young children to the park, she tries to schedule it for after 4 pm. 
“All the sunscreen in the world won’t be enough if you’re out there for too long or during the wrong hours,” she says.
Pass on the knowledge and habits
As the mom of three children ages 8, 6 and 2, George also knows the importance of protecting her children from the sun. Just like she does with her own skin, she tries to keep her children out of the sun during peak hours, applies sunscreen and makes sure they’re armed with hats and sunglasses.
But she does more than that. She teaches them about the importance of sun protection.
“We try to make it a habit with them,” she says. “Sun protection should be a regular part of your day, just like brushing your teeth.” 

Online Comfort For Real-World Cancer Can Be Surprisingly Sweet

Steve Julian, a radio host with KPCC in Los Angeles, was diagnosed with terminal brain cancer last November. He and his wife, Felicia Friesema, turned to social media for solace, support and the space to process their heartbreaking journey.
Steve Julian, a radio host with KPCC in Los Angeles, was diagnosed with terminal brain cancer last November. He and his wife, Felicia Friesema, turned to social media for solace, support and the space to process their heartbreaking journey.
Rachael Myrow/KQED
The KQED podcast Love in the Digital Age explores "how technology changes the way we experience love, friendship, intimacy and connection." The most recent episode focuses on two people — a Los Angeles radio host and his wife — who have drawn great strength from their online communities and social media as they face his diagnosis of terminal cancer. You can listen to the podcast here.
Felicia Friesema had seen the signs of brain cancer before. Her husband, Steve Julian, wasn't just forgetting his keys on the kitchen counter, or having another of the myriad brain farts we often associate with middle age. He'd stop in the middle of a sentence, like he'd just hit a brick wall. And that was that.
"It wasn't that kind of gradual onset that Alzheimer's is," Friesema recalls. "It didn't sound or feel like dementia. This was so sudden — and it was very eerily similar to what happened to my aunt, my tia Gloria," Friesema says.
This time, the loved one with cancer was her husband.
Over the years, they've built a cozy life together in a sweet, spacious home in Highland Park, a neighborhood in northeast Los Angeles. She's head of marketing for Foothill Transit. And Julian is one of a handful of trusted voices helping Angelenos navigate the freeways every day, as morning anchor for a public radio station, KPCC-FM. In his off hours, he'd been active for years in local theater as an actor, writer and director.
Steve Julian and Felicia Friesema in easier times.
Steve Julian and Felicia Friesema in easier times.
Courtesy of Felicia Friesema
Now, he was having trouble navigating his way through a sentence.
"Technically, all tumors are operable," Friesema explains. "The question that comes into play is, what are you willing to sacrifice in order to get it out? The position and location of his tumor is such that you would have to completely destroy a lot of healthy brain tissue in order to remove it. You would be creating a situation of paralysis, major cognitive dysfunction, irreversible brain damage — and, ultimately, for possibly very little reward. There's no way of skirting it: I was looking at his death."
Around Thanksgiving last year, Julian was diagnosed with terminal brain cancer at the age of 57. They decided not to try to stretch his last months with chemo and radiation therapy. Julian has less time than he might have, but he can eat what he wants, sleep with their dogs, and squeeze the last juice out of the days that remain with his wife.
She's taking time off from work, thanks to a compassionate boss. In the 20 or more hours a day that Julian now sleeps, Friesema takes care of everything else — the meals, the housekeeping, the medicine, insurance and the emotional management.
Of course, friends and family are helping. Larry Mantle, Julian's dearest pal, comes over for company and a wee dram of whiskey. Friends have delivered dozens of lasagnas to the doorstep and whipped out their credit cards to cover what insurance doesn't. But at the end of the day, Friesema is alone. And every morning, there's a little bit less of Julian.
Reaching Out Online
It was a few months into his diagnosis when we noticed Felicia Friesema's journal onCaring Bridge, a website designed to help families and friends of someone who is ill give updates and get them, and offer and receive encouragement.
We recognized a kindred spirit in Friesema — someone else in the special club of those who have lost or who are losing a close loved one. We had to fly down to Los Angeles and meet this woman who wrote so deeply and thoughtfully, and with such compassion, about a journey no one chooses.
"I know that this is treacherous ground we walk on and that time is of the essence. We wake up to the juxtaposition of joy in another day together and terror at what may come.
"There is no detailed prognosis yet. But we do know that there is no outcome we like. And I have never been so scared. But I have also never been so completely full of love for him."
That was Dec. 2, 2015. At that point, Steve Julian could still help his wife craft a communique to friends:
"I miss being at work and in the studio. I miss being with all the people I love at KPCC. I'm still good at traffic. We chose UCLA for the surgery and treatment, and navigating to the westside can be tricky. The tumor can take away what I had for dinner, but not my memory of the traffic jams I've sat in.
"I am sad. I feel the unfairness of all of this. But I also feel the love for my wife, which grows every day as she balances the technical work of our affairs with the emotional work of our daily life. Like making sure I eat three solid meals. And I mean really solid. Four, sometimes. She tells me I'm loved about a hundred times a day — I remember a few of them. Larry [Mantle, host of Air Talk], my brother in all but blood, is a rock for both of us and has been by our side from diagnosis until now."
Many people facing down the gun barrel of something this awful retreat into family. But Friesema reached out from the beginning to friends online.
"We kind of had to," she explains. "We've kind of got a unique and peculiar situation. I mean, Julian's a very popular radio host in a very large market. He's also incredibly involved in the theater community here. He also used to be a cop. So, you have these seemingly disparate communities that he's connected to. That's thousands of people — his most intimate friends all the way down to the casual listener."
Felicia Friesema is not your regular home cook. She studied at the Ecole de Cuisine in Pasadena.i
Felicia Friesema is not your regular home cook. She studied at the Ecole de Cuisine in Pasadena.
Courtesy of Felicia Friesema
From the peace and quiet of their home on the hill, when Julian is sleeping, Friesema can write about all the medical details that would exhaust her if she had to repeat them to people in one individual conversation after another.
Friesema also uses the blog to process what's happening in her world, "to take this jumbled puzzle-piece of Post-it notes and ideas and thoughts and put them together into something that is like, 'Oh! OK.' "
"Usually, I don't know when I'm going to conclude until I start writing," she says, "and by the end of it, I'm like, 'Oh, that's my "aha" moment. OK. All right.' "
On Facebook, for a smaller, closer audience, Friesema shares bite-sized missives from her daily journey — proof the bees in the backyard are making "So. Much. Honey." Or her desperate wish that MRI machines played Brian Eno instead of frightening clicks and buzzes. Her rage against the insurance company, or her pride in yet another crazy, beautiful meal made for Julian.
And then there are the jokes. If anything, staring down death has heightened the couple's sense of humor.
"Fun with brain cancer:
"Steve: Jen!
Me: Yeah, babe (knowing full well he was calling for me).
Steve: Oh, I'm sorry. I just called you Jen.
Me: Yeah, I know, babe. It's OK. What's up?
Steve: (tells me some stuff he needs).
Me: No problem. By the way (smiling), I'd like to know who the hell Jen is.
Steve: (chuckles) So would I!"
The love has come pouring in from all corners. By Jan. 4, Friesema reported that more than 100 people had made deliveries, run errands or completed tasks around the house.
Julian's had a sandwich named after him at Wax Paper, a local sandwich shop with a thing for public radio. Friends have blogged about Julian. Local Morning Editionhosts across the country recorded their well wishes on YouTube.
Steve Julian of KPCC in Los Angeles gets a studio named after him, and a great big hug from President and CEO Bill Davis.i
Steve Julian of KPCC in Los Angeles gets a studio named after him, and a great big hug from President and CEO Bill Davis.
Courtesy of Felicia Friesema
People "are grateful for being included," Friesema says, "or grateful just to know that Steve's OK for now. Or they're grateful for an opportunity to help. I'd been crying so hard just a few days ago. I just couldn't stop. I was so sad and so dejected. And, at the end of the day, my status update on Facebook was, 'There just aren't enough tissues in the box.' So, the next day, what arrives on my doorstep but a case of Kleenex. And the message was, 'We know that this isn't enough, but hopefully it helps.' "
"One of the things we've been focusing on," Friesema says, "is making sure that every day is about some kind of pleasure — some kind of happy moment, some laugh, something in there that actually makes the day not a routine of caregiving."
Friesema sighs. "You know, something that reminds us that there are all these wonderful pieces to life and that living doesn't stop with a cancer diagnosis."
What remains online from this journey is a whole lot more than the testament to the love that people have for Steve Julian and Felicia Friesema. It's a social network — in the best sense — that will be there for Friesema, waiting to engage and respond anytime she wants.
This story was produced by The California Report at KQED, with production support from California Report's LA Bureau Chief Steven Cuevas.