Author: D.B. Sieders

Cancer and Career: Stigma, Discrimination, and Other Challenges for Patients and Survivors

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Photo credit Deposit Photos.

A cancer diagnosis affects all aspects of a person’s life, and that includes employment. Coupled with the astronomical cost of cancer healthcare, especially for the un- and underinsured, the short and long term impact of cancer on financial stability and employment can be disastrous. If you are female, a person of color, disabled, and/or LGBTQIA+, these negative impacts are very often compounded by sexism, racism, ableism, and homophobia.

The stigma is real*.

Photo credit Chronic Disease Coalition.

Sexism, racism, discrimination, and other biases make working, maintaining productivity, and feeling valued for your work much more challenging in the face of cancer. I’ll cover some of those challenges in this post, as well as protections in place within the United States to alleviate them (with the caveat that we need more), and additional policies and protections that we could implement to protect and support cancer patients and survivors in the workplace. I’ll focus on breast cancer, but many of these challenges and solutions apply to people diagnosed with other types of cancer.

What are some of the challenges cancer patients and survivors face when it comes to work and careers? According to a recent study published in the Journal of Clinical Oncology challenges like job loss, decreased earnings, and increased spending (the last two described as “financial toxicity”) are some of the greatest. It seems like a no-brainer: if you lose your job or part of your income plus healthcare coverage while the medical bills for treatments pile up, you’re not really surviving all that well financially, let alone thriving. But we like and trust peer-reviewed data here, so let’s look at data.

The Problems

Click here to link to source.
  1. Financial distress caused by job loss/lost wages not only makes you feel worse, it has also been linked to “increased symptom burden and emotional distress and to decreased quality of life and treatment adherence.” In other words, if you’re strapped for cash or you’re suffering from the mental health effects of a cancer diagnosis without resources, you’re not as likely to be treatment or medication compliant. That leads to poor outcomes. Worse, cancer patients are more than twice as likely to file for bankruptcy after diagnosis, and bankruptcy is associated with almost double the risk of death among survivors.

That’s the biggie, and adds insult to injury. You have to pay for your treatments in order to live, but you may have to go bankrupt to do it, which increases your risk of DYING!

2. The scope is significant. Around 45% of people diagnosed with cancer in the United States are working age (20-64). This affects a LOT of people, y’all!

3. Many, if not most, people diagnosed with cancer do not have the means, privilege, or opportunity to take leave, paid or unpaid, for treatments, even under the Family and Medical Leave Act (FMLA). In fact, only 21% of low wage workers have access to paid sick leave. And for many workers who do, there aren’t protections in place to make certain they can return to their jobs following treatment. The Americans with Disabilities Act (ADA) provides protections for cancer patients against workplace discrimination and requires employers to make reasonable accommodations to allow cancer patients to continue to work, but it only applies to employers who have 15 or more workers. And a significant percentage of low wage workers are employed by small businesses that are exempt from FMLA and ADA requirements.

These are the same essential workers we’ve failed as a nation to support during the global pandemic.

4. Aside from concrete challenges, the mental and emotional health costs of a cancer diagnosis can reduce social engagement and a patient’s sense of self worth. I work as a cancer researcher and a cancer center, have a TON of privilege, and even I’m not immune to these challenges*. If I’m not, imagine how awful it is for patients and survivors with fewer resources and protections.

5. I cover disparities related to cancer care, outcomes, and financial toxicity in my book, but suffice to say, if you are female, not white, not able bodied, and not straight, you are likely to disproportionately experience all of these challenges on a much more significant level thanks to racism, sexism, homophobia, and ableism.

Existing and Future Solutions

In addition to FMLA and ADA protections (for those who qualify), many non-profit organizations offer financial assistance to cancer patients. Funds are available from Susan G. Komen for the Cure, the American Cancer Society, Young Survival Coalition, and other organizations, many of which I cover in my book, that can be used to cover the costs of treatments, bill pay, home health care and childcare, and a variety of other expenses.

Photo credit Deposit Photos.

But to truly and comprehensively tackle this issue, we need systemic changes. Some of the more so-called “progressive” solutions, like universal healthcare coverage, tend to be met with skepticism or outright hostility from free-market (*cough, cough – rich, white conservatives – cough, cough*) advocates who complain about lack of “personal responsibility,” think the current system works just fine, and/or think vouchers for purchase of private insurance and other non-government solutions work better (even though universal healthcare works very well in most other industrialized nations).

Aside from universal healthcare, there are other initiatives that have worked in other nations that might appeal to conservatives while making a significant impact on job retention and financial stability for cancer patients and survivors. For example, as noted in the Journal of Clinical Oncology Society study cited above, “A 2012 systematic review evaluated the effectiveness of government policies in place from 1990 to 2008 in Canada, Denmark, Norway, Sweden, and the United Kingdom to change employer behavior with regard to return to work. The most successful policies included financial incentives for employers to hire people with disabilities; flexibility and adaptations in the work environment, particularly with flexible schedules and giving employees more control over work demands; and programs that involved employers in return-to-work planning.” These incentives benefit everyone, including employers, patients/survivors, and society as a whole.

Patient-oriented interventions that tackle physical, psycho-educational, and/or vocational portions of cancer patients’ employment retention were associated with higher return-to-work rates compared to patients who received standard care. And patients who received this type of multidisciplinary intervention “experienced a significant increase in perceived importance of work, work ability, and self-efficacy with regard to returning to work, and return to work was 59%, 86%, and 83% at 6, 12, and 18 months, respectively.”

It’s going to take a lot of work in the form of political will, advocacy, legislation, and incentives to solve this problem. What can you do to help? Contact your elected officials and voice your support for programs that support cancer patient financial stability and access to reliable and affordable healthcare, job retention, and return to work with appropriate accommodations. It’s the right thing to do, and it’s good for the economy, society, and humanity.

If you’ve experienced workplace discrimination based on your status as a cancer patient/survivor, click here for information about your rights and what you can do to protect them.

*Story Time

You’d think being a cancer researcher who works at an academic institution dedicated to cancer care, research, and saving and improving the lives of those diagnosed with cancer, I’d be immune to the bullshit discussed above.

In many ways, I am. Thanks to a supportive Department Chair and Division Chief (both female), I was granted an extension on my tenure clock, additional discretionary funds, and professional/personal support from my (largely female) colleagues. To these individuals, I see you. I appreciate you. I love you.

Then there are the (largely male) colleagues who have made my experience working while undergoing cancer treatment and returning to work after the Covid-19 shutdown and a (very short) medical leave a lot shittier. My passion for breast cancer researcher didn’t diminish when I was diagnosed. I became MORE passionate! I worked through radiation treatments, horrible systemic therapies while trying to find one I could live with for 10 years, and after surgeries when I remained swollen, sore, fatigued, and mentally struggling with all of the emotional fallout associated with cancer.

And yet…a peer reviewer for a grant I submitted felt the need to make the following comment in his (I’m 99.999999% certain it’s a dude) review summary: “Dr. Brantley-Sieders is an Assistant Professor of Medicine…who completed her Postdoctoral fellowship in 2003. A concern is her lack of productivity, with only a single first or last author publication since 2017, and only 4 in total since 2012. That said, as noted in her letter of support by [DEPARTMENT CHAIR], she is a breast cancer survivor and there may be circumstances that underlie her less than optimal extent of productivity.”

First of all, it’s not true. I had and have more first/senior author publications since 2017 and 2012. In fact, I have published over 55 papers in high tier journals, which demonstrates my highly collaborative approach to science. Secondly, WHAT THE ACTUAL FUCK??? This reviewer thought it was okay to weaponize my own breast cancer diagnosis on a grant I submitted to a BREAST CANCER RESEARCH ORGANIZATION in the presence of other BREAST CANCER SURVIVORS serving as consumer reviewers. But, since my application wasn’t de-identified, and with my hyphenated last name (for which I’ve received inappropriate feedback about), this reviewer felt entitled to pose this outrageous and untrue criticism on an application by a female scientist.

Rather than hiding in a corner to lick my wounds, I reported this to the organization starting with leadership. Was it a risk? Of course! Backlash and retaliation are always a risk, especially for women who dare to speak out. But, if I stayed silent, I would have become part of the problem. I refuse to do that. I’ll be part of the solution.

I’m in the middle of another situation with a colleague I once trusted (my mistake) that centers around perceived shortcomings related to how I am balancing my work and ongoing treatments. What started as a communication issue is rapidly escalating into something more serious. At best, it’s a problematic situation. At worst, it may represent a serious violation of policy. I hope to resolve it in a way that is fair and satisfactory to both parties, but the damage is done in terms of trust and my perceived value to the project. Again, I could just sit quietly and accept it, but I’m not going to be part of the problem. I’m a fighter. I’m a damned good researcher who has made and will continue to make valuable contributions to science, and I’m worth it.

I HAVE A PUBLICATION DATE!

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Talking to My Tatas: A Breast Cancer Researcher’s Adventure With The Disease And What You Can Learn From It is scheduled to be published February 8, 2022!

On. My. 49th. Birthday.

I’m not one for signs, but this is the second serendipitous date associated with this book baby so far. The first was getting the offer for publication from Rowman & Littlefield on November 5 of last year, the same day I was in surgery for the first step in my left breast reconstruction. This is the second. I am filled with joy and delight!

What’s next in the process? Now that I’ve turned in finalized chapters and other components of the book with edits in response to super helpful comments and notes from editor Suzanne Staszak-Silva (shout out to my amazing literary agent Barbara Collins-Rosenberg for giving me edits and notes prior to sending them to Suzanne), the manuscript enters the production phase. I’ll be receiving notes from the Production Editor, completing any revisions, going through proofs, reaching out for endorsements – shout out to the folks who already said, “Yes, send it to me for an endorsement!” – and planning for the release and promotion.

I cannot WAIT to see the cover!

I also cannot wait until this book is available to the public, including the hundreds of thousands of newly diagnosed breast cancer patients, current patients, survivors, and caregivers. If I can help even one of those people – my survivor sisters and brothers – by informing them, inspiring them, helping them cope, or giving them a much needed laugh, then I will have accomplished something really special.

This book will also help me develop a guide for newly diagnosed breast cancer patients at my institution, another labor of love.

I send love and gratitude to all of the mentors and colleagues who’ve made me into the scientist I am today, my healthcare team for saving my life and helping me thrive, and my family for being my strength and limitless supply of love.

Healthcare Workers Shouldn’t Hate Poor People (And I Shouldn’t Have to Blog About It)

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Healthcare workers are under tremendous stress, which has been made worse by the global COVID-19 pandemic. The pandemic has also brought to light the ugly underbelly of the (for profit) United States Healthcare system and how it fails the poor, POC, women, and the uninsured/underinsured. These are complex problems that will require equally complex solutions, some of which I’ll cover.

Angry white male doctor – wasn’t hard to find on Deposit Photos

But first, I’d like to highlight a glaring example of the WRONG approach to these problems. This one is brought to you by ER physician, author, alleged man of faith (though he really needs to read what Jesus said about the poor), and blogger, Dr. Edwin Leap. It’s an older article, circa 2014, but the attitude toward poor folks seeking healthcare in the ER (because they can’t afford primary care, don’t have health insurance, can’t get off work, etc.) is one that I’ve heard from medical professionals in my circle and from the GOP. We have the opportunity to change the system in ways that will increase healthcare coverage, lower overall costs, and create a healthier population, but do we have the will? Do policy makers?

I believe we do, but if people like Dr. Holier-Than-Thou have their way, the system will continue to be draconian, one in which blaming poor people for their plight, making false assumptions about their frivolous spending on “luxury items” rather than prohibitively expensive healthcare plans, and belittling them for life choices and culture (that are often code for racist and sexist assumptions) are standard-of-care.


Look, nice people have tattoos! Deposit Photos.

What does Dr. Edwin consider America’s “inverted priorities?” For starters, he has a big problem with tattoos, piercings, and Smartphones, particularly in the context of uninsured patients. Why would they spend money on frivolous things like ink, bling, and phones when they could use the money to pay for (overpriced) health insurance? Tattoos and piercings have grown in popularity, but apparently Dr. Edwin still thinks only bikers, gang members, drug addicts, unruly metal heads, or ex-cons get inked and pierced, a prejudice experienced by ordinary human beings who choose tattoos as a form of self-expression.

BTW, bikers aren’t bad people, nor are metal heads. Gang members, drug addicts, and ex-cons are often victims of circumstance. Yes, they made poor choices, but you won’t “turn their lives around” by refusing to attend to their medical needs.

According to Dr. Venita Mehta, this phenomenon, known as “controllable stigma,” is like “obesity, drug abuse, and lung cancer as a consequence of smoking. This is known as a ‘controllable stigma,’ and it includes tattoos, because they arise as a matter of choice.”

The stigma is worse for women. “Research reveals that women with this form of body art are perceived as more promiscuous, as being heavy drinkers, less attractive, less caring, less intelligent, and less honest.” Given Dr. Edwin’s assertion that, “on the southern end of things, carefully groomed pubic hair is not at all out of the question. The teeth may fall out; the nether regions will be carefully tended,” he’s likely judging his female patients more harshly based on ink as well as personal pubic grooming habits, since women are more likely to shave, pluck, wax, tweeze, and laser all parts of their mammalian bodies to satisfy the demands of the patriarchy.

Side note: what kind of doctor publicly obsesses over his patient’s pubic hair? That’s creepy. I’m pretty sure that violates the spirit of ethical standards if not the letter of the law. So gross, dude.


Set of touchscreen smartphones that are totally luxury items and not required to function in the modern economy according to Dr. Jackass –
Deposit Photos.

Of course, people with tattoos, piercings, and/or groomed pubic hair aren’t inherently awful leeches to the system who should spend less on their proclivities and more on health insurance. It’s a false equivalence. And even if these patients didn’t have tattoos, piercings, or Smartphones (which are a necessity these days for school and work), they wouldn’t automatically have the funds to pay for health insurance. Tattoos cost anywhere from $150-$800 (and up to $4,000), and body piercings run between $30-$85. Smartphones are priced at $550-$1,400 + carrier service, and are often essential for work or school (think of students in virtual school who can only access online classes by phone; think how many times you check work emails or answer work calls in the 24/7 economy; think gig workers who rely on phone Apps in ride share and food delivery). I’m sure Dr. Edwin, like my clinical colleagues, uses his smart phone to check messages, review patient records, communicate with colleagues, etc. How is that different from his “irresponsible patients?”

He’s a very busy and important doctor, and his patients are mere peasants who can’t manage their money or priorities?

Spoiler alert: That’s ^^bullshit.

For the sake of argument, even when you factor in additional costs of personal grooming (assume Brazilian wax at $50-$120 every month – $1,020/year). Add that to $400 for ink, $50 for piercing, $1,368/year for phone and service, you’re looking at $2,838. Private insurance for a HEALTHY person will cost around $5,580/year with up to a $4,000 deductible. Even if you took your took your “savings” of just under $3,000 and scrimped on other trivial things like food, clothing, and shelter (smell the sarcasm?) to come up with around $2,700 to cover your private insurance, you’d still be dealing with that steep deductible, high co-pays, procedures and preventative care that may or may not be covered, expensive prescription drugs that keep getting more expensive thanks to greedy assholes like Pharma Bro, and probably conditions related to malnutrition and homelessness since you can’t get health insurance AND pay your rent unless you’re privileged like, oh I don’t know, and medical doctor!

Would Dr. Judgy McJudgyton have a problem if the inked/pierced/groomed patient with a cell phone in question had insurance or could pay full price? Three guesses!

The answer, according to Dr. Self-righteous is priorities! It’s so simple. Modern definitions of poverty need to change, because heaven forbid poor people have things like an “expensive cell plan, new truck and big-screen TV with satellite” without putting up “a little money for their own health care.” Newsflash! $5,580/year isn’t a little money. It’s a year and a half’s worth of car payments (at $300). It’s 6 months’ worth of groceries (at $200/week). It’s 6 months’ worth of rent ($784/month).


This bum wouldn’t be so poor if he just skipped the ink, personal grooming, and phone. Trust Dr. Edwin – he knows it all because #doctor. Deposit Photos.

Nearly 8 million people in the United States are impoverished. One in four workers are either unemployed or working at poverty level wages. Three of four are WORKING (as hard if not harder than doc here) for pittance. Are they less important? Do they matter less? Or, perhaps, are the bootstraps of the poor frayed, broken, and a WHOLE lot shorter than the doc’s?

The doc’s biggest flaw, as far as I’m concerned, is behaving as if he’s the rightful moral authority for his patients. He claims, “I care for the poor; I love the poor and have always tried my best to help those in genuine need. Those truly hurting.” But in the next paragraph, he bitches about, “But when cosmetics, vices and electronics are considered reasonable expenditures while the rest of us pay for necessities like prescriptions (or over the counter Tylenol and Motrin as I’m often asked to prescribe for Medicaid), then we are entering the death spiral.” Well, thanks for clearing that up, Dr. God Complex! How dare the poor turn to “vices” like personal expression and phones necessary for work when they COULD be living right in your eyes by paying for healthcare while living in a box.

Oh, and he’s all about shaming smokers and opioid addicts, which is of course the best way to inspire lifestyle changes (NOT). Try that on veterans. I fucking dare you. I doubt you’d get funding or IRB approval for that study.

This sort of mindset is common among cis/het white males who are voluntarily blind to their privilege, so they preach “hard truths” to the downtrodden people without privilege while profiting from their misery. The real hard truth to face is owning your own privilege (as an educated, affluent, cis/het female, I’ve got plenty), understanding the advantages of a system that rewards you for no other reason than you’re a white human being and you’re a male. Do I doubt he’s had struggles? Not at all. But his race, gender, sexual orientation (he’s straight), religion, and self-professed conservative views haven’t been barriers to his success.

Speaking of being completely unaware, this is from his blog: “I’m also a conservative, so you’ll excuse me (I hope) if I also post things that reflect my political views. I promise not to be hateful, cruel or demeaning to anyone, because that would violate my allegiance to Christ, against which political leanings are merely dust in the winds of eternity.”

Because shaming the poor is totally what Jesus would do and isn’t totally hateful and cruel…


Searched for “Dr. Meany Poophead.” Wasn’t disappointed! Deposit Photos.

“Hate me if you want,” he writes. I don’t hate him. I pity him. But I pity his patients and colleagues and those he influences even more. You want to be a moralist? Leave medicine and enter philosophy or the clergy. You want to help people? Judge less and advocate for expanded access to healthcare, preventative care, and an end to poverty – there should be no such thing as the working poor. Do that, then I might be inclined to listen to you “speak the truth.”

Sincerely – me and my bald, irradiated arm pit ❤

Screw The Woo Woo – Spell Casters!

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Facebook is a great place to meet some weird-ass motherfuckers. We all know that. But I’m still surprised and more than a little dismayed by the scammers. I normally just report ads that include woo woo, sometimes leaving a snarky comment, or just hide or block scammers. It’s rare that they actively seek me out, but it does happen.

Check this out! In response to my post on a blog post about legitimate, peer-reviewed science and breast cancer, Mr. Ansari was compelled by the power of the spell caster, “Dr” Akhigbe, to testify about the amazing things the spell caster can do.

It’s an impressive list worthy of the most outrageous scammy chiropractor. He apparently has the cure for herpes (HSV – I assume the genital variety), HIV, gonorrhea, low sperm count, menopause disease (it’s not a disease, even if it feels like it sometimes; he’s big on STDs and fertility), epilepsy, asepsis (I think he means sepsis – “asepsis” refers to aseptic techniques that minimize risks of bacterial, fungal or viral contamination during surgery and medical procedures), and cancer (which kind, dude?).

Where has this paragon of the medical community been all my life? Why haven’t we heard of him?

I have a few theories, but I decided to go down the rabbit hole and read more about the good “doc” and his miraculous healing abilities. First off, he has at least three profiles. Sketchy. The spell caster profile is apparently now dedicated to marriage, fertility, and “total freedom and happiness.” Hmm, I wonder how much that costs?

The posts are a feast of stock photos with tons of woo, attractive people who seem to be happy, and hashtags a plenty (candlemagic #magicspells #candlespells #astrology #occult #spellcandles #witchyvibes #bruja #pagan #witches #astrologer #psychicreading #witchcraftspells #spellcraft #conjurer #metaphysical #lovespecialist #spellcasters #brujasofinstagram #spiritualoils #spellworker #moneyspells #spiritualawakening #healing #lovespellsmaster #follow #spellcandlesofinstagram #spiritual #altarsofinstagram).

I’d take medical advice from Nandor the Relentless over the “Spell Caster” any day!

Yup. He’s a busy, busy man. There’s a lot going on there…

I kind of hope there’s a mockumentary based on this dude. Not that it would be as good as What We Do In The Shadows, but I’d LOVE Colin Robinson to explain the history of herbal medicine to The Spell Caster until he’s utterly drained.

I’ll focus on the other profile, which deals with herbal remedies for “great diseases,” because “it’s a gift from God.”

Here’s one of his posts related to cancer:

I’ve already covered turmeric, antioxidants (this includes the berry thing), and I’m covering mushrooms in my book, so let’s dig into what garlic and ginger can do for you (and more importantly, cannot do for you) as a cancer patient.

Note: My medical oncologist is a fan of veggies as well as legitimate research on diet and breast cancer molecular signaling/drug responses. Check out his blog for legit information and some great recipes!

Garlic. It makes food delicious, your breath stinky, and wards off vampires, but what can it do for cancer? When I searched the web, the first promising result I found was from Memorial Sloan Kettering Cancer Center. Reputable enough for me! When I clicked, a big fat pop up window with a disclaimer and a “Continue” button I had to click to proceed tried to jump out of the screen:

“This Web site — Information About Herbs, Botanicals and Other Products — is for general health information only. This Web site is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. Users of this Web site should not rely on information provided on this Web site for their own health problems. Any questions regarding your own health should be addressed to your own physician or other healthcare provider.”

They have a whole disclaimer to protect them from yahoos looking for woo woo!

What did it have to say about garlic? In terms of cancer, here’s the 411:

https://www.mskcc.org/cancer-care/integrative-medicine/herbs/garlic

Getting into the nuts and bolts, the clinical summary (with references) states:

1. Possible correlation with garlic supplement and gastric (stomach) cancer mortality (death) but not incidence (getting cancer), but other studies found no evidence of either. Remember, correlation does NOT equal causality.

2. Mixed results on garlic and colorectal cancer, with some observation of reduced number and size of adenomas (precancerous lesions) in patients with a history of adenomas.

3. Mixed or unclear results on risk of other cancers, but possible association with reduced risk of blood cancer. Remember, correlation does NOT equal causality.

Bottom line: garlic makes food tasty! Enjoy it in your favorite recipes, but don’t rely on it to keep you safe from cancer or to treat your cancer.

As far as ginger, I found a great article that already covers it:

“Walk Gingerly Before Declaring Ginger a Cancer Cure
It is not at all unusual to find plant extracts that will kill cancer cells in vitro. There are hundreds of phytochemicals that will do this. Neither is it unusual to find an effect in mice that have implanted tumours. But this is a long way away from demonstrating a viable cancer treatment in humans.”

Bottom line: this pretty much sums up the majority of studies on plant extracts and cancer. Enjoy ginger for the flavor, but don’t count on it to cure your cancer.

AND DON’T TRUST INTERNET “SPELL CASTERS!”

Book Draft is DONE!!!!

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Wow, I haven’t posted since January??!! Shame on me! But I’ve been busy writing, and I now have a completed draft of Talking to My Tatas: A Breast Cancer Researcher’s Adventure With The Disease and What You Can Learn From It.

It feels pretty freakin’ AWESOME! I learned so much through the research, especially about the clinical aspects and how my own experience fits with breast cancer care in the United States. I also learned more about emerging therapies, disparities, and mental health related to breast cancer.

When I started this process, I had been writing fiction for about 10 years and understood more or less how to construct a story in my genre, how to query agents and small presses, how to self-publish when a particular book or story doesn’t fit with traditional publishing, and how to write blurbs (it’s HARD), synopses (it’s TORTURE), and other things that go along with the fiction universe.

When it came to nonfiction, aside from my scientific manuscripts, I had no clue where or how to start. Fortunately, I had the amazing Alice Sullivan in my corner to coach me through the process. A long time ago in a pre-COVID galaxy far, far away, I became friends with Alice, and she sent me a guide to writing nonfiction proposals. That proved to be one of the BEST tools I had in hand when I started the process for Talking Tatas.

Unlike fiction, which requires a full, complete, polished manuscript (for the most part) prior to querying agents/publishers, nonfiction requires a proposal rather than a completed manuscript. Memoirs are sometimes the exception. What is a proposal? It’s basically a plan for your nonfiction project. It includes a working blurb, detailed outline of each chapter, what makes your book stand out from other comparable titles in the market, unique selling points, a marketing plan, your credentials (or reasons for writing the book, like personal experience), and sample chapters.

A tight, well-written, carefully crafted proposal is the key to getting an agent and a publisher if you’re going the traditional publishing route. Even if you’re not, it’s a great way to map out and organize your thoughts and to be thinking about defining your target market and how you’ll reach readers in that market. If you’re planning a nonfiction project, check out these sites for proposal essentials/how to, templates, and examples of successful proposals: Nonfiction Authors Association, Reedsy Blog, Scribe Media.

Once you write the proposal and craft a killer query letter, you start the long and arduous task of sending these items to literary agents (whom you’ve selected based on research and matching interests) and hope to get some interest. It’s not speed dating, but you’re definitely looking for a connection. Be prepared for LOTS of rejections with the understanding that it’s not personal. I repeat. IT’S NOT PERSONAL. If you take rejections personally, you’re going to have a tough time in the publishing biz. That being said, if you’re lucky enough to get feedback with a rejection, put it to good use by revising your proposal. For example, I received a lot of rejections based on the fact that my proposal was cross-genre (story of my writing life/same issue with my fiction). In Tatas, I’m blending elements of memoir with the personal story and prescriptive, which is the informational component.

Ultimately, I restructured my proposal to focus more on prescriptive and less on memoir (about 80/20), and that worked!

Once you get an agent, you’ll most likely tweak your proposal again for submission to editors, perhaps having a few drafts tailored for different editors. The submission process can also be a long, arduous process, and remember, rejections are NOT PERSONAL.

Trust me – you want an agent and editor who are super enthusiastic about your work. Someone who’s lukewarm won’t be as likely to champion you, and in this very competitive business, you need champions.

While you’re querying/submitting, you should be working to build or expand your platform. This blog is part of my platform. It gives readers information to supplement what I include in the book, to showcase my style and strengths, and to hopefully connect with readers who are likely to be interested in my book. It’s also great to network with other folks who have platforms with interests that match yours. I LOVE The Bloggess and have been lucky enough to connect with her by advertising on her blog and cultivating a relationship based on fangirling and promoting her stuff. It wasn’t so much strategic as it was OMG-I-LOVE-HER-AND-EVERYONE-NEEDS-TO-KNOW-ABOUT-HER! I also adore SciBabe, A Science Enthusiast, and Sana Goldberg, so I’ve been connecting with them.

Thanks to my day job, I’ve cultivated relationships with a lot of influential people and organizations in the cancer research field and I’m forging relationships in the patient/survivor advocacy community – of which I am now a part. All of this will help me spread the word about my book, get endorsements, and hopefully make the book a success.

It’s been one hell of an adventure! Stay tuned for more. In the meantime, I’m working on a new Screw the Woo Woo post on a “spell caster” who was recommended to me on Facebook. That one’s going to be wacky and fun. Mwahahahahahaha!

Getting to Know the Covid-19 Vaccines!

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With the recent emergency use approval of two independent vaccines for SARS2-CoV-2, the virus responsible for the horror that is Covid-19, many folks have questions: What the heck are these vaccines? Are they safe and effective? Should I get one?

Note: I’m not going to dignify any wild conspiracy theories about vaccines and microchips. Bill Gates doesn’t care about you or me or anyone else he doesn’t know and he has better things to do that track you with a microchip in a vaccine. Seriously. People believe some weird shit… If anyone wanted to track you, they’d do it digitally by your freakin’ cell phone.

Also, vaccines don’t cause autism. Period. They. Fucking. Don’t.

That being said, the first three questions are completely legit. My goal in this post is to break down the science behind the Pfizer and Moderna vaccines, what we know so far about their safety and effectiveness, and dispel some common misconceptions about them.

First, here’s a crash course on how your immune system fights infections. This is important, since vaccines harness the power of your immune system to mount a rapid and robust defense if and when you encounter the actual pathogen (i.e. virus or bacteria that cause disease) in your daily life. The arm of the immune system that does this is called the adaptive immune system. The other arm is the innate immune system and includes natural barriers like skin, the tiny hairs and mucous in your nose, and stomach acid.

How does the adaptive immune system work? First, it involves cells that roam around your body looking for something suspicious. Cells like macrophages and dendritic cells, which patrol various organs and tissues, find pathogens like bacteria or unhealthy cells infected by viruses like SARS-CoV-2, and eat them (fancy word is phagocytosis). Infected or damaged cells send out protein signals called cytokines as a distress call to attract macrophages and dendritic cells. While “digesting” the bacteria/infected cell, they salvage proteins or pieces of proteins—antigens—that identify the bacteria or virus as “other,” and they present these to immune cells, usually in lymph nodes, that mount an immune response. Macrophages and dendritic cells are known as professional antigen presenting cells (APCs)

From Pennington Biomedical Research Foundation LSU.

When activated by APCs, immune cells called B-cells produce antibodies against the antigen, which can do a lot of things to fight an infection. Some antibodies neutralize the pathogen by binding it and stopping it from entering a cell. Other tag infected cells for other immune cells to come and kill them. Others coat pathogens or infected cells in a process called opsonization (meaning to “make tasty”), which signals other cells like macrophages to come and eat the coated pathogens/cells. Specialized B-cells called memory B-cells archive the information about the antigen so your immune system can recognize the pathogen when it hits you again and mount a faster immune response.

Other immune cells called T-cells become activated by APCs and mount a different kind of immune response. Cytotoxic T-cells seek out and kill infected or damaged cells, and helper T-cells help activate B-cells so they make antibodies, activate cytotoxic T-cells, and activate macrophages to go eat nasty invaders and infected cells. Memory T-cells also archive information about past infections to mount a rapid, strong response the next time your body sees it.

That’s a simplified by hopefully digestible explanation of immunity and the major players (there are other immune cells, but APCs, B-cells, and T-cells are the biggies). Memory is key to protection, and memory is built by exposure to pathogens.

But what if there was a way to expose your body to pathogens without making you sick? That’s where vaccines come in!

The way vaccines work is to tap into this process and activate the adaptive immune response using an artificial antigen supplied by the vaccine, getting your immune response geared up and, importantly, building those archival memory B- and T-cells that will recognize the real infection when your body encounters it so it can rapidly fight it. Types of vaccines include: Live-attenuated vaccines; Inactivated vaccines; Subunit, recombinant, polysaccharide, and conjugate vaccines; Toxoid vaccines.

Live-attenuated means using a weakened form of the virus to initiate an immune response—examples include measles, mumps, and rubella (MMR) and chickenpox vaccines. Inactivated means using a dead version of the virus that cannot infect cells but contains antigens that can be used to activate adaptive immunity—examples include flu, hepatitis A, and rabies vaccines. Subunit, recombinant, polysaccharide, and conjugate vaccines use pieces of the virus that act as antigens, like proteins and sugars—examples include HPV, hepatitis B, and shingles vaccines. Toxoid vaccines use toxins produced by the pathogen to mount an immune response against the toxic protein—examples include tetanus and diphtheria vaccines.

What the heck are these (Covid-19) vaccines?

The current FDA approved (for emergency use) Covid vaccines from Pfizer and Moderna belong to a newer class called mRNA vaccines. See my previous post on DNA to mRNA to protein (Central Dogma of Molecular Biology) for a refresher on mRNA. This is really just a modification of the subunit, recombinant, polysaccharide conjugate vaccine approach in that it delivers messenger RNA coding for the SARS-CoV-2 spike protein, which the virus uses to enter a cell, instead of delivering the spike protein itself. See my previous post on SARS-CoV-2 for information about the spike protein. The cells in your body that take up the mRNA make spike proteins themselves, which in turn activates your immune system and provides protection.

Are they safe and effective?

Since these are new vaccines approved for emergency use, and since due to the accelerated nature of their development and approval, some people are understandably wary of their safety and ability to protect against Covid.

While they may be new, a lot of the groundwork for these vaccines started in in 2002 with the emergence of the first SARS virus (SARS-CoV) and continued with study of the related MERS-CoV virus. SARS-CoV uses the same spike protein to enter target cells through angiotensin-converting enzyme 2 (ACE2). Scientists learned a great deal about coronaviruses by studying SARS-CoV and MERS-CoV, including how to develop vaccines.

Let’s look at safety first. Clinical trials involving tens of thousands of healthy volunteers have been performed. Safety concerns include allergic reactions to the vaccine or components of the vaccine. Providers who deliver the vaccine are equipped to deal with anaphylaxis on site, which is why you’ll be asked to hang around for 15 minutes after your shot just in case. You might feel feverish, fatigued, and generally yucky the day after one or both shots (the first activates the immune system and the second gives it a signal boost), which is NOT a sign that you have Covid. It actually means your immune system is working, building memory and its arsenal of weapons to fight Covid if you encounter the real virus.

The FDA is continuing to monitor those who received the vaccines in clinical trials, as well as those who received the vaccines after emergency approval. So far, they appear to be safe.

As far as effectiveness, data from trials looking at the number of Covid-19 cases in trial participants relative to the total number of participants revealed that the Pfizer vaccine is 52% effective after the first shot (39 cases of covid-19 in the vaccine group and 82 cases in the placebo group) and 95% effective after the second shot (8 covid-19 cases in the vaccine group and 162 cases in the placebo group; 43,448 trial participants) – New England Journal of Medicine (NEJM). Similar efficacy was reported for the Moderna Vaccine in NEJM.

There’s still a lot we don’t know – most importantly, we don’t know how long immunity produced by these vaccines will last. Some experts hypothesize they might provide a year or two of immunity, after which you’ll need more shots, but we won’t know until we see in real time as we track vaccinated people.

Should you get the vaccine?

Me getting my first dose of the Pfizer vaccine!

The more people who are vaccinated against this virus, the better. Vaccines will slow the spread of the virus by preventing infections in vaccinated people. Along with mask wearing and social distancing, the vaccines are a vital tool in stopping this pandemic. As a cancer survivor, I’m in a high risk category, meaning Covid-19 could kill or debilitate me. The same is true for people with diabetes and other underlying medical conditions.

That’s why I got my vaccine! Had the second shot a few days ago, which gives me peace of mind as I prepare to return to work after reconstruction surgery. I’m with Dr. Fauci on this one, and I encourage everyone to talk to their healthcare providers about getting vaccinated.

I HAVE A BOOK DEAL AND NEW HEADSHOTS!!!!

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First off, HUGE news! My amazing literary agent, Barbara Collins Rosenberg, landed a publishing deal for me with Rowman & Littlefield!!! I’m honored, thrilled, and still squee-ing! So, stay tuned for Talking to My Tatas: A Breast Cancer Researcher’s Adventure With The Disease And What You Can Learn From It.

Here’s the Working Blurb – it will likely change based on guidance from my amazing editor, Suzanne Staszak-Silva, but it will give you a taste of what I intend to share (my story) and spread (scientifically sound information) with this book:

Can I talk to you about my personal relationship with my breasts?

I’ve spent twenty years working as a biomedical breast cancer researcher. Then, I was diagnosed with breast cancer. I thought I knew breast cancer before it whacked me upside my left boob and left me bleeding on the curb of uncertainty. Turns out, I had a lot to learn. The purpose of this book is to share my personal adventure with breast cancer, from the laboratory bench to my own bedside, and to provide accessible information about breast cancer biology for non-scientists. I say adventure, because I’d rather think of it as an action movie with some really cool side quests instead of another tragedy-to-triumph saga. I’m not big on sagas. I am big on kickass intellectual badassery, pathological nerdiness, and talking about my sweet, sweet rack.

Why do we need another cancer memoir? In a sea of inspirational stories, celebrity survivor stories, and physician memoirs that bring a clinical perspective, nothing I’ve found in the current market tackles breast cancer through the lens of a breast cancer researcher who became a survivor. We live in an age of fake news and pseudoscience, made worse by the pervasive anti-intellectual and anti-science political culture gripping the United States and much of the world. The Internet and social media are plagued by scammers selling “alternative medicine” and woo woo “cures” for cancer. Through Talking to My Tatas: A Breast Cancer Researcher’s Adventure With Breast Cancer And What You Can Learn From It, I offer accurate, evidence-based science that is accessible to laypersons, including the more than three hundred thousand individuals diagnosed with breast cancer every year*, their caregivers, and their loved ones. 

Knowledge is power, and lack of it can lead to overtreatment, unnecessary pain and suffering, and can even be deadly. By demystifying the process from mammograms, biopsies, pathology and diagnostics, surgical options, tumor genomic testing, and new treatment options, I aim to offer hope in a story intended to blend the humor and delivery style of  Jenny Lawson’sLet’s Pretend This Never Happened (A Mostly True Memoir) with the integrity and scientifically sound beauty of Siddhartha Mukherjee’s The Emperor of All Maladies: A Biography of Cancer.

*American Cancer Society Facts & Figures 2020

I’ve got some work to do! In addition to writing and fleshing out chapters for my editor to review (and work her magic on), I’ve been busy working on figures and visuals for the book, cover art forms, marketing and promo plans, and getting a new headshot! The one I currently have on this page and all over the Internet is absolutely gorgeous, fun, and from 2012. A LOT has happened in 8 years, and I have aged. I’d like to think I’ve aged gracefully, but at any rate, it was time to update the image.

Lillian Boeskool is MAGIC! She made me look so good and captured the essence of my personality in a series of amazing headshots (If you’re in the greater Nashville area and need headshots or other photography, HIRE HER). I have two favorite images and I cannot decide which one to use for this page and the book. I invite y’all to enable my decision-making disorder vote for your favorite!

Photo Credit Lillian B Photography

This one on the left is super fun and catches me trying not to laugh at something funny Lillian said and/or did. It captures my mischief, my sense of humor, and really makes my face look nice.

And, unlike the previous headshot for which I straightened my hair, this one highlights my popping natural curls!

I’m almost 48 years old. Anything that makes my face look nice is gold.

Told you she was MAGIC!

Photo Credit Lillian B Photography

There’s just something about this next one on the right that speaks to me.

I think it captures my sass and tells my readers that I’m going to take them on a really funny adventure that will make them a smidge uncomfortable but will ultimately leave them laughing and glad they went along for the ride.

That’s me in a nutshell.

I can’t decide between the two!

And…just to throw a monkey wrench into this whole program…

Photo Credit Lillian B Photography

This one is my husband’s favorite.

It’s nice, too.

I’m glad he thinks I look good in all of these photographs and still thinks I’m beautiful in spite of time marching across my face and body and in spite of cancer leaving me with a janky left breast-in-progress*.

He’s pretty awesome!

I think I’ll keep him.

*Janky left breast-in-progress on display in the first two photos as the line of discoloration just above my shirt collar. Lillian asked if I wanted to Photoshop it out, but I said no. It’s where I am right now. It’s why I’m blogging, writing this book, and becoming a breast cancer patient/survivor advocate as well as a breast cancer researcher. It’s a badge of fucking honor and it stays!

Fundraising for Tanisha

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Tanisha Jones MBC & Renal Failure Fund

From Goodreads

I’ve met and admired many survivor sisters over the years. After my diagnosis, they held me in their arms and lifted me up so I didn’t have to face breast cancer alone. Before I was diagnosed, I got to know a really cool woman named Tanisha Jones. We were represented by the same literary agency at the time, writing romance and urban fantasy* and trying to break into the fiction publishing world in a big way.

*Side note: If you’re a fan of Anne Rice and J.R. Ward, TREAT YOURSELF to Tanisha’s The Fallen Series. This exciting series is full of vampires, Fae, Weres, demons, and other supernatural beings hiding in plain sight in New Orleans. Throw in a hot homicide detective with some supernatural abilities of his own and you’ve got one helluva story!

Like me, Tanisha works in academics (one of her many jobs). She also has a daughter, just a little bit older than mine. She has hopes, dreams, highs, lows, a wicked sense of humor and a drive and work ethic to rival any I’ve seen in my almost 48 years on the planet.

Like me, she has breast cancer. Unlike me, she’s living with metastatic breast cancer (MBC). While there is no cure, she hasn’t allowed MBC to define her life or steal her dreams. She’s still writing – she published Unbound, Book 3 in The Fallen series, this month. She’s still raising her daughter. Due to health issues related to MBC, she isn’t working at the moment but she’s worked since her diagnosis in 2016.

Because America is still balking at the idea that healthcare is a human right rather than a privilege reserved only for the white and wealthy (and healthy), like many Americans, Tanisha is struggling financially due to the cost of her cancer care. I could write an entire rage post on the topics of American healthcare’s failures that include the real possibility of financial ruin, disparities in access and care, and the lack of healthcare equality and equity that is still VERY much a problem in 2020 in this country, and I will.

But right now, what matters is helping my friend who’s struggling with breast cancer.

Tanisha’s family also has a GoFundMe initiative (you know, the largest healthcare “plan” in the United States) to help her. Click here to donate what you can. It helps. It matters.

I have taken the extra book royalties I earned in November plus a small windfall that came to me at just the right time to support Tanisha. I can think of no better person in whom to invest.

$hit You Shouldn’t Say To Cancer Patients Or Survivors: Part 1

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(Filched from my personal FaceBook Page. It’s not plagiarism if it’s mine)

Some thoughts on people who think my cancer wasn’t “that bad,” was “baby cancer,” and wasn’t such a “big deal.”

Yes, people have said that to me.

People have also asked me why I think I got cancer. I could go into a lengthy discussion of the Central Dogma of Molecular Biology, random mutations and failed/imperfect DNA repair, etc., or I can just get pissed off because I KNOW they’re asking if I got breast cancer because I’m fat and every now and then I like a nice juicy steak or cheeseburger. From now on, I think I’m going to just use this as a reply:

Photo credit somewhere on FaceBook – TinEye results were vague and I have NO idea who came up with the text. But it’s pretty fucking awesome! If it’s yours, tell me so I can give you credit.

I had breast cancer. I didn’t have to have chemo. I’m lucky and benefited from decades of biomedical research that made OncoType DX testing possible (I WILL get around to blogging about this test eventually, I swear), and I happened to have a low score.

I still had cancer. I’ve had three surgeries (and I’m not done), radiation, and I’ve got a ten year sentence with estrogen blockers and medically induced menopause. I’m still lucky. I know and understand that. Very well.

Photo credit Snarky Cancer – Seriously, check out their site and their merch. I’m going to order about 5 totally snarkalicious T-shirts!

I still had cancer. When someone in or out of the survivor club (it’s always worse when it’s another survivor) tells me I had “baby cancer” or “good cancer,” I get a special kind of homicidal that will probably get me locked up someday when I finally lose my 💩.

Never, ever, EVVVVVVVVVER say that to someone who has had cancer. It’s not a contest. It’s a suck fest and no one, not even fellow survivors, should not presume to understand the level of suffering endured by cancer patients and survivors.

Don’t be a dick.

Thank you for coming to my TED talk.

Surgery Made Me An A-hole

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Photo Source

First off, I’m doing GREAT nine days after autologous (fancy term for my surgeon using my own fat and tissue to build a new boob) breast reconstruction! The procedure went very well, and the graft took. My amazing surgeon, Dr. Galen Perdikis (and his team, including the surgeon who assisted with the microvascular attachment work), took muscle and tissue from my right thigh and made a very nice left breast by grafting it under the skin he saved following my mastectomy back in May. The official medical lingo for this type of reconstruction is diagonal upper gracilis (DUG) flap reconstruction. I’ll blog more about the specifics and the experience later, but right now, I want to talk about something else.

I want to talk about a bit of an epiphany I had.

Photo Source

Disclaimer – I have NO scientific or medical data to back me up on this, partly because I couldn’t FIND IT on Google or PubMed. This could be a search strategy issue (the closest thing I did find was Post Intensive Care Syndrome, PICS), and I hope it is, because I’ll be super disappointed if no one has studied the phenomenon I’m experiencing right this very moment—a phenomenon that I’ve decided to call Wounded Animal Asshole Syndrome, or WAAS.

This should TOTALLY be included in the DSM. And I fully expect credit for it.

Here’s the deal. The first time I left the house on my own after surgery, which was yesterday, I was, for lack of a better word, a RAGING asshole. Now anyone who knows me will tell you that I can be a Grade A asshole on any given day under the right set of circumstances, but this was something else. Something visceral and deeply animalistic. I was angry, suspicious, and viewed every other human around me as a potential threat. Like a wounded animal, I gave off a heavy dose of don’t-fuck-with-me vibes that fell just short of low, guttural growls.

By the time I reached the Breast Center for my appointment, I was a little worried about the safety of those around me.

Photo by Aleksandr Burzinskij on Pexels.com

Then, it hit me. I am—quite literally—a wounded animal. Yes, I volunteered to undergo the procedure that left me with the healing surgical incisions I was subconsciously guarding. Yes, my rational mind knew that the arguably weird man in Walgreens wasn’t out to snatch me and throw me in his trunk. And yet, I was experiencing the same level of heightened awareness and suspicion of strangers around me that I felt shortly after the birth of each of my children—a time during which I was still sore, bleeding, and physically vulnerable.

That fed into the horrible postpartum depression (PPD) episodes I experienced, but that’s a story for another time…

I have no idea if this is a common thing or a me thing (I suspect it’s a common thing because I’m not special, no matter what my mom told me growing up), but it is both fascinating and disturbing. It happened again today when I took my son to the zoo and we encountered a crowd at the entrance. In addition to generalized COVID anxiety (note: the Nashville Zoo is SUPER cautious, mandates masks, and limits the number of daily visitors like a responsible organization), I was freaked the fuck out and felt the urge to turn in a circle and hiss to keep people away from me and my cub, er, I mean, son. It was weird. It doesn’t happen when I’m out with my mate (husband) or when I’m in in a small herd (of socially distanced friends)—only when I’m alone or with a child (who is almost as tall as me, which makes it weirder).

Photo Source

The only reason I can think of for this bizarre behavior is that it is a throwback from ancestral human days when we were running from cave lions, saber toothed cats, and wooly rhinos. Hide pain, conceal wounds, show no weakness, and act so aggressive that the big scary predator won’t bother with you and will instead seek an easier meal.

Maybe it’s a manifestation of generalized anxiety disorder (GAD), but honestly, I’ve been managing that very nicely with medication and therapy—or so I thought.

Anyone else out there have this? Drop me a note in the comments. We’ll call it an informal survey.