Patricia Prijatel

Our Friendly Little Place

Patricia Prijatel

January 31, 2018

My mantra when we were building was, “It’s just a mountain cabin.” So, pretty much, it’s just a mountain cabin, but a beautiful welcoming home and I truly love it. The housing appraiser called it a “friendly little place” and my sister Phyllis says it reminds her of a dollhouse.

It’s a tiny charmer, built with love and by my family—the siblings and nieces and nephews who still live in Colorado all had a hand in it. My brother Ed and his son Matt built the main part: the exterior, a simple double-garage sized rectangle, 480-square-feet, with a green metal roof. The rest of us finished the interior and built the decks.

Our kitchen cabinets are antique cupboards from Pella, Iowa. The coffee table is a wooden icebox my dad made sometime in the 1950s. The heavy wood toolbox he used to lug tools all over Pueblo when he built his house sits along one wall. The bed is a walnut four-poster that Joe and I got from Goodwill when we were first married in 1970. If I did it again, I would have more windows, but those we do have bring in the Colorado sun and light up the place like a welcoming lantern.

We’re all off the grid, with solar power, propane gas, a composting toilet, a small wood heating stove, and well water. Our only utility is the phone line and that is erratic. Cell coverage is minimal because we’re in a mountain valley.

Our deck faces the meadow and the mountain, with the back of the cabin to the road. There’s little human activity on the road, although we often see signs of bear and deer and, once, a mountain lion, on it. The only people who ever use it are family, friends, or people who are lost, usually looking for the scout camp. We have to tell campers they can’t get there from here, that our road is a dead end and they have to turn around and drive another 45 minutes back and around, even though it’s only a mile away.

This is an excerpt from Burn Scars: A Memoir of the Land and Its Loss, about the aftereffects of the East Peak Fire on this little bit of paradise.

Racial Discrimination and TNBC

Patricia Prijatel

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April 23, 2023

Republished from Psychology Today

Racial discrimination adds an extra layer of stress that increases the aging process for African-American cancer patients, according to a study published in the journal Cancer. Respondents who reported higher incidences of discrimination were more likely to show signs of premature aging and frailty. This was true despite educational level, employment, or insurance coverage.

Whether rich or poor, cancer survivors who experienced more discrimination reported greater levels of frailty, said lead author Jeanne Mandelblatt, MD, MPH, director of the Institute for Cancer and Aging Research at Georgetown University’s Lombardi Comprehensive Cancer Center in Washington, D.C.

The stress of discrimination can throw the body off balance, increasing rates of aging and leading to a greater risk of frailty, Mandelblatt said. She and her colleagues surveyed 2,232 African American adult cancer survivors diagnosed with breast, colorectal, lung, or prostate cancer within the previous five years. The research was part of the Detroit Research on Cancer Survivors (ROCS) Study.

The study uniquely focuses on the relationships between discrimination and aging in cancer survivors.

Measurements of Aging and Discrimination

Discrimination was measured by reported instances of being unfairly fired, denied a promotion, or not being hired for a job; being unfairly stopped, searched, questioned, physically threatened, or abused by the police; being unfairly discouraged by a teacher or advisor from continuing education; receiving inferior medical care; being prevented from moving into a neighborhood because the landlord or a realtor refused to sell or rent a house or apartment; and moving into a neighborhood where neighbors made life difficult.

Aging frailty was determined by cardiovascular and metabolic health; the number of medical prescriptions; activity level, including time spent in bed; social support; body mass index and unintentional weight loss; physical, emotional, and functional well-being; depression; anxiety; and fatigue.

Three-quarters of respondents showed signs of aging-related frailty. Most of these experienced major discrimination in their lives. Those with four to seven types of discrimination events had the largest increase in frailty, despite age, time from diagnosis, cancer type, stage, therapy, and sociodemographic variables.

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Effects of Treatments

The authors noted that cancer treatments such as chemotherapy and radiation can age patients because they shock and destabilize the body, in contrast to treatments for other chronic diseases that stabilize systems, such as controlling blood pressure or blood sugar.

The highest rates of accelerated aging were among breast and lung cancer patients. Radiation treatments were most strongly associated with frailty.

Some aggressive cancers with aggressive treatment may have more effect on aging, Mandelblatt said, although that was not a focus of this research. For example. triple-negative breast cancer disproportionately affects African-American women, and it can be aggressive, requiring chemotherapy, radiation, and surgery.

“In other studies, persons with aggressive cancer generally receive more treatment, and that treatment causes damage to cells that lead to increases in aging,” she said.

The Stress of Waiting for a Diagnosis

Patricia Prijatel

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January 4, 2023

Originally published in Psychology Today

I finished my tests—mammogram, ultrasound, fine-needle biopsy—by mid-afternoon. I’d gone in for a regular mammogram in the morning, but the doctor found a shadow. She ordered an ultrasound, which revealed the crab-like shape of cancer. She was honest, saying it likely was breast cancer, but it would be the next morning before the biopsy could confirm it. I had roughly 18 hours to stew.

Instead, I told myself I was going to be fine. I’d had shadows before, and those had turned out to be benign cysts; I decided that was the case this time as well. I didn’t have time for breast cancer, so I shrugged it off. I was a busy woman—I had tests to grade, reports to write, academic hoo-ha to do. Breast cancer was not on my schedule.

Mostly, I put the worry out of my mind. But, when it popped back in, as worry does, I focused on Googling good stuff‚ such as breast cancer survival rates, especially the one from the American Cancer Society for localized disease: 99%. That is, an overwhelming majority of those with breast cancer that remains in the breast survive. Great. I don’t have cancer, but even if I do, it’s local. And I am in the 99%, baby!

When the doctor called and told me it was cancer, she reassured me that it was small—it ended up being only 1.1. cm—and likely had not spread to the lymph nodes, so this calmed me. I was facing a 99% survival rate. “Patricia,” she said. “This is not so bad.”

I was merrily looking on the positive side of things when I got the bigger, badder news a few days later: The cancer was triple-negative (TNBC), which has a killer reputation, and I don’t mean that in a good way. Many media reports on it call it “deadly” and, occasionally, “untreatable.” Neither is true, but I didn’t know it at the time. The oncologist who gave me the TNBC diagnosis had the bedside manner of Attila the Hun and basically called the disease a “bad actor” and implied my survival was going to be a challenge. He even said the tumor was larger than it was, which put me at higher risk.

TNBC is fairly rare—about a quarter of all women diagnosed with breast cancer have it—and it can be more aggressive than the more common forms. It is not fueled by estrogen and therefore does not respond to drugs like tamoxifen, which would be what I would have gotten with a tumor my size. Instead, because of this new diagnosis, I got the full blue-plate special—surgery, chemotherapy, then radiation.

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The first doc framed my diagnosis positively, which helped, but the second was pretty ominous. Through it all, though, I had the attitude that I would survive just fine. Why?

Researchers at the University of California-Riverside, led by psychologist Kate Sweeny, suggest one reason: looking toward the future with hope can soften the blow of bad news. That is, we cope better if we focus on the silver lining ahead, rather than expecting the dark cloud. We don’t ignore the possibility of a setback, but we set ourselves up to deal with it.

In their most recent research, Sweeny and her team studied four groups: law graduates awaiting bar exam results; voters approaching the results of the 2016 presidential and 2018 midterm elections, respectively; and undergraduates awaiting the results of a health risk assessment. They asked participants to write about their expectations or to fill out a survey that asked about their attitudes and behaviors. The research was published in Personality and Social Psychology Bulletin.

Across all four studies, researchers found those who looked for the benefits beforehand were more content during their waiting periods and reacted to the news with more resilience.

In previous research aimed specifically at patients waiting for the results of a breast cancer biopsy, Sweeny and her team found that women could frame the possibility of getting breast cancer as having some positives—helping them improve their diet, get closer to family, finally stop smoking. However, these positives did not make them any more resilient to the eventual bad news. One thing that might help, they suggested, was if medical personnel offered reassurance. My first doc did, and that made all the difference.

Sweeny says you can take steps to settle your mind while waiting for a diagnosis and to help improve your resilience should you not get the news you wanted.

Use this time to consider how you might better care for yourself or change your life to be healthier, no matter the diagnosis.
Develop a plan for dealing with the diagnosis. Who takes the kids to school? What does your insurance cover? How do you handle being off work, if needed? “Taking action gives you a sense of control,” Sweeny says.
Keep the worry manageable by finding a “flow state,” or totally immersing yourself mentally in an activity—crafting, sewing, painting, gardening, playing with the kids, reading a page-turner. Whatever you love doing so much that time disappears as you’re doing it. “Flow is good for shutting worries off,” she says.
Walking or hiking can be a positive way to spend your time as long as you practice mindfulness, or seeing the exercise as meditation. This helps you “coexist with worry,” she says. You’re telling your mind, “I can let that go for now.”

Women Without Breast Reconstruction Are OK With Their Decision

Patricia Prijatel

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December 8, 2022

Originally published in Psychology Today

I have “gone flat,” as have many women I know. That beguiling descriptor applies to breast cancer patients like me who do not have reconstruction after a mastectomy and therefore have pancake chests. After my bilateral mastectomy in 2015, I didn’t want foreign material in my body. I miss my breasts, no doubt about it. In Western culture, breasts can define us as sexual beings; without mine, I feel a tad less desirable. Breasts equal beauty and I have the profile of a pencil. But I can remedy this with bras with prostheses that are comfortable and look natural, so why sign up for additional surgery and a continued need for medical surveillance?

Many other women choose differently, especially those who are younger; I understand and respect the importance of reconstruction for their own mental and physical well-being.

But my decision to “go flat” was right for me, and new research shows I am in good company.

The great majority of women who have decided against reconstruction are comfortable with their choice, according to a study published in the Annals of Surgical Oncology. Researchers surveyed 931 women who had a unilateral or bilateral mastectomy without reconstruction.

Of the women surveyed, 74 percent were satisfied with their outcome. But 22 percent were dissatisfied with their surgical treatment, either because the surgeon did not offer the choice of reconstruction, did not support the patient’s decision, or intentionally left additional skin in case the patient changed her mind. Twenty-seven percent reported not being satisfied with the appearance of their chest wall. I fall into that category—I think my surgeon could have tried harder and I wish I’d had a plastic surgeon involved, but none of this changes my mind about not having reconstruction.

Women in the survey said they decided against reconstruction for a faster recovery and to avoid foreign material in their bodies. In some cases, reconstruction was just not important for their body image. Count me in all three categories.

“Undergoing a mastectomy with or without reconstruction is often a very personal choice,” said Dr. Deanna Attai, an assistant clinical professor of surgery at the David Geffen School of Medicine at UCLA, and senior author of the study. “We found that for a subset of women, ‘going flat’ is a desired and intentional option, which should be supported by the treatment team and should not imply that women who forgo reconstruction are not concerned with their post-operative appearance.”

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The results challenge past studies showing that patients who chose not to undergo breast reconstruction tend to have a poorer quality of life compared with those who do have the surgery. But Attai and her team believe the survey tool commonly used in those surveys was biased towards reconstruction.

To avoid that bias, the team partnered with patient advocates to develop a unique online survey to assess why women chose to “go flat” and how they felt about it. They also identified concerns unique to these patients not captured by other validated surveys.

“Some patients were told that excess skin was intentionally left, despite a preoperative agreement to perform a flat chest wall closure, for use in future reconstruction, in case the patient changed her mind,” Attai said. “We were surprised that some women had to struggle to receive the procedure that they desired.” Surgeons may hesitate to recommend mastectomy without reconstruction because they are less confident that they can provide a cosmetically acceptable result for patients who want a flat chest wall, she said.

“We hope that the results of this study will serve to inform general and breast surgeons that going flat is a valid option for patients, and one that needs to be offered as an option,” she said. “We also hope the results may help inform patients that going flat is an option, and to empower them to seek out surgeons who offer this option and respect their decision.”

The Sacred Mountain

Patricia Prijatel

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April 14, 2022

The earliest settlers of this beautiful land said the Spanish Peaks in Southern Colorado were sacred. It feels holy here. (The East Spanish Peak is on the left.)

The locals call them the breasts of the earth, or Wahatoya, using the Comanche word. Geologists call them the Spanish Peaks. The great twin mountains, the East Spanish Peak and the West Spanish Peak, rise up from the high desert of Southern Colorado, alone and distinct, their own separate mountain range. Breasts emerging from the earth.

The East Peak rises to 12,683 feet; the West Peak is nearly a thousand feet higher, at 13,625 feet. Two enormous pyramids reflecting the azure of the Colorado sky.

The geological highlights of the Spanish Peaks are the immense and stunning walls of rock, or dikes, that radiate from the peaks for miles at widths from a foot to 100 feet. The largest, the Big Wall, stretches 14 miles from the West Peak toward the town of La Veta, looking like a natural version of the Great Wall of China.

Dikes are rock walls that formed 25 million or so years ago when volcanic activity broke cracks in the earth—earthquakes—through which lava flowed, filling the gaps with molten rock, which then dried, creating underground walls. The bigger the quake, the bigger the dike. As the ground eroded, the walls began to emerge, and through millions of years, the resulting structures, the dikes, grew into formations that are the focal point of the land around the peaks.

Some dikes remain underground, some barely break through the earth, and some create awe-inspiring ramparts that dominate the landscape like mythical vestiges of an ancient land. Scientists come from around the world to study these geological marvels and have counted at least 400 separate dikes around the two peaks.

The Comanches and Utes who once lived here believed the mountains were sacred and those who lived in their shadow were blessed. It feels holy here. And after the East Peak fire of 2013 burned 13,500 acres of the mountain’s mostly forested land, we’re praying for a resurrection. Our prayers are not being answered the way we’d hoped.

This is the introduction to Burn Scars: A Memoir of the Land and Its Loss, a chronicle of the 2013 East Peak Fire and its aftermath on the land and its creatures, including the people whose lives it forever changed.

Clusters of P53 Protein Mutations Offer New Treatment Potentials for TNBC

Patricia Prijatel

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March 4, 2021

The p53 protein in its natural state, sometimes called “the guardian of the genome,” is a front-line protector against cancer. But the mutant form appears in 50 percent or more of human cancers and in 80 percent of triple-negative breast cancers. It actively blocks cancer suppressors. Researchers at the University of Houston Rice University have discovered the same mutant protein can aggregate into clusters. These in turn nucleate the formation of amyloid fibrils, a prime suspect in cancers as well as neurological diseases like Alzheimer’s. The research was led by Peter Vekilov at the University of Houston (UH) and Anatoly Kolomeisky at Rice University.

The condensation of p53 into clusters is driven by the destabilization of the protein’s DNA-binding pocket when a single arginine amino acid is replaced with glutamine, they reported. “It’s known that a mutation in this protein is a main source of cancer, but the mechanism is still unknown,” said Kolomeisky, a professor and chair of Rice’s Department of Chemistry and a professor of chemical and biomolecular engineering. “This knowledge gap has significantly constrained attempts to control aggregation and suggest novel cancer treatments,” said Vekilov, the John and Rebecca Moores Professor of Chemical and Biomolecular Engineering and Chemistry at UH.

The mutant p53 clusters, which resemble those discovered by Vekilov in solutions of other proteins 15 years ago, and the amyloid fibrils they nucleate prompt the aggregation of proteins the body uses to suppress cancer. “This is similar to what happens in the brain in neurological disorders, though those are very different diseases,” Kolomeisky said.

The p53 mechanism may be similar to those that form functional and pathological solids like tubules, filaments, sickle cell polymers, amyloids and crystals, Vekilov said. Researchers at UH combined 3D confocal images of breast cancer cells taken in the lab of chemical and biomolecular engineer Navin Varadarajan with light scattering and optical microscopy of solutions of the purified protein carried out in the Vekilov lab. Transmission electron microscopy micrographs of cluster and fibril formation contributed by Michael Sherman at the University of Texas Medical Branch at Galveston (UTMB) supported the main result of the study, as did molecular simulations by Kolomeisky’s group All confirmed the p53 mutant known as R248Q goes through a two-step process to form mesoscopic condensates. Understanding the mechanism could provide insight into treating various cancers that manipulate either p53 or its associated signaling pathways, Vekilov said.

In normal cell conditions, the concentration of p53 is relatively low, so the probability of aggregation is low, he said. But when a mutated p53 is present, the probability increases. “Experiments show the size of these clusters is independent of the concentration of p53,” Kolomeisky said. “Mutated p53 will even take normal p53 into the aggregates. That’s one of the reasons for the phenomenon known as loss of function.” If even a small relative fraction of the mutant is present, it’s enough to kill or lower the ability of normal, wild-type p53 to fight cancer, according to the researchers.

The Rice simulations showed normal p53 proteins are compact and easily bind to DNA. “But the mutants have a more open conformation that allows them to interact with other proteins and gives them a higher tendency to produce a condensate,” Kolomeisky said. “It’s possible that future anti-cancer drugs will target the mutants in a way that suppresses the formation of these aggregates and allows wild-type p53 to do its job.”

Women Satisfied With "Going Flat" After Mastectomy

Patricia Prijatel

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January 13, 2021

Many other women choose differently, especially those who are younger; I understand and respect the importance of reconstruction for their own mental and physical well-being.

But my decision to “go flat” was right for me, and new research shows I am in good company.

The great majority of women who have decided against reconstruction are comfortable with their choice, according to a study published in the Annals of Surgical Oncology. READ THE STORY HERE.

Looking for Research Participants in the UK on Building Resilience Online to Counter Psychological Effects of Breast Cancer

Patricia Prijatel

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November 2, 2020

Readers in the UK: Here’s your chance to participate in research through King’s College London on the psychological effects of breast cancer, and how to build resilience through online participation. From the news release:

Worrying (thinking about how things might go badly in the future), is normal from time to time, but for most people this passes fairly quickly. However, some people find that once they start worrying, it is very difficult to stop. Research studies have shown that people who are particularly resilient experience less worry and low mood. In the present study, we hope to increase resilience and decrease low mood and worry in people who have had breast cancer. We also want to find out how people find doing the intervention via the web-platform.

For more information, and to see if you are eligible, check out The Frame Project.

The People of Burn Scars

Patricia Prijatel

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October 3, 2020

While memoirs are written from one person’s perspective, the lives of families and friends naturally become part of the telling. All those affected by the East Peak Fire share the story I tell in Burn Scars: A Memoir of the Land and Its Loss. I am heartened, energized and, yes, relieved, that those whose lives I put into the book have responded with pleasure, thanks, and encouragement. Many readers have asked to see the family and friends who shared my story. So this is for you.

First, there’s Ed. The shot of him below is from 2012, when we hiked the West Spanish Peak, “our” mountain’s twin sister, the westernmost breast of the earth. (The prologue to the book explains that.)

The group shot of Gwyn, Ed, me, and Joe is from 2006.It shows the forest before it burned. I had just finished chemo for breast cancer, so the funky hat hides my bald head.

*From left: Gwyn, Ed, Pat, Joe. Sweet Sofie is the dog in front. She’s now buried in the pet cemetery.*

Dave, who warned us of the fire and gave us time to get out just before the flames came swooping down our ridge, took this wonderful selfie in front of the pond by his house. The East Peak and the top of the West Peak are in the background. Dave grew up in the house where he now lives, which his dad built. His mom, Ruth, lived there until her death in 2010.

*Dave, on his property, with the East and West Peaks in the background.*

Harlan and Pat stand in front of their berm house, with the peak in the background. They both grew up in Colorado, ran a successful business in Kansas, then moved here. Harlan is the man in charge of most things. First, he is the one who told firefighters our little settlement was up the road and, therefore, helped save it. He also arranged for us to have garbage pickup in normal, no-fire years, and has done seriously important work on our road.

*Harlan and Pat in front of their berm home, at the entrance to our valley.*

The shot of me and Joe and our kids is one of my favorites. It was taken just after we had the boulder moved to the front of the cabin and before the three adorables entered our lives—Ellen’s husband Steve and their two sons.

*Joe, Pat, Josh, Ellen in the early days of the cabin.*

The year after the fire, our grandsons visited and fished for tuna in our creek. Sadly, they were unsuccessful. Cute as the dickens, but no tuna.

And, finally, Ross, who was a regular companion on our walks, but who died before the book came out. Here’s he’s napping next to Ed and Gwyn’s guest cottage.

To order your copy of Burn Scars: A Memoir of the Land and Its Loss, go to Amazon, Bookshop, or your local bookseller. Or contact me for an autographed copy.

The Pirate on the Mountain

Patricia Prijatel

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September 15, 2020

I can see the pirate on the mountain from the window in front of my desk in the cabin. It’s a formation of trees and rocks that create a Johnny Depp sort of swashbuckler, with features defined by 50-foot ponderosa pines poking out of granite skin. He has a pert nose, neat beard, and a large, graceful hat; one eye squints and the other one is covered with a patch. — Burn Scars: A Memoir of the Land and Its Loss.(Photo from 2012)

The pirate was a big casualty of the 2013 East Peak Fire.

Now, most of the pirate’s eye and nose are gone, his beard a pale shadow, barely visible against the rock of the mountain. His eye patch, plume, and part of his hat have some life to them, the rest is burned away. We hadn’t been up to check on it, but we heard the miner’s shack was also gone.

We and other neighbors once used the pirate as a beacon—if we left the mountain, we could still see him, guiding us back. We now have a vague reminder of our swashbuckler on the mountain, but it’s a sad one, a sign of all the forest we have lost. And since 2013, the United States alone has lost more than 40 million acres to wildfires. While the West has always had forest fires, these new ones are beasts—increasingly larger and hotter, fueled by dry timber and insect-infested trees that are the result of the climate crisis. Now, as I write this, California, Oregon and Washington are burning with a historically destructive force, sending ash-polluted air across the country. What will be left after that conflagration? And will we get serious soon about slowing this devastation down?

If, like me, you see this land as God’s creation and recognize that we have a responsibility to protect it, check out Interfaith Power and Light, a faith-based group that shows us how to be better stewards of the land God entrusted to our care.

Get Burn Scars: A Memoir of the Land and Its Loss from your local bookstore, or on Amazon.

Or contact me for an auto graphed copy.

HDAC6 Effective in Metastatic TNBC

Patricia Prijatel

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August 12, 2020

A news release from the George Washington University (GW) Cancer Center.

Genetic modifier HDAC6 was found to control tumor growth and halt metastasis in triple-negative breast cancer in vivo, according to a new study published in the journal Cancer Research by investigators at the George Washington University (GW) Cancer Center.

Immunotherapy – the use of drugs to stimulate one’s own immune system to recognize and destroy cancer cells – has been successful in melanoma and other cancers. However, it has been less effective in breast cancer.

“There is an urgent medical need to find new ways to potentiate or increase the efficacy of immunotherapy in breast cancer, especially in aggressive and highly metastatic triple-negative breast cancer,” said Alejandro Villagra, PhD, member of the Cancer Biology Program at the GW Cancer Center and assistant professor of biochemistry and molecular medicine at the GW School of Medicine and Health Sciences. “Our research lays the groundwork for a clinical trial that could lead to new, life-saving treatment options for breast cancer patients that do not respond to conventional immunotherapies.”

Molecularly targeted agents, such as HDAC6 inhibitors, have been widely described in the research literature as cytotoxic – toxic to both cancerous and healthy cells. Villagra and his research team found new non-canonical regulatory properties of these epigenetic drugs, discovering that the inhibition of HDAC6 has a powerful and strong effect on the immune system unrelated to the previously cytotoxic properties attributed to HDAC inhibitors.

This research demonstrates for the first time that HDAC6 inhibitors can both improve response to immunotherapy and diminish the invasiveness of breast cancer, with minimal cytotoxic effects.

“We are excited about the work because, in addition to the potency of immunotherapy, this drug alone is capable of reducing metastasis,” said Villagra. “This could have implications beyond breast cancer.”