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<!--Generated by Squarespace Site Server v5.11.5 (http://www.squarespace.com/) on Fri, 30 Jul 2010 18:35:14 GMT--><rdf:RDF xmlns:rdf="http://www.w3.org/1999/02/22-rdf-syntax-ns#" xmlns:rss="http://purl.org/rss/1.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:admin="http://webns.net/mvcb/" xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:cc="http://web.resource.org/cc/"><rss:channel rdf:about="http://www.annemullens.com/journal/"><rss:title>Journal</rss:title><rss:link>http://www.annemullens.com/journal/</rss:link><rss:description></rss:description><dc:language>en-US</dc:language><dc:date>2010-07-30T18:35:14Z</dc:date><admin:generatorAgent rdf:resource="http://www.squarespace.com/">Squarespace Site Server v5.11.5 (http://www.squarespace.com/)</admin:generatorAgent><rss:items><rdf:Seq><rdf:li rdf:resource="http://www.annemullens.com/journal/2010/6/14/2010-a-computer-odyssey.html"/><rdf:li rdf:resource="http://www.annemullens.com/journal/2010/6/1/bedevilled-by-phones.html"/><rdf:li rdf:resource="http://www.annemullens.com/journal/2010/5/29/the-sanctity-of-diaries.html"/><rdf:li rdf:resource="http://www.annemullens.com/journal/2009/11/26/screening-mammography.html"/><rdf:li rdf:resource="http://www.annemullens.com/journal/2009/11/18/a-few-addendums-to-previous-blogs.html"/><rdf:li rdf:resource="http://www.annemullens.com/journal/2009/11/10/my-take-on-peanut-bans.html"/><rdf:li rdf:resource="http://www.annemullens.com/journal/2009/10/9/hpv-not-studied-enough-you-judge.html"/><rdf:li rdf:resource="http://www.annemullens.com/journal/2009/10/8/why-i-support-the-hpv-vaccine.html"/><rdf:li rdf:resource="http://www.annemullens.com/journal/2009/9/27/a-short-reno-tale.html"/><rdf:li rdf:resource="http://www.annemullens.com/journal/2009/5/4/marking-a-significant-day.html"/></rdf:Seq></rss:items></rss:channel><rss:item rdf:about="http://www.annemullens.com/journal/2010/6/14/2010-a-computer-odyssey.html"><rss:title>2010 A Computer Odyssey</rss:title><rss:link>http://www.annemullens.com/journal/2010/6/14/2010-a-computer-odyssey.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2010-06-14T17:04:33Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<p>My new computer gave me the dreaded blue screen of death this past week. Not once but five times in a row, all within 20 minutes of start up and restarts. The block of text was as ominous and incomprehensible as the Star Wars opening.&nbsp;&nbsp;</p>
<p>"A problem has been detected and Windows has shutdown to protect your computer. ....Modifications of a system code or critical data structure&nbsp;was detected.... Stop code 0x00000109."</p>
<p>The first time,&nbsp;I was startled. The second time perplexed. The third time, hyperventilating. The fourth time&nbsp;(before I could even update my status on Facebook: Anne is hyperventilating) I was a quivering mass of nail-chewing hysteria. The fifth time&nbsp;- ya don't wanna go there.</p>
<p>I had just bought the system three weeks earlier, dropping $1300 plus on the top of the line monster with 8 GB of RAM, a hard drive with enough computing capacity that would have taken up 6 city blocks of IBM mainframes in the 1970s, and an enormous flat screen monitor capable of having three documents full size, all viewed at once for editing and multitasking.</p>
<p>&nbsp;I had a day of writing and editing to do in a busy week and a nutso month. This could not be happening. &nbsp;I have all my data obsessively backed up, but I need a functional computer just to get work done. &nbsp;Telling editors, clients, and art directors that you are late on a deadline because of computer problems sounds as convincing as "the dog ate my homework."</p>
<p>But five blue screens! This was not a computer problem, this was a meltdown. My keening moans of woe&nbsp; shook the quiet 1940s Victoria apartment block where have my office.</p>
<p>Calm down. Rending garments does nothing. This is obviously a hardware fault on a new system. It is all under warranty. Call Future Shop.</p>
<p>"What is the make and model of your computer?" the clerk asked between my sobs.</p>
<p>&ldquo;Gateway MS Pro.&rdquo;&nbsp;</p>
<p>&nbsp;&ldquo;Let me see&hellip; oh here. Gateway has a chat forum and email tech support on their website. Just go to www.gateway.com&rdquo;</p>
<p>&nbsp;&ldquo;Calm down ma&rsquo;am. You are right, email is not much use if your system is not working. &nbsp;I&rsquo;ll see if I can find a phone number. Hmmm. I don&rsquo;t see a phone number. I will transfer you to our tech support.&rdquo;</p>
<p>I waited while Michael Buble played. Eventually a man came on whose voice sounded completely bored and flat -- to counteract no doubt the hysterical calls he gets all day.</p>
<p>I could hear him sigh as he listened to my problem: &ldquo;That needs to be dealt with by Gateway, Ma'am. &nbsp;You are still under warranty. They have online email support and a tech support chat room&hellip;.&rdquo;</p>
<p>&ldquo;Okay. Calm down ma&rsquo;am. Yes I guess that is no use if you can't get online. Yes, I do have a tech support phone number but we can&rsquo;t give out that phone number as that is the one we use..."</p>
<p>My frustration was sky high. I tried to keep my voice as even as his. What did he suggest I do with a three-week old malfunctioning system?</p>
<p>"Well the best thing to do is pack up your computer and bring it in here. Blue screens are hard to determine. We will run diagnostic tests. That takes four or five&nbsp; business days, depending on the problem. If it is not a software problem or a virus, but a manufacturer's hardware problem -- and it sounds like hardware -- then we ship it back to Gateway. It is all under warranty.</p>
<p>And if it was hardware ( I knew it was hardware) how long would my computer be gone?</p>
<p>"One or two months at the most...</p>
<p>&nbsp;&ldquo;Well no, we don&rsquo;t give a loaner&hellip;&rdquo; he said.</p>
<p>Eventually the bored-voice man - to get the hysterical me off the phone -- &nbsp;found a phone number for me to call &ndash; that of Acer, the manufacturer of Gateway.</p>
<p>I called the 1-800 number and a pleasant, computer generated woman&rsquo;s voice answered.</p>
<p>&ldquo;Welcome to Acer. Please say as clearly as possible the issue you are calling about. You can say sales or tech support or..&ldquo;</p>
<p>&ldquo;Tech Support&rdquo; I yelled.</p>
<p>&ldquo;Okay. Tech support. What is the technical issue you are calling about?&rdquo;</p>
<p>&ldquo;Blue Screen!&rdquo;</p>
<p>&ldquo;Okay, blue screen. For operating system issues we need your 11-digit SNID number. You will find this number underneath the bar code on the side of computer. If you do not have this number handy, this automated system will wait until you find it. Say halt to look for the SNID and then say continue when you are ready to proceed.&rdquo;</p>
<p>(Oh dang!) HALT!</p>
<p>I pulled the computer tower out from my desk, disentangling wires and cords. The bar code was a tiny patch and the SNID an even tinier number underneath it. It looked like this: <span style="vertical-align: sub; font-size: 70%;">00083383712.</span></p>
<p>I got out my reading glasses and rummaged for a pen light. On my hands and knees under my desk I still could barely make it out. I wrote it down as best I could and then climbed &nbsp;back up to the phone.</p>
<p>Continue! I yelled.</p>
<p>&ldquo;Please type in or say the 11-digit SNID number.&rdquo;</p>
<p>I typed in the number, trying to get the zeroes, 8s and 3s in the right order.</p>
<p>&ldquo;To confirm, the SNID you provided is: zero, zero, zero, eight, three, three, eight, three, seven, one, two.</p>
<p>That was what I had written down.</p>
<p>&ldquo;Yes! &rdquo; I said.</p>
<p>&ldquo;This is not an Acer Product. Please call the company who made your computer. Goodbye,&rdquo; said the voice. The phone clicked dead. &nbsp;The computerized woman hung up on me.</p>
<p>Shit! I pulled the computer back out, got out a magnifying glass and got back on my hands and knees. Dang!! I had an 8 and a 3 reversed.</p>
<p>I dialled the 1-800 number again.</p>
<p>&ldquo;Hello,&rsquo; said the pleasant computer female. &ldquo;Is this the same problem you recently called about?&rdquo;</p>
<p>Okay, at least she is efficient. We can get right back to entering the correct SNID.</p>
<p>&ldquo;Yes,&rdquo; I said.</p>
<p>&ldquo;This is not an Acer Product. Goodbye."</p>
<p>I called my husband Keith, frantic. "Find me another number for Gateway or Acer. I am being blocked by a cyber control freak." He searched websites and got a different number for customer support. I called this one. The same computerized woman's voice answered.</p>
<p>&ldquo;Is this the same problem you recently called about?&rdquo; the computer voice said.</p>
<p>&ldquo;No!&rdquo; I lied.</p>
<p>&ldquo;Are you sure? Is this the operating system problem you called about at 10:05 am June 9, 2010,&rdquo; she tested, almost HAL-like in her menacing, overly-calm tone.</p>
<p>&ldquo;No!&rdquo; I lied.</p>
<p>&ldquo;Okay ( I could tell she didn&rsquo;t believe me.) &nbsp;To go any further we need your 11-digit SNID number. You will find this number underneath the bar code on the side of computer. If you do not have this number, the system will wait until you find it. Say halt to look for the SNID and then say continue when you are ready to proceed.&rdquo;</p>
<p>I entered in the number, holding my breath that this time I would do it correctly.</p>
<p>"You are being transferred," the system said. Muzak played.</p>
<p>A human voice finally came on.</p>
<p>&ldquo;Hello, this is Raminder, how may I help you?.&rdquo;</p>
<p>He was in a data call centre on the outskirts of Mumbai, India.</p>
<p>I sputtered out my blue screen problems, the three-week old system, the whole sorry tale.</p>
<p>I could tell Raminder was reading from a binder. He was a lovely caring man ( I couldn't understand half of what he said, but he mumbled it in a very caring kind way.) But he was no use what-so-ever. Ultimately, his only advice: pack up computer in its box -- it was all under warranty -- and either ship it or deliver it by hand to the Gateway office in Burnaby or Toronto. It would be back in one to two months, all covered. But no, they do not give a loaner.</p>
<p>I was on my own. &nbsp;</p>
<p>&nbsp;(PS. Thank God for Darryl Gittins, tech writer for Boulevard and computer whiz extraordinaire. He took away my new system, hooked up an old lap top of his to let me survive for three days.&nbsp; Running my new system through a series of diagnostic tests he discovered &nbsp;my blue screen woes were coming from a 2GB module of RAM that had a manufacturing glitch. He pulled the RAM -- I still have 20 times more RAM than my last system. Now I am going to see if Future Shop or Gateway will reimburse the cost. I have a feeling, no, because I did not pack up the computer and send it back.)</p>
<p>&nbsp;</p>
<p>&nbsp;</p>
<p>﻿</p>]]></content:encoded></rss:item><rss:item rdf:about="http://www.annemullens.com/journal/2010/6/1/bedevilled-by-phones.html"><rss:title>Bedevilled by phones</rss:title><rss:link>http://www.annemullens.com/journal/2010/6/1/bedevilled-by-phones.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2010-06-01T17:48:13Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<p>My paternal grandmother, a pious Irish-Canadian Catholic, believed the telephone was an instrument of the devil &ndash; and that was even before her long dead sister Ella phoned one night with a warning.</p>
<p>The story of that spooky 1919 call and the death that Ella foretold is family legend. It goes like this: Six-year-old Gerald ( my father&rsquo;s older brother in a family of 10 siblings)&nbsp; cut his foot on an ice skate. It became infected, and, in the age before antibiotics, gangrenous. He was to have his leg <span class="full-image-float-right ssNonEditable"><span><img style="width: 150px;" src="http://www.annemullens.com/storage/phone%20off%20hook.jpg?__SQUARESPACE_CACHEVERSION=1275414671775" alt="" /></span></span>amputated in hospital the next day. The family, all worried about the fate of the sweet young child, had finally gotten to sleep when the phone rang. It was midnight ( of course.)&nbsp; My grandmother, who usually never answered this new fangled contraption, did not want everyone to awaken again.</p>
<p>&ldquo;Mary,&rdquo; the voice said. &ldquo;This is Ella in Heaven. Don&rsquo;t let Gerald have the operation.&rdquo;</p>
<p>My grandmother screamed and fainted, so the story goes, and the rest of the family found her on the hallway floor, &nbsp;the earpiece dangling off the hook. Stopping the operation was not an option, the leg was too far gone. But Gerald died during the procedure.</p>
<p>&nbsp;Ghost stories like this abound in my paternal lineage, but only one of the visitations occurred via phone.</p>
<p>&nbsp;Naturally Grandma thereafter refused all late night calls, saying nothing good can come from them.</p>
<p>I think she was onto something: I&rsquo;ve been bedevilled by phones for at least two decades.</p>
<p>In my 20s my cat, Fauve, loved to chew through telephone cords. I&rsquo;d be cut off in mid-sentence. I&rsquo;d rub Bitter Apple repellent or spray her with a water gun, but it remained a game for her to wrap herself in the cord and gnaw as fast as she could whenever I talked.&nbsp; Once I waited on hold for 45 minutes, motionless, to seek out training tips from the vet on a CBC call-in show. &ldquo;We could be cut off at any minute. What do I do?&rdquo; I asked.&nbsp;</p>
<p>&ldquo;Get a cordless phone,&rdquo; he said.</p>
<p>But cordless phones are worse, at least in my house where no one <em>EVER</em> puts them back on their base. &ldquo;Where&rsquo;s the $#@ phone!!!?&rdquo; we yell, frantically lifting couch cushions, newspapers and sports gear as we can hear it ring &mdash; somewhere.</p>
<p>I bought two identical phones so that one, at least, might make it back to a base. We soon learned they wouldn&rsquo;t charge unless coupled with their true mate. But which went where?&nbsp; It took weeks to figure it out and when we finally did I painted bright pink nail polish blazes on the upstairs set and pearly white ones on the downstairs set.&nbsp; So now its: &ldquo;Who put the pink phone on the pearly base!!!?&rdquo;</p>
<p>Of course, if it stays off the base long enough the batteries die completely. We once lost the dead downstairs phone for a good four months. I scoured the house repeatedly, finally resorting to Grandma Mary&rsquo;s remedy: praying to St. Anthony, Saint of lost items. (And I am not even a Catholic since my father left the fold. ) &ldquo;Guess what was in the pullout couch?&rdquo;&nbsp; Kate announced after a sleep over. (<em>Wow, good work St</em>. <em>Ant!) </em></p>
<p>I won&rsquo;t tell you how many trips I&rsquo;ve made to London Drugs to buy new batteries for phones so dead they won&rsquo;t recharge.<em> </em></p>
<p>Being prudent, we also got tethered phones on both floors &ndash; but they root you in place. We were a host family for a guide dog in training, a black lab puppy named Piper,&nbsp; who soon learned we couldn&rsquo;t move and discipline him when on a fixed phone. During the year we had Piper we put everything possible chest high or higher. Like Pavlov&rsquo;s dog, Piper would hear the ring, and if he saw I was immobile, take off to find a leather shoe, washcloth, kid sock,&nbsp; butter dish, hair brush, or Barbie doll to devour. &ldquo;Can&rsquo;t talk now,&rdquo; I&rsquo;d say, slamming down the phone to run after him shaking rocks in a tennis ball can, a training tip to control his ravenous appetite that failed miserably. He gnawed everything, including a telephone.</p>
<p>While dogs can figure out tethered phones, some modern youth can&rsquo;t. My sister called a friend and got her young daughter: &ldquo;Can you get your Mommy for me?&rdquo; my sister asked. &ldquo;Oh no,&rdquo; said the girl. &ldquo;This phone is attached to the wall.&rdquo;</p>
<p>Now we hardly ever use the house phones at all. Messages left on the home answering machine can sit there for days, everyone else assuming another person in the family has lifted the receiver to listen for them.&nbsp; "You have ten new messages" the computerized voice almost nags when one finally remembers to check. "What is wrong with you people?!" our former friend Michael greeted us one day this past month when we bumped into him at the Moss St. Market. Three of his messages that week had still not been heard.</p>
<p>These days of course each of us in the family has our own cell&nbsp; phone.</p>
<p>But OMG, I could go on and on about the bane of cell phones: the mafia-like contracts, the frustration of companies that seductively court newbies with sweet deals but jack the prices on long-time customers; the umpteen ones lost by teens that even St. Anthony can&rsquo;t help find; &nbsp;the one destroyed after it was dropped in a puddle;&nbsp; the exorbitant bills; the overheard irritating conversations in public venues; the tyranny of never being unavailable.</p>
<p>In rebellion, I refuse to use my cell phone for all but the most urgent calls. ( I do rather like texting; I am a writer after all.)</p>
<p>But I will take a call anytime, from Ella. There is one thing I have to know: &ldquo;Ella, how did you make that call? "</p>
<p>Because in my heaven, there are no phones.</p>
<p>﻿</p>]]></content:encoded></rss:item><rss:item rdf:about="http://www.annemullens.com/journal/2010/5/29/the-sanctity-of-diaries.html"><rss:title>The sanctity of diaries</rss:title><rss:link>http://www.annemullens.com/journal/2010/5/29/the-sanctity-of-diaries.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2010-05-29T06:24:21Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<p><img src="file:///C:/Users/Anne/AppData/Local/Temp/moz-screenshot.png" alt="" /><img src="file:///C:/Users/Anne/AppData/Local/Temp/moz-screenshot-1.png" alt="" /><span class="thumbnail-image-inline ssNonEditable"><span><a href="javascript:showFullImage('/display/ShowImage?imageUrl=%2Fstorage%2Fdiary.jpg%3F__SQUARESPACE_CACHEVERSION%3D1275167895635',407,520);"><img src="http://www.annemullens.com/storage/thumbnails/865312-7131169-thumbnail.jpg?__SQUARESPACE_CACHEVERSION=1275167895638" alt="" /></a></span></span>Today, on my Facebook page, I got into a discussion with friends about the modern dilemma of whether a facebook profile is equivalent to the sanctity of the diary.</p>
<p>The situation that prompted this discussion is that last week my 19 year old daughter used my office computer to write and print out resumes. Today, the first time in a week, I typed in www.facebook.com and instead of having my login pop up I was taken directly to her home page. At first I was confused. The first name I saw, in bold print, was a young man, a friend of Kate's whom I happen to have strong feelings against for a few egregious infractions I witnessed or was recipient of&nbsp; during those awkward teen years. I have heard he has since grown up and become a decent young man, but when I saw his name front and centre on what I thought was my home page I went: WHAT? He IS NOT my Friend!!??# He's in JUVIE!!</p>
<p>That name shocked me into the recognition that this was not my homepage but in fact my daughter's that she had neglected to exit. I wanted my page,&nbsp; so I logged her out. But in the time it took to sign on to my profile I thought: Oh dang! Wasn't that just the perfect opportunity to explore ( some might say "spy") on the life of the flesh I gave birth to?&nbsp;</p>
<p>The role of parent is a weird one in the teen years. It is like parenting toddlers who have access to alcohol and car keys. I&nbsp; believe Mother Nature has designed the relationship between teens and parents to be increasingly distant so that around age 19 both sides say: all right, time to get out and explore the world. If our children stayed as sweet and lovely as they are at 10, holding our hand as we walk to the grocery store, we would never want them to grow up and get on with their own lives.&nbsp; "Live with us forever darling, no need to find a job, mate and produre a family of your own." If our children continued to look at us with those eyes of adoration and dependency that gazed at us as we tucked them into bed at age 5, they, too,&nbsp; would never want to go.</p>
<p>And then no new generation would have babies and everything would collapse. So Mother Nature makes sure teens and parents spar and separate. The survival of the species is at stake!</p>
<p>So by 19, when the kid has all the answers and roles her eyes you both know: time to get some experience of your own, dearie dee.</p>
<p>But I miss knowing the details of their lives, their ups and downs they used to share so readily, the who- said-what-to-whom. It is natural for teens to withdraw into grunts upon being asked "how was your day?" And I am luckier than many in that my girls are still rather open with me.&nbsp;</p>
<p>&nbsp;But while both my daughters ( and many of their friends) have friended me on Facebook, both have put me on "extreme limited profile" to curb my intrusion on their space. Both have made it clear that if I should somehow get access to their unguarded face book page and read it, it would be akin to reading their diary.</p>
<p>I know all about diaries. I was an obsessive diary keeper from the age of about 11 to the age of about 32. I have 13 large volumes in a box in my attic. My early jotting years are largely juvenalia: " "Jennifer likes Scott, but I like him, too. And he smiled at me yesterday and I smiled back and said Hi. But Jennifer saw it and then we got in a big fight in the girls'washroom and she said she wasn't my friend anymore."</p>
<p>Once in my late 20s,&nbsp; I read out loud my diaries from those early teen years&nbsp; to my mother and a sister and we laughed so hard we had tears streaming down our faces. My excruciating recording of those awkward angst-filled years hit a chord of hilarity with&nbsp; of us&nbsp; -- every woman has been there in her teen years.</p>
<p>Though much in my 13 tomes is fogettable drek that I would happily now burn at no loss to the world of literature and letters, within those pages are hints of the writer I was to become - Holden Caulfield-like observations of hypocrisy, Thoreau-like ruminations on nature, Leacock-like ( well at least I like to think so ) riffs on life's absurdities. And there are sketches and paintings, concert stubs and snapshots,&nbsp; and heart-felt revelations and honesty that still move me to read to this day. There is also some pretty racy bits -- I was single to age 30 after all -- and that content in my 20s is rather akin to the "I like Scott"&nbsp; material of the early years but with way, way more at stake.&nbsp;</p>
<p>But here is the thing. They are nothing like facebook. They are my most private and intimate thoughts on life. There is no way, in the world, I would have ever have posted my entries to share with 500 so-called friends. I would have been humilated and&nbsp; mortified to have anyone -- my mother, my sisters, my friends -- read about my insecurities and bravado, my loves and likes, my insights and worries, my pratfalls and pontificating.</p>
<p>Now I have the dilemma: what to do with my diaries? I still am not keen to have anyone read them (i.e racy bits) least of all my husband and children who have a certain image of me. (Note to family: I will notice if anyone goes up to the attic and touches them!! Thank goodness the attic is only accessible by a long ladder hauled up from the basement and a trap door.)&nbsp; And I still cringe with the thought that after I am dead, someone will read them. But I cannot burn them yet-- they still contain too much of me even though I have not read them in years.</p>
<p>But as I said on my Facebook profile, a daughter's face book page is not really like a diary at all, it is like a teen party with no adult supervision in which there is no expectation among friends of privacy. All is shared -- every last camera angle and thought. It is life lived as if on stage, knowing, hoping, all are watching.</p>
<p>I do hope they are finding a quiet time for pause,reflection and rumination somewhere, somehow. I think it is good for the soul and for the maturation of an adult.&nbsp; Facebook does not provide it.</p>
<p>But I will give them their privacy on FB, because like a closed door in teenage years, they seem to really want and need it.</p>
<p>But it ain't no diary.</p>
<p>&nbsp;</p>
<p>&nbsp;</p>
<p>&nbsp;</p>]]></content:encoded></rss:item><rss:item rdf:about="http://www.annemullens.com/journal/2009/11/26/screening-mammography.html"><rss:title>Screening mammography</rss:title><rss:link>http://www.annemullens.com/journal/2009/11/26/screening-mammography.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2009-11-26T21:22:06Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<p>The last two weeks have seen a flurry of comments about the merits of screening mammography for women under the age of 50. There is nothing new here. This debate has been going on for more than 20 years now. Evidence has existed for years, that in population terms, screening younger women does not save lives from breast cancer and probably harms more woman than it helps. The US has chosen for years to ignore this, while the rest of the western world generally does not promote screening to women under 50.</p>
<p>Before we get into the details let me make two things perfectly clear:</p>
<ul>
<li><strong>Screening versus diagnostic mammograms</strong>: the general public often doesn't understand the difference between screening and diagnostic mammograms. Screening takes a healthy population of women <em>with absolutely no symptoms</em> and tests them with regular mammograms. A diagnostic mammogram, on the other hand, is done when there is a detectable lump, a discharge,&nbsp; a change or puckering in the skin or when a woman is found or suspected by family history to carry BRCA-1 or BRCA-2 genes. The debate about mammograms is around <em>screening </em>healthy women with no symptoms or genetic risk and its value in saving lives. If you or a loved one at any time has any symptoms&nbsp; or carry the gene for breast cancer, get a <em>diagnostic </em>mammogram as fast as you can. In the same way, <em>screening </em>breast self exams -- which means teaching healthy symptomless women how to check their breasts in a routine way at the same time ever month -- has not been found to help. That is completely different from the need for all women to simply know her breasts and notice any change -- a lump, a puckering, a discharge or thickening of the skin. As soon as you have a <em>symptom,</em> get into the doctor right away. </li>
<li><strong>The need for clear informed consent and personal decision-making:&nbsp; </strong>A woman&nbsp; must be the master of her own body. If, with her family doctor, a woman at any age is fully aware of the pros and cons of mammograms and decides she needs one or wants one, and the doctor agrees, she should be able to get one. But as I will detail below, there has been a lack of clear informed consent around mammograms. Only the benefits, and none of the downsides, are widely promoted in the invitations to screening programs. But, if a woman knows the pros and cons and decides to get one, I absolutely support that right. I personally know many women who chose screening and had early cancers, mostly DCIS,&nbsp; found. They firmly believe this saved their lives and I support their right to believe that and make that choice. More informed consent is needed.</li>
</ul>
<p>Now that those two things are clear, let me tell you a story. Back in 1987, when I was medical reporter at the Vancouver Sun, I got a call from the BC Cancer Agency that the Canadian National Breast Cancer Screening Study was comparing the outcomes of women screened to women not screened in huge numbers -- more than 90,000 Canadian women. But there was a problem - not enough women knew about the study and so not enough were signing up to take part. I wrote a story about a woman whose breast cancer was found on a screening mammogram, and how grateful she was. And I urged women to take part in this important study. The Cancer Agency had so many calls in the week after my story ran -- more than 3,000 -- that they had to put in extra phone lines. The BC arm made its target number for the study in part based on my promotion of it. I firmly believed early detection was the way to go.</p>
<p>But then, around 1988/89, I began to hear concerning rumors among my sources that results of the study were astonishing and confounding. In the 40 to 49 age group, more women were dying in the screened group than were dying in the control group. This did not make sense. We all believed so firmly that early detection would save lives, and that the earlier that screening was started, and a cancer detected, the better. No one wanted to believe that finding it earlier might in fact be harmful.&nbsp; Canadian lead researcher Dr. Cornelia Baines says the data about worse outcomes in screening in younger women started showing as early as 1983, but by the early 1990s, with more than 90,000 women studied,&nbsp; it was clear - the young mammography group had more deaths, more false positives and more overdiagnosis ( treatment of harmless cancers) than the control group. When Baines et al published the results in 1992 they were roundly criticized, their study methods were faulted (there was nothing wrong with the study) and the Canadian team's credibility was assaulted. It was shocking to see how ideology trumped the research. The message was ignored and the messengers shot instead.</p>
<p>But two otherr large European controlled studies found exactly the same result -- women under 50 had more deaths.&nbsp; UK surgeon and breast cancer expert Dr. Michael Baum, who in in the 1980s was the strongest proponent in that country for mammography and set up its national screening program, has become one of its strongest and most vocal critics. Baum is particularly concerned by the huge increase in ductal carcinoma in situ ( DCIS) found in women under 50 who have mammograms.</p>
<p>Here is what Dr. Baum has said widely in various interviews, including to me in an article I did on DCIS in spring 2008 Best Health, about his theory about what is occurring:</p>
<p style="padding-left: 30px;">"<em> Ductal carcinoma in situ is probably not a good word, and we should call it latent cancer. These latent cancers, particularly in premenopausal women, are grossly over-represented in women given mammograms--something like five times more, compared to what you would expect. This suggests that if left to their own devices, these latent cancers might never trouble a woman. But if you identify these latent cancers and biopsy them, you have traumatized the area. You immediately trigger the natural healing mechanisms, and natural healing mechanisms involve angiogenesis ( </em>formation of new blood vessels<em>.) So, effectively, the biopsy could be considered an angiogenic switch. You take a latent cancer that would never hurt a woman, biopsy it, turn on the angiogenic switch, and it ceases to be latent. A latent disease becomes an aggressive disease."</em></p>
<p>This theory of angiogenesis is highly controversial and you won't hear it discussed much, but it is strongly supported Michael Retsky, PhD, a researcher at Harvard Medial School and the late, famed researcher Judah Folkman, also of Harvard, who is credited as the father of angiogenesis research in many disease processes including cancer. Another interesting finding that might support the theory that mammography may somehow help turn on a switch making some breast cancers more aggressive. For years researchers have known about "interval cancers"&nbsp; -- breast cancer that shows up, suddenly between the screening as a felt lump in women who have been having mammograms every year or two.&nbsp; There is no evidence of a cancer at all on the screen, but then one suddenly grows rapidly before the next scheduled mammogram. Interval cancers are usally more aggressive than those found at the time of screening or those found in women who have never undergone screening. They don't know why interval cancers are particularly nasty, but Baum theorizes that perhaps radiation or the intense squeezing of the breast during the screen may switch on the healing response of angiogenisis that also spurs a cancer growth.</p>
<p>Baum resigned from the UK screening program in the 1990s when it refused to share the pros and cons with all women taking part in screening as a necessary discussion about informed consent. He believes that fully informed women over the age of 50 should choose for themselves as there is evidence past age 50 it saves lives, but he is on the record saying: "To promote screening mammography to women under the age of 50 is absolutely unethical."</p>
<p>But let's take a closer look at that age of 50 -- that age is chosen because the median age of menopause in western women is around 49.&nbsp; Onset of menopause ranges from the early 40s to the late 50s. Some women do not experience menopause ( a full year without a menstrual period) until age 58 or 59. The evidence is that it is likely menopause not age, that is the defining factor of whether screening mammograms are helpful.&nbsp; ( It could again be angiogenesis and the menstrual cycle, some theorize.) The evidence is convincing enough for me that I have decided I will not undergo a screening mammogram until I have had one full year of cessation of menstruation. The best results for screening is among women aged 60 to 69, likely because all women by that age are menopausal.</p>
<p>Here is another fact that more women should know. The huge drop in the use of hormone replacement therapy corresponds exactly, with a lag time, with a significant drop in breast cancer incidence. In fact, more lives may be saved by not doing HRT than from screening.&nbsp; There was a 13 per cent drop in hormone receptor positive breast cancer between 2001 and 2004 and an 8 per cent drop in a single year ( 2002/2003) that tracks exactly to the sudden stop of HRT by millions of women following the 2001 results of the Women's Health Initiative, that found HRT was harming women.</p>
<p>Look at these two graphs from the New England Journal of Medicine and note the&nbsp; drop&nbsp; corresponds to the sudden decline in prescriptions for HRT. Although the issue is still being debated, a similar decline was seen in Canada, Spain and the UK, and a special study by regions in California also showed the same result. Click to enlarge the thumbnail to better read the graph, from New England Journal, Berry et al, April 19, 2007<span class="thumbnail-image-block ssNonEditable"><span><a href="javascript:showFullImage('/display/ShowImage?imageUrl=%2Fstorage%2F13f2.jpeg%3F__SQUARESPACE_CACHEVERSION%3D1259276400856',805,572);"><img src="http://www.annemullens.com/storage/thumbnails/865312-4890925-thumbnail.jpg?__SQUARESPACE_CACHEVERSION=1259276400859" alt="" /></a></span></span>&nbsp;</p>
<p>For those of you wanting more references, here are a few ones to start. The literature is huge. Just google pubmed and go to the National Library of Medicine data base. You could be reading for hours. I am citing the British Medical Journal and European journals primarily because there seems to be a more open discussion of the pros and cons over the last decade in Europe than in North America,&nbsp; which may be interesting to Canadian women. Here in North America we still shoot the messenger, as has been seen by the coverage of the past week. Thus, I am wearing my flak jacket.</p>
<p><img src="file:///C:/DOCUME%7E1/COMPAQ%7E1/LOCALS%7E1/Temp/moz-screenshot.png" alt="" /></p>
<dl><dt><br /></dt><dt> H Gilbert Welch<strong>. </strong>Overdiagnosis and mammography screening.</dt><dd>BMJ 2009 339: b1425.                                                                                    <a href="http://www.bmj.com/cgi/content/extract/339/jul09_1/b1425">[Extract]</a> <a href="http://www.bmj.com/cgi/content/full/339/jul09_1/b1425">[Full Text]</a></dd></dl>
<p>Zackrisson S, Andersson I, Janzon L, Manjer J, Garne JP. Rate of over-diagnosis of breast cancer 15 years after end of Malm&ouml; mammographic screening trial: follow-up study. <em>BMJ</em> 2006;332: 689-91.<a href="http://www.bmj.com/cgi/ijlink?linkType=ABST&amp;journalCode=bmj&amp;resid=332/7543/689">[Abstract/<span style="color: #cc0000;">Free</span>&nbsp;Full&nbsp;Text]</a><sup> </sup></p>
<p>Duffy SW. Some current issues in breast cancer screening. <em>J Med Screen</em> 2005;12: 128-33.<a href="http://www.bmj.com/cgi/external_ref?access_num=16156943&amp;link_type=MED">[Medline]</a><sup> </sup></p>
<p>Moller B, Weedon-Fekjaer H, Hakulinen T, Tryggvadottir L, Storm HH, Talback M, et al. The influence of mammographic screening on national trends in breast cancer incidence. <em>Eur J Cancer Prev</em> 2005;14: 117-28.<a href="http://www.bmj.com/cgi/external_ref?access_num=10.1097/00008469-200504000-00007&amp;link_type=DOI">[CrossRef]</a><a href="http://www.bmj.com/cgi/external_ref?access_num=000228622000007&amp;link_type=ISI">[ISI]</a><a href="http://www.bmj.com/cgi/external_ref?access_num=15785315&amp;link_type=MED">[Medline]</a></p>
<p>H Gilbert Welch, Lisa M Schwartz, and Steven Woloshin.<strong> Ramifications of screening for breast cancer: 1 in 4 cancers detected by mammography are pseudocancers</strong> <br /> BMJ 2006 332: 727. <a href="http://www.bmj.com/cgi/content/extract/332/7543/727">[Extract]</a> <a href="http://www.bmj.com/cgi/content/full/332/7543/727">[Full Text]</a></p>
<p>&nbsp;Michael Baum. <strong>Ramifications of screening for breast cancer: Consent for screening </strong>BMJ 2006 332: 728. <a href="http://www.bmj.com/cgi/content/extract/332/7543/728">[Extract]</a> <a href="http://www.bmj.com/cgi/content/full/332/7543/728">[Full Text]</a></p>
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<p>&nbsp;</p>]]></content:encoded></rss:item><rss:item rdf:about="http://www.annemullens.com/journal/2009/11/18/a-few-addendums-to-previous-blogs.html"><rss:title>A few addendums to previous blogs</rss:title><rss:link>http://www.annemullens.com/journal/2009/11/18/a-few-addendums-to-previous-blogs.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2009-11-19T01:06:33Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<ul>
<li>I've had differing reactions to my blog on peanut bans, one of which was that young allergic children cannot be charged with keeping themselves safe. I totally agree and I did not want to give that impression. Risk management must have responsible adults oversee it. Adults ensure safe processes are followed. It means that teachers or cafeteria staff must enforce the rules that everyone sits in place and eats their food, with no food sharing. It means that the adult asks who has an allergenic food that day, and that kids are separated in a way that no one feels bad, or singled out or isolated. It means the adult oversees the safe and effective clean up - "Johnny, you missed that spot there, wipe it up again." or " Dylan, don't throw that wash cloth, walk over to the sink and rinse it out." Without a process that all agree to, responsible adults to monitor the process and consequences if the process is not followed, the allergic child is left to fend for his or her self and risk management is equally unsafe as peanut bans or no plan at all.</li>
<li>An interesting article on HPV vaccination appeared in the Nov 5 New England Journal of Medicine. Instead of using the vaccine to prevent infection with HPV -- as it is being used now -- Dutch doctors created a variant of the HPV-16 vaccine and gave it to 19 women with early precancerous lesions of the vulva. Typically these women would have had to undergone an invasive course of repeated ablations with a carbon dioxide laser ( burning) or wide excision via surgery ( cutting) of their vulva to remove these lesions to stop them progressing to cancer. Recurrence is almost universal. So instead the Dutch doctors gave the vaccine to prime the women's immune systems to fight the HPV strain themselves. Of the 19, 15 had a marked improvement of symptoms&nbsp; and 9 women completely cleared the lesion and remained lesion free 2 years later. The use of immune modulating to fight early cancer is a fascinating and hugely important area of medicine. The HPV vaccine and the Hepatitis B vaccine are both proving that some future cancers can be prevented by immunization. Now new evidence is emerging that early cancer may one day be widely treated by the same means. I believe the viral role in cancer will be an area of explosive research in the decade ahead. Some are suggesting that viral causes of prostate cancer and some forms of&nbsp; breast cancer may also be revealed.</li>
</ul>
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<ul>
<li></li>
</ul>
<p>&nbsp;</p>]]></content:encoded></rss:item><rss:item rdf:about="http://www.annemullens.com/journal/2009/11/10/my-take-on-peanut-bans.html"><rss:title>My take on peanut bans</rss:title><rss:link>http://www.annemullens.com/journal/2009/11/10/my-take-on-peanut-bans.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2009-11-10T22:00:37Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<p>Recently  peanut bans have come under fire, particularly by writer Patricia Pearson who in  the October issue of Chatelaine wrote a provocative piece claiming peanut bans  are nuts. She is the mother of a picky child, whose favourite food is peanut  butter. She writes that schools are over-reacting to peanut allergies.&nbsp;  Naturally, some 270+ comments have now been posted on the Chatelaine website,  the majority from parents of allergic children saying "Shame on You Chatelaine,"  calling Pearson irresponsible and stressing that life-threatening allergies must  be taken seriously. Other parents have praised her for finally speaking out,  saying parents of allergic children are hysterical and  irrational.</p>
<p>As the  mother of a peanut allergic child I have a unique perspective. Both sides are  right: allergies must be taken seriously, but parents of allergic children often do blindly promote peanut bans without reflection. I support a sensible third  way: risk management.</p>
<p>&nbsp;Early in  Kate&rsquo;s school years we learned peanut bans were actually dangerous to her.&nbsp;  Their effectiveness relied completely on all the school's parents, staff and children  honouring the ban. Twice peanut bans were broken around Kate by parents whose  children would only eat peanut butter sandwiches. One parent at our tiny  preschool told the child to quietly eat his lunch out in the play area. He did  so on the swing set and he put his hands all over the swing's chain. Kate  touched the chain later that day and there was enough residue that her face  swelled up to twice its size and her eyes closed shut. She was taken to hospital  where we tried to figure out how in the world she had come in contact with  peanuts. Fortunately she did not put her hands into her mouth or she might have  died. In search for the reasons for her reaction, we were told other children  had seen the child eating his sandwich on the swing. The parent confessed that  she had encouraged him because he would eat nothing else. She didn't want him to  starve. The ban forced her to act surreptitiously and that put Kate in danger. A  second incident occurred when a grandparent made a peanut butter sandwich and it  came into Kate's Grade 1 classroom without anyone knowing. The fumes caused a  serious asthma attack for Kate.</p>
<p>Those two  incidents convinced me that peanut bans are quietly breached all the time  leaving no protection in place.&nbsp;In fact Kate's safety was in the hands of some  600 people we did not know. &nbsp;I wanted the control in our hands, and ultimately  in Kate's hands. She is the one who must move through the world with her  allergy. She must learn how to manage risk to keep herself  safe.</p>
<p>&nbsp;Here is  how risk management deals with food allergies at schools and is applied to all  children with or without allergies:</p>
<ul>
<li>All food is eaten at children&rsquo;s desks or the cafeteria (  no food in school yards, halls or playgrounds &ndash; this reduces risk of choking  too.) </li>
<li>All desks or eating surfaces are wiped clean and hands  washed before and after all food consumption. In particular, kids are charged  with keeping their desktop and their hands clean and free of food residue ( This  reduces transmission of viruses, too.) </li>
<li>The serious allergies in each classroom are noted and  posted &ndash; nuts, peanuts, fish, egg, etc. If another child has a food that  contains an allergen, it is announced. In Kate&rsquo;s classroom,&nbsp;the kids would say:  &ldquo;I have peanut butter today, Kate&rdquo; and arrangements would be made to put the two  of them far apart and be extra careful with the clean up. Most of Kate&rsquo;s friends  decided they would not eat peanuts around her. But she always knew who had  what.&nbsp; It promoted communication and understanding. And the child with the  shrimp allergy was safe, too. </li>
<li>We stressed to Kate, &ldquo;If you don&rsquo;t eat it, it won&rsquo;t kill  you.&rdquo; She might get hives or wheezy, but she would be okay. She was calm around  other people's food. She didn't freak out if she saw peanuts, she just kept  herself away or washed her hands really well. She always carried her epi pen,  asthma meds and antihistamines. </li>
<li>We also stressed: &ldquo;Don&rsquo;t eat what you don&rsquo;t know&rdquo; which  meant no experimentation or food sharing. She learned to assess the risks of  each situation and judge the places where peanuts traces might be hiding (  chocolate, ice cream, a jam or honey jar at a friend&rsquo;s house, cross  contamination at a Thai or Vietnamese restaurant.) She would avoid those  situations. </li>
</ul>
<p>These  simple clear techniques not only kept her safe and in control of her own health  &ndash; she had no further peanut reactions despite peanuts being all around her &nbsp;&ndash;  but kept other kids safe, too, no matter what their allergies. While I agree  peanuts must not be eaten in closed air environments like airplanes &ndash; the risks  are too high &ndash; I strongly encourage all parents of allergic children to lobby  for the adoption of risk management rather than peanut bans. Then we can stop  the ridiculous name calling and truly reduce the chance that an allergic child  will come to harm.</p>
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<p>&nbsp;</p>]]></content:encoded></rss:item><rss:item rdf:about="http://www.annemullens.com/journal/2009/10/9/hpv-not-studied-enough-you-judge.html"><rss:title>HPV not studied enough? You judge</rss:title><rss:link>http://www.annemullens.com/journal/2009/10/9/hpv-not-studied-enough-you-judge.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2009-10-09T16:34:18Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<p>A girlfriend sent me a note today, after my previous blog, saying her GP told her the HPV vaccine has "not been studied enough" and advised her against having her daugther get&nbsp; it.</p>
<p>I will present a summary of some of the research facts and you can judge.</p>
<p>But first, if you don't trust my interpretation, you can go yourself to read abstracts from all the medical literature at the US National Library of Medicine. The US National Institutes of Health provides an incredible free research tool which is a searchable database of every medical journal in the world. Just put "Pub Med" into google and it will come up. Then in its search bar put "HPV vaccine" ( for everything about it) or "HPV" adverse events" if you are particularly interested in the risks.</p>
<p>The medical language can be hard for neophytes, but I go to Pub Med almost everyday to look up something in my job as a medical writer and summarzing medical literature is a big part of what I do.</p>
<p>Since 2000, there are more than 3100 research studies, commentaries and reviews about the HPV vaccine in the world's medical journals. One or both of the two available vaccines are now licensed in 98&nbsp; countries and being used in high school innoculation campaigns in hundreds of jurisdictions, including all of the provinces of Canada. Australia has been doing school innoculations since 2006, UK since 2007, so Canada is slow to adopt it as this is the first year it is being offered to highschool girls in mass immunizations. Millions of girls and women have now been vaccinated</p>
<ul>
<li>Prior to licensure in 2006, more than 60,000 young women had been given the vaccine in trials. In that number, the incidence of adverse events following immunization (AEFI) was very low but 60,000 was too small to find the true incidence of serious rare events.</li>
<li>In August of this year, the US Centre for Disease Control published in the Journal of the American Medical Association the "Postlicensure Safety Survelliance" of the vaccine now that millions of women and girls have received it. All jurisdicitons report AEFI rate. ( It is a passive system, in that the people doing the shot must report. So some events may go unreported, but not likely the serious ones.)&nbsp; Here is the most recent AEFI per 100,000 innoculated :      
<ul>
<li>8.2 girls per 100,000 fainted ( syncope) </li>
<li>7.5 had local site reactions</li>
<li>6.8 got dizzy</li>
<li>5.0 were nauseated</li>
<li>4.1 got headaches</li>
<li>2.6 got hives (uticaria)</li>
<li>0.02&nbsp; ( 2 in a million) got a venous-thromboembolic event (a blood clot) or developed Guillan-Barre syndrome ( they are not clear these events were vaccine related)</li>
<li>0.01 had anaphylaxis and/or died&nbsp; ( 1 in a million )</li>
<li>There have been 32 deaths reported world wide now that upwards of 32 million women have been innoculated. Some of the deaths such as a 14 year old girl in Coventry England two hours after the shot is now being ruled not related.</li>
</ul>
</li>
<li>The first women innoculated were back in 1998-1999 in Seattle. IN that research study 100 % of the women with the vaccine were negative for HPV and there were no AEFI except site soreness, dizziness and headache. Koutsky has followed up with 200 of these women and found, 9 years later, more than 90 per cent were still negative.</li>
<li>Australia also now has data on about 8 years post vaccine followup. They report an 87 per cent still negative rate&nbsp; 8 years later.</li>
<li>There is a lot of debate in the medical literature about the psychological impacts and a number of studies have done surveys of parents and young girls for attitudes. Here are some of the findings<br /> 
<ul>
<li>&nbsp; Parents not signing the form, more than 50 percent feel it encourages sex without risk and condones premarital sexual activity. (Hmm, "I would rather have my daughter at risk of cancer, genital warts than have her think sex is normal and healthy.") </li>
<li>&nbsp; Most 11-12 year old girls, when surveyed, say they want the vaccine when told about the pros and cons. Among girls whose parents did not sign the form, 50 per cent said they wanted it but their parents wouldn't allow it.</li>
</ul>
</li>
</ul>
<p>A lot of debate exists about HPV's impact on the PAP screen and fear that it will undermine the Pap Screen process and the 40 years of its success.&nbsp; Here is some of that debate:</p>
<ul>
<li>All agree, women must still have regular paps</li>
<li>With much fewer cases, will the PAP screen have a higher false negative rate? ( Screeners seeing less cancer, and therefore becoming less good at catching it?)&nbsp; - This to me is a quality control issue and saying we need more women getting cancer so that our screeners can properly read the slides is a ridiculous argument. We already know in some jurisdicitons, quality control is poor. I say put the resources in primary protection ( stopping it in the first place) and not secondary ( catchng after it has occured and women need invasive treatment to cure it.)</li>
<li>50 per cent of women who get cervical cancer haven't had a PAP in 7 years. Many of these are aboriginal, immigrant or poor women.&nbsp; Pro side says mass innoculation of young girls removes this socio-economic determinant and levels the playing field. Cons say " we have to reach out to them more and get them regular medical care and not accept the status quo." I say do both -protect all the girls equally now, and work upstream to ensure disadvantaged women are not lost to medical care through life circumstances. Where's the conflict?</li>
<li>Cons say only 1,700 women in Canada each year get cervical cancer but the cost of the vaccine is so high that it is disproportionately spending resources on a cancer that is no longer a big problem.&nbsp; But, as the pro side points out, it is not just cervical cancer in the total cost. HPV causes ( and costs) for all the following:      
<ul>
<li>&nbsp;genital warts ( 50 per cent of all sexually active people get it) - it can take multiple trips for docs to burn off the warts.</li>
<li>recalls of PAP tests</li>
<li>Colposcopies ( viewing the cervix)</li>
<li>Cone biopsies of precancerou cells</li>
<li>treatments of displasia ( - freezing, buring, cutting away the cervix) all in the pre cancer stage.</li>
<li>other cancers likely caused by HPV ( penile, anal, oral and esophageal, vaginal and vulvar -- although low in numbers, collectively significant.)</li>
</ul>
</li>
</ul>
<p>Despite the PAP test and the huge drop in cervical cancer, world wide cervical cancer remains the second most common malignant disease in women. In third world countries it is still the leading cause of death for women. In developing countries like Africa and South East Asia, where PAP screening is deplorable, the HPV vaccine may make a huge impact in protecting women and saving lives.</p>
<p>In the Western world, HPV vaccine provides very high rates of prevention for at least 8 years post vaccine, preventing women from getting cancer in the first place. Why in this day and age, when a vaccine has been proven safe enough and effective for the years when girls are most at risk, would we be arguing that waiting for cancer to strike and then spending all sorts of resources to find it is the more logical option?</p>
<p>( Perhaps look at the vested interests in the systems at work in finding the cancer.)</p>
<p>And note, some of the objections to the HPV vaccine is actually moralistic religious view points, hiding behind "scientific" argument. That moralistic view ( as seen in the parents interviews) has at its basis that sex with less risk is inherently wrong and that teenage sexuality must be discouraged and must have its negative outcomes. That, to me explains, why the Catholic diocese in Vancouver has advised parents not to let their girls have the shot. It is not science folks, its morality.</p>
<p>Me, I know my teenage girls will be exploring with sexuality. It is human. I want them to do so safely.</p>
<p>&nbsp;But don't just listen to me -- after 7 years of reading about this, I am very firmly in the pro camp. Read the literature yourself at www.ncbi.nlm.nih.gov/pubmed/</p>
<p>&nbsp;</p>]]></content:encoded></rss:item><rss:item rdf:about="http://www.annemullens.com/journal/2009/10/8/why-i-support-the-hpv-vaccine.html"><rss:title>Why I support the HPV vaccine</rss:title><rss:link>http://www.annemullens.com/journal/2009/10/8/why-i-support-the-hpv-vaccine.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2009-10-08T05:01:53Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<p>I just got off the phone with an old friend, a dad of two teenager daugthers. One of his daugthers this year is set to receive the mass immunization taking place in Grade 9 girls in BC. The mom, a close friend, signed the permission form, but the dad was hesitant.</p>
<p>"Call Anne", the mom said, "She will convince you."</p>
<p>He called me up tonight, all worry and concern about unnecessary vaccinations and immune modulations, risks and benefits. And this is what I told him in a 30 minute conversation:</p>
<p>Back in 2002 I was ghost writing a massive provincial health document - <em>The Health and Wellbeing of People in British Columbia </em>-- for Provincial Health Officer Dr. Perry Kendall, a doctor and epidemiologist whom I know very well.&nbsp; Perry is the best of public health officials, firmly committed to the principles of pubic health, constantly weighing the pros and cons of intervention versus the cost of doing nothing, assessing the evidence and formulating a reasoned, safe, proactive response to keep BC on the cutting edge of health protection.</p>
<p>&nbsp;We were finishing this 245 page tome about how to improve the health of British Columbians when a study in the New England Journal of Medicine reported amazing findings of a new vaccine. It was one of those situations were researchers prematurely broke the anonymous code in a double blind study because one arm had such unamimous results that it was unethical to continue. The results were this: 0f 768 women who received the HPV vaccine, none developed any cervical changes nor even had any HPV-16 residing in their genital tract where it could infect new sexual partners. Not one! ( Koutsky et al, 2002; Crum, 2002) The placebo group had 16 infections, three of which had already developed cervical lesions. The trial had run 17 months.</p>
<p>We knew the results were highly preliminary. We knew there were almost 70 different strains of HPV and this vaccine only protected for the two most virulent strains, HPV-16 and HPV-18. But those two strains alone were responsible for more than 50 per cent of all cervical cancer. This was an amazing result - 100 per cent effectiveness in the vaccine group.&nbsp; It is estimated that 50 per cent of all seuxally active men and women will have an HPV infection at some point in their sexual lives and while 90 per cent clear, it is now known that HPV is not only behind all cervical cancer, it is also a cause of anal, rectal, oral, penile, vulvular and vaginal cancer.</p>
<p>BC had an important history in the cervical cancer story. In the 1950s this province was the first in the world to institute the PAP screen and make it a part of necessary pro-active health care for all sexually active women. Over the last 4 decades, because of PAP screening, cervical cancer has fallen by 85 per cent. Cervical cancer used to be much more common than breast cancer and was a horrible cancer to get. Its dramatic reduction was a true success story.</p>
<p>But here is what frustrates public health and cancer officials: while 50 per cent of women who get cervical cancer have not had a PAP test in the previous 7 years, the other 50 per cent have had regular tests like clock work. They have been coming, year after year, for their PAP test, and they still get it. That 50 per cent has stuck in the craw of cancer prevention officials for years. ( They always focus on the 50 per cent who don't have the tests. "If only we could increase the participation of Aboriginal and immigrant women in the provincial screening program," they say, not mentioning the diligent compliant gals who put their feet in the stirrups year after year to no avail.)</p>
<p>Some HPV viruses are so virulent the can take hold and destroy in less than a year. Researchers do know that the younger the age at first intercourse the faster the advance to cervical cancer. In Canada about 1400 cases of cervical cancer are diagnosed each year and 400 women die from it.&nbsp; What is not stated is how many thousands of women get the call that unusual cells were found on the PAP test and they need to come back, or they need a cone biopsy, or an cryro-ablation for pre-cancerous cells. The impact of HPV is much, much greater than that 1,400 number of cervical cancer cases. I bet that the majority of sexually active woman in Canada will have in her life time at least one of her PAPs come back with unusual cells, prompting worry and follow up tests, even invasive therapy.</p>
<p>Was this new vaccine a potential cure? Perry and I carefully selected our words for the report and I inserted a special text box in the 11th hour: "Although results are very preliminary and the length of protection is not known, research on expanding the vaccine to protect against more strains of HPV continues. While experts predict PAP smears will still be needed to screen women in conjunction with the vaccine, over the next decade we may see widespread adoption of the HPV vaccine to help further reduce the toll of cervical cancer."</p>
<p>Those words stand up remarkably well 7 years later. I have followed the debate about HPV ever since. I've seen all the various research studies, read all the articles of pros and cons.</p>
<p>Of course, there are some who are against all vaccinations in general.&nbsp; That is their choice to make - but only because the vast majority chooses vaccination. By doing so, by us absorbing the risk, the&nbsp; nay-sayer's children are kept safe - lucky for them. We give them herd immunity. They don't have their children die in their arms, like my grandmother did. My paternal grandmother at the beginning of the 20th century lost five of her 11 children to vaccine-preventable illnesses - whooping cough, diptheria, meningitis. In my family, vaccines are seen as one of the greatest advances of medical science. To reject vaccination for the serious childhood illnesses, in the eyes of my father, who became a doctor, is an abroggation of your societal duty.&nbsp;</p>
<p>All vaccines, of course, must be weighed for their pros and cons, their risks and benefits. For me the pros of the HPV vaccine vastly outweigh the cons. I had a girlfriend die of cervical cancer in her 30s. I had a Pap test come back with concerning cells.&nbsp; My girls are too old for the first mass innoculation. I had them vaccinated at my own expense ( $400!! each.) I felt it was a must and they both wanted it.</p>
<p>Some parents recoil that the vaccine is to be given in Grade 9. "They are still such little girls. Couldn't they give it when they are more obviously sexually mature?"</p>
<p>But here is the problem: we know that in grade 9 more than 90 per cent of the girls are still virgins; by Grade 12, some 50 per cent, or more, are not. How can we determine the right age for each girl? A vaccine program must get them well before they need it.</p>
<p>Here are the things we do know:</p>
<ul>
<li>Women will still need regular pap tests.&nbsp; It is just one more arrow in the quiver. They will have to have their partners still wear condoms. It does not allow complacency.</li>
<li>The protection may wear off in the girl's 20s. To me that is understandable -- it gives them protection in the early years when they are most likley to be exposed for the first time. By the 20s it is likely most girls are in more stable relationships. Koutsky et al has now followed more than 200 of the original women who got the shot in 1998 and 1999 in Seattle -- the vast majority still remain negative for HPV. The protection is lasting for most women at least 8 to 9 years or more.</li>
<li>Research has shown the teenage cervix is more susceptible to infection and HPV infections in those years can be particularly virulent and advance more rapidly to cancer. The need for innoculation is in the teen years.</li>
<li>With mass innoculations, bad side effects will arise. It is sheer statistics. The media will focus on this: " High school girl has fatal reaction!" if and when it occurs. Rare reactions don't happen among just 768 women. But as thousands and then hundreds of thousands and then millions get innoculated it is inevitable that some rare reaction will occur. So far the efficacy and safety of the vaccine has been remarkably good, with very few side effects. But it is certain that a 1 in 100,000 or a 1 in a million occurence of anaphylaxis will happen. That risk ratio exists in all medical care.&nbsp; I accept and live with that risk. Alas many people don't understand it. 1 in 100,000 is a reasonable risk. But if you are that unlucky 1, I am truly sorry.</li>
<li>The viral connection to cancer, that has been revealed by HPV will lead to huge gains in cancer understanding in the coming decade. This HPV vaccine is the cusp of very exciting medicine. We may finally&nbsp; understand the origin of some of the common cancers in our life because of what HPV teaches us. </li>
</ul>
<p>I believe that all young boys should also get the HPV vaccine -- that way the transmission of this nasty virus would truly stop. But the expense of the vaccine program is such they will only target the girls. That's because it is girls and women who bear the brunt of its impact.</p>
<p>And that's the way it has always been, whether fair or not. Contraception has significant risks - women bear the brunt of it. Pregnancy has even more risks -- all on women's shoulders.</p>
<p>HPV vaccine has risks. But the risks are far greater without it.&nbsp; I accept those risks for my charges. And we have to ask, what would our daughters want as sexually active adult women? My daughters would want this vaccine. And I want it for them.</p>
<p>&nbsp;</p>]]></content:encoded></rss:item><rss:item rdf:about="http://www.annemullens.com/journal/2009/9/27/a-short-reno-tale.html"><rss:title>A short reno tale</rss:title><rss:link>http://www.annemullens.com/journal/2009/9/27/a-short-reno-tale.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2009-09-27T23:53:08Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<p>Today I found myself uttering a string of words I never expected to say in a sentence outloud, in public, with no embarrassment to a middle aged man : " I need a good stud finder and some extra long screws."</p>
<p>Of course, the guy was wearing the orange bib of Home Depot where everyone talks about studs and screws and male and female parts of all sorts of equipment without blinking an eye. He just smiled and said "Sure, right this way.</p>
<p>Soon he was equipping me with the $29.95 deluxe automated stud finder and the 2 1/2 inch carpenters screws which he tells me will do just fine to mount ( ah those words) the corner wall cabinet that I just bought off Used Victoria.</p>
<p>After almost 20 years in the same house, we finally did the kitchen reno, a right of passage for any homeowner it seems. I remember how I feigned interest when other moms at the preschool playground told their reno tales.&nbsp; How could sensible, bright people get so consumed with paint colours, faucet design, and the headaches of knob and tube wiring in Victoria's otherwise lovely older homes? Surely there must be more interesting things to talk about.</p>
<p>Of course, in my head I had my grand reno plans -- the open concept, the moving of walls and windows, the french doors out onto the back deck, the integrated kitchen and dining room with a second deck out the side. But as the years passed it became clear that big, hugely expensive dream was never going to happen.</p>
<p>And then over the past few years I began to just want simple things: cupboard doors that were not falling off their hinges, a broom closet,&nbsp; lights that didn't zap and explode, a fume hood so that a fine mist of grease would not be dispersed over everything on the main floor, no matter what we cooked. I became reluctant to entertain because our kitchen was becoming progressively more embarrassing and non-functional.</p>
<p>And then, this summer, we risked losing our house insurance, or having our rates jacked sky high because it was found that, despite the appearance of updated wiring and a good breaker box, we still had fragile, disintegrating knob and tube in our kitchen ( hence the zapping lights and hot switch plates.)</p>
<p>I set out to do the $10,000, cheapo kitchen reno. Could it be done?&nbsp; Well almost. First it started with Bob Bourgeois, our handy man who did our bathrooms a few years ago. He just happened to have two sets of white kitchen cabinets he bought off used victoria that he would give me for a song.</p>
<p>We started in mid August. I had grand plans to blog and post pictures through out but I soon realized three things: 1) no one wants daily updates because it is boring to everyone but those actually doing the reno.&nbsp; 2) It is not like Extreme Make Over where the whole process is over in five days, it goes on and on and on and it is at times like watching paint dry or writing about paint drying; some days nothing happens at all. 3) On the days that unexpected things do happen, the days when Bob phones and says: "you better come home, we've got a problem" you are so busy dealing with the problem that you don't have time or inclination to write.</p>
<p>I did learn one thing that surprised me: having a lack of choice when choices abound is actually rather freeing in its restrictive way. This point was first made to me way back in 1990s by a palliative care doctor in Holland about euthanasia. He ran a lovely hospice in which euthanasia was not allowed in a country where it was readily available. He said: "It removes the pressure of a profound decision... it is more simple for them in their dying days when they know choice is not an option here."</p>
<p>Applying that philosophy to my reno is one of the bigger writerly leaps I have made in my life, but in a way it was true. We had very little choice about what we did and therefore the choices were easy. I actually had fun.&nbsp; Bob had a set of cabinets so that was what used. He had them only in certain configurations so we had to try to puzzle that out. I was keeping to a strict budget so all kinds of choices of counters and flooring and fixtures went by the wayside. I never fretted a moment about the choices I had to make ( which those who know me will know that is rather unlike me) because either there was no choice or the choice was between the few range of items in the price point we could afford. Voila, this one looks better. This is it!</p>
<p>And we even have a few laughs from our limited options. One drawer cannot be opened without first opening the oven door. If we had customed ordered all the cabinets this quirk would never have happened. But it was the only set that could go there. Now we know that is the drawer where we will keep the chocolate, the halloween candy and the credit cards -- you have to think twice and go to extra trouble to get at it.</p>
<p>I even began to delight in finding deals. Kate and I found a great cheap tile that was less than the linoleum we thought we would be forced to buy and they had just enough left to do our floor. I decided that we would do all the painting ourselves and was delighted to find that Kate was a natural with a real talent and perfectionist streak.&nbsp; Maddy has a great eye, but is definitely going to be in management - she could see all the places we missed and was very good at direction, but not so keen on the manual labour herself.&nbsp; I was spackling and finishing, I even worked as Bob's assistant, learning handy tips about mounting cabinets.</p>
<p>We were going to live with an odd gap in&nbsp; one corner -- we had run out of wall cabinets. The kids said it looked stupid and Bob and I decided we would build a small book case there to fill it ( which still would have looked odd.)But for the last week I was scouring craigslist, used victoria and kiiji looking for the right cabinet to fill our hole.</p>
<p>Yesterday I finally found it -- the perfect corner cabinet in exactly the same design as Bob's used one. It was in Duncan. I drove up there this morning at&nbsp; 7 am, arriving at a beautiful farm. I wanted only two pieces -- they wanted me to haul away all 10, but we bargained and I took three. And I am going to mount them myself. Bob is now off on another job.</p>
<p>So we are almost done - six weeks and about double my $10,000 cost, but not bad for a complete overhaul. The counters don't come until mid-october and the fridge comes next week -- and when it is all in place I will post a picture.</p>
<p>But at least now we have a working kitchen. I will no longer bore my self and others with reno tales.&nbsp; And last night I made a meal and turned on the fume hood. It was lovely.</p>
<p>&nbsp;</p>
<p>&nbsp;</p>]]></content:encoded></rss:item><rss:item rdf:about="http://www.annemullens.com/journal/2009/5/4/marking-a-significant-day.html"><rss:title>Marking a significant day</rss:title><rss:link>http://www.annemullens.com/journal/2009/5/4/marking-a-significant-day.html</rss:link><dc:creator>Anne</dc:creator><dc:date>2009-05-04T22:00:00Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<p>Let us&nbsp; pause for a moment, May 4th, International Chicken Appreciation Day, and give thanks to chickens.</p>
<p>I, for one, definitely appreciate chickens. In fact, I love them. Chickens are the most comical, cost-efficient,&nbsp; and entertaining of all the barnyard animals -- not that I know other barnyard animals very well, but I do know chickens.</p>
<p>From 1999 until 2002 we had three free range chickens in our urban backyard in Victoria: Penny, Rita and Lucy. The gals - as we called them - were a nattering, clucking, fussbudgetting hoot.&nbsp; I could watch them for hours as they bustle-wagged about our yard munching on everything. And Keith and I often did sit and just watch, sometimes with a cup of tea sitting on a lawnchair in the sun, sometimes on a summer evening with a cool tall G&amp;T.<span class="full-image-float-right ssNonEditable"><span><img style="width: 150px;" src="http://www.annemullens.com/storage/chickens spagh.jpg?__SQUARESPACE_CACHEVERSION=1241670448195" alt="" /></span><span class="thumbnail-caption" style="width: 150px;">Penny, Rita and Lucy eating spaghetti</span></span></p>
<p>They were handsome hens. Penny was a lovely salt and pepper Barred Rock. Rita was a deep ginger Rhode Island Red. And Lucy was a coal black ( with blue green shimmers in the light) hydrid, we think with strains of Andalusian. We often asked people to guess: "What is the common link in their names?" And the sharpest would answer in seconds: "Beatles Songs!"</p>
<p>Victoria bylaws, from time immemorial, allow backyard chickens even in the heart of the city,&nbsp; maximum six, no rooster. In our downtown community of Fairfield small coops are common. Our neighbors down the street, who had a fantastic organic vegetable garden, had a clutch of six and I covetted them for years, especially the daily treasure of warm, freshly laid eggs.&nbsp;</p>
<p>I was writing from home, obsessed with my organic vegetable garden and I began to feel I must have chickens, too,&nbsp; as part of the complete organic cycle: hens eat weeds and garden pests, poop in soil, guano fertilizes soil, soil produces healthy rich veggies ( and weeds),&nbsp; hens eat weeds, etc.</p>
<p>I designed a tiny coop, with laying box, and a chicken run to occupy an unused, shady side of our house ( about three feet from our west wall and about 9 feet from the next house, the placement of which turned out to be a mistake.) We researched what kit we needed ( heat lamp, watering dish,<span class="full-image-float-right ssNonEditable"><span><img src="../../storage/chickens%201%20small.jpg?__SQUARESPACE_CACHEVERSION=1241670198276" alt="" width="150" height="115" /></span><span class="thumbnail-caption" style="width: 150px;">Designer coop</span></span> feed tray) and bought the items at farm supplier Borden Mercantile and set up a lovely little home. And then on a spring day in 1999 my two daughters and I went out to the Saanich Christmas Tree farm ( and chicken hatchery)&nbsp; to get three chicks. We were told we could buy day old, un-sexed chicks for something like $5 each. But if we waited two days for them to be sexed, it was a few dollars more. On account of the rooster ban, I didn't think I would have the heart, or stomach, to kill and eat any males so we paid extra. I never did learn how one could sex those teensy-weensy chicks, but I guess it was simply turning them upside down, peering between their legs to look for something even more teensy-weensy.</p>
<p>We brought home the three cheeping yellow fluffy feather balls in a cardboard box, with towels and a hot water bottle and set them up below a heat lamp in a corner of our dining room and they rapidly grew and took on their distiinctive plummage. Kate, then about 10, and one of those kids who speaks animal, never left the box. Like a mini-Konrad Lorenz, Kate became their imprint and they would stick their little heads in both her armpits and elbow crooks for warmth for hours on end. When they were older, they would follow her around the yard, right at her heels, altering their direction with her moves like wind shifts over a field of grain. It was a highly entertaining show, particularly on a summer night with that G&amp;T. Also amusing was feeding them spaghetti ( they loved all left over pasta.) Two chickens would each pick up an end of a strand and eat towards each other, oblivious, until they knocked beaks in startled surprise. Sidesplitting every time.</p>
<p><span class="full-image-float-left ssNonEditable"><span><img style="width: 150px;" src="http://www.annemullens.com/storage/kate%20chickens.jpg?__SQUARESPACE_CACHEVERSION=1241670327537" alt="" /></span><span class="thumbnail-caption" style="width: 150px;">Kate aka Konrad cuddling chickens</span></span>At three weeks of age we moved them out to the coop with the heat lamp and sometime around the mid summer, when the gals were about 4 months old, the first egg was laid. It was a tiny misshapen, soft, thin-shelled thing -- and we are not sure which one was the first to lay. But the three of them were all so excited and proud of their accomplishment ( and so were we) that it was like we had opened the laying box to discover the Mona Lisa. That marked the beginning of their prolific laying career. &nbsp;</p>
<p>From then on, almost ever single day, three perfect brown eggs would be awaiting us somewhere around mid-morning. We could always tell when, because the gals would, one after another, make a series of laying screams each one more intense: Bawk, BAWK, <strong>BAAAWK!</strong> (From the sound I am convinced it hurts a chicken to lay an egg.) And then, when the deed was done, she would chatter so excitedly to the others as if to say: Look what I've done! Look what I've done! Oh my, LOOK WHAT I'Ve Done! She would get out of the box and the next would go for it.</p>
<p>When all the ruckess had settled, there in the box,&nbsp; still beautifully warm and flawlessly smooth, would be three biological gems of nature. Nothing beats taking it right into the kitchen, craddled in the palm of your hand, for a breakfast omelette or french toast. The yolks were brilliant orange because the gals had the roam of our yard throughout the day, eating grubs, buttercup and chicory and grass and weeds ( and anything, really, that was green and succulent or bug-like.)&nbsp; At first our daughters refused to eat bright orange french toast and bright orange omelettes but the taste, even to an 8-year-old, was out of this world and worth the startling colour.</p>
<p>Each night, as the sun was setting, the three of them, moving together like synchronized swimmers, would head back to the coop. If we forgot to open the door, we would find them huddled on the roof in the dark, almost purring like cats, waiting to be let in. I found it fascinating that in winter the light-sensitive photo cell of their tiny little brains was set to exactly the same lux as the photo cell in the automatic timer for the Christmas lights. Just as the lights turned on they would be at the coop - the reproduceable precision of xmas lights on/chickens home to roost was scientifically fascinating.</p>
<p>We had to ensure they were locked in at night because the resident racoons would have made short work of them. Dogs were their enemies too. One day, in mid summer, our friend's boisterous golden retreiver, Lewis, came bounding into our yard when the gals were out roaming. Our backdoor was open and in a flash he had chased them up into the house. Kate and Maddy and Chya (Lewis's 8-year-old owner) were screaming. I came into our kitchen to see a blind blur of Lewis chasing Rita and Lucy round and round our main floor kitchen, dining room and living room, feathers flying. Penny was up on the window sill in the front hall squawking her head off and flapping her wings. When we final caught Lewis by the collar and locked him outside on the front porch, we gathered up the chickens in our arms. Their tiny hearts were beating so frantically I feared they might die of fright. But we carried them back gently to the safety of their coop. They survived but didn't lay for a few days. I will never forget, however, the insane sight of the dog and chickens roaring round and round my house. My life, it seemed, had become something out of an Erma Brombeck column.</p>
<p>Make no mistake, chickens are work. We had to clean the coop at least weekly, lay in fresh straw,&nbsp; feed and water them daily, make sure they were safe at night. But the feeling of self-sufficiency, the closeness to nature, was empowering. We could have gone on happily like this for years except for two things. Lucy was a flyer and she would regularly fly the coop, learning by the third year to exceed our six foot fence. We would have to go around the neighborhood searching for her, asking, "Anyone seen a black chicken?"&nbsp; Once she got a street over. Kate would have to carry her or lead her home. She regularly did a bee-line for our next-door neighbor's prize garden, eating once a whole swath of his succulent plants. He was not amused and even some lovely fresh eggs did not help. And on the other side, right beside the coop, the noise of their daily cluckings and egg laying screams grated on a new tenant ( the previous one had been raised on a farm and she told us she loved the sounds.) And when rats moved into that big old house, the exterminator pointed across the fence at our coop&nbsp; and told them: "There's your problem: chickens attract rats because the grain give them a free food source."</p>
<p>We got a note that night in our mail box kindly requesting, for neighbourly relations, the removal of our lovely gals. We didn't want to start a fight and I couldn't imagine eating them for dinner. We arranged a lovely home for them on Salt Spring Island. We tearfully said good bye one day as they were hauled away in cage in a truck. Kate was almost inconsolable. Maddy, a french toast fanatic, mourned not only the loss of her feathered friends but of her favourite breakfast.</p>
<p>We never called to see how they were doing as time went by lest the new owners told us, when the gals no longer layed, that they had been boiled up for some chicken stew. I like to believe they lived out their life in the idyllic surroundings of the rolling farm and died of old age.</p>
<p>One of these days, I swear, I will have chickens again. I loved their simplicity and functionality. They made me very happy. So have a toast to chicken appreciation day. I think I may go home and raise a G&amp;T to Penny, Rita and Lucy and fry an egg.</p>
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