BC Becky

Never thought I'd want to be a breast cancer survivor

Category: Opinion

  • Patient Health Literacy

    Patient Health Literacy

    I posted this originally over on my academic blog: http://rjh.goingeast.ca. However, I think those who read this blog are in a better position to answer the question I’m asking at the bottom – so please bear with some of the academic language.

    In Arthur Frank’s (1995) seminal book The Wounded Storyteller, he cautions “On rare occasions when I have taught this book, students’ biggest initial difficulty is to stop reframing everything ill people say into a question of how some health-care worker might respond.” (Location 115)

    I often find myself falling into that trap. I find myself thinking about my research, and the focus on peer-to-peer patient learning, and yet seem to feel that the value in the research is in the change in how health-care workers respond. Really, my focus should be a change in how my work can help patients and caregivers find agency within the healthcare system.

    This idea of value of knowledge (or value of literacy) is something that Brian Street talks about in Social Literacies: The Schooling of literacy. I talked a little about it in my post on critical digital health literacy. In the chapter I’m reading now, Street (1995) talks about how the definition of what literacy is (the value proposition) is defined by the dominant culture. When we talk of a critical literacy, we are turning that around and looking at it from the perspective of the non-dominant – perhaps those who are seen as not literate.

    In the health literacy context, we see the definition of digital health literacy from the perspective of healthcare systems –  “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem” (Norman & Skinner, 2008, para. 6). To me, this definition feels like what health professional want patients to have, not what patients necessarily want or need. The health literacy definition is from the perspective of the dominant culture. It is also very solution oriented – as if there were only one solution to the “health problem”. The human body is complex. It is a complex system. There are many different ways in which to approach a health problem, and not all of those involve solutions.

    Now if I look at it from my perspective as a patient, and not a healthcare professional, I can see literacies in a different light. If I look at what I consider important to be “health literate” from a patient perspective, I’d say:

    1. Understanding the disease well enough to explain it to both non-medical professionals and medical professionals (knowing that the language of the medical profession is not the same as the language used by the general population).
    2. Understanding the healthcare system well enough to get the care you are looking for. This in part means knowing who to ask which questions to, and knowing even what things are available to you as a patient. Understanding the hierarchies within the healthcare system helps to ensure you are asking the right people the right questions.
    3. Knowing where to go to get support from peers.
    4. Knowing how to identify individual experiences of disease experience versus generalized experiences. That is, developing an understanding of what aspects are typical and what aspects are unique to the individual experiencing the disease.
    5. Understanding the disease well enough to search for information on the internet, and discern appropriate sources of information (e.g. being able to identify snail oil).

    My question to you is, as a patient, what you see as the important things YOU need to know in order to manage your personal health? 

    Feature image: By NASA/MSFC/David Higginbotham – NASA Image of the Day, Public Domain, Link

  • Health (illness) bloggers

    Health (illness) bloggers

    In my literature review for my research I came across a great article (Keating & Rains, 2015) on the social support health (illness) bloggers receive. The article does a good job looking at social support of bloggers over a three year period.

    One of the things that came clear in the article is the use of the term health blog rather than the term illness blog. It has really got me thinking. A lot of bloggers shy away from the term illness blog because of the negative connotation around it. My immediate thought was the opposite of illness blog is wellness blog, but the term wellness blog is already used for those who are promoting wellness (e.g. diets, exercise routines, etc). Although the health (illness) blogs are written by someone who is experiencing illness, the focus of the blog is often the personal journey – and that journey is someone trying to figure out what health looks like for themselves. I do like the more positive connotation that health blog implies.

    I pulled out the following findings from the article:

    “The results indicated that changes in support available from blog readers and from family and friends over the course of 3 years were significant predictors of changes in bloggers’ well-being. Increased support availability from bloggers’ family and friends was associated with a decrease in bloggers’ feelings of loneliness and an increase in their feelings of health self-efficacy” (Keating & Rains, 2015, p.1454)

    The article makes mention of the idea of strong-ties and weak-ties. Strong-ties would be those with close family and friends. These are the people you can call anytime. They are your primary support. Weak-ties are those of acquaintances. They are not necessarily your close friends, but they still provide support through your experience. In this case, bloggers often have weak-ties with other bloggers. These weak-ties also help in increasing the feeling of support and decrease feelings of loneliness. I think we need both.

    “The results also demonstrate the benefits of blog reader support and suggest that this type of support can serve as a unique resource about and beyond strong ties. After we controlled for changes in support available from family and friends, change in blog reader support was associated with decreased health-related uncertainty. Bloggers who reported an increase in support from blog readers across the two measurement periods also felt that their health condition was less unpredictable” (Keating & Rains, 2015, p. 1454)

    What really resonated with me here is the idea that reading blogs helped to make my experience with breast cancer treatment less unpredictable. I was able to read a lot about people who had experienced the same surgery and breast reconstruction – so I better understood what my experience might be like. You cannot fully predict your experience as each journey is individual, but it really does help to have some general ideas of what you might experience as well as some tips on how to better cope.

    “In addition, the findings suggested that bloggers who perceived themselves as being in better health at the first time point were less likely to continue blogging over an extended period of time. It could be the case that those who evaluated themselves as being in better health were less likely to perceive value in continuing to document their experiences” (Keating & Rains, 2015, p. 1455)

    The idea that we blog less when we are healthy is something that I’ve definitely seen and experienced. We often feel like when things are going right we have nothing to say. A blog post that says “today was normal” does not feel that interesting, and yet, it is an important thing to say. It is really important to celebrate the good days, so that the blog is also providing encouragement to other patients. When cancer bloggers stop blogging we assume one of two things (1) they are healthy and don’t think they have anything interesting to say, or (2) they have died.

    “Through connecting authors with individuals who are coping or have coped with a similar condition, blogs appear to be a particularly useful resource for helping individuals to better understand their illness experiences” (Keating & Rains, 2015, p.1455)

    As a blogger, and one who reads blogs, I completely agree. Reading other blogs did help me better understand my experience. Overall, I did find that this particular study aligned with my experience as someone who both authored and followed breast cancer blogs. Now I just need to get into the habit of using the term health blogger rather than illness blogger.

    Reference

    Keating, D. M., & Rains, S. A. (2015). Health Blogging and Social Support: A 3-Year Panel Study. Journal of Health Communication, 20(12), 1449-1457. doi:10.1080/10810730.2015.1033119

  • The changing sense of pink’tober

    The changing sense of pink’tober

    As many of you are well aware, October is breast cancer awareness month. My first year, while still going through chemotherapy and having taxol kick my ass, I wrote about the mixed blessings of cause marketing and the over sexualization of breast cancer that is so clearly represented in October. A year ago I was dealing with a puffy arm caused by lymphedema, a potential and for me real side effect of breast cancer surgery.

    This October I’m seeing things a little different than last. This October I’m much more aware of what is happening within the metastatic breast cancer community. This is in part because one of my best friends has metastatic breast cancer. It is in part because another friend died metastatic breast cancer. She had just turned 31. I am just so much more aware of the toll this disease takes on so many young women. The young women who die from this disease are the ones that are most silenced by pink’tober, as their stories are rarely pretty enough to share in all the pretty pink hyper sexualization of breast cancer awareness that pervades October.

    This October also represents two years since the end of chemotherapy – my last treatment was on October 31st, 2014. Today also represents a new transition. I have officially graduated to one year follow up with my breast surgeon! I’m still seeing my medical oncologist every six months as I’m doing endocrine therapy (i.e. hormone suppression therapy) which has its own issues with side effects and other general suckiness. I don’t expect those appointments to get any less frequent for at least 5 years.

    The interesting thing is that I feel ready for my follow ups with my surgeon to be yearly. An aside for those that are not aware, the surgeon is the first doctor you see when you are told you have breast cancer. They are the ones that first explain what it means to have breast cancer, what the likely treatment options are, what your specific pathology is, and they set the first steps in your treatment path.

    I feel like I have made great progress. Three months ago I was happy to have a plan that involved seeing my surgeon every 6 months and my medical oncologist every 6 months, with the appointments staggered so I was seeing someone every 3 months. But today I don’t feel that need. Today, I feel like I’m OK with knowing that I don’t need to go back to my surgeon’s office for a full year. My surgeon highlighted that if I was concerned about anything not to hesitate calling and she’d see me. She even offered me a hug, which I gladly accepted. This last two years has been a hell of a ride.

    Feature Image from Metavivor and their Stage IV Stampede protest event earlier this month. For more information about Metastatic Breast Cancer (the kind that kills) see http://www.metavivor.org/. 

  • Mammograms and overdiagnosis – a hard truth to hear #breastcancerrealitycheck

    Friday while flipping through my RSS blog feed reader, I came across an blog post about an article on overdiagnosis. Unfortunately, I cannot remember where it was or I’d link back to it. The blog post was talking about recent research study:

    Welch, H. G., Prorok, P. C., O’Malley, A. J., & Kramer, B. S. (2016). Breast-Cancer Tumor Size, Overdiagnosis, and Mammography Screening Effectiveness. N Engl J Med, 375(15), 1438-1447. doi:10.1056/NEJMoa1600249

    You can get the abstract from: http://www.nejm.org/doi/full/10.1056/NEJMoa1600249

    If you’d like to see the full document, feel free to leave a comment and I can send along my annotated version.The article itself is very well written and the language is not so filled with scientific mumble jumble such that it does not require a PhD in cancer science to understand.

    The study compares population data (so not just those who have breast cancer but the population as a whole) for 1975-59 (pre-mammography era) and 2000-2002 (post-mammography era). This is the most recent one can get because they are using 10-year survival as a measure – so those who live 10 years post diagnosis are considered to have survived the disease. Also the study applies to the general population at “average risk”, so it does not apply to anyone who is high risk such as those with family history or generic mutations such as BRCA.

    What I took from the article is that mammography has led to finding tumors while they are smaller. Those tumors which might have grown to be large are found sooner. However, and this is a big one, mammography also finds a LOT of tumors that will never grow to be clinically significant. That means, it might find a tumor that won’t kill you and won’t spread. This is very similar to the controversy around PSA screen for prostate cancer. The idea is that you may test positive but the cancer won’t be what kills you. You’ll die of other age related illness first.

    “although trial data may provide an assessment of some negative consequences of screening, such as false positive results and associated diagnostic procedures, such assessments may underestimate what actually occurs when screening is implemented in the general community” (p. 1439)

    It is easy for me to read this report, because it would not have changed anything for me. I had heard that it might be an issue for younger women (under 50), so I had chosen to not do the mammogram that my family doctor ordered back in March of 2014. I do not regret that decision. In June I found the lump. My cancer WAS clinically significant. The first primary tumor was growing rather rapidly. The other two tumors were growing at a slower pace. For me, I can look back and know that I made the right decision.

    “Although the biologic characteristics of a tumor are now recognized to be more relevant to breast cancer prognosis than the size of the tumor,  tumor size is more relevant to the assessment of the proximate effect of screening” (p.1439)

    The challenge with reading the report is more with people for whom overdiagnosis may very well be the case. These are some of the women that I see in support group meetings. They go through horrible body deforming surgeries and long term systemic treatments like hormone therapy for cancers that very well may never have become clinically significant. They do not want to hear about overdiagnosis. They are ristant to the whole idea. They need to believe that they went through this horrible treatment in order to save their life. It is the only way one can live – knowing that you made the best decision you could with the information you were given. No one who has experienced early stage breast cancer directly wants to hear that they did not need the treatment they underwent.

    “given the stable incidence of metastatic breast cancer for more than three decades, despite spanning the era of increasing prevalence of screening-mediated breast cancer and changing patterns of hormone therapy” (p.1439)

    Let that quote sink in a little. The stable incidence of metastatic breast cancer for more than three decades! What this means is that although more women are being identified and treated as having breast cancer, the same number of women are dying from it. Again think about that. It means that some of the women that are being treated would never have died from it even it if had not been treated.

    “Assuming a stable underlying incidence of disease burden and no overdiagnosis of tumors, the additional detection of small tumors should be accompanied by a corresponding decrease in large tumors over time” (p.1440)

    Now for the numbers …

    “The incidence of large tumors decreased by 30 cases of cancer per 100,000 women” (p.1441)

    This is the argument for screening and early detection.

    “The incidence of small tumors increased by 162 cases of cancer per 100,000)” (1441)

    “Assuming that the underlying burden of clinically meaningful breast cancer was unchanged, these data suggest that 30 cases of cancer per 100,000 women were destined to become large but were detected earlier, [meaning caught early or “early detection”], and the remaining 132 cases of cancer per 100,000 women were overdiagnosis (i.e. subtracted from 162)” (p.1441)

    So for 30 people the mammogram meant they found the cancer sooner which may translate to less deforming surgery (I say MAY because treatment options are constantly changing/improving), but for 132 people new cancers were found that otherwise would not have been found or become clinically significant. Note that statistics don’t translate directly to the individual, but this is one way to represent what the data means.

    “For large tumors, the declining case fatality rate predominantly reflected improved treatment” (p.1442)

    One other challenge with overdiagnosis is that it causes a skew in the long term survivorship numbers. If more people are said to have cancer, and they survive, then it looks like our treatments and survival statistics are improving. However, it is an artificial improvement because a portion of the people said to have cancer never would have been diagnosed with it in the first place.

    “Screening can advance the time of diagnosis of a tumor, thereby detecting the tumor when it is still small, without changing its prognosis, a phenomenon termed ‘biologic predeterminism’” (p. 1444)

    In other words, you spend more of your life knowing you have breast cancer. Some women argue for mammography because it does matter for a portion of the population. However, what if you are the person for whom mammography found a tumor, you underwent life-altering deforming surgeries and chemotherapy that has horrible side effects only to learn that your cancer was not the kind that would kill you or even grow to a point that you ever noticed it? Would you not have preferred to not have known about it in the first place?

    “Because tumors with favorable molecular features grow more slowly, they are disproportionately available to be detected by screening (so-called length-bias sampling). Thus, the expectation is that some tumors that are detected by screening when they are small would have favorable biologic characteristics and could have been treated equally effectively at clinical presentation. For this subset of tumors, earlier detection at a smaller size would not translate into a mortality reduction.” (p.1444)

    This is largely what caused me to decide not to that have initial mammogram. I had heard that it didn’t make a difference in survival. I was happily naive. If the cancer is going to kill you anyways, would you not have preferred to have the two, three, five years of living your normal life cancer free before finding out you were going to die from the disease?

    The challenge with the rhetoric around mammography saving lives is that it is not true. What this does say is that we should be focusing more of the cancer research dollars on figuring out what biological characteristics actually translate into cancers that do become clinically significant. We don’t need more complex 3D mammography. We could use more methods of detecting the biological characteristics, not the physical size. We do not need to detect cancers when they are so small that they may never actually be an issue. Rather, we need to be looking at what causes metastasis – what makes it spread – and how can we better predict which tumors will need aggressive treatment and which will never turn out to be a problem – an incidental finding.

  • Trivializing rather than educating … #breastcancerrealitycheck

    Trivializing rather than educating … #breastcancerrealitycheck

    Get your tickets today to meet our panel of famous judges: <redacted>, Olympic Gold Medalist and World Cup Champion, <redacted>, First Lady of <city> and <redacted>, head of <radacted> Center for BRCA Research as they judge our unique display of decorated bras!

    screen-shot-2016-10-07-at-4-19-00-pm

    <cancer charity> Board Member, <redacted> will discuss new breast reconstruction developments and a special patient will share her journey through breast reconstruction.

    This fun evening will also include appetizers, gift bags and some shopping opportunities, all to benefit <cancer charity>.

    This just crossed my inbox. Now, amongst the pinkness of October (Breast cancer awareness month in case you missed it), there are special days within the month. One key example is BRA day – or Breast Reconstruction Awareness Day. But I fail to see how a competition to decorate bras does anything other than trivialize the exact thing it is trying to educate about. Worse, it makes women who chose to undergo these procedures feel like they are doing so for pure frivolous vanity. It totally delegitimizes something that is a perfectly valid medical procedure.

    Reconstruction was one of the hardest decisions I had to make. What made the decision harder was that I had to overcome my personal self-doubt but also concern over sigma relating to how breast reconstruction is done for vanity reasons. For those who followed my blog, you know that I was convinced I was not going to reconstruct. That was the sigma talking. That was my self-doubt over it being an option that would feed my vanity rather than something that might be critical to my long term mental health. I did a lot of soul searching, and really a lot of self-reflection before I could come to the decision to do breast reconstruction. The surgery was hell (10+ hours under, 5 days in the hospital). I also did a lot of research. I wanted to be truly aware of what I was signing up for.

    For those that want to actually gain some awareness about breast reconstruction, how about you start here: 10 Reasons why breast reconstruction isn’t a boob job by Nancy Stordahl, or maybe watch this great video by Dr. Lee at Stanford that talks about What every women should know about breast reconstruction.

    Breast reconstruction is an individual choice. It can be really empowering and healing to a breast cancer survivor. It is certainly not an easy choice. It is rarely done from a pure vanity perspective – it is hugely more complicated than that. I don’t know of a single breast cancer survivor who would have chosen to get cancer for the opportunity to get a “boob job”. Ugg.

    What gets more even more is that the organization that is sponsoring this, a local charity that provides services to cancer patients. One of their biggest groups of clients are breast cancer survivors. So, why is it that even these organizations are contributing to this type of non-awareness campaign. Could they not think of a better way to fundraise?

  • I wish someone told me …

    I wish someone told me …

    Lucinda: “I wish someone told me more about how my reconstructed breasts would look after surgery. I wish I knew that when I flexed my muscles my breasts would move sideways leaving a flat gap between them. It seem so unnatural. I wish someone told me that when I exercise they would move this way.

    Lucinda: “I was at a conference last week and I learned that there is a name for this. It is called I was surprised to learn there is a name for this. It is called ‘window shading‘. It is common enough that they have given it a name, and yet no one told me.”

    Surgeon: “When would you have wanted to be told?”

    I was having a conversation with my friend Lucinda yesterday. We were talking about information overload, but also the desire to know more about the potential issues/complications with our reconstruction surgeries.

    Having done neo-adjuvant chemotherapy, I had a lot of time to research my surgery. I learning a lot about possible side effects not from the literature, but rather from participating in online support groups (e.g. there is a DIEP flap Facebook group). Listening to the stories of other women helped me better understand the real side effects – not just the one or two ones that the doctors inform you about.

    When patients are doing surgeries that involve immediate reconstruction, they are usually still mentally coping with having been told you have cancer. In some cases you only have a week or two (or less) to make a decision about the type of surgery you want. You are overwhelmed with information about cancer itself, and yet need to decide what surgical options are best for you. It is overwhelming at best.

    I’ve helped a few women through their early journeys in treatment. I have given ‘the talk’ a few times. The talk that I give is about how breast cancer metastasizes and what you really need to look for / worry about. I find that doctors don’t give enough detail. They tell you that you are now cancer free (in remission) and only give you a vague idea of what symptoms you should be looking for. After that, every ache or pain scares you. I should know, I’ve gone through many scares. So now I help educate women about what it looks like and what warrants worry and what doesn’t. But I also need to wait until they are ready. When you are making chemotherapy or surgery decisions you are not ready to hear about the next steps. You are still dealing with the now. But there comes a time when you need more information–a time when you need to know more about the longer term impacts of the disease you are living with. I know when the time is right because I develop a relationship with these women. I know when they are struggling with anxiety largely because they lack information rather than the anxiety related to dealing with diagnosis (it looks different). It is when that anxiety shifts from the present to the future, that is when I give ‘the talk’.

    The surgeon asks a good question. When is it appropriate to bring up the different possible side effects? When would you like to know? And my question is, when are you ready for ‘the talk’?

    Feature image public domain via Pixabay.

  • #breastcancerrealitycheck – support a cure not awareness

    #breastcancerrealitycheck – support a cure not awareness

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    This is what early stage breast cancer looks like. It doesn’t look like pretty breasts or pink ribbons.

    The artificial “awareness” campaigns like “no bra day” and “save the ta-tas” only serve to arouse young men who already have a hypersexualized impression of women.  Worse, the whole idea of no bra day doesn’t align with the realities of breast cancer. Breast cancer treatments often deform breasts (or completely remove them) such that women who have gone through breast cancer need to wear a bra in order to hold the prothesis or to avoid pain. It is insensitive and insincere. As a breast cancer survivor it is downright offensive.

    We don’t need “awareness campaigns” about breast cancer, we need a cure. Consider supporting organizations that fund research into a cure, or organizations that help women recover from the physical and mental wounds associated with breast cancer treatment. Perhaps the awareness should focus on the lifetime financial impact for those with a cancer diagnosis. It certainly should not focus on pretty breasts and pink ribbons.

    Today, October 1st, in reaction to the launch of breast cancer awareness month (pinktober) and “no bra day”, there is a twitter campaign called #breastcancerrealitycheck – supported by women with breast cancer to help bring about true awareness, rather than pretty pink ribbon campaigns. Please retweet this post.

  • Book launch: Agony and Absurdity: Adventures in Cancerland: An Anthology

    Book launch: Agony and Absurdity: Adventures in Cancerland: An Anthology

    Tomorrow (Wednesday) at about 7:30pm Pacific I’ll be reading my chapter, titled “Window Shopping” for the launch of the latest Bay Area Young Survivors (BAYS) anthology titled: Agony and Absurdity: Adventures in Cancerland: An Anthology. I hope to have my reading periscoped – and if we manage that I’ll put the link in here.

    If you are interested, you can buy the book on Amazon. Proceeds go directly to support the Bay Area Young Survivors (BAYS) allowing them to provide support for your those diagnosed with breast cancer under the age of 45.

  • What if patients made the recommendations?

    What if patients made the recommendations?

    I was reading through Caroline’s post about What I wish I had known before treatment. She mentions an article about recommendations from breast surgeons regarding prophylactic mastectomy. There is concern that more patients are opting for them, even though there is no oncological benefit (article is here – if you want a copy and don’t have access, email me).

    I see lots of these recommendations – and misinterpretations of them. I found this article to be interesting because of its emphasis on individual patient decision making. It wasn’t pushing a particular recommendation, just saying that this is the evidence to help you and your patient come to a shared decision.

    I do wonder, however, what would happen if the recommendations came from patient’s rather than “evidence” that has not been humanized. I wonder if instead of giving patients the “facts” you gave patients a booklet or video of stories from different patients who opted for the different treatment options. You let other patients describe the impact of the different treatment decisions.

     

    A lot of the decisions that breast cancer patients need to make are emotional decisions. They are not necessarily logical decision. The choice between lumpectomy and mastectomy (when it is a choice) is individual, but patients aren’t adequately prepared to make that decision. They are presented with facts from a medical system perspective. For example, in the tools to help you make your decision you are told that if you have a lumpectomy, you will keep your breast however, you’ll need to be screened (e.g. mammogram or MRI) every 6 months. If you do a mastectomy there is no systematic screening. It is very much a medical system oriented description of things to help you make your decision. However, the decision isn’t strictly a medical decision – it is an emotional one. It is a quality of life decision. There are also a host of emotional and practical side effects that are never discussed. They are things that the medical system doesn’t care about, but the patient does.

    Age also matters in these decisions – and yet most of the evidence that is used for recommendations does not take this into account. A young survivor (I’ll use under 50 at diagnosis, although most use under 45) has very different longer term life circumstances when making their decisions – and yet that isn’t often taken into account when looking at statistics to provide recommendations.

    So I wonder, what if there was a resource that was a series of concise yet down to earth patient stories, told from a patient perspective? A retrospective analysis of patient experiences – provided in both storied text format and in video format. Something that really helps patients make decisions from a patient perspective, not a physician perspective. Something that deals with the emotional and longer term health impacts of the decision – not just from a medical system perspective but from a human who has to spend the rest of their lives living with the decisions they make.

    What do you think? Would this type of resource have helped you make a decision? Would surgeons be willing to provide this type of resource for patients? Would this be a useful discussion topic for Virtually Connecting ePatients?

    Feature image CC0 from Pixabay

  • Pokemon Go – My urban exercise buddy

    Pokemon Go – My urban exercise buddy

    So I finally got around to trying out Pokemon Go. I wanted to see what all the fuss was about. I also wanted to see what all the concern and criticism were about. I listened to the advice of one blogger and didn’t use my gmail account to sign up, rather I created a separate account that wasn’t attached to my main email. My husband had a better idea, and that is to create a second gmail account with an alias that you use for all such things – things that you don’t really care about and that you don’t want to spam your friends with. Anyways, I set it up. Watched a YouTube tutorial on how to actually throw poke balls, and I was good.

    I found it really rather a fun experience. The first task you have is to find Poke Balls. They are found in caches that are shown on an overlay of the Google map. They are usually found in obscure (and sometimes not obscure) points of interest. There were not a huge number in my area, but I did a bit of a walk around (about 5000 steps worth) and found a few fun things like a tile painting on a local business building. I also see that there are several on a bike path near my place that I had forgotten existed. I will probably go on a reconnaissance bike ride this week to find more of the poke ball caches.

    I found that I did not need to be looking at my phone the whole time. I could see where things were on the maps, hold my phone in my hand (not looking at it) and just walk to the next landmark, and look again. The phone didn’t need to use my camera and didn’t actually use it to collect Poke Balls. Once I got some balls, some of the Pokeman things started showing up. Again I didn’t need to be watching my phone. My phone vibrated when I got close to something. I could then stop where I was, the game turned the camera one, and the Pokeman thing was on the screen in the camera. I just positioned it and threw the ball to catch the Pokeman. I could also chose to just it the run button and keep walking.

    I may be a naive player at this point, but I do find it a fun way to get in some urban exercise. I wouldn’t use it in a nature setting as I’d rather be looking out at the world. But it did encourage me to get out for a walk and to explore areas that I had not been to before. I find myself actually planning to go on walks in different areas just so that I can discover various random things. I could spend all my time just collecting Poke Balls.

    I see the parallels between this and geocaching. I find this slightly more interesting in part because the caches are setup to be in places of interest rather than hidden in random places.

    So for now, I will use Pokemon Go as my urban exercise buddy. It will encourage me to walk more and bike more – and that is a good thing. I just hope it plays nicely with the Runkeeper app. I haven’t tried that yet!

    Have you tried Pokemon Go yet? What do you think of it?

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