September 27, 2010
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September 27, 2010
I remember when I was young, listening to the grownups, especially the elderly go on and on about their health. I would quietly think, “Puleeze!!” But times change, and you know, now the urge for me to stand up here and blather on about my body parts for the next ten minutes is almost irresistible. I might even run into overtime!
But I won’t. This talk is mostly about you. Or some of you. Or most of you. I want to offer some tips to you on how to cope with your or your significant others’ treatment, effects and psychological stress of cancer.
Demographers estimate that 40% of the American population will contract cancer at some time in their lives. 52% of those Americans are men and 48% women. You will deal with it a some point in your life. But it’s not the end of the world, and that is more than a trite comment.
The historically fatal nature of cancer almost inevitably results is an immediate, black realization of one’s mortality. And it feels imminent. “Will I see my son graduate in the spring/” “I’ll miss my daughter’s wedding!” Or my favorite, “This summer, the whole family will be eating at that patio table; laughing, talking; and my chair will be empty.” Well, relax. Detection rarely leads to immediate death. In fact detection is usually the lifesaver.
Early detection results in vastly higher survivability. Across the spectrum of cancers, five year survivability rate among those diagnosed early is in excess of 80%. In my case, I read a book. The author had gotten a three dimensional CT scan and was describing it. Reading the book, I thought, “I can afford that ” My doctor at the time refused to arrange for me to do it, telling me I was healthy, and that it was a waste of time and money. My new doctor told me that same thing, but said it was my decision and my money and set it up.
Lo and behold, my left kidney was enlarged. After a year of observation, it was removed, and tested positive for renal cancer. Early detection meant no chemotherapy. The only slight shadow on the horizon was a small tumor on the attached adrenal gland that the surgeon elected not to remove.
Fast forward five years, and the adrenal gland began to grow It was removed, again it was positive for renal cancer, and again, the cancer was completely encapsulated. So far, I have never had chemotherapy, radiotherapy or any cancer symptoms, and there is no significant diminution of my actuarial survival.
Early detection is your ultimate weapon. So get your checkups, especially if you are over 50.
Choose your doctor like you would choose your spouse. With the speed of research, keeping current cancer treatments can be like drinking from a fire hose, for your doctor. As a result, the chances are better than average that your oncologist has, at least informally, developed an expertise in treating certain cancers, not all cancers. Which one is your doctor good at? Is it yours? Better ask around. Oncologists who have set up treatment rooms have hefty business expenses. To be successful, they need customers, so they are disinclined to turn you away.
Get a second opinion, or a third or fourth. That doctor with the treatment room may be treating your cancer with a protocol from 2005, the last time he read up on your form of cancer. You want today’s successful protocol. There is incredible progress in certain cancers and there are multiple treatments. Which one is right for you? Consult with your doctor, but in the end, only you can decide. No one will tell you what the latest treatment is unless you ask and ask and ask. Your cancer has a website or ten. You can learn the latest treatments. Challenge your doctor.
Get a doctor you like. You will be attached at the wrist and ankle to this person for years, and you will need to ask for favors. Is he/she empathetic? Is he willing to work for you? My doctor writes me a report for the Federal Aviation Administration each year. He doesn’t have to, but they won’t accept it from anyone else. Remember. In this case, it really is all about you.
Here are a couple of treatment guidelines, neither of them hard and fast. First, some protocols that call for one treatment every three weeks were developed to allow people to hold down a job. Generally, if you are offered several options, if you have the flexibility, take the one that has the most number of smaller treatments. They are easier on your body and harder on the cancer, because it has no time to recover.
Next, schedule your treatments to suit your timetable. When you get chemotherapy, the mixture often contains large amounts of steroids, to blunt nausea. So on treatment day and into the wee hours of day 2, you will be full of energy and a bit manic. For two or three days thereafter, you will be down with the flu. Then you will have two days of feeling normal, if tired. Set up your treatment schedule to give you the best days when you can use them. For Lynne, that meant treatment on Monday morning, so that her steroids were active mostly during daylight hours and her good days were on the weekend.
Don’t shy away from supplemental alternative therapies. Peripheral neuropathy, or numb hands and feet, is common in the later months of chemotherapy. Lynne and several other patients used acupuncture to reduce or eliminate it. Supplements are useful. They may provide deterrence and at the least they help you feel like you are participating in your cure.
If you have cancer surgery, get a tissue sample frozen for later use. The next big development in cancer treatment will most likely be genetically determined, individualized treatments. If you don’t have a tissue sample, you’ll have to wait for a tumor to grow and be harvested. Better to be prepared. There are multiple “tissue banks” that will store your tumor tissue for a reasonable sum.
If surgery is indicated, choice of surgeon is equally important. You probably won’t get any bedside manner at all. Surgeons tend to be mechanically-inclined. But you are concerned about expertise and technique. Just because a surgeon operates on your diseased organ does not make him/her an expert on the cancer of that organ. If you can get an expert, do it.
Discuss with your doctor the advantages of regular vs. laparoscopic surgery. Laparoscopic surgery, that is going in with tool through incisions, and not cutting the patient open, is preferable if complications are unlikely. It is less intrusive, creates less scar tissue and allows the patient to heal quicker. But if complications are likely, consider normal surgery. A laparoscopic surgery with a complication becomes an emergency surgery – massively intrusive, rushed and prone to missteps.
Always try to schedule your surgery in the morning. The surgeon and all the staff are fresh, the room is freshly cleaned and the air has been filtering all night. I always followed this maxim and had great luck. This last time, I let the surgeon talk me into a 2:00 pm slot. One or two earlier surgeries took longer thanexpected, and I was eventually moved into surgery at 5:30 pm. The surgical crew has been in the operating room for 10 straight hours. It did not go well. While I could find no statistical evidence one way or another, the anecdotal evidence is overwhelming that surgical teams push themselves too hard in the course of the day, and afternoon surgeries reap the whirlwind of that mistake.
Finally, consider other therapies, such as radiation, laser or even proton therapies for small tumors. These are non invasive. Ask your oncologist, not your surgeon who, armed with a hammer, sees everything as a nail.
I hope these tips are helpful. Thank you all for the gift of your time.
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