Osteoporosis and Breast Cancer

Osteoporosis literally means porous bones. The result is that the bones can become thin or snap. Osteoporosis cannot be cured and often is not found until after bones break. It affects half of women over 50 and one in five men in that age range and some people who receive treatment for breast cancer are at an increased risk of ostoeporosis, however, treatments are available to try to keep bones strong and less likely to break.

Women who have not gone through the menopause before they are treated for breast cancer have an increased risk of osteoporosis. Indeed, chemotherapy can cause an early menopause and a rapid, significant reduction in bone density and result in osteoporosis.Even women who have been through the menopause may be at increased risk of osteoporosis because of the hormone therapies they take for breast cancer.

balanced her 2.jpgI am being treated with letrozole for my breast cancer. My tumour was of the fast growing HER2 positive variety. The letrozole is one of the drugs that reduces the amount of oestrogen circulating in my body and this could result in osteoporosis. I have my bone density checked with a bone density scan and, so far, I do not show signs of osteoporosis. Generally speaking, people with a good bone density before getting treatment for breast cancer are less likely to develop osteoporosis while taking an aromatase inhibitor such as letrozole.

I have been careful to put some simple lifestyle choices to help keep my bones strong and healthy. I ensure that, although I am vegetarian, I have a well-balanced diet. Although dietbalanced-diet changes will not cure bone defects, it may stop them osteoporosis getting worse. Eating meals that incorporate a wide variety of foods including fruit and vegetables, carbohydrates, milk and dairy products and proteins help achieve this. As a general rule it is recommended that we eat at least five portions of fruit and vegetables a day. You would be amazed how many people, including vegetarians, do not manage this! I have also significantly reduced my alcohol intake and the amount of fizzy drinks I take.

Calcium is a vital mineral for teeth and bones. It gives them strength and rigidity. Most of the calcium found in our bodies is in our bones. Dairy produce is our main source of calcium. People  can usually get enough calium through a healthy diet that includes dairy products. If your diet did not include dairy produce you would need to ensure you got calium from another source such as a calcium supplement.

I also have to bear in mind that vitamin D is needed to help my body absorb calcium. The best source of vitamin D is sunlight. Human bodies use the sunshine to make vitamin D in the skin. The vitamin D is fat-soluble and the body stores it for use in the winter months. balanced sunWe only need to be out in the sun for about quarter of an hour a day during the summer months to give most people enough vitamin D for the whole year. So a walk, some gardening or a round of golf should make sure we get enough vitamin D. In addition to that, margarine, egg yolks and oily fish also contain vitamin D.

Regular weight-bearing exercise is also important to put force through the bones. This helps stimulate growth and strength and keep bones strong and healthy. Such exercise includes skipping, aerobics, tennis, and dancing are good bone building activities, even a brisk walk can be of benefit to bones. I try to do some exercise at least three times a week in order to combat the cancer-related fatigue I suffer and the potential for weight gain that my medication induces. I really try very hard to make sure that I do not add osteoporosis to my list of worries.

Valerie Penny

 

Radiotherapy after Breast Cancer

My Uncle suffered from colon cancer and had told me that radiotherapy was not nearly as difficult to bear as chemotherapy. However, when I came to receive radiotherapy for my breast cancer, I came to disagree with him. Radiotherapy treatment is planned and delivered by specially trained professionals called therapy radiographers. It is given by a machine called a linear accererator. Breast cancer patients are usually treated for between 3 to 6 weeks.

The treatment only lasts a few seconds, but to get prepared and settled on the machinery, the period each patient is in the room is about 10 minutes. I needed four weeks treatment. It is given on week days, every week day except for public holidays, for the stated period, so I had to go for treatment 5 days a week for four weeks.

The treatment, at least at first, is painless. Still, reasons that I did not agree with my uncle were that the journey to the hospital that delivers the treatment is an hour’s drive from where I live, and an hour’s drive back. Given that and the wait for treatment at the beatsonhospital could mean a 3-4 four round trip. That was terribly tiring. Also, the treat ment is given in a large room that contains nothing but a chair to place my cloths on, a screen for the radiographers to stand behind as they deliver treatment and the machine, itself.

Patients are not treated by the same radiographers each day and students, male or female, may be amongst the team. I should have been asked if I was willing to have a student present , but I never was. Like many who suffer from breast cancer, I come from a generation that is not used to displaying my body to other people, especially much younger men. I was simply told to take off the clothes on my top half and come over to the machine. It was embarrassing and demeaning. I was just given a piece of paper towel to cover my modesty. Needless to say, that did not work!

The way this treatment was delivered was embarrassing and demeaning. The journey to get the treatment was long and tiring. During treatment I had to lie in a specific position so that the radiotherapy could be delivered most accurately. The radiographers dimmed the lights for a short time while they positioned the machine. They then stood behind the b machinescreen while the treatment was delivered.Once or twice the treament given was slightly different in that it was a boost to my scar area. However, the method of delivery and the lack of attention to personal sensitivities was the same as ever.

The treatment results in a cumulative effect to the cancer and side effects. At first, I felt no different after treatment. It was only after two weeks or so that I bagan to feel side effects and so terribly tired, weary, as a result of the treatment. It also caused burning on and in the flesh around my breast. The hospital provded aqueous cream to soothe that.

I needed the radiotherapy to help beat the cancer, but it was difficult to bear.

Valerie Penny

FEC Chemotherapy for Breast Cancer

When I was diagnosed with breast cancer, apart from being completely taken aback that something like this could happen to me, I got detailed advice from the oncologist about the type of treatment I would need.

fecI was told that after surgery to remove the tumours, the oncologist told me that I would receive chemotherapy and then  radiotherapy. The chemotherapy I received was called FEC. This is a combination of three chemotherapy drugs 5 fluorouracil, epirubican and cyclophosphamide. FEC takes its name from the initial of these three drugs.It is normally used to treat people with primary breast cancer that has not spread to other parts of the body. Chemotherapy destroys cancer cells by interfering with their ability to divide and grow.

All cells in our bodies continually divide and grow. This enables growth and repair of body tissue. Cancer cells are different because they grow by dividing in a disorderly and uncontrolled way. Different chemotherapy drugs work in different ways and attack the cancer cells at different stages of their growth. This is why a combination of drugs is often more effective than just one drug.

I was given my FEC intravenously. I had a Hickman line fitted because the veins in my hands did not allow easy acces for the cancer nurses.  All my medication was given through my Hickman line. I did not like having it, but it was useful. I was given the FEC as an out patient, every three weeks for 18 weeks. This meant I could go home on the same day after treatment, that was nice, but the days were long and tiring. The time involved is not just that required to give the drugs, but also waiting time, blood tests and time for the drugs to be prepared.fec tired

I suffered side effects with FEC. The common side effects include bone marrow suppression.Bone marrow suppression or myelotoxicity is the decrease in production of cells responsible for providing immunity, carrying oxygen and those responsible for normal blood clotting. Bone marrow suppression is a serious side effect of chemotherapy. The decrease in blood cell counts does not occur right at the start of chemotherapy because the drugs do not destroy the cells already in the bloodstream. However, the drugs affect new blood cells that are being made by the bone marrow. The suppression of bone marrow activity causes a deficiency of blood cells. This condition can rapidly lead to life-threatening infection, as the body cannot respond to invading bacteria and viruses.It can also leading to anaemia due to a lack of red blood cells and spontaneous severe bleeding due to deficiency of platelets. This resulted in me suffering from severe tiredness and exhaustion. It is difficult to describe the depth of the feelings of exhaustion. I also had several spontaneous nose bleeds.

Other side effects include nausea and vomiting. The hospital supplied medication to minimise this. I was instructed to take the medication at specified times after my treatment. However, the most visual side effect of chemotherapy is hair loss. I did try an ice-cap to reduce that, but to no avail. It did not work.

fec baldWhen people think of hair loss, they, and women in particular think of the loss of hair on their head. Certainly that does go. The result is a cold head in winter! However, all of the hair on my body was lost. This included the hair on my limbs and inside my nose. The good news was that I did not need to shave my legs for a year, the bad news is that it meant there were no hairs to stop my nose from running. Always carry a handkerchief!

I was not going to bother buying a wig. However, my cancer nurse advised that I should. This was partly because it might make the sight of me during my illness less difficult for my children and my elderly mother. She also pointed out that it would keep my head warmer, especially in winter. She was right on both counts.

Cancer affects not just the person who is diagnosed, but all the people who love them: their friends and family. I hope you never suffer such a diagnosis, but if you do, bear in mind the agony of those around you.

Valerie Penny

 

Information about Taxotere (Docetaxel)and Breast Cancer

During my treatment for breast cancer, one of the drugs that I was treated with was Taxotere. It is also known as Docetaxel. It was used for me to treat primary breast cancer that had not spread to other parts of the body. It was used in combination with other drugs in combined chemotherapy. Docetaxel is also sometimes used to treat breast cancer that has come back after treatment or spread, for example, into the lymph nodes.

It works by interfering with the development and growth of cancer cells. Docetaxel blockshickman line.jpg part of the cancer cells before they divide and grow. This makes the cancer cells die off at an early stage.

When I was given Docetaxel, it was gven to me intravenously through my hickman line. I had three weeks between each round of chemotherapy. So, just about the time I was feeling normal again, another dose of the drugs was given.

Docetaxel has side effects. All drugs have side effects. Some people are more suseptible to them than others.Amongst the common side effects of Docetaxel are: bone marrow suppression, hair loss and nausea.

The bone marrow supression was the side effect that worried me most, because this means that I had an increased risk of getting infections when my white blood cell count was low. As a result of this, I was unable to go out and mingle with friends or relatives after my treatment. It made me feel isolated and lonely. My resistance was lowest around 5-10 days after I had had my dose of Docetaxel. So for about one week in every three, I had to be particularly careful to avoid infection. I was warned that, if I did feel unwell during this time, or if my temperature ever did go up over 38C then I was to get medical help or go to the hospital.

I managed to avoid having to go into hospital, but I did find that I bruised more easily and had nose bleeds that were difficult to stop and did suffer from anemia.I did not need any blood transfusions, but I did take iron tablets to boost my red blood cells.

Nausea was a problem for me, however, I was given medication to control this. The anti-sickness tablets were very effective and I was grateful for that. I also noticed that the taste of many foods changed while I was on chemotherapy. Much tasted like tin. However, I am glad to say that my sense of taste has returned to normal since my chemotherapy cancer-101-s8-tnm-stagingtreatment has finished. I was told that I might suffer from diarrhoea, however, my body reacted differently and I suffered more from constipation than diarrhoea.

The other side effects I suffered when being treated with Docetaxel tiredness, fatigue and pain in my muscles and joints. I still suffer from these over a year after termination of my treatment. When the pain is severe, I take pain relief or anti-inflammatories, but I try to avoid them as far as possible. Common practice says that gentle exercise improves the fatigue. I find it merely replaces it with exhaustion!

All in all I found chemotherapy difficult, but it is miles better than the alternative: no treatment: no recovery.

Valerie Penny

Dealing with Cancer in the Workplace by guest author Ryan McChrystal

This article, Dealing with Cancer in the Workplace by Ryan McChrystal first appeared on Tuesday, 10 March 2015 in http://elitebusinessmagazine.co.uk/people/item/dealing-with-cancer-in-the-workplace

Serious illness – particularly cancer – can have a devastating impact on your employees and your business, therefore it is essential to have a plan in place that ensures the best way forward for all concerned

Dealing with cancer in the workplace

Cancer isn’t an easy thing to discuss. There is no shame in admitting that. However, with around 750,000 people of working age with some form of it in the UK – representing over a third of the 2 million people living with the condition – it is wise to think about your approach now before you, as an employer, have to deal with it. With people living longer and retiring later, the numbers of people in the workplace diagnosed are only going to increase. Cancer is just one – and certainly the most emotive – example of the serious illnesses that could impact on your employees, their attendance and productivity.

“The pressures put on an employee with cancer have a direct effect on their ability to manage or even recover,” says Elliott Hurst, director of health consulting at AXA PPP Healthcare, one of the biggest UK health insurance providers. The physical and emotional strain of a serious illness can be severe and, when you combine that with the potentially damaging financial impact, the result can be devastating. But that’s not to say a diagnosis automatically leads on to periods of absence.

“From an employer’s perspective, it is better to have your experienced and valued employees contributing to the workplace in some way, shape or form than not and with proper planning this can be achieved,” says Hurst. Therefore, an effective workplace policy should be in place to ensure you are best equipped to deal with cancer and other serious illnesses. As with all good policies, it is best to begin by amassing all the relevant information that’s available, including a full understanding of the law. As an employer, you are legally obliged to make workplace adjustments where appropriate, just as you would with any other disability. Access to Work is a specialist disability service delivered by Jobcentre Plus, which gives practical advice and support that may be able to help with the cost of making workplace adjustments.

“It is good to have a better understanding of the illness your employee is suffering from. Cancer, for example, is not a single disease with a single cause and a single type of treatment,” says Hurst. “Each cancer experience is different, but having a little knowledge can help you as an employer to better understand what the person is going through and how best to support them.”

A government white paper in 2011 suggested that employers need to do more about the health of their employees. Dr Gordon Wishart, a cancer surgeon and medical officer at HealthScreen UK has seen a major rise of employers offering cancer screening as part of their benefits packages. “Companies are engaging with us to explore early cancer detection for their employees, which in many ways is adding to the already existing employee benefits that are available through employers and in some cases that’s been completely sponsored by the company,” he says.

With most cancers, if you pick it up early it requires less treatment, which is a better outcome for employees and for the employers. “It means less time off work, and getting that employee back to their desk as soon as possible and back to being an efficient, productive member of the team,” says Dr Wishart. A screening by HealthScreen UK only costs around £100 and if it is paid for through a salary sacrifice, it becomes more tax efficient and an employee will only pay around £50-60, or about £5 per month.

Often a small business won’t think about the issue of cancer until it is raised by an employee, which can take managers and HR by surprise. Therefore they are often nervous and uncertain about what to say. Good quality conversations between employee and employer are essential to understand their requirements and plan for the best possible support.

“It is important for employers and managers have some kind of training or insight that allows them to understand how much a serious illness like cancer can really turn somebody’s life upside down,” says Dr Jill Miller, a research advisor at CIPD. “Have an awareness of the emotional and financial strain it puts on people and that how you respond and support employees has a huge impact on both their morale and on the rest of the workforce as they will see the organisation is a good place to work.”

There are a few things to bear in mind when having these conversations. “It is best for the manager, the employee and HR to get the expectations out at the beginning,” says Dr Miller. “It is important to talk about who the employee wants to know among the business and how they want other people to react. Do they want people to talk about it, or do they want them to act normal and talk to them as they always have done?”

Needs will differ from employee to employee and from cancer to cancer. Different cancers will have different paths and treatments will have different demands on people, so constant conversations with employees to get updates on their progress is essential to know what’s going on. “It’s important to think about what support and flexibility you can offer to help people stay in work,” advises Dr Miller.

Employers also need to understand that recovery is a process and that it takes time. Legally, they have a duty to make reasonable adjustments to support a return to work, which will depend on the circumstances, including practicality, cost and the extent to which an adjustment will be effective in alleviating any disability. Adjustments might include offering lighter duties or allowing extra breaks.

These days, many people are cured of cancer or are able to live with it for many years. Some people may have short or long-term side effects from the illness or its treatment. Therefore, they may continue to need support after their treatment ends. “Many people tell us that that work can help to restore a sense of ‘normality’ after a cancer diagnosis. Try to find out a little about the type of cancer your employee or the person they are caring for has and what the effects of treatment are likely to be,” recommends Hurst.

Work contributes to financial independence, provides a sense of purpose, creates structure in our lives and is a lifeline back to normality, wellbeing and recovery for those suffering. For Dr Miller, it is essential to make the transition back to work as easy as possible. “It is also important to think about employees caring for those with serious illnesses and how to respond to employees who are supporting a family member or close friend who has had a cancer diagnosis.”

There is comprehensive legislation in place to support a successful return to work. Together, the Equality Act 2010 and the Disability Discrimination Act 1995 provide protection from discrimination. Everyone with cancer is classed as disabled from the point of diagnosis for the rest of their life, and their employer or a prospective employer must not treat them less favourably for any reason relating to their cancer. All areas of employment are covered including recruitment, promotion, training, pay and benefits.

Coming back to work can be very difficult for a patient. A recent study by Macmillan, the cancer charity, showed that 57% of survivors who were in work when diagnosed had to give up their job or change roles due to their illness. This means the total loss in productivity of survivors unable to return to paid work in England was estimated, in 2008, to be as high as £5.3bn. You must be prepared for such a possibility because small businesses often rely on teams that, while few in number, are high in skills and experience, so the impact can be particularly devastating.

If an employee comes back to work, which is often the case, there are a number of steps that can be taking to make things easier. This includes implementing a standard, phased return to work plan. You should also provide regular catch-ups to check all is working well.

More than anything, a clear policy is key to coping with cancer in the workplace. But it’s important to remember that with the devastating effects of serious illness on employees, there are no quick fixes.

Ryan McChrystal

How Cancer Will Affect Your Business by guest author Professor Gordon Wishart

gordon wishartProfessor Gordon C Wishart MB ChB MA MD FRCS FRCS FRCS is a graduate of The University of Edinburgh, Scotland and consultant breast & endocrine surgeon at Addenbrooke’s Hospital, Cambridge, England.

It is calculated that, currently, one in three people in the UK will get cancer of one type in their lifetime. Cancer charity Macmillan estimate this will rise to one in two by the year 2020.

New methods used by Cancer Research UK to calculate these figures, however, suggest that the 50 percent level of cancer incidence may already be upon us. A recent survey conducted by Cancer Research UK also revealed that cancer is now the UKs number one fear, ahead of being in debt, old age, being the victim of knife crime, car accidents, having a heart attack or losing a job or home.

This, of course, is not good news for anyone – but some employers may still be wondering what this has to do with them. The fact is, whether employers choose to take action or not, cancer is going to have a serious impact on them, their workforce, and their business. The NHS has identified that around 13,000 men and women die every year from work-related cancer – but the impact is not limited to areas of work that specifically put workers at higher risk. Of the 325,000 people diagnosed with cancer each year, over 100,000 are of working age, and estimates suggest that over 750,000 people of working age are now living with a diagnosis.

Alongside this, we need to consider the friends, spouses and families of employees. One does not have to be personally diagnosed with cancer to be hit by its effects; having to care for a loved one under these trying circumstances – not to mention the psychological impact of a cancer diagnosis – can also mean increased downtime among employees who are otherwise healthy.

Little wonder then that the Department of Health is asking employers for help to fight the massive cancer burden. On the positive side, there is a lot that employers can achieve, if they choose to act. The key is cancer screening and awareness in the workplace.

About Check4Cancercancer microscope

Check4Cancer Ltd. (previously known as International HealthScreen Technologies Ltd) started its existence in Cambridge in 2006 when the two founders Prof Gordon Wishart and Troels Jordansen met. The first BreastHealth UK clinic started at Spire Cambridge Lea in April 2008.

Today Check4Cancer offers 6 innovative different services for early detection of cancer. The services are:

BowelCheck BreastCheck GynaeCheck
LungCheck ProstateCheck SkinCheck

Above 6 services cover 90% of all new cancer incidence in the UK every year.

The services are supervised by a Board of Clinical Advisors; please click here for more details. All advisors are nationally renown  experts within each cancer area.

Throughout a network of over 80 clinics across the United Kingdom private individuals and companies can access these services. 2 of the life saving services (BowelCheck and GynaeCheck) requires no clinic but are based on home sampling.

Besides services for early detection of cancer Check4Cancer also operates the largest independent network of genetic counsellors and test. GeneHealth UK offers several cancer genetic tests ranging from gold standard BRCA 1&2 tests to innovative cancer panels. Pre-conception testing is being introduced during 2015.

Breast_Cancer_1With around 1 out of 2 Britons getting cancer over their lifetime cancer is a very serious issue for individuals and companies. On this background Check4Cancer is proud to be working with some of the leading companies to offer affordable services for early detection of cancer and cancer awareness services. Please click here for a list of such companies.

Check4Cancer is working according to ISO9000 and ISO270000, regulated by CQC, complies with the requirements of the Cyber Essential Scheme, registered with ICO is very proud to have 93% of our clients rating us ‘Very Good’ to ‘Excellent’.

Gordon Wishart

Risk of Recurrence of Breast Cancer

herceptin_drugMy body has endured surgery, chemotherapy and radiotherapy. As a result of this I have lost my hair and my energy. Still, that tumour the size of a baked bean is perceived as a threat. Its return must be further discouraged. My oncologist therefore insists on mammograms every six months and prescribes Letrozole. I must take one 2.5mg tablet each day for 5 years.

Breast cancer is often discussed as a general condition, but there are several different types that require different treatments. One way to distinguish breast cancer cells is through your genes. When you are diagnosed with breast cancer, your doctor will test the cancerous cells to determine their genetic makeup. My tumour had more of the HER2 protein in it than it should have had. HER2 is a protein that stimulates the growth of breast cancer cells. It can be found in your blood and urine. Sometimes it is referred to as a tumour marker. Tumor markers like HER2 cannot be used for cancer diagnosis, but they can provide other important information and the presence of HER2 helps the doctor predict how likely the breast cancer is to respond to treatment.

It is estimated that about 20 percent of breast cancers are HER2-positive. Younger women are more likely to be her_2_geneHER2-positive than older women. HER2-positive breast cancer tends to be more aggressive and to spread more quickly than other cancers. That is why it is important to find out if the cancer cells in your body contain this protein. If your breast cancer is HER2-positive, you have a much better chance of successful treatment with methods that target the HER2 protein specifically. Results show that those who tested positive for HER2 at an early stage of the condition (with tumours 1 centimeter or smaller) had a higher risk of recurrence. Researchers have also found that HER2-positive patients had a 77.1 percent five-year survival rate, with no recurrence. However, they also are
around five times more likely to suffer recurrence than those who were HER-2 negative and have close to three times the risk of recurrence of those who tested negative for HER2. So I am absolutely sure I want to discourage recurrence.

Tumours that are HER2-positive are more often associated with factors that increase recurrence rates. For example, HER2 tumours are more likely to occur in younger women and have higher nuclear grade. Generally, the higher the nuclear grade, the more aggressive the tumour. HER2 tumours are also more likely to show positive margins during breast surgery. Positive margins occur when cancer cells extend beyond the edge of tissue that is removed. HER2 tumours also have a higher likelihood of residual disease being found when additional tissue is removed. Up to 70 percent of patients with HER2-positive breast cancer respond to treatment. However, total remission for the condition occurs only in around 7 to 8 percent of patients. Targeted treatments (medicines that target the HER2 protein, like the Herceptin I was treated with) have improved the prognosis for HER2-positive patients. Remissions can also be lengthy, offering another bright spot in prognosis and reports show that remission can last more than 15 years for some patients.

tabletI was diagnosed HER2-positive and this brings special challenges in my recovery from breast cancer. The HER2 protein can make the breast cancer more aggressive. It can also make it harder to treat with hormone treatments used for other types of breast cancer. However, drugs like trastuzumab (Herceptin) target HER2 directly and effectively. This drug, when used in combination with other drugs, shows some very promising results for improving prognosis and survival rates for patients with HER2 cancer. However, there is a small but real risk of heart damage and possible lung damage. Scientists are still studying how long women should take Herceptin for the greatest benefit. I am not ashamed to tell you that I hope their studies are successfully concluded soonest. I have a vested interest in this, as my tumour was HER-2 positive.

All in all, having made the decision to stay alive long enough to thoroughly embarrass my children, when the oncologist tells me that I must take one 2.5mg tablet of Letrozole each day for the next five years, I will do just that. Letrozole has side effects but I have decided that whatever they are, they have to be better than allowing the tumour to return.

Valerie Penny

A View of Cancer Care – Book Review – The Spare Room by Helen Garner

The Spare Room is a novel about caring for a friend with cancer by Australian writer Helen Garner. She is an Australian novelist, short-story writer, screenwriter and journalist who was born in Geelong, Australia on 7, November 1942. She is a graduate of the University of Melbourne. Garner’s first novel, Monkey Grip, was published in 1977, and immediately established her as an original voice on the Australian literary scene. The Spare Room is a story set over the course of three weeks while the narrator, Helen, cares for a friend dying of bowel cancer. The cancer sufferer can be very stubborn and selfish. It is a form of self-preservation. This story reflects this. The book was published in 2008.

I am a cancer survivor. I have written about my journey in https://survivingbreastcancernow.wordpress.com/. When I chose this book from the local library, I did not realise the topic it covered. I was not sure that I would be able to cope with it. However, The Spare Room is a magical gem of a book. It is gripping, moving, and unexpectedly funny. The book packs a huge punch, charting a friendship as it is tested by the threat of death.

The book made me think about how those who love had suffered when they were caring for me and watching my treatment and recovery. How much of they gave up to help me in my time of need. Likewise in this book, Helen has little idea what lies ahead and the strength she will need to muster when she offers her spare room to an old friend, Nicola. Helen arrives in plenty of time to pick Nicola up from the airport, but she wasn’t expecting to see her friend look so sick, so sick that she could hardly walk. Of course Nicola insists it was just the flight that has taken its toll on her and that she’ll be fine once she has a rest. Nicola has arrived in the city for cancer treatment. She is skeptical of the medical establishment, and placing all her faith in an alternative health center. Nicola will be attending The Theodore Institute where she she will undergo extensive alternative treatment for her cancer. She is convinced that after three weeks of this alternative treatment she will be cured of her cancer. The alternative treatment is high doses of vitamin C. Nicola is determined to find her own way to deal with her illness, regardless of the advice Helen offers.

Nicola explains to Helen how the treatment works and as far as Helen is concerned it is a load of rubbish. Helen knows that there is no miracle cure for the final stages of terminal cancer, but Nicola refuses to be convinced. However, after only a few treatments of vitamin C, Nicola starts to feel very sick and is in a lot of pain. In the weeks that follow, Nicola’s battle for survival will turn not only her own life upside down but also those of everyone around her.

She wakes during the night to sopping wet bedding from sweating and chronic pain. Each night Helen helps her change thehelen garner bedding and tries to comfort her, but her patience are wearing thin knowing this treatment will not work. As Nicola continues with the treatment, Helen becomes increasingly angry, frustrated and exhausted. She cannot seem to make Nicola see that this treatment is not only expensive, but is a waste of time. She only wants what is best for her friend:that is to make sure the time she has left is as pain free as possible.

Helen Garner’s book was a relatively quick read, but it definitely was not an easy read at times. A heartbreaking and powerful read about care, friendship and dying. The Spare Room is a book well worth reading.

This review originally appeared in Valerie Penny’s Book Reviews at: http://bookreviewstoday.info/2015/01/18/the-spare-room-by-helen-garner/.

Valerie Penny

Post Cancer Fatigue

Cancer related fatigue (CRF) is very common.   I had just no idea how long I would suffer from fatigue after my treatment had finished.  Fatigue can often be confused with tiredness, but there are differences between the two conditions.

chronic-fatigue

Tiredness happens to everyone, especially after certain activities or chemotherapy however,  fatigue is less common and is an excessive whole-body tiredness that is not relieved with sleep.   This debilitating condition can impact your quality of life. It certainly impacts upon mine.  I am still unable to walk for the kind of distances I did previously and only do half a line dancing class instead of a full one.  My 18 weeks of chemotherapy ended almost 10 months ago.

Fatigue can be acute (lasting a month or less) or chronic (lasting from one month to six months or longer).   Mine is clearly chronic.  The precise reason for this intensive tiredness is unknown, but practitioners believe it may be related to the process of cancer itself or chemotherapies and radiation treatments.  Although  CRF is one of the most common side effects of cancer and its associated treatments, nobody told me about it or warned me I might suffer from it.  Therefore, I thought I was just being lazy and not pulling myself together properly.   I was quite wrong.

Usually  it comes on suddenly, and does not result from activity or exertion.   Although in my case exertion makes it worse.  The fatigue is often described as “paralyzing.”  It may continue for months, even after treatment is complete.

If you are a cancer survivor and feeling tired or fatigued even long after your treatment is finished, you must know you are not alone.

fatigue

About one-third of breast cancer survivors experience CRF for periods of time ranging anywhere from a year to several years post-treatment.  While there is no conventional therapy to resolve it, studies are increasingly showing yoga and other gentle exercises can help. Some patients with different cancers report relief with exercise.

Valerie Penny

The Psychological Effects of Cancer

There are other effects of cancer and its treatment that are not so widely known or discussed.  I have only discovered this recently and these are side-effects that affect not only me but also those close to me who are nearest. These are the psychological effects of cancer that make everything doubly hard: for everybody.

It was only when I was chatting to my cousin about cancer suffered by another member of our family and the outbursts of temper they displayed, that I began to understand that cancer results not only in physical, but also psychological effects.  The emotional effects of chemotherapy can be just as debilitating as the physical effects. From the initial diagnosis of cancer to the final dose of chemotherapy, patients undergo levels of emotional distress well beyond a healthy limit. The emotional effects of chemotherapy can be directly related to the medication or to external factors such as family, work and social life. The range of emotional distress felt by patients depends a lot on their particular support network and  their rate of recovery.  Emotions run high for the whole family during chemotherapy.  It made sense when I thought about it, but I never had.   

I asked my husband if I had ever displayed any outbursts of temper. I was sure I had not, until he reminded me of an uncharacteristic and ugly diatribe to which I subjected my daughter during a telephone conversation.  I felt so guilty because he was right.

The outburst to which I subjected my daughter is not the only evidence of my fragile mental state during cancer treatment, at present.  When the District Nurse arrived to clean my hickman line and take my pre-chemo bloods at a time different to that arranged I lost the plot and ended up asking her to leave. Oh dear! The problem is it all seemed so logical at the time.

Chemotherapy can have an emotional impact on patients because the treatment itself is a sign of emotional self-preservation. The choice to fight cancer does not end with the first dose of the medication and patients often feel emotionally taxed when recovery is slow. The physical side effects can contribute significantly to emotional distress. Insomnia, constant nausea, weight loss, hair loss and a diminished sex life can all make a patient feel emotionally distraught. Family and friends bear their pain too.

Chemotherapy also affects patients because of a perceived burden of loss on family, friends and work. Patients may feel isolated from participating in family activities due to fatigue and medical appointments. Social life is also dramatically affected by chemotherapy due to fatigue and often shame.  Therefore, some of the classical negative emotions during chemotherapy include anger, fear, anxiety, depression and isolation. The emotional distress from chemotherapy may come from a sense of not having any control over the matter.   Cognitive function and emotional health are strongly interconnected and chemotherapy can take a serious toll on both of them. In some cases, emotional distress can affect cognitive function, while in other cases, impaired cognition can alter judgment and emotional responses during cancer treatment.

However, I have to confess that, perhaps unsurprisingly, my worst outburst to date has been reserved for my long-suffering husband. This combination of temper and depression was my worst to date.  When I asked my cancer nurse if this was a normal side effect she replied in the affirmative. My husband just said very quietly, “But that does not make if acceptable.”  Of course he is right and none of the victims of my temper deserved it.

Depression is a persistent sadness that interferes with usual activities and ability to carry out roles at home, work, community, or school. Depression may also be known as sadness, feeling “down,” despair, or hopelessness. Depression and its side effects affect both men and women.  There are several risk factors that increase the potential for development of depression in the patient with cancer.  Medications commonly prescribed for cancer patients can be one of those risk factors.  There are many classes of medications that may have depression as their side effects.  Some examples are: analgesics, anticonvulsants, antihistamines, anti-inflammatory agents, antineoplastics, chemotherapy agents, hormones, immunosuppressive agents, and steroids.

Depression during chemotherapy, and generally can be managed, but it has to be admitted first.  You need to recognise what puts you at risk of depression.  Triggers include –

    • History of depression in yourself or your family.
    • Pessimistic view of life.
    • Living with a chronic disease like cancer.
    • Stressful events in your life.
    • Effects of some medications & chemotherapy.
    • Lack of support from family or friends.
    • Unrelieved physical symptoms (like pain).
    • Alcohol or drug abuse.
    • Unrelieved grief (not working through feelings of angry about how cancer & its treatment have affected your life).
    • Any persistent change in your mood, with the signs of depression listed above.
    • If you feel suicidal you must tell someone and get help. It is not safe to be on your own at these times.  

I am told it is not unusual to have times when you feel very low after a diagnosis of cancer, and during or after treatment. Many people feel physically and emotionally exhausted from the treatment, and this can lower their mood. However, for some people affected by cancer their low mood may continue or get worse and they may need specialist help or treatment. Some people find that their sadness gives way to a situation where their mood is low most of the time for several weeks or more, and they are depressed.

The relationship between cancer and depression is complex. Depression may be triggered by the diagnosis of cancer, other issues related to the cancer and its treatment, or the impact of the cancer on a person’s life. However, depression may occur by chance or be related to other difficult events, either in the past or in the present, which are nothing to do with cancer, such as the loss of a loved one.    Depression can develop slowly, making it very difficult for either you or your family to recognise when it started. In other cases it can seem to hit you suddenly – one day you wake up and realise that you feel hopeless and helpless and are engulfed in a ‘black cloud’ or, as Winston Churchill called it “black dog” of depression.  

Depression can affect anyone at any age. It is extremely common – one in five (20%) people are affected by depression at some time in their lives. Depression is not a sign of personal failure or inability to cope. You can’t ‘pull yourself together’ or ‘snap out of it’.  Depression can usually be successfully treated. The first step to feeling better is to admit the problem, then to get appropriate help.

Valerie Penny

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