Tag Archives: chemotherapy

things we forget to tell you

May 1, 2012 By in after treatment, chemotherapy Tags: , , 11 Comments

I met with a young patient recently, a woman who has been done with chemotherapy for lymphoma for close to a year. She was feeling well, and she had no symptoms of cancer, nothing that made her suspicious of a recurrence. After I examined her and reviewed her most recent CT scan and labs, I agreed. No recurrence. I wrote in my note, “NED,” the acronym for no evidence of disease.

As we were wrapping up the visit, I asked her if there was anything else on her mind, anything else she was concerned about.

There was.

“I still get really nervous and anxious before coming to see you and before each scan,” she said. “I was prepared for how chemotherapy would make me feel. I expected to feel tired, to get sick. What I wasn’t prepared for was how to move on with my life, without letting cancer take over. No one told me that getting on with life after cancer would be like this. No one told me that this would be so hard.”

And, to a large degree, I think she’s right.

We’re very good at getting people through chemotherapy treatments. Oncologists and oncology nurses are great at counseling on side effects, helping to manage nausea and other ill-effects of treatment. Families rally around the cancer patient during this time, providing much-needed emotional support and physical support. Friends – hopefully – step up to the plate and offer shoulders to cry on, hugs, personal experiences, and distraction.

But when treatment is over? Well, life gets back to normal. Right?

Hmm…not so fast. It’s just not that easy. That’s what we forget to tell patients. Getting back to normal, getting on with life, is harder than everyone expects.

Picking up the pieces of your life before cancer – before chemotherapy or radiation wreaked havoc on the body and soul – takes much longer than one might expect. With the end of treatment comes an upwelling of fear of recurrence, fear that because active treatment has stopped, the cancer will be able to grow again. There is fear surrounding each scan and each blood draw. Anxiety swells before each oncology visit.

We might have forgotten to tell you that this is all normal. It’s an expected part of the recovery process. The fatigue from chemotherapy will get better over time. The hair will grow back. The fear of recurrence will subside with the passing of the months.

Another thing that we may have forgotten to tell you? You will be able to get on with your life again after cancer treatment. You’ll probably be a changed person after your experience, but you’ll get back to normal. If not the old normal then for sure a new one. Your life will resume, despite cancer, beyond cancer.

Just be sure to rally the support during this time. You still need it.

how to handle fatigue during cancer treatment

January 30, 2012 By in chemotherapy, during treatment, treatment side effects Tags: , , , , Leave a comment

One of the most common side effects of almost any type of chemotherapy is fatigue. And because the effects on the body from chemotherapy are cumulative, the fatigue often builds, worsening as treatment progresses. Fatigue from chemotherapy often happens during that first week or two after receiving the treatment, but as time goes on, the symptom may last longer and longer.

For many people, it can be disabling.

Feeling tired or weak during cancer treatment can be related to several things — sadness or depression, poor nutrition or not eating enough, disrupted sleep or not enough sleep, pain medications (especially narcotic medications), or anemia (decreased hemoglobin, which is carried by red blood cells). If any of these are occurring, it’s important to take care of these issues first to see if the fatigue improves. Sometimes the fatigue is related to the cancer or the treatment itself, however. That kind of fatigue is harder for us, as oncologists, to help with.

The one big thing that patients can do that can help? Stay active.

People undergoing cancer treatments are usually concerned about whether it’s okay for them to exercise, to go to the gym, to continue playing tennis or going for their morning runs. If there are no other health reasons — like a recent surgery — that would prohibit exercise, my advice is always to continue staying active during chemotherapy.

Here are all of my tips to combat fatigue during chemotherapy, once any treatable conditions have been dealt with appropriately:

  1. Get moving. Whether it’s walking or swimming or going to the gym, do something on a daily basis if possible. Not only will the exercise help with fatigue, but it helps to improve appetite and quality of life.
  2. Take time to relax. Schedule some rest in your day so that you conserve energy when it’s not needed.
  3. Eat well. Keeping up with your nutrition is important on so many levels. Even if you can’t eat three big meals a day, snacking or grazing throughout the day on healthy snacks can keep things going in the right direction.
  4. Practice good sleep habits. Taking simple steps, such as limiting naps to short periods of time (maybe 45 minutes to 1 hour), turning off the television or computer during the hour before bedtime, and avoiding caffeine in the afternoon, will help nighttime sleep be more restful. With better rest at night, you might feel more energized for more physical activity the next day.

photo credit: Caitlin Regan, 2008

your voices: kathy and breast cancer

December 8, 2011 By in caregivers, chemotherapy, during treatment, taste changes Tags: , , , , 2 Comments

Today I’m thrilled that Kathy Gori is sharing her story with us. Kathy is a breast cancer survivor who has a great perspective on eating well during cancer therapy and beyond.

Kathy, photo by Alan Berger

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Tell us a little about your history with cancer.

I was diagnosed with breast cancer in 1990, while in my 30′s. I found the lump while doing a monthly self exam. I had gotten a clean mammogram just 3 months before as part of a full physical well baby program (we were trying to get pregnant) . The tumor was small but practically on the chest wall. My doctor was surprised I was even able to find it. Since I was a vegetarian, a runner, and did not smoke or drink, and given my age, no one thought the lump could possibly be malignant. But I had a biopsy and it was.

The cancer was non-hormonal dependent which is common in younger women and so considered aggressive. I had a mastectomy, and chemotherapy (at the time they did not do radiation if one had a mastectomy, though now they do). The cellular matter in my tumor was aneuploid and I was given a poor prognosis.

What type of changes did you notice with your appetite for food or your tastes for food during your treatment? How did you learn to overcome these changes?

When I was first diagnosed, eating was the last thing on my mind. I didn’t have much of an appetite, mainly because I was so scared. I was doing conventional western medicine and decided to augment my treatment by following a strict macrobiotic diet recommended for breast cancer patients.

I like Japanese food but the very strict diet was boring the pants off me. Since I was not allowed eggplant, potatoes, or tomatoes (in macrobiotic terms they were considered deadly nightshades and so a big no no), which were some of my favorite foods, and since the diet was so restricted, I wasn’t eating much. I started losing a lot of weight fast. This was not good. There was talk of putting in a port to get more nutrition into me. My doctors were concerned since I was skinny to begin with and I needed to keep up my strength. My internist suggested instead of macrobiotics I might try a more Ayurvedic diet (Indian food) where I could eat the foods I liked. My sister in law is an Indologist/archeologist (expert on 3rd century BC Indian art) and has lived and worked in India. She’s also a great Indian cook and she got me started with cooking my own Indian food. I quickly began preparing my own organic healthy Indian vegetarian dishes. My appetite was stimulated and I happily ate my way through treatment.

Of course there were chemo days when I was nauseous and unable to cook and so my husband would take me out to a neighborhood vegetarian/vegan restaurant if I felt like it (sometimes going out was good for me) or he’d bring food back for me. I also smoked marijuana — which I’d never done before (my oncologist and internist both recommended it) — to stimulate appetite. It worked.

Do you have any tips for enjoying food despite cancer for other people going through a similar situation?

People told me when starting chemo to suck on hard candy so that I wouldn’t taste the medicine. I bought tons of butterscotch hard candies to the hospital with me. The result was, 21 years later I now hate butterscotch. It ruined butterscotch for me, so I always tell people if you’re bringing something to chemo to take the taste away, bring something you’re not nuts about as you may never want to eat it again after this is all over. Also I always say eat what you feel like eating..but eat! For my first round of chemo I had an insane craving for peanut butter and jelly sandwiches with big glasses of pink lemonade. Alan made all of these for me non-stop. I couldn’t get enough. Was it organic? Hell no. Was it healthy? What do you think? But I wanted it, I could and would eat it..so I did. It made me happy!

In short my advice is to eat what makes you happy. I do a lot of cooking for friends having cancer treatment and I always ask them first, what do you want to eat? What do you feel like eating? If there was ever a time to eat dessert first this it it.

Do you have any tips for caregivers of cancer patients going through the cancer experience?

To patients and caregivers I always say: be patient. This isn’t easy for anyone. I found that it was good sometimes to do things for my husband while I was having treatment so that the caring wasn’t all going one way. It also made me feel better and much more “normal” to do the things I always did.

It’s always important to remember that there’s life after this illness and when it’s over you want those who helped you to still be speaking to you.

Do you have a recipe to share you were fond of during or after your treatment?

One of my favorite treatment, post-treatment, and right-up-to-now dishes is Indian style spinach with corn. I make this at home all the time. It’s nourishing, tasty, and on the menu when I do cooking for other cancer patients. It’s easy to eat and everyone seems to like it.

photo by Alan Berger

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Kathy Gori has been cooking Indian food for 20 years. A screenwriter by trade, she works at home, so trading a hot keyboard for a hot stove was just a matter of a few steps. Her obsession with Indian cooking began when her sister-in-law, Elizabeth, an Indologist who’d lived and worked in India, introduced her to the intricacies of the Indian kitchen. Thousands of hours and hundreds of dishes later, Kathy makes her own chutneys, grinds her own spices and enjoys exploring the various cuisines of the sub-continent. She has cooked for some of the Dalai Lama’s monks, the Director of the Delhi Museum and President Clinton’s California campaign staff. She is always learning and loves to share her knowledge and love of Indian cooking with others.

In addition to her writing and cooking, she was the voice of Rosemary the Telephone Operator in the series Hong Kong Phooey. She has voiced many films and commercials, winning a Clio Award, and she ever “dated” Don Draper. Kathy and her husband/writing partner, Alan Berger, live with their Siberian Husky, Patsy, in Sonoma, and most recently worked on the screenplay for Chaos Theory starring Ryan Reynolds.

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