Archive for March, 2009
AFTER CANCER: AFTEREFFECTS INVOLVING THE HEAD AND NECK
What If My Eyes, Nose, and Mouth Are Dry?
Dryness can be due to
• radiation- or chemo-induced changes in the glands that supply moisture to these areas
• medication effect
•an immune disorder that damages or destroys the glands that supply moisture to these areas
What If It Is Hard to Swallow?
Difficulty in swallowing after cancer treatment can be due to
• dry mouth
• injury to the nervous control of swallowing •radiation changes to the mouth, throat, and/or esophagus
• infection in the esophagus
Short-term radiation changes will usually resolve within a few weeks to months of completing therapy. Permanent scarring of the esophagus can occur months to years following radiation to the chest (mediastinum). This delayed scarring can cause narrowing, called stricture, of the esophagus, which is treated with dilations by a gastroenterologist (a doctor specializing in diseases of digestion).
Infections (viral, fungal) are usually quite painful and require treatment aimed at eradicating the infection.
Can Cancer Treatment Cause Cataracts?
Cataracts are common in otherwise healthy people over sixty-five years old. They can occur earlier and more frequently following
• radiation to the eye
•long-term exposure to steroids (corticosteroids, or cortisone-type drugs, such as prednisone)
Why Does Food Sometimes Taste Different after Cancer Treatment?
Treatment of head and neck cancers can result in temporary or permanent alteration in taste due to
• changes in the tongue
• diminished or absent smell sensation
• diminished saliva
• effect of medication
What Is Osteoradionecrosis of the jaw?
This is a serious complication of radiation to the jaw and is due to bone infection. High-dose radiation to the jaw causes permanent changes that render the bone unable to respond normally to infection in the gums or teeth. This problem has become uncommon as techniques of delivering radiation have improved and attention has been given to proper care of teeth. You can prevent this complication by
• getting frequent (every three to four months) high-quality dental care
• brushing properly and flossing regularly
•seeing your dentist at the first sign of swelling of the gums or the first hint of pain in your gums or a tooth
What Are Radiation Caries?
This is an aggressive form of dental caries (cavities in the teeth) that occurs after radiation to the head and neck. Because it is usually painless, it can, if not picked up by frequent dental exams, progress to such a point that the teeth cannot be salvaged. It is caused by changes in the quality of the saliva, as well as by decreased quantities of saliva.
How Can I Prevent Radiation Caries?
You can help prevent radiation caries by
• having frequent dental exams
• practicing meticulous oral hygiene (brushing and flossing) •applying topical fluoride every day
• eating a healthy diet
*95/32/5*
AFTER CANCER: POSTCANCER FATIGUE (PCF)
The oncology literature acknowledges the existence of a characteristic fatigue that occurs following treatment when remission is achieved. It is not explained completely by detectable abnormalities and persists despite the evaluation and correction of all identifiable causes of fatigue. Anyone involved in the care of cancer survivors knows that fatigue is universal during and immediately following aggressive treatment and is difficult to understand, explain, or fix. Patients who experience postcancer fatigue describe it as different from any fatigue they ever experienced under healthy circumstances; they often describe it as feeling similar to infectious mononucleosis.
Postcancer fatigue is a symptom that
• is due to the effects of prior cancer and/or cancer treatment •persists after all other known physical causes of fatigue have been ruled out or corrected
• persists after any depression, anxiety, or other emotional problem has been ruled out or resolved
•persists despite good-quality sleep, good nutrition, and abstinence from medicines that cause fatigue or sleepiness
• hinders the performance of activities of daily living (ADLs)
Postcancer fatigue affects daily life and requires significant adjustments in habits and schedules. If severe, it may prevent you from performing desired activities. Before your illness, when you felt wiped out, one or two good nights of sleep probably recharged your batteries and made you feel refreshed. With postcancer fatigue you may at times feel exhausted even after doing all the things that used to make you feel refreshed.
Before your illness you experienced a predictable pattern of progressive exhaustion after becoming sleep-deprived: you felt okay when you first got up, or after a cup or two of coffee, and then gradually got sleepy by late morning or early afternoon. Similarly, individuals with postcancer fatigue learn that their fatigue is worse under certain circumstances (before or after meals, before or after exercise, during and following family conflicts, before checkups, and so on) and that it worsens gradually. Diverse circumstances may exacerbate postcancer fatigue in different people.
Although some circumstances predictably make you feel worse, the pattern with postcancer fatigue is often variable, with days or weeks of more energy followed by days or weeks of extreme fatigue. In addition, people with this symptom often report episodic bouts of fatigue: they feel pretty good for a while, and then suddenly, while reading a book or working on a report, they are unexpectedly overwhelmed with debilitating fatigue. They may feel fine until halfway through lunch—and all at once become too tired to finish eating.
“Postcancer fatigue” is a term that can be applied only after all treatable causes of fatigue have been ruled out by your oncologist or internist, or have been corrected.
*68/32/5*
AFTER CANCER: HOW CAN I DEAL WITH OTHER PEOPLE’S CANCER DEATH?
To grieve when you have to deal with another’s death is normal. This has not changed just because you, too, had cancer. Preparing for someone’s death or understanding the source of your feelings will not keep you from having feelings when the person dies. You must allow yourself to go through the grieving process, even if it means touching on some feelings that are discomfiting. Unthinking, unfeeling people are protected from the pain of grief. Accept your feelings as a sign of your personal depth and your connection with the world.
Talk about the person and your feelings. Allow yourself to cry, feel mellow, or be distracted and inefficient for a while. Remember that some of your emotions may seem a little bit out of proportion, because the news may have stirred up emotions about issues that are closer to you. The loss of a casual friend from cancer can awaken major grief over other losses, as well as your own fears.
Remind yourself that death is not defeat. Death is a normal, natural, unavoidable, expected part of life. Living the life you have is a victory. Someone can die with chemotherapy dripping, fighting cancer to the last breath, while someone else dies peacefully at home after accepting that the time to die has come. The act of choosing how to live your life is a triumph, no matter what the outcome.
*155/32/5*
AFTER CANCER: FEELINGS. HOW AM I SUPPOSED TO FEEL AS I COMPLETE MY THERAPY?
The completion of therapy is usually accompanied by many different, seemingly contradictory, feelings. You may feel any combination of relief, anxiety, confusion, a sense of unreality, fear, anger, and depression. Your feelings may be mild or intense, exhilarating or frightening. They may fluctuate from day to day, even hour to hour. Take comfort in knowing that you will not always feel this way. These emotions will smooth out. Your life and emotions will seem more normal with time.
What you feel is less important than what you do with these feelings. When you have intense emotions, share them with someone you trust. Somehow, after an empathetic friend, relative, or counselor listens, you will feel better, even if you do not find any new answers. You do not move your refrigerator very often, but when you do, you would not think of moving it yourself. Completing cancer treatment is an exceptional circumstance. Why should you try to manage the emotions yourself?
If you feel like crying, find a safe place and cry until you do not feel the need any more. If you feel angry, find a safe place to vent your anger, or engage in an activity such as exercise or writing that will release some of the pent-up energy.
Try writing down your thoughts and feelings. Keeping a diary will provide a safe outlet for all your emotions and help you sort out some of your thoughts and feelings. Writing can be therapeutic, even if you throw away everything you write.
Most of your intense thoughts and feelings will fade as you move farther away from your recent experiences with cancer. If you capture them now, you will be able to remember what was happening at this time of your life. Your diary will allow you to look back and see how far you have come. Other forms of writing, such as letters and poems, provide the added dimension of being able to share with others.
There are times when the best way to handle a rough day is to go to bed early and start again tomorrow. Rest and escape are sometimes better than all the talking, analyzing, hugging, or exercising in the world. Obviously, going to bed does not change anything or solve problems. It just allows you to settle down, recharge your batteries, and start over.
What feelings you experience is less important than what you do with these feelings.
*128/32/5*
AFTER CANCER: DO I NEED ANY VACCINATIONS?
Vaccinations are given to help prevent specific diseases. They come in many different types. Some are routinely given to almost everyone, such as the tetanus vaccine. Others are given only to people with special medical conditions, such as the pneumonia vaccine. Still others are given to anyone with an increased risk of being exposed to the disease, such as yellow fever vaccination before travel to high-risk areas, or hepatitis vaccine before the start of work with high occupational exposure.
Discuss with your primary care giver whether you need any vaccinations now or in the foreseeable future and whether there are any vaccines that you should avoid. Vaccinations in adults are given when the benefit outweighs the risk, such as when there is an increased risk of getting infected or an increased risk of complications from the infection. In general, adults who are at increased risk of infections and who may benefit from certain vaccinations, such as the flu vaccine or pneumonia vaccine, include those who
• are over sixty-five years old
• have significant heart, lung, or kidney problems
• have certain cancers
• have had their spleen removed
•know that they are going to be exposed to a preventable infection
Vaccinations are given in hopes of building up your body’s immunity to specific infections before you are exposed to the infection. Exposure to the infectious agent after your immunity is boosted usually results in a milder illness or none at all. Vaccination does not guarantee protection, because many factors determine whether the vaccine works in you.
Vaccines containing live virus can be dangerous in certain patients. Be sure to discuss your cancer treatment with any doctor who recommends that you receive a vaccine, and discuss any plans for vaccination with your oncologist.
*102/32/5*
GROWING OLD – SOCIETY AND OLD PEOPLE 2
Today, in our rapidly changing society, old people tend to be discarded as unproductive, unable to adapt to change, often sick, a liability both to society and to their family.
It is ironic, too, that middle-aged people have a much greater ambivalence to old people than do young people, and their relationship to the old is much less understanding. A middle-aged man has been taught to treat the old with respect, and he fulfils what he sees as a duty. At the same time, he considers the older person physically and mentally inferior, a person whom he expects to conform to society’s image of age. If the old person shows that he will not, he is condemned as an ‘extraordinary’ old man, an old ‘duffer’ or a ‘dirty’ old man.
It is important, today, to ask ourselves why we treat the old in this way; why the old are so alienated; why so many old people are condemned by society to relative poverty, to exploitation, to loneliness, and to inferior living conditions. Goethe wrote, ‘Age takes hold of us by surprise’. Today, because of better nutrition, better sanitation, and better health care, an increasing proportion of the population is surviving to become old. In many Western countries, 12 per cent of the population is over the age of 65, and by the year 2000 one person in six will be over that age. Many of us will be among them, so it is to our own advantage to think about growing old. We must avoid age taking hold of us by surprise.
*350/16/1*
SOCIETY AND HOMOSEXUALITY
To what extent do homosexuals see themselves as oppressed by society? An American study by Dr Weinberg and Dr Williams of the Institute for Sex Research is revealing. They surveyed over iooo male homosexuals in the U.S.A., over iooo in the Netherlands, and over 300 in Denmark. The American men were more fearful about being known as homosexual than were the Europeans, because of the greater acceptance of homosexuality in Europe. When asked what would result if their erotic preference were known by heterosexuals, over 60 per cent of American men believed it would lead to problems at work, and nearly 50 per cent believed some of their heterosexual friends would break off the friendship.
*304/16/1*
IMPOTENCE – RESTORING
It is obvious that the man who comes for treatment is far more personally insecure, and has far greater anxiety, than a man with one of the other sexual problems. His deep conviction that his manhood is suspect, and that he is a sexual failure, is augmented by his anxiety that other people will learn of his sexual inadequacy. He may fear that his wife has told her friends of his defective sexuality.
The man’s partner is also frustrated. She has tried comfort, she has tried sympathy, she has tried aggression, in an effort to help her man, with no effect. She, too, becomes tense and anxious, as she thinks that his impotence is due to her lack of physical appeal, or that he is obtaining sexual relief with another woman while denying her any sexual experience. She may be worried that he is a latent homosexual.
The essence of the therapy is to restore the man’s belief in his sexuality, not just to treat his symptoms of impotence. At the same time his partner’s fears for her man’s sexual ability need to be changed. Sex therapists seek to replace the fears by pleasure. They seek to enable the couple to re-establish that human sexual contact is pleasurable. They seek to enable the couple to re-establish (or to establish for the first time) communication with each other about sexual matters. They seek to remove inhibitions and childhood or adolescent hang-ups.
*258/16/1*
PREMATURE EJACULATION – THEORIES 2
None of these theories fits the clinical situation as well as the theory that premature ejaculation is an anxiety-induced response to early unsatisfactory and stressful sexual experiences. Because of these unsatisfactory experiences the man has learned that sex is furtive, quick, and guilt-ridden. It is something which is pleasurable, but also shameful. It is something which should be done quickly and is stressful. He has learned a pattern of response to sexual stimulation, in which he is rapidly aroused and is unable to damp down the arousal, keeping it in the late plateau stage. He has lost his voluntary control over his sexual response because of his anxiety about his sexuality. He has pushed the anxiety into his subconscious where it reinforces his quick response pattern, until it becomes the only way he responds to sexual arousal. His sexual impulse has escaped his brain control.
In other instances, premature ejaculation occurs because the man is over-anxious or over-sensitive about his ability to satisfy his partner sexually. He may be unaware that many women fail to reach orgasm during penile thrusting and may feel that because his partner does not, he is a sexual failure. He may be over-sensitive about his relationship with his partner. This can induce anxiety and lower his self-esteem so that, paradoxically, he loses his own ejaculatory control, and comes increasingly quickly.
*211/16/1*
THE BARREN MAN – EJACULATION
The condition, which is an advanced form of retarded ejaculation, is uncommon. But if a man has it, it can be desperately worrying. The most complete study is from Belgium where Dr Geboes and his colleagues have treated seventy-five men with the problem. They found that most successful therapy was the use of an electrovibrator. The vibrator (which is often used to help women reach orgasm) is placed against the glans of the penis. Within five or six minutes the man has his first conscious orgasm. A few of these vibrator-induced orgasms, with ejaculations, convince the man that he is normal. Many men will then be able to reach orgasm and ejaculate during sexual intercourse, but those who fail and only ejaculate with the aid of the vibrator can be helped. Their semen can be collected and their wife artificially inseminated with it, provided that it is of good quality. These are uncommon causes of infertility.
*164/16/1*
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