Health related information and news from around the world.

The fact that you have cancer does not mean that you suddenly stop being an adult person with all the accepted and recognised rights of any adult person. It is your cancer, your body and your life. You are entitled to expect and get control over all important decisions to do with yourself. I have seen many patients give away their basic rights through ignorance, fear, awe, feelings of overwhelming helplessness and a need for protection. Unfortunately, giving away those rights completes a vicious circle—giving away rights leads to dependency on others, which leads to fear and helplessness, which leads to further giving away of rights and so on. You can break that vicious circle. Know about and insist on your rights to remain in control, that is, to function as a normal adult person, in every respect for which you remain physically and mentally able.

*1/40/1*

Do I Need to Take Any Special Precautions with My Skin?

There are steps all people should take to protect their skin, whether or not they have ever had cancer. They are especially important after radiation to sun-exposed areas of your body or if you notice that your skin is drier or more sensitive to sunlight. These steps include

•avoiding sun exposure, especially between 10 a.m. and 2 p.m.

• avoiding tanning booths

•using sunscreen regularly (SPF at least 15)

• avoiding drying agents

• using moisturizers liberally

• avoiding harsh rubbing

• making sure a skin exam is done periodically as part of your routine medical examinations

•monitoring your skin for spots or moles that change (become itchy, develops an irregular border, bleed, change color)

What Is Shingles?

Shingles is a skin eruption caused by reactivation of the dormant chicken pox virus, herpes zoster. Shingles usually begins as burning or pain in a strip of skin, which is followed by the eruption of groups of vesicles (blisters) or pustules (pimples) in the distribution of the nerve involved. Occasionally, but not commonly, the virus can spread widely in the body from the nerve.

Who Gets Shingles?

Anyone can get shingles, but it is uncommon in healthy people under fifty years old. Radiation therapy, chemotherapy, and suppression of the immune system are all thought to allow reactivation of the virus. It is not uncommon to have a bout of shingles in the first two years after treatment for Hodgkin’s disease. It is often seen in AIDS patients.

What Should I Do If I Think I Might Have Shingles?

Call your doctor immediately, and specify that you are concerned about shingles. Antiviral therapy is available that, if administered early, can

• shorten the course of skin eruption

• bring about earlier relief of symptoms

Your doctor may feel comfortable making the diagnosis over the telephone on the basis of your description. Many times your doctor will need to see the rash to confirm the diagnosis.

When Will My Hair Grow Back?

If you received chemotherapy that caused hair loss (alopecia), you can expect your hair to start growing back within weeks of your last treatment. Many people note hair growth even during their chemotherapy.

If you received radiation to your scalp, it may take weeks or months before you see some growth. How long it takes to grow and how well it grows will depend on the dose of radiation you received. High-dose radiation can cause permanent hair loss in the area of the scalp radiated.

What Will My Hair Look Like When it Grows Back?

The texture, color, and/or curl pattern of your hair may be different from what they were prior to cancer treatment. Many people are elated—when gray is gone, say, or hair is thicker, wavier, and softer. Unfortunately, some people are disappointed—when blond hair returns a mousy brown or naturally wavy hair returns frizzy and unmanageable.

The hair that first grows back may not remain the same over the subsequent months and years. For example, hair that first grows in soft may become coarser with time.

*93/32/5*

Feeling drained all the time can impair your quality of life in a major way. After having tolerated other, more dramatic symptoms or problems, you might expect fatigue to be a minor nuisance. However, it is challenging because of its effect on all aspects of your life. Lack of energy and all its repercussions represent ongoing loss.

After cancer the rhythm of routine and the feeling of satisfaction that comes from completing tasks helps you feel that your life is getting back to normal. Unfortunately, you may neglect some tasks, or do them poorly, if you are straining just to fulfill daily responsibilities. A sense of routine may seem elusive if you lack adequate emotional or physical reserves to deal with everyday interruptions and problems (such as spilled milk, misunderstandings with friends, or news of a friend’s heart attack). Without the satisfaction of completing tasks or the comfort of a routine you may experience a lingering sense of being sick and out of control.

The stress of knowing that you cannot do as much as before is augmented by the stress caused by the consequences of this incapacity. For example, added to the inconvenience of your child’s not having clean clothes because you were too exhausted to do the laundry is the tension caused by your child’s disappointment or anger that her favorite shirt is dirty (still). At work you have to deal not only with the nagging discomfort that accompanies being behind schedule with assignments but also with the stress that accompanies your sense that you should be functioning better than you are.

The stress level is further raised by the negative effect of chronic fatigue on your mood, outlook, appetite, ability to think clearly, and memory. Perspective can be lost; the little bumps of normal daily life seem like mountains. You may forget to buy milk and then, because you are so tired, perceive your error as a catastrophe. And, since life goes on whether you are ready or not, you may find yourself, for the first time ever, unable to cope with serious issues or problems such as the loss of a loved one.

You may wish for a magic fairy to help you with your jobs and yet decline offers from willing friends, family, and co-workers. Why? Perhaps the accepting of help diminishes your sense of renewed control, freedom, and self-esteem. You feel stuck between what you want (independence, self-affirmation) and what you need (assistance, delayed gratification).

Unfairly, low energy carries the connotation of laziness for some people. You may decline help and push yourself beyond what common sense dictates in order to meet your own standards of performance. You may feel that you should be doing more and that you are lazy if you do not. Or you may worry that other people will interpret your complaints as malingering despite their show of understanding and support.

The problem is compounded by the common misconception that cancer brings a death sentence. Even though you are in remission, you sense that others perceive you as a doomed individual. You avoid anything that suggests illness, such as a needed nap, because of concern, justified or not, that others will see your napping as a sign of deterioration instead of as part of a normal recovery.

*66/32/5*

What If I Feel Like a Young Child Sometimes?

After completion of cancer treatment you are physically and emotionally vulnerable. Your physical and emotional needs are greater than they were before your cancer. Under the best of circumstances, you still need help, attention, support, and comfort.

You may experience this vulnerability and neediness as something embarrassing to yourself and to others. Neediness may be confused with immaturity or weakness. Your vulnerability is an expected consequence of the treatment. Your neediness is the normal, healthy consequence of recognized vulnerability.

Just as thirst protects you from dehydration, neediness protects you from isolation that would be detrimental to your physical and emotional well-being. Respect your neediness as your well-balanced self attending to itself. You feel needy because after cancer treatment you have legitimate needs. Satisfying these needs will encourage uneventful healing, physically and emotionally.

What If I Find Myself Reacting like a Child to Stresses?

Children are expected to have little tolerance for stress. When a two-year-old licks the scoop of ice cream off the cone and onto the floor, the expected, normal response is to cry. The two-year-old child cries from disappointment, frustration, and a sense of powerlessness.

Losing a scoop of ice cream will elicit some emotions at any age, but will be less and less likely to cause you to cry as you get older. As an adult, you have acquired a repertoire of feelings, thoughts, and actions that allows you to absorb and respond to stresses in a socially acceptable way. You developed these tools as you matured and practiced them until they became your normal way of responding. Mature responses give you identity and self-respect.

During recovery from cancer treatment you may find yourself literally crying after little stresses like that of losing your ice cream. When you are under great stress, especially chronically, you may temporarily lose access to some of your acquired mature responses. This state is called regression, where you feel and act like a child in stressful situations that, under more normal circumstances, you would handle in a mature way.

Cancer survivors can experience regression during recovery because of

• fatigue

• anxiety

• sleep deprivation

• pain

• frustration

• medications

• effect of the cancer or cancer treatment on the brain

Extra emphasis needs to be given to the effect of sleep deprivation and fatigue. These two factors have a major impact on how we see and react to the world around us, and they are the easiest two to control.

Regression is a normal response to chronic physical and emotional stress. Although you may find it embarrassing or frustrating, regression is a mechanism of self-protection that helps you attend to your needs and conserve your energy.

What Can I Do about My Responding like a Child?

When you feel and see yourself responding like a child, it will help to

• accept this as a common, normal, temporary part of recovery •accept yourself with your human

needs

• get extra rest

• avoid unnecessary stresses

• let your support people know what things are difficult for you and what things help

Understandably, serious illness can cause you to become preoccupied with yourself, another characteristic often associated with children. A degree of self-centeredness after cancer treatment is necessary for healing, because it allows you to recognize your physical and emotional needs and conserve your energy for recuperation.

*153/32/5*

A tale recounted by the ancient Roman philosopher Cicero has much to teach the cancer survivor about living with fear and uncertainty. According to Cicero, Dionysius the Elder of Syracuse enjoyed enormous wealth and power, but lived in constant fear of assassination. His inability to trust anyone made him desperately lonely. One day a subject, Damocles, was praising with awe and jealousy all the wealth and luxuries enjoyed by Dionysius. Damocles declared, “All these wonderful things must certainly make you the happiest man alive.” Dionysius offered Damocles the opportunity to experience royal “happiness” himself.

Damocles was made comfortable on a golden couch, near an elaborate banquet of edible delicacies. Beautiful servants attended to his every wish. Damocles was enjoying himself immensely. Dionysius then ordered that a large, gleaming sword be suspended from the ceiling by a horsehair in such a way that the tip of the blade hovered inches above Damocles’ neck.

Damocles could no longer enjoy any of the surrounding luxuries. Eyes fixed on the sword at his neck, he was completely paralyzed by his perception of the looming threat. In the end, he begged to be released from his torturous “happiness” and allowed to return to his normal life.

Cicero’s message for us is that happiness is out of the question if you are perpetually menaced by some terror. Damocles could escape his terror by stepping out from under the sword. Unlike Damocles, you will not be freed by a change of locale. As a cancer survivor, you can escape your sword only by confronting the realities of your cancer and finding a proper place for it in your life.

What is that proper place? Can the cancer survivor ever really escape the terror of cancer? Many people believe that survivors must resign themselves to living forever with the fear of recurrence, illness, and death. Such resignation is not a useful or healthy way to confront life after cancer.

The fact is that many cancers are now curable or treatable, rendering the cancer survivor as healthy as someone who has never had cancer. For these survivors, the image of the dangling sword is simply not justified from a medical point of view. Yet too many of these healthy cancer survivors live the rest of their lives waiting for their recurrence. They never feel healthy, normal, or free of their cancer, no matter how many checkups or CAT scans indicate that they are. This feeling is often reinforced by friends and family who view the survivor as a doomed individual and who ask, “Any sign of a recurrence yet?” Such survivors are trapped under a sword of Damocles, and can never be truly happy or live a normal life.

Other survivors must live with cancer or with a high likelihood of recurrence. Yet happiness and fulfillment are still possible if they can only tame the terror.

What you must do in order to feel normal again is step out from under the sword and learn to perceive your life differently. Your fear of cancer is a state of mind. You cannot choose not to have cancer or a cancer history. But you can choose how you live with your cancer or cancer history. You can learn ways to focus on your present life and not your risk of recurrence or future illness.

You can diminish the fear, anxiety, and immobility that accompany the image of a dangling sword by mentally creating a distance so that the sword is but a dot in the landscape, or by mentally turning away so that the sword is but a vague shadow in your peripheral vision. Each of these mental exercises blunts or blocks the impact of your fear on your day-to-day experiences.

*126/32/5*

Do I Need a Dental Exam?

If you received radiation that affected your mouth or if you received certain chemotherapy regimens, you need to pay extra attention to the care of your teeth and gums. It is best to have an exam before your cancer treatments in order to find and treat any dental problems. After completing your cancer treatments, it is important to have another thorough dental evaluation and an exam every three to four months for a few years. This is because you are at increased risk of tooth decay, which can be prevented with good daily hygiene and frequent professional evaluation and treatment.

If you received radiation to your jawbone, you have extra reason to be meticulous about the care of your teeth. Extracting teeth because of decay or infection increases the risk of a serious complication called osteoradionecrosis.

When Do I Resume My Routine Non-Cancer-Related Medical Care?

Set up an appointment to see your general doctor in the month or two after the end of your cancer treatment. This allows your doctor to be familiar with all the changes that have taken place and with your new baseline. Your doctor can focus on all the non-cancer-related health issues.

Can I Wait a While before Getting Involved with More Doctors and, Possibly, More Tests?

After cancer treatment is completed, people tend to be weary of the expense, inconvenience, anxiety, and discomforts of checkups. However, in general, the sooner you go the better. It is important that any new noncancerous conditions be diagnosed and evaluated, in order to

• prevent complications from the problem

• promote healing and recovery from your cancer

• help you feel better

• prevent symptoms or problems that can make you or your doctor worry about your cancer when, in fact, the symptoms or problems are due to a new, noncancerous condition.

One middle-aged woman, while recovering uneventfully from treatment for a muscle tumor, went for her routine annual mammogram. She was found to have a tiny breast cancer. At first she was overwhelmed. After getting through the shock and anger, she was glad that she had proceeded with her mammogram. The breast cancer was there whether she screened for it or not. By getting her mammogram as scheduled, it was diagnosed while small enough to be cured without chemotherapy. Delaying the mammogram, and thus her diagnosis, would have made her recovery from the muscle tumor easier but have threatened her overall health and her life. A six-month wait might have given it time to spread to the lymph nodes, thus requiring chemotherapy for any chance of cure.

An elderly man who was recovering from treatment for melanoma was reluctant to have his colon checked for cancer. He did not have any increased risk of colon cancer and was symptom-free, but he was feeling particularly vulnerable. Proceeding with his colon evaluation and getting a good report was the best medicine in the world for him.

*100/32/5*