We usually think of life in the watery womb experience as a blissful time. Held within a protected bubble, the fetus floats in it’s own universe, growing and developing along the humanoid evolutionary pathway. We think of the womb as a haven, an impermeable, all-protecting nirvana that shields new life from the dangers existing in a more tumultuous and toxic outside world. At least for a time, it is believed that the developing child is perfectly safe.The protective placenta is a truly amazing organ. It surrounds the fetus and attaches to the mother, controlling metabolic changes. By month three of pregnancy, a human placenta is two inches in diameter. The attached umbilical cord is about four inches long. It will eventually grow into a curly twenty-two-inch-long and a half-inch wide rope. The placenta will expand into a disc that is eight inches wide and an inch thick, that weighs slightly more than a pound. The placenta is expelled with the fetus during birth.*1/165/1*

Cancer, when it has become established in any tissue, spreads in various ways. The process by which it spreads is known as Metastasis, in medical parlance. The cancer cells multiply at the site of their origin and form a tumour mass, which may grow gradually and ultimately attain an enormous size. The cells may also penetrate into the surrounding tissues, and gradually destroy them. Some of the cancer cells which are loosely attached to one another may get detached and be carried by the lymph stream to the regional lymph nodes and later, to the distant organs. There, they grow independently, multiply and reproduce the original growth.
In rare cases, they spread by invading the bloodstream and setting up secondary growth in bones, lungs and particularly, the liver. For instance, cancers of the intestines especially spread to the liver through the portal system of vessels. Cancers arising in the brain do not metastasize, but cancers arising elsewhere metastasize to the brain.
*3/355/5*

Firstly, consider taking a trusted friend or relative with you each time you see your practitioner, especially if important decisions have to be made. Two heads are always better than one. This is especially true if you are anxious and frightened. These feelings are very natural and to be expected but they do make it more difficult to concentrate, think clearly and remember. The presence of a friend or relative will give you more confidence. Afterwards you will find that, between you, you have taken in and remembered much more than you would have on your own. Your friend or relative will also be in a good position to help you make decisions.

My next tip is to write down a list of questions beforehand and take them with you. Don’t be embarrassed about bringing out this list in front of your practitioner—you are under stress and you have a lot to remember. Your practitioner might give you some written information but, if not, it is almost impossible to remember everything, especially if you have only been told once. Therefore, bring a pen with you and write down the information that you want to remember. If you are finding it hard to get answers that are clear enough to write down, ask again until you do. Your practitioner may try harder to be clear once he or she sees that you are determined to get the answers.

*6/40/1*

Can I Continue My Routine Non-Cancer-Related Medical Care with My Oncologist?

In general, it is best to continue your routine non-cancer-related care with your internist or family practitioner, not your oncologist. Some of the reasons for this are that •oncologists’ offices are set up to diagnose and address cancer-’ related problems, not general medical problems

• oncology offices are not set up for routine comprehensive medical evaluations

• it is not cost-effective for you

• if a new medical problem were diagnosed, you would probably be referred to a general internist or a family practitioner

If you do not have an internist or family practitioner, ask your oncologist for a referral. If you want your oncologist to be your only doctor, discuss with him or her whether this is an option for you and whether it is in your best interests.

Which Oncologist Do I See If I Move to Another City?

In our mobile society, where it is common to move to another city, you can

• establish yourself with a new oncologist in your new hometown and have all of your cancer-related care attended to locally (your original oncologist can be kept informed of your progress and provide input on your care through telephone calls, letters, and reports)

•return to your original oncologist for routine follow-ups or if you develop a new cancer-related problem (this is not practical if you have ongoing problems or require frequent follow-up)

•continue your major checkups with your original oncologist and establish yourself with a new oncologist in your hometown who can do the brief checkups and attend to minor problems (your original and your new oncologist must both be agreeable to this arrangement)

The best choice for you will depend on

• your type of cancer

• the complexity or unusualness of your situation

• the sophistication of the local facilities

• financial concerns

• the location of family and support people

*98/32/5*

Do All Cancer Survivors Get Postcancer Fatigue?

No. Survivors who required limited treatment usually recover fairly quickly and completely. Although some fatigue following treatment is almost universal, if it resolves after correction of an identified cause of fatigue, it was not postcancer fatigue.

One woman complained, “I’m running on empty, and I can’t do what I need or want to do. It’s making me feel depressed.” An evaluation revealed iron deficiency anemia and low estrogen levels. She was placed on iron and estrogen replacement, and her fatigue and depression resolved completely over the subsequent month. She had anemia and reactive depression; she did not have postcancer fatigue.

Another woman with the same complaints and abnormalities (anemia and estrogen deficiency) was also treated with replacement iron and estrogen. After a few weeks she felt somewhat improved, but complained, “Now I’m running on an eighth of a tank all the time. I can get some stuff done, but if anything extra or stressful occurs, I can’t handle it.” After another year this, too, resolved. The medications took care of her anemia and estrogen deficiency, but not her postcancer fatigue.

How Long Does Postcancer Fatigue Last?

The same factors that affect the duration of fatigue in general would be expected to affect the duration of postcancer fatigue. Anecdotal evidence suggests that for many survivors, it is a temporary, if protracted, condition. As a rule, the more intense and prolonged your treatment, the longer its aftereffects. As the population of survivors grows and research progresses, solid answers will become available.

What Can I Do If I Have Postcancer Fatigue?

Recognize that this is a real medical condition. Avoid blaming yourself with such thoughts as “I’m not trying hard enough. I must like being sick. My attitude isn’t good enough.” Avoid negative thoughts such as “If I’d known recovery was going to be so tough, I wouldn’t have gone through the treatment. My doctors must have given me too much treatment; that’s why I feel so awful.” Postcancer fatigue is one of the aftereffects that requires patience and hopefulness.

The first step you need to take is getting evaluated for any treatable problem(s) that may be causing or exacerbating your malaise. Just as important, make sure that you are reevaluated periodically if your fatigue persists. Normal results obtained by an evaluation six or twelve months ago do not guarantee normal results now.

If your doctors have ruled out all other causes of fatigue, including recurrence, and conclude that you have postcancer fatigue, reassure yourself that nothing is being missed. Remind yourself that postcancer fatigue is real, is not due to any detectable (or treatable) problem, and is not just in your head. As long as you are reevaluated periodically, you can let go of the fear of recurrence or other medical problem between evaluations.

Find out what you can do to prevent any new medical problems or flare-ups of old ones. Conserve your physical and emotional energies. Doctors, nurses, social workers, psychologists, psychiatrists, and clergy can all help you find a balance between your energy needs and supplies. Adjusting to energy limitations may be a novelty for you, and it is not always obvious what the best way to pace yourself is.

Even when your fatigue is not due to emotional stress or problems, it can cause emotional and social stress. A healthy understanding of the problem and a healthy attitude toward it -will help you cope with the necessary changes. Like your other losses, the losses accompanying postcancer fatigue (loss of energy, ability to do things, companionship, etc.) can be dealt with better when you accept emotional and spiritual support.

*70/32/5*

What If Old Emotionally Charged Problems Unrelated to My Cancer Have Resurfaced?

Completion of cancer therapy is an emotional time, with anxiety, sadness, anger, and other emotions all stirred up. This setting of high emotions often triggers recall of past events or problems that elicited similar emotions that were never well resolved.

You may not have adequately grieved the premature loss of a parent or sibling. After completion of your cancer therapy, as you deal with grief over loss of a body part or loss of a job, you may re-experience a deep sense of loss of your parent or sibling.

Many problems and issues that were important before your diagnosis became dwarfed by the immediacy of your cancer and its treatment. Since the problems were not resolved, but rather forced into the background, they can reappear after treatment. These problems can be even more complicated and pressing after cancer because of the changes in your life. If before you had cancer you and your spouse argued about the amount of time and money you spent on leisure activities, or about the division of labor at home, these arguments can resurface with an added edge of urgency.

Problems pop up periodically for everyone, even in families that are not dealing with cancer or other crisis. Resist the temptation to blame every bad and unpleasant thing, every change and adjustment, on your cancer. Instead of using your cancer as a focus of blame, you should use it as a reminder that you can get through hard times.

Your cancer experience is not responsible for everything difficult or unpleasant that arises after cancer. Normal life involves good and bad times, easy and hard times, tense and relaxed times, happy and sad times.

What Can I Do If Emotions Are Surfacing in Regard to Past Issues?

See your unwanted cancer experience as an opportunity to put closure on lingering or reappearing unresolved issues. Your survival of cancer can show you that, with proper help and guidance, you now have the tools and strength to deal with these old issues.

Emotions do not go away by themselves. They go away when the problems that precipitated them are resolved or coped with in a healthy way. If you try to ignore or deny your emotions or the causative issues, they will continue to affect you in negative ways. In the long run it takes less physical and emotional energy to resolve than to deny problem emotions and issues.

One couple was very stressed by the wife’s loss of employment. The husband felt that she could be doing more to find an acceptable job. The two were reaching a point of confrontation when she developed cancer. The job issue became a nonissue. After completion of treatments the job issue resurfaced with a vengeance. The money concerns were obvious. The husband genuinely wanted to do what was right for his wife’s recovery, but did not want to allow her to use her recent illness as an excuse for continuing the posture she had assumed before. A difficult issue became complicated by the overlay of the illness.

This couple’s problem predated the cancer. With guidance, the cancer history will not prevent the couple from dealing with this fundamental problem. Their approach to the problem and the possible solutions will be affected by the cancer experience. You can offset added difficulties by the insights and strengths you have acquired through surviving.

Strong emotions can signal unresolved problems or issues.

Do I Have to Deal with These Old Issues Now?

You do not have to deal with every problem at once, whether you have had cancer or not. You have to use judgment about which problems you can afford to postpone and which you can solve more easily with a little bit of distance. If your tax papers are out of order and you do not want to deal with them, but you will pay a heavy fine if you miss a filing date, the chore is probably worth getting done. If you have had strained relations with a relative who is moving far away or is terminally ill, and you think that you would like to mend things, now is the time. If you cannot decide what you want to major in at college, or you are thinking of changing careers, you can decide not to decide for a while. The longer you delay dealing with a problem,

• the longer you will feel the negative effects

• the more energy you will be using to deal with the emotions and avoid dealing with the

precipitating issue

• the greater the chance these old issues will have for creating new problems

Sometimes the intensity of your emotions in response to cancer-related issues is heightened by emotions about old issues that are being attributed to the cancer. Recognizing this will help you deal with the real issues and will make the cancer-related emotions much more manageable.

*157/32/5*

What If I Feel Relief?

After completion of cancer therapy, you may feel relief because

• your cancer was controlled

• you survived your cancer treatment

• you can retire from the full-time or part-time job of being a cancer patient

• your time and schedule will be more your own

• the emotional and physical discomforts that accompany treatment are behind you

• you will not need as much help as you did during treatment

• this chapter in your life is behind you

What If I Feel Anxious?

Many people expect all the anxiety to disappear after treatment is over. In fact, many cancer survivors actually become more anxious after treatment ends. The completing of treatment is a time for drawing conclusions and making major decisions. Is the cancer completely gone? Did I receive enough treatment? Is there anything else we can do to maintain this remission? Having choices and making decisions is anxiety producing, especially when the decisions are so important. Once these decisions are made, the anxiety will diminish.

Completing your cancer treatment and the consequent decreased contact with your health care team can be a source of anxiety. Traumatic as treatment may have been, you were reassured by knowing that while you were getting it, you were doing something active to control your cancer. Many people worry that a remaining cancer cell will multiply in the absence of treatment.

After treatment is over, you may also feel anxious about not being screened and followed as closely as you were when you were being treated. No matter how much you disliked the doctor visits and treatments, it was reassuring to have someone check you frequently. Being told to come back for a checkup in what seems like a distant three to four months can be unsettling.

In addition, as health professionals become less involved in your recovery, you may feel more responsibility for your own health and continued recuperation. Professionals and friends helped shoulder the emotional and practical burdens of your illness when you were sick. Their withdrawal after treatment can leave you feeling somewhat abandoned even though you understand rationally that their intensive involvement is no longer needed.

After treatment, at home and at work, anxiety may accompany your trying to figure out how much you can do physically and emotionally. Your reserves are depleted. You are balancing your needs for recuperation against others’ seeming needs and demands. It is hard to predict the pattern or speed of your recovery and that just adds to the anxiety.

There is the anxiety that something you do, eat, or even think may encourage the cancer to come back. You are more self-conscious about aspects of your behavior that you used to take for granted.

There is free-floating anxiety that something else may happen to you or someone you love. After all, the impossible happened once. You worry that it could happen again.

You may be on medication that makes you feel anxious. Your body’s chemistry may have been affected by your cancer or your cancer treatment in such a way that you experience the side effect of anxiety. For example, many women undergo menopause as a result of their treatment. Anxiety can be a side effect of lack of estrogen.

Some of your anxieties related to your cancer diagnosis and treatment may be repressed during treatment. This is a common, normal adaptive mechanism for getting through the ordeal. Once the distraction of your treatments is gone, you may grasp the full impact of your situation and your experiences, and this can cause significant anxiety.

*130/32/5*

Do I Need a Hepatitis Vaccine?

The hepatitis vaccine is recommended to people at increased risk of exposure to hepatitis B. Transfused blood undergoes extensive sensitive testing for hepatitis В prior to approval for transfusion, so the risk of transfusion-associated hepatitis В is very low. It is an expensive, three-shot regimen, usually given over six months. An optional regimen is given over two months. This type of vaccination can be discussed if there is a reasonable concern that you will need blood products in the future. For example, if you had a type of cancer that is treated with bone marrow transplantation if it recurs, then you might consider having this vaccine given to you while you are in remission.

Can My Children Proceed with Their Routine Vaccinations?

Some of the routine vaccines that children receive are “live” vaccines, namely, weakened but alive viruses. Check with your oncologist whether and when it is safe for you to be exposed to someone who has received a live vaccine.

Who Owns Ну Medical Records? My Scans and X Rays?

Medical records belong to your doctor, but you have a right to a copy of the records. Your scans and X rays belong to the doctor who ordered them or the radiography center where they were taken. You have a right to a copy of your X rays, but oftentimes you will be charged a copying fee.

Is It a Good Idea to Read My Own Medical Records?

For most people the disadvantages outweigh the advantages. The main reason people want to read their records is to find out about their condition. In general, if you feel you are not getting accurate or enough information about your medical condition from your oncologist, ask him or her to discuss your case with you in greater detail. If you still feel that you are not getting answers to your satisfaction, it is time to find a doctor with whom you communicate better, and not depend on self-interpretation of your records. The advantages of reading your own medical records include

• finding out details you missed during the discussions

• verifying your understanding of your condition

A major disadvantage of reading your own medical records is the enormous potential for misinterpretation of symbols, phrases, and medical conclusions. Once you read these things, it can be difficult for you to dismiss them from your mind even if subsequent discussion clarifies your misunderstanding. Some misunderstandings are easily corrected, and even amusing (“male, c/o SOB” is a man who is complaining of shortness of breath). Other misreadings are subtle but dangerous. Your doctor’s notes may indicate that “there is no evidence of metastases at this time,” which is a standard phrase to document a thorough exam. You may be left with a disquieting sense that your doctor is anticipating you developing metastases, when in fact your doctor is not.

You may read things that you really did not want or need to know and that cause you unnecessary anxiety. When evaluating a patient, doctors commonly write a list of different conditions that could be causing a symptom or problem. They may be unconcerned about most of the possibilities but include them for completeness. You, on the other hand, may be left worrying about problems you had not even thought of before.

*104/32/5*

Related Posts:

• YOUR CANCER YOUR LIFE – RIGHT TO HAVE QUESTIONS ANSWERED (IMPORTANT DECISIONS)
• AFTER CANCER: QUESTIONS ABOUT ONCOLOGIST
• AFTER CANCER: POSTCANCER FATIGUE. MORE QUESTIONS
• AFTER CANCER: FEELINGS. SURFACING EMOTIONS
• AFTER CANCER: FEELINGS. RELIEF AND ANXIETY