Thursday, February 2, 2017

19 ways to help someone with cancer

BY MD ANDERSON

144
Want to help a friend or loved one dealing with cancer? It can be hard to 
know exactly what you can or should do.
 
That's why we asked the cancer patients, survivors and caregivers
 in our Facebook community to tell us the most helpful thing you can 
do for a friend or loved one dealing with cancer. Here's their advice.

1. Visit. Cancer patients and caregivers are still people, and they want to see you, 
talk to you and laugh with you.

2. Listen. Ask questions to show you care, but let your friend or loved one lead the conversation.

3. Pray.

4. Find a way to help and just do it. Don't ask if there's anything you can do. Chances are 
your friend will just say thank you and won't ask you to help. Many of our Facebook fans 
suggested just doing something for friends with cancer instead of asking what they need.

5. Tell a joke.

6. Send a Facebook message, text message, email or card. Or, better yet, pick up the phone. 
Anything to show you're thinking of your friend.

7. Help with the laundry or cleaning.

8. Take a meal to the family. It's great if it's a home-cooked meal, but picking up food at a
favorite restaurant will be equally appreciated. Just be sure you find out if there are any 
foods the patient needs to avoid or has developed an aversion to during cancer treatment.

9. Volunteer to look after the children or pets.

10. Give them a ride to their appointments. If you can't give them a ride, give them a gas gift card.

11. Give hugs.

12. Maintain some normalcy. Remember, people with cancer aren't just cancer patients, 
      and they don't want to be treated differently.

13. Stay positive.

14. Give them a roll of quarters for the hospital vending machines, or give them a 
        bag of their favorite snacks. Some patients have entire days of appointments, and a 
        snack break helps.
 
15. Help take their minds off cancer, even if just for a little bit.

16. Help fundraise.

17. Bring them a blanket or hat. Hospitals and waiting rooms can get cold, so it's 
       always nice to have something to help stay a little warmer.

18. Give their caregivers a break. Take them a gift. Take them out to lunch. Take over 
      for the day. Remember, caregivers are deeply affected by cancer, too.

19. Just be there. Make sure your friends know you're there for them and show that you
       still care throughout their cancer journey. And remember, even the smallest
       gesture can make a huge difference to cancer patients and caregivers.

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Hormone Blockers Can Prolong Life if Prostate Cancer Recurs

By DENISE GRADY
Radiation therapists planned treatment for a patient with prostate cancer. A study shows that in addition to radiation, hormone-blocking treatment positively affects survival. Science Source
Men whose prostate cancer comes back after surgery are more likely to survive if, along with the usual radiation, they also take drugs to block male hormones.
The finding, published Wednesday in The New England Journal of Medicine, comes from a long-running study that experts say will help clarify treatment for many patients.
After surgery to remove the prostate, more than 30 percent of men have a recurrence, and until now there has not been clear evidence about the best way to stop the disease from killing them. Most are given radiation, but prescribing drugs to counter the effects of male hormones has been inconsistent.
The study, paid for by the National Cancer Institute, showed that among men who received radiation and hormonal treatment, 76.3 percent were still alive after 12 years, compared to 71.3 percent who had radiation alone.
At 12 years, the men who had both treatments were also much less likely to have died from their prostate cancer — 5.8 percent versus 13.4 percent — or to have the cancer spread around their bodies — 14.5 percent versus 23 percent.
“This is a big deal,” said Dr. Ian M. Thompson Jr., of the Christus Santa Rosa Health System in San Antonio, who was not part of the study but wrote an editorial accompanying it.
“There are so many things we do in prostate cancer that we don’t know if they make a big difference in survival. This is one of the things where now we can say for sure.”
He added that he hoped the findings would change medical practice.
The medical term for blocking male hormones is chemical castration, and the treatments can cause hot flashes, sexual problems and other side effects. So to put a man through it, said Dr. Anthony L. Zietman, an author of the study, “you’d better have some decent justification.”
Dr. David F. Penson, the chairman of urologic surgery at Vanderbilt University Medical Center, said the study “gives more credence to the concept that you have to treat the whole patient,” rather than just irradiating the area where the cancer used to be.
He said the idea of blocking hormones in men like those in the study was finding its way into medical practice.
About 161,360 new cases of prostate cancer and 26,730 deaths are expected in the United States in 2017, according to the American Cancer Society.
The average age at diagnosis is 66. Globally, there were 1.1 million cases and 307,000 deaths in 2012, the most recent data available from the World Health Organization.
The study, begun in 1998 and led by Dr. William U. Shipley, a radiation oncologist at the Massachusetts General Hospital, had an ambitious goal: to follow the patients long enough to find out whether hormone-blocking treatment would affect their survival.
Prostate cancer grows slowly, so it took well over a decade for answers to emerge. Researchers and patients from 150 sites in North America participated. The patients were 760 men who had their prostates removed for cancer that had not spread, but who then had a sign of recurrence — a rise in their blood levels of prostate-specific antigen, or PSA, a protein associated with prostate cancer. The men in the study had PSAs of 0.2 to 4 nanograms per milliliter.
“That’s just like the first wisp of smoke,” said Dr. Zietman, who is a professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School. “There’ll be fire someday.”
The fire might take five, 10 or 15 years to break out, but Dr. Zietman said, “Many are in their 50s or 60s, and will live long enough to get into trouble.”
The traditional practice for a rising PSA after surgery has been to give radiation, which targets only the pelvis.
The idea of the study was to add hormonal treatment, which might stop minute clumps of cancer that had spread to other parts of the body.
All the men in the study had radiation for six and a half weeks. For two years, half also received a hormone-blocking drug, bicalutamide, and the other half were given placebos. They were followed, on average, for about 13 years.
“This is the first trial that’s shown, if you follow these patients long enough, there is a real difference,” Dr. Zietman said. “More people survive 15 years later.”
Men who had more aggressive cancers — reflected by higher PSA readings after surgery and by the pathology and surgical reports on their tumors — had the most to gain from the hormone-blocking treatment.
The results do not mean that every man with a rising PSA after surgery should have hormone treatment, Dr. Zietman said. Men 75 or older may not need it, because they may die from other causes before the cancer can catch up with them.
“But if they’re younger and with a longer life expectancy, treatment is reasonable,” he said.
Bicalutamide causes men to develop breasts and potentially other problems, and the high dose given in the study is no longer used in the United States.
Other hormone-blocking drugs like Lupron have mostly taken its place, and may be even more effective, Dr. Zietman said. The study proved the concept that hormone blocking increases survival, he added, so other drugs that do the same thing should also help patients live longer.
Another study in progress in Canada and Europe uses the newer drugs, and is trying to determine whether taking them for six months, rather than two years, might be enough.
https://www.nytimes.com/2017/02/01/health/prostate-cancer-hormone-blockers.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well&_r=0
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Thursday, January 26, 2017

Tips for safe food choices during cancer treatment

By Lonnie Fynskov, R.N. February 18, 2016
"Eat well to maximize your body's fuel for everyday tasks." This is a key behavior for a healthy lifestyle.
In treatment you may be advised to avoid any unnecessary bacteria to prevent food-borne infections. Meanwhile, you read and hear often about needing to eat more fruits and vegetables on a daily basis. But what happens when you are told to avoid fresh produce during treatment? Is it still possible to eat well while avoiding fresh fruits and vegetables?
In the past, you may have been told to follow a neutropenic diet if your white blood cell count was low during treatment. Over the past year, recommendations have changed and that's no longer necessary. However, it's still important to follow rules of good food safety during treatment.
Rather than remembering long lists of what's safe and what might be a problem, think about how these general guidelines to limit your risk of food-borne illnesses.
  • Make sure that meat and fish is fully cooked.
  • Choose cooked vegetables instead of fresh.
  • If eating vegetables at home, wash them well, even if they are pre-washed.
  • Eat hard cheeses instead of softer cheeses. Avoid those made from unpasteurized milk.
  • Choose fruits that are easy to clean well or are cooked, such as canned peaches, pears, applesauce, etc.
  • Use pasteurized eggs when preparing recipes that call for raw or undercooked eggs.
These suggestions may help you to eat healthy and avoid food infections during treatment. I’d love to hear what has worked well for you. Please share your suggestions with each other on the blog.
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Cancer pain: Relief is possible


Learn what causes cancer pain and how you can work with your doctor to ensure your cancer pain is controlled.
By Mayo Clinic Staff
Photo of Timothy Moynihan, M.D.
Timothy Moynihan, M.D.
Not everyone with cancer experiences cancer pain, but 1 out of 3 people undergoing cancer treatment does. If you have advanced cancer — cancer that has spread or recurred — your chance of experiencing cancer pain is even higher.
Cancer pain occurs in many ways. Your pain may be dull, achy or sharp. It could be constant, intermittent, mild, moderate or severe.
Timothy J. Moynihan, M.D., a cancer specialist at Mayo Clinic in Rochester, Minnesota, offers some insight into cancer pain, reasons why people might not get the pain treatment they need and what they can do about it.

What causes cancer pain?

Cancer pain can result from the cancer itself. Cancer can cause pain by growing into or destroying tissue near the cancer. Cancer pain can come from the primary cancer itself — where the cancer started — or from other areas in the body where the cancer has spread (metastases). As a tumor grows, it may put pressure on nerves, bones or organs, causing pain.
Cancer pain may not just be from the physical effect of the cancer on a region of the body, but also due to chemicals that the cancer may release in the region of the tumor. Treatment of the cancer can help the pain in these situations.
Cancer treatments — such as chemotherapy, radiation and surgery — are another potential source of cancer pain. Surgery can be painful, and it may take time to recover. Radiation may leave behind a burning sensation or painful scars. And chemotherapy can cause many potentially painful side effects, including mouth sores, diarrhea and nerve damage.

How do you treat cancer pain?

There are many different ways to treat cancer pain. One way is to remove the source of the pain, for example, through surgery, chemotherapy, radiation or some other form of treatment. If that can't be done, pain medications can usually control the pain. These medications include:
  • Over-the-counter and prescription-strength pain relievers, such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others)
  • Weak opioid (derived from opium) medications, such as codeine
  • Strong opioid medications, such as morphine (Avinza, Ms Contin, others), oxycodone (Oxycontin, Roxicodone, others), hydromorphone (Dilaudid, Exalgo), fentanyl (Actiq, Fentora, others), methadone (Dolophine, Methadose) or oxymorphone (Opana)
These drugs can often be taken orally, so they're easy to use. Medications may come in tablet form, or they may be made to dissolve quickly in your mouth. However, if you're unable to take medications orally, they may also be taken intravenously, rectally or through the skin using a patch.
Specialized treatment, such as nerve blocks, also may be used. Nerve blocks are a local anesthetic that is injected around or into a nerve, which prevents pain messages traveling along that nerve pathway from reaching the brain.
Other therapies such as acupuncture, acupressure, massage, physical therapy, relaxation, meditation and humor may help.

What are some reasons for not receiving adequate treatment for cancer pain?

Unfortunately cancer pain is often undertreated. Many factors may contribute to that, some of which include:
  • Reluctance of doctors to ask about pain or offer treatments. Some doctors and other health care professionals may not specifically ask about pain, which should be a normal part of every visit with your doctor.
    People with cancer should be asked if they are having any pain. If they are, the doctor should stop there and deal with the issue.
    Some doctors don't know enough about proper pain treatment. If this is the case, your doctor might refer you to a pain specialist.
    Other doctors may be concerned about prescribing pain medications because these drugs can be abused. However, people in pain are very unlikely to abuse pain medications.
  • Reluctance of patients to speak up about pain. A second factor might be a person's own reluctance. Some people might not want to "bother" their doctors with the information, or they may fear that the pain means that their cancer is getting worse.
    Some are reluctant to report it or report it as thoroughly as they should because they're worried about what doctors or others might think of them if they complain. They might feel that because they have cancer, they're supposed to have pain and be able to deal with it. That simply isn't true.
  • Fear of addiction. Another factor might be a person's fear of becoming addicted to pain medications. This is something that we know doesn't typically happen if you take medications for pain.
    If you take medications when you're not in pain or to get high, then, yes, you can get addicted. But the risk of addiction for people who take pain medications in an appropriate fashion — for pain — is very low, so this shouldn't be a concern.
  • Fear of side effects. Some people fear the side effects of pain medications. Many are afraid of being sleepy, being unable to communicate with family and friends, acting strangely, or being seen as dependent on medications. People are also sometimes afraid that taking morphine may shorten their life. There is no evidence of any of these happening if the medication is dosed appropriately.
    Recent evidence suggests that good control of symptoms, including pain, actually helps people to live longer.
    And although strong pain medications can cause drowsiness when you first take them, that side effect usually goes away with steady dosing.

What are the side effects of cancer pain treatment, and what can you do about them?

Each pain treatment may be accompanied by its own unique side effects. For example, radiation treatments may cause redness and a burning sensation of the skin. And, depending on what part of the body the radiation is applied to, the radiation may cause diarrhea, mouth sores or other problems, such as fatigue.
Chemotherapy certainly can cause side effects, such as nausea, fatigue, infection and hair loss, but it can be effective in relieving pain if it shrinks the tumor. There are medications to help with nausea. Relaxation techniques also may help.
Pain medications each have their own unique side effects that should be reviewed with your doctor before taking them. One of the common side effects of the stronger pain medicines is constipation — common to opioids. It can be treated with appropriate bowel regimens as prescribed by your doctor, such as adding a stool softener and something to stimulate the bowels.
Preventing constipation is much easier than treating it, so anyone who takes these strong pain medications should automatically begin a regimen to keep their bowels moving.
Some of the other side effects of strong pain medications include confusion, lethargy and sleepiness. The severity of these effects varies from person to person and commonly occurs with the first several doses. But once a steady amount of the medicine stays in your body, the side effects usually resolve. Hallucinations and behavior changes are uncommon.
The less potent pain medications actually may have more side effects, which also should be discussed with your doctor before taking them.
For instance, common over-the-counter pain relievers might damage your kidneys, cause ulcers or increase your blood pressure. Aspirin can cause gastrointestinal bleeding, and acetaminophen (Tylenol, others) can cause liver damage if you take too much.

When should you discuss cancer pain with your doctor, and what points should you bring up?

Report any bothersome pain to your doctor. If there is a minor pain that goes away, don't worry about it. But if the pain interferes with your life or is persistent, it needs to be reported and should be treated.
Although no one can guarantee that all pain can be completely eliminated, most pain can be lessened to the point where you can be comfortable.
It may help to keep track of your pain by noting how strong it is, where it's located, what makes it worse, what brings it on, what makes it better and anything else that happens when you have the pain.
A pain-rating scale from 0 to 10 — with 0 being no pain and 10 being the worst pain you can imagine — may be helpful in reporting pain to your doctor.
In addition, pay attention to what happens when you attempt to relieve your pain. If you take medicine, do you feel any ill effects from it? Note any ill effects of your pain medications. If it's a massage, hot or cold packs, or something physical that relieves the pain, those are important to report, too.

What steps can you take to ensure you're receiving adequate cancer pain treatment?

First, talk to your doctor or health care provider if you're having pain.
Second, you and your doctor can set a goal for pain management and monitor the success of the treatment against that goal. Your doctor should track the pain with a pain scale, assessing how strong it is. The goal should be to keep the pain at a level with which you're comfortable. If you aren't achieving that goal, talk to your doctor.

If you're not getting the answers you need, request a referral to a facility more skilled in the care of pain, particularly a major cancer center. All major cancer centers have pain management programs. For the most part, the medications and treatment for pain are covered by standard insurance.

https://mail.google.com/mail/u/0/#inbox/159dbd75e91f219a
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Friday, January 13, 2017

 Jan 12
Isn't it time your life began? What are you doing today to push a little more than yesterday?

Just saw this on Twitter posted by Sean Swarner and loved it....

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A Cancer Memoir of Literature and Science

Living With Cancer
By SUSAN GUBAR 
Since a cancer diagnosis in 2008, I have always taken reading material with me on all hospital trips. For one visit, which took nine hours, my reading material included a posthumously published memoir: Paul Kalanithi’s “When Breath Becomes Air.”
Sonny Figueroa/The New York Times
Reviewers have emphasized the pathos of Dr. Kalanithi’s fate. On the threshold of a promising medical career, the 36-year-old resident at Stanford University received a diagnosis of Stage 4 lung cancer. His book spoke to me not only about cancer but also about the imperative, yet imperiled, connection between the arts, the humanities and the medical sciences. Dr. Kalanithi believed that the arts and humanities provide crucial tools for comprehending the body under siege.
Like many cancer memoirs, “When Breath Becomes Air” begins with diagnosis: Dr. Kalanithi flips through CT images of his lungs matted with tumors. Then a flashback traces his childhood and education. In college and graduate school, Paul Kalanithi majored in English, although he went on to study philosophy and then to train in neuroscience and neurosurgery, earning high honors along the way. His background, along with his descriptions of the challenging lessons he learned during his medical training, serves as a startling retort to the dictum of the so-called “two cultures”: C.P. Snow’s idea that the humanities and the sciences remain deeply divided in Western intellectual thought and never the twain shall meet.
As a student, Dr. Kalanithi understood that “literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.” Words function as “an almost supernatural force,” bringing human beings “into communion,” but that process exists “in brains and bodies, subject to their own physiological imperative, prone to breaking and failing.” What was the relationship between the discourse of emotions and that of neurons?
Paul Kalanithi in 2014 during his neurosurgery residency at Stanford University.Norbert von der Groeben
Operating on regions of the brain that control language and therefore on “the crucible of identity,” neurosurgeons must consider “what kind of life exists without language” and “what kind of life is worth living.” Because Dr. Kalanithi needed to address these profoundly philosophical questions, he knew that “when there’s no place for the scalpel, words are the surgeon’s only tool.”
After the cancer diagnosis, Dr. Kalanithi’s oncologist insisted on words, but he wanted numbers: “If I had two years, I’d write. If I had ten, I’d get back to surgery and science.” Yet he came to realize that “getting too deeply into statistics is like trying to quench a thirst with salt water.” Instead, he found in literature a vocabulary to ease the anxiety attendant upon diagnosis. A “seemingly impassable sea of uncertainty parted” when he recalled Samuel Beckett’s famous words: “I can’t go on. I’ll go on.” They convinced him that “even if I’m dying, until I actually die, I am still living.”
It makes perfect sense to me that Dr. Kalanithi completed a master’s thesis on Walt Whitman’s conceptualization of “the Physiological-Spiritual Man.” He knew that literature provides “the richest material for moral reflection.” Unfortunately, it also makes sense that one of his thesis advisers told him that it would be difficult to find a community in the literary world “because most English Ph.D.s react to science, as he put it, ‘like apes to fire, with sheer terror.’”
Is this one of the reasons the humanities are currently endangered?
Dr. Kalanithi’s memoir asks humanists pointed questions about what must be done to make their disciples supple in an engagement with science. Considering issues at the intersection of literature, philosophy and medicine, Dr. Kalanithi also underscores the importance of the medical humanities: a multidisciplinary field that involves artists, humanists, social scientists and scientists in issues related to wellness and sickness.
In the epilogue of “When Breath Becomes Air,” supplied by Dr. Kalanithi’s widow, Lucy, we are informed that his oncologist wanted him videotaped daily, doing the same task, so his deficits could be tracked. He decided to recite from T.S. Eliot’s “Waste Land,” setting the book facedown. We also learn that when his fingertips developed fissures from chemotherapy, he wore seamless, silver-lined gloves that allowed him to use his trackpad and keyboard. Composing “When Breath Becomes Air” became his palliative therapy as well as the consummation of his love of literature.
The example of Dr. Kalanithi proves that we need more physicians who assimilate the arts and the humanities as well as more artists and humanists who assimilate the science of medicine. By connecting the empirical, reproducible data of cancer science to visceral, unpredictable and subjective experiences of the disease, “When Breath Becomes Air” points toward an approach that can mitigate the mutual incomprehension that baffles too many doctors and patients.
Dr. Kalanithi illuminates how the arts and humanities can help us negotiate that moment we will all inevitably confront: when our breath becomes the air others breathe.
https://www.nytimes.com/2017/01/12/well/live/a-cancer-memoir-of-literature-and-science.html?emc=edit_tnt_20170113&nlid=52389906&tntemail0=y&_r=0
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Wednesday, January 4, 2017

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