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Wednesday, February 1, 2012

If Symptoms Persist...

Cancer Chemo
If Symptoms Persist...
By DR. JOSE S. PUJALTE JR.

“I am not going to fight against death but for life.” — Norbert Segard (1922-1981), French Minister of State, physicist, on suffering from cancer, London Times 2 Feb 81

MANILA, Philippines — The shock of knowing you have cancer will always be there, but you’ve decided you won’t go down without a fight. Starting chemotherapy (as cancer treatment) is one way out ofthe drowning feeling of helplessness. It’s a positive step towards taking charge.

Why chemotherapy? Cancer cells multiply without control and rapidly at that. Anti-cancer drugs stopthese abnormal cells from dividing and growing. Mostof the time, these strong drugs are used in combination because they work better together than alone. Chemotherapy also includes drugs that blockthe effects of the body’s hormones. So, depending onthe type of cancer, chemotherapy can cure (the endpoint is the absence of cancer cells), control, or keep the cancer from spreading, and relieve symptoms of cancer (for example, pain).

How is chemotherapy given? When getting chemo forthe first time, your oncologist (cancer specialist) may want to admit you in the hospital for a few days. This is for monitoring purposes because your body’s reaction to a massive dose of anti-cancer drugs is not yet known. Otherwise, most chemotherapy sessions are done on an out-patient basis. Most drugs are given intravenously (IV), that is through a plastic tube and needle stuck temporarily in a superficial vein. Sometimes, medications are administered by mouth, by injection, or by skin patch.

Side effects. Since anti-cancer drugs target fast-growing abnormal cells, some normal fast-growing cells may also be affected. Call it collateral damage inthe war against cancer. These normal cells are theones in the bone marrow, cells of the digestive tract, including the mouth, esophagus, stomach, and intestines, those of the reproductive system, and hair follicles. This is why patients undergoing chemotherapy temporarily lose hair, get mouth ulcers, feel nauseous and vomit, and feel fatigued (because of anemia or low blood count, lack of sleep, pain, stress, and poor appetite), get diarrhea or constipation. The good news is that side effects wane when chemotherapy stops. Hair grows back. Mouth and gum problems disappear, and energy returns.

Watch out for infections. As chemotherapy attacks thebone marrow, production of defensive cells specifically white blood cells dips. This makes it easier for infections to develop since the immune system is weak. Some oncologists hasten the recoveryof white blood cells by giving colony stimulating factors (CSF) medicines. But on your own, you may lessen the risk of life-threatening infections by:

* Washing hands often after using the toilet, before eating, after touching pets.
* Staying away from people who are sick, even mildly so (those who have coughs and colds, with flu and so on).
* Temporarily avoiding crowds.
* Wearing a face mask.
* Do not wait for skin to get dry and cracked; use lotions.
* Taking care of cuts and nicks.

Questions for the doctor. Most of the anxiety before starting chemotherapy stems from ignorance. So it is very important to think about your concerns and putthem down on paper. I’ve had many patients who come with a list of questions and I gladly answer them one by one. From the doctor’s point of view, the inquisitiveness means you are very focused and motivated on getting better.

So ask: (from the US National Cancer Institute-NCI):
* How many treatments will I be given?
* What drug or drugs will I be taking?
* How will the drugs be given?
* Where will I get my treatment?
* How long will each treatment last?

As for side effects, do ask:
* What are the side effects to expect and when willthey occur?
* Are there any side effects that I must report right away?
* What can I do to relieve the side effects?

Finally, the NCI article covers coping and making the chemotherapy period tolerable and life enjoyable. These won’t be hard to figure out: share your feelings with friends and family, watch funny movies, listen to music, try hobbies and learn new skills, exercise if possible, and help others.

Chemotherapy is the road back to wellness. Good luck!

Dr. Pujalte is an orthopedic surgeon. E-mail jspujalte@yahoo.com

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