Tag: risk

Let’s Goooo!

Ok guys. Here is all the latest and greatest updates. My brain is cancer free and looks positively boringly normal! Yesss!

My vision is 20/15 with my glasses on and I am able to get rid of my bifocals! Yess!

My memory is doing pretty awesome and a lot of the short term loss has returned. Yess!

I am able to do complex puzzles and remember strings of 12 numbers. Yess!

My energy is good. I still have to have the occasional power nap, but who doesn’t? Yess!

My hemoglobin is finally in the normal range! Yess!

I am inches away from being granted full functioning privileges at the hospital with no restrictions! All the paperwork is in. Yess!

Obviously, I still have some precautions to follow with my baby immune system and all and I still need to get revaccinated for everything. But, it is truly time for everyone to bring the level of worry down to a healthier level. I totally get and appreciate all of it and I understand all of it. But, it is time to climb down from def con five level. We have done it folks! It is time to celebrate and live! I promise everyone that I am not going to do anything that I don’t truly feel ready for or that could put myself or anyone else in danger. Let’s do this! Have a great day!

Dr. Katz

How am I ever going to have an ache or pain again without panicking?

You know, when I am all done with all this cancer stuff, when the last treatment is over, when the last scan has been read as clear, I will never really be done. What I mean is, I will have to follow up regularly for at least the next five years, if not forever, depending on how things go. It will be like a little shadow over my life probably for the rest of my life. There is a post traumatic stress element to having gone through any illness like this that is not likely to disappear any time soon. How am I ever going to have what seems like a normal ache or pain without overthinking it? What if that little ache is my cancer coming back? I already HAD normal-ish symptoms seemingly consistent with menopause and overwork….and they turned out to be cancer! Yes I know, I know, the growth was not a normal symptom, but you see what I mean about the rest of it right? You see? I am not even done with treatment yet and I am already pre-thinking about overworrying. Oh for heaven sake.

Being diagnosed and treated for cancer is in itself a stressful and potentially traumatic situation. Patients experience a whole range of feelings including fear, sadness, anger, anxiety and adjustment issues. There is such close association with cancer patients and post traumatic stress that the DSM-IV post traumatic diagnostic criteria were expanded to include diagnosis with a potentially life-threatening illness as a possible stressor significant enough to induce PTSD. The DSM-V PTSD diagnostic criteria allow for specific implications of cancer- related post traumatic stress, but there is still a lot more research needed in this area. Studies done by Mehnert and Koch showed that 54% of breast cancer patients viewed cancer as a traumatic stressor. Andrykowski and colleagues interviewed survivors of lung cancer and found that 37% viewed their diagnosis and treatment as a traumatic stressor. There are other studies that reflect similar results. Still other studies correlated the incidence of cancer related post traumatic stress to lower socioeconomic status, young age, limited social support or dissociative symptoms regarding the cancer experience( Not being able to recall any cancer related discussion with the doctor.) The bottom line is that cancer is considered a traumatic stressor by some patients. There just isn’t enough data out there right now to describe the entire course of cancer related post traumatic stress, but we know that it is out there.

So, now that we know it exists, what do we do about it? I think the key is integrating psychosocial support into the acute care phase and survivorship phase of cancer care. I think it is important to make therapy and mental health care directly available in the oncology setting, not as a completely separate venture in a different location. A lot of patients, myself included, have a difficult enough time getting to their regular oncology appointments, much less a whole separate group of appointments with a mental health professional. I think it is also important to take a detailed mental health and trauma history on every cancer patient from the very beginning. You need to know what background you are dealing with even before the intense stress of cancer treatment begins. If a patient already has an extensive trauma or psychiatric history, they are a set up for post traumatic stress with cancer treatment. Maybe if you are able to highlight that risk ahead of time, the patient can already be directed into mental health treatment before the stress of cancer treatment takes root. It is also important to continue to monitor distress and stress as treatment is ongoing. Ongoing screening for distress is already a component of the National Comprehensive Cancer Network’s clinical practice guidelines. There are specific pathways for management of acute stress, traumatic stress, and adjustment disorders. I think this is the very checklist that I have to go through every time I go to the doctor’s office. I also have a list of mental health support resources, but they are in a different location than my doctor’s office and it is still up to me to seek them out and make arrangements.These checklists and protocols are great, but they mean nothing in the grand scheme if the availability and connectability of mental health treatment is not easily and readily available. I still feel like it would really be up to me to bring up if I am having any mental health issues when I truly think it is the doctor’s role to watch for these signs even before I would bring them up. As a cancer patient, your mind is whirling all the time. You really do need some one watching out for you to clarify some things that you cannot clarify for yourself as readily. I am not saying that cancer patients are all helpless or anything. I am just saying that we may need a little extra support or supervision than most with everything else going on that potentially distracts us from caring for ourselves. Post traumatic stress is real. Now that we can identify it, we need to get better at addressing it.

Dr. Katz

Is it ever going to be over?

Right now, I feel like we all have divided up our lives into two categories: pre-pandemic and during pandemic. I find myself using and thinking the phrase “before the pandemic” all the time. Before the pandemic I used to go to concerts and go on trips. Before the pandemic I had regular outings with friends. Before the pandemic, I didn’t think twice about going out. Before the pandemic, I had freedom. Before the pandemic, I didn’t weigh out every single social decision against the possible consequences. Now that has all changed. It’s not all bad. There is nothing wrong with actually weighing your decisions a little more carefully rather than flinging yourself into everything. On top of that, I have to admit that I have gained from the extra caution in the world now that I have cancer. I was already getting used to social distancing before my diagnosis. Now the reality of my vulnerable and immunosuppressed state is not such a shock. I have already been practicing the precautions. It is pretty much life as usual.

Still, I wish it were over. I understand all the precautions and the waiting to lift restrictions until more vaccine is distributed. I am just inpatient, even though the increased freedoms won’t really apply to me. I just want to see my friends and family live a little more. I just want to see them happier again. I feel like everyone is in the same boat. It’s ok to be frustrated. It is human nature.

Here is what I don’t understand. We have more than one vaccine now. Despite the perception that these vaccines are somehow new or rushed, the technology being used has been around for the last ten years or so. Yes, we are having issues with the order of availability. That is true. But, we are attempting distribution the best that we can. I say this even though my own hospital ran out of vaccine for me and I had to travel to get mine because other vaccine groups opened up before all of us physicians were vaccinated. Nonetheless, I was grateful to get it when I was able to, even though there was a significant wait. So, we have these vaccines, which are what people have been clamoring for all these months, and yet, many people are still declining them? The scare techniques against the vaccine are particularly insidious and unfortunately, effective. What is the point? The vaccine is our best option to get us closer to this all being over. Why holler and demand for answers and solutions and just shut them out once we get them? I get that there may be risks with the vaccine. There are risks with anything. But, I am here to tell ya, the risks of Covid are much greater than any risks the vaccine could impose. I guess it all boils down to one big question. If what we really want is for this to be over, why aren’t we more willing to do what it takes to make that happen?

Dr. Katz