Heart Health After Cancer

In February, we celebrated American Heart Month and as part of our core values, we’re happy to raise awareness not only about heart health, but how issues with your heart can affect life after cancer treatment.

Did you know that heart disease is the leading cause of death for men and women in the hearthealthUnited States? Every year, 1 in 4 deaths are caused by heart disease.

Living a heart-healthy lifestyle can be incredibly important when you’re faced with difficult traumas like treatment for cancer. According to a new report from the American Heart Association, certain cancer treatments may take a toll on the heart, but there are certain precautions you can take to protect your heart before treatment. “From the start, women [and men] should have their cardiovascular health evaluated,” Dr. Richard Steingart, chief of cardiology service at Memorial Sloan Kettering Cancer Center said. “Then, they and their doctors should try to get any heart disease risk factors under the best control possible.” It’s incredibly important to talk with your health care team if you’re concerned about how treatment may affect your heart.

“When it comes to chemotherapy, any effects on the heart typically show up in the short term and can be detected during treatment,” said Steingart. The report also suggested that in some cases, women might need a break from their cancer treatment to see whether any heart effects reverse. If they don’t then the treatment plan may need to be changed.

It’s important not only to focus on your heart health during treatment, but after as well. Side effects from treatment can arise long after treatment has been completed.  You should talk with your oncology team and your primary care team to ensure that you are receiving appropriate health screenings moving forward.

On March 13, Triage Cancer is hosting a free webinar on Cancer Survivorship Care Plans & Late Effects. Cancer Survivorship Care Plans can be valuable tools to understand the cancer treatment you have received and how it impacts your ongoing follow up care after cancer treatment is completed. The webinar discusses the elements of an effective care plan, shares ways to access plans, explains long-term and late-term side effects that some cancer survivors may experience, and provides information on screening options related to those side effects.

You can also take steps towards living a heart-healthy lifestyle by joining the American Heart Association’s national movement in support of healthier communities and healthier lives. https://www.yourethecure.org.

You can watch these Triage Cancer webinars on nutrition and exercise.

Putting plans into action for caring for your heart after treatment is essential to your health.

How to Get a Better Night’s Sleep During and After Cancer Treatment

Sleeping well during and after cancer treatment can be a challenge. Cancer patientsSleep-Better often experience pain, fatigue, and discomfort that interferes with sleep.

While it’s not always easy, it’s important that you get the best sleep possible, as sleep deprivation can weaken your immune system and make symptoms or side effects, such as chemo brain, worse.

Improving sleep hygiene, treating sleep disorders, and participating in cognitive behavioral therapy can help cancer patients get better sleep.

How Cancer Affects Sleep

Sleep disturbances are not unusual among cancer patients. Between 30 to 75% of cancer patients experience sleep problems. Unfortunately, sleep problems can persist even after treatment has ended, with 25% of survivors reporting continued difficulty sleeping.

Cancer side effects and treatment can make it more difficult to sleep. Increased anxiety and depression can make way for insomnia. And with extensive treatment, you may be fatigued and experience cancer-related sleep disorders. It’s also common to experience hot flashes and night sweats. Sleep disorders can be serious and require treatment to improve your ability to sleep, as well as your quality of life.

How You Can Sleep Better During and After Cancer Treatment

Better sleep habits and treatment for sleep disorders associated with cancer can improve your sleep during and after cancer treatment. Try these tips and methods to improve your sleep:

  • Choose comfortable bedding materials: Cancer patients who experience night sweats or hot flashes may have difficulty sleeping due to heat. You should lower your bedroom temperature, and choose bedding and clothing that sleeps cooler and is more breathable. If you are experiencing discomfort and sensitivity to cold from chemotherapy, a memory foam mattress can offer softness and heat retaining properties.
  • Maintain a sleep routine: Go to bed at the same time every night, even on weekends, to help train your body to go to sleep at a regular time. You can support a regular sleep schedule with a sleep routine, going through the same actions before bed each night. Your routine can involve stretching, brushing your teeth, reading, and other nighttime tasks. The exact actions you do aren’t as important as doing them on a regular basis.
  • Try cognitive behavioral therapy: This therapy is helpful for insomnia, using techniques to reframe your emotions and thoughts around sleep. You will learn relaxation techniques and deep breathing exercises to help you fall asleep. You may also promote restfulness with progressive muscle relaxation and other therapeutic techniques.
  • Get treatment for sleep disorders: If you’re suffering from sleep disorders, it’s a good idea to talk to your doctor about treatment so you can get better rest. Good sleep is important. Sleep disorders may include those that are common among cancer patients, including insomnia, excessive daytime sleepiness, or restless legs syndrome, but other disorders, such as sleep apnea or narcolepsy, should be addressed as well to improve your sleep quality and quality of life.

Sara Westgreen is a researcher for the sleep science hub Tuck.com. She sleeps on a king size bed in Texas, where she defends her territory against cats all night. A mother of three, she enjoys beer, board games, and getting as much sleep as she can get her hands on.

Opioid Crisis in America

Every day, about 90 Americans overdose on Opioids, according to the National Institute Opioid-Crisison Drug Abuse. This has been termed the ‘opiod crisis.’ Opioids come in a variety of modes, including prescription pain relievers, synthetic opioids, and even heroin. The CDC estimates that the “economic burden” of prescription opioid misuse is approximately $78.5 billion a year; this sum includes the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.

The opioid epidemic became prevalent in the late 90s, when healthcare providers began to prescribe them at greater rates, after the risks of addition were downplayed by drug producers. In 2015, nearly 33,000 Americans died of opioid overdose, including by prescription opioids, heroin, and fentanyl, a powerful synthetic opioid.

The opioid crisis also has an impact on the labor market. A Goldman Sachs economist found that the opioid epidemic may be responsible for the lack of people looking for work in the current job market. According to the U.S. Bureau of Labor Statistics, the number of people working or actively looking for work has fallen since the Great Recession and has stagnated near 63% for the last four years.

The United States Department of Health & Human Services (HHS) released its 5 priorities for dealing with the opioid crisis:

  1. Improving access to treatment and recovery services
  2. Promoting use of overdose-reversing drugs
  3. Strengthening our understanding of the epidemic through better public health surveillance
  4. Providing support for cutting edge research on pain and addiction
  5. Advancing better practices for pain management

In April, HHS announced that they would be administering grants totaling $485 million to all 50 states, the District of Columbia, four U.S. territories, and the free associated states of Palau and Micronesia, in order to combat the crisis. A table including the grant breakdown for each state/territory can be found here.

While the HHS’s efforts are a great start, there is a lot of work to be done. For more information on the epidemic, watch the New England Journal of Medicine special report, given by NIDA Director Dr. Nora Volkow and Dr. Collins, in May 2017.

The response to the opioid crisis by many in the health care field is to stop prescribing opioid medications.  Many cancer patients are being caught in the middle of this crisis. Patients already often underreport their pain, but those who seek assistance from their health care team for pain, are often undertreated or not taken seriously enough. It is crucial for patients to have open and ongoing conversations with members of their health care team to effectively address their pain and need for palliative care.

If you are prescribed opioid medications, here is practical information about opioids.

Sexual Health and Pleasure With Cancer in Your Life

By Barbara Musser of SexyAfterCancer.com

We all understand the need for physical health and how precious that can be when we Sexual Healthare on the cancer journey. Serious or chronic health issues like cancer change our lives and we have the opportunity to take responsibility for our health and wellbeing in all areas in new ways. We learn when to get help, what kind of help we need and how to create plans for health management.

Physical health includes sexual health. For many people it’s embarrassing to even have sexuality and know that we are sexual beings ~ just look at the design of our bodies to know that we are designed for sexual function and reproduction. We can take this for granted, and then it all changes with cancer treatments. We aren’t asked about our sexual health, we don’t know how to talk about it, and we don’t always know what sexual health really is. Doctors are trained to look for pathology instead of wellness, and to treat pathology. It’s easy to end up ignoring our sexuality ~ the old “out of sight, out of mind” approach. Or we can get superstitious about it, thinking things like, “What’s meant to be, will be.”

When our genitals and sexuality are altered by cancer and treatments, it’s easy to think we’re not meant to have a healthy sex life.  We may not even know what a healthy sex life is. Stop for a moment and think what you were taught about sex when you first learned. Who told you about sex? What did they say? Chances are is what all about pregnancy and disease prevention, not about pleasure. There may even have been some shaming. Most of us didn’t learn a lot about the joys of sex and how to be creative in our pleasure.

When cancer comes into the picture things often don’t work in the same ways in our bodies and genitals. The traditional ideas that sex involves penetration and intercourse can now be painful and we avoid it. After all, who wants to do something that’s painful? What can we do?

This is an opportunity to define intimacy and sexuality for ourselves and discover our capacity for sexual health. To begin, get to know what your capacity is by exploring what feels good to you now. What kind of touch and where, how much or how little pressure? Where do you feel numb or pain? Does massage feel good? Gentle stroking with fingernails or a feather? Stretching and gentle pulling? Kissing? Where? What kinds of lubricants do you like?  Is intercourse painful? Do you use any sex toys? If so, what do you use and how? What would you like to explore and learn about? Is it easy for you to talk about these matters with your partner?

Whatever state you are in with these questions and your sexuality, you can always radiate erotic energy simply by thinking about it.  This doesn’t have to be anything overtly sexual; rather, it’s a state of mind, something that is internal to you. We can tap into deep sexual energy with a partner without getting physical. You can affirm sexual health regardless of external circumstances.

Join me on April 19 for a FREE webinar all about this: “You and Your Body – Cancer, Intimacy and Sexuality.” We’ll talk about what happens in the body, how arousal happens (or doesn’t) and some ways to begin to feel pleasure again. There will be plenty of time for questions and it will be a lively conversation. Register today!

Lymphedema Basics

What is it?

Lymphedema is an abnormal collection of high-protein fluid just beneath the skin. This swelling, or edema, occurs most commonly in the arm or leg, but can also occur in other parts of the body.  The collection of the high-protein fluid attracts more fluid to the region thus increasing swelling.  It also can cause your body to have an inflammatory reaction resulting in scar tissue called fibrosis in the affected area. The presence of fibrosis makes it even more difficult for the excess fluid to be eliminated from the area.  All this fluid prevents the delivery of oxygen and essential nutrients to the area, which then can delay wound healing, create an environment for bacteria to grow, and increase the risk of infections in or below the skin.

Primary lymphedema is a hereditary condition.  Cancer patients are at risk of secondary lymphedema.  Secondary lymphedema is caused by the damage of lymph vessels or the removal of lymph nodes.  In cancer treatment, lymph nodes are removed when a tumor is removed to determine the spread of the cancer. Lymphedema is a chronic condition that cannot be cured, but it can be treated.

What are the symptoms?

The earliest symptoms of lymphedema can include achy, heavy limbs, a tingling in the limbs and maybe even some minor swelling that comes and goes. It is very important that these symptoms are not ignored and that you report them to your healthcare team right away. The earlier you treat lymphedema, the greater the chance of preventing it from becoming a larger, more severe condition.

What is the treatment?

Treatment of lymphedema is called complete decongestive therapy (CDT) and it is broken up into 2 stages: in clinic care and maintenance. The maintenance phase means applying the same treatment techniques to yourself, in your own home.  CMT is a non-invasive therapy that includes:

  • Manual lymph drainage (MLD) – This combines the gentle stretching of skin and deep breathing to reroute lymphatic fluid around the blocked areas
  • Compression bandages
  • Compression garments
  • Special exercises
  • Skin care – Those who suffer from lymphedema are at a greater risk of catching an infection from the bacteria that lives on our skin. Cleansing with low PH soap and using a low PH moisturizer are essential to managing lymphedema

Is lymphedema treatment covered by insurance?

If you have private health insurance, maybe. Coverage for the treatment of lymphedema gets very confusing because those treatments are bandages and garments and not medications.  The ACA (Affordable Care Act) requires all Marketplace plans to cover 10 general categories: (1) ambulatory patient services, (2) emergency services, (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services which includes behavioral health treatment, (6) prescription drugs, (7) rehabilitative and habilitative services and devices,(8) laboratory services, (9) preventive and wellness services and chronic disease management; and, (10) pediatric services, including oral and vision care.  The problem is that states are allowed to determine the definition of these categories.  Some states, like California, Louisiana, North Carolina and Virginia have laws that improve the coverage of compression supplies.  Some other states have legislation pending.  Bottom line, you need to call your insurance company and ask them very specific questions about lymphedema treatment coverage.

If you have Medicare, the coverage answer is generally no. Medicare’s failure to cover compression treatment supplies stems from the fact that these items cannot be classified under any existing benefit category in the Medicare statute. The Center for Medicare Services (CMS) does not have the authority to add or redefine benefit categories, only Congress does.  Right now there is a bill before Congress called The Lymphedema Treatment Act (HR1608 and S2373). This bill was first introduced in 2010, and has been reintroduced since then.  It has gathered more and more support over the years, but it is still a bill and not a law.

Lymphedema is very real and uncomfortable risk for cancer patients.  There are resources out there, like the National Lymphedema Network.  Educate yourself before your cancer treatment begins so you can be vigilant in recognizing the early symptoms of lymphedema.  Early treatment makes a difference.

Infections – The Ugly Side Effect of Chemotherapy

triage-cancer-blog-infectionsWe are all familiar with the common cold, flu and ear aches.  These are all infections – either caused by bacteria or viruses.  Sometimes these infections need to be treated with prescription medicines, but often times our body just gets over an infection.  This is because our miraculous bodies have a built in protection called white blood cells.  When we develop an infection, our immune system produces more white blood cells to fight the infection.  This is the process in a typical, healthy person.

Unfortunately if you have cancer, you are not a typical, healthy person.  On top of the cancer itself, the treatment of cancer can make you sick.  Chemotherapy, while it may be saving your life, can also be putting you at risk of contracting an infection.  Chemo is a powerful drug that goes into your body and kills the fastest growing cells in your body – the good and the bad cells.  So the chemo kills your cancer cells, but it also kills your white blood cells.  Remember, white blood cells are the things you need to fight infections.  Generally, you will experience the lowest white blood cell count 7-12 days after your last chemo dose, and it could last for up to a week.  This period of time is called your “nadir,” meaning lowest point.  At this point you are at the greatest risk of getting an infection.  During this time you need to be extra diligent in protecting yourself against, and watching for signs of, an infection. Infections during chemo can be life threatening and may delay your ability to receive your next life-saving chemo treatment.

What are the signs of an infection?

Fever is the number one and most serious sign of an infection.  Take your temperature anytime you feel warm, flush, chilled or generally unwell.  At your nadir you may not be able to fight this infection on your own, so you need to call your doctor if you temperature is 100.4ºF or higher for more than 1 hour, or a one-time temperature of 101ºF or higher.  Seriously, night or day, call your doctor.  Make sure you:

  • Keep a working thermometer near you, and know how to use it.
  • Keep your doctor’s phone number with you at all times. Make sure you know if there is a different number to call when the office is closed.  Do not hold out through the night, waiting for your doctor’s office to open.
  • If you end up going to the emergency room, tell them right away that you are undergoing chemotherapy. You cannot wait around in a germ infested waiting room while your infection is left untreated.

Other signs of infection include:

  • Chills and sweats, with no fever
  • Change in a cough, or a new cough
  • Sore throat, or mouth sore
  • Shortness of breath
  • Nasal congestion
  • Stiff neck
  • Pain when you urinate
  • Unusual vaginal discharge or irritation
  • Increased urination
  • Diarrhea and/or vomiting
  • Redness, soreness or swelling near surgical wounds or ports
  • Pain in the abdomen or rectum

If you experience any of these signs or symptoms you should call your doctor immediately.

Can you reduce your risk of infection?

Every school age child knows that you can avoid a cold or flu by washing your hands.  As a cancer patient receiving chemo, you need to be absolutely obsessive about this.  Good old soap and water are the best choice, but hand sanitizers are a good second choice. You should wash your hands:

  • Before, during, and after cooking food
  • Before you eat
  • After you go to the bathroom
  • After you change a diaper
  • After you touch your pet, or clean up after your pet
  • After touching the trash
  • Before treating any wound

Beyond washing your hands, you should also maintain good oral and body hygiene, use disinfectants to keep your household clean, avoid coming into contact with sick people, and try to avoid getting scraped or cut.  You should also avoid undercooked or raw meat and eggs, avoid unpasteurized or raw products, and wash your fruits and vegetables really well.

Undergoing chemotherapy is uncomfortable enough without getting an infection.  Be overly observant and very, very clean and you can minimize your chances of getting infections.

Medical Marijuana: A Post-Election Update

medical marijuanaOn Election Day, voters across the country showed they were in favor of legalizing medical marijuana, and in some states, recreational marijuana as well. California, Maine, Massachusetts, and Nevada voted to legalize the recreational use marijuana, while Arkansas, Florida, and North Dakota passed ballot initiatives legalizing medical marijuana.

Marijuana, whether used recreationally or for medical reasons is still illegal under federal law. However, over the last few years, the federal government has opted to let states pass laws in this area and not to prosecute people who are following those state laws.

We have posted previously about the laws related to medical marijuana, which you can read more about here.

President-elect Donald Trump has nominated Senator Jefferson Sessions for Attorney General of the United States. If confirmed, it is likely that Senator Sessions will take a different approach towards state laws on medical and recreational marijuana.

To learn more about Senator Sessions’ views on marijuana, read this informative article: http://www.politico.com/magazine/story/2016/12/jeff-sessions-coming-war-on-legal-marijuana-214501.

Cancer-Related Fatigue – Fighting Those Zzzzzs

Triage Cancer FatigueHas your treatment left you feeling unusually tired? If yes, you be experiencing cancer-related fatigue.

What is cancer-related fatigue?

Cancer-related fatigue is a persistent feeling of physical, emotional, or mental tiredness or exhaustion related to cancer and/or its treatment. Some of the symptoms include:

  • Feeling tired and it not getting better, it constantly returning, or it becoming severe
  • Being more tired than usual during or after an activity
  • Feeling tired with no relation to any activity
  • Putting less effort into your appearance because you’re too tired
  • Being too tired to do the things you normally do
  • Having no energy and/or feeling weak
  • Feeling tired even with sufficient rest and sleep
  • Spending more time in bed and/or sleeping more
  • Staying in bed for more than 24 hours
  • Not being able to concentrate or focus your thoughts
  • Having trouble remembering things
  • Becoming confused
  • Feeling tired and it disrupting your work, social life, or daily routine
  • Feeling sad, depressed, or irritable
  • Feeling frustrated, irritable, and upset about the fatigue and its effects on your life

What causes cancer-related fatigue?

There are several factors that can contribute to cancer-related fatigue. Some of the causes include:

  • Cancer treatment
  • Anemia
  • High/low hormone levels
  • Loss of appetite
  • Dehydration
  • Lack of exercise
  • Anxiety
  • Depression

 How is cancer-related fatigue treated?

The first step in treating fatigue is to identify the cause. If the cause is not known, you may need to try several different methods in order to figure out which one works for you. Staying physically active can help both manage fatigue and improve strength. Over time, try to build up to 150 minutes of moderate activity (walking, cycling, swimming) per week. You can also add in strength training exercises. Make sure that you are staying hydrated, by drinking enough water.

A psychosocial care professional (e.g., therapist, counselor, social workers, psychologist, psychiatrist, etc.) can help provide you with emotional support, which may alleviate your fatigue. Many patients have also found that acupuncture and yoga can help. Cancer-related fatigue can persist months or years after treatment, so it’s important to receive both short-term and long-term care.

Although common among cancer patients, cancer-related fatigue is not something that should be taken lightly. It is important that you talk with your doctor, or other members of your health care team, if your fatigue is affecting your health and well-being.

For more information on cancer-related fatigue, click here.