Medsarticles. Medical Weblog

Cancer: In every study done on rodents, statins have caused cancer. A review published in the Journal of the American Medical Association states that “All members of the two most popular classes of lipid-lowering drugs (the fibrates and the statins) cause cancer in rodents, in some cases at levels of animal exposure close to those prescribed to humans.” Studies done on humans have not produced such dramatic results because cancer is a disease that takes a long time to develop, and most clinical trials done on statins have not gone on for more than two or three years. This same study made the following final statement: “the results of experiments in animals and humans suggest that lipid-lowering drug treatment, especially with the fibrates and statins, should be avoided except in patients at high short-term risk of coronary heart disease.” These studies have been conveniently forgotten, because millions of patients around the world are being put on cholesterol lowering drugs even if they have very few risk factors. Statins are also a drug that must be taken for life. One study done on humans, called the CARE trial found that breast cancer rates in those taking statins went up 1500 percent. Statins may get your cholesterol down, but at what price?

Heart Failure: The world has experienced an enormous increase in the incidence of congestive heart failure. The incidence of heart attacks has gone down slightly, but heart failure rates are going up. In Australia there are approximately 300 000 people currently living with heart failure, with 30 000 people being newly diagnosed each year. Congestive heart failure occurs when the heart becomes weaker and cannot pump blood around the body as well as it should. Over time the heart becomes enlarged, thickened, and continues to get weaker. It becomes much less efficient at pumping blood.

Statins deplete the body of Co Enzyme Q10; the heart is a muscle, and heavily relies on Co Q 10 for energy. Without Co Q10, the mitochondria in the cells making up the heart cannot produce enough energy, leading to muscle weakness. The higher your dose of statins, and the longer you take them, the more likely you are to end up with heart failure. Ironically, virtually all patients with heart failure are placed on statins, supposedly to protect them against heart attacks, even if their cholesterol is normal.

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However good your prognosis, your cancer still represents – at best – a major scare in your life. However matter-of-fact and sensible we are, none of us cares to acknowledge our own mortality, but some circumstances do push us into considering whether our practical and financial affairs are in reasonable order.

Making a will

If you have not already made a will, then even if your prognosis is good, you may feel that this is a task you should put off no longer. You may still find the resolution to do so easier than actually tackling the task – but it is a very worthwhile exercise. It is often mistakenly believed that if your affairs are relatively simple then your assets will automatically pass to your wife or partner or children. This is not necessarily the case, and it is much better if you set down your wishes in writing. Not only does it make the task of administering your estate much more straightforward for your executors but it also gives you the opportunity to express any wishes you may have about bequests. A will does not have to be a complicated document. You can ask a solicitor to help you draw it up, or you may prefer to do it yourself from a ready-made ‘kit’ which you can obtain from stationers, or to use a book on the subject to devise your own will from scratch. The Which? Guide to Wills and Probate edited by the Consumers’ Association is very useful. The New Natural Death Handbook also contains a good section of general guidance on wills. It may still be a good idea to ask a solicitor to check your will to ensure it is valid, unambiguous and would be legally acceptable.

Once your will is drawn up, you can forget about it (unless anything occurs in your life which necessitates changes). It is an important task dealt with.

We had made our wills in an unusual burst of good sense while in our mid-20s, largely because I was in the process of setting up my business and we were not then married. They were very simple, and we typed them ourselves using a library book on wills and probate. When we received the news that my prognosis was looking much worse, we had another burst of sorting out our affairs and my partner (we were married five days later) made a panicky phone call to our local solicitor who kindly looked over our wills the same day and checked that they were ‘legal’ and contained no ambiguities. We hadn’t realized that although they were basically fine as they stood, they would have become invalid after our marriage and were redrafted to take account of this. This was another item crossed off the list. We did not enjoy the process because of the implications, but it somehow felt like a small matter over which we still had some control and which we could sort out ourselves, and that is very important when it seems that everything else is running away from you.

You might also be spurred on to check that your financial and legal documents are accessible and reasonably well-organized. Again this is not an easy task to contemplate, and you may feel it is simply too much for you, or that somehow it is ‘tempting fate’. If you can’t manage it, fine – some people can and others can’t. At first it may seem too overwhelming a task or you may feel that you need time to build up to it, but ensuring that your affairs are in good order can both relieve a potential source of worry and contribute to a sense of control on your part.

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You will need to find ways to hold on to your sanity when your usual activities are severely curtailed. An understanding listener can make a big difference when you need to express your frustrations, but you still need to find ways to pass the time and occupy your mind. Television or videos or radio might keep you entertained at first, but these can wear thin and you may start to feel too passive, as if you need more stimulation than a TV picture. What you need to find are pastimes which you enjoy but which are not too strenuous, which stave off frustration but which you can put aside immediately if you need to rest. The most simple pastimes can often be the most effective.

Reading is fine if you enjoy it and can concentrate. Books and glossy magazines tend to be expensive, but you can ask a friend or relative to visit the local libraries and charity shops as a cheaper alternative. If friends ask if they can bring you anything when they visit, a magazine might be a suitable present. If you find it difficult to concentrate or simply find it hard work to hold a book for long periods, you could try listening to books on tape, which are widely available at libraries. As well as books, a whole variety of television and radio programmes can be obtained on tape. If you don’t already own one, a personal stereo might be an extremely useful gift.

Listening to music can be therapeutic as well as pleasurable. Choose your music to suit your mood – sometimes loud, ‘angry’ music can provide a better release for your emotions than the more obvious calm and relaxing choices.

Writing letters, if you are able to, gives you the opportunity to keep people in touch with how you are and is sometimes an easier way of expressing your thoughts than a conversation. We are accustomed to using the phone rather than letters to maintain contact with family and friends, and you may feel, ‘What’s the point of writing when I can pick up the phone. Anyway, I haven’t written a personal letter since I was at school.’ It may take you a while to get started, but there’s a sense of satisfaction gained with signing off a letter. We all love to receive a personal letter, and you may find that people’s pleasure in hearing from you gives you a boost too.

Taking the theme of putting your thoughts on paper a step further, keeping a diary or journal of your experiences and thoughts during your treatment can provide another outlet for your emotions. It doesn’t have to be anything grand – perhaps a notebook in which you record notes of how your treatment is progressing, how you are feeling, the positive and negative sides of your experience.

Games are a good source of distraction and can help to keep your mind ticking over. Those which are not too long, intricate and involved are generally preferable, such as card games, backgammon or Scrabble. If your concentration levels are not brilliant or you have a tendency to become tired, these can be quickly started and easily put aside or picked up later.

Sometimes it’s useful to have an ongoing ‘project’ to give you a sense of purpose and to provide another thread of continuity in your life at a time of disruption. Try not to choose anything which will require constant physical effort, but ideally a project which can be picked up and put down whenever you wish. It might be something you had always promised yourself you would do ‘when you had the time’, or something completely new or something you have been meaning to return to for years. It will obviously depend on your particular interests as well as your physical capabilities: keeping a diary of your experience of cancer, cataloguing your record or CD collection, learning a new computer program, taking up sketching again, helping in some way with a cancer support group…. As well as helping you to feel that you are able to use your time resourcefully, you will have something tangible as an end result.

Alternatively, you might choose to plan forward for a project to be undertaken when your treatment is over – something constructive to look forward to. This could be connected with your house (plans for your garden or decorating); associated with work (the outline for an idea or project you have always wanted to develop but never had the time); or something entirely personal (choosing the destination for the holiday you plan to take after your treatment).

If you have (or if someone can arrange) access to one, a portable PC can open up new horizons. Whether you are accustomed to more sophisticated technology or have always been a technophobe, you can use it as a word processor, to play games or for whichever programs suit your needs and interests.

‘Treats’ can give you a boost too, even if they do suggest childhood. What they are depends entirely upon you; the point is that they represent something which is a luxury for you, even if a very small one. This might be something to eat or drink, a CD or record, a book or magazine, a game or gadget, an item of clothing. … It doesn’t need to cost much, but should make you feel good. Have regular treats – they are good for you! Make sure other people know about them, but don’t let them embarrass you by spending large sums of money or going to great trouble.

If you are well enough, avoiding being confined to home can make a difference to your state of mind. You may be content to spend more time than usual quietly at home, but gazing at the same four walls can leave you feeling stir-crazy after a relatively short time. Going out can also boost your self-assurance. If your mobility is not particularly affected, then this may be easy for you. If on the other hand, trips or visits need to be planned and depend on how you feel on a given day, then they can assume a greater significance. You might visit friends, or favourite old haunts or new places further afield. The location and purpose is less important than dispelling the sense that your life revolves entirely around your cancer. You do need other distractions in your mind, and ‘a change of scenery’ can help. Similarly, taking a holiday either during or after your treatment can provide a boost: even a break of a few days away can be very beneficial.

Having always led such a busy life, the enforced inaction of the first six weeks or so following my diagnosis were an alien concept to me – but at the time I was too ill to have any choice. After that initial period, I actually found to my surprise that I was enjoying having this ‘leisure’ time (although not the reason it was forced upon me!) and for the first time in years, I had time to call my own. It was also a period for reflection and reassessment of my priorities, but quite apart from that, I enjoyed being able to sit in the garden and read or write letters, have friends to visit, spend days on end at local cricket matches, go to my favourite record shops (going unaccompanied for the first time was a big day!), and spend time pottering around the countryside, going to places we’d always promised we’d visit ‘when we had the time’. Our finances were pretty stretched, but our lifestyle was not exactly extravagant at that time and our pleasures were generally simple ones. We saw this as a finite period, which would change again when my treatment was complete, so we thought we might as well make the most of it.

It is not only at home you will need ways to fill your time, but also in hospital if you are being treated as an in-patient. The same principles apply, although your days will be punctuated by your treatment, by drug rounds, ward rounds, mealtimes and so on. Even if the environment is busy and bustling and you have family and friends to pay regular visits, time can drag simply because you want to have your treatment as quickly as possible and get home again.

By my third or fourth chemotherapy cycle I was feeling much stronger and fitter and more like my ‘old’ self, and found I had to switch into what we called ‘hospital mode’ as soon as we walked through the hospital entrance. As an impatient person who likes to get on with things, I found the waiting around and the inevitable delays incredibly frustrating at first – it seemed they were occurring just to annoy me. This, of course, is not the case -blood tests had to be taken and the results checked, chemo had to be ordered, I had to wait for a doctor to be available to examine me, drugs had to be ordered from the pharmacy, sometimes scans had to be organized. All of these procedures take time. ‘Hospital mode’ involved switching off the active part of my brain, turning on the TV or radio or settling down with a good book and trying to be the patient person I definitely am not – but there’s no point in trying to fight the system. In fact, my three or four days often passed very quickly – but it didn’t always feel that way, and the only solution for me was to switch off completely.

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As we know, cancer is not a disease which can be treated quickly and simply and then forgotten. One man whose daughter had cancer treatment as a baby described it as ‘lifetime membership of a club’. Although his daughter is now in her teens and completely well, the experience has never faded entirely and a slight fear of recurrence always remains in the back of his mind. His feelings are very typical. Some cancers do respond extremely well to treatment and some men are completely cured, but the check-ups can continue for years, so that you never forget completely.

It is a powerful experience which leaves a lasting impression and which can bring about changes in your outlook, priorities and lifestyle. Many men comment during or after their treatment that ‘I could never have gone through it without my wife/partner/parents/friend’ or ‘The treatment was unpleasant, but I wanted to get through it for the sake of my children/wife etc’. Comments like these emphasize how much we value and rely on our family and friends, often unconsciously, and how important these relationships become at times of crisis. You may find it difficult at first to accept that you need their support, especially if you have always been – and been seen as – a strong and supportive person yourself. There will be difficult and distressing times, but you will find your journey through treatment easier to bear if you undertake it together with the people you are close to.

This does not mean that you will not have some rocky times and sticky moments together with your loved ones. It is often assumed that people facing a crisis together will automatically ‘pull together’ and be constantly mutually supportive and saintly. It is true that for some people, facing a crisis together does strengthen their relationship. Others find their relationship under a huge strain. There is no ‘norm’ and no one should be expected to live up to unrealistic ideals of behaviour. However, if you stick together with those close to you and are willing to accept that we are all only human, then you may be surprised at the level of support you are able to offer each other.

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It may feel at times that a whole range of doctors, nurses and other specialists are involved in your treatment, making it hard to establish a constructive ‘working’ relationship with any of them. At first it can be difficult enough just to learn their names and what their role is. Once your diagnosis has been made and your treatment begins, this problem should ease as you become more familiar with the staff on your ward or at your clinic if you are being treated as an out-patient. In most hospitals, you will be assigned a consultant who is in charge of your care, and who may be one of several attached to your ward or clinic. Indeed, you may see more than one consultant if you are undergoing surgery as part of your treatment: you may have an oncology consultant responsible for your overall treatment, with a different specialist consultant in charge of your operation. Working for the consultants are a number of registrars who are doctors at various levels of seniority, and more junior doctors known as house officers. If yours is a teaching hospital, student doctors may also observe your care from time to time.

If you are undergoing radiotherapy, you will have contact with the specialist staff in that department who will administer your treatment each day. Men undergoing chemotherapy will be looked after during their treatment by specially trained oncology nurses, who are skilled both in administering chemotherapy drugs and looking after people affected by cancer. If you are treated as an in-patient, oncology nurses play a vital role in your day-to-day care.

You may also spend time at the X-ray department having scans or X-rays; a dietician can help if you have difficulties eating or with your diet; social workers are attached to the hospital to help sort out financial difficulties or benefits; physiotherapists can provide support with issues related to mobility and maintaining physical activity; occupational therapists can help and advise with special equipment or changes to your home which will make your daily life more comfortable; counsellors will be available to offer support. These are just some of the specialist services available to you as a patient, and which you can draw upon at any time. You may or may not need their expertise, but it is reassuring to know that they exist.

Outside the hospital, your GP will be kept informed of your treatment, and a district nurse will be available to visit you at home if needed and provide additional support. Depending on your circumstances and how unwell you are, Macmillan nurses or Marie Curie nurses can offer information, general support and specialist care at home if you need it.

While this may seem an excessively long list of people to be involved in the care of a single patient, it is also an indication of the sheer breadth of resources available to help and support you. While you may have contact with only a few of them throughout most of your treatment, it is important to know that your hospital can provide support with a variety of cancer-related issues, from pain-relief to dietary advice to financial advice. Do use these specialist skills when you need them!

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The prospect of embarking upon a journey through cancer treatment is often made more difficult because we have little knowledge about how it works and what it ‘looks like’. This can contribute to a sense of fear and trepidation, because it is a journey into the unknown. Before you start any treatment, your doctors will explain the planned course of action to you but it is still natural to feel daunted, not least because you are still trying to come to terms with your cancer diagnosis and the changes this has brought to your life. Don’t ever feel afraid to ask doctors or nurses questions or to repeat explanations to you if you feel you haven’t fully grasped or absorbed what they have told you. It is very important that you come to understand the nature of your treatment and the potential outcome.

Although progress is being made in newer therapies, the most common treatments for cancer are

surgery

radiotherapy

chemotherapy.

The intent behind treatment can be ‘curative’ or ‘palliative’. Treatment whose intent is curative aims to cure a patient completely of his cancer, so that no evidence of it remains and he returns to normal health. A cure means that all evidence of your cancer is eliminated and that it will not return. However, the term ‘cure’ can only be applied with confidence after the passage of time – in the majority of cases, after five years. ‘Palliative’ treatment does not aim to cure, but the term can be used in two different contexts. First, palliative treatment can be used to shrink a tumour and thereby improve the patient’s quality of life. This does not necessarily mean that you have only a short time to live, but rather that it is not thought possible to eradicate your cancer completely: for example, the majority of men with prostate cancer actually die from something other than their cancer. Second, palliative care may be used purely to control and alleviate the symptoms of cancer where no other treatment options are available. It is important for you to clarify with your doctor the intent behind your treatment. This may be a difficult question to ask, and indeed a difficult question for your doctor to answer, but you will be better prepared to cope with your treatment if you understand what it is intended to achieve. The terms such as ‘cure’ or ‘remission’ which your doctors may use in discussing the intent behind your treatment are described in more detail in Chapter 4.

A tremendous amount of research has been carried out in recent decades to establish the most effective type of treatment for individual cancers. Just as there are several hundred different forms of the disease, so there are many ways in which treatment can be geared to your particular cancer. Different cancers behave and react in different ways, so the appropriate treatment for, say, bowel cancer will not be the same as the treatment for lung cancer. You may have a single type of treatment or a combination of treatments, say, surgery followed by chemotherapy or radiotherapy, but you can be assured that the decision as to which is most appropriate for you will be based on the most effective proven treatment for your particular circumstances.

Once your cancer has been diagnosed, treatment often starts very quickly and it is easy to feel that you are being carried along by events beyond your control and understanding. Finding out as much as you can about your proposed treatment and, just as importantly, about any anticipated side-effects, can help you to regain some sense of control. Building up knowledge does take time, especially in such difficult circumstances, but knowing what to expect will help you to cope better once the treatment is underway.

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Coping with a long period of impotence can be very difficult, especially when the cause is unknown and the prospect of restoring potency is uncertain. (This situation is becoming less common as diagnoses and treatments improve.) Marjorie and Bert had been married almost 20 years. Before they were married, Bert explained to Marjorie that he had a persistent erection problem. For the first years of their relationship, Marjorie was able to accept the situation, but as the years went on, she found it increasingly difficult to adjust.

Bert’s condition was such that sometimes he could get an erection, only to lose it before he could attempt intercourse. Some therapists think that this situation may be more difficult for a woman to accept than when the man is simply unable to get any erection at all. This is because when there is an erection, the woman becomes hopeful. She thinks, “Maybe this time things will work,” and she allows herself to become aroused. If she feels intercourse is the only acceptable expression of her desire, she’s frustrated when her partner loses his erection. And, like Marjorie, despite efforts to “not take it personally,” she may do just that. Her anger may build and feed on itself.

The years without a good sexual relationship have hurt both Bert and Marjorie. Her pain shows in her face, in her voice and in the way she twists and kneads her hands as she speaks. “We’re fortunate with other aspects of our relationship,” she says. “But I do have anger, and it is a lot deeper than Bert realizes. The last few months we’ve been withdrawn because of me. Hugging or kissing is okay, but fondling or anything else, no. I enjoy lying in his arms, but I don’t want to start anything we can’t finish.”

Marjorie has been deprived of something most married women take for granted. The lack of successful treatment and her self-blame and frustration have taken their toll. And because, like many of us, Marjorie regarded intercourse as the only “real” sex, perhaps she suffered even more. Allowing herself to explore other ways of having sex would keep her from being locked into a life without any sexual contact. She doesn’t want to leave Bert and he doesn’t want to leave her. Right now they’re in a standoff, both in pain. As in most sexual battles, there are no winners.

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If there is anything that a stressed-out person deeply appreciates, it’s a back massage. Strong hand movements up and down the back trigger nerve fibers and increase blood flow and circulation by dilating blood vessels. The result is a relaxation response that both of you will enjoy.

To start, have your partner lie on her stomach. Straddle her lower back comfortably. With your palms facing downward, make gentle circles around each shoulder blade. Then, using the knuckles of both hands, stroke her back from the neck down, about two inches away from either side of the spine. Explore the contours of her back with rotating fingers and deep kneading motions. Finish the massage with slow strokes. As one hand, with fingers spread wide, makes its way up the length of her back, the other should descend to the lower part.

As you progress, ask your partner how she feels. Find out if you are applying too much or too little pressure. Ascertain what feels good to her and what she doesn’t like. Tell her how touching her body and giving her pleasure affects you. Paying a person this kind of undivided attention can be a big turn-on.

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It’s very important for you to consider adding vitamin C supplements to your diet. The current RDA is 60 milligrams, and while it may be justified for disease prevention, it is far from optimal for a healthy life. This was proved in a study from the National Institutes of Health, which delved into the varying dosages to determine which was the most effective. The men taking part in the research were first fed a vitamin C-deficient diet. Then they were given it sequentially, in six specific dosages: 30, 60, 200, 400, 1,000, and 2,500 milligrams daily. The results showed that:

• On 30 milligrams the subjects were irritable and fatigued due to vitamin insufficiency.

• On 200 milligrams blood plasma levels were almost totally saturated with vitamin C.

• At 1,000 and 2,500 milligrams the blood plasma was completely

The NIH researchers now believe that an intake of up to 1,000 milligrams a day of vitamin C is safe (and doesn’t cause diarrhea), but that dosages above 400 milligrams have “no evident value.” But while food is the best source of this vitamin—citrus fruits are superior suppliers, and most other fruits and vegetables contain it—most Americans don’t eat enough every day to get the amount they need.

For optimal antioxidant power, I recommend a supplement of at least 200 milligrams of vitamin C daily. When taking this supplement, it’s best if you divide your dose in two, taking half in the morning and the other half in the evening. Since the body eliminates vitamin C in the urine in about twelve hours, taking both doses will ensure steady antioxidant protection throughout the day and night.

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Consider the comments from Leslie, a thirty-eight-year-old woman whose ten-year marriage was at a crossroads. “Will says he’s overjoyed that he can get the kind of erections he used to have. But we’ve been through too many tough times; we’ve fought a lot. He complained about the weight I gained, not realizing that it was in response to his not wanting to have sex with me. Of course, for a very long time I didn’t know—because he didn’t tell me—that he couldn’t have sex. I felt so rejected, food was my only consolation.

“Now he wants to have sex again. I have to ask myself: does he still care for me, or is it just that he hasn’t been able to have sex for a long time, wants to play catch-up, and is worried about straying from home and contracting AIDS? He’s so enraptured with his erections, I can’t honestly believe that they have much—if anything—to do with me. It makes me feel angry and used, and less attractive than ever.”

Leslie’s view is understandable, especially in the context of the way women judge themselves in our culture. Sadly, many women, beginning early in their lives, regulate their self-esteem through how they see their bodies, or think other people judge their physical attractiveness. We see evidence of this everywhere. Losing weight is a national obsession, supermodels are ideals for young girls, and prepubescent female athletes, many whose growth and menstrual cycles are stunted, are heroes for impressionable children.

Aging is, for many women, an enemy that must be fought at all costs. Looking and feeling the best they can while accepting their age is not their goal. Instead, beating the clock is, no matter how much self-esteem is sacrificed in the process. When self-value is solely reliant on the reactions of others to how one looks, problems are inevitable. Certainly ours isn’t the first culture to put such emphasis on looks. However, the advent of a new world of sexual medicine is bound to exert more pressure on the way women view their appeal, both physically and emotionally.

According to psychologist Dr. Robert Broad, at New York’s Mount Sinai Hospital, “In our society, how a woman attracts and arouses a man is a primary source of self-esteem. That initial appeal is often based on how a woman looks. This component of self-evaluation is a key factor to how a woman will respond to a man with erectile dysfunction—and how she will feel about herself.”

The more vulnerable a woman feels—regardless of her age—the more she will question herself, both as the source of a man’s ED and as the object of his attention.

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