F6 Thursday, April 14, 2011 • THE BULLETIN
M CELEBRITY M EDICINE Multiple myeloma usually causes bone or back pain and paralysis Geraldine Ferraro, the first female vice presidential candidate for a major U.S. political party, died last month from a blood cancer known as multiple myeloma. According to the National Library of Medicine, multiple myeloma is cancer of the plasma cells in bone marrow. Plasma cells help the body’s Geraldine immune system fight Ferraro disease by producing antibodies. In multiple myeloma, those plasma cells grow out of control in the bone marrow and form tumors in the areas of solid bone. These tumors impede the bone marrow from making red blood cells, white blood cells and platelets. As the cancer cells grow in the bone marrow, they can cause pain and destruction of the bones. If the bones in the spine are affected, it can also put pressure on the nerves resulting in numbness or paralysis. Symptoms include bleeding problems, bone or back pain, unexplained fever or fractures, vulnerability to infections and feelings of fatigue. People who have a milder form of the disease may simply be monitored for any change in progress. More aggressive forms might be treated with medication or radiation, but chemotherapy or transplants rarely lead to a permanent cure. — Markian Hawryluk, The Bulletin Source: National Library of Medicine
How to prevent infections from surgery By Alison Johnson Daily Press (Newport News, Va.)
Before surgery, you can prepare your body for healthy healing — and cut the odds of a surgical site infection that requires hospital care. Here are tips from Dr. Calin Moucha, associate chief of joint replacement surgery at Mount Sinai Medical Center in New York City: Quit smoking. Smokers have a much higher risk of complications because nicotine interferes with wound healing. “Smoking is the single most important modifiable risk factor for postoperative complication,” Moucha said. Even quitting for a month before elective surgery helps. Don’t go on a big diet. Many people try to lose weight if they are obese — itself a risk factor for complications — or are afraid of gaining weight after surgery. But dieting usually isn’t smart due to the threat of malnourishment, which again can slow the healing process. Take care of your teeth. Heavy plaque build-up and infections in the teeth or gums can release bacteria into your bloodstream. If you have an obvious problem, see a dentist before an operation. Control your blood sugar. If you are diabetic or have an elevated blood sugar reading, work to normalize levels both before and after an operation. Check on your medications. Some drugs for chronic illnesses, including many anti-inflammatory pills for arthritis, may increase the risk of infection. Ask about pre-surgical testing. Some doctors will check for potentially dangerous bacteria that can live in the nose, as well as for existing infections in patients having a repeat surgery.
Attitude Continued from F1 Now that prevailing notion of the right way to cope may be starting to fade. Patients and their caregivers are beginning to rebel against the external pressure to don a sunny disposition and are advocating to allow each patient to choose his or her own way of dealing emotionally with cancer. But the tyranny of positive thinking may be so ingrained in our popular culture that it could take years before attitudes change.
Myth of optimism Barbara Ehrenreich, a journalist and author of the book “Bright-sided: How Positive Thinking is Undermining America,” was diagnosed with breast cancer more than 10 years ago, and soon after learned what attitude was expected of her. Even among other cancer patients, nobody seemed to share her outrage at the burdens of her disease and the prescribed treatment. One day she ventured onto a cancer message board and under the subject line “Angry,” ranted about the debilitating effects of chemotherapy, the fights with her insurance company, carcinogens in the environment and, most daringly, the “sappy pink ribbons.” The rebuke from her fellow patients was swift and powerful. Her attitude, she was told, would do her in and she needed to “run, not walk” to counseling. The experience led Ehrenreich to examine the evidence that a positive attitude improved a patient’s odds of surviving cancer. She found there was little conclusive research to support the claim. The concept that attitude can conquer cancer may be traced back to several wellpublicized studies in the 1990s. One concluded that mental attitude was a better predictor of survival than the size of a patient’s tumor, the severity of their cancer or the patient’s age. Another found that breast cancer patients who expressed helplessness after their diagnosis were more likely to die or more likely to have a recurrence after treatment. Patients welcomed the new findings, giving them at least some sense of control over what is generally an unpredictable process. By 2001, 64 percent of U.S. and Canadian survivors of ovarian cancer in one survey said that stress had in some way caused their cancer and four out of five credited their positive attitude for warding off a recurrence. “I think there was certainly a time when a lot of support programs in the community depended on the suggestion that not only were they providing support, but they were extending patient lives,” said Dr. James Coyne, an oncologist with the University of Pennsylvania. “And I think they’re backing off of that now.”
Paucity of evidence Coyne has been a vocal critic of the trend toward forcing optimism on cancer patients and has conducted research and analyses that dispel the notion that attitude and outcomes are somehow linked. In a large, nine-year study published in 2007, Coyne and his colleagues asked more than 1,000 cancer patients participating in a clinical trial to fill out quality-of-life questionnaires. Over the course of the study, about 60 percent of the patients died, but researchers could not find any link between emotional wellbeing and cancer progression or death. Coyne also led a 2007 review of the evidence behind the link between positive attitudes and outcomes. The analysis found the studies claiming a link were methodologically flawed, often relying on anecdotal reports, or were of such small size that they carried no statistical significance. Many of the studies were plagued by confounding factors. For example, patients with higher income and better social support were more
likely to report positive attitudes, but those same resources may lead to better health outcomes. Similarly, patients with better initial health may have more positive attitudes, and better initial health predicts better cancer outcomes. The evidence, Coyne said, was underwhelming to say the least.
For the sake of others Although the tendency to promote a positive attitude may cross over into other health conditions — the nation took solace earlier this year that Rep. Gabrielle Giffords was described repeatedly as “a fighter” as she underwent treatment following the Tucson, Ariz., shooting — it seems to be most prevalent in the cancer world. “Cancer is scary in ways that more life-threatening conditions are not,” Coyne said. “For instance, a woman being diagnosed with congestive heart failure has a much more negative prognosis, and she has a much rougher time ahead, in what little bit of life she has left, yet no one talks about a fighting spirit in heart failure.” Coyne believes the pressure may come from family and friends who find cancer so frightening they create this myth that the patient can somehow control his or her own fate. It’s a natural defense mechanism. When someone gets lung cancer, others distance themselves from the same risk by attributing it to smoking. Or when someone has a heart attack, acquaintances attack the diet and lifestyle as if to say, “That won’t happen to us.” So when cancers that seemingly appear or reappear for no apparent reason, there may be a tendency to blame the person and their attitude. It’s somehow comforting to us to think we wouldn’t succumb to cancer ourselves because our attitude is better. “You almost burden the cancer person who’s diagnosed with it to protect us from being frightened,” he said. “But I find that often patients recognize that a positive attitude is so discrepant with the experience they’re having, that it’s a front that they feel a need to put on. It’s a way of managing the distress in the people around them.” And Coyne said even doctors and other caregivers have used this to their advantage. “I think that a hopeful cancer patient is a lot easier to manage than one who’s upset,” he said. “Sometimes (oncologists) don’t want the burden to deal with distraught patients and negativity. I certainly know of situations where they’ll pass out antidepressants like candy. It won’t be in the way of a formal diagnosis of depression, but as a way of ending an encounter with a patient who is crying or upset.” Bend resident Nina Behrens, 71, was diagnosed with Hodgkin’s lymphoma in January and is currently undergoing treatment. While she says she’s had wonderful support from her family and friends, she admits she doesn’t always give everybody the real story. “People don’t like to hear constant sick stories,” she said. “And so if anybody asks me how I’m doing, I say, ‘I’m doing really great,’ and try to keep a positive spin on it, and gradually get off the subject. Because I don’t want to talk about it, or it becomes, ‘Oh, here she comes again.’ That type of thing.” Behrens said she does believe a positive attitude is helping her cope with the process, but cancer patients must decide for themselves how they will approach their situation. “I think when people are given this diagnosis, it affects you in such a profound way,” she said. “All of a sudden you think, ‘How am I going to live the rest of my life? Am I going to be like a curmudgeon or depressed, how am I going to do this? Is that the way to live? I don’t want to live like that.’”
A feeling of control A 2001 survey of U.S. and Canadian women who had survived ovarian cancer found that many attributed their diagnosis to stress and their outcome to a positive attitude. The 200 women surveyed had been in remission for an average of 7.2 years.
To what do you attribute your cancer? Stress 64% Diet 39% Genes 37% Environment 37% Hormones 30% Sex life 11% Smoking 10%
To what do you attribute being cancer free? Positive attitude 83% Close medical follow-up 82% Healthy lifestyle 69% Prayer 68% Stress reduction 67% Diet 63% Exercise 59% Source: Medscape General Medicine Greg Cross / The Bulletin
when the family member is not there, They’re more apt to admit, ‘I actually am having some pain, I’m having trouble tolerating this pain, but I didn’t want to burden my family with it.’” Patients quickly learn that most people don’t want to hear the horror stories and feel uncomfortable. “We do that in our lives anyway, and it’s just magnified in the situation of cancer,” West said. “When people ask you, ‘How are you doing?’, they’re not looking for, ‘I’m having marital problems and my sister just lost a baby.’ They don’t want hear that. They want to hear, ‘Oh yeah, things are fine. Let’s get margaritas later.’” But while most people can deal with the social convention of ignoring the negative, for cancer patients, the expectation to be positive can have tremendous consequences. “I see that particularly in this whole notion of a ‘fighter’ attitude,” West said. “There’s a huge difficulty for patients with stage IV breast cancer when they decide they don’t want to fight anymore. A lot of them feel like they lose their whole sort of support system from other patients because other patients are so into this fight mentality.” Instead, patients are pressured to adhere to the unspoken rule that they cannot be negative, that they must fight to the end, and cannot quit. “Which is not necessarily exactly what’s going on,” West said. “It’s a realistic idea of what you want to obtain from treatment
and sometimes the treatment is worse than the disease.” Coyne agreed. “It’s seen all the time in palliative care. In the very last weeks where there’s a real push from family members for aggressive treatment, to really put the patient through unnecessary pain and distress and destruction of the remaining quality of life,” he said. “And often, ultimately the family members resent that they got caught up and feel guilty that they got caught up in this.”
Removing barriers Many ardent supporters of the positive attitude hypothesis maintain they don’t believe that willpower alone can stop cancer in its tracks or prevent recurrence, but that it can be a valuable adjunct to medical therapy. The right attitude, they claim, can maximize the odds that the medical treatment will work, removing impediments, not the least of which is patient adherence to treatment protocols. Patients who feel depressed or fatalistic about their condition might not see the need to meet all of their appointments, take all their medications or take other steps for which there is good evidence of a positive impact. In one study, people who described themselves as optimists were less likely to have diabetes, hypertension, high cholesterol or depression. They were less likely to smoke, to be sedentary or overweight. Others contend there’s a continuum of attitudes that can help cancer patients cope. On one end, there’s a warrior approach to fighting cancer, a modern-day St. George battling the dragon, that’s taken root in the public psyche. On the other, there’s a growing contingent of patients who won’t be told how to feel, who assert their right to be angry, sad, even irreverent about their condition. Researchers maintain that for people who fit the warrior mentality, it’s a positive coping strategy that allows patients to have a feeling of control over their fate. Some oncologists urge patients to visualize the battle between cancer cells and the immune system or their chemotherapy agents, or even illustrate the battle scenes on paper. Sandy Henderson, 43, an event promoter in Bend, used visualization when she went through her chemotherapy in 2003. “What I likened it to was the old Pac-Man game. I would sit there and watch them put the needles into my veins and the chemotherapy is super cold. You can really feel it going through your arms. I just sat there visualizing PacMan, that Pac-Man was coming into my body, and chomping up the cancer and killing the cancer, and that’s how I did it every single time,” she recalled. “I would literally sit there, going ‘chomp, chomp, chomp, chomp, chomp.’ Some people thought I was crazy. I don’t really care, because the thing is, it worked.” Henderson describes herself as the type of person who likes to take control of her life and that while every cancer patient needs to find his or her own road, she wanted nothing to do with negativity. “I think people respond to positive energy, if the sun is shining
and it’s a happy day, then you’re happy. If it’s gloomy, you’re more down,” she said. “If you have someone near who’s being negative about it, you choose not to engage with that person.”
Unintended consequences Still, many patients struggle with the warrior mentality, and despite going through the same treatment and experiencing the same successes as more natural fighters, they wind up feeling they are somehow losing the battle. Nancy Stohrdahl, a freelance writer from Wisconsin who is blogging about her cancer at nancyspoint.com, cringes when she hears reports of celebrities or other cancer patients whose prognosis is linked to a positive attitude. “People don’t know what else to say and they mean well by saying it, but I think it puts pressure on the cancer person because they feel guilty if they don’t maintain a positive attitude,” she said. “If they don’t survive, it’s like, ‘Well it must be their fault.’ If all it took was a positive attitude to survive cancer, everybody would be walking around with a smile.” Katie Hennessy, a licensed clinical social worker at the OHSU Knight Cancer Center in Portland, counsels patients at all stages of cancer treatment and with varied approaches. “Cancer treatment is very hard, and so in some ways, to have a little bit of spirit or feel the push — sometimes I’ve used that word — there’s a push that sometimes can be helpful in walking through the door in the morning here,” she said. “But there are clearly people who are kind of warriors around this, and then there are other people for whom that doesn’t fit.” So when the people supporting a patient push for a positive attitude or a change in nutrition or whatever they think the magic bullet is going to be, it puts tremendous pressure on a patient already struggling with their treatment. “Here this poor person is sick but they’re also getting all this pressure from the people they love to either put on a happy face, pull themselves up by their bootstraps or whatever it is, because they’re going to be sick if they don’t, and they’re going to feel like they’re failing,” she said. But Hennessy thinks the tide may be turning. “I think we are in a little bit of a shift that we haven’t named yet, about authenticity, or at least it feels that way to me,” she said. “There’s been a lot of dominant messages about attitude and positive thinking, but I think it is receding a bit.” Coyne advocates allowing patients to experience their cancer diagnosis and treatment however they want. “Often there’s a whole range of emotions that patients go through, and often they rapidly shift back to forth,” he said. “Just allow them that, rather than hold them responsible for preserving a positive outlook or even a harshly realistic one. I think patients should be able to say all kinds of things.” Markian Hawryluk can be reached at 541-617-7814 or mhawryluk@bendbulletin.com.
Put Life Back in Your Life Living Well with Ongoing Health Issues Workshops begin April 21. If you have conditions such as diabetes, arthritis, high blood pressure, heart disease, chronic pain and anxiety, the Living Well with ongoing health issues program can help you take charge of your life. The six-week workshop and
Interfering with care
the book “Living a Healthy Life with
Dr. Heather West, an oncologist with Bend Memorial Clinic, said she definitely sees the impact of external pressures for positivity on patients. “There is often a big difference in how patients act when they come in themselves, versus when they come in with a family member,” she said. “A lot of times they feel like they need to be positive for their family members, and say everything is going fine. And then
Chronic Conditions” costs only $10.
Living Well serves the communities of Deschutes, Crook and Jefferson counties
Workshop series offered: Bend Workshop Times (please call for class locations)
April 21–May 26, 2pm–4:30pm (Thursdays) www.livingwellco.org
(541) 322-7430