Tag Archive for: cancer

How Cancer Can Affect Your Dental Health

More than one-third of all cancer patients develop complications or side effects that can affect the mouth, according to the National Institute of Dental and Craniofacial Research. While it is probably one of the last things you want to think about when faced with a cancer diagnosis, assessing your dental health and developing an action plan for how you will care for and protect your teeth and gums is a great way to ensure you don’t experience complications that can affect your treatment and general health.

Assessing Your Dental Health

The American Dental Association recommends treating areas of concern before you engage in any cancer treatment as it may help reduce possible side effects associated with chemotherapy and radiation. If you are able to do this beforehand, you will be able to address any issues such as cavities, gum disease or other dental hygiene issues that have the possibility of getting worse as you get further into treatment. They also recommend stopping the use of all tobacco products, eating healthy foods to help make your immune system stronger and rinsing your mouth with hot water, baking soda and salt to ensure it’s clean and not a breeding ground for infection.

How to Care for Your Teeth with Cancer

If you experience issues such as dry mouth, mouth sores, jaw pain or sensitive gums, you will want to speak directly with your doctor as they can provide you with more accurate advice and medications. However, to ensure you’re following a great general oral hygiene routine, it’s recommended to brush twice a day with fluoride toothpaste and to floss every day as it helps remove plaque buildup and keep your mouth extra clean. If your mouth and gums are sore, there are alternatives to traditional flossing that might feel more comfortable. If you are still experiencing pain, try soaking your toothbrush in hot water before brushing to make it softer and look for a toothpaste with aloe vera and allantoin as they’ve been shown to help soothe pain in the mouth.

Common Oral Side Effects During Cancer Treatment

During treatment for cancer, your oral health and dental hygiene can be affected, among other things, due to the fact that your immune system is weakened and you are prone to various side effects. Dry mouth and painful sores are some of the most common side effects reported and can cause issues for the health of your teeth as saliva is generally used to wash away food particles and other bacteria. If you find that are experiencing dry mouth, whether in treatment or not, it is best to ask your doctor for artificial saliva and also fluoride gel. This gel will come with a tray that will slip into your mouth and, with the help of the fluoride gel, strengthens and protects your teeth.

Staying Positive About Your Health

Caring for your oral health is just one aspect of working through a cancer diagnosis and subsequent treatment. It is important to consult your doctor with any concerns you might have and gain a solid understanding of what your treatment will require and how it will affect your dental hygiene. Throughout all of it, however, it is most important to remain positive about your health and work to understand that it is a tough process, but with the right care and support, will only make you stronger.

Returning To Work After Cancer Treatment. Part 1: Preparing the Ground

This month’s article is the first in a three-part series which deals with common concerns on returning to work after a cancer diagnosis and offers practical solutions for helping with your re-entry into the workplace.

A diagnosis of cancer is a profound disruption in our lives, leaving no area untouched. Cancer impacts our family life, our relationships, and our careers.  If you have been absent from work, the decision to return often brings with it mixed emotions.  While you may welcome a return to normality, a steady income, the company of work colleagues and a sense of identity, you may also be feeling apprehensive about how you will cope.

Particularly if you are used to identifying closely with your job, a prolonged absence from work can be difficult. Even if you continue working during treatment, you may also experience some difficulties. You may be wondering how you will cope with your workload.  Will your co-workers treat you differently? How will your boss react to you? Will your promotional opportunities be affected?

Although the majority of those who return (or continue) to work after cancer adapt well, some will encounter difficulties. In Part 1 of this series, we will take a look at some practical ways to prepare for your re-integration back into the workplace.

When Do You Know It Is Time To Return To Work?

There is no one-size fits all answer to the question of when it’s time to return to work. It will depend on the type of treatment you received, your financial situation, your physical and emotional state and other personal factors.

Only you know whether it would be better for your psychological health to be at home, away from any professional stresses, or at work, where distractions may take your mind off other things.  Chris Lewis, founder of Chris’s Cancer Community, believes that “work can be a fantastic therapy, when dealing with life’s challenges. We feel valued, and of course, can provide an income for our family.”

On the other hand, perhaps you see cancer as an opportunity to re-evaluate your career. You may find that your work priorities have changed, or you feel unable to keep up with the demands of your previous work pace. Perhaps you want a new job which will allow you more flexibility to pursue other goals or you may want to explore working in a field which is more personally fulfilling (we will look at this in more detail in Part 3).

Preparing the Ground

Doing some groundwork before you return to work should help make re-entry more manageable.  Plan in advance how you will respond to questions from co-workers, deal with your boss’s expectations, and handle your workload. Here are some tips to help you.

1. Making adjustments and accommodations to your work environment

Your employer has a duty to make ‘reasonable adjustments’ to your workplace and working practices. What is considered a ‘reasonable adjustment’ depends on factors such as the cost and practicality of making the adjustment, which is why it’s important to discuss things as soon as possible with your employer.    Some things to discuss include the possibility (at least temporarily) of a phased or gradual return to work, job-sharing, working from home or flexi –time.

A word of caution here. It is not unusual for part-time work to turn into a full time job. Set clear boundaries about what is achievable in the hours you have agreed to work.  If you are thinking about working from home, be aware that this can be quite isolating. Will you miss the camaraderie of the office?

Breast cancer blogger @lifeafterlola suggests that “A phased return is good, combining time back at work with work from home or a day off on, say, a Wednesday to break up the fatigue. The hardest thing to cope with,” she says,  is getting back up to pace with early mornings, late finishes and travel on top of work and social adjustment.” Julia, co-founder of breast cancer Twitter chat, #BCCWW offers a practical tip to reduce the stress of traveling to work.  “If it’s possible travel outside rush hour,” she advises.

Next, think about your physical environment at work. Revisit you work-station. Does it need to be redesigned or fitted with equipment such as back support or other devices to make you more comfortable?

The size of your company may affect how much accommodation to your needs you can expect to get. Larger organizations are in a better position to offer you more flexibility and support, but most employers will be understanding if you communicate your needs clearly with them. It may be helpful to have a letter from your doctor to document any accommodations required.

2. Getting up to speed with changes at work

Depending on how long you have been absent, you may find things have moved on since you were away from work. If this is the case, take some time to get up to speed with new systems and developments. This may include attending formal training sessions in advance of getting back to work, or having a colleague take some time to get you caught up again.  Julia explains how she struggled initially with her job which “involved reading lots of draft legislation, policy papers, etc.” and after speaking to her boss, did some refresher training to get up to speed again.

3. Updating your co-workers on your plans to return to work

Most of us have built up a carefully constructed professional persona and we work hard at protecting it by keeping a fairly strict line of demarcation between our personal and professional lives. It can be unsettling to find these lines have become blurred by your illness.

Not everyone knows the right thing to say or how best to offer support. Connecting with colleagues before you return to work can, in the words of Julia, “get a little of the first day nerves out of the way, especially  if you are feeling anxious about their reactions to your changed appearance.”

In general people will take their cue from you, so take the lead with colleagues. Talk them on the phone, send an email or arrange to meet for coffee or lunch. Reassure them that you are doing ok and that you still want to be a valued member of the team.  Decide in advance how much you are comfortable sharing.  If you are a naturally open person, then you can talk frankly with your work colleagues, letting them know what they can do to help you ease back into work. If you are more private, just tell everyone that you appreciate their asking, you are doing ok now and you are looking forward to getting back to normal.

4. Communicating with your manager

Most managers and bosses will support your transition back to work, but they may be unsure of how best to handle this. As Kate Bowles points out in this post: “The particular challenge of having oncology patients (which is what we still are) as staff under your management, as colleagues and as workplace friends, leaves everyone falling back on adhoc interpersonal skills.”

It can be difficult for managers and colleagues to know how to strike the right balance between giving you extra support and allowing you to carry on as normal.  As Julia points out “Your line manager isn’t a mind reader. Be honest about what you can/can’t do, offer solutions, about managing work and don’t just leave it to them.  It should be a two way process.”

For your part, you may have concerns about being perceived as a productive member of the team.  Open and honest communication is key here. Check in regularly with updates on how you are coping and to review your productivity.   If there are things that you are not ready to undertake initially, then be honest, and ask for help if you need it. Set clear boundaries that will allow you to say no to certain types of requests, such as staying late for non-essential projects.    “Learn to say I can’t ….YET,” advises Siobhan Freeney, founder of Being Dense, an organization which raises awareness of Breast Density and its associated links to breast cancer and screening.

A note on work discrimination. Legally, your cancer history can’t be used against you in the workplace. But it can be difficult to determine this, because discrimination can be subtle.   Know your rights. Look into whether you are protected by the federal Americans with Disabilities Act or your state’s Fair Employment Law.

5. Book a counseling session

If you are worried about how you will cope on your return to work, consider booking some sessions with a counsellor or cognitive behavioral therapist to build up your confidence and coping skills.  Some employers have an employee assistance program in place which allows you to speak in confidence to a trained professional about your concerns. Ask if this is available in your company.

Learning some stress management techniques in advance of your return will also help you cope better (we’ll look at this in more detail in Part 2).

6. Stock your freezer

When we’re tired, we tend to gravitate towards processed food which depletes our energy reserves further. Siobhan suggests you “stock up handy home cooked freezer meals in advance of returning to work to avoid being tempted to skip dinner when over-tired.”

The key to managing the stress of working after a cancer diagnosis is to prepare as much in advance of your return to the work place. Be prepared to be flexible in your planning approach. Cancer recovery is an ongoing process. There will be many ups and downs.  You may have to deal with late side-effects of treatment or side-effects related to medication. Be ready to adjust your work practices if and when you need to.

Next month, I will share more tips and practical advice on handling your work load, managing your time and dealing with issues such as fatigue and concentration once you return to work. Until then, if you have any tips to share with readers about how you prepared your own return to work, please share them in the comments below.

Patient Profile: Jack Bell

Jack Bell

Hepatoblastoma

Today, Jack Bell is a 13-year-old 8th grader. He’s the second of four siblings, and he’s a generally happy kid. While he doesn’t remember much about it, he is also a childhood cancer survivor. Along with Jack, there are more than 400,000 childhood cancer survivors in the United States, and that number is growing. Over the past 40 years, cancer death rates in children have declined 70 percent. However, with cancer still the leading cause of death from disease among people under age 19, a childhood cancer diagnosis is difficult for the entire family.

“It was not a good time. It really wasn’t,” says Rachel Bell, Jack’s mom, remembering his diagnosis. It was late December 2007. She was expecting her third child in a couple of months and preparing for New Year’s Eve guests, but when Jack, an active two and a half year old, took a four hour nap while she was putting away the Christmas decorations, she took notice. There were other things, too. He fell asleep during a shopping trip to Costco, and Rachel’s husband Ed, who was in charge of bath time, had noticed a protrusion in Jack’s abdomen. With a doctor’s visit coming up, they planned to have it all checked out, but they didn’t have a chance. Jack woke up screaming the morning of New Year’s Eve, and he just wouldn’t calm down. They called the doctor’s office, but were advised to go to the emergency room, where Jack was checked for mono, appendicitis and cystic fibrosis. “They kept ruling things out,” Rachel says, adding that the list of possible illnesses kept getting worse. Unable to determine the cause, Jack was admitted for more testing.It was the next day, New Year’s Day, that Jack’s pediatrician told Rachel and Ed that Jack had cancer.

Jack Bell during chemotherapy, age 2

“It went fast from that point,” says Rachel. “You’re in a completely new world.” Jack had stage four hepatoblastoma that originated in his liver and had spread to both lungs. Hepatoblastoma is a very rare type of malignant tumor, and the exact cause is unknown. Rachel says that in Jack’s case, doctor’s believed it was a fetal mutation in which his liver didn’t stop growing when it should have. Jack had surgery that day. He had multiple masses in both lungs and one in his liver the size of a watermelon. That’s what was pushing his ribs out causing the protrusion in his abdomen.

Jack’s chemotherapy started January 9, and they were making weekly trips to the hospital. They were in and out of the hospital a lot during that time. Anytime Jack had a fever they had to go to the hospital. Just as they were adjusting to their new world, they got another surprise. Though she was not due until February 28th, Rachel went into labor February 5th, and their third son, Sam, was born. Within five hours of coming home with the new baby, they were back in the hospital with Jack who had a fever.

“It was chaos,” says Rachel. She had a new born, a two year old with cancer, and Charlie, her oldest, was five and in kindergarten. In addition, Jack was sick from the chemo and losing his hair. After the second round of chemo they learned that the tumors in Jack’s lungs were gone and the one in his liver had shrunk 50 percent, but it was wrapped around a main artery, and Jack needed a liver transplant. “I just wanted someone to tell me that he was going to be okay,” says Rachel, but no one could do that. Rachel and Ed learned that without the transplant surgery, Jack had only a ten percent chance of survival. With the surgery his survival rate went up to 85 or 90 percent.

Jack got on the transplant list on April 1, but there were indications that the cancer was spreading. Jack’s Alpha-Fetoprotein (AFP) numbers were going up. The AFP numbers serve as a marker for liver health. Normal levels are below ten; Jack’s had been 365,000. Doctors were unable to determine if and where the cancer was spreading, but if it was, it could jeopardize the transplant surgery. So, Jack was moved to emergency transplant status May 1. Rachel, Jack, Ed and Baby Sam had to be ready to leave for the transplant hospital at a moment’s notice. They had to have air transportation available, and arrangements for someone to care for Charlie. “We had to wear a beeper and be ready to leave at any time,” says Rachel, who adds that they were willing to jump through whatever hoops they had to or try just about anything to help Jack. “If they tell you to stand in the street and throw glitter in the air and sing a song, you’re going to do it four times a day,” she says.

On Mother’s Day that year Rachel remembers praying for a liver for Jack, but also being acutely aware that his liver would come from another child, and she grieved for the mother that would be losing her child. It was three days later, May 14, at 3 a.m. while she was nursing Sam, that they got the beep. They had a liver and had to leave immediately. Jack was prepped for surgery which went through the night and ended May 15. The doctors discovered that Jack’s AFP numbers had been correct; the tumor was growing, but it was contained to his liver so it did not affect the transplant. The surgery went very well. Jack was a perfect match to his donor, and they were home by June.

Jack Bell after his liver transplant, age 3

Jack, who turned three during his liver transplant recovery, recently celebrated being ten years cancer free. “Thankfully, he doesn’t remember much,” says Rachel adding that Jack does seem to be very in tune with his health for his age.“He does know a lot about his liver,” she says. Like other childhood cancer survivors, Jack will spend the rest of his life being monitored. Every two months he returns to the hospital for blood work. “I am constantly watching the AFP number,” says Rachel, who adds that after transplant surgery, Jack’s AFP went down to 12, and then to two, and that it has held at two ever since. He also takes immune suppressant medications to prevent his immune system from attacking and rejecting his liver, which has happened twice in the past decade. Jack also has a yearly cancer check that looks for late effects of the chemotherapy which are common among childhood cancer patients due to the effects of treatment on growing bodies. Rachel says that so far, any sign of late effects in Jack, which include some hearing loss, are minimal compared to what could have happened. Late effects can be physical, emotional, and/or cognitive and vary in degrees of severity. “It changes your whole attitude about what is important,” says Rachel.

In 2009, the Bell family welcomed their fourth child, Anna Kate. She is nine now. Sam is 10, and Charlie is 15. Even though Jack doesn’t remember much about his diagnosis and treatment, Rachel says it has definitely shaped who he is. Over the years Jack has become very close with his doctors and nurses and considers them part of his family. He even says that one day he’d like to be a doctor who specializes in the liver. “It’s important for these kids that survive to know how lucky they are,” says Rachel. “There will be a day he understands how serious it was and maybe he’s starting to realize that now.”

Coincidentally, while Jack was recovering from his transplant in May 2008, the United States Senate declared September 13 National Childhood Cancer Awareness Day. Later in 2012, September was made National Childhood Cancer Awareness Month. The proclamation states, “This month, we remember the young lives taken too soon, stand with the families facing childhood cancer today, and rededicate ourselves to combating this terrible illness.”

From left transplant surgeon, Dr. Frederick Ryckman, Survivor Jack Bell, Rachel Bell, and oncologist, Dr. Emad Salman. Rachel says, “I love any chance we get to be with these two docs!”


Sources:

https://www.cancer.gov/types/childhood-cancers

https://www.acco.org/childhood-cancer-awareness-month/