Cancer Basics, an Introduction

This blog is the first of two narratives on the subject of cancer. Because cancer is the second-leading cause of death in the United States today, it seems to be appropriate to discuss this disease, within the newest and most current information.

Cancer was identified in the 1960s as a family of diseases which remains true today, although it is not a “one size fits all” application of information. The Mayo Clinic website on cancer describes this as “any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer often has the ability to spread throughout the body.” Cancer causes changes (mutations) in the DNA of cells, which prompt the workings of the cells to reproduce rapidly to a new formulation of genes, thus increasing production of abnormal cells and tissue. Gene mutations can be something a person is born with, although it is a very small percentage of cancers that result from such genetic patterns. A more common cause of changes in cell life is in response to a number of life cireumstances including factors such as exposure to chemicals, smoking (primary or secondary), radiation, viruses, obesity, lack of exercise, and chronic inflammation.

Perhaps you have heard the adage “listen to your body.” There are general physical signs and symptoms that can occur in our bodies that can prompt someone to seek the evaluation of a medical doctor, for the purpose of “ruling out” or “ruling in” a disease process. Common symptoms that warrant a health exam include:

  • Fatigue that is constant
  • Lump or thickening of the skin or in other locations of the body
  • Weight loss that is unintended
  • Changes in bowel or bladder habits
  • Persistent cough and/or on-going trouble breathing
  • Difficulty swallowing
  • Hoarseness
  • Persistent indigestion
  • Persistent, unexplained fevers or night sweats
  • Unexplained bleeding

While a physician has an expert level of knowledge and experience about causes of cancer, the majority of cancers occur in people who have no known risk factors. A thorough health history assists in diagnosing cancer, or can be a basis for ruling out the disease. It is an important part of diagnosis to consider:

  • Your age: some cancers take years, even decades, to develop, or can occur at a young age.
  • Your habits: excessive sun exposure, smoking, excessive use of alcohol, obesity, unsafe sex, intense sun exposure.
  • Your family history: keep in mind that only a small number of cancer diseases are actually inherited.
  • Your environment: again this refers to smoking, air pollution, chemical exposure.
  • Your health conditions: chronic indigestion can increase your risk of developing colorectal cancer, for example.

There is variation in type of cancer, its severity and extent, the prognosis and options for treatment. Some of these characteristics will be presented in the next blog entry.

SHOP 'TIL YOU DROP . . . or maybe not

My cousin Yvonne has always been healthy, strong, energetic, and capable from early in her life, helping on the farm, and through midlife of raising five children. Even now, I would describe her as a 'young' 80-year-old. She has vigorously led many community projects to completion, is a faithful participant in activities of the church community. However, in recent years her husband has had a series of health crises, requiring Yvonne to focus much of her time and energy on his needs. She never complains, her strength does not waver, and she keeps busy each day with positive energy.

It was entirely unexpected when Yvonne called me some weeks ago to report that she had spent the weekend in the intensive care unit of the hospital. She reported that she had felt “sort of dizzy and off-balance” for a couple days, and her daughter insisted on taking Yvonne into the emergency department where her heart rate was found to be at 150, definitely out of range of the usual adult average rate of 80. With several diagnostic test results in an acceptable range, the heart rate came down to normal with the help of some medication and her provisional diagnosis was atrial fibrillation. This diagnosis, sometimes referred to as “a-fib” is not always cause for great alarm, but if the abnormal heart rate continues, it may indicate that something is amiss.

During this phone conversation Yvonne said she was now taking some pills but didn't pay attention to the names of them or exactly what they were intended to treat. She said her written instructions from the hospital were “return to usual activities.” She sounded strong, we chatted about other family activities, and I had only slight concern about her when our phone call ended.

Within a week, another call came, with more serious concerns for Yvonne. Clearly the hospital staff made some assumptions about her usual daily activities at the time of discharging her from the initial hospitalization; her usual days include care for her husband and a large home. Yvonne said that when she had been home two days she felt just fine and was feeling a bit restless “just sitting around.” She decided to meet some friends for coffee, and during the course of the conversations, the group decided it would be fun to go to the Mall for some shopping. Yvonne described it as “really doing the mall . . . hitting every store . . . finding lots of good sales.” Then, with little or no warning symptoms, Yvonne collapsed at the mall, lost consciousness for several minutes, awakened in the ambulance on her way back to the hospital. Of course her friends felt terrible; of course her family members were upset and greatly concerned.

This time, just one week since the 2-day hospital stay, Yvonne had a full-blown heart attack. Her experiences provide some useful information for all of us to consider. The first concern noted by the physician was a painful reddened area on Yvonne's right lower leg. She hadn't mentioned it to anyone the week prior because she said “What does that have to do with dizziness and heart beat?” Actually, that painful reddened area was a blood clot in her leg, which broke away and traveled to her heart, resulting in the heart attack. When her family brought in Yvonne's pill bottles from home to show that staff exactly what she had been taking, there were no pills to thin the blood. With the initial diagnosis a week earlier, blood-thinner was appropriate treatment to prevent a heart attack, which often can be a complication of atrial fibrillation. To Yvonne's credit, she did take all her written prescriptions to the pharmacy, but that blood-thinner had a co-pay greater than $400. With that “sticker shock,” Yvonne opted out of filling that prescription and promised the pharmacist that she would discuss alternative medication with her doctor – but she hadn't gotten around to having that conversation yet. There are options for blood-thinners that are much less costly.

There is much to be learned from this experience. Following discharge instructions from hospitalization is very important; if instructions are non-specific, ask for clarification. Any and all symptoms need to be reported to the physician, even when the patient isn't aware of the significance of them. Often there are a number of medications that may treat a particular health condition; discuss options with the physician when the costs are beyond the ability of the patient to pay. It is true that time with friends enhances well-being. But within a week of being hospitalized in the intensive care unit was too much for Yvonne, and likely would be too much for many patients. “Doing the Mall” can be a grand outing at some point in Yvonne's future, but the marketing slogan “Shop 'til you drop” should not be taken literally. I am happy to report that Yvonne is getting stronger each day, and she wants others to gain the insight into healthcare and self care that she learned firsthand.

WHEN . . .

In the gospel of Matthew we hear the persistent questions from Jesus' followers: “When did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison and did not help you?” The reply from Jesus speaks to all, both then and now: “Whenever you did it to the least of my people, you did it unto me.”

When we read that passage, it is very likely we hear it from the perspective of one being called to do the helping tasks.  But take a moment in reading this and try to imagine yourself as the one who is hungry or thirsty; imagine yourself in need of clothing for warmth in a Minnesota winter, or imagine yourself sick and without healthcare available, or in prison without legal representation. Jesus speaks to us, calls us to serve those in need. Serving others is what stewardship is about.

The parish nurse is one person among us to assist in care of those who are ill and infirm, who may be experiencing acute short-term illness, or who may be struggling with one or more chronic long-term health issues.  With an acute illness there is sometimes need for hospitalization for a short time followed by a recovery period at home, with a reasonable goal of returning to normal independent living. With chronic and/or complex medical conditions, someone may require care in a hospital followed by a transitional care facility or rehabilitation facility. If health status returns to a reasonable level of normalcy, the individual might return home, but often there is need for extended care in a facility or at home with assistance of healthcare professionals and/or family.

Our pastors provide care for our members through regular visits to those who are in hospital.  When there is a surgery planned, the pastor makes a point to arrive at the hospital early enough prior to the procedure to have prayer with the patient.  The church staff make every effort to learn when exactly someone goes into, and goes home from hospital or care facility.  The patient, i.e. you or a family member, can help with that by notifying the church office when a surgical procedure is scheduled as well as when there needs to be a hospital admission for a change in health status. Try to remember to ask your family or the hospital staff to phone Good Shepherd to inform us of your illness. The reason we ask for this information is found in the verses from Matthew 25, we want to obey the Word of the Lord to visit the sick.

The role of the parish nurse is to visit someone who is ill at a hospital or other care facility, as well as after that person returns home. The reason for this is continuing support, spiritual, emotional, and physical, during a period of healing.  Not everyone regains an optimal state of health, and over time the need for assistance at home is the new normal for the individual.  The decline in health and strength often results in need for assistance in mobility (walking, bathing, everyday activities), at some point driving may be restricted, or there comes a time when the care needed is too complex for family to manage.  In those circumstances, it is not unusual for someone to become homebound.

As we, the congregation, remain faithful in our various callings, we do not want to ignore those in need. We don't want to forget those dear members who can no longer participate as actively in the life of Good Shepherd as they once did. What a privilege and calling to be the church to those who are limited in their ability to be a part of Sunday worship and other means of service and worship.  In addition to regular visits from church staff, there are opportunities for members of Good Shepherd to volunteer to visit the sick and homebound and bring communion to them.  Pastoral Intern Heather Roth-Johnson organized a team of Lay Eucharistic Ministers (LEMs) to bring communion to our homebound members once each month. There are others who have regularly visited the sick and homebound over many years, since the years past when there was a formal Friendly Visitors program at Good Shepherd.  There is opportunity for additional visitors, and it remains fairly informal with some guidance from staff―pastor, intern, or parish nurse.

Imagine again that you may be the one who is ill, frail, weakened or homebound.  Be reassured that a visitor from church is not a social call; it is understood that you are not well, nor strong --- you need not serve coffee and cookies, nor do you need to clean your house. Be assured that any personal private information about you that arises in these conversations is held in confidence by your visitor and not shared with others. You are not any less valued in our faith community because you are limited in your abilities and activities. Please do not let your health condition isolate you from church. Our visitors have the intention and the goal of bringing a friendly greeting, words of encouragement and compassion, prayer, and if you wish, communion.  Our ministry of visiting is enmeshed with our prayer shawl ministry and our prayer chain, as other avenues of expressing care for our members. Be assured that you are not forgotten by the church, nor are any of ever forgotten by our Lord Jesus.

In conclusion, here are some responses from those who are the visitors, and some reactions from those who receive the visit themselves.

“What a privilege to share communion in such a personal and private setting; it felt especially holy.”

“I never knew him before I started regularly visiting him; what a rich history his life and faith have been.”

“She showed me her garden; she feels God's presence in all of nature.”

“It probably did me more good that it did for her!  She wanted me to play her piano so I did.”

“She wept when we left; she was so happy to be included in this sort of worship.”

“I didn't have to worry about what I might say; once I got there, it was a blessing to me, as well.”