Butterflies and Roses

The newly diagnosed breast cancer patient reminds me of a butterfly. Shrouded in transcendent beauty; their fragile nature can be so easily tossed to and fro by the winds of adversity. During this dread experience, they make their way along the path of life with great difficulty sometimes appearing as if there is little direction to their forward progress, yet somehow making it to their intended goal. Sometimes only with great difficulty is their destination accomplished. Sometimes, the flight is smooth and undaunted and occasionally the path leads to an untimely end.

For those who survive and endure the flight the reward is met by a transformation of resolve and duty to help protect the species. At this point they become as roses. Majestic, beautiful yet delicate and filled with sweet nectar of life from which the butterfly may draw its sustenance. The rugged thorns, spawned by adversity, provide an unyielding source of resiliency and protection to the fragile butterflies that descend upon these flowers for sustenance. It is a magnificent transformation that occurs in the lives of these women whom I admire greatly. To play a small but instrumental role in that transformation from despair to hope, to a new fulfilling and more meaningful life, is a daily inspiration and constant testament to the undaunted human spirit. The sadness of those who enter and do not leave only strengthens my resolve to fight cancer together and search harder and work more diligently.

To be among the butterflies and roses has been a pleasure, at times chaotic and thorny, but for the most part beautiful and rewarding. It is my hope that we can all embrace the beauty and hope life brings despite the adversity and sorrow we each must face.

-Charles E. Cox, M.D.

Hints to Help with Cancer-Related Fatigue

Ever wonder why you are so tired all the time? This may be related to your treatment. Here are some hints to help with fatigue you may be having. Your nurse or doctor will review this information with you and answer any questions that you may have.

What is cancer-related fatigue?

Cancer-related fatigue is a feeling of tiredness, often much worse than the tiredness healthy people feel. It may not go away with sleep and can occur when you are not doing anything. It can appear suddenly and is often overwhelming.

It may be physical, emotional and/or mental exhaustion. Your body, especially your arms and legs, may feel heavy. You may have less of a desire to do normal activities, like eating or shopping. You may also find it hard to concentrate or think clearly. Some words often used to describe fatigue include weakness, a lack of energy, sleepiness, drowsiness, confusion, and impatience. Some have described fatigue as ‘I don’t feel like myself’ or feeling drained after activities like cooking or bathing. Other words used to describe fatigue include worn-out, pooped, low blood, low energy with a strong desire to stop and rest or lie down and sleep.

Causes of fatigue

·         Fatigue is one of the most common symptoms of cancer treatment. Problems like sleep disruption, stress, not eating or drinking enough may make fatigue worse. Treatments such as surgery, radiation therapy, chemotherapy or other forms of cancer treatment and their side effects can add to fatigue.

·         Patients who have nausea and vomiting may not eat enough to keep up their energy levels. Anemia, a low blood count of red blood cells, is another common side effect of cancer treatment that is known to cause fatigue. Your doctor will check your blood counts and may order treatment if the counts are low.

·         Emotional stress, coping with anxiety, conflict, sadness, traveling to and from treatments and even tension among loved ones require extra energy, which can add to the feeling of fatigue. Changes in your routine such as sleeping, eating, and working patterns may change and affect your level of energy.

To help avoid or lessen fatigue

Side effects from treatment, such as fatigue, vary among persons with cancer. Here are some tips to help you cope with fatigue:

·         Plan rest breaks into your day. Take short naps or breaks, rather than one, long rest period. Don’t overdo it with rest and sleep. Too much rest can decrease your energy level.

·         Eat as well as you can.

·         Drink plenty of fluids.

·         Pace yourself and stay as active as you can. Do regular light exercise such as short walks if possible.

·         Try easier and shorter versions of activities you enjoy.

·         Try less strenuous activities such as listening to music or reading.

·         Keep a diary of how you feel each day. This can help you plan your daily activities.

·         Share your feelings with others such as in a support group. This can help ease the burden of fatigue and can help you learn hints from talking about your situation.

·         Save your energy for the most important things. Spread your activities throughout the day. Do not force yourself to do more than you can manage.

·         Store items you will use a lot within easy reach and close by to reduce trips.

·         Allow others to do some things that you usually do. Mowing the lawn, food shopping, helping with meals, and running errands are good examples.

·         Become aware of what helps you to feel less tired and make those activities a priority for you.

·         Use proper body mechanics. When sitting, use well-supporting chairs; adjust work heights when possible to avoid bending over; bend at hips and knees, not at back; and carry several smaller loads or use a cart.

·         Limit overhead work by using long handled tools, storing items lower, and asking for help.

·         Avoid extremes of temperature, smoke or noxious fumes, and long, hot showers or baths.

·         Wear a terry cloth bathrobe to dry off after bathing instead of a towel.

·         Learn techniques to help you relax.

Call your nurse or doctor if you

·         Get dizzy

·         Feel a loss of balance when walking or getting out of bed or up from a chair

·         Fall or hurt yourself

·         Have a problem waking up

·         Have a problem catching your breath

·         Have a sudden increase in fatigue

·         Have been too tired to get out of bed for the past 24 hours

·         Feel confused or cannot think clearly

·         Feel your fatigue has worsened

  

If You Need to Call

Our clinic phone number is: 813-793-4272

If you are interested in learning more about support groups, you may contact the nurse navigator, Theresa Winsey at (813) 615-7121. The American Cancer Society also offers support groups. You may call 1-800-ACS-2345 for more information or the local office in Tampa, at (813) 254-3630.

Sentinel Lymph Node Biopsy—Answers to Your Questions

Here is some information about sentinel lymph node biopsy that many patients have questions about.

Q. What is the sentinel lymph node?

A.  The sentinel lymph node is the first node(s) in the body to come in contact with cancer cells as they leave the primary tumor in the breast and start to spread into the rest of the body’s tissues.

Q. What are the benefits of sentinel lymph node biopsy?

A. By removing only the sentinel node(s), the pathologist who reviews the tissue sample to detect cancer will have a more targeted approach and spend more time looking at the areas most likely having the cancer. Also, if the sentinel node is found to be negative for cancer cells, patients can potentially avoid getting more invasive treatment like an axillary lymph node dissection (ALND), which leads to a higher risk of developing lymphedema. Sentinel lymph node biopsies (SLNB) typically lead to shorter recovery times and less post-operative pain than an ALND.

Q. Who is a candidate for sentinel lymph node biopsy?

A. Women who have undergone a breast biopsy and have been diagnosed with breast cancer should ask their doctor if sentinel lymph node biopsy is an appropriate alternative to axillary lymph node dissection for them.

Q. Who is not a candidate for sentinel lymph node biopsy?

A. Patients with non-invasive cancers may not require sentinel lymph node biopsy. Also, patients with known positive nodes may not need SLNB unless other areas are suspected.

  

Understanding the Extent of the Cancer

When a woman is diagnosed with breast cancer, one of the first questions she and her doctor want to answer is, “Has the cancer spread?” Advances in procedural techniques have helped answer this question and improve the physician’s ability to develop a more effective treatment plan for breast cancer. One of these techniques is the sentinel lymph node biopsy, which helps the physician better understand the extent of the cancer, potentially sparing patients from more invasive surgery and/or side effects.

Lymph nodes are small structures located throughout the body that filter out and destroy bacteria and toxic substances. The sentinel lymph node is the first lymph node of the breast. If cancer cells have broken away from the tumor and traveled away from the breast, the sentinel node is more likely than other nodes to contain these cells. By examining the sentinel node, the physician may better determine the status of the entire axilla (underarm area). For example, if the sentinel node is negative for cancer cells, then the remainder of the lymph nodes are more likely to also be cancer free.

Learning About Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy (SLNB) is a minimally invasive technique. For the procedure, the tumor site is injected with a radio-isotope, blue dye, or both. The radio-isotope or blue dye is tracked into the sentinel lymph node. If a radio-isotope is used, a gamma detection device helps the surgeon identify the sentinel lymph node. Once the sentinel node is identified, the surgeon removes the node (or sometimes the first few nodes).

The node(s) are then examined under a microscope. If no cancer is found in the sentinel node, it may not be necessary to remove additional nodes. If cancer is found, more lymph nodes are removed to check for additional areas of cancer.

Studies have shown that SLNB is an accurate way to detect whether or not cancer cells have spread outside of the breast.  These studies have found that sentinel lymph node biopsies have accuracy rates greater than 96% for predicting the presence or absence of cancer cells in the axillary lymph nodes.

Axillary Lymph Node Dissection

Axillary lymph node dissection is an alternative, as well as a follow-up procedure, to SLNB. If the SLNB shows that the cancer has spread to the lymph nodes, an ALND may be performed to determine how many lymph nodes are affected.

Unlike SLNB, in this procedure, multiple nodes are removed at once. The procedure removes more tissue and requires more work around the blood vessels and nerve bundles. Although both procedures have the following side effects, more patients reported persistence of these side effects following ALND than those having only sentinel lymph node removal:

•  Arm swelling and numbness
• Limitations in range of motion
• Time until return-to-normal activities
• Seroma
• Axillary pain

Your doctor may also recommend ALND if you have lymph nodes that feel abnormal or are enlarged.

(Source: Mammotome)


Watch Dr. Charles E. Cox perform a sentinel lymph node biopsy in the video below:

Hooked on Hope 2011

This year's Hooked on Hope was a huge success! Thank you again to everyone involved. Watch the video below to see some of the inspiring messages from speakers at the event.




For more information on Hooked on Hope's events, go to their website and join us in getting Hooked on Hope!

Alcohol Consumption and Breast Cancer: How can it affect me?

Recent news about alcohol consumption and breast cancer raises questions about how much a person should or shouldn't drink. Dr. Rache Simmons explains how the findings in a recent study could affect you.

What is a Breast Cancer Patient Navigator?

I have been asked frequently, “What exactly do you do??” The answer, quite frankly, is…..a little bit of everything!

Every day brings with it a different set of issues and challenges as I assist our patients through this very confusing and sometimes daunting maze of health care. On any given day you might find me in the Women’s Center recovery room at the bedside of a patient and her family after her breast cancer surgery…or in the chemo lab sitting with a patient as she is being given her treatment…perhaps at the Breast Care Center to be there for a woman that has just learned she has breast cancer, or in Radiation Oncology helping a patient apply for Medicaid or other financial assistance. Many times they are here from out of town and need assistance with lodging during their treatments. While a large part of my role is centered on the breast cancer patient, I also navigate our other cancer patients as they undergo radiation therapy treatments. Since this was a new role, it was a “learn as you go” experience in the beginning. Three years later, this role has expanded to include navigation of all of our cancer patients.

The role of cancer navigation may be new to our facility, but it has been a real concept for quite some time. The idea originated in 1990 by Dr. Harold Freemen at Harlem Hospital Center in New York City. The goal of the program, funded by an ACS grant, was to ensure that a patient with a suspicious breast cancer related finding would receive timely diagnosis and treatment. Additionally, the hospital provided free and low cost screening mammography, as well as outreach and public education efforts in the community. With all this in place, the 5-year survival rate for patients diagnosed with breast cancer at Harlem Hospital jumped to 70% in 2000 compared to 39% in 1986! From this pilot program, patient navigation has grown into a national movement and encompasses programs sponsored by ACS, NCI, and Centers for Medicare and Medicaid services.

So, what exactly does a Breast Cancer Patient Navigator do?

v  A Coordinator of patient-care activities to support the transition from diagnosis to treatment.

v  A provider of educational information and support to all patients concerned about their breast health.

v  An educational and emotional consultant for women with benign breast diseases

v  A supporter of the cancer patient and the family in understanding and coping with the strong emotions that accompany a cancer diagnosis. She remains a constant caregiver and overseer of the patient’s educational, emotional and social needs.

v  A provider of educational resources for the patient and the family to answer their questions and address their fears during the cancer experience.

v  A facilitator of physicians’ recommendations for patient care to help ensure patient compliance and understanding.

v  A triage manager in assessing patients’ educational and social needs identifying healthcare barriers and appropriately referring to the proper source of help.

v  An educator for other medical personnel in understanding benign and malignant diseases, their treatment and the patient’s emotional and social recovery from the disease.

v  A public educator on the early detection of breast disease and breast self-exam skills.

v  A public advocate for the needs of cancer patients and their families.

When the plans for our Breast Care Center were in early stages, it became evident that in order to be successful, this was how we needed to model our breast program--and so the role of navigator was established. Studies have shown that hospitals with navigators in place have increased patient satisfaction, increased physician referral, but more importantly, increased survival rates. I am proud to say we have accomplished the same goals set forth by Harlem Hospital 20 years ago. We offer free screening mammograms to the uninsured women of our community through our “Heroes ’n Heels” program. We have established a library of books for our patients to educate them on all aspects of cancer treatments, as well as prevention and nutrition. The education does not just exist for the patient; I also incorporate education and support for the family and caregiver of the patient. We have initiated a lymphedema program in the Physical Medicine department for our post mastectomy and lumpectomy patients.

Imagine being given a diagnosis of cancer…the shock, the fear, and the disbelief are numbing. You don’t know what to do next---who to call…what appointment should I make? Which doctor to make it with? What other tests do I need? How will my films and reports get there? What about disability? Can I receive financial assistance? Am I going to die? What about my children? How do I get to my treatments? Can I work through my treatments? Will I lose my hair? Where do I get a ...wig? These are just a few of the concerns my patients have when they are diagnosed.

When a patient at the Breast Care Center is given a diagnosis of breast cancer, I am there with the Radiologist to offer her a folder full of pamphlets and books, support group information, appointments, etc. Depending on which surgeon their referring physician prefers, an appointment has been made for them. A breast MRI is already ordered and, if necessary, an authorization is in process. She will get a personalized card in the mail from me, the first of many I send to my patients as they go through this journey. I follow this patient and her family through her entire experience--from surgery to treatment--into survivorship. I offer the same support for the already diagnosed cancer patient as they begin their radiation treatments.

The rewards of this job are immeasurable. There is not a day that I don’t give thanks for my health and that of my family. My patients teach me the priceless treasure of not taking that for granted. I am blessed beyond measure that these brave people allow me, someone they did not even know before the moment that their lives changed so dramatically, into a very private and intimate experience. They have no idea how honored I am by it and how each and every one of them have changed my life.


By Theresa Winsey, CBPN-IC

For Theresa's contact information, visit our website.

A Story of Survival!

thinkpink

In the latest edition of Think Pink, from The Ledger a former patient of Dr's. Mary Gardener and Charles Cox shares her remarkable story of survival.

Here is a link to her story. Check it out!

Stories From Community Survivors-- Gail Allen

To see the entire issue of Think Pink, click HERE. There are some great articles about patient survivors, body image, breast reconstruction, and information from the American Cancer Society on many resources they provide for breast cancer patients.