Awareness is the key to Prevent Suicide

Suicide…the last act of a depressed, dejected and despondent being, which they choose as a last resort to solve their life’s problems. But is suicide really a solution? Although the body can be freed from worldly pain through suicide, can the soul?

According to statistics from the WHO, there is an average of 1 suicide every 40 seconds all over the world. This means while you’re taking a sip of your cup of tea, , somewhere in the world someone is voluntarily taking a vacation from life. Even Bangladeshi statistics for suicide are quite alarming. According to sources, a total of 14,436 people died due to suicide in Bangladesh last year alone, which is 70% more than the total number of deaths due to corona in the first year of the country’s corona epidemic. But as much as we have been able to stay aware and take precautions for the corona epidemic and other physical problems, have we been equally aware and prepared to resist this silent killer called suicide?

The first important step in preventing suicide is to find out the reasons why a person chooses this path. Suicide is usually the ultimate manifestation of some mental disorder, one of which is depression. Sufferers of depression, often failing to achieve any dreams or goals, feel that their lives are meaningless at some point; as a result, they seek salvation through suicide. People may also choose this extreme approach due to stress, relationship problems, fear of loss of respect, family problems, physical pain, drug addiction and psychological abuse. According to WHO statistics, suicide rates are higher among people under the age of 30. Men are more vulnerable than women. On the other hand, apart from these regular reasons, the financial crisis caused due to the ongoing coronavirus epidemic, tension in relationships and depression caused by loneliness, the tendency of people to commit suicide has increased significantly.

There are several signs shown by a person at risk of suicide, which can largely help in predicting their decision. This is because suicidal tendencies don’t develop overnight. On the contrary, after a long period of time, the person loses his will to live when depression and shame accumulate in their mind. During this time, various negative thoughts are seen in the speech and activities of the person. Self-hatred, guilt, feeling like a burden to others etc. emerge in their conversations. Such people tend to be restless, get easily irritated by everything and distance themselves from friends and family. They even start searching online for various suicide execution plans.

A suicidal person’s thoughts usually go round and round in circles, and at some point, they unknowingly push themselves towards suicide. Therefore, a person at risk of suicide can mostly be helped by family members and close friends. In many cases, a suicidal person has communicated his or her thoughts directly or indirectly to those close to them through social media. Therefore, it is important to discuss with loved ones as soon as any such symptoms are seen. They need to be convinced that suicide is not a solution to the problem and that it is possible to find alternative ways to solve it. In addition, any deadly and dangerous material should be kept out of the reach of these vulnerable people. Above all, the person at risk should be referred to psychiatrists and psychologists as soon as possible. This is because proper care and counselling can help turn a suicidal person away from this path.

Loving yourself and those you love, and a little attention and care from your loved ones can prevent this silent killer called suicide. Negative thoughts like suicide can be eradicated only by making life meaningful and enjoyable through social values, mutual harmony and understanding. This requires education, discussion and above all, awareness. So let us be aware and help others to be aware. Let awareness be the key to prevent suicide.

 

Fabia Alam
ounselor
Evercare Hospital Dhaka

Heart disease: the new concern for young people

In today’s world, heart disease, cardiac arrest or heart attack is considered to be one of the leading causes of death. At one time, it was thought that only the elderly were at risk of heart attacks. That notion is now deemed irrelevant due to the current situation, where young and middle-aged people are now suffering from heart attacks.

Around 20 million people worldwide die from cardiovascular disease each year, accounting for about 32% of global deaths. 60% of these deaths are due to heart attacks; coronary heart disease accounts for three-quarters of deaths in low- and middle-income countries in South Asia. In developing countries like Bangladesh, the risk of death due to heart disease is about 14.31%. In the last 10 years, the death rate due to heart attacks has increased 35 times for men and 48 times for women in Bangladesh. What is most alarming, however, is that incidents of heart attacks are gradually increasing among the younger generation.

Although common, many people may not know what a heart attack is or why it happens. For their convenience, I would like to convey the information that Myocardial Infarction, heart attack or whatever you may call it, is a medical complication when blood flow to the heart suddenly stops due to an obstruction. Plaque, also known as a block, is usually formed by the accumulation of fat and cholesterol in blood vessels. It is one of the main causes of a heart attack. Simply put, a blocked artery blocks the flow of oxygenated blood to a part of the heart, which results in a heart attack. If the blocked artery cannot be reopened quickly, the part of the heart that was supplied blood by that artery stops working, leading to death.

Symptoms usually appear days or weeks before a heart attack. If a doctor is consulted, the risk of death decreases with proper treatment; but in case of a sudden heart attack, the risk of death is quite high. A sudden heart attack is undoubtedly a large shock for the body and there is no specific age at which it occurs. Rather, the risk increases when there are inconsistencies in your lifestyle, consumption of unhealthy food, genetic problems, stress etc. But to think that it is asymptomatic because it occurs suddenly is the wrong assumption to make. Some of the symptoms of a sudden heart attack are constant pain or pressure in the chest, which lasts for a few minutes and can happen intermittently; you may feel pain while working, and then feel better while taking a rest. Besides this, nausea, indigestion, excessive sweating, fatigue etc. are some common symptoms of a sudden heart attack; but it is not the same case for everyone. On the other hand, another possible cause of death due to heart attack is post-Covid heart problems. Many who have recovered from Covid-19 have experienced blood clotting problems, which increases the risk of heart attacks.

It is true that the risk of heart attack increases as you get older. It also goes without saying that the risk skyrockets if there are problems with the heart and blood vessels.

Except nowadays, incidents of heart attacks are increasing at a significant rate even at a young age. The last 10 years of Global statistics show that heart attack rates among young and middle-aged adults have increased by 2% per year. According to doctors, inconsistent changes in modern lifestyles and physical inactivity are the two major reasons for increased problems in the heart and blood vessels. Incidents of heart attacks among young people are increasing day by day due to excessive smoking, lack of physical activity, not enough sleep, weight gain, excessive anxiety, eating unhealthy food, especially fat and cholesterol-rich food, diabetes, unhealthy lifestyle, hereditary causes etc. – but what is the best way to cure it?

The answer is very simple. Young or old, a heart attack can be life-threatening for anyone. Even if it doesn’t result in death, it can cause serious damage to your health. So, you need to get used to a lifestyle that does not increase the risk of heart problems. Eat food that does not clog blood vessels. Do things that keep your body active. The steps you can take to maintain this are to keep heart-friendly healthy food in your diet, exercise daily, avoid drugs and tobacco products, keep yourself cheerful, and if there is a history of a heart attack in your family, get screened from a young age. Even if not immediately, the risk of heart attack will decrease gradually.

Every living being must taste death; but a premature death is something no one desires. Heart attacks have become one of the leading causes of premature deaths among young people in recent times. So, everyone must be aware, and become interested in living a healthy life to prevent deaths due to heart attacks.

Prof. Dr. A.Q.M. Reza
Coordinator & Senior Consultant- Cardiology
Evercare Hospital Dhaka

Advanced treatment for Uterine cancer now in Bangladesh

41-year-old Piara Begum, a resident of Bhola. She was suffering from a tumour, situated in her uterus, for 9 years. It was initially small in size, so she did not consider it a major problem; but slowly the tumour started to grow in size, increasing her problems. At one point, her condition worsened and abnormal bleeding started. When Piara Begum did not receive any solutions from her local doctor in Bhola, she was moved to Evercare Hospital in Dhaka.

Her treatment started under Dr. Monowara Begum, Senior Consultant and Coordinator of the Department of Obstetrics and Gynaecology at Evercare Hospital Dhaka. Diagnoses revealed that Piara Begum had endometrial polyps in her uterus, due to which she was bleeding continuously. Anaemia was also diagnosed due to this bleeding. This was temporarily solved by supplying her with two bags of blood. Dr. Monowara Begum decided to remove the patient’s tumour through an immediate laparoscopic hysterectomy. Piara Begum’s tumour removal was successful. Dr. Monowara Begum sent the patient’s removed tumour for a biopsy. As everything had been done properly, and there were no complications after the surgery after one day of observation, the patient was discharged.

A few days later, when Dr. Monowara Begum received the patient’s biopsy report, she found that the tumour had turned into cancer because it had been in the patient’s body for such a long time. Piara Begum’s grade-3 stage-2 endometrioid cancer had infected more than 50% of her uterus. So, to save the patient at this stage, the doctor decided to perform lymphadenectomy again through laparoscopy and then radiotherapy. The patient underwent lymphadenectomy followed by the removal of her ovaries along with the affected part of the pelvic lymph nodes, and radiotherapy for further treatment of the cancer. For this purpose, Piara Begum was taken to the operation table for the second time and was operated on successfully.

Laparoscopic surgery is now well known to everyone. Today many surgeries are done this way. Surgery through laparoscopy is less painful as minimal or small cuts are made in the patient’s body and the wound heals faster. Therefore, the patient does not require any long post-operative observation. The patient can soon return to a normal life.

Although laparoscopy is used to treat cancer surgery in foreign countries, it was not common in Bangladesh until now. Recently, cancer surgery is being carried out through laparoscopy in Evercare Hospital Dhaka. If the patient’s cancer is in the early stage, then it is possible to treat it with this method of surgery. Evercare Hospital Dhaka is always ready to provide better and more effective treatments to patients through new technologies.

Due to the skillful hands of Dr. Monowara Begum, Senior Consultant and Coordinator of the Department of Obstetrics and Gynaecology at Evercare Hospital Dhaka, Bhola resident Piara Begum is now clear of danger. After two such major surgeries, the patient had no complications and is slowly recovering. She also expressed her gratitude for the sincere support she received from everyone after being admitted to Evercare Hospital Dhaka.

Radiotherapy or Radiation Therapy During Breast Cancer

Radiotherapy or radiation therapy is the use of high-energy x-rays, protons or other particles to eliminate cancer cells. Fast-growing cells such as cancer cells are more sensitive to the effects of radiation therapy than normal cells.

Breast cancer can be treated through radiation therapy in different ways

EBRT — External Beam Radiotherapy or external radiation:
A device delivers radiation from outside the patient’s body to the breast. This is the most common type of radiation therapy used for breast cancer.

Internal Radiotherapy or internal radiation (brachytherapy):
An object that delivers temporary radiation to the patient’s breast is placed in the place where the cancer was, after surgery to remove the cancer.

Radiation therapy can be used to treat breast cancer at almost every stage. Radiation therapy is an effective way to reduce the risk of breast cancer recurrence after surgery. Additionally, it is also commonly used to ease symptoms caused by cancer that has spread to other parts of the body (metastatic breast cancer).

Radiation after Lumpectomy:

If there is any breast tissue left after breast cancer surgery, it is called a Lumpectomy or Breast Conservation Surgery or Breast-conserving. After this surgery, radiation is recommended to eliminate the cancer cells. Adding radiation after a lumpectomy greatly reduces the risk of cancer returning to the affected breast. Lumpectomy combined with radiation therapy is often referred to as Breast Conservative Therapy. This type of treatment is just as effective as the removal of all breast tissue or a mastectomy.

Radiation after mastectomy:

Radiation may also be used after mastectomy. In this case, the decision is made based on the patient’s pre-operative cancer status and the post-mastectomy biopsy report.

In the past, radiation therapy or radiotherapy was given for a long time – for almost 5 to 6 weeks, but now there are also options for giving radiotherapy for 3 weeks or even just 1 week.

If the breast cancer has spread to other parts of the body, which we call metastasis, radiation therapy may be recommended to help reduce the cancer and control symptoms such as pain.

Side effects from radiation therapy can manifest in a variety of ways depending on the type of treatment and which tissues are being irradiated. Side effects are usually most noticeable from the third week or towards the end of radiation treatment. Some side effects of radiation treatment for breast cancer are:

Mild to moderate fatigue
Skin irritation, such as itching, redness, peeling or blistering
Swelling of the breast
Swelling of the arm (lymphedema) etc. if the lymph nodes under the arm are treated.
However, most of the side effects go away or subside after a few days, and advanced treatments are likely to reduce the side effects.

A radiation oncologist is a doctor who specializes in treating cancer with radiation. The radiation oncologist prescribes the appropriate therapy for the patient, monitors the progress of the treatment and provides necessary treatment for side effects if necessary. Radiation oncology medical physicists and dosimetrists also perform calculations and measurements related to radiation dose and delivery. A radiation technologist administers treatment to a patient using a radiation therapy machine. A radiation oncology nurse or physician’s assistant answers questions about treatments and side effects and helps manage the patient’s health during treatment. Therefore, it is “teamwork” and with the participation of all the people mentioned above, radiation therapy is successfully completed.

Currently in our country, many hospitals organize tumour boards before starting any cancer treatment. A tumour board is a very important topic in cancer treatment. This is because a tumour board includes an operation doctor, a radiotherapy doctor, a medical oncologist i.e. chemotherapy doctor, a histopathologist i.e. who reports on biopsies, a radiologist i.e. who reports CT scan-MRI and other members. Their objective is to prescribe an international standard treatment pathway for the patient. After that, according to the advice of the doctors on the tumour board, neoadjuvant therapy is sometimes used to reduce the size of the tumour during the treatment of breast cancer and then proceed to surgery. In many cases the operation is done before everything else. Sometimes treatment is started through Hormone Therapy Treatment. However, before starting treatment with Hormone Therapy, it is necessary to know the status of hormone receptors by immunohistochemistry along with a biopsy. This is how a patient is treated for cancer through surgery, chemotherapy, radiotherapy, hormone therapy and sometimes immunotherapy. Due to unprecedented advancements in medical science, now our country has all kinds of treatment options for breast cancer patients. You just need to find the right doctor and the right hospital.

Dr. Arman Reza Chowdhury
Cancer specialist
Consultant – Department of Radiation Oncology
Evercare Hospital Dhaka

Heart Disease: Getting Serious About Prevention

Here’s one more way men and women are equal: neither sex should have heart disease.

New data:

Last year, Finnish investigators showed that 4 of 5 heart attacks in men could be avoided. All the men had to do were five things: be modestly active, eat a good diet, not smoke, drink alcohol moderately and maintain a normal body weight.  The findings of this robust study made an impression on the cardiology community. But it was a study of just men.

This year, a group of American researchers reported similar results in women. In the Nurses’ Health Study, women had to do six things to avoid heart disease: not smoke, keep a normal body weight, exercise 2.5 hours per week, eat a good diet, drink less than 1 alcoholic drink per day and watch less than 7 hours of TV each week. In this 20-year study, the 23-44 year-old nurses who made those basic choices were 73% less likely to get heart disease. These were nearly the same odds as the Finnish men.

There was a bonus in the Nurses Health Study. The same six lifestyle factors prevented 93% of diabetes and 57% of high blood pressure in women.

Inactivity:

A note on watching too much TV: three studies published this month showed inactivity—sitting for long periods–was linked to higher rates of heart disease and even death. Although regular exercise lowered the risk,  it did not eliminate it. (Athletes with desk jobs pay attention to that.)

Although the research on “sitting disease” is still early, not sitting in one place for hours at a time may be an important way to live longer and better.

Changing the language:

Perhaps the most important thing about this new research is its effect on the language of heart disease prevention. Rather than treating diseases like high blood pressure and high cholesterol, doctors are looking at the basic and fundamental things that keep us from getting heart disease. Moving our bodies, making wise food and drink choices, not smoking and getting away from white screens will deliver far more health than any pill or capsule.

I know what you may be thinking: This is not new.

That’s partly true. But what’s different is that these studies are changing the way doctors think. They may now emphasize lifestyle changes before drugs. More doctors are writing prescriptions for exercise.

Remember these numbers: four out of five.

For four out of five men or women, heart disease need not happen. It is not necessary. It is not normal to let heart disease do this to us.

How to Get a Handle on Your High Blood Pressure

High blood pressure is a condition that patients tend to dangerously underestimate – many people just don’t take it very seriously. But they should. It’s a leading cause of death and disability; in fact, it’s been estimated that high blood pressure is a primary or contributing cause of over 400,000 deaths per year – that amounts to more than 1,100 deaths per day.

So why aren’t we more afraid of it?

I think the answer is a mix of familiarity and treatability. The recent statistics show that roughly 50% of adults have it – so most of us probably know someone with high blood pressure. And most of us are aware that it is treatable – we can take medications and make lifestyle to keep it under control.

The problem is, we’re not keeping it under control.

According to the CDC, only about ½ of those with high blood pressure are adequately controlling their condition. Some people are unaware that they have high blood pressure. Others are reluctant to take high blood pressure medications because of real or perceived side effects; or maybe they don’t want to (or can’t) make the needed lifestyle changes. But one of the biggest reasons people aren’t controlling their blood pressure is that they’re having trouble getting an accurate view of what their blood pressure numbers are exactly.

In the past, high blood pressure was determined by the blood pressure reading your get in your doctor’s office. But data has shown that blood pressures in the doctor’s office are often not accurate – even up to up to 65% of the time.

So, if you have, or are concerned that you have, high blood pressure, monitoring your readings away from your doctor’s office is crucial.

Here are the recommendations I give to my patients about monitoring blood pressure at home:

  1. Get a monitor where the cuff goes on your upper arm.  And make sure it’s the right size for you. Well-rated devices cost between $25 and $100.
  2. Sit quietly for at least 5 minutes before you take your blood pressure.  Make sure the cuff is on your bare arm and not over clothes.
  3. Vary the time of day that you check your blood pressure. Record your results and bring them with you to your next doctor’s appointment.

Blood pressure greater than 180/120 mm Hg is called a hypertensive crisis.  If you aren’t having any symptoms, it may be reasonable to wait 5 minutes and check it again before contacting your health care professional. If you are having any concerning symptoms (at any level of blood pressure), such as chest or back pain, shortness of breath, numbness or weakness or difficulty with your vision or speaking, you should call 911 immediately. 

Appropriately monitoring your blood pressure is an important opportunity for you and your doctor to work together to make sure you get the best treatment for your blood pressure.

Not All Blocked Arteries Should Be Fixed. Here’s Why

If you think all heart artery blockages should be fixed, you’re not alone. For years, cardiologists also thought if we can open a blocked artery with a stent or a balloon, we should.

It makes sense, but in some cases, it’s wrong. Let me explain.

Reviewed by James Beckerman on 9/9/2019

Doug is a 67-year-old man who came to see me because he feels like he’s a little slower during vigorous exercise than he should be. He doesn’t have chest pain or shortness of breath, and his endurance is good, but he’s not able to keep up as well as he wants. Part of the investigation into his symptoms included an exercise treadmill test – a stress test – which indicated ischemia, meaning it showed the possibility of blockages in his heart arteries.

An exercise stress test is useful, but isn’t highly accurate. So, to confirm a positive stress test, we usually run an additional test to look at the arteries themselves. In Doug’s case, I recommended a CT coronary angiogram, which is an x-ray test that directly evaluates the heart arteries to assess for blockages. Doug’s study showed a highly narrowed artery in his heart. Importantly, this artery was a minor one that provided blood to a relatively small area of his heart. When I told him the results, he was initially surprised I didn’t recommend fixing this blockage with a stent.

Who Needs a Heart Artery Stent?

There are almost one million heart artery procedures (called PCI’s or percutaneous interventions) done each year in the U.S., making them among the most common surgeries performed. But, recent research suggests some of these surgeries may not be necessary.

In broad terms, heart artery stents are performed in two situations. One is during a heart attack or an impending heart attack. This is called acute heart disease. The other is when stress tests or other heart artery tests discover blockages. This is called stable heart disease.

During a heart attack, it is well accepted that opening the heart artery with a stent procedure is beneficial. There is solid research evidence that opening the artery lowers the risk of death, further damage to the heart, and future heart failure.

However, the same is NOT true for most blocked heart arteries discovered by stress-testing when the patient is not having a heart attack.

While it seems logical that opening blocked heart arteries would be helpful, multiple research trials have not shown a benefit to fixing blocked arteries in stable patients.

One of the first large research studies that showed opening blocked heart arteries in stable patients did not save lives was the COURAGE trial. This study compared people who had heart artery blockages treated with stents and medications to those treated with just medications. After following these individuals for almost five years on average, there was no difference in death rates or heart attack rates between the two groups.

The result was a surprise for many cardiologists, and the study was criticized for several potential flaws.

However, a more recent trial showed the same lack of benefit for stents in stable patients.

The ISCHEMIA trial of over 5,000 people with a blockage in a major heart artery were randomized to fixing the blockage and medications or just medications. Just like the COURAGE trial, the study found no differences in death, heart attack, heart failure, or hospitalization between the two groups.

It is now generally accepted that stents in blocked heart arteries in patients who are not having a heart attack do not lower the risk of death or future heart attack. However, the COURAGE and ISCHEMIA trials did show a decrease in chest pain for those who had stents compared to medical treatment alone, but even this benefit is controversial

The decision to perform a stent in a heart artery involves weighing the risks and benefits. In the case of heart artery stents, the risks of the procedure are known. While infrequent, serious complications such as heart attack, stroke, or even death can occur in less than 1% of cases. Bleeding complications, kidney damage, or an allergic reaction are more common, although still infrequent.

However, if there is no benefit to the procedure, ANY risk is unacceptable.

The decision to perform a stent procedure is a complex one. There are numerous factors to consider, too many to explain in a single article. So, to decide the best course for you, have a thoughtful discussion with your doctor to explore the medical risks, benefits, and alternatives, balanced with your values and goals.

After I reviewed the medical information with Doug, we decided that his symptoms were unlikely due to his heart artery blockage. Since a stent was probably not going to help him feel better, and we knew it would not lower his risk for death or heart attack, we decided on treating his heart artery disease medically. We started an aggressive prevention treatment regimen that included excellent blood pressure and cholesterol control, along with his healthy lifestyle.

One year later, he continues to do well.

High Blood Pressure? These 3 Things Could Save Your Life

If you’re concerned about your high blood pressure, you’re right to be. High blood pressure is called the silent killer for a reason.Although high blood pressure typically doesn’t cause symptoms, it has a devastating effect on our health. High blood pressure is the primary or contributing cause of more than 1,300 deaths every day in the U.S. That’s someone dying almost every minute. It’s one of the leading causes of two of our most feared diseases, heart attack and stroke, and also increases the risk for dementia and kidney failure.

How to Check Your Blood Pressure

Roll up your sleeve and slide on that blood pressure cuff. It’s important to check how well your heart pumps blood.

ABOUT

These numbers are frightening, but here is something even more striking.

Almost all the deaths, diseases, and disabilities caused by high blood pressure are preventable.

We just aren’t doing it.

The Surgeon General’s Call To Action To Control Hypertension notes that only 1 in 4 people with high blood pressure have it under control.

As a cardiologist, I think this is unacceptable, so I have come up with the three most important things I want all my patients to know about lowering their blood pressure — and possibly saving their lives.

1. Know your numbers.

If possible, check your blood pressure at home. Reliable automatic blood pressure cuffs (get the ones that wrap around your upper arm) are inexpensive and widely available.

Although it is tempting to rely on the blood pressure from your doctor’s visits, the reality is these blood pressures are more likely to be inaccurate than not. Regularly checking your blood pressure at home — it’s critically important to sit quietly for 5 minutes before taking it — will set you up to be your own blood pressure expert and help guide your doctor in the best treatment options for your blood pressure. Talk to your doctor about how often to check your blood pressure and when. Empty your bladder beforehand, and wait at least 30 minutes after exercise, smoking, or drinking caffeine.

2. Treat the cause of your high blood pressure.

If you had a continuously running kitchen faucet, you wouldn’t treat it by bringing a mop. You would turn the faucet off. The same logic applies when treating your blood pressure. If you have a cause, the best treatment will be eliminating the cause.

Common causes of high blood pressure include:

  • Sedentary lifestyle — Even modest levels of activity can lower your blood pressure and minimize medications.
  • Eating highly processed food — Particularly if high in sodium
  • Being at an unhealthy weight — Losing 5%-10% of your weight can lower your blood pressure as much or more than any medication.
  • Excess alcohol — More than a drink a day can increase your blood pressure.
  • Untreated sleep apnea — Experts estimate 30%-50% of people with high blood pressure have sleep apnea, most untreated. If you snore, don’t wake up feeling rested, or your partner notices you periodically stop breathing while asleep, ask your doctor if you should be checked for sleep apnea.
  • Primary aldosteronism — This is a hormone problem once thought to be quite rare, but recent research has shown it to be relatively common. If your blood pressure is not well controlled on several medications, ask your doctor if high aldosterone levels could be the cause.

Talk to your doctor about what may be causing your high blood pressure. Certainly genetics are important, but experts estimate half or more of high blood pressure is caused by factors we have control over.

3. Take your medications.

Nobody wants to take medications. I get it. And I’m a firm believer we all should be selective about any medicines we take (including supplements) and know the benefits and risks.

However, if you know your blood pressure is regularly over 130/80 — even after doing all you can to treat high blood pressure causes — not taking your blood pressure medications puts you at higher risk of heart attack, stroke, and early death. The first-line blood pressure medications are effective, inexpensive, and have a low risk for side effects. It is critically important to work with your doctor to have a strategy for treating your blood pressure that makes sense to you and controls your blood pressure.

Although high blood pressure often doesn’t cause symptoms, its effects on our health are potentially devastating. But you have more control than you may have realized to lower your risk for heart attack, stroke, and early death. By following the three steps above, you are well on your way to controlling your blood pressure — and not becoming a statistic.

6 Simple Rules to Heart Healthy Eating

What is a heart healthy diet?

When I first became a cardiologist about 15 years ago, the answer to this question seemed simple. It was a low-cholesterol, low-fat diet. Unfortunately, that answer ended up falling apart. Turns out, eating foods with cholesterol probably doesn’t have much influence on your cholesterol levels; but eating processed, packaged foods with a “low fat” label has been terrible for our health.

Today, the answer to the heart healthy diet question is more controversial. Is it low carb? Plant-based, vegan, Mediterranean, gluten free, DASH? The list goes on, and each diet has their advocates.

But who is right? Unfortunately, the “experts” haven’t been very helpful. Each one seems to have research and reasons “proving” why their diet is best (and why you should buy their book).

There was a time when I wasn’t sure what to tell my patients about a heart healthy diet.  So I did my own research. I read the important papers, attended conferences, talked to the experts and my patients to see if I could cut through the noise to come to a simple message I could share with my patients.

In the beginning, the more I learned, the more confusing it was. Research findings were often conflicting and seemed to change weekly. Each diet had testimonials of success –  even the ones that seemed to directly contradict each other. In the end though, I came to see that we have been overcomplicating the task of eating well.

Here are the tips I give to my patients who are looking for a heart healthy diet (and by diet I mean the type of foods you usually eat, not restrictive eating to lose weight).

6 Simple Rules to Heart Healthy Eating

1. There is no one “right” diet for everyone

The beauty – and challenge – of medicine is how different we are and how the same treatment can lead to different responses in different people. A medication that saves one person’s life can cause a life-threatening side effect in another.

The same principle applies to diet. While one person may have amazing results with a certain diet, that does not mean you will have those same results. And just because a diet doesn’t work for you, doesn’t mean you failed – it may just mean that diet wasn’t right for you.

2. You should like it (even better if you love it)

Even if we had research that proved that one diet is best (and we don’t), if you won’t eat it, it won’t do you any good. We don’t do well when we feel deprived, and if you’re eating food you don’t like, you’re setting yourself up to fail.

Find a healthy eating style you love and that loves you back. There are too many great tasting and healthy options to settle for food you don’t like.

3. Avoid highly processed foods

If you only follow one of these 6 rules, make it this one. About 70% of the US diet is highly processed foods and it’s a major contributor to the obesity, diabetes and high blood pressure epidemics.

What are highly processed foods? There are several definitions, but here is one I like. Processed food is manufactured food, typically high in added sugars (like high fructose corn syrup) or refined grains (for example, white flour or white rice).  These foods often contain many ingredients you would not recognize as food such as preservatives and other chemicals.

4. Include vegetables and other plant based foods

Mom was right. Eat your vegetables. Every reputable expert recommends that vegetables and other plant based foods should be a big part of your diet.

This doesn’t mean you need to be vegetarian (I’m not), but the simple act of getting planet-based foods into most of your meals can do wonders for your heart health.

5. Portion size still counts

Even if it’s healthy food, eating too much is still, well, too much.

Slowing down, eating mindfully, and serving your meals on smaller plates are all proven strategies to decrease the amount you eat without feeling like you are going hungry.

6. Eat at home

Who has time to cook anymore? YOU do! Cooking at home can be quicker than going out, and the benefits are indisputable. Better quality food, lower cost, a stronger connection with loved ones, and a healthier weight are just some of the benefits of home cooked meals.

You don’t have to be a master chef to put good quality, nutritious food on your table. Start with one or 2 “go to” meals that you enjoy and can prepare quickly.  Or you could try one of the many meal delivery services that are available.

Eating heart healthy is not one size fits all, nor is it written in stone. For most of us, it’s a constant process of trying new things and judging the response. To make things easier, you can start with one of the major diets (i.e. Mediterranean, DASH, vegan, Paleo, etc.) and adapt it to your tastes and needs, or you can start with your own creation.

As long as you follow the 6 rules, you will be able to find YOUR best heart healthy diet!

Could COVID-19 Be Causing Strokes? Know the Signs

A new, and frightening, expression of COVID-19 infection has surfaced. Numerous physicians around the world are reporting a possibly increased risk for blood clots in patients with COVID-19.

Blood clots (what doctors call thrombosis) are particularly worrisome because of the potential consequences. Blood clots in the veins can travel to the lungs (which is called pulmonary embolus), a potentially life-threatening problem. Blood clots in the arterial system are even more alarming because these can lead to heart attacks, strokes, and amputations.

COVID-19 appears to increase blood clots in both the arteries and the veins. Although all of the studies are small and observational at this point, one study from the Netherlands showed that 31% of subjects with COVID-19 in the ICU developed blood clots despite usual measures to prevent clotting. Another small study from China showed that 25% of the COVID-19 patients developed blood clots in the veins. These are shockingly high numbers.

Physicians are particularly troubled by this possible blood clotting issue for several reasons. One is that the usual treatments (such as blood thinner medications) aren’t working for some patients. Another reason is the report of COVID-19 positive people as young as their 30’s experiencing large strokes that are more typically seen in a much older population.

More information is needed to understand if this is a true correlation between COVID-19 and blood clotting disorder, what the mechanism is, and, most importantly, how to prevent and treat it. 

For now, be aware that there’s reason to suspect that COVID-19 could possibly put any of us at risk for stroke.

So, be alert for stroke symptoms – sudden weakness, numbness, trouble speaking, seeing, or the onset of a severe headache without other explanation – even if you wouldn’t ordinarily need to be concerned about stroke risk, and even without other signs of COVID-19 infection.

If you do experience symptoms that may be stroke-related, it is critically important to seek urgent medical attention. Timing is crucial because the best treatments for these types of stroke need to be delivered in the first 3 hours of symptoms to be most effective. As stroke neurologists like to say, “Time is brain.”

And if you suspect a stroke in someone else, act F.A.S.T.:

F.A.S.T. stands for:

F—Face: Ask the person to smile. Does one side of the face droop?

A—Arms: Ask the person to raise both arms. Does one arm drift downward?

S—Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?

T—Time: If you see any of these signs, call 9-1-1 right away.

Understandably, some are reluctant to go to the hospital during the COVID-19 pandemic, but when it comes to a stroke, the consequences of delaying medical treatment could be devastating. Do not delay. Call 911 if anyone has these symptoms.

How to Avoid the Diabetes/Heart Disease Connection

If you have diabetes, is it inevitable that you’ll end up with heart disease as well? Traditional teaching suggested that it was, or at least highly likely – if you were diagnosed with diabetes, you were automatically categorized at “high risk.” But more recent data suggest that, with a little work, you can stay out of that high risk category – even with diabetes.

This research not only provides hope, but also a road map to lowering your risk for heart disease.

John’s Story

John had been told for years that diabetes increases his risk for heart disease, but he didn’t take the risk very seriously until chest pain and pressure led to the discovery of a blocked artery. We inserted a stent that opened his artery and relieved his pain, but the experience left John deeply concerned about his future health. He worried that he had missed his chance, that the damage was already done because he didn’t pay attention to his health when he was younger.

John’s new interest in his health resulted in some big changes. He started participating in cardiac rehab and exercising every day. He is eating nutritious food and has already lost 10 pounds! He is taking his medications and his blood sugar and cholesterol numbers are much improved.

But he is wondering if that is enough? Does he need to do more, or will his efforts even make a difference?

Diabetes and Heart Disease

One of the first major research studies to show that people with diabetes were at very high risk for heart disease was published in 1998. This was eye-opening to the medical community and led to a change in the way doctors treat patients with diabetes. Based on the recommendations from researchers, we began taking an aggressive preventive approach for all patients with diabetes, emphasizing lower blood pressure, improved blood sugar and statin medications. Around ten years later, a small study looked at the effects of this “multifactorial” approach to prevention and found that it does, in fact, lower the risk of death and heart disease in patients with diabetes. And now we have evidence in large populations that death rates and heart disease rates are falling in patients with diabetes.

These research findings are important because they show that heart disease is not inevitable if you have diabetes. A recent study goes a step further, not only showing that some people with diabetes can lower their risk for heart disease and stroke to the same levels as those without diabetes, but also provides a 5-step road map on how to do it.

(Lots of) Hope for People with Diabetes

A recently published study in the New England Journal of Medicine of over 1.6 million people showed that if 5 good health targets are met, those with diabetes have a similar risk for death, heart attack and stroke as those without.

Those 5 good health targets are:

  • Good blood sugar control (Hemoglobin A1C < 7.0%)
  • Good blood pressure control (Systolic blood pressure < 140 mm Hg, Diastolic < 80 mm Hg)
  • No protein in the urine
  • Not smoking
  • Good LDL cholesterol (LDL < 97 mg/dL)

We now have good evidence that if you have diabetes, you have a lot of control over your risk for heart disease. John was very happy to hear the news that his recent efforts are likely to pay big dividends for his future health. If you have diabetes, work with your doctor to identify the ways you can manage your diabetes and not let it manage you.

Would You Recognize the Symptoms of a Heart Attack?

Someone dies of heart disease in the United States about every 40 seconds. And more than one in three of those deaths occur suddenly – something doctors call “sudden cardiac death.”

Here’s why this is important. Most of the people with sudden cardiac death had symptoms in the hours and days before dying; they either just didn’t recognize the signs as worrisome or ignored them. Many of these people missed the signs because they didn’t think they could be at risk for heart disease – they were fit, they exercised, they felt strong.

Just like Rob.

Rob was training for his 4th Iron Man when he started to notice his throat felt dry during strenuous parts of his training. He ignored it at first, but it was getting worse. Rob began to feel the throat dryness earlier in his bike rides and even started to feel it when he wasn’t training. When he mentioned his symptoms to his wife, she insisted that he seek medical attention.

Ultimately, Rob ended up in the emergency room, where it was confirmed that he was having a heart attack. He had an urgent heart catheterization, which found not one, but two blocked heart arteries. He had stents put in to open the arteries, and fortunately only had mild damage to his heart.

Rob had never considered the possibility that he could have a heart problem. Sure, he had a family history of heart disease, and his cholesterol wasn’t great, but people with heart problems had chest pain – and they weren’t Ironmen!

Rob was fortunate that he wasn’t one of the 300,000 people who die each year in the US from sudden cardiac death. I have several patients with similar stories. They had symptoms that were recognized too late to prevent significant heart damage. But unlike many others, at least these patients were able to tell their story.

The message is that symptoms of heart disease are complex. It’s not just chest pain or pressure that radiates to the left arm. There is a lot of individual variation in how heart disease presents, making it a challenge for all of us, including doctors, to determine when symptoms are heart-related.

Here is the information I want everyone to know about possible heart symptoms.

  1. Symptoms that occur with physical activity or emotional stress and go away with rest – like what Rob experienced – need to be evaluated by a medical professional.
  2. Symptoms such as chest pain or pressure, nausea, indigestion, or heartburn that aren’t going away – particularly if associated with shortness of breath, sweating, palpitations, or feeling like you will pass out need to be evaluated by a medical professional urgently. Don’t drive yourself to the hospital, but call 911.
  3. If you’re concerned, I’m concerned. Be safe and have your symptoms evaluated by a medical professional. It’s much better to be told it isn’t your heart than to find out too late that it is.

Rob’s story was a success because it ended well. He has resumed participating in Ironman competitions, although he doesn’t push himself to the limits anymore. More importantly, he has continued his duties as a loving father and husband.

Recognize the possible symptoms of heart disease. Don’t become a statistic.

COPD

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide, causing more than 32 lac deaths in 2019. COPD is a highly prevalent and grossly underdiagnosed public health problem in Bangladeshi adults aged 40 years or older. Illiteracy, smoking and biomass fuel burning are modifiable determinants of COPD. It is estimated from a population study that between 10-13% of people above the age of 40 in Bangladesh fulfil the international criteria for diagnosing COPD. Older age, male sex, illiteracy, underweight, history of smoking (both current and former), history of asthma and solid fuel use were significant predictors of COPD.

Chronic obstructive pulmonary disease, or COPD, describes a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed. COPD is a common, preventable, and treatable chronic lung disease which affects men and women worldwide.

Abnormalities in the small airways of the lungs lead to limitation of airflow in and out of the lungs. A number of processes cause the airways to become narrow. There may be destruction of parts of the lung, mucus blocking the airways, and inflammation and swelling of the airway lining.

COPD usually develops because of long-term damage to your lungs from breathing in a harmful substance, usually cigarette smoke, as well as smoke from other sources and air pollution.

Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD) worldwide. The majority of people with COPD are current or former smokers. There is a huge amount of evidence that links tobacco smoking with COPD:

Between 15% and 20% of smokers develop COPD.

Up to 90% of COPD cases are the result of lung damage caused by smoking.

Tobacco smoking is the cause of 90% of deaths that are related to COPD.

The risk of developing COPD gets higher the more years a person smokes, and the more they smoke per day. However, the good news is that it is never too late to stop smoking. When people smoke tobacco, they breathe tiny particles of irritants into their lungs each time they inhale the smoke. This has two damaging effects:

The small airways inside the lungs become swollen and inflamed.

The lining of these airways produces a larger amount of secretions to trap the irritants.

The combined result of these effects is that the airways become thickened and narrowed because of the swelling and mucus. This reduces the amount of air that can flow through them. The increased amount of mucus also causes a persistent cough, in an attempt to clear the airways. Over a period of time, this constant irritation and inflammation in the airways causes many smokers to develop COPD.

If a smoker is also regularly exposed to other kinds of irritants that can cause COPD, then his or her risk of getting this condition is even higher. For example, smokers who also work in an environment where they are exposed to toxic fumes, chemicals, or dusts have a much higher chance of getting COPD than their co-workers who do not smoke.

Research also shows that women who smoke experience worse respiratory symptoms than men who smoke the same amount. This means that female smokers may be more likely to develop COPD than male smokers.

Jobs where people are exposed to dust, fumes and chemicals can also contribute to developing COPD. There is strong research evidence that COPD can be caused or made worse by dusts, fumes and irritating gases at work. Work related COPD is a priority because of the human costs in terms of suffering, its effects on the quality of life and the financial costs due to working days lost and medical treatment.

You’re most likely to develop COPD if you’re over 35 and are, or have been, a smoker or had chest problems as a child. Some people are more affected than others by breathing in noxious materials. COPD does seem to run in families, so if your parents had chest problems then your own risk is higher.

There is no cure for COPD but early diagnosis and treatment are important to slow the progression of symptoms and reduce the risk of flare-ups.

COPD should be suspected if a person has typical symptoms, and the diagnosis confirmed by a breathing test called spirometry, which measures how the lungs are working. In low- and middle-income countries, spirometry is often not available and so the diagnosis may be missed. 

There are several actions that people with COPD can take to improve their overall health and help control their COPD:

  • stop smoking: people with COPD should be offered support to quit smoking;
  • take regular exercise; and
  • get vaccinated against pneumonia, influenza and coronavirus. 

Inhaled medication can be used to improve symptoms and reduce flare-ups. There are different types of inhaled medication which work in different ways and can be given in combination inhalers, if available. Inhalers must be taken using the correct technique, and in some cases with a spacer device to help deliver the medication into the airways more effectively.

As COPD progresses, people find it more difficult to carry out their normal daily activities, often due to breathlessness. There may be a considerable financial burden due to limitation of workplace and home productivity, and costs of medical treatment.

During flare-ups, people with COPD find their symptoms become much worse – they may need to receive extra treatment at home or be admitted to hospital for emergency care. Severe flare-ups can be life-threatening. People with COPD often have other medical conditions such as heart disease, osteoporosis, musculoskeletal disorders, lung cancer, depression and anxiety.

As COPD constitutes a huge hidden burden of disease in people of 40 years of age or older in Bangladesh, it has become a major public health problem here and there should be more research and action to be directed toward preventive measures and intensive efforts must be made to target smoking cessation and reduction of indoor air pollution due to biomass fuel burning.

Dr. Ziaul Huq

Senior Consultant

Respiratory Medicine

Evercare Hospital Dhaka

How to Talk to Children About Cancer

“Actually, it seems strange, but I am not really so worried about me, I just don’t know how to tell my sons.” says Jane, a 52-year-old woman who was recently diagnosed with lymphoma. “If they were younger, maybe I could just hide it from them, but my boys are expecting me to be there at soccer games and teacher conferences, and drive them to friends’ houses. They have busy lives, they should not have to worry about me, and I definitely don’t want to be a burden on them.” For patients who are parents, figuring out how to share their cancer diagnosis with their children can be a real challenge.

If the children are babies or toddlers, things are straight forward from a psychological perspective, given their care does not require explanations about cancer or treatment. They need primary caregivers who will be attentive, warm, caring, cuddling, and mindful of their need for nutrition, proper sleep, and play time. Susan would often reassure herself during hospital stays for her myeloma treatment that her 1-year-old daughter Eliza was safe, and well cared for, with her mother-in-law. “Of course I want to be there, but I know Eliza is in good hands, and we will have time together next week. Reading her stories on FaceTime is the highlight of my day, and helps me feel connected to her.”

Children under the age of 10 are usually observant, curious, and caring. They respond well to straight forward answers to questions. Jennifer was in the middle of chemo for breast cancer, and her son Tom was 6. Tom would ask his mom about her bald head, but also gently pat her scalp from the backseat of the car. One infusion was on the same day as an event at Tom’s school, and Jennifer missed it. Instead of making up a work or traffic excuse, Jennifer told Tom she was getting medicine to “keep cancer under control.” Tom had already been told that cancer meant part of the body was growing too fast, so for him cancer being under control meant his mom was growing “at just the right speed,” which was a reassuring thought for him. For Jennifer being able to talk a bit about cancer, at Tom’s level of understanding, was a relief. “Trying to hide the side effects of treatment would have been exhausting, and Tom obviously saw the change in my hair.” Certainly there was grief because she missed the event, but Jennifer knew she and Tom would have other activities to share, and they specifically set aside time to catch up about the school event (and other school activities important to Tom) over a board game before bed.

Preadolescent children, ones in middle school, often want to be helpful as this is an “industrious stage” of development. When they are given a task, one that is matched for their ability, they tap into a sense of agency that is helpful in developing a healthy self-esteem. Jim was limited from doing physical activity after his surgery for colon cancer, which was disappointing because he had always been the one to build the sets for his 12-year-old daughter Judy’s school plays. While Jim was not able to do any of the construction himself, he was able to find a handy neighbor who was appreciative of the chance to build the set and make a little extra money. Judy and her school friends enjoyed working with the neighbor, and Jim was able to assist with the designs. Jim was especially proud to see Judy acknowledged in the play’s program as one of the set designers for the production, and when she took a bow on stage, she pointed to her dad in the audience. “Even though cancer slowed me down for now, it did not stop me from appreciating Judy and encouraging her to carry on with the play.”

Teens are tricky (no news flash there), and their reaction to cancer will vary depending on the teen’s personality, as well as by the day and maybe even the hour of the day. Fortunately, the same principles apply to manage teens as with children of other ages; provide a caring environment, explain things on their level (answer questions clearly as possible but not too detailed), and let them help as they are willing and able. Let them hang out with friends, even if the timing is not ideal (the day you get home from the hospital). They are likely to circle back home, and be attentive to a parent with cancer, when they are ready. Jane, the woman with 2 high school age sons, took this advice and gave herself permission to tell the boys her diagnosis and treatment plan. She had information available from a trusted group (Lymphoma and Leukemia Society) to share if they wanted to read more, and offered to let them meet her oncologist if they wanted. “I am doing everything I can to manage cancer, and be healthy, which is reasonable for them to know and see.” With specific instruction, the boys did a bit more picking up at home, cooked a couple dinners, and asked for rides to games from friends. “I know that when I take care of family I don’t think of them as a burden, so why should I consider myself one? Shoot, they probably feel good about contributing!” said Jane. While not all kids are going to be able to help in a way you may hope for, asking for specific help, small tasks on certain days, is reasonable.

There are many programs for kids whose parents are going through cancer. Ask at your cancer center about specific support for families including programs like CLIMB and Camp Kesem. Ask the guidance counselor at your child’s school about support too. For kids who are struggling with depression or anxiety, speak to their pediatrician about getting treatment.

Cancer Changed Your Appearance – Don’t Let People’s Reactions Keep You Indoors

As anyone who goes through cancer knows, the significant physical changes that come with treatment – whether it be hair loss, dramatic weight changes (down or up), surgical scars, or amputations – can cause people to stop and give you The Look. The Look is not just eye contact, or a quick scan head to toe, but a facial expression that shows surprise at the change in appearance or concern for your health – or, worst of all, pity.  

Why do we need to talk about The Look people with cancer get while they are out in public? Mostly because The Look comes with a psychological toll that can be exhausting, and in some cases, can keep patients from going out in public during treatment. Many people don’t want to share their medical stories with the world, but being bald, losing your eyebrows, having visible scars, amputations or weight changes puts your medical story (in part) on display for the world to see. If you have to be reminded of cancer and the changes in your body with each Look, then seeing people becomes a trigger for cancer worries, and another painful reminder of how much your body and life have changed with cancer treatment.  

So should you stay home to avoid The Looks? Absolutely not! Social isolation is problematic on many levels. Staying home usually means sitting on the couch, which only worsening fatigue during cancer treatment. Passive entertainment with TV or boring video games only dampens your thinking skills which worsens chemo brain. Talking with people, navigating social situations, is actually good exercise for your brain. Finally, because we are wired as social beings, being alone at home often worsens your mood. Here are tips on dealing with The Look while out in public:

  • Be YOU! If you like a cool head, go bald, if you love long hair, wear a wig, if you enjoy colorful scarfs, buy yourself a couple soft ones, and if you are a sports fan, treat yourself to your favorite team’s authentic flat bill. Find what suits you. You can’t change how people look, but you can change some things about your look.
  • Remind yourself the Look is about them, not you. People react to what they see based on their personal histories. Your scar may remind them about their own medical problem; your bald head might trigger memories about an uncle who smoked and raised goats (really, you just never know). Remember the classic advice for back to school anxiety? No need to feel self-conscious since most people are more concerned about their looks than yours.
  • Let your style protect you. Wearing a clever t-shirt (“stupid cancer”, “my surgeon flipped my lid”, “yeah they are fake, my real ones tried to kill me”) or a flashy pair of shoes (beaded driving slippers or cowboy boots) seems to diminish the seriousness of cancer Looks. Carry something that makes you feel strong (a Wonder Woman bag, sturdy walking stick, faith symbol) so if you are reminded of your cancer, you are also reminded of how strong you are to be out in public!
  • Remember that the way you look during cancer treatment will change. Weight goes up and down again, hair grows back (sometimes curlier or whiter), and prosthetics and wheelchairs make getting around in public possible. Your appearance changed because you were battling cancer. Your scars showed how hard you worked and are reminders of your efforts to stay well. 

If going out in public was a major challenge even before cancer, talk to your oncology team about a referral to a mental health specialist to explore whether you may have social anxiety disorder (SAD). For more information on SAD visit adaa.org.

The Financial Pressure of Cancer Takes an Emotional Toll

Receiving a cancer diagnosis, and going through treatment, is emotionally difficult. Not only are you worried about whether the treatment will work (and how the side effects will impact you), you also have to deal with the high financial cost of cancer care, even when treatment is covered by insurance. Health care in the United States is expensive, and to make matters worse, being out of work for surgery, chemo, and radiation reduces income, causing more stress. Below are examples of comments from patients that demonstrate how emotionally difficult dealing with cancer and money can be.

I lay awake at night with swirling thoughts about all the bills that need to be paid, wondering how I might ever possibly pay them all.  (Insomnia from money anxiety)

I have to go to work – I’m a single parent so I can’t afford to not work – but I am so tired I can barely keep my eyes open. (Cancer fatigue from money anxiety)

My immune therapy cost thousands of dollars a month. I feel so guilty for getting this medicine when other people don’t even have insurance. I wonder if my life is worth all this. (Depression from money guilt)

Cancer centers cause a lot of stress by charging for parking. I already have car and gas payments, but then parking too! I come here so often, it really adds up. Plus my son needs the car for work. I hate having to choose between my cancer treatment and his work. (Relationship stress from money needed for transportation)

Dealing with the emotional toll of cancer-related financial stress is a tremendous challenge. Ideally the cost of care would be less, everyone would have comprehensive insurance, and there would be nonprofits to provide transportation and cover copays. Until that time, the goal is to manage the financial stress of cancer in the way you might manage other major life stress: Accept the situation, check out resources, prioritize, and plan.

  • Accept that you have a medical problem to treat, and you are going to take care of yourself the best you can, which means a financial investment. You are worth spending money on. Remind yourself that if you don’t take care of your health, you won’t be able to work (or enjoy life) at all.
  • Check to make sure that your medical care is based on scientific evidence and that you are not wasting money on treatment that has not been proven to be helpful. Don’t waste money on supplements, infusions, or interventions that have not been supported by good quality science. Cancer centers with NCI or NCCN designations, or affiliation with a university, or reports on patient outcomes for treating your kind of cancer are likely to practice evidence-based medicine.
  • Check out financial support options with the social worker at your cancer center and with pharmaceutical companies and organizations that focus on your specific kind of cancer. Consider clinical trials where treatment may be covered by research grants.
  • Prioritize your spending, which starts with a written budget. Figure out what is a need versus a want, then reduce the wants as possible.
  • Check prices for medications at different pharmacies, or free medicines from the pharmaceutical company. Goodrx.com is a helpful website.
  • Plan for part-time work when you are medically ready, especially if you have been out for a while. Returning to work is like returning to running or playing a sport if you have been out for a while – you need time to get back into shape.
  • Plan time for daydreaming. Cancer is a major life interruption. This may be a good time to think about what work would be most meaningful to you in the future.

Financial pressures are truly very difficult. But putting a budget on paper, being thoughtful about what is really needed, collaborating with family, friends and the cancer support system can help you get through treatment and keep the emotional toll of cancer and money as low as possible.

How to Handle Worry During ‘Watchful Waiting’

If you’ve been diagnosed with cancer, it’s likely that at some point in the process, your oncologist will recommend a period of “watchful waiting.” Depending on your diagnosis and time in active treatment (chemo, radiation or surgery), watchful waiting can be psychologically challenging.

You may worry that cancer will grow and spread while you wait; you may feel anxiety that they are not “doing anything” to fight cancer while you’re waiting; or you may feel stuck, unable to get back into your regular life until you know the results of the scans or tests that will happen at the end of watchful waiting (yes, the oncologist should give you a timeline for how long watchful waiting lasts). Hearing about other people’s experiences can help you form a coping strategy that works for you; here are a few stories that may give you some useful insights.

Beth was diagnosed with a stage I breast cancer in her left breast, which was treated with surgery and radiation. During her breast cancer work up, a mammogram revealed a potentially concerning spot on the right breast; to her surprise, instead of suggesting immediate active treatment of the right breast, her oncologist recommended watchful waiting for 3 months and a repeat mammogram. Beth voiced her concern to her oncologist, “in 3 months that spot could be cancer and start spreading all over the breast!” Beth’s oncologist explained that since the spot had been stable on previous mammograms, it was very unlikely to be an active cancer site and reassured her that there were several things she could do to fight cancer over the next three months.

The cancer fighting plan during watchful waiting for Beth included an anti-inflammatory diet and a safe movement program. She replaced red meat and sodas with beans, veggies, and bubbly water and joined a dance group for exercise three days a week. Losing weight and getting active not only improved Beth’s body image, but also diminished her worry about cancer growing or spreading, “I am doing everything I can to stay healthy, and that feels good!”

Steve was diagnosed with prostate cancer last year, treated with surgery and hormone therapy. When his PSA (prostate specific antigen) went up 2 points, his oncologist did not recommend immediate radiation therapy as Steve imagined, but rather watchful waiting. Steve was not just worried, he was scared that if he waited on radiation the next PSA would be even higher. “So now I just sit at home and watch Netflix until the next PSA?! My whole life feels like it is on hold till the next PSA is checked!” This type of thinking is common for people with cancer: they feel that their life needs to be on hold while they get treated, or until they know exactly what the next treatment plan will be. Unfortunately, this mind set of waiting till “cancer is over” means people miss out on a lot of what makes life worthwhile.

For instance, over the next month Steve’s family was going to the beach, his grandson was playing in a baseball tournament, and his coworker had nominated him to go to a special conference. To manage his fear about the next PSA, Steve had to actively work on practicing helpful thinking, for instance, “my oncologist is an expert, he wants to beat cancer as badly as I do,” “I do have a plan, the PSA will be followed up on,” “the whole reason I have gone through treatment is so that I can participate in cool family and work events,” and “I have gotten through follow up labs before, I can do it again now.” Steve not only practiced saying these helpful thoughts but also wrote them down in a journal each day. The act of writing down the thoughts is key to helping the brain hold on to them, and allowing the brain to access them quickly when cancer reminders come up in everyday life, as they so often do (commercials on TV, ads on the internet, bills in the mail).

Karen was three days from finishing chemo and radiation therapy for a brain tumor when she realized that her worry about cancer was getting worse. Treatment had been difficult: Five weeks of daily trips into the cancer center, a mask that held her head down while the beam of radiation targeted her tumor, and nausea that kept her from enjoying food for four days after chemo. “I know I should be glad it is almost over, but I am going to miss the people at radiation, they have been so encouraging, and then after chemo is done, what is my job, who am I? Am I the brain tumor patient, or am I supposed to be the person I was before cancer?” Karen had been in nursing school when she was diagnosed with cancer, and was now having to think about next steps in life once the active part of cancer treatment was done.

For Karen, managing the worry of watchful waiting till the next brain MRI required attention to how she saw herself, specifically not as a “cancer patient” but as a “survivor,” and also a daughter, friend, girlfriend, student and lover of gardening and Marvel Movies. Cancer can be an all-consuming process, and if you don’t pay attention to thinking about yourself as a complex, multifaceted person, then cancer worry can take over. For Karen a gradual return to nursing school was key. Trying to take all her classes at one time was too taxing on her energy and concentration, so a part time return meant that she could keep working towards her goal of being a nurse, but also have time for self-care (exercise, nutrition, stress management) that would keep her energy up as a cancer survivor.

The watchful waiting period often comes with some worry, but with attention to thinking patterns, and self-care, watchful waiting could be a time that you really focus on meaningful life activities outside of being a cancer patient.

5 Signs You Need More Support During Cancer Treatment

Sometimes it can be hard to recognize that we need help, especially when it comes to our mental health. Many of the cancer patients I counsel were surprised, or even confused, when their oncologist or nurse referred them to my practice for mental health support. It’s not uncommon for them say things to me like “Do they think I am crazy? But I was just having a bad day last time I was in clinic!”, “I have cancer, of course I am worried, isn’t everyone with cancer worried?”, or “This is how I have always managed my stress, why would I need help now?”

So, how can you tell that you need more support during your cancer treatment? If you answer yes to one or more of the signs below, then strongly consider making an appointment with a therapist.

  1. If you do not feel like your regular self, at all, for days on end. Or if you yell “like a crazy person” but are usually calm and thoughtful, then you may benefit from having an evaluation for irritability.  
  2. If you can’t manage a smile, even for your favorite people or beloved pet dog or cat, then you may benefit from having an evaluation for depression. Many people are sad, and tired, during cancer treatment, but the small, simple pleasures in life should still bring some sense of joy. A favorite song on the radio, a blossoming tree, colorful tulips, and little kid art projects are all simple joys in life – if you can’t sense any of that joy, then you may need more support during cancer treatment.
  3. If you can’t think about one future activity you are looking forward to, not even a fun movie, event, or visit to the mountains because you are always thinking about cancer, then consider getting an evaluation for anxiety. Cancer treatment can be all consuming, to the point of making you think there is nothing else in life except managing cancer. If you are so hyper-focused on medical care (symptoms, appointments, medications, results) that you can’t divert your attention from cancer for even 30 minutes at a time to think about life outside of cancer, then you may need treatment for an anxiety disorder.
  4. If it takes you 3 hours to go through your work email, when typically you can respond to work email in 20 minutes, or you normally have the kids’ backpacks organized and packed before breakfast, but you find yourself without the energy to even ask if they have a backpack, you may benefit from an evaluation of fatigue. Mental fatigue may come from psychological cancer distress as well as medications and medical problems, like anemia, that come with cancer treatment.
  5. If you don’t talk to single person about your cancer experience, then you may really need more support. Talking about stressful life experiences helps us all cope by diffusing the tension about the experience, problem solving about challenges, and gaining information that can be psychologically empowering (and lifesaving if related to medical issues). Denial, anger, or shame may stop people from talking about cancer, and these are exhausting and painful emotions. Yes, some people are more private and shy, but think hard about why you have not shared your cancer experience with a single person. Ask yourself if being silent really feels comfortable or does it worsen your mood and worry? Of course, when you do open up, be sure to choose the person wisely (a trusted, caring family member or friend, or a trained therapist) so that sharing your cancer experience feels helpful.

The Emotional Impact of Testing Positive for a BRCA Gene Mutation

When Ann’s genetic test came back positive for a BRCA gene mutation (indicating that she is at higher risk of developing breast or ovarian cancer), she was more anxious than she had expected to be – and her anxiety became even worse after her first meeting with a surgical breast oncologist. “It felt like all he wanted to cut off my breasts right away! Do I have to get a surgery this minute? Does my daughter have to have a breast surgery too? What about my son, is he at risk for breast cancer? Wow, having this genetic information makes me really wonder what to do!”

Getting tested for a BRCA gene mutation can be a psychologically difficult process. Because genetic testing is medically very complicated, it’s important to discuss the results with a trained genetic counselor who can help you avoid the anxiety that invariably comes with complicated medical information. Once you have the benefit of learning more from the genetic counselor, the next step is to find a specialist (doctor or nurse) who takes care of people who have a BRCA gene mutation. A specialty clinic can help you work through the medical choices to minimize your cancer risk, such as increasing the frequency of scans or blood work to detect cancer, or meeting with a surgeon to talk about how an operation may reduce cancer risk. For Ann, the meeting with the surgeon came before she really knew how the BRCA mutation increased her breast cancer risk and what the surgery would do to reduce her risk. But once she met with a genetic counselor and connected with a specialty high risk clinic, she better understood the percentages and felt much more comfortable making a decision about surgery that felt right for her. She also learned that her kids would benefit from appointments with genetic counselors and a specialty clinic too, so they could get help making a decision that was best for them.

It is normal to worry and wonder about your cancer risk when you learn that you have a BRCA gene mutation. For some people, being positive for the BRCA mutation not only generates worry, but also guilt. For Ann, the guilt came from thinking her son and daughter would get breast cancer because of her: “I have really burdened them with this terrible disease!” It took some time talking about her relationship with her children and paying careful attention to all the good qualities they had because of her (great smiles, tendency to be kind to others, musically gifted) before Ann was able to move past this terrible feeling of guilt and think in a more realistic, helpful way. “I can’t possibly blame myself for genes I got at birth! I certainly wish I did not have the BRCA gene mutation, but I know now that I would never choose to put my kids through this, and it is not my fault if they have it too. What I will do is help them minimize their cancer risk in whatever way I can!” Ann and her kids all decided to adopt an anti-inflammatory diet and join a hiking club in order to keep their weight down and stay physically fit, habits that not only minimize cancer risk but also help manage daily stress.

For some people, finding out they are positive for a BRCA mutation can generate so much negative emotion (like anxiety) that it is hard to make a decision about treatment. Speaking up about the anxiety with your primary care doctor, or a genetic counselor, will not only mean you get the support and information you need to make a treatment decision, but also possibly get care for your emotional distress. Treating emotional distress, like anxiety, gives you the sense that even though the situation is difficult, it is something that can be managed.

The Cancer Is Gone, But the Fear Remains

I had my annual cancer checkup last week. I didn’t even mention it to my husband until the night before. I brushed away his concerned look and his instruction to “call/text as soon as you know.” I cheerily went off to my mammogram/nurse practitioner appointments.

Even though I could barely admit it to myself, I was faking. Cancer is fairly far in my rearview mirror these days. I am seven and a half years post diagnosis, six years post treatment. But the fear is still there.

There is really nothing I can do about it, that nagging knowledge that mortality is REAL. So much in our culture pretends that we don’t get old, that we don’t get sick, that we aren’t anxious, that we’re not afraid. And yet, while the entertainment and advertising that envelopes us also denies this underside of life, it also encourages anxiety and fear.

Buy this product and you’ll never get old! Watch/read/experience this movie/book/vacation/whatever and you’ll never be sick, fat, poor or whatever!

Well, if you’ve ever had a doctor say, “You’ve got cancer,” you know that there’s really no escaping fear.

What I’ve found is that, paradoxically, accepting that fear also allows me to cope. I know that my husband prefers to pretend that cancer is over, done with, not an issue anymore. I know that, for me, it never will be over. And that has to be OK.

While I pretend that I’m not in the least worried about my cancer check-ups, I am. I’m not paralyzed with fear, just a little nervous – just a little cold pinprick of fear.

In the waiting room, in my hospital gown waiting to have my breasts squished, I talk to another breast cancer survivor who’s also years out. We pretend we’re not too nervous; we swap surgery/chemo war stories. We both comment that we love that our medical center lets us know results immediately. A radiologist reads your images as soon as you go back into the waiting room. You get an answer within five or ten minutes.

We both got the “all clear.” Dressed again, we waved to each other in the hallway as we headed confidently back into our lives. We’re weren’t afraid in that moment. But the fear was there—just lurking, in the background—until next year.

How to Be a Better Advocate for Yourself as a Patient

The ability to advocate yourself, especially as a breast cancer patient, can be incredibly powerful in shaping your cancer experience. It took me a while to realize that as a patient, I have an active and very important role in my medical care.

Yet I also realize that we’re never taught how to navigate the world of medicine from the patient seat. As a result, it’s easy to feel overwhelmed and develop frustration and confusion regarding your diagnosis and treatments — which is the last thing you need on top of dealing with the emotional impact of a cancer diagnosis.

By practicing the following steps, you can conquer your medical journey by getting your care team on your page, on your terms, and with your best interest in mind.

Do Your Homework

Doctor: “Do you have any questions?”

You: Blank stare

You, 5 minutes later as you’re driving away from the office: “Oh yeah, I forgot to ask her about that rash, and I needed a prescription refill. … ”

Sound familiar? Our most burning concerns tend to escape us just as we sit down in front of our doctor to talk about them. It happens to all of us. Your doctor has an agenda for your appointment, and you can, too. By preparing for your office visits, you can optimize your time with them to meet all of your needs. I start by writing down all of my questions as they come to me so that when I’m with the doctor, I’m ready to have them addressed.

The same goes for any symptoms I’ve experienced since my last visit. Is my headache worse than usual or have I noticed some new swelling? I jot down the symptoms and any relevant details, like when they occurred, how long they lasted, and whether I took any treatments or not. Writing this down while it’s fresh in my mind makes it easier for me to share with your doctor.

Lastly, I bring all of my current medications (the bottles or a list of them) and new medical records, like test results or a consultation visit with a specialist to the visit with me. This helps keep the doctor up to date on how my health is being managed outside of their care.

Pro tip: State your agenda at the beginning of your visit so your doctor can tailor the appointment to address your concerns appropriately. For example, if you have a follow-up visit after chemo to see how you’re tolerating the medication(s) but you also have questions about an upcoming test they ordered, mention this at the start of your appointment. That way, your doctor can make sure to allocate enough time for your questions. Waiting until the last 2 minutes of the appointment to raise your questions can be a disservice to you, as you may not receive a thorough or fulfilling enough answer.

Ask Questions

Many patients feel intimidated by the idea of asking questions because they don’t want the provider to think they’re questioning their expertise. Others have a strong desire to please the doctor and try to do so by not questioning them. (Research backs this up.) That being said, I know that if I have a question or don’t understand something the doctor said, I absolutely deserve to ask for clarification about all matters pertaining to my health.

Misunderstanding your health care can lead to unnecessary fear, anxiety, and confusion that could be relieved by a simple clarification. Thus, I think a patient-provider relationship functions best when you maintain two-way communication. And remember: There’s no such thing as a stupid question! Even if I ask the same question more than once or ask the same question to different providers.

If you’re not sure what to ask, here are a few questions that have helped me understand more about my health:

When you get a diagnosis:

  • What is my diagnosis?
  • How did I get this diagnosis? (From symptoms? From a lab test?)
  • What does this diagnosis mean?
  • What’s the prognosis, or expected course, of this diagnosis?

When considering tests or treatment options:

  • What are my options?
  • What’s the purpose or goal of each option?
  • What are the potential risks of each option?
  • What are the potential benefits of each option?
  • What would you do and why?

Pro tip: The amount of information you receive at your doctor visit can be daunting and difficult to remember. Ask how you can access this information after the visit to refer to or share with others (for example, a printed handout, email summary, or written notes).

Be Honest       

Although honesty with my provider can be uncomfortable or embarrassing, it’s truly the best policy. No matter what I’m sharing with the doctor, it’s only beneficial to disclose exactly what’s going on and what I’m thinking. Often, medical decisions are made and actions are taken (or avoided) based on the information I provide, so it’s vital to be honest and tell my doctor everything.

This extends beyond symptoms you may be experiencing to your preferences or even your satisfaction with the provider. Your health is more than just what’s happening with your body, and it all can impact your health experience. Don’t be shy. For example, I have a preference for female providers only, so when my female oncologist left the practice and I was reassigned to a male provider, I called the office to tell them I needed to see a female provider. Arrangements were made for that to happen.

Most important, if you sense an issue with your provider or feel your relationship is tense or troublesome, please say something. It’s best to bring it to their attention, as they may not even be aware of your experience. This allows them an opportunity to clarify their behavior and intentions and/or adjust it appropriately.

Pro tip: State your preferences ASAP. For instance, everyone has different preferences about how they receive information — you might want to know the details of each test result and what it means, you could prefer a one-line summary, or maybe you’d rather the doctor explain it to a loved one instead. Don’t make your provider guess — be clear and tell them exactly how you want to receive medical information.

Being a patient isn’t easy. It can feel like cancer robs us of so many important pieces of ourselves, with our control as individuals being the most devastating loss. By following these steps, you can harness your power as a patient and guide your experience based on your values and desires.

My Oncologist Is My Rock

My relationship with my oncologist is a critical and cherished one. She is as much a part of my cancer battle as I am — the light guiding me through the muddy, shady path. In my urgent situation, I didn’t find her through a comprehensive selection process or from others’ recommendations. Rather, it was a series of chances that united us, but I know now she was meant to be my oncologist.

On paper, it may seem obvious why we got along so well. We’re both female, we’re both physicians and we’re both mothers. Although we related in these aspects, the depth of our relationship ultimately had nothing to do with either of these commonalities. I attribute my experience with my oncologist to her humanity and excellence as a provider.

I will never forget the first time I entered her exam room as a mentally disheveled young woman who’d recently received a devastating cancer diagnosis. She sat directly in front of me, our knees almost touching. Then she met my gaze with her graceful blue eyes and introduced herself. In that moment, I felt her genuine and comforting presence. An overwhelming sense of relief washed over me and the tears started to flow.

“We are going to figure this out,” she affirmed. I had no idea what kind of breast cancer I had, if I needed surgery or radiation, or if I was going to live or die, but I felt the power of having my oncologist with me, on my side.

In each and every conversation we had my oncologist remained receptive and patient, which deepened my conviction in her. Through all of my questioning — sometimes repeating questions (thank you chemo brain!) — she listened, kindly explained, and then checked my understanding to see if she’d answered my question. Although I know the busy, time-restricted schedule she worked within, I never felt it. When we were together, all her attention was on me.

I wasn’t just a patient in her office. I was a busy person with a budding family and career who happened to be diagnosed with breast cancer. My cancer connected us, but our conversations spanned all topics of life and I know I was heard because time after time my oncologist demonstrated that she understood me.

She acknowledged my beliefs, my values, and my goals. As she presented the best treatment options, she did so objectively, or “by the book,” and then explored each with me through my lens of my life. In this manner, my oncologist gained my trust. I knew she was acting in my best interest. I didn’t have to say many words for her to understand exactly what I was thinking; sometimes even before I realized what I was feeling, she knew. And it amazed me. She truly got me.

Being able to have this connection with my oncologist was incredibly empowering and positively impacted my experience with breast cancer. I am so grateful to have had her by my side. All individuals with cancer deserve to trust and receive the grace and compassion of their oncologist as I did.

When I Heard ‘Breast Cancer’, I Wasn’t Sure I’d Have a Future

I always suspected I might get cancer. My maternal side is riddled with cancer. My mother had ovarian cancer when she was pregnant with me in her late 20s. My grandmother had cervical cancer in her mid-40s. An aunt had breast cancer in her early 50s. I assumed it would only be a matter of time before I would be added to the family cancer tree, but I never thought it would happen before I had even turned 40.

I was able to receive a preventative mammogram at 35 due to family history. It was clear, and I was told to come back when I was 40.

Two months after my 39th birthday, I spotted a circular bruise on the back of my left arm and found what felt like a large hard fist near my left underarm. I called my primary care doctor, and she immediately wrote an order for a diagnostic mammogram, which then led to a biopsy.

My biopsy was on a late Friday afternoon on 9/11/15. It felt wrong and scary to have a biopsy of the mass in my left breast on such a nationally tragic day. I was told the results would be available within 24 to 48 hours. Since I was the last patient of that day, I was expecting the results either Tuesday or Wednesday.

So when my cellphone rang at 3:05 p.m. that Monday, I instinctively knew I should answer it even though I didn’t recognize the number. When I flash back to this memory, it is like I am suspended above my work cubicle, watching everything unfold.

I see myself running down the hall into an empty conference room.

I see my eyes filling with tears yet widening in disbelief.

I see my hand shaking while holding my phone.

“Megan-Claire, you have invasive lobular breast cancer. We don’t know the stage yet. You need to get a pen and paper and take some notes because time is of the essence.”

I will never forget the fear and panic crushed me like a tsunami after receiving the cancer call. Once I met my medical team, I was officially diagnosed with Stage IIA invasive lobular, ER+/PR+, HER2- in the left breast. It is the second most common type of breast cancer, but only accounts for about 10% to 15% of all invasive breast cancers.

It’s crazy how hearing those words completely changed the trajectory of my life. Every plan and dream I had up to that point became frozen because I didn’t know if I would survive breast cancer. I wasn’t even sure I would have a future.

Since I was diagnosed under age 40, I was often the youngest person in the infusion room. I had to work during all my treatments. I wasn’t even close to the typical retirement age. Fortunately, I was able to find fantastic online support aimed at adolescent and young adult cancer survivors (AYA) through organizations like Elephants and Tea, GRYT Health, and Stupid Cancer.

My diagnosis forced me down a path that no one could fully prepare for, including coming face-to-face with my own mortality at 39. I’ve survived 16 rounds of chemo, eight total surgeries, 33 radiation treatments, blood transfusions, multiple infections, and infertility.

Life is fleeting. The fear of the unknown and getting scans every 6 months for 10 years pushes me to live life with renewed passion and purpose because tomorrow is not promised.

How I Changed My Relationship With Fear

I’m 32 and I have no family history of breast cancer. So when my doctor ordered a mammogram, it seemed like an unnecessary test. I was certain the lump I had felt in my breast was simply a cyst or a fibroadenoma — two of the most common benign breast tumors. Breast cancer hadn’t even crossed my mind.

When I received my diagnosis of invasive ductal carcinoma, I was in disbelief, emotionally labile (that’s doctor speak for shaky), and confused. I kept asking myself:

  • How did I get cancer? 
  • How long has it been growing in my body?
  • Could it have been detected sooner if I performed regular breast self-exams?

Fixated on these questions, I drowned in devastation and denial, searching for something to blame for the fact that I had cancer. Every cause has an effect, right? But I’ll never know what caused me to get breast cancer.

It’s only natural to wonder how the hell I got to this point, but staying stalled in my past didn’t serve me in my current situation — a newly diagnosed breast cancer patient who needed to get a port placed to start chemotherapy ASAP.

I wasn’t ready to accept this new label, so I opened my mind to explore what it felt like to have cancer. I examined the thoughts and feelings coursing through my body, noting one sensation that prevailed: fear.

Fear of the unknown, fear of pain and suffering, fear of loss, and fear of death.

I didn’t want to feel fear. (Who does?) We’re taught that fear is bad, fear feels awful, and that we should avoid fear at all costs. Yet the more I resisted it, the more it seemed to persist, and the worse I felt. So I tried something different: I allowed it. I figured, what did I have to lose now?

Allowing my fear to surface, I noted it as a heaviness in my core that radiated icy-hot spikes through my limbs and a blossoming, steamy fullness in my cheeks. Fear didn’t feel good, by any means, but by sitting in it I realized that my fear, like all of my emotions, was just a vibration in my body. Nothing more — what a relief this was! Like that, my fear of feeling fear melted away.

I learned to recognize my fear, acknowledge it (“Hi, fear, I see you”) and sit with it until it went away. Sometimes it lasted longer than others, like in the days approaching my first chemo session, but it always passed. This is a secret every cancer patient needs to know, especially, when you’re diagnosed: Face your feelings, feel your feelings, and the feelings will fade away.

The more I practiced this process, the easier it became to experience all the emotions that arose when I was diagnosed with breast cancer. In fact, understanding myself in this way brought me clarity as to how I wanted to proceed as a young mom and doctor diagnosed with breast cancer and ultimately shaped my strength through my breast cancer journey.

No one ever expects to be diagnosed with cancer or is prepared for their own response to such news. If you’ve been diagnosed with cancer, I encourage you to approach your emotional experience with compassion and curiosity. Allow and acknowledge all of your emotions and move forward in your cancer journey empowered. You can’t control cancer, but you can control how you experience it.

Identifying Breast Cancer and Keeping it At Bay

When cells in one’s breasts begin to grow abnormally and uncontrollably, the disease is called breast cancer, a leading cause of cancer in women all over the world. Approximately 1 in every 8 women worldwide is expected to develop breast cancer during her lifetime. Only 1% of breast cancer patients are biologically male.

Although exact countrywide statistics are not presently available to us, it is clear from hospital data that the number of breast cancer patients in Bangladesh is increasing on a yearly basis. There are numerous reasons for the increased number of breast cancer incidences in Bangladesh. Thanks to wider availability of common diagnostic facilities, we are seeing a higher number of breast cancer diagnoses.

Risk Factors for Breast Cancer

There are some risk factors which may be managed in order to avoid breast cancer. Men and women who heavily drink alcohol are both at greater risk of developing breast cancer. Women who are physically inactive are more likely to develop breast cancer, as are overweight and obese women, particularly after menopause. Also after menopause, if a woman has been taking hormone replacement therapy for a long period of time, the risk of breast cancer is higher.

A woman’s reproductive history might also pose a significant risk factor for breast cancer. If she has been taking certain contraceptive pills for a long time, bore a child after 30 years of age, is intentionally childless, or did not breastfeed any children she bore, she is at greater risk of breast cancer.

Besides these, there are some risk factors which, unfortunately, cannot be changed. Being a woman, especially one older than 50 years, is the biggest risk factor for breast cancer development (and in fact, most cases of breast cancer are found in women over the age of 50). Genetic mutations, inherited changes to certain genes such as BRCA 1 and BRCA, make breast cancer more likely for women at an earlier age when they are premenopausal.

Another risk factor we can not change is early age of starting menstrual cycle (i.e. before 9 years of age) and late menopause (i.e. menstruation till 55 years).

Symptoms of Breast Cancer

It’s important for any woman, and even men, to know the signs which might indicate the presence of breast cancer. Note that while different people have different symptoms, some may not have any symptoms at all.

Look for signs that your breasts might be afflicted by cancer. If one finds a new lump in the breast or armpit (axilla), experiences itching or swelling of part of the breast, notices irritation or dimpling of breast skin, experiences pain or notices redness or flaking of the nipple, observes that the size/shape of the breast has changed, or secretes any nipple discharge other than milk (such as blood), one might have breast cancer.

Breast Cancer Screening

During a breast cancer screening, a woman’s breasts are checked for cancer before there are signs or symptoms of the disease. During a screening, breast cancer is detected at an early stage to ensure that the cure rate can be high with the help of appropriate preventive treatments. As breast cancer incidence among Bangladeshi women is highest between the ages of 45 to 74 years, it is a good practice to do a screening mammogram test every 2 years.

How Breast Cancer is Diagnosed

The diagnosis of breast cancer can be undertaken in multiple ways. The following tests can help to detect breast cancer: breast ultrasonography, diagnostic mammogram, breast MRI (when and if needed), biopsy (core needle biopsy/open biopsy for histopathological diagnosis, and FNAC.

FNAC is used for cytological diagnosis and carried out if the lump size is very small, usually less than 1cm, making it impossible to use a biopsy needle. FNACs tests can give false negative results, in up to 15% of cases. Another disadvantage is that immunohistochemistry tests are usually not done from FNAC specimens.

Another way of diagnosing breast cancer is through immunohistochemistry (IHC). Carrying out IHC tests helps us to find out the type of cancer, oncologists can decide on the treatment options and the future of the patient can be predicted. IHC tests measure ER (Estrogen Receptor) status, PR (Progesterone Receptor) status, HER2 (Human Epidermal Receptor 2) status, Ki67 status, P53 status.

Treatment of Breast Cancer

After breast cancer has been detected, it can be treated in several ways. It depends on the type of breast cancer and on how far it has spread. People with breast cancer often get more than one kind of treatment. Treatment options for breast cancer include surgery, chemotherapy, radiotherapy, hormone therapy, targeted therapy, and immunotherapy.

How to Lower the Risk of Breast Cancer

Predicting the onset of breast cancer might be difficult. However, there are certain steps one can take in order to lower their risk of developing breast cancer. By maintaining a healthy weight, exercising regularly, abstaining from consuming alcohol or limiting alcohol intake, avoiding certain oral contraceptive pills, foregoing Hormone Replacement Therapy (HRT) and breastfeeding one’s child, one might hope to keep breast cancer at bay.

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