Detecting Esophageal Cancer


Dearest Readers:

Although the month of October is Breast Cancer Awareness month, I wanted to share a story about my father’s battle with esophageal cancer. The month of April is the scheduled month for Esophageal Cancer Awareness.

When my father was diagnosed, medical professionals assumed he was a smoker. He never smoked – EVER!

DIAGNOSIS – ESOPHAGEAL CANCER

The diagnosis rings in your ears. Esophageal cancer. A thousand thoughts and questions race inside your mind and you find it difficult to cope, think or relax. You want a second opinion. You want to live and you want things to be the way they were, before your quality of life was questionable due to cancer.

Tuesday, December 9, 1997 was the day I became an advocate for esophageal cancer. The endoscopy revealed a tumor, located in the esophagus. A malignant tumor…Cancer…the dreaded word echoed inside my brain. No! I screamed! It cannot be cancer! There must be some mistake! My father took such good care of himself, but like lots of men from his generation, he refused yearly exams and only went to the doctor when he was ill.

Symptoms of Esophageal Cancer

Esophageal cancer is a difficult cancer to detect. Many of the symptoms, such as coughing, difficulty swallowing {dysphagia), and indigestion are thought to be acid reflux. Esophageal cancer may start as tightness in the throat or pain in the chest. Recurring hiccups, hoarseness, difficulty swallowing, or regurgitating food and weight loss, could be symptoms of cancer of the esophagus. Until my father’s diagnosis, I was clueless of the disease. Now, I serve as an advocate, to educate others, and to prepare families about this debilitating disease that attacks profusely, steals dignity and quality of life and can kill. I describe esophageal cancer as the silent cancer.

SYMPTOMS 

The symptoms of esophageal cancer rarely appear until the advanced stages of the disease. Unlike early detection of breast cancer and other forms of the disease, cancer of the esophagus is not able to detect by early screening. While it is recommended by the American Cancer Society to get regular physicals, eat a proper and healthy diet, quit smoking, if you are a smoker, and to maintain a healthy weight, esophageal cancer is a silent cancer that creeps up only after it advances. The major complaint from someone diagnosed with the disease is the inability to swallow or retain food. Social activities with friends and quality of life become a major issue.

Treatments for Esophageal Cancer

Cancer of the esophagus is a treatable disease in many cases, including surgery, chemotherapy and radiation and clinical trials. If surgery is an option, the procedure could relieve the excruciating symptoms and improve the quality of life for the patient. If surgery is not an option and quality of life is threatened, due to the inability to swallow or retain nutrition, the doctor may prescribe a PEG tube.

The Percutaneous Endoscopic Gastrostomy (PEG tube) is a form of life support for patients who are having difficulty with swallowing, or eating. Insertion of the PEG into the stomach is performed by an endoscopic procedure. With the PEG tube in place, liquid nutrition, along with medications, may be administered directly through the feeding tube, into the stomach. Introduced in 1979, the PEG tube has been used for an estimated 200,000 patients, serving as a form of nutritional support.

At the age of 84, Walter W. Perkins fought the battle of his life. His prognosis was not a good one. On two occasions, I prayed for a miracle to happen when he was near death, and on those two occasions, the miracle was granted. The doctors said he might live six months, if chemo and radiation therapy were successful. He beat their odds, battling this disease for nineteen months with stiff determination, faith, and positive thoughts guiding his way. Due to the location of his tumor, surgery was not an option for us. A few days after his diagnosis, he permitted the doctors to connect the PEG tube to his frail body. Furious that he could not swallow without regurgitating his food, he called his feeding tube an umbilical cord. His quality of life decreased at a rapid rate after his diagnosis of esophageal cancer. Fortunately, the PEG tube provided him the ability to regain some of his weight, extending his life until he became despondent and demanded to eat food again. His doctor consulted with me, letting me know that if he insisted on eating, he would aspirate his food and choke to death. For us, it was a quality of life issue. I did not fight the battle to override his decision to enjoy food again, even though I knew eating food would lead to his death. On July 6, 1999, while I was entering the nursing home for my daily visit, my father aspirated his food and was gone.

Before his diagnosis, I was naïve to the prognosis of esophageal cancer. This disease was not marketed or publicized whenever I read stories about cancer, and I called it the silent cancer, because it silently develops without many warning signs. When I expressed my guilt to the oncologist, I was told that esophageal cancer is increasing and is quickly becoming one of the fastest growing cancers in the world.

Additional treatments are based upon the type of esophageal cancer, location of tumors, and how capable the patient is to respond to treatment. In my father’s case, his age, fragile condition and the location of his tumor dictated his treatment of chemo and radiation therapy. After his second dosage of chemo, his treatment with chemicals and radiation were cancelled. The drugs had left him so weak we almost lost him. The chemotherapy had drained every ounce of strength he had. From this point on, the only treatment would be for the quality of his life.

Photodynamic Therapy (PDT)

A new method of treatment for cancer of the esophagus is photodynamic therapy. PDT is helpful in some cases by injecting chemicals into the blood. Laser lights target the cancer by an endoscope procedure. A minor disadvantage of PDT is the light may only reach cells on the surface, and cancers that have spread are not treated.

Survival Rate

According to the American Cancer Society, the survival rate of esophageal cancer is low. New cases are increasing at a rapid rate. It is estimated that in 2008, approximately 16,470 patients will be diagnosed with cancer of the esophagus. Deaths are predicted to total 14,280. The Five-Year Survival Rate is estimated to be only 34%. These statistics are not encouraging; however, with developments of clinical trials, drug therapies and the willingness to fight the battle of cancer, I am hopeful the statistics will increase soon.

Quality of Life

All types of cancer create issues with the quality of life for the patient and family. Esophageal cancer certainly affects the quality of all. The American Cancer Society identifies four basic quality of life factors, including social, psychological, physical, and spiritual. Watching my father fighting esophageal cancer, I would like to add one more quality of life issue, the quality, and loss of independence. Before my father’s diagnosis, I watched an amazing independent man walking in his shoes. He lived alone in a retirement community and at the age of 83, he took daily strolls, cooked his meals, gardened occasionally and he enjoyed singing. After the diagnosis and the PEG tube insertion, he was observed by medical professionals to need skilled care – a term I became most familiar with as his advocate. Skilled care was a medical term that meant he needed the daily care of a registered nurse. His social life consisted of a roommate in the nursing home and the staff of medical professionals caring for him. He was too weak to go anywhere most of the time, and when he was able to go out with me, I had to be careful not to take him to restaurants or out for ice cream since he was receiving liquid feedings from the PEG tube and he could not swallow. His physical activity was non-existent because he was so frail. All that remained was the spiritual quality of life. Before his death, my father tapped into the spiritual side of his life, reading the Bible constantly, quoting verses, and singing religious songs, aloud. Before his death, the singing quieted. He coughed constantly and would lose his breath from the coughing attacks. In a whispering voice, he reminded me he was ready to go, if the good Lord decided it was his time. I noticed his voice was still hoarse and his eyes did not hold their usual sparkle.

Additional research for Esophageal Cancer is underway and I am hopeful that in time there will be a cure for all cancers. Cancer Aid Research, education, and advocacy serve as strong components to understand cancer. Esophageal cancer is usually diagnosed in the late stages of cancer, as was the case with my father. When I inquired about the stage, I was told he was in Stage Four. The outlook for this disease is not a good one. The survival rate is low. If you are a smoker, quit. If you have symptoms such as unexplained weight loss, pain or difficulty swallowing, hoarseness, non-stop coughing, heartburn, or hiccups, make an appointment with your doctor and ask about esophageal cancer. If you are at high risk, the doctor might suggest an endoscopy.

Serving as my father’s caregiver gave me a new perspective on life and the belief in miracles. Now I appreciate the beauty of a new morning sunrise and I can look towards the future while doing all that I can to educate others about esophageal cancer and care giving. The experience of watching my father suffer so much, still with a smile on his face, even when he was angry and in denial about his cancer taught me so much. He encouraged me to move forward with life. I have chosen my life’s direction, or perhaps it chose me, and I will do all that I can to become an advocate for those who battle this dreadful disease. My passion is one of hope so cancer will soon become a curable disease that is not silent. I still believe in miracles.

Sources:

Barbie Perkins-Cooper is a freelance writer who loves the journey and exploration of travel and health. She works full-time as an editorial photojournalist and has published numerous articles and photographs for regional, health and beauty and travel publications including the Travel Channel. Barbie resides in Charleston, South Carolina with her husband. She is the author of Condition of Limbo and Career Diary of a Photographer. Visit her website www.barbieperkinscooper.com

 

 

Steroids…Weight Gain…Weight Watchers…


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Dearest Readers:

Have you ever gotten so ill that your doctor prescribed steroids? Years ago, my doctor prescribed Prednisone to me. After taking it, I noticed my cognitive abilities were affected. I could not sleep. During the day, I was wired, and while driving, I drove off the road! Fortunately, no one was nearby!

I shared these side effects with my doctor, telling him I would refuse any prescriptions for Prednisone. What I should’ve told him was I will not take steroids! After my steroid consumption in June, I will let him know the side effects and I will not take ANY STEROIDS again! I mentioned to him how I struggled to communicate a simple sentence while taking Prednisone! Since I am a writer, my cognitive abilities must be sharp! For the life of me now, I cannot recall what the name of the drug was, although I do remember it started with a D. I took this drug faithfully, anticipating I would be better within a few days. I finished the medication and was still so weak, so ill, and coughing so hard, so I phoned my doctor. He refilled the same prescription.

Two weeks later, I was still sick, but getting better. My breathing meter said I was stronger, in the green area of the meter, and I was feeling better, with one exception.

I wanted to eat anything and everything within my home. I actually felt as if I would eat the kitchen cabinets IF they were flavored and edible. During one day, I went to the pantry, finding Ritz crackers. I took a sleeve of the crackers out, eating them in one sitting. Eating like this is NOT something I do. I joined Weight Watchers years ago. Before getting so sick, I had two pounds to lose to hit my first goal. Not the official goal at Weight Watchers to become lifetime, but my official first goal since it would be the number I weighed when I graduated from high school.

What is wrong with me? I am so hungry and I cannot stop this ridiculous eating! 

I phoned my husband. “Ice Cream. Ice Cream. I want ice cream.”

That evening, he brought ice cream home. I was eating everything I should not eat, and I was not tracking anything.

I glanced at my calendar, recognizing I had missed three Weight Watchers meetings. When I returned, I gained almost five pounds. At first, I blamed the gain on the steroids. Believe me when I say they have a serious side effect. Constant hunger and weight gain!

I was furious with myself. I cannot blame the steroid for making me gain weight, after all, I am the one who controls what goes into my mouth. Meanwhile, I’m still eating. Finally I realized I had to get control.

According to the Mayo Clinic website, http://www.mayoclinic.org/steroids/ART-20045692?pg=2, oral steroids, commonly referred to as Corticosteroids, some of the side effects are:

  • Elevated pressure in the eyes (glaucoma)
  • Fluid retention, causing swelling in your lower legs
  • High blood pressure
  • Problems with mood, memory, behavior and other psychological effects
  • Weight gain, with fat deposits in your abdomen, face and the back of your neck

My eyes were affected with blurred vision. I did not notice fluid retention in my legs, but I certainly gained weight and I was furious with myself. My blood pressure increased, along with my blood sugars. On several mornings, my blood sugar was over 200.

I was definitely moody. Snapping at my husband over the least little thing, and when the phone rang when I recognized it was another telemarketer telling me I had won another cruise…Would I like to attend a seminar about hearing issues, time shares, how to invest retirement funds, blah…blah…blah. Well, let’s just say I used a bit of colorful language telling them to stop calling this number! I started blocking almost every phone number, including two of my best friends. Fortunately, I’ve learned how to correct these errors. It certainly is quieter in my home now, without the constantly ringing telephone. Maybe we should cancel our landline!

Yep. You guessed it. Steroids were making me a B-I-T-C-H! Funny, the phone isn’t ringing much now! Thank goodness!

August 7 was exactly seven weeks since I took the last of the steroid prescription. When I see my doctor in October, I will tell him I cannot take steroids OF ANY KIND now. For me, it isn’t worth the risk. I find it interesting that medical professionals will tell us when we need to lose weight; nevertheless, when we become ill with an acute illness such as acute bronchial asthma, the professionals will prescribe steroids. The side effect of steroids is weight gain, only I’ve never had this side effect until June when I was so weak and ill.

How I pray I will remain well for a bit. I find it a bit funny that I was scheduled for ‘clinical testing’ to see if my asthma would respond to new medications. When I went for the clinical testing, my breathing was ‘too healthy’ to be considered for the clinical testing.

Suppose I’ll be happy now that I am able to breathe so much better and I can walk and exercise again! Thank you, God!

What did I learn after taking steroids? Simple. I learned that my body cannot accept them or allow them to be taken orally. For me, the side effect of weight gain and being such an arrogant maniac just isn’t worth the risk. I like myself when I am the real me…Not the B-I-T-C-H I become, thanks to steroids. Once, while in California, I saw a bumper sticker on a car. I loved it, wrote it down and practice it. It revealed:

I’m a Bitch.

B = Beautiful

I = Intelligent

T = Talented

C = Charming

H = Honest — in all honesty – the H = horny, but I changed that! There’s no need to advertise when hormones kick in!

Yeah. I suppose I could say I’m a Bitch…but a Nice One!

 

 

 

Mammogram 101


I suppose this is an article for women only; after all, I don’t think men would appreciate the subject matter. Here goes. Have you ever had a mammogram?

During the month of October, I scheduled my yearly mammogram. Since I do monthly breast exams, I wasn’t afraid. Nothing was different so I was confident that I would receive a letter telling me to return in a year. When the letter arrived, I was concerned. I needed an additional mammogram and/or ultrasound. I scheduled it immediately. Before the appointment, I got a call from the hospital informing me that I needed to bring $265.99 to pay for the additional test.

“What…I have Blue Cross Blue Shield. They pay for my mammogram.” Surprise — only 80% this time!

I almost cancelled the appointment. After contemplating the additional test, I phoned the Breast Cancer Center again, asking why I needed this appointment. “We can’t discuss that,” the voice on the other line said.

I was furious.

The more I thought of it, the more I realized I needed my Julia Sugarbaker diplomatic style to kick in. “Hello,” I said. “I have an appointment for an additional mammogram and was told no one could discuss it with me. Don’t I have the right to KNOW Why?”

“Of Course, you do,” the kind voice responded.

She transferred me to the radiology doctor where I discovered why. It seems that my yearly mammogram noticed a change…something in the glandular structure. I heard the word “asymmeticral,” or something similar.

“Have you lost or gained weight in the past year?”

“Yes…about 35 pounds. I’m doing Weight Watchers.”

“That could be the reason. It’s nothing to get alarmed about.”

Alarmed? Could we be talking a lump, or breast cancer?

The appointment was scheduled for the next Monday. I had exactly seven days to stress, worry while my imagination went crazy with fear.

I’ve always been told I have a nice chest.  For me, this compliment convinced me years ago that a woman’s chest is one of her most feminine assets. Perhaps some people can’t imagine stating that, but when it is one of the major compliments received, especially from my husband all types of fear entered my mind.

My maternal grandmother developed breast cancer — back in the days when cobalt was the treatment used after a brutal surgery. I had to change her dressings for her when she came home. Her chest was brutalized — like a raw piece of red beef. I was a teenager at the time and I’ve never forgotten how dreadful my grandmother looked. Never did I squint or show her my fears while I cleansed and dressed her wounds. Never did I forget how she looked. My grandmother was a grand lady, an inspirational, loving role model for me, showing me what a lady should always be, how a lady should act and dress. She influenced my life significantly!

What if that happened to me? How would my husband love me anymore IF I lost a breast?

I suppose every breast cancer survivor has felt that fear. I’ve known many women who have battled and won, but I’ve never discussed their fears, or dressed their wounds. I have been told that the incision is much better now, and there is plastic surgery that can be completed.  Before I went for the additional mammogram I researched breast cancer, reconstructive surgery and on and on. I do not recommend others to research. You must ask breast cancer survivors — those who have endured breast cancer. As a writer, I have the tools nearby to find the research. Sometimes a little knowledge can make one frightened out of their minds. Still, I could not pick up the phone to ask a friend. So many women do not want to talk about the experience, and I can certainly understand.

I told myself not to worry. Easier said than done, I assure you. Then, I took my maternal grandmother’s wise advice — I went to my window lifted my eyes up towards the Heavens and I prayed, having a lengthy talk with God. My grandmother’s advice of finding a special window to have God lift a burden has always worked for me. This time, I felt the burden lift. Thank you, Gramma!

An additional mammogram. I’ve had several but I knew this one would be different. Just imagine a portion of your body placed into a paddle where the radiologist pushes, pulls, probes, squeezes, tightens….oops, not the right position so it is time to push, pull, probe, squeeze and tighten again — while attempting to get the muscles, tissues and dense breast materials to tighten, flatten — perhaps like a pancake.

My breast could never become a pancake!

If you are a man, just imagine a tender part of your body pulled into the paddle while having the radiologist tighten…and tighten…and tighten…until there is a pancake size and when the position is intact, she says, “Now don’t move.” Meanwhile your special area feels so tight, uncomfortable, and a bit painful while you attempt to escape into a part of your memory reserved for relaxation.

What? You’ve never heard of a mammogram? A mammogram is an x-ray. Allow me to discuss it further:

According to the American Cancer Society, “Getting a mammogram is one of the best things a woman can do to protect her health. This simple test can find breast cancers early, when they’re small and have not spread. This is when breast cancer is easier to treat and the chances of survival are higher. http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer

If you’re 40 or older, you should get a mammogram every year. Don’t wait. Call your doctor to schedule one today.”

The American Cancer Society strongly recommends that women over 40 have a yearly mammogram. October is Breast Cancer Awareness month, so when you see women, and those who are close to women, wearing the pink ribbons, or pink clothing, remember to schedule your mammogram.

Remember to do monthly self breast exams every month.  For  thoroughly detailed images of how to do a self breast exam, visit the website: http://women.webmd.com/healthtool-self-breast-exam

Every women should have a yearly physical and have a breast examination by a doctor. While examining your breast, pay close attention to the nipples and if you see any changes, be sure to see your doctor.

In the event you should see a change, a lump or swelling, irritation or dimpling, any pain at the nipple, redness, or a discharge, please see your doctor.

After making the appointment, checking with BCBS, I approached my husband about my letter.  I’ve got to have an additional mammogram/ultrasound. It seems I have a glandular change in my left breast.

He looked up from the computer. Wow! This time, I had his complete attention.

What if…what if I have breast cancer and I lose my breast? I could not live like that.

Phil rushed to hold me. Suddenly the weight of the world lifted as he held me. Those arms of strength and love have gotten me through some rough times in my life.

“Did you speak with the doctor?”

Yes. Let’s just say my Julia Sugarbaker kicked in.

“You’ll be fine,” he said. “Don’t worry about it.”

Easy for him to say. What if He was the one who would have a part of his anatomy placed into paddles that desire to flatten the tissues like they are pancakes.

Finally the day arrived. I did my best not to worry; after all, I had a talk with God. I arrived early. The appointment was at 3:40pm. I didn’t leave until after 5pm. This time, the radiologist explained what she was doing. She even allowed me to look over my shoulder. Silly me. I was still attached to the paddle so when I turned to look to the right — well, let’s just say — it wasn’t comfortable!

When will I know the results?”

“I’ll show these to the doctor before you leave. You might still need an ultrasound, but we’ll wait until the doctor says we do.”

Thanks.

Moments seemed like hours as I went back to the dressing room — dressed in a thin bed jacket style of fabric. I couldn’t get dressed until the radiologist said I could. So, the wait began. I know it was only a few minutes, but it seemed like hours. I kept glancing down at my manicured nails. I have a tendency to pull the nail polish off when I am so stressful. I played with my nails and waited. A knock was at the door. I opened it.

The radiologist introduced me to the doctor. “We’ll see you in a year,” she said.

I can go home? I don’t need the ultrasound?

I sighed with delight. Such sweet words to hear.

“It’s just a glandular change. Nothing to be alarmed about.”

How I wanted to hug her but I knew if I lifted my arms, I would be exposed to the world. Instead, I shook her hand.

“Happy Thanksgiving,” she said.

Yes, it will be a great Happy Thanksgiving now.

I suddenly felt guilty while driving home, thinking of the women who have experienced the same tests, only to hear the dreadful six-letter-word that starts with a C.

Somehow. Someway. Someday. Cancer must find a cure. Just when — and at what cost will that day arrive? Every day I pray for a cure while remembering my precious grandmother. Her courage. Her strength. Her love for her granddaughters. How I miss her!