Maintaining Balance Work and Life During Treatm ent

Most likely, when you heard you had cancer, your world seemed to tilt off kilter, and everything seemed different. It can be very strange to realize that other aspects of your life progress as if nothing has changed. You should certainly take time coming to grips with your diagnosis and allow yourself leeway to feel sad or even to cry seemingly out of the blue on some days. However, re-engaging in normal life activities is not only necessary, it can make you feel better and more like yourself again.

How much your treatment will impact your day-to-day activities depends largely on what treatments you receive.

If you are having surgery, the disruption in your routine will happen right away. For a hysterectomy, you will probably need to take time off work. After most hysterectomies, you should expect to spend from 2 to 4 days in the hospital. Once you go home, you will still not feel quite yourself and should not be driving or doing heavy lifting. The surgery section in Chapter 4 discusses these postsurgical considerations, as well as catheterization, which may also delay your return to work. Depending on the demands of your job, you can expect to need between 2 and 6 weeks off. If your surgery will be done robotically, you can expect a much faster recovery; usually you can go home the next morning and will feel back to normal much sooner.

Some women want to return to work as soon as possible so they can feel more like themselves again and think about something besides their cancer. Other women want as much time as possible to get themselves in order prior to returning to work. The Family and Medical Leave Act of 1993 provides some protection for you to take time off work while you are recovering.

Other responsibilities you might have (such as raising children) do not provide medical leave. It is important to arrange for help with these tasks, especially during the first few days after you come home from the hospital.

If you are having radiation, the disruption to your schedule will be less per day but will be spread over a longer period of time. Radiation is given in short treatments every day over several weeks. Most radiation oncology centers are set up to get patients in and out quickly in an attempt to minimize the impact on their schedule. You will likely need to work with your boss to align your work schedule so you can attend your radiation appointments. While some women have to take time off from work during their radiation treatments, most find it possible to work during radiation.

Radiation usually is well tolerated but tends to make you tired. Expect to have less energy than usual. Asking friends and family to help you around the house or with childcare during this time is a good idea.

The impact of chemotherapy on your daily routine depends on which chemotherapy regimen you receive. Platinol AQ chemosensitization is usually fairly well tolerated, but it will require a weekly infusion in addition to your radiation appointments.

Other chemotherapies are given on different schedules. These schedules are called "cycles." In general, you will receive an infusion of chemotherapy on the first day of a cycle and have other appointments or tasks on other days. For instance, you may receive chemotherapy on day 1, come back for some lab work to make sure your blood levels are OK on day 5, have another infusion of chemotherapy on day 8, and have your blood work checked a few other days. This cycle would then repeat itself after 21 or 28 days.

Often you can have your blood work done at a lab near your house if you live farther away from the hospital. On the days you have chemotherapy, you will usually come to the infusion center. Some infusion centers are set up as open areas so patients can share their experiences and gain strength from each other, while others are set up to focus more on providing a quiet, private space. Usually the infusion process takes a few hours, so you should come prepared. Consider bringing a friend with you, especially for the first few sessions until you know what to expect.

The side effects of each type of chemotherapy are different, so it is important to speak with your doctor or chemotherapy nurse about what to expect. In general, if you are going to experience gastrointestinal problems, symptoms usually start between 16 and 48 hours after you receive the chemotherapy. Chemotherapy can make you feel tired and decrease your appetite; allow yourself some downtime to take naps and indulge in the foods you do crave.

While receiving chemotherapy, your white blood cells (the cells that are in charge of fighting off infection) can decrease significantly. This usually happens about 1 week after your infusion. When your counts are low, it is especially important to avoid infection. Wash your hands often, stay away from sick people, and consider wearing a mask if you have to travel by plane during those times. Receiving a flu shot before you start chemotherapy is also a good idea.

Regardless of what treatments you receive, it is important to let your friends and family help you. Make a list of tasks you could use some assistance with so when people ask if there is anything they can do, you can say, "Why yes. Thank you for asking." Your friends and family will be glad there is something concrete they can do to help you through this time, and you will have time and energy to attend to getting better.

surviving cervical cancer— Re-engag ing in Mind and Body Health After Treatm ent

Your surgery is over and/or your course of radiation is completed! The move from being a patient to being a survivor can be both frightening and thrilling at the same time. When the surgery is finished and/or the radiation treatments end, a sense of panic may set in out of fear that the medical providers are no longer keeping such a close watch over you. You may start to feel hypervigilant about your body, worrying that every twinge represents a recurrence. Anytime a friend or relative is diagnosed with cancer, you will likely feel a wave of emotions as you recall how you felt when you were first diagnosed. If a friend dies from cancer, you may be gripped with worry that it will happen to you as well. Whenever a doctor's appointment is scheduled or an anniversary of the diagnosis or surgery approaches, these fears may come rushing forward.

How you manage these feelings is an individual decision. Some women find that support groups for cancer survivors are very helpful. These groups can help you realize that your feelings are normal reactions to what you have been through and can offer insight from others who have walked the same path you have. Other women prefer to rely on the support and care of their friends and family. Some women find that volunteering to help educate other women about cervical cancer prevention helps them as they become a survivor while providing a way to help others and give back some of the help they received during their treatment.

Scheduling and going to each follow-up appointment may be stressful because you are worried that the doctor will find evidence of a recurrence, and it may bring back a rush of emotions and memories from when you were first diagnosed. However, it is very important to have follow-ups with your gynecologic oncologist for the rest of your life. It is also important to note that recurrences found early are more likely to be treatable—so keep your follow-up appointments!

As you transition from being a patient to being a survivor, it would be great if all the side effects of your treatment stayed on the patient side of the equation. However, on top of the emotional adjustment you will be making, your body will also still be making adjustments over the next few months. You should not expect to feel entirely back to "normal" for several months after completing your treatment. Symptoms such as fatigue can linger for several months. In addition, some of the side effects of therapy can be permanent and your "normal" after treatment may not be the same as before treatment.

If you were premenopausal and had your ovaries removed or irradiated, you will likely experience menopause. Symptoms can include hot flashes, vaginal dryness, and irritability. While doctors used to think that all women should be on hormone replacement therapy, recent research has shown that hormone replacement therapy may increase the risk of strokes or breast cancer. However, it is a slightly different picture when the hormones are replacing hormones that your ovaries would have been making if they hadn't been removed. You should talk with your doctor about whether hormone replacement is appropriate for you.

Your sexuality may also be affected by both your cancer and the treatment of your cancer. Surgery can lead to vaginal shortening, as can radiation. Radiation may also cause your vagina to become dryer and scarred. These changes may make you more likely to have some bleeding with intercourse. And of course, anytime you see any vaginal bleeding, you are likely to worry that you have a recurrence. All this can lead to a lot of anxiety! Working with a dilator can be helpful, and frank, open discussions with your partner are also important.

Radiation can leave you with other long-term side effects as well. Bladder irritation and blood in your urine can last for a while after treatment. Bowel irritation leading to diarrhea or blood in your stools can also occur for a while. You should tell your doctors if you are having these problems so they can make sure nothing else is going on.

Doing everything you can to keep yourself healthy can be empowering as you move from being a patient to being a survivor. You have overcome one obstacle. Now is a great time to embrace a new, healthy lifestyle. Good nutrition and regular exercise are important to your overall health.

It is important to keep up with screening for other cancers too. While the thought of being diagnosed with another cancer is terrifying, remember that cancers caught early are much easier to treat. You should have a mammogram yearly if you are over 40 years old. If you are 50 years of age or older, you should have screening for colon cancer, usually by colonoscopy.

It is especially important that you stop smoking if you are a smoker. Not only does smoking increase the risk of developing cervical cancer, but it also increases the risk of it recurring! Give yourself the best chance of staying disease-free and quit smoking. It can be very difficult, and the average smoker has to make several attempts before they successfully quit. But it's worth it! Besides decreasing your risk of recurrent cervical cancer, you decrease your risk of lung and bladder cancer and the risk of emphysema. Talk to your doctor about different medications to help you quit by decreasing your cravings. Set a quit date and make sure your friends know about it. Have them remind you how important it is to your health that you quit smoking. Set aside the money that you would be spending each day on cigarettes, and after a month, several months, or a year treat yourself to something nice with that money. Figure out your triggers for smoking. Do you always smoke when you drive? When you talk on the phone? Then make sure you have something else to do with your hands during those times. For example, keep lollipops in the car, or keep a pen and paper by the phone to doodle with. Quitting smoking will significantly decrease your risk of recurrence and make you a much healthier person overall.

Surviving cancer can have some positive long-term side effects as well. After coming through this ordeal, you are seeing the world with new eyes. Coming face to face with your own mortality can make you take a step back and reassess who you are, what is important to you, and who you want to be. You may decide to make some changes in your life: go back to school, change careers, work less.

Many women who survive cancer report that their enjoyment of life eventually becomes greater than before their diagnosis because they realize how much their family and friends mean to them. They see life in a new way and savor the chance to strengthen their relationships with the people who mean the most to them. Things that once seemed like big problems now seem insignificant when compared to cancer. Life after cancer is certainly different than life before cancer, and it holds big challenges. However, it also holds possibilities for a fresh start to a brighter, more fulfilling future.

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