A Doctor Speaks Out

By Dean Gesme‚ MD
Medical Oncologist‚ Cedar Rapids‚ Iowa
Chair‚ National Coalition for Cancer Survivorship

Question:
When will I feel normal?

Answer:
Feeling normal is often more than just taking an inventory of body systems and finding no disease; it includes having the physical energy to get back to the usual activities that defined life before treatment. The physical side effects of chemotherapy have a direct effect on your attitude and interest in jumping back into a normal style of life and good health.

While the physical effects of chemotherapy vary among the different anticancer treatments‚ it isn’t the chemotherapy itself that makes you feel miserable. Chemotherapy rarely stays in your body more than a few hours because your body uses many sophisticated means to break down and eliminate the potent cancer–fighting drugs. It is the damage that chemotherapy causes to normal cells that takes much longer to repair. And that is what gives rise to the toxic effects seen from cancer treatments.

Some toxic effects‚ like drug–related nausea‚ might persist for only a few hours after the drug is stopped. If you are on chemotherapy‚ you might also experience nausea from ulcers or gastritis‚ which are caused by other factors‚ but are irritated by the chemotherapy. Other toxic effects‚ like nerve injury or neuropathy‚ which result in numbness and lack of feeling‚ can persist for weeks‚ months‚ or even years because nerve tissues re–grow very slowly when damaged.

Chemotherapy can affect other parts of the body. Mouth sores‚ called mucositis‚ heal relatively fast‚ recovering over a few days because cells lining the mouth grow and replace themselves more rapidly than other cells in the body.

Hair follicles‚ which manufacture strands of hair‚ can be injured‚ too. This injury is a brief effect from chemotherapy‚ but even when the follicles recover‚ it might take weeks or months for the strands of hair to approach “full and normal length.”

Getting back to normal includes having the physical energy to resume the activities that defined your life before diagnosis‚ which demands a lot of energy.

The fatigue that you might feel after cancer treatment is often due to many contributing factors‚ which are compounded by surgery‚ radiation‚ and/or chemotherapy. Sometimes‚ cancer–related fatigue resolves rapidly when treatment goes well and the cancer responds favorably. When that happens‚ it seems that you can jump back into your normal life without missing a beat. More commonly‚ however‚ fatigue can be much slower and more gradual in its resolution than expected.

When will you feel normal again? The answer is different for everyone‚ depending on your expectations and how quickly the cell damage done by treatment can be reversed. Most people are expected to completely recover from the physical symptoms from their treatment in a matter of weeks to months.

Rare‚ long-term or permanent side effects are occasionally seen following highly toxic treatments like stem cell or bone marrow transplants. Fortunately‚ the terrible side effects‚ which we accepted a decade ago‚ have been significantly reduced in the past few years.

There is a large number of new and amazing drugs being developed and utilized that can markedly reduce the range and severity of the toxicities from cancer treatments.

The faster toxicities are reduced‚ the sooner you will get back to feeling normal.


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A Survivor Speaks Out

Barb Schultz lives in Joliet‚ Illinois. She has always wanted to write and says that part of her new normal is not putting off what she wants to accomplish. CURE is pleased to help her meet this goal.

Question:
When will I feel normal?

Answer:
I am 52 years old‚ and I’m still learning not to obsess about little things. The other day I was heading to my sewing machine to make a copy of a chemo–hair scarf I had seen in a catalog. “Well‚ I hope this comes out OK‚” I said. My teenage son replied‚ “Mom‚ you’ve made‚ like‚ two wedding dresses and how many evening gowns‚ and you’re worried about getting a bandanna right?“

I’ve discovered from living with cancer that life does get back to normal‚ but it’s a new normal—and the new normal keeps changing. The most significant aspect of my new normal has been a mellowing process as I learn not to be a perfectionist about every little thing in my life. On June 18‚ 2001‚ I was diagnosed with multiple myeloma‚ an incurable cancer of the blood plasma cells. It was the same day Geraldine Ferraro went public with her own account of multiple myeloma.

At the time of my diagnosis‚ I had dangerously low hemoglobin‚ high blood calcium‚ and a fractured vertebra. I was shocked to find out I had cancer but relieved to know there was a good explanation for how bad I had been feeling.
Immediate treatment got me out of danger and on the road to controlling the disease.  But I was overwhelmed with this new situation. My family and I wondered if our lives would ever return to normal. Would I ever again be able to manage all the details of my life?
 
Well‚ we did get back to normal‚ but it was a new normal. For a while‚ new normal meant being grateful for a night free of muscle spasms as my back began to heal. In the new normal I could nap four times a day as the fatigue from anemia gradually lessened. New normal meant allowing other people to take over some tasks and letting go of others because medical appointments and keeping track of bills and insurance payments took so much time.

As my disease was brought into remission‚ new normal changed.  It meant returning to my part–time job‚ but for 10–12 hours a week rather than the previous 25.  It meant being satisfied to walk two miles three times a week‚ instead of the three miles five days a week. New normal meant coping with annoying side effects from the oral medications that were controlling my cancer while rejoicing that such a relatively easy treatment was producing a dramatic reduction in my disease level.  New normal was beginning to feel a lot like old normal as it looked like my cancer‚ although incurable‚ could be managed as a chronic condition.

Then the medication stopped working‚ the remission ended‚ and I had to begin another form of treatment.  The newest normal involves hospital stays for intravenous chemotherapy. It means saving enough money on haircuts to almost cover the cost of my wig. And it means getting used to hearing people say‚ “You look great!” and being thankful that this treatment is harder on the cancer than it is on me.

But this newest normal also means never again buying something  in a color I don’t love just because it’s on sale. It also means not waiting until two days after my friend’s birthday to call her because the rates are lowest on the weekend. Newest normal means not agreeing to work on Sunday afternoon because the library pays double the hourly rate when I’d rather be doing The New York Times crossword puzzle. It means I mop the floors less often‚ I cook simpler meals‚ and everyone is satisfied.

Living with cancer has taught me the value of saying “I love you‚” ”Thank you‚” and “I’m sorry” more often. People with cancer know‚ probably better than most‚ that our time here is finite. This is not a scary or depressing thing to know.  It makes for a sweeter journey.