Cancer Blog
By Brian Zimmerman
Begun on July 31, 2021
Email: dyingman1@yahoo.com
My Dying Words
“’It isn’t cancer is it, Doctor? I haven’t got cancer?’ Pavel Nikolayevich asked hopefully…. ‘Good heavens, no. Of course not,’ Dr. Dontsova soothed him for the tenth time….’”
Alexander Solzhenitsyn, Cancer Ward, (New York: Bantam Books, 1969), p.1
Entry #9
August 31, 2021
It’s Up to You
Here’s another dictum: Remember the referee’s warning when the two boxers enter the rink: “Defend yourself at all times.” When you enter the health care system, and I don’t care where you are: you could be in the best system in America, don’t forget this dictum. First of all, doctors have tunnel vision. They try to watch what other docs are doing, but nobody can keep up with everything. When you are in a hospital, the hospitalist (a MD that is like a general contractor when you’re building a house), will try to keep track of all the MD’s who are involved in your hospital stay: for me, it was pulmonology, radiology, and gastroenterology. But, no one can watch every test, every med, every injection, pill, etc., that you receive or are subject to. I tell everyone: get a notebook and write down every MD who enters your room, and record what he said, what you asked, what tests are coming up and meds are to be added/changed/deleted, etc. Keep track of appointments, tests, etc. DON’T EXPECT THEM TO DO THAT FOR YOU! I know I’m repeating myself in these entries but some of these dictums overlap and some just need repeating. Take responsibility for your health care. It’s not the MD, the nurse, the therapist’s responsibility to remember everything about your care. You must be involved. You don’t have to be abusive or angry or accusatory, but you can politely ask about tests, meds, diagnoses, etc. I went for a CAT scan and the tech was going to do the scan on my leg rather than the arm I knew the MD had ordered. I merely asked if she was sure that was correct, and when she checked and saw that I was correct, she was very apologetic. She wasn’t lazy, or careless, or incompetent. She just misread the order, and was glad for the help I gave her to prevent a mistake. Know your tests, write down your meds, and know who your MD’s are. You will be glad you did at some point.
Exercise Can’t be Overemphasized
The next Brian’s dictum, one I mentioned last time, but feel that it’s so important, I’ll say it again: “Don’t sit more than 1 hour. Get up and stay on your feet for more than one minute.” Try to find chores you can perform no matter what your strength and endurance are. Of course you don’t want to overdo it, but underdoing it is just as big a problem. Get some guidance from your physical or occupational therapist. No matter what you’re suffering from: serious surgery, serious injury, or serious illness (like cancer), you need to continue to practice some form of regular activity, preferably exercise. I have had numerous patients with any of the above (surgery, injury, illness), and invariably the ones who do best are the ones who push to remain active. I know I’ve discussed the importance of exercise in a previous entry, but I just can’t say it enough: you need to exercise, even with cancer and chemotherapy. You will feel better in the long run if you continue to remain active rather than giving in to what you feel like doing, which is sitting or lying down all day. Don’t yield to that feeling. Try to participate in normal daily activities as much as you can: attend worship, go to the grocery store, visit the library, visit friends and family or encourage or permit them to visit you, etc. Again, in the long run, you’ll be glad you did and it will pay not only physical benefits, but also social and emotional ones as well.
For Instance
Here’s a suggestion for an exercise: the best exercises are what PT’s call functional ones, i.e., ones that are molded around an activity that will help you do something that you perform regularly. So, I almost always assigned one called simply “Sit to Stand.” The exercise is exactly what it sounds like: you are to stand up from a sitting position. You should do a stand up and sit down exercise for 5x repetitions (5x sit to stand) starting out, using your hands as much as you need to. Try to work your way up to 10x (10 repetitions) and do it two to three times a day at a minimum, more if you can. And, here’s how I suggested progressing this exercise (i.e., making it more difficult): try to stand using only one hand to help. And, with the elderly, I reminded them to perform it using proper technique, viz., scoot forward in your seat, then lean forward , putting your “nose over toes” to get your center of mass (COM) over your base of support (BOS), in other words putting your body weight over your feet. Otherwise, physics is against you. I can’t count the number of times I’ve had an aide or family member tell me that they have to practically pick grandma up to get her on her feet because grandma can’t do it without a huge amount of help. I then said, “Let me try.” I then coached grandma through proper technique with me simply urging her to push when time to stand and, surprise!, up she popped, usually with me barely or not touching her at all.
The next step is begin trying to do the sit to stand without using your hands (yes, no hands at all (I usually had people cross their arms over their chest) (if this sounds easy to you, then try it. If it is easy for you, then you are an exception unless you are young). If you have to use your hands to perform a sit to stand, then your thigh muscles are weak and need strengthening. I once had a patient who couldn’t do the sit to stand from her wheelchair without using both hands and pushing on them with a lot of force. I kept warning her that doing it that way was very risky because she might not always be able to use both hands. Sure enough, I came one day to her home for a PT session and she had one arm in a sling. I asked her, “Mrs. Smith, how are you able to stand up from your wheelchair with only one hand?” “I can’t,” she replied. She reported that she had injured her shoulder getting into the transport service van to go to a MD appointment. I spent the rest of the session working on her shoulder to help her shoulder feel better so she could use both hands to stand up. When I left, I told her, “Now you see why it’s important to practice sit to stands to reach the point where you can do them without using your hands.” “I know,” she said. Of course, knowing is one thing, doing is something else.
In the next entry, I’ll talk about my thoughts on my effort to prepare to die from cancer.