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Collateral Damage

Posted 9/1/2015

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  Collateral damage is most often a military term. You know, those unfortunate children who just happened to be in the school building that was bombed as part of a mission to destroy enemy operatives nearby. There seems to be all too much war language used in Cancer World. but this phrase, thank you Susan Gubar, seems absolutely correct. Reminds me of the analogy used years ago by one of my patients: "My body and my life after treatment are like a bombed out city. I have to rebuild brick by brick."

  All too often, the rebuilding cannot recreate the original. Think of the obvious examples: even the best reconstructed breasts are not really breasts, even hair that returns after chemotherapy is apt to be somewhat different than what previously graced your head. Then there are all the damages that cannot be repaired. My Gubar begins her essay (which I will share later) with descriptions of men post prostate cancer radiation or surgery who are trying to deal with the incontinence and impotence that resulted. Surgery can change bodies in permanent ways: missing parts or things that have been awkwardly added like ostomy bags.

  Surgery and chemotherapy can kill dreams. Many younger people are rendered infertile by treatments; men hopefully were advised to sperm bank, but it is much more complicated for women. Even if babies, or the loss of possible future babies, was not part of your agenda, intimacy and sexuality are always slammed by cancer treatment. Do libido and responsiveness return? Usually,yes, but not always, and frequently in a diminished state.

  It is pretty remarkable that we adapt as well as we do. Most of us, most of the time, recognize that the trade off was worth it: more life at quite a cost. If you were told, at the time of diagnosis, that the prescribed chemotherapy brings a risk of leukemia some years in the future or that the prescribed radiation may cause heart damage that will be a problem decades later, you probably would have signed the consent form. Is that short-sighted or realistic or wise? Most of us are also pretty good at denial. Once we have finished treatment and regrown hair and recovered energy and rebuilt our lives, we don't spend a lot of time thinking about the possible long-term damage that the treatment has done. Maybe that is naive, but I think it is also adaptive. After all, what exactly is the point of daily fretting about something we cannot change and that may never happen?

  It is worth, however, recognizing that we have come through a lot, that we likely are different physically and psychologically than we were in the pre-cancer days. Here is the start and a link to this excellent piece: 

Living With Cancer: Collateral Damage

by Susan Gubar

When I was invited to attend a prostate cancer group called “Us Too” in my town, its members were meeting
in a private room in our public library. About eight men, some accompanied by their wives, had great difficulty
communicating their discomfort about urine leaks and diapers. They wanted to know what strategies my
gynecological cancer group used to talk about sexual issues. To alleviate their daily problems, the participants needed professional help that I could not furnish.
Sexual dysfunction and incontinence in prostate cancer survivors underscore a quandary that stalks oncology.
As we all realize, procedures that prolong lives also impair them. Yet cancer patients who must forfeit quality of life to gain quantity of life rarely receive adequate warning before treatment or guidance afterward.
A vigorous defender of conventional medicine, the British journalist John Diamond nevertheless admitted
that the impairments he faced had nothing to do with his throat cancer but were instead produced by efforts to cure him of it: a missing lump of tongue, a hole in his throat from a tracheotomy, shooting pains in the neck and jaw, the loss of voice and saliva glands and tastebuds, a limp, edema, overproduction of mucus and saliva, ulcers, a frozen shoulder, toothache, constipation, diarrhea, and radical weight loss. The surgery, radiation, and chemotherapy that inflicted these damages gave him four years of a compromised existence.


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