Saturday 24 March 2018

Coping after cancer: outer scars and inner emotions

Ask the GP...

Dr Nina Byrnes
Dr Nina Byrnes

Nina Byrnes

Advice from our GP on post-cancer recovery and on the best approach for acne.

Q. I had a post-cancer check-up recently and it is all clear. My doctor says it was caught early and I should do well. This was great news so why do I feel so down?

Dr Nina replies: Cancer is a word that rings fear in most. Hearing the word in reference to yourself or a loved one causes a cascade of emotions that can take months and years to overcome. The treatment itself can be long and arduous and recovery is not always guaranteed. It is no wonder that up to one in four of those diagnosed with cancer will experience some form of mood change.

Cancer care is improving all the time. Patients are usually very well informed about what to expect during treatment but the after effects aren't always so well described. Nearly every patient I see who has gone through cancer treatment experiences some form of mood change afterwards. This is most common in the days and weeks after they have been given the all-clear. I refer to this as the "post-cancer adjustment reaction". The diagnosis of cancer brings its own stress. The body goes into fight or flight mode, releasing all the stress and energy hormones it can. The days, weeks and months that follow are filled with hospital stays and appointments, chemotherapy and radiotherapy treatment - sometimes complicated by infections or further physical ills. Patients often get through this time on a wave of adrenaline that helps them cope.

The check-up that brings the good news of cure should be a happy day but the calm that follows often is the time where the true emotional impact of the previous months takes its toll. Feelings of anger, depression, guilt, anxiety, fatigue and a sense of dread are all really common. Many have made promises to themselves that life will be different once cancer ends, and if this doesn't happen, even more guilt can set in. Physical scars and change may bring emotional turmoil and adjusting to the new you can take time.

It is important to recognise that you are not alone with these emotions. Tell your family and friends how you feel. Talk to your GP. Engage a professional counsellor. Connect with cancer support services such as ARC House or others. Connect with other cancer survivors at peer group meetings or on social media. They will know how you feel and can be a great source of support and advice. Learn how to practice mindfulness; it can help greatly.

Don't put too much pressure on yourself to physically bounce back straight away. Focus on a healthy lifestyle. Eat well. Drink plenty of water. Don't rely on alcohol as a stress release. Gently return to exercise. Walking and yoga may be easier on the body and really helpful to the mind. Enquire about a post-cancer rehab class. This will help improve your strength and your confidence in your abilities. Get plenty of restful sleep. This heals body and mind. Remember, treatment likely ran for six months to a year. Healing takes time too. The good news is the majority of people do get back to themselves and today more cancer survivors are leading full and happy lives. Mental and physical recovery is possible.

Q. My son has terrible acne covering most of his face. He has been asking about treatment. We are getting mixed responses. Some say I should just let him grow out of it. What is the best approach?

Dr Nina replies: Acne occurs in over 90pc of people at some stage of their lives, for most this is during adolescence. Those with conditions associated with high male hormone levels, such as polycystic ovarian syndrome, have a higher incidence of acne. Women often notice a flare before their periods. It can run in families, especially in male relatives. Stress can make acne worse. It is not a condition of poor hygiene. A diet high in unrefined starches and sugar can make acne worse too.

Many creams and lotions are available. The best of these are those that contain benzoyl peroxide or Retin-A. They cause an irritant effect to the skin that dries out the upper layers reducing the chance of keratin plugging and inflammation.

Antibiotics either applied to the skin or taken in a low dose over a prolonged period may help. For those with severe unresponsive acne, treatment with Roaccutane can be transforming. The course can be difficult as there are many side effects, most due to the drying and scaling of the upper skin layers, but it works and can permanently cure acne in up to 90pc of people. Effective contraception or complete abstinence must be used during treatment and for several months afterwards. It can’t be prescribed to those with a history of depression.

Teenagers should not be left to grow out of acne, as scarring can be permanent. Wash twice a day. Washing regularly will help clear sebum and shedding skin cells, but over washing exacerbates it. Bacteria can live on facecloths so either use your hands or a wipe, and whatever you do, DON’T run to the mirror and squeeze — it won’t get rid of it and you will make it worse.

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