Friday, February 14, 2020

Sex and Cancer: Getting Your Swerve Back On

Valentine's Day is a hot day for sex, or so the popular lore goes. But for someone who is dealing with or has dealt with cancer, this can be a loaded holiday.  Cancer treatments can push women into early menopause, bringing issues like vaginal dryness, atrophy, etc. into a bedroom, or, for men, result in erectile dysfunction, decreased libido or other bedroom challenges. So what is someone with a cancer issue to do on this most romantic of holidays?  Believe it or not, it is possible for a cancer kid to have and enjoy sex.  In fact, having orgasms does a body good, leading to less stress and a boosted immune system (What Happens To Your Body When You Masturbate Regularly (Bustle, March 2019) and for the  scientific explanation, Effects of sexual arousal on lymphocyte subset circulation and cytokine production in man. (Neuroimmunomodulation, 2004)).

So there's no reason not to get back into the intimacy business if you're dealing with the side effects of cancer.  The question though is how do you go about doing this? Luckily, there are a host of experts out there talking about just this topic. Memorial Sloan Kettering Cancer Center (MSK) offers guidance to patients through its Sexual Health and Intimacy services. And oncologists like Dr. Don Dizon have focused on the area, creating the Sexual Health First Responders Clinic at the Lifespan Cancer Clinic in Providence, Rhode Island. Also, sexual enjoyment companies like Jo Divine in the UK offers great information on Women's Sexual Health and Men's Sexual Health,  providing information on issues such as, Sex After Testicular Cancer, Sex After Breast Cancer, along with a whole  host of other sexual health topics.

So let's talk about the problem of vaginal atrophy, for instance, which makes the vagina and vulva (the skin on the outside of the vagina) dryer and less elastic; a common problem for many women during and after treatment for breast cancer.  Blogger Jane Lewis tackles this issue in Living with Vaginal Atrophy, and Memorial Sloan Kettering Cancer Center offers even more information in its October 2019 information page, Improving Your Vulvovaginal Health. Rather than resigning to a life without sex, there's hope. Non-hormonal hyaluronic acid products such as Revaree can be used to treat vaginal dryness, and for non-hormone sensitive cancers, estrogen-based vaginal suppositories can be used. In addition, pH balanced vaginal lubricants like Yes (my personal favorite) can be used during sex to make the experience enjoyable rather than painful.

Certainly, the resources above don't begin to cover all the information out there to help us cancer kids get our swerve back. If you have helpful info you've found, please feel free to tell us about it in the comments below.  But this is a good start, and hopefully can help you end your evening with the bang you so desire. Or at least this can help you make a good start of it. Find what works for you, take your time, be gentle with yourself and your partner as you go. But most important, you go get your swerve on.

Friday, February 7, 2020

Patient Hopelessness in the ICU

My family has a long history with the ICU.  My mother first ended up in an ICU in the '80's when she went into pulmonary arrest after a minor surgical procedure. Her children visited her room two at a time, standing next to her bed, a ventilator tube filling her mouth, her eyes panicked, a look that didn't leave until the ventilator was removed.

Luckily my mother didn't experience the ICU again until her death, this time all of us able to visit her coma-laden body at the same time in the ICU after she'd experienced a major stroke. We spoke to the doctors of the damage to her brain, and decided to honor her advance directive and remove her from support. A cart of food and drinks for the family, what I began to refer to as the Death Cart, mysteriously appeared next to the door, and the room filled with the smell of dying.  We were able to help her die peacefully thanks to pain killers, but her children were indelibly marked, grieving her sudden and tragic loss.

Sadly, soon after my mother's death my sister spent time in the ICU, again on a ventilator when she was not able to breathe after a minor surgery. But this time the stay was longer. Let me tell you what happens when a patient has an extended stay in the ICU. My sister was on a ventilator, highly sedated. After a period of time she began to try to pull the tubes from her throat, leading to more sedation and finally physical restraint. This then led finally to a psychotic break - up to 85% of ICU patients will experience ICU psychosis. My sister became more and more panicked, writing notes to us begging us not to let hospital staff kill her, begging us to stay by her side. We obliged. Finally, my sister was taken off the ventilator, but she never really recovered.

Now my turn. Last Thursday night I began to vomit blood.  This gastrointestinal bleed earned me a spot in the ICU, my careful doctor wanting me to be closely observed after stopping the bleed.  I was tethered to monitors and IV poles via an adhesive pulse sock on my right index finger, adhesive leads on various spots on my torso, two IV's, one in each arm, an oxygen calendula in my nostrils, and a blood pressure cuff that inflated so tightly on the hour a bruise was left on my right arm.  I was conscious and lucky to not be on a ventilator. If my blood oxygen level dropped below 90, the monitor would alarm. If the IV bag line was blocked or the bag was empty, the IV would alarm. If the blood pressure cuff didn't fully inflate, the monitor would alarm. If the contact on the pulse sock didn't read, the monitor would alarm. The lights outside the room were never lowered, and the curtain drawn across the glass wall didn't block that light. The multiple monitors and IV displays lit the room.  And each time the alarms sounded, the staff ignored those bells, likely to keep their sanity, leaving me to listen to the constant piercing sound. And when I would press the call button, the staff was often busy with other patients, so I was forced to listen to that sound until finally someone would arrive.  I couldn't sleep. I couldn't relax. I was increasingly anxious. I suddenly understood why my sister lost her mind.

On top of that, while I was in ICU, two other patients in ICU died. Luckily, I was mobile and I'm smart, maybe the kind of patient nurses love to hate. I learned how to disconnect the leads and silence the alarms for a few minutes at a time, so that I could walk down the hall and use the restroom instead of the in-room commode. This meant though that I was seeing the grieving families, the Death Cart, the patient in the process of dying each time I walked out of my room.  I was in ICU with hopes of living, and instead I was reliving my own family's grief memories, and forced to face the fact of my own imminent mortality from Stage IV breast cancer each time I needed to take a bathroom break. And I had to take many bathroom breaks (better than edema).

After a period of time, the doctors and nurses began to tell me I no longer needed to be so closely observed, I could be moved to a regular room. But winter is the time when hospitals are full, thanks to the flu, and no regular rooms were available for my move, so I had to stay in ICU. That meant I had to follow ICU protocol and remain tethered to monitors, calendulas, and IV's, and continue to listen to the constant alarms.  The problem was that I began to feel trapped in this world of alarms, never-off lights, no rest, and death. And with each day I stayed trapped in this world, I lost more and more hope.  A close friend once told me that he knew there was trouble when I began to lose my sense of humor.  After day three in ICU my humor was entirely gone.  The ICU staff was kind, caring, they meant well, but I didn't belong there and the sense of hopelessness was getting worse and worse  Frankly, I've begun to believe that no one belongs in ICU, at least not with the inhumane, alarm-driven, lights up way ICUs are designed now.

Day four I was finally moved to a regular room, but at that point, the damage was already done.  My mood did improve as soon as I left ICU, but an encounter with a cruel nurse on my final day at the hospital dropped me back into the ICU hopelessness.  I came home feeling sad, demoralized, and tearful.  And the problem was worsened by the fact that no one else seemed to understand my experience.  I just wanted to drop into someone's arms and sob. Instead I sobbed by myself and I still can't seem to let this sadness go. Luckily, the hopelessness seems to be morphing into anger, and for that I am grateful.  I'd rather be angry about this horrible experience than to internalize it as a hopeless loss of the will to live.  I am still trying to find a counselor to help me deal with all these feelings, because honestly, how is a stay in an ICU, watching others die, any different than the grief and trauma of a tragic death of a loved one or the death of a classmate at a school?

I personally do not have the energy to fight the world of bad ICU design.  There has been research and solutions proposed to re-humanize the ICU by changing lighting and reducing sound.  I do know I never want to end up in an ICU again. I've added a DNR and instructions to remove any ventilators past hour six to my advance directive.  And, if I end up in an ER again, I will fight like hell to stay out of ICU.  I would rather lie on the floor in an ER than spend any time in another ICU. I just don't think I have the energy to fight the death, alarms and constant light.