I haven’t
updated lately (I’m sorry Aunt Onvie).
As much as the blog has come to mean to me these last few years, I just haven’t
been able to make myself sit down and write lately.
The nurses
brought Dr. Berryman out and they moved him into a back room where he could lie
down on a bed. He calmed briefly but
then started back almost immediately – to the point that he was throwing up and
seemed disoriented and unsure of where he was.
When Dr. Berryman sat down to try and talk to him, Tanner told him that
he was “scared -just scared” - and he shook his fist in the air. There was so much fear and anger all tied up
together inside of him at that moment.
Finally, Dr.
Berryman told us that he was going to admit Tanner to the hospital and was
going to call in a Pain Specialist – and a Psychiatrist.
He ended up
staying in the hospital for six days and, from what I can gather, they seem to
think most of the issues Tanner is experiencing at this time are mental – and that
he was experiencing a panic attack there in the doctor’s office.
Why is this
medication prescribed?
Duloxetine is used to treat depression
and generalized anxiety disorder (GAD; excessive worry and tension that
disrupts daily life and lasts for 6 months or longer). Duloxetine is also used
to treat pain and tingling caused by diabetic neuropathy (damage to nerves that
can develop in people who have diabetes) and fibromyalgia (a long-lasting
condition that may cause pain, muscle stiffness and tenderness, tiredness, and
difficulty falling asleep or staying asleep). Duloxetine is also used to treat
ongoing bone or muscle pain such as lower back pain or osteoarthritis (joint
pain or stiffness that may worsen over time). Duloxetine is in a class of
medications called selective serotonin and norepinephrine reuptake inhibitors
(SNRIs). It works by increasing the amounts of serotonin and norepinephrine,
natural substances in the brain that help maintain mental balance and stop the
movement of pain signals in the brain
KLONOPIN (Clonazepam):
Why is this medication prescribed?
Clonazepam is used alone or in
combination with other medications to control certain types of seizures. It is
also used to relieve panic attacks (sudden, unexpected attacks of extreme fear
and worry about these attacks). Clonazepam is in a class of medications called
benzodiazepines. It works by decreasing abnormal electrical activity in the
brain.
Several
past studies on the psychological impact of childhood cancer have focused on
the people around the patient, such as the parents and siblings, or on children
during and immediately following their cancers. But what happens to those
children when they grow up?
Anne
Kazak, Ph.D., professor and director of psychology research at the
University of Pennsylvania and director of the Department of Psychology at the
Children’s Hospital of Philadelphia, has led a decade-long effort to understand
the mental toll of childhood cancer.
Kazak
is now leading a randomized study, funded by the National Cancer Institute, to
determine whether intervention with use of cognitive behavioral therapy and
family therapy can help cancer survivors and their families. She will also
develop an intervention program with support from the Lance Armstrong
Foundation.
Most
recently, her group found that many childhood cancer survivors exhibit signs of
post-traumatic stress disorder (PTSD) when they reach young adulthood. PTSD,
the malady most famous for lingering, hidden emotional reactions to war in
shell-shocked veterans, is now recognized as a syndrome in patients whose
feelings about their disease are not resolved. Patients may just want to get on
with their lives, but these emotions, often unrecognized, do not always vanish;
they can grow stronger and erupt unexpectedly.
Post-Traumatic Stress
Kazak’s
latest study revealed that 20% of 78 young adults who survived cancer met the
full clinical diagnosis of PTSD. Of the remaining patients, 45% to 90%
exhibited at least one symptom of PTSD, depending on the type of criteria used.
Many
of those symptoms included overwhelming bursts of anxiety and avoidance related
to their cancer experience. “The patients worried that their lives remained in
danger and events associated with treatment, such as returning to the hospital,
or even smells associated with hospitals, are potent reminders strong enough to
generate strong physical and emotional responses years, even decades, later,”
said Wendy Hobbie, one of the study’s authors. The rate of PTSD symptoms in these adults, aged 19–40, was four times higher than in a group of cancer survivors aged 9–17 who were studied earlier. The younger survivors’ sense of mortality was not as fully developed. The emotional price to pay for surviving cancer seems to coincide with the normal increased stress of young adulthood, when people are setting out on careers and spouses and children, said Hobbie. “They reach a point where, developmentally, they realize cancer has a far-reaching impact. At 16, you don’t care if you had it. At 30, when you meet the love of your life, you do.”
This most recent study is just one of a series led by Kazak, in collaboration with a team of researchers that includes Margaret Stuber, M.D., of the Neuropsychiatric Institute at the University of California at Los Angeles. Kazak’s ultimate goal is to design intervention strategies that can help patients, parents, and siblings to recognize PTSD symptoms and treat them effectively.
Kazak and Stuber were the first to find an association between ongoing difficulties, concerns, and anxieties in former leukemia patients and trauma seen in PTSD. They also found, among other discoveries, that mothers of pediatric cancer survivors have significant symptoms of PTSD—much higher rates than PTSD seen in their children, who were only several years past treatment. Their studies revealed a pattern of increasing PTSD as patients aged, but unremitting widespread symptoms of trauma in their parents.
More Survivors
More
and more adults are survivors of childhood cancer; it is estimated that by 2010
one in every 250 to 400 adults between the ages of 21 and 44 will be a survivor
of childhood or adolescent cancer. But, mostly, the research accurately
reflects what has been seen in cancer treatment. Just as many patients
experience physical penalties from their initial cancer cure, they also exhibit
psychological consequences. “We believe this isn’t something brand new in the
1990s,” said Stuber. “It’s just that no one had asked the right questions before.
The advice that had often been given—that patients should go out and celebrate
their survivorship and pretend nothing ever happened to them—was not good.”
University
of Pennsylvania pediatric oncologist Anna Meadows, M.D., said that she is
concerned that adult cancer survivors receive even less psychosocial support
than children, and that includes childhood cancer survivors as they age and
move into general medical care. She also worries that in the future, as now,
money will not be available to implement intervention programs for any of these
patients or for the parents, who can be the most traumatized. “Mental health
efforts just do not get reimbursed for the effort expended,” she said. “There
is more to a cure than just being alive, and it’s time the funders recognize
that.”
I know that my son is experiencing stress – to a degree
that not even I have realized.
Posttraumatic stress disorder[note 1] (PTSD) is a severe anxiety
disorder that can develop after exposure to any event that results in psychological trauma. This event may involve
the threat of death to oneself or to someone else, or to one's own or someone
else's physical, sexual, or psychological integrity, overwhelming the
individual's ability to cope. As an effect of psychological trauma, PTSD is less frequent
and more enduring than the more commonly seen post traumatic stress (also known
as acute stress response).Diagnostic symptoms
for PTSD include re-experiencing the original trauma(s) through flashbacks or nightmares,
avoidance of stimuli associated with the trauma, and increased arousal—such as
difficulty falling or staying asleep, anger, and hypervigilance.
Formal diagnostic criteria require that the symptoms last more than one month
and cause significant impairment in social, occupational, or other important
areas of functioning.
After the six days in the hospital and taking his new medications,
Tanner seems better, calmer, happier… but basic cancer treatment is not all Tanner
will have to deal with the rest of his life.
He’s also going to have to live with this fear for the rest of his life.
He told Cearra the other night at the hospital that as
scary and hard as it was, the initial six months of his treatment were the most
important days in his life. He said “As
bad as it was, some of the best memories I have with mom were when we were in
Arkansas”, and I know what he means. In
Little Rock, when they were giving him daily chemo treatments and his two stem
cell transplants, he and I were both totally focused on the “now”. We were dealing with getting to the hospital
every day, handling his illness and weakness every day. There was no time to think of anything else…
Just survival and “beating” the cancer… Some
of the best people we’ve ever met, we met during treatment in Arkansas… But then you come home and you have to start living your "normal" life - and it's not as easy as it sounds.
Who would have ever thought that Tanner would have
cancer? How many moms have asked
themselves that about their children? How many people ask that question about
themselves or their loved ones every day?
He may not always make the "right" decisions... Who does? But until you've walked in his shoes, you have no idea how scared this boy is...
There is no guide book to getting through this... We just do the best we can.
The one who loves you will make you weep... Argentine Proverb
