Pre - Bereavement Care and Thoughts

It’s tragically common for patients to ignore warnings of other types of cancer, adds Dale Shepard, MD, PhD, a cancer specialist in the department of solid tumor oncology at the Cleveland Clinic. “Cancer can almost always be cured if it’s caught early, but all too often, people wait so long to see a doctor that the disease has spread to the point that it’s no longer curable.”

If you notice any of the following unexplained warning signs, don’t delay—make the time to consult a doctor promptly.

• Unexplained weight loss. While most people would be happy to drop pounds without dieting, unexplained weight loss (of 10 or more pounds) or sudden loss of appetite are among the most common warning signs of cancer, says Dr. Shepard. This symptom is most likely to occur with cancers of the pancreas, stomach, esophagus or lung, reports the American Cancer Society (ACS). It may turn out not to be cancer—there are a number of other serious health conditions that may cause this symptom, including an overactive thyroid, diabetes, liver disease, and depression.

• Persistent low-grade fever. This can be the first symptom of certain cancers, particularly leukemia, Hodgkin’s disease or non-Hodgkin’s lymphoma. Low-grade fever—meaning a temperature between 99.8 and 100.8—can also be caused by a wide range of infections. 

• Worsening fatigue. “If you suddenly can’t get through the day without taking a 3-or 4-four nap, when you never need one before, that can be suggestive of cancer,” says Dr. Shepard. According to the ACS report, this symptom is particularly likely to occur with leukemia, as well as cancers that cause blood loss, such as colon cancer or stomach cancer. Other medical conditions that cause profound exhaustion include anemia, sleep disorders, heart problems, diabetes, fibromyalgia, and arthritis.

• A sore that doesn’t heal or skin changes. You probably know that moles that are asymmetrical (one half doesn’t match the other), have irregular borders, contain a variety of colors, or are larger than a pencil eraser can bewarning signs of melanoma, the deadliest form of skin cancer. What’s not well known, however, is that skin sores or changes (including a persistent rash) can also herald other forms of cancer. Dr. Shepard had a patient whose first symptom of colon cancer was a sore on his scalp that didn’t heal. He has also had patients with lung cancer and lymphoma whose symptoms included persistent rashes.

What Does Skin Cancer Look Like?

• Trouble swallowing or chronic hoarseness. These symptoms, along with lip sores that don’t heal, unusual bleeding, pain or numbness in the mouth, and chronic sore throat, can herald oral cancer. Other reasons for chronic hoarseness can include gastroesophageal reflux disease (GERD), allergies, cancer of the throat or laryngx, smoking, and underactive thyroid, reports the National Institute of Health. A wide range of esophageal disorders can impair swallowing.

• White patches in your mouth. Also known as leukoplakia, these thickened whitish or gray patches on the gums, inside of the cheeks, or the tongue are often mistaken for thrush (an infection that causes white patches). Unlike thrush, which can be scraped away, leukoplakia cannot be removed in this manner. While the condition isn’t always harmful, oral cancer often occurs near leukoplakia patches, the Mayo Clinic reports, and the patches themselves can develop cancerous changes.

• Blood in the toilet. This symptom is frequently dismissed by patients, says Dr. Shepard. “People are quick to think that the problem is a urinary tract infection even if they’ve never had one before. However, blood in the urine can also be a sign of bladder cancer and needs to be investigated by a urologist. Oftentimes, bladder cancer isn’t diagnosed until it reaches an incurable stage because people wait so long to see a doctor.” Similarly, it can be a dangerous mistake to dismiss blood in the stool as being triggered by a hemorrhoid, since it could also be a warning sign of colon cancer, as is any change in your normal bowel habits.

• Unexplained pain. This can be an early symptom of testicular or bone cancer. A headache that doesn’t get better with treatment, such as taking an over-the-counter pain reliever, may signal a brain tumor, while back pain can mark colon or ovarian cancer, the ACS reports. “Unexplained pain is one of the more common symptoms of cancer and always warrants a consultation with your doctor,” says Dr. Shepard.

• A lump or thickening. Several types of cancer, including those of the breast, testicles, and lymph nodes can be felt through the skin. A lump or thickening can either be an early or late sign of cancer, ACS reports. Also be aware that in some cases, breast cancer can cause red or thickened skin, rather than the expected lump, so any change in how your breast looks or feels needs to be checked out. 

• Any persistent, unexplained or troubling symptom. “If something doesn’t seem right, don’t assume it’s nothing,” says Dr. Shepard. ”Listening to your body and getting this symptom checked out sooner rather than later could save your life if the problem turns out to be cancer.”

Anticipatory Grief

Anticipatory grief is the normal mourning that occurs when a patient or family is expecting a death. Anticipatory grief has many of the same symptoms as those experienced after a death has occurred. It includes all of the thinking, feeling, cultural, and social reactions to an expected death that are felt by the patient and family. Anticipatory grief includes depression, extreme concern for the dying person, preparing for the death, and adjusting to changes caused by the death. Anticipatory grief gives the family more time to slowly get used to the reality of the loss. People are able to complete unfinished business with the dying person (for example, saying "good-bye," "I love you," or "I forgive you"). Recommended Related to Cancer General Approach to Care for Children with Brain and Spinal Cord Tumors Important concepts that should be understood by those treating and caring for a child who has a brain or spinal cord tumor include the following: The cause of most childhood brain tumors remains unknown.[1] Selection of an appropriate therapy can only occur if the correct diagnosis is made and the stage of the disease is accurately determined. Children with primary brain or spinal cord tumors represent a major therapy challenge that, for optimal results, requires the coordinated efforts... Read the General Approach to Care for Children with Brain and Spinal Cord Tumors article > > Anticipatory grief may not always occur. Anticipatory grief does not mean that before the death, a person feels the same kind of grief as the grief felt after a death. There is not a set amount of grief that a person will feel. The grief experienced before a death does not make the grief after the death last a shorter amount of time. Grief that follows an unplanned death is different from anticipatory grief. Unplanned loss may overwhelm the coping abilities of a person, making normal functioning impossible. Mourners may not be able to realize the total impact of their loss. Even though the person recognizes that the loss occurred, he or she may not be able to accept the loss mentally and emotionally. Following an unexpected death, the mourner may feel that the world no longer has order and does not make sense. Some people believe that anticipatory grief is rare. To accept a loved one's death while he or she is still alive may leave the mourner feeling that the dying patient has been abandoned. Expecting the loss often makes the attachment to the dying person stronger. Although anticipatory grief may help the family, the dying person may experience too much grief, causing the patient to become withdrawn.