Category / cancer and nutrition

by Jacqueline Chartier

Cancer and Other Complications

As ovarian cancer invaded my body, at one point I was given no alternative other than to live without eating solid food for a month. Although this experience was eleven years ago, it will always remain one of the most vivid and horrible memories from my cancer treatment. Looking back, I’m rather proud of myself and the fact that I accomplished what was necessary to survive. In the end, I was capable of enduring something that not many other people have had to face.

How I came to require NPO (the medical abbreviation for nothing by mouth) on my chart for a month is a complicated story, but still a situation that many gynecologic cancer patients will understand. Bowel blockages occur at an alarming rate for people diagnosed with these cancers— although when I was an innocent newcomer to the realm of ovarian cancer, I still had little idea how common these obstructions are in patients with the disease.

Sometimes it’s directly due to a recurrence of the cancer and a new tumour is pressing on the bowel. In other cases, the explanation is severe scarring of the bowel due to surgery or other aggressive treatments; excessive scarring can lead to a life-threatening obstruction. The second scenario is what happened to me and prompted my medical team to take such drastic measures. At first, I was sent home following an emergency room visit, as they were able to stabilize me and my symptoms seemed to subside. However, within a matter of weeks I was hospitalized again and involved in what felt like a terrifying fight for my life. 

I’d never felt abdominal pain so severe or nausea so intense, every minute that passed seemed like an eternity that stretched on forever. I was informed by my doctors that they wished to address my bowel obstruction non-surgically if possible. I was also reassured that they were almost certain the cause of the obstruction was scarring and adhesion and not an advancement of my malignancy. In any case, I was aware that my condition was extremely serious—soon it became necessary for me to receive nutrition intravenously through a PICC line, or what is otherwise known as a peripherally inserted central catheter. 

At first my medical team chose to take a wait and see approach. Unfortunately, despite ongoing treatment there was no resolution to my problem. My bowel remained blocked, so I remained hospitalized and in a great deal of physical distress. First solid foods were removed from my diet, and then even liquids. Inevitably, my mental health and psychological well-being began to deteriorate as I agonized nonstop about my possible future. They finally made a decision to operate after my condition required them to insert an NG tube one evening. I’ll always remember the pain of having the tube inserted and then the humiliation of having the brown liquid contents of my stomach gradually pumped out. 

I was eventually wheeled into an operating room where I underwent yet another major abdominal surgery, this time to correct my bowel obstruction. The procedure went well, from what I understand a couple of bowel resections were necessary to repair the scarring and adhesion that had developed. Upon waking in the recovery room, I was delighted to learn that they didn’t have to perform an ostomy. Still my recuperation was long and difficult and for several months I was on a low fibre diet.

Today I’m fully recovered and have so few problems with eating or digestion that sometimes I find it hard to believe this terrifying nightmare ever happened. Years after my ordeal I’m grateful that my ovarian cancer continues to stay in remission, I’m just as thankful for the fact that I’m now able to consume a normal diet and enjoy the many pleasures of eating. I become frustrated when I look around me and I witness people who don’t realize how important it is to eat properly—I see so many individuals who rush through meals without a second thought or don’t take time to prepare them. “Oh, I’m too busy to cook,” they argue. “With my work schedule and social obligations, who has time to prepare a meal from scratch?”

I would argue back that making time should be a priority—self-care and proper nutrition are essential for your long-term health and can’t be pushed aside without eventually facing the consequences. Ultimately you might discover, as I have, that cooking and dining are two of life’s greatest pleasures. Learning to cook can be enjoyable, and the shared experience of savouring a meal with friends or loved ones considerably enhances your quality of life. As for me, I’m determined that even if my cancer returns, I’ll never allow it to destroy me relationship with food.

by Jacqueline Chartier

My Relationship With Food: Part II

My previous blog post introduced the topic of how being an ovarian cancer patient has influenced my relationship with food and transformed my attitude toward eating. I’ve always valued my relationship with food and I appreciate how it enhances the quality of my life. But in the spring of 2012 each day that passed only seemed to make my abdominal pain, nausea and other digestive symptoms worse. On May 11, 2012, I received my fifth round of chemotherapy, 72 hours later I was facing a life-threatening medical crisis—it had taken time to gradually materialize, but my aggressive cancer treatments had led to an extremely serious bowel blockage. Vomiting and in pain, I was transported to the emergency room through early rush hour traffic. It was a bright May morning when I entered the doors of Calgary’s largest medical centre. I had already been to the ER twice during my cancer treatments with similar complications, but this time my instincts told me that it would take a miracle or another surgery to save my life.

I was quickly readmitted to the gynecologic oncology unit, by this point I had formed a close relationship with many of the nurses and support staff. I could tell that many of them empathized with my setback and were hoping like me that I would somehow make it through such a terrible predicament. At first my doctors took a wait and see approach, they thought that perhaps with a little time and rest my bowel blockage might correct itself non-surgically. When my condition hadn’t improved after about a week in the hospital, a crucial decision was made, my doctors told me that I would no longer be able to consume any food by mouth! Even liquids were basically forbidden, I had to suck on ice cubes or take tiny sips of water to moisten my mouth. A certain degree of panic set in as I thought about the prospect of not consuming food, surgery also seemed more imminent.

PICC Image

Nothing had prepared me for the invasive medical procedures that I would endure in the coming weeks or for the length of my hospitalization. Forty-eight agonizing days elapsed, during which time I received virtually all of my nutrition through a large intravenous device called a peripherally inserted central catheter (PICC or PIC line). It was continuously hooked up to a large bag with total parenteral nutrition. TPN is a thick whitish liquid containing essential nutrients, about every twelve hours the nurses would come to hang a new bag of “food” and remove my empty one. It was during my hospitalization that I first met with a registered dietitian, a food and nutrition expert. Even when they don’t encounter a crisis as substantial as mine, the nutritional well being of cancer patients often requires consultation with a professional. In my situation, we discussed the specifics of a low fibre diet that I would be required to follow before I could resume a normal eating regimen.

PICC Nutrition

On June 18, 2012, a critical surgical procedure was skillfully performed. When I awoke in the recovery room I sensed that my crisis was at last resolved. Although only half-conscious, I was filled with elation as they informed me that the procedure to correct my obstruction had been successful. The primary cause was established to be scar tissue from my previous operations and now my digestive system was expected to function normally again. Most of all, I was comforted and reassured by the fact that my cancer had not metastasized to other regions of my body. Following my surgery, I spent a couple of more weeks in the hospital recovering and learning how to eat all over again. I was required to start cautiously with liquids and semi-solids such as soup, Jell-O, and pudding. When I was ready to try my first solid food, I commenced a strict low fibre diet, whole grains and the majority of fruits and vegetables were forbidden. My goal was to consume less than 10 grams of fibre daily and eat only foods with 2 grams or less. White bread, egg salad, chicken and low fibre cereals became some of my staples.

Two years after this ordeal I’m grateful that my ovarian cancer continues to be in remission, I’m just as thankful for the fact that I am able to consume a normal diet and enjoy the pleasures of eating. I become frustrated when I look around me and I witness people who don’t realize how important it is to eat properly—I see so many individuals who rush through meals without a second thought. “Oh, I’m too busy to cook,” they argue. “With my work schedule and social obligations, who has time to prepare a meal from scratch?” I would argue back that making time should be a priority—self-care and proper nutrition are essential for your long-term health and can’t be pushed aside without eventually facing the consequences. Ultimately you might discover, as I have, that cooking and dining are two of life’s greatest pleasures. Learning to cook can be enjoyable, and the shared experience of savouring a meal with friends or loved ones considerably enhances your quality of life. As for me, I’m determined that even if my cancer returns I’ll never let it destroy me relationship with food.

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by Jacqueline Chartier

My Relationship With Food: Part I

One of the classic symptoms of ovarian cancer, especially as it becomes more advanced, is a feeling of fullness when you try to eat and a general lack of appetite. This was my experience as I tried to eat meals and enjoy food prior to my diagnosis, something was definitely wrong, but I didn’t know what it was. Throughout my life I’ve always had what I consider to be a positive relationship with food. As a small boned and extremely petite woman I enjoy eating from a full range of food groups—I’ve never been obsessed about dieting trends, such as low carb diets or low fat diets. Even before my cancer diagnosis I was a health conscious individual, aware of the strong connection between our physical and mental health and proper nutrition. I would deliberately avoid such temptations as eating large quantities of prepackaged or processed foods or dining regularly at fast food restaurants. I generally prefer the wonderful taste of home cooking and meals prepared from scratch anyway.

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As my symptoms progressed I was sometimes just going through the motions of eating, and I wished that the doctors would find out what was wrong so my meals would be pleasurable again. Leading up to my cancer diagnosis, even many of my favourite foods such as homemade spaghetti sauce, fresh stir-fries and strawberry smoothies were quickly losing their appeal! I ultimately had a hysterectomy performed in the fall of 2011, one week following my surgery the pathology report came back positive for uterine and ovarian cancer. I was in shock and emotionally devastated, but at least I knew what the enemy was that was trying so hard to destroy my life and my relationship with food! What is more, my cancer journey had begun. I was immediately referred to Calgary’s Tom Baker Cancer Centre where I underwent a highly specialized surgery to remove my remaining ovary and to more accurately stage my disease.

My second surgery was performed on December 13, 2011, and much to my consternation I nearly spent Christmas Day in a hospital bed. While it came as a relief when I was discharged on Christmas Eve, a scrumptious turkey dinner was definitely not going to be part of the celebration for me. I could still hardly stomach solid food. There had been complications following my surgery in the form of a partial bowel blockage. My situation was unfortunate, but perhaps not surprising. Not only had I undergone two surgeries within about eight weeks of each other, during the second procedure my surgeon chose to remove a section of my small bowel in order that it may be tested for cancer. I experienced severe nausea and vomiting in the days following this operation and they used just about every medication in their arsenal to get it under control. At one point we even placed a patch commonly used to treat seasickness behind my ear!

Hospital Food

As soon as I was recovering at home, my mother made a special effort to prepare meals that are my favourites, we both hoped that my appetite would return to normal and that I would gain weight. It was wonderful to taste home cooking again after nearly two weeks on hospital food, but I could sense that something wasn’t exactly right in terms of my digestion. Meanwhile I was assaulted with more bad news, the pathology report from my second surgery revealed that cancer cells had spread to some of my abdominal lymph nodes. It was recommended that I undergo six cycles of chemotherapy, which I started almost immediately. I was given the customary warning about nausea and about how people on chemotherapy often experience a lack of appetite. Typical symptoms also include, constipation and a metallic taste in your mouth that impairs the normal flavour of certain foods.

Once my treatments began, I became completely focused on making it through my chemotherapy and I assumed that the bowel blockage issue that I had experienced was resolved. As my symptoms such as nausea and constipation grew worse, I just attributed it to the carboplatin that I was receiving every three weeks intravenously or to the other medications that I was taking. Soon I was forcing myself to eat what little I could—and even more disturbing was the fact that I hadn’t gained any weight since my recent surgery. The only positive experience I can remember from this period is my discovery of the Living With Cancer Cookbook by Kris Ghosh and Linda Carson, a fantastic volume of recipes specifically aimed at women going trough cancer treatment.

There’s an abundance of comfort food here and a sense that the authors truly have compassion for those of us who struggle to eat, for example breakfast recipes include cheesy ham and asparagus bake and home-style oatmeal with raisons. I also love the way this cookbook is organized to deal with the specific symptoms of cancer treatment. The four most common side effects are nausea, mouth sores, diarrhea and constipation. Eating the right foods can help alleviate these issues and make them more bearable. But as I would soon discover, I’d developed extremely serious complications with my digestive system that would require more surgical intervention. In my next post I’ll discuss my ordeal when I was hospitalized and unable to eat or drink for over a month!