CANCER IS A CRUEL DISEASE

CANCER IS A CRUEL DISEASE

Hillcrest, tucked up on a hill in KwaZulu-Natal, has a slight chill in the air, even in summer. Mist rolls across the surfaces of roads and fills the valleys, driving residents deeper under their down duvets.

But I cannot imagine it was the weather that concerned the Browns that summer in 2011. Carrie, after undergoing another painful surgery, had been told there was nothing more the doctors could do for her. Her son had just turned five. Her sister-in-law Kerry, my very best friend from high school, busied herself with work as the realisation of death washed over her and left her numb. It was a difficult time for the whole family. Should they take time off work? How long might it be? Was this really the end? Sister Cherry Armstrong sat with Carrie as she lay in her bed suspended between life and death, her pale skin bearing no sign of the seven years of torture she had endured.

‘As a patient starts his or her journey of death, they are very aware of what is happening. Their skin is very pale, maybe bluish in colour. Everything lacks lustre, eyes can become sunken with no brightness,’ Sister Armstrong tells me. She has sat by the side of many cancer patients and held their hands as they have slipped into deathly sleep. She spends the time before consoling, advising, pacifying and helping them confront the fear and trauma of the experience. ‘Death is a profound human experience. As someone approaches death, their emotional and spiritual needs are as great, if not greater, than those of their body.’

I had known Carrie since my school days, when she returned from England with her husband, Kerry’s brother. They were high-school sweethearts and she often told us their love story. They had met at the ice rink in Durban as teenagers, got married in their early twenties and gone on to travel the world, eventually working in the UK. Her stories were intoxicating; we, in the adolescent stage of our lives, drank them in and made them our own. It was Carrie who advised us through our early, insignificant relationships. Her sense of humour, good-natured demeanour and compassion had me enthralled.

Tragedy struck soon after their return to South Africa, in 2004. A lump was found in Carrie’s breast. Not even a year later, Kerry’s boyfriend underwent treatment for testicular cancer. I wondered how much one family could bear. A lot, I would come to learn. Kerry stayed in KwaZulu-Natal as her family fought the dreaded disease that had invaded their lives, Carrie only ever on the cusp of recovery before tragedy would strike again. I went away to study, isolated by my newfound wonder of the world.

I got the call in early December 2011, while rushing off to interview someone for a magazine article. Carrie was gone. I put down the phone and drove to the appointment no longer caring how late I was. My throat was dry as I asked my questions and I barely heard the answers.

DEALING IN DEATH

How do you console a family who have spent years fighting demons? I didn’t know. The Browns had been in a war zone for so long and now it was all over. And yet there are so many others in our country, in our world, who are right now standing in that same war zone, fighting the same cruel disease.

The World Health Organization (WHO) reports that cancer is the leading cause of death worldwide, responsible for 7.6 million deaths in 2008 alone; and that worldwide deaths from cancer are rising. It estimates that 13.1 million people will die from the disease in 2030.1 Cancer’s prevalence, however, does nothing to quell the grief of those who have lost loved ones.

‘There is never a way to ease anyone’s pain. Everyone goes through their own journey of grief in their own way; you can just be there to listen and be honest with whatever questions they have,’ Sister Armstrong explains.

Carrie’s death was a tragedy that I struggled to come to terms with, for myself and her family.

Carrie and her husband had bravely decided during her battle with cancer to try to conceive a child before the inevitable hysterectomy. Their beautiful boy was born in November 2006. I asked Sister Armstrong what Carrie spoke about in her last few days and it was mostly her son. ‘Patients speak of their fear, their beliefs, their families, the people they are leaving behind and, as they near death, they often speak about the people they are seeing, the people who are close to them and these are always people who have died. I truly believe they have a link to the other side at this point,’ she tells me.

While death might bring with it some respite for the suffering cancer patient and his or her family, the effects are still devastating on those left  behind. The Browns are just one family in a sea of many to have their lives changed irreversibly by this disease. My uncle passed away from cancer in 2008. One of the youngest girls in the country to have been diagnosed with breast cancer at the age of eighteen attended my university. She passed away in 2012. Knowing someone who has lost someone to cancer is by no means rare. In America, one in eight women will develop invasive breast cancer over the course of her lifetime. According to Breastcancer.org, an estimated 230 480 new cases of invasive breast cancer were expected to be diagnosed in women in the US in 2011.2 While some resources suggest that death from cancer and cancer itself is decreasing ever so slightly, it is still prevalent enough for just about everyone to know someone who has had cancer.

TREATMENT AND DIET

According to the WHO: ‘Even with late stage cancer, the suffering of patients can be relieved with good palliative care.’

How though? As we’ll see, diet is one way. But the Internet is saturated with information and theories regarding what diets to follow to prevent cancer and which foods to avoid. There are stories about cancer patients who healed themselves by eating only grapes and research into how modern diets may or may not play a role in illness. You will be forgiven as a cancer patient or someone looking after a cancer patient for not knowing where to start. The resources are sporadic and varied, with medical practitioners often reluctant to give specific advice because of the varying opinions. They also do not want to discourage cancer patients from undergoing traditional cancer treatments like radiation, chemotherapy and surgery. Former Miss South Africa, journalist and radio broadcaster Monica Fairall, who died of myeloma in  2009, wrote in Challenge Cancer the Holistic Way (1999): ‘Deciding whether or not to receive conventional treatment is a matter of individual choice, but not too many doctors would be comfortable with the prospect of a cancer patient refusing all treatment. Doctors’ training gears them to take action with the tools they have at their disposal.’

While many doctors shy away from alternative forms of treatment, there are some that acknowledge the role of diet specifically. Dr Elizabeth Murray, a Cape Town-based breast cancer oncologist, says that she checks her patients’ vitamin D levels regularly, as well as her own. ‘I do not think there is any doubt that modern diet plays a role in cancer,’ she explains. ‘While the role of red meats and dietary fat in breast cancer development is uncertain, I think it is likely that it plays a role.’ It is because of this that Dr Murray refers many of her patients to a nutritionist or dietitian for an expertly guided, balanced diet to supplement treatment.

For Dr Murray, a crucial step for post-menopausal women to reduce their chances of breast cancer is to not become overweight and to limit or avoid alcohol and smoking. For her patients with breast cancer, she recommends that ‘they stick to low-fat dairy products, if they are going to use dairy products, and that they avoid too much soya, as this I believe has oestrogen in it. I also advise my patients to make sure they get enough vitamin D and calcium as they are supposed to play a role in breast cancer.’

This book does not aim to dispute the benefits of traditional cancer treatments, but rather takes a look at which dietary and lifestyle changes may assist with these treatments, and which could in fact influence cancer prevention.

KNOWLEDGE INTO PRACTICE

Kerry explains that even though diet came up as something to focus on when her boyfriend was diagnosed with cancer in 2005, nothing was done about it. ‘People that talk about other people getting cancer always bring up the fact that it’s because of hormones in all of our foods these days, and while I believe that it is a contributing factor, no one really does anything about it. Once he had recovered from cancer, he continued to eat fast food and his eating habits and lifestyle habits did not change.’

Similarly, she adds, during Carrie’s treatment the family tried their best to look up what lifestyle and dietary changes they could make to assist her treatment. They began ordering their chicken from an organic farm and were a bit more mindful of the nutritional value of their meals. ‘When she was first diagnosed, I think they tried to read up on what to eat and what not to do.

She stopped eating lettuce during her first chemo as doctors said it contained a lot of bacteria and germs that wouldn’t help her immune system. I think they really tried in the beginning.’ However, towards the end it became more of an attitude that, because she was going to die, she might as well enjoy what she could. ‘Right at the end she ate what she could stomach – Bovril toast, cheese and biscuits and nutritional milkshakes when she didn’t have an appetite.’

This is a common occurrence. Sister Armstrong says ‘patients tend not to eat as death nears, their bodies shut down and they don’t eat or drink. If they are still eating, it is normally a small piece of fruit or yoghurt but in tiny portions.’

So what are we to do? How do we ease pain and nausea for our family members and friends who are already suffering from this illness? How do we prepare meals for our loved ones that they will not only eat, but that will provide them with the nutrients they need? And will it make a difference? Are there resources out there that can assist us in making everyday groceryshopping decisions that could have a much bigger impact?

‘Do everything in moderation,’ Sister Armstrong suggests as a first step. ‘Never shock the body with a sudden complete change of lifestyle; too much or too little of anything is not good. Follow a healthy eating plan with a balance of all nutrients.’ She adds that Hospice provides a great platform for resources and advice in such matters, especially as they are trained in palliative care. Hospice South Africa describes palliative care in their mission statement: ‘To promote quality of life, dignity in death and support in bereavement for all living with a life-threatening illness.’

It is the body’s basic need for nutrients such as proteins, carbohydrates, fats, and certain vitamins and minerals that, says registered dietitian Catherine Boome, make diet so important during cancer treatment.

Confirming what Sister Armstrong told me, she explains, ‘Certain cancer therapies have side effects that may also affect the cancer patient’s ability to consume food. Some of the side effects include a decrease in appetite, nausea, vomiting, changes in taste and smell, and changes in bowel movements.

These effects put the patient at risk for developing malnutrition as a result of a lower intake of food.’ Cancer treatments like surgery, radiation and chemotherapy can also negatively affect how the body digests and uses foods, she says. ‘The patient is at risk of weight loss, as well as various nutrient deficiencies.’

By focusing on proper nutritional care during cancer treatment, the patient’s ability to maintain quality of life, manage nutrient deficiencies, avoid weight loss (especially muscle loss) and minimise the side effects of the various treatments is improved.

So how does one go about ensuring patients are getting the correct nutrition to meet their bodies’ needs? It is tough to find answers when so many theories from raw food diets to coffee enemas are circling the world. In desperation, many of us would try just about anything if it meant there was a chance for a cure. We will explore these ideas in-depth, and look at how nutrition and diet can play a role in both preventing cancer and assisting in its treatment, as well as how this can be practically integrated into daily life.

CARRIE ON TOMORROW

The mist continues to roll in and out of Hillcrest, and temperatures continue to rise and fall with the changing seasons. Carrie’s death echoes in the hills, her too-short life tattooed in the minds of those who knew her best. I hope that in her memory I can offer just a little something to those who suffer as she did and to their families who never leave their sides. In the following pages, you will find the stories of those who have been ill and those who have looked on, helplessly, as well as advice from experts in the fields of cancer and nutrition. This book aims to assist those dealing with cancer, by offering some guidelines and warm, comforting and compassionate advice from the very people who have dealt with what you are dealing with right now. Most importantly, this book aims to remind you that you are not alone. A tribute to the Browns and their strength, I wish everyone reading this the same courage.

‘Every life is a purpose; some purposes are completed before others.’ – CARRIE BROWN