Michelle Gillie Barnes

CONTACT US: ABJ BENONI 140 Princes Avenue Tel: +27 - ABJ KLERKSDORP Cnr Marmer & Ametis Street Tel: +27 -/1 ABJ VEREENIGING Cnr Hofmeyer Ave & Joubert Street Tel: +27 - ABJ MIDSTREAM Building Goz, Midstream Hill Tel: +27 - ACT PRETORIA EAST Cnr Garsfontein & Netcare Rds Tel: +27 - SATELLITE CLINICS ABJ POTCHEFSTROOM Mediclinic, Block 2, Suite 5 Tel: +27 - ABJ TRICHARDT 41 Richter Street Tel: +27 - / 1 A guide to your Oncology treatment ABJ WITBANK 1173 Beatty Ave Tel: +27 - General Practice Email:- Reg. No: 1994 / 010256 / 21 Practice No:- WE WELCOME YOU TO THE ALBERTS, BOUWER & JORDAAN (ABJ) PRACTICE OF DOCTORS PATIENT NAME: PATIENT FILE NO: Specialist Fields: · Radiation Therapy · Chemotherapy · Haematology Oncology · High-dose Chemotherapy and Stem Cell Rescue · Bone Marrow Stem Cell Transplants (adults and children) · Radioactive Seed Implants · Radio Surgery · Dynamic Conformal Radiotherapy · I.M.R.T. · Radioactive Isotope Therapy · Palliative Care OUR DEDICATED TEAM OF PROFESSIONALS: TREATING DOCTOR: Your treating Doctor will discuss the following with you, and answer any questions you may have: DIAGNOSIS: CAUSE: STAGING: Dr Samuel Fourie | MBChB MMed (Rad Onc), BSc (Comp Science) Dr Rudi Maré | MBChB, MMed (Rad Onc) TREATMENT: Dr Daniel Rens | MBChB, MMed (Int) Sub Spec Oncology BSc Hons Dr Frank B-Persson | MBBCh FC Rad (Onc) MMed (Rad Onc) BSc Dr David Brittain | MBChB, FC Path (Haem), Cert. Clinical Haematology Dr Wilhelm van Zijl | MbChB MMed (Rad Onc), FC(FC (Rad Onc), MBA PROGNOSIS: Dr Theo Gerdener | MBChB, FC Path (Haem), Cert Clinical Haematologist Dr Lorraine Blaauw | MBChB, MMed (Rad Onc) Dr Maritha Rossouw | MBChB, FC Rad (Onc) FOLLOW UP: THE DIAGNOSIS IS CANCER. WHAT NOW? TREATMENT OPTIONS The first few weeks of shock and uncertainty after diagnosis are traumatic, in many ways, rob the patient and their family of their security and peace of mind. Before considering any form of medical treatment, it is important for you to understand what the procedure and side effects of each treatment entail. We want to reassure you that you will be treated with the most modern equipment and treatment methods available anywhere in the world. The information contained within this booklet will give you a broad knowledge of each treatment; however it may not necessarily answer all the questions you may have. Please feel free to discuss any questions, side effects or problems with your Doctor, Nurse or Radiographer when you visit your Oncology Centre Your team of specialists are all vastly experienced in all areas of chemo- and radiotherapy and will select the best possible treatment for you. Our doctors also super-specialise in all branches of Oncology: Haematological Oncology, Conformal Radiation, Brachytherapy, Neuro-Radio surgery, Immunotherapy applied together with state-of-the-art remedies and techniques. The specialists are assisted by a team of professional, highlyqualified General Practitioners, Nurses and Radiotherapists who are well-versed in the treatment of Oncology patients. In the instance of solid tumours being present (i.e. those not found in the blood) chemo- and radiotherapy are the recommended treatments. These two modalities, their side effects and what can be expected are discussed in more detail in the following two sections. RADIOTHERAPY We encourage you to make use of our support services to help you deal with with any anxiety or uncertainty. These services are provided by a team of specialists, who understand the unique needs of the Oncology patient specifically in the following fields: What is radiotherapy? • Nutrition / Dietetics (Charged separately) • Counselling / Therapy (Free of charge) To understand how ionising rays work, you must first understand how cancer cells affect your body. Within each specialist field some of the world’s latest treatment methods for patients suffering from life-threatening disease are available. We encourage our patients and their families to utilise these services to derive the maximum benefit from the full, holistic spectrum of medical treatment. Cancer starts with one cell that has lost control over its growth. Normal cells divide in a highly controlled manner to form new cells. Cancer cells also divide and form new cells, but at a more rapid rate. In simple terms, radiotherapy means treatment with ionising rays; in this case with high-energy x-rays and electron beams which have various energy levels. In addition, cancer cells do not know when to stop dividing. They keep on dividing and multiplying until they have displaced or damaged the affected body tissue or organ. The cancer cells continue their excessive growth and because they do not grow within an enclosing capsule, some cells break away and are carried to the next organ by the lymph system or the blood stream and there they multiply further. This is called metastasis. Irradiation damages and eventually destroys the cancer cells. But the rays cannot distinguish between normal and malignant cells. The success of irradiation lies in the fact that malignant cells are more sensitive to irradiation than normal cells. The goal of irradiation is therefore to irradiate until the malignant cells have been eliminated or sterilised. The surrounding normal tissue is, however, still capable of complete recovery. If you are to receive thirty treatments and another person only five, please do not assume that your prognosis is worse than theirs. The dose administered, the number of treatments and the specific diagnosis are very closely linked Irradiation is done during the week and may be interrupted for a day when the irradiation machine is being serviced. During your course of treatment, you will meet other patients and you will probably compare your treatment and symptoms. It is important to understand that irradiation is used differently for the treatment of different conditions. Your irradiation and side effects may consequently differ considerably from those of another patient. In certain phases of division, cells are more sensitive than in other, dormant phases. To irradiate as many of the cells as possible in the sensitive phase, the treatments are fractioned, in other words, they are spread out over a defined period. Another reason for fractionation is to give the normal cells, which recover faster than malignant cells, a chance to recuperate. (That is why you do not receive only one treatment). The sensitivity of the various types of tissue and organs differ, therefore the number of treatments for different diagnoses will inevitably also differ. The number of treatments prescribed bears no relation to the degree to which the cancer has advanced. Whilst we appreciate the anxiety and uncertainty that accompanies a cancer diagnosis we urge you to discuss any concerns with you have with your treating Doctor or nursing staff. As specialists in their respective fields, they possess the knowledge and experience that will help put your mind at ease. The area to be irradiated is determined by means of a localising scan or X-rays, and then marked. This is called a simulation. PLEASE BRING ALONG PREVIOUS X-RAYS OR SCANS that may be of use. Sometimes the treatment area is decreased during the course of the treatments. This is called a booster. It is very important that the marks that have been made on your body remain there. IRRADIATION PROCEDURE: YOU MAY BATH OR SHOWER, but you must make sure that these marks are not washed off. A quick bath or shower is preferable. If you do take a bath, do not soak in the water. We also advise you to make use of a gentle soap such as Dove, for example. Irradiation is not painful, and patients are not radioactive after irradiation, therefore you pose no threat to other people. During irradiation you will be alone in the treatment room, but you will be monitored on a television screen. There is also an intercom system. It is important that you remain very still during treatment, and continue to breathe normally. It is very important for you to visit the Oncologist once a week during irradiation. Please arrange these appointments with the Oncologist’s receptionist in good time once you have received the irradiation dates. Please get your irradiation file from the Radiotherapists on the day on which you are to visit the Oncologist, and please be so kind as to return your file to the Radiotherapists after your appointment. SIDE EFFECTS OF RADIOTHERAPY When the simulation or booster is done, please bring along all your scans and X-rays so that the position of the irradiation area can be determined. It is only natural to be concerned about the side effects of irradiation, especially as there are so many misconceptions about this treatment. To change radiotherapy appointments, please phone the relevant radiotherapy receptionist as soon as practically possible. However, if you understand what may or may not happen, you can avoid unnecessary anxiety and fear. The aim of providing this information is ultimately to give you peace of mind. MOUTH AND THROAT PROBLEMS Patients receiving irradiation over the throat area will start suffering from a sore throat after about ten treatments. Gargling with a solution of half a teaspoon of Bicarbonate of Soda mixed with half a teaspoon of salt in a glass of lukewarm water will help. There will also be dryness of the mouth due to the irradiation affecting the salivary glands. This condition may be permanent. SKIN REACTIONS IMPORTANT: Please do not use any ointment, powder or deodorant spray on the irradiation area. These will make any skin irritations worse. You may use a roll-on deodorant such as Dove. If the skin feels tender, you could use aqueous watersoluble cream. If necessary, your doctor will prescribe a special cream. You may experience a temporary loss of speech, but speech will return in the course of time. You might also find that you develop a double chin after irradiation. Do not expose the treatment area to direct sunlight. Always wear a hat and suitable clothing in the sun. Men who are receiving irradiation over the face must not shave the treatment area, as it is likely to cause skin irritation. If a skin reaction is to be expected, the Oncologist or Radiotherapist will let you know. A reddening of the skin will become visible after about fifteen treatments. DIARRHOEA If you have three or four loose stools a day, you should drink clear fluids (soup, soft drinks, tea and approximately two litres of water per day). Also consult your General Practitioner or Oncologist immediately. It is vital that you prevent your body from dehydrating. Eat a lot of bananas, cooked carrots and grated apple (without the skin). The Dietician can develop a special diet for you to help combat the diarrhoea. It may also be advisable to take one or more nutritional supplements. These supplements can be prescribed by the Dietician. You may also take medication for the diarrhoea. Please ask the nursing staff to assist you with this. HAIR LOSS (ALOPECIA) Your hair will only fall out if you receive irradiation over the scalp. Irradiation of other parts of the body will not cause hair loss on the head. The hair will only start falling out after about fifteen treatments, and in most cases will start growing again after about three months. WHITE BLOOD CELLS White blood cells are the body’s protective mechanism against infections. The white blood cell count of patients receiving irradiation over large areas of bone may decrease, therefore regular blood counts will be taken if you are such a patient. When smaller areas of the body are irradiated, the loss of white blood cells is so small that regular blood counts are not necessary. DIET DURING IRRADIATION A good, balanced diet will help you manage some of the side effects better. The Dietician can assist you with a special diet and vitamin supplements specifically for your type of cancer and treatment. Once again, it is important to remember to take plenty of fluids. In some cases, it will be necessary to take nutritional supplements. These supplements will be prescribed by the Dietician. You may feel tired, but you will still be able to perform most of your normal tasks. Try to maintain your normal routine and activities as far as possible. If you get very tired, the Dietician can also assist you with supplements or review your diet. An analysis of your diet to determine which nutrients it lacks, is essential. FOR YOUR ADDED COMFORT AND CONVENIENCE PLEASE NOTE: accommodation is available for patients who live far away and who need to receive chemo- or radiotherapy. However, such accommodation is only available from Monday to Friday at the Wilgers, Benoni, Vereeniging and Klerksdorp practices. Transport to the respective consulting rooms can also be arranged. CHEMOTHERAPY What is chemotherapy? Chemotherapy is the treatment of cancer by means of chemical drugs. It is administered to kill, retard, or prevent the growth of cancer cells. Sometimes a combination of more than one drug is given to fight the tumour cells in different ways. Chemotherapy makes cancer cells more sensitive to the effect of irradiation, therefore these two methods are often combined to obtain the best result for a specific condition. The chemotherapeutic drugs reach the cells via the blood stream. Cancer cells divide very rapidly and consequently absorb most of the chemotherapy, therefore they will die off and not divide and grow any further. The abnormal cells die, while the normal cells recover. The damage to the normal cells may nevertheless cause temporary side effects. The effect of chemotherapy differs from one person to another and according to the type of cancer being treated. Admission to the hospital, with a conventional infusion. An infusion administration system that enables you to receive the chemotherapy at home over a period of 24 hours. Use of the latter method is only possible if you are provided with a “port”. A port is a small metal chamber (the size of a two-Rand coin). It is implanted under the skin under local anaesthetic. A catheter runs from this small chamber into one of your main veins. Access to this chamber (port) is gained through a special needle that is inserted vertically through the skin into the port. This needle will remain in position for the duration of the chemotherapy. An elastomeric administration system ensures that the chemotherapeutic drug flows directly into your blood stream at a specific rate per hour. When the chemotherapy has been completed, the needle is removed. CHEMOTHERAPY IS ADMINISTERED IN THE FOLLOWING WAYS: Intravenously, in the form of direct injections or an infusion. This is the most common method of administration. Intra-arterially directly into the supply artery of the affected organ. Orally, in the form of tablets. Intramuscularly, as an injection into the muscle. Subcutaneous injection into the fatty tissue. Each treatment is followed by a rest period to give the normal cells time to recover. The schedule differs from one person to another, and your Oncologist will discuss the details of your treatment to you. Chemotherapy is normally given at the Oncologist’s consulting rooms. If it requires an intravenous infusion over several days, however, there are two options that can be followed, namely: Admission to the hospital, with a conventional infusion. An infusion administration system that enables you to receive the chemotherapy at home over a period of 24 hours. Use of the latter method is only possible if you are provided with a “port”. A port is a small metal chamber (the size of a two-Rand coin). It is implanted under the skin under local anaesthetic. A catheter runs from this small chamber into one of your main veins. Access to this chamber (port) is gained through a special needle that is inserted vertically through the skin into the port. This needle will remain in position for the duration of the chemotherapy. An elastomeric administration system ensures that the chemotherapeutic drug flows directly into your blood stream at a specific rate per hour. When the chemotherapy has been completed, the needle is removed. CHEMOTHERAPY IS ADMINISTERED IN THE FOLLOWING WAYS: Intravenously, in the form of direct injections or an infusion. This is the most common method of administration. Intra-arterially directly into the supply artery of the affected organ. Orally, in the form of tablets. Intramuscularly, as an injection into the muscle. Subcutaneous injection into the fatty tissue. Chemotherapy is no more painful than any other injection or blood test. The nursing staff rinse the vein during and after administration of chemotherapeutic drugs to prevent the vein from burning or being damaged. If the injection area becomes painful or burns, you must report this to the nursing staff immediately. If you take medication other than that prescribed to you, you must keep the Oncologist and / or nursing staff informed of this. It is also very important that you make separate appointments for your weekly and monthly chemotherapy treatments. These appointments can be made with the Oncologist’s receptionists. SIDE EFFECTS OF CHEMOTHERAPY DISCOLOURATION OF URINE NAUSEA AND VOMITING Some of the medication may cause discolouration of your urine. It is recommended that you increase your fluid intake so that the kidneys are flushed through properly. Some medication may cause nausea and vomiting, the severity of which varies from one person to another. Anti-emetic medication is always given together with chemotherapy. There are also a variety of tablets, injections and suppositories that can be used to combat nausea. Please ask the nursing staff to arrange a prescription for you and use this medication regularly. Diet also plays an important role, and the following is recommended: Always eat before you receive chemotherapy. Eat lighter meals with less fat. Eat smaller meals, but more often. Drink plenty of fluids. You must eat, even if you have no appetite for food. Take anti-emetics regularly while you are receiving chemotherapy and for a few days afterwards. CYSTITIS (BLADDER INFECTION) Report irritation of the bladder to the Oncologist so that if any infection is present, it can be promptly treated. Remember to also increase your fluid intake. DIARRHOEA AND CONSTIPATION Diarrhoea: If you have three or four loose stools a day, you should drink clear fluids (soup, soft drinks, tea and approximately two litres of water per day). Also consult your General Practitioner or Oncologist immediately. You should try in so far as possible to prevent your body from dehydrating. Eat a lot of bananas, cooked carrots, grated apple (without the skin) and Maizena porridge. If you would like more information, please talk to the nursing staff or Dietitian to assist you with this. Constipation: You could become constipated because of the chemotherapy. Drink a lot of fluids and follow a balanced diet that is rich in fibre. It is important that you take all types of fibre, so please ask the Dietician to assist you. Laxatives may be taken, but you must first obtain the Oncologist’s permission for their use. You could try the following remedy for constipation (it is not habit-forming): One sachet of Duphalac dry = ½ teaspoon of Epsom salts, dissolved in a glass of water. You may request a prescription for this. HAIR LOSS (ALOPECIA) PAIN CONTROL Some of the drugs will cause your hair to fall out, but it will grow back after the treatment has been stopped or completed. In some cases a scalp-cooling device (also called an ice bonnet) is used to limit hair loss as far as possible. For a small donation you may also obtain a wig from your nearest branch of the Cancer Association. There is no reason for you to suffer unnecessary pain. For the best results, painkillers must be taken as prescribed and not only when you feel you need them. If your home medication does not provide sufficient relief, you may be admitted to hospital to bring your pain under control. If you find that your home medication is ineffective, please ask the Oncologist for a prescription. SORES IN THE MOUTH OR THROAT (STOMATITIS) BONE MARROW SUPPRESSION If you develop sores in your mouth or throat, you must report this immediately. If necessary, your Oncologist can prescribe medication for you. You can also do the following to provide relief: Use a mouth wash (one teaspoon of Bicarbonate of Soda in a cup of lukewarm water) after each meal and at bedtime, or four times a day. Avoid food containing a lot of spices or herbs. Do not smoke. Avoid food that contains a lot of acid, for example lemons, grapefruit and tomatoes. Certain vitamins provide relief for sores in the mouth. Please consult our Dietician for more information. If you can no longer eat, or have difficulty swallowing, you must contact the Dietician immediately so that a nutritional supplement can be prescribed. Bone marrow forms new blood cells in the body. Each of the different types of blood cells plays an important role, namely: White blood cells fight infection. Red blood cells carry oxygen to all the parts of the body. Blood platelets help with the clotting of blood. Because bone marrow cells grow more rapidly, they also absorb more of the chemotherapy: therefore it is necessary that a blood count be taken before each treatment. If the white blood cell count is too low, you will be very susceptible to infections. It is therefore advisable that you avoid, as far as possible, people who are suffering from colds or other infections. If you experience fever or cold fever, you must contact your General Practitioner or Oncologist immediately. BONE MARROW SUPPRESSION DIETICIAN Your treatment may be postponed or the dose may be decreased because your blood count is low. This only shows that your body is not yet ready to withstand the next chemotherapy session, and does not influence the effect of the treatment on the disease There are many myths about foods that are allowed and foods to be avoided when you have cancer. These myths not only cause confusion but may ultimately lead to unhealthy food choices that could be detrimental to your wellbeing in the long run. The value of sound nutritional advice must therefore not be underestimated. DIETICIAN It is well-known that 50% of cancer patients experience weight loss even before diagnosis. Even minor weight loss before treatment is started (less than 5% of body mass) may have an adverse effect on the outcome of treatment. A common secondary diagnosis in patients with advanced cancer is proteinenergy malnutrition (PEM). The overall goals of the nutritional care of the Oncologist patient are: Preventing or correcting nutritional deficiencies. Minimising weight loss and maintaining a sound nutritional status through early nutritional assessment and intervention as a preventative measure; therefore screening for risk of nutritional problems should occur at diagnosis and continue throughout treatment. Providing guidelines regarding nutritional problems that may be experienced during treatment, eg. guidelines for diet modifications and food selection and preparation. Counselling individual patients and their families on general nutritional principles, the basic rules for a healthy diet and healthy eating habits, and nutritional monitoring. You may not have control over your disease, but you do have control over your food choices. Making smart nutritional choices can make your journey through cancer treatment a little easier. The right nutrition before, during, and after treatment will get you on track for more rapid healing and long-term wellness. . Maintaining your weight can also help you finish your treatments on time, recover sooner and feel better. This service is available free of charge to patients and their families. Please contact the dietician for enquiries or an appointment. REMEMBER: YOU ARE WHAT YOU EAT! COUNSELLING SERVICES Being diagnosed with cancer is often accompanied by feelings of shock and disbelief and can affect every aspect of a patient’s life. Professional counselling services are available to patients and their families to help them cope with stress, anxiety and other psycho-social aspects experienced during the various phases of cancer. This includes the impact of cancer on your self-esteem, relationships, family life, work, friendships and attitude towards life. The following counselling services are offered: Individual counselling. Marriage and family therapy. Basic information regarding your cancer diagnosis and treatment. Basic information to children regarding cancer and treatment of a family member. Hospital visits and discharge planning. Referral to resources. Crisis intervention. Support groups (you will get information regarding support groups from the counsellor).Please contact the counsellor at your practice for information on support groups. The counselling service is available free of charge to patients and their loved ones. Please feel free to contact the counsellor for more information or for an appointment. CONTACT DETAILS OF SOCIAL WORKERS / COUNSELLORS ABJ WILGERS Ronelle de Klerk | M Soc Sc (SW) Linda Schneider | BA (SW) Hons Tel:- ABJ VEREENIGING Hedri Powell | BA Soc Sc (SW) Tel:- ABJ KLERKSDORP Hanelie Malan | BA (SW) Hons Anita Garbers | (Psychology), MA (Industrial Psychology) PhD (SW) Tel:- ABJ BENONI Cecile Booth | BA Social Work Honours (voeg by nuutste kwalifikasie M-graad in Pall sorg) Tel:- ALBERTS STEM CELL TRANSPLANT CENTRE Louisa Janse van Vuuren | BA SW (Hons) MTh Past Counselling Avril de Beer (kwalifikasies) Vera (kwalifikasies) Tel:- SUPPORT SERVICES ACCOUNTS During this challenging time there is no shame in needing as much emotional support as possible. To address these needs, there are various support groups that provide assistance to patients during the difficult period following diagnosis. We understand that payments are the last thing on your mind right now, but we nevertheless need to draw your attention to a few important aspects. These groups consist of volunteers who have the same type of cancer you have and who are able to help you with some of the non-medical problems you may experience. Please contact your counsellor for information on support groups. CANSA also provides comprehensive support services to patients. For more information go to: CANSA Helpdesk:- Email:-Website: https://cansa.org.za Chemotherapy and radiotherapy treatments are relatively expensive. Because medical schemes cannot guarantee payment, you remain responsible for the account. We will nevertheless do everything in our power to negotiate with your medical scheme to ensure payment. It is, however, important that you contact your medical aid before your first treatment. Each medical aid has specific rules for cancer treatment. Our accounts department will assist you in all respects, so please feel free to contact them if you need any information. The accounts department are only able to supply the following to your medical scheme: Treatment plan. Motivation for treatment. Authorisation numbers: our authorisation department will get authorisation from your medical aid. Please phone our authorisation department before you start your treatment to determine if your treatment has been approved by your medical aid. If your treatment plan is changed or if your treatment has to resume after a dormant period, a new authorisation number will need to be obtained. RADIOTHERAPY APPOINTMENTS ACCOUNTS Please also remember to inform us as soon as possible if your medical fund or benefit option has changed, if the main member of the fund has changed, as well as any change of address or telephone numbers. PATIENT NAME: PATIENT FILE NO: IN CONCLUSION..... SIMULATION: In this brochure we have attempted to provide you with basic knowledge and information you will need during your treatment. BOOSTER: However, no brochure can meet the needs of every individual, therefore we hope that you will feel comfortable to share your problems or concerns with us. You and your family’s peace of mind during the treatment is especially important to us. Therefore, if any questions, side effects or problems arise that have not been covered in this booklet, please consult the Radiotherapist or nurse treating you. If they feel that you need to speak to your doctor, they will make the necessary arrangements for you to do so. INDEMNITY: Please note that the information in this booklet is subject to change without notice. Rx DATE TIME NOTES RADIOTHERAPY APPOINTMENTS NOTES: Rx DATE TIME NOTES