Have a cancer survivorship care plan; pacifying a panic attack
Q: I was diagnosed with breast cancer six years ago, and we've recently moved. Even though I have a new primary care doc, I don't feel she understands all of my medical history. What should I do? - Lauren E., Hyde Park, New York
A: There are 15.5 million cancer survivors in America, and around 33 percent of office visits for cancer are handled by primary care physicians. Unfortunately, research shows they're often unprepared to do the job.
A new study published in JAMA Internal Medicine looked at 12 advanced primary care practices selected from a national registry of workforce innovators. One would think that this group would be better than average in paying attention to patient needs. However, the Rutgers University researchers found that NONE of the practices had what's known as a "comprehensive survivorship care program." The program should include checking for cancer reoccurrence (with scans, blood tests and exams), monitoring long-term effects of radiation and chemotherapy treatment (such as atherosclerosis, joint or bone issues, organ damage, impact on the endocrine system and hormones, cognitive changes, neuropathy, fatigue) and assessing psychological well-being.
There is a push to improve survivors' follow-up care, but it's essential that you take charge.
First step: Have medical records made accessible to your new primary care doctor (most electronic medical records are shareable if you allow them to be), and get a digital and a hard copy for yourself. Include information from your cancer diagnosis, surgery, treatment and post-treatment follow-up with your oncologist and oncological surgeon, plus your records from your former primary care doctor.
Second step: Contact a local cancer treatment center. Ask about scheduling a follow-up visit with an oncologist, and inquire about cancer rehabilitation services they offer. If you make an appointment, have your records transferred there, too.
Third step: Download info from the American Society of Clinical Oncology at www.ASCO.org; search for "Survivorship Patient & Family Resources." They offer ASCO Cancer Treatment Summaries and Survivorship Care Plans - forms for patients and doctors to complete together. Bring these to your new primary care doctor, and set up your own survivorship care program.
Q: I'm selling my house and have a new great place to move into, but I had a panic attack last week. Before it happens again, what should I do? - Rose W., Meadowlands, New Jersey
A: Eileen O'Meara created a three-minute, animated film called "Panic Attack" that starts with a woman who is pregnant, caught in a traffic jam, wondering if she'd left the stove on and can't get back home to check. Her worries then spiral from one fear to the next, until she ends up thinking her unborn child might be a spawn of the devil and perseverating on what she should do about it. Clearly, having a panic attack is frightening, despite the fact that O'Meara, who suffers from them herself, turned one such episode into an amusing cartoon.
Panic attacks often are triggered by fear of disaster or losing control when there's no actual danger or threat. They can be amplified by side effects of medications, excess alcohol use or lack of sleep. Physical symptoms usually start with hyperventilation and shortness of breath, and can progresses to chest pain, feeling faint, trembling, sweats or chills and heart palpitations. Recurring attacks can lead to cardiovascular problems and development of a phobia.
Panic attacks sometimes are called a "panic disorder" because they're a disordered stress response. They can develop after physical or emotional trauma, or an upheaval in your life (moving!). PAs may run in families, and women experience them twice as often as men.
Fortunately, there are effective treatments. In the short term, tranquilizers or antidepressants may help. In the long term, cognitive behavioral therapy can teach you ways to short-circuit PAs before they happen by identifying trigger situations and helping you avoid them, or teaching you techniques that dial down stress.
Distributed by King Features Syndicate, Inc.
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