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In her essay “Illness as Metaphor,†Susan Sontag discusses the danger in associating metaphors with cancer. The metaphors our culture has attached to cancer, Sontag argues, also attach a stigma to the disease, and cast undeserved blame upon the patient. She addresses the fact that we often use warfare metaphors when discussing cancer. Cancer cells “invade†and “coloniseâ€; a patient fights a “battle†with cancer – one that often necessitates a counter attack of chemical warfare.
It was this final surge that most affected my body. It has often been remarked that, while cancer is a life-threatening disease, the cancer itself is not the most difficult part; it is the treatment that blasts, burns, and sickens us. I have been diagnosed with synovial sarcoma (a rare soft tissue cancer) five times throughout my twenties. In spite of six previous surgeries and a course of adjuvant radiation in 2004, I did not truly feel like a “sick person†until my most recent recurrence, in the fall of 2008, when I began my first cycle of doxorubicin and ifosfamide, the standard sarcoma protocol. Chemo rocked and shocked my body as nothing had before. As expected, I lost my hair, and then eventually, my eyebrows and eyelashes. I shed fifteen pounds from my already-thin frame. I became severely anaemic, and immuno-compromised, as my haemoglobin and neutrophils plummeted, sending me to the Emergency Department once a week for a blood transfusion or antibiotics for a new infection. And severe mouth ulcers and thrush, coupled with a lack of appetite and the usual nausea made eating – and likewise nourishing my now vitamin- and mineral-deficient body – challenging, to say the least.
It was the latter consequence of chemo that left a lasting impression on me.
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Chemo patients are cautioned against continuing or beginning supplementation during treatment, as large enough doses of some vitamins (ascorbic acid, or Vitamin C, for example) can interfere with the drugs and reduce their effectiveness. It is a double-edged sword, really, as it is during this time that patients most need vitamin support: in addition to slaying the bad cells, chemotherapy does a number on our nutrient levels, and most patients become deficient in many of the essential vitamins and minerals. A strong immune system and healthy vitamin and mineral levels, moreover, are important factors in fighting cancer and preventing recurrence. Though Sontag would probably not appreciate an extension of the warfare imagery, nutrition and immune system support are arms we need to go into any cancer battle. It became clear to me that this was of very little concern to oncologists and in-hospital dietitians.
I couldn’t really blame my oncologists for this, however. It is an oncologist’s job to screen for cancer and rid our bodies of existing malignancies. Oncologists are in the business of killing cancer; they are not in the business of preventing it. I believe that, nonetheless, there should and can be a place for preventative medicine within the Western system. The page on “What to Eat During Treatment†in the chemotherapy pamphlet I was given after diagnosis included many tips on increasing my caloric intake, such as eating saltier and sweeter foods, including more butter, margarine and ice cream in my diet, and adding sauces and gravies to my meals, but nowhere to be found was information on how I could maintain a healthy diet during chemo. Of course there was also a complete dearth of information on maintaining a vegan diet during cancer treatment, which I expected, and the dietitian who visited me while I was on inpatient chemo did everything she could to discourage me from continuing with my vegan diet. I remember in particular how I was practically forced to include eggs in my chemo diet, because I would “need the extra iron†(in fact, one serving of eggs contains only 2.3 mg of iron, compared to 6 mg for chickpeas and 9 mg for soybeans, although the plant-based iron-rich foods contain non-heme iron, which is less well-absorbed, unless consumed with foods rich in Vitamin C, such as broccoli). More frustrating was the fact that my commitment to a healthy vegan diet, combined with the weight loss I experienced as a result of my chemo-induced food aversions and painful mouth ulcers and thrush was mistaken for an eating disorder. It is my belief that, had I been referred to a nutritionist or at least a dietitian who had experience working with vegetarian and vegan patients, I might have received more effective nutritional support during chemotherapy.
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It is also my belief that, if hospital menus were given a major overhaul, we would see healing times improve in many patients. It is rather ironic that hospital patients -- those whose appetites are sometimes suppressed and whose nutritional needs are perhaps the highest -- are often served the least appetizing, least nutritious foods. Upon my first evening as a chemo patient, I stared at the six chickpeas bathing in a mess of runny tomato sauce on my tray, and decided that I would politely solicit my mother’s skills as personal chef instead. How is a plate of mystery meat and rubbery, over-cooked carrots and canned corn intended to appeal to a perpetually nauseated, appetite-suppressed chemo patient? It is a problem worth fixing. I realised this most acutely when -- after having indicated on my dietary request form that I was a lactose intolerant vegan and would prefer soy or rice milk over cow’s milk -- I was served non-dairy creamer with my breakfast cereal. Something has to change. A hospital is supposed to be your house of healing. This should be reflected in the food.
My experience as a health-conscious vegan on chemotherapy may have been frustrating at times, but some good came of it: my stint as a reluctant consumer of eggs, margarine, and rubbery carrots and corn inspired me to embark on a study of nutrition. I am now partway through the Canadian School of Natural Nutrition’s RHN (Registered Holistic Nutritionist) programme, and I have begun a wellness and recipe blog (with a particular focus upon cancer-preventing and chemo-friendly foods). While I am wary of the term “remission†and, as a five-time survivor, I hesitate to use the word, my body has been free from signs of the disease for a year and a half now. Three times a year, I visit a doctor in Venezuela who specialises in cancer prevention and immune system repair following aggressive treatment. I have also relocated, along with my partner, from Downtown Toronto, to a rural area in the Kootenay region of British Columbia, where we have started our own organic garden, with the intention of eating what we grow (and making hospital food a very distant memory).
Regardless of whether the inclusion of complimentary therapies in my treatment plan are making an actual difference in preventing my disease from recurring, it is a comfort to me that I am doing the most that I can and taking charge of my own health, gathering the necessary arms and promoting myself to CEO of my body. The adoption of new diets and lifestyles after cancer is no longer a radical thing: many cancer patients seek alternative or complimentary therapies in the forms of macrobiotics, raw foods, juicing, and organic veganism, to name a few. This trend is on the rise. If it isn’t my doctor’s or my dietitian’s job to prevent cancer, I can make it my own.
-- Laura Duralija Rocca