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Cardio & Blood-Cholesterol Do you get a little breathless on climbing those extra floors, or carrying that extra weight? Has your energy diminished with age? Does your belly protrude a little too much, or do your muscles feel too flabby? If you have answered yes to any of these questions then you are a little unfit. Getting fit doesn’t mean changing your whole life. You don’t need to run 10 miles a day or swim 20 laps of the pool. You don’t need to join a gym, buy special shoes or weights, or become a member of an exclusive health club. The first step to getting fit is to feel the need to do so. Perhaps you have been thinking all along that it’s about time that you got a little exercise, but lacked the will power to start or were not sure about how to go about it. Whether you are young or old, in or out of shape, a heart patient or not, you should make exercise a part of your life, little by little. If you have trouble doing it all alone, exercise with a friend or your spouse. Start an activity that you enjoy, but do start. It’s never too late to take the crucial first step towards fitness!
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Cancer I. EARLY EFFECT
Esophagitis A. Prevention
1. Sucralfate (Carafate) slurry, starting on the 1st day of irradiation, has been suggested to decrease incidence and severity.
a. Dose: 10-20 mg/kg per dose PO q.i.d.
b. Available: suspension: 100 mg/mL
2. Ranitidine HC1 (Zantac) has also been suggested to decrease severity.
a. Dose: Infants and children: 4-5 mg/kg/day, divided, b.i.d. or t.i.d.
b. Available
Tablet: 75 (OTC), 150 or 300 mg Syrup: 15 mg/mL
B. Presentation
Symptoms include substernal pain on swallowing, sensation of lump in throat, and sore throat.
Symptoms begin about 2 weeks into the course of thoracic radiation therapy.
Symptoms usually ease after radiation to esophagus stops or even decrease when oblique fields start.
a. Treatment
i. Treat the same as oral mucositis.
ii. If dysphagia persists or there is evidence of oral can-
didiasis, start candidal treatment (See above,
“Section IB under “Side Effects of Head and Neck
Irradiation”).
iii. If the dysphagia is severe, the patient may need a
break from radiation treatment.
II. INTERMEDIATE EFFECTS
Radiation pneumonitis
A. Presentation
This presents either during radiation therapy or up to about 6 months after treatment is completed; it is very rare with doses <3000 cGy
Symptoms are shortness of breath, dyspnea on exertion, and cough
Fever is rare.
Radiographic changes seen in most patients are infiltrates within the irradiated volume of lung.
Decreased vital capacity and diffusing capacity are present.
Actinomycin D and Adriamycin may reactivate.
Abrupt steroid withdrawal may reactivate.
B. Treatment
Bedrest
Prednisone
a. Dose: 0.5-2 mg/kg/day (maximum 80 mg/day), divided
t.i.d. to q.i.d.
b. Available
Tablet: 1, 2.5, 5, 10, 20, or 50 mg Syrup: 1 mg/mL (5/6 alcohol)
III. LATE EFFECTS
A. Cardiac complications
1. Late cardiac complications
a. Acute myocardial infarction
b. Acute pericarditis
c. Constrictive pericarditis
d. Valvular disease
2. Risk factors
a. Complications are dose, volume, and exact target
dependent.
i. Proximal coronary arteries tend to be in high-dose
mediastinal fields.
ii. Pericardial problems require that most of the heart
be in treatment volume; this is rare today.
b. Age dependent: Risk decreases as child’s age at treatment increases.
c. Acute pericarditis may be precipitated by abrupt
steroid withdrawal.
d. Malignant hypertension can exacerbate arteriosclerosis in irradiated vessels, precipitating myocardial
infarction in patients at risk.
e. Previous treatment with doxorubicin enhances the
risk.
3. Presentation
a. Acute myocardial infarction
Remember this risk in patients who present with chest pain or congestive failure after chest irradiation.
b. Acute pericarditis
Pain
c. Constrictive pericarditis
Chest pain, poor tolerance of exercise, and normal heart size
B. Pulmonary fibrosis Presentation
Radiographs: scarring in field of radiation, sometimes with retraction
Rarely symptomatic
Reduced diffusing capacity
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Cancer Ideas about the cause of lung cancer have been so dominated by recognition of the effect of smoking for the last forty years that it is sometimes easy to forget that there may be other important causal factors and that lung cancer still occurs in non-smokers. The effect of smoking is so strong that it can be quite difficult to unravel other causes, because the presence of a few smokers in any group will so alter the statistics. However, there are undoubtedly other factors at work in the development of lung cancer and many of them can now be judged.
Lung cancer is not inherited in any simple way and in Scandinavia, studies of identical twins have shown that it is smoking that determines any difference in risk of lung cancer. Identical twins have identical genes and if there were a simple relationship between inherited genes and lung cancer, we would expect the incidence of cancer to be the same in identical twins, regardless of any differences which we might find in the smoking habits of each twin in a pair. This is not the case. If one of a pair of twins smokes, the risk of lung cancer in that twin is greater. While, however, there is no simple link between genetic inheritance and the incidence of lung cancer, the fact remains that some non-smokers get cancer and some smokers do not. This raises the possibility that genetic inheritance may be influential in some subtle way and provide at least part of the explanation for this odd fact. One of the teasing questions which biologists now have to tackle is the part played by innate genetic make-up in protecting some smokers from cancer and disposing some non-smokers to the disease. One suggestion that is being studied is that there may be genetic differences in the way in which the body handles the chemicals produced in cigarettes so as to detoxify them. If research along these, or similar, lines produces answers, we shall be able to identify the patients whose genetic make-up puts them at special risk.
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