The Health Blog
Welcome to our look into the world health
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Your loved one may continue to lose weight in spite of your combined best efforts. If they do this, try not to take it personally. Their weight loss doesn’t mean that you are not caring for them properly, nor does it mean that they are not grateful for your efforts and eating as much as they comfortably can of what you prepare. It is no more possible to stop some people with cancer from losing weight than it is possible to stop some people with cancer from dying of it.
So try to aim for what is possible. If you refuse to settle for anything less than stopping a person who has extensive cancer or is having very intensive chemotherapy from losing weight, you are likely to succeed only in making both of your lives miserable. Both of you have enough to deal with without getting into battles over food. Why not simply aim for pleasant meal times, free of nagging or feelings of guilt? Perhaps there are even times when both of you would benefit more from a chat and a cuddle than more food!
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There is no symptom that automatically means you have to go into hospital. However, you may choose to go into hospital for
tests or to have some form of treatment that cannot be done at home. The need for hospitalisation is one of the costs you should
take into account when deciding what tests and treatment to have.
The decision as to whether to stay at home or go into hospital in the final stages should largely be yours. However, a decision to stay at home is practical only if you can rely on a lot of support and cooperation from family and friends. I suggest that, if you do want to be at home, you make some preparations towards this while you are still relatively well. Talk with your family and friends about what you want and find out how much help and support they are prepared and able to give you. Get to know a doctor who will make home visits. Find out whether there is a special palliative care/terminal care/hospice team in your town and ask to be referred to them when the time seems right for that. Keep in mind that, at least throughout Australia, there is a government-subsidised home-nursing service. It is easy and inexpensive to arrange for nurses to visit your home for a particular purpose such as to do dressings, supervise pressure care, help you with bowel or bladder problems or just for a friendly check on how you are managing. Special aids that you might need such as wheelchairs, bedpans, commodes, special bedding, oxygen masks, etc, are often available on loan or hire from public hospitals or through the home-nursing services, so the fact that you can’t afford to buy such things shouldn’t mean that you have to go into hospital.
You may also be able to get financial assistance from your local cancer society, for example, to cover the cost of a nurse or companion to stay with you at times when friends and family cannot manage this.
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Eczema
Eczema of the nipple may sometimes occur as a result of irritation caused by the rubbing of clothes – contact eczema – or of a general skin infection. Some people are born with eczema, and it can occur on the nipple as on any other area of the body.
Once the diagnosis has been confirmed by a specialist, which may, rarely, be done by means of a wedge excision under local or general anesthetic, and the cause of the irritation has been removed, a short course of steroid cream may be necessary. Infection can be treated with antibiotics.
Paget’s disease of the nipple
Paget’s disease normally occurs in women over the age of 45, and is caused by a ductal cancer growing onto the areola. It is quite a rare condition which may be confused with eczema, but which spreads over the areolar region far less quickly and may destroy the nipple completely over a long period of time. If left untreated, it never heals and eventually forms an ulcer.
Wedge excision of the affected area, or the cytological examination of scraped cells under a microscope, will confirm the diagnosis. This is a far more serious disease than eczema and treatment may involve complete removal of the breast. A woman with persistent redness or nipple discharge should always report it to her doctor even if she has eczema elsewhere on her body as the cancer associated with Paget’s disease is not palpable.
Infective ‘mastitis’
This can occur in women who are breast-feeding their babies. It may be caused by the transfer of micro-organisms from the hands to the breast through a cracked or inverted nipple, by an infection passed on from the baby’s mouth, or by blood-borne infection such as a sore throat.
If the ducts become blocked when a woman is lactating, the milk may stagnate within them and an infection can develop. This may cause a dull pain with inflammation, tenderness and swelling or engorgement of the breast, and sometimes an infective discharge from the nipple.
Treatment with antibiotics is usually effective if given early, but breast-feeding will have to stop while these are being taken. Breast milk can be expressed with a breast pump, but, as the milk will contain traces of the antibiotic, it should not be given to the baby. Your midwife will be able to advise you in this situation.
Ulcers
Rarely, ulcers can develop on the nipple during breast-feeding. The baby’s sucking can irritate the skin, leading to pain and bleeding from the affected area.
Washing and drying the nipple carefully after each feed, and the use of Calendula ointment can help to prevent ulcers forming, but once present, frequent washing with a sterile solution and breast-feeding using an artificial nipple should help. If necessary, breast milk can be expressed with a breast pump.
Ulcers are more common in fair-skinned women, particularly those with red hair.
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