Following on from my last blog, it really isn’t “rocket science” to appreciate that even short term and temporary impairment to such important functions, is hardly likely to find us in the ‘pink’ of health at that precise moment in time. And it is this temporary and short-term impact that contributes to the feeling of unwellness, in some cases causing tiredness, breathlessness and chronic fatigue. It may also increase our susceptibility to infection and heighten a temporary tendency to bruise and bleed more freely. Of course, should one become anaemic or need antibiotics, or a boost to platelet levels, this will require (and doubtless receive) prompt attention in the form of the relevant treatment.

It is also important to bear in mind that that same oxygen resource is vital for normal brain functioning.  (Although the brain accounts for approximately one fiftieth of overall body weight, its consumption of oxygen, involving the oxidisation of glucose (simple sugar) supplied by the bloodstream in the resting state, exceeds 25%). It is hardly surprising therefore that patients and relatives sometimes comment to the effect that they or an affected family member is becoming short tempered, tearful, forgetful, unable to cope with often otherwise moderate levels of daily stress and strain. Moreover – and as we have already seen – chemotherapy can ‘trigger’ nausea and vomiting and loss of vital fluids and (with some agents more than others) cause temporary hair loss.

If we take the latter of these two first, it is not surprising that anti cancer drugs – which inhibit cell turnover generally – affect the most rapidly dividing, i.e. those cells with the fastest turnover, first of all. Among these are bone marrow, intestinal lining, skin and hair follicles. Not all anti-cancer drugs cause hair loss but where such loss is going to occur, it is likely to begin within a few weeks of treatment commencing and will most probably include body and pubic hair also.

From time to time in my clinical practice, I have seen patients who have decided to obtain and wear a wig, although not necessarily during every part of the day. Looking good and making the best of what we have in this sense is important to most of us and rightly so. True, some find it easier to talk to family and/or friends about aspects of their appearance than do others. Many clearly feel unable to talk to anyone although they nevertheless care and are concerned every bit as much. Perhaps their basic nature or upbringing (or combinations of such historical, cultural and current influences) has led them to outwardly shun what they describe and appear to regard as vanity and self-conceit. Whoever we are, we need such assurance and the confidence that flows from it, thus enabling us to function and perform to satisfactory levels. The simple truth is that much of this emanates from self-perception, i.e. how we see ourselves.· There is no doubt in my mind that some patients do experience a great deal of unnecessary and, in certain ways, harmful loss of self-esteem during times of illness. Consequently every effort should be made to boost confidence and help restore morale.

How we feel about ourselves is massively important and it is neither trivial nor vain to want to keep up appearances, even when feeling far from one’s best. Moreover, many people have found – sometimes to their surprise but always, where it happens, to their delight – that they have come both to value relationships more and to be themselves valued more highly as a person, not in spite of but because of their illness and for who they truly are. At this level of appreciation, neither status nor age nor anything to do with outward appearance as an outcome of illness, will be likely to so much as enter the equation. Yet again, over the years, it has been my good fortune to have ready access to experts of which I have tried to make good use on patients’ behalf. For this reason – and because of my own limitations on such an extensive and complex subject matter – may I suggest that where such help is needed, you contact an appropriate person in your oncology department? Alternatively, you might ‘tap into’ an organization such as Macmillan or CancerBACUP who will, I am sure, arrange prompt access to an experienced counsellor as well as provide you with genuinely ‘state of the art’ material, all prepared and written by experts.