Rodney Warner, JD

Jay made me laugh. He had a dry, sarcastic humor, like my own. We had other things in common. We were regulars at the blood cancer support group at Gilda’s Club Delaware Valley. We also volunteered our time there. We also had been treated for lymphoma. I, for Hodgkin’s, he, for non-Hodgkin’s.

Jay had a harder time of treatment than I. His non-Hodgkin’s never really went away, as I understand it. I’ve been in remission since 2003. Jay suffered from interstitial fibrosis due to his chemotherapy. It permanently impaired his breathing but he seemed to get by pretty well most of the time. Other than the really good job chemo did as permanent, male birth control, I haven’t had any long term side effects from treatment.

One of the benefits of his condition was that it allowed Jay to get a disability pension from his job as a middle school teacher. You may read stories of tearful, retiring teachers, reluctant to leave and lose contact with kids. Jay was not that teacher. I think he was more than happy to leave. He didn’t seem impressed with the students and would tell me of the drugs readily available in the school bathrooms. Jay was not one afraid to speak his mind.

We would see each other mostly in support meetings. We would take turns playing the straight man, with our bad, dry jokes and plays on words. We would goof on our doctors, fellow patients we’d met and hospital food. At our meetings, if there was someone new, each of us would have to tell our story. We’d heard each other’s treatment history so many times, we could’ve told each other’s story. With all due respect to Gilda’s staff, we’d been through so much treatment, and so many meetings, we could’ve run the meetings and given the staff member the night off.

Jay spent a lot of time at Gilda’s. He’d volunteer to answer phones. He’d help club members with computer problems. He’d volunteer to help at major events.

Jay loved hockey and the Flyers. He had no interest in baseball or football. He also loved France, especially Alsace Lorraine. Jay and his wife took frequent, long vacations there. During one trip, I think to Paris, he ended up in a hospital. The particularly attractive French nurse who treated him made his time there easier. I think he was reluctant to leave.

I guess the best way to describe Jay is as a character. He was full of life, humor, wit, he cared about others and would give you a hand if you needed it.

Today I learned Jay died three days ago. It sounds like an infection, in addition to his interstitial fibrosis, and maybe the return of his cancer, was his undoing. Jay was ill for a while, it sounds like the doctors he saw didn’t get a good handle on what was going on. He ended up in Cleveland, I’m guessing to go to the Cleveland Clinic. Given a choice, I doubt Jay would’ve wanted to die in Cleveland, far from home, in a city without an NHL team. I’m guessing Jay was in his 50′s.

I haven’t been spending as much time as I used to at Gilda’s, so it’s been a while since I last saw Jay. It was a bright, sunny day, Jay was in good health and I hope that’s how I’ll try to remember him, not as a desperately ill man battling for, but losing, his life in a hospital bed far from home.

Seeing, and talking to, Jay, was always a pleasure. He will be missed. The world is a little darker now, more humorless, without Jay. We lost another helpful, caring, funny, loving man due to cancer.

Carolyn Vachani, RN, MSN, AOCN

Flu vaccine information is everywhere you turn these days, from the supermarket to the news. Every year around this time, questions about flu vaccination start popping up in cancer clinics. Many people with cancer may be wondering how they can best prevent getting sick, and if they should be vaccinated against the flu. Here are the facts…

According to Neil Fishman, MD, associate professor of Infectious Diseases and director of Healthcare Epidemiology and Infection Control at The University of Pennsylvania, all immunosuppressed individuals should receive influenza vaccination (a single shot now includes both “seasonal” strains and the H1N1 strain). People currently undergoing treatment for cancer and those who are in remission should be vaccinated, as both of these groups are at higher risk for developing complications from influenza infection. These patients should receive only the injected vaccine, since the inhaled form contains live viruses. It would be best to receive the vaccine when they are the least immunosuppressed in order to guarantee a maximal response. This means that they should not receive the vaccine during their nadir (the time when blood counts are at their lowest, typically 7-14 days after treatment). Talk with your healthcare team about the best time for you to get vaccinated.

Dr. Fishman also advises that people with cancer (particularly those on therapy or post-transplant) also get a pneumovax vaccine. This vaccine helps to prevent a common strain of bacteria that can cause pneumonia as well as other serious infections. The CDC recommends pneumovax for adults over 65, for smokers and for “people with certain health problems” – this includes health problems or treatments that weaken the immune system. People with cancer may require a second dose of pneumovax, given 5 years after the first. Patients should discuss their need for re-vaccination with their healthcare team.

Remember, while receiving cancer treatment, you are at an increased risk of getting infections, including colds and the flu, particularly when your blood counts are low. What precautions should you take as a patient receiving cancer therapy? Most importantly, wash your hands often- it is the easiest, most effective way to prevent the spread of infection. Keep hand sanitizer in your bag, desk, car or anywhere you may not be able to access a sink for handwashing. Avoid touching your eyes, nose and mouth- that is how germs get in. It is perfectly acceptable not to shake hands or to ask people who are sick (or have sick people in their household) not to visit you. Ask any visitors to wash their hands upon arrival and, whenever possible, avoid places with crowds of people, particularly when your blood counts are at their lowest. Have other members of your household get vaccinated as well; you don’t want them bringing these infections into your house where it will be harder to avoid.

Still, even the best handwashers get sick sometimes, so don’t blame yourself if you do. Get plenty of rest, drink plenty of fluids, and help to prevent the spread of the flu to others by staying home when you are sick.

You can learn a lot more about cancer and the flu through the CDC webpage on this topic.

Now roll up your sleeve – this won’t hurt a bit!

Carolyn Vachani, RN, MSN, AOCN

Flu vaccine information is everywhere you turn these days, from the supermarket to the news.  Many people with cancer may be wondering how they can best prevent getting sick and if they should be vaccinated against the flu, both seasonal and H1N1 (often called Swine flu).  Here’s the facts…

According to Neil Fishman, MD, associate professor of Infectious Disease and director of Healthcare Epidemiology and Infection Control at The University of Pennsylvania, all immunosuppressed individuals should receive the influenza vaccines (both seasonal and H1N1).  This includes people receiving cancer treatment. These patients should only receive the injected vaccines and not the inhaled forms of the vaccines, which use a live virus.  It would be best to time the vaccine to when they are the least immunosuppressed in order to guarantee maximal response.  So, they should not receive the vaccine during their nadir (the time when blood counts are at their lowest, typically 7-14 days after treatment).  Talk with your healthcare team about the best time for you to get vaccinated.  You can receive both the seasonal flu and H1N1 vaccines at the same time.

Dr. Fishman stresses that the novel H1N1 influenza virus is not any more dangerous than seasonal influenza at this point. It is no more deadly, but we need to take the same precautions we take for seasonal influenza.

Remember, while receiving cancer treatment, you are at an increased risk of getting infections, including colds and flus, particularly when your blood counts are low.  What precautions should you take as a patient receiving cancer therapy?  Most importantly, wash your hands often- it is the easiest, most effective way to prevent the spread of infections.  Keep hand sanitizer in your bag, desk, car or anywhere you may not be able to access a sink for handwashing.  Avoid touching your eyes, nose and mouth- that’s how germs get in.  It is perfectly acceptable to not shake hands or ask people who are sick (or have sick people in their household) to not visit you.  Ask any visitors to wash their hands upon arrival and, whenever possible, avoid places with crowds of people, particularly when your blood counts are at their lowest.  Have other members of your household get vaccinated as well- you don’t want them bringing these infections into your house where it will be harder to avoid.

Even the best handwashers get sick, so don’t blame yourself if you do.  Get plenty of rest and fluids and help prevent the spread of the flu to others by staying home when you are sick.

Now roll up your sleeve- this won’t hurt a bit!

Also see Ask the Experts: Exposure to People After Vaccines.