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Dawn just completed her 4th chemo treatment. She started having mouth sores a week ago. She is sitting in the Tribal Council Meeting room alone when her daughter, Amanda comes in.

Amanda (asking gently):
Mom, what are you doing? You look like you are just staring into space?

Dawn: Ah, hello Amanda. No, I am fine. I am just working on some visual imagery.

Amanda: Okay. Is everything okay? You seem a little weak still from the chemo yesterday. Can I get you anything? How about some orange juice?

Dawn: Oh, no, I am fine, really. I just have some pain because of the sores in my mouth. I forgot and had some orange juice. OOOOhhhh. My mouth just hurt so badly. It is still stinging. No more orange juice until these sores heal! So I am using my mind to think of something other than the pain (chuckling).

Amanda: Oh Mom, I'm so sorry.

Dawn: Oh, it is okay. I am just angry at myself for being so silly. I know better than to put something acidic in my mouth right now. I was just thinking that the juice would be okay for my diabetes and maintaining the weight I've been losing on the chemo. I guess the sores are worse than I realized (sigh).

Amanda: How can I help, Mom?

Dawn: Oh, you can sit here with me for a few minutes and hold my hand.

They sit quietly together for a few minutes.

Dawn: Oh, that is better. Now, would you pray with me for the Creator to help me heal and take better care of myself?

Amanda bows her head and says a prayer in their Native language while still holding her mother's hand.

Amanda: So it sounds like you didn't eat any lunch because the sores in your mouth hurt too badly?

Dawn: Yes, I didn't eat. I don't think I am ready to eat anything yet.

Amanda: But Mom, you have to remember your diabetes and not let your blood sugar get low.

Dawn: Yes, you're right. How about some cottage cheese? That should be okay for me to eat … nice and soft … and good protein for me.

Amanda: Great, I will go get you some. You just rest here, okay, Mom?


DawnJohnLeslieJoeTop of Page

Dawn completed her 5th chemo treatment and is having trouble with sores in her mouth that are causing her pain. She is having dinner with her mother and her daughters, Crystal, Amanda and Susan in her home.

Amanda (asking gently):
Mom, what are you doing? You look like you are just staring into space?

Dawn: thank you Crystal for bringing the meal over. I just didn't feel like driving anywhere. I don't feel like talking much, okay? It is just hard because my mouth hurts.

Grandma (Dawn's mother): I thank you too. I was very tired today and your mom was gone most of the day.

Amanda: Yes, I'm sorry you were alone today, but Mom told us that she had to take care of a few things for the Tribe on her way home from the clinic.

Crystal (looking at Dawn): Well, I am always surprised that you are still working full-time for the tribe while you are going through the chemo.

Grandma: I told her she should tell the Tribal leaders what is going on and she should stay home.

Dawn: No Mom. Thank you, but I like to stay busy. It helps keep my mind off the discomfort.

Crystal: Well Amanda and Susan helped me pick up food for tonight. We went online and looked at the foods that may be easier for you to eat and swallow.

Dawn smiles at them but doesn't try to speak. Crystal sets out a pitcher of water, mashed potatoes, gravy, pureed broccoli soup, scrambled eggs with cheese, applesauce, Jell-O and pudding. Dawn smiles at the food and pours herself a glass of water. She leans her head back to help swallow the liquid. Susan dishes out food for Dawn and her grandmother.

Susan: Can I help you, Mom? Dawn shakes her head, … no … and smiles at Susan.

Grandma: Oh, it all looks good.

They all eat some. Dawn leans her head back to help her swallow after chewing the foods carefully. She takes a sip of water in between each bite of food.

Amanda: How are the sores in your mouth? Did the medicine the dentist give you help any? Don't try to talk, just nod or shake your head, okay Mom?

Dawn nods her head and smiles.

Crystal: I am making dinner tomorrow night. We are going to have pasta with a cream sauce. Do you think that will be okay for your mouth?

Dawn nods her head and smiles broadly. The family finishes their meal.

Crystal, Amanda and Susan come out from the kitchen after cleaning up and all three are smiling and holding their hands behind their back. Dawn tilts her head at them curiously. They bring their hands forward and each is holding … no sugar added … foods: popsicles, a vanilla shake, pudding and custard.
Crystal: The website also said that it was good for you to have any of these. They do not have sugar added so shouldn't be bad for your diabetes. Which would you like? Or do you want ALL of them?

They all start laughing as Dawn reaches for the shake.


DawnDawn 2LeslieJoeTop of Page

John is about to start his 1st chemo treatment. John's son, Joseph picked him up from the dentist.

Hey Dad, what did Dr. Sam have to say? (Dr. Sam is their dentist)?

John: Oh he was really sorry to hear about my cancer. He gave me a special soft toothbrush and he talked to me about rinsing my mouth often.

Joseph: What? Like with a breath freshener?

John: No, just with water. Dr. Sam said that some people get infections and mouth sores when they go through chemo. So to help prevent these, he says I need to brush my teeth more often and use a real soft toothbrush. I also need to drink a lot of extra water to help get the poisons out of my body and to rinse my mouth to help get rid of bacteria.

Joseph: Oh, that doesn't sound too bad.

John: No, it is all pretty straight forward.

Joseph: So what is in the bag you're carrying?

John: He gave me some sample toothpastes and some lip gloss.

Joseph: Why did he give you lip gloss?

John: Because some people get real dry, cracked lips while they are on chemo.

Joseph: Oh man. That chemo is just poison.

John: Well, yeah it is. That's the whole point. They are trying to poison the cancer cells without killing me!

John smiles and Joseph laughs


DawnDawn 2JohnJoeTop of Page

Leslie's cancer was too advanced to do surgery. She is having heavy dosages of chemo. She is in the living room when her husband, Ralph, comes in the house.

Uh ho. You don't look very happy.

Leslie (a little grouchy): You won't be happy if you had sores all over your mouth and throat.

Ralph: Oh honey, I am so sorry. What can I do to help?

Leslie: I don't know. I just hurt. I'm irritated. I'm angry at this cancer. I want it to just go away. I asked Thomas to go online for me and find out what I can do about these sores.

Ralph: So what did he learn?

Leslie: Well, they'll go away … but I may have them for a while. He is stopping by the dentist to get me some numbing solutions. He says I will need to put some of it on with a cotton swab and the other I need to gargle with and then swallow small amounts to try to get the solution to hit the open sores in my throat.

Ralph: Oh, that doesn't sound good.

Leslie: Oh, I won't mind if it helps any.

Thomas comes into the house carry a small bag.

Thomas: Hi mom. Hi dad. I got here as fast as I could. I also picked up some popsicles and hard candies for you, Mom.

Leslie: Huh? Why?Thomas: The dentist said it was okay for you to have the candies and that they have a numbing ingredient that may help your throat. The popsicles will help cool down the sores and may reduce the inflammation too.

Leslie: Well, that's the best news I've heard all day. I'll take a Popsicle please. Would you two like to join me?

They all smile.


DawnDawn 2JohnLeslieTop of Page

Joe is 42 years old. He was diagnosed with head and neck cancer at age 40. He started smoking commercial / manufactured tobacco when he was 12.

He is a recovering alcoholic (2 years sobriety, 18 years of alcoholism). He is also diabetic and overweight (but not obese).

He is divorced and has 4 children: Sara, age 24, Mark age 23, Carol age 20, and Rose age 18. Carol and Rose live with their mother on the reservation, 150 miles one way from where Joe lives. Both Sara and Mark live on their own, both on the reservation about 180 miles from where Joe lives.

Joe was a hot shot fire fighter until he was fired because of his alcoholism when he was 34. He was unemployed at the time of his cancer diagnosis, but obtained help for his cancer care through the Veterans Administration.

He entered Alcoholic's Anonymous for the 5th time 2 weeks after receiving his cancer diagnosis.

His cancer is stage 3 (cancer cells were found in his lymph nodes and the tumor was about the size of a baseball on the right side of his neck, part of his jaw and mouth.

He lost teeth, part of his gums part of his tongue and part of his jaw.

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