How Physical Changes Can Affect Emotions

Increasingly we are finding that mood disturbances, such as depression and anxiety, are largely due to chemical imbalances in the brain. Read this as it's not your fault if you are experiencing symptoms of a mood disorder. Hormones such as those associated with the thyroid gland or sex hormones such as estrogen and testosterone may be affected by cancer treatment for a number of reasons. Sometimes these hormones help to stimulate the growth of tumors and need to be suppressed intentionally as a...

Working toward Emotional Balance

If you think you have symptoms of anxiety or depression, you should talk to your doctor about how you are feeling. Improving your emotional health will not only enhance your quality of life, but it will also help you to physically heal. One way your doctor can help is to consider the physical reasons behind your emotional problems. The more common physical factors are listed in Table 11.5. Just recognizing your symptoms and having a frank discussion with either your primary care physician or...

Alternative Medical Systems

Homeopathy dates back to the Greek physician Hippocrates, who founded some of its basic principles in the fifth century b.c. Hippocrates believed that it was essential to understand people's symptoms and how they reacted to disease in order to treat them. Although understanding the whole person is a founding principle in homeopathy, the field wasn't fully established until the German physician and chemist Samuel Hahnemann (1755 1843) began experimenting on himself. Dr. Hahnemann had...

An Energy Inventory

Before you begin to seriously pace yourself, it is a great idea to spend three days keeping track of what you are doing. After all, one of the best ways to see how you can save coins is to first see how they are now being spent. In my clinic, we recommend that patients keep a three-day log of their activities. They write down all their activities and also document when they are experiencing pain or feeling particularly fatigued. The occupational therapist then reviews this log with the patient...

Contents

Chapter 1 Get Your Life Back on Track 1 chapter 2 Understand Physical Healing 11 Prioritize What You Do and Pace Yourself 32 chapter 5 Seek Help from Western Medicine 47 chapter 6 Explore Eastern and Other Medical Systems 58 chapter 7 Dance, Skip, and Walk Exercise Your Way Back to Health 78 chapter 12 Tap into Your Spirituality 181 chapter 15 Look What's on the Horizon 232 Appendix Where to Find Help 243 Index 261

Conventional Medicine An Imperfect System

Although prescription medications undergo much study before they come to the market, medical doctors sometimes try other treatments and procedures that have not been rigorously tested. A well-known example occurred during the 2004 American League Championship Series. When pitcher Curt Schilling injured his right ankle, the Boston Red Sox's general manager vowed to explore every medical technique under the sun to try to get his tendon stabilized. According to the Boston Globe, here's what...

Faster Better Stronger Julie K Silver MD

The Johns Hopkins University Press Baltimore Note to the Reader This book is not meant to substitute for medical care of people with cancer, and treatment should not be based solely on its contents. Instead, treatment must be developed in a dialogue between the individual and his or her physician. Our book has been written to help with that dialogue. In order to protect the privacy of patients whose stories are told in this book, the author has changed their names and identifying...

Fatigue

Studies reveal that about one-third of the general population say they feel tired. In cancer patients, both undergoing treatment and post-treatment, the number is approximately double. So approximately two of every three cancer survivors have symptoms of fatigue and fatigue tends to hinder recovery and daily functional activities. Patients and caregivers often have different perceptions about fatigue. Caregivers are likely to underestimate its frequency, severity, and impact on quality of life....

Legitimating Some CAM Therapies

In 1993 Harvard physician and researcher David Eisenberg and his colleagues published a report titled Unconventional Medicine in the United States Prevalence, Costs, and Patterns of Use. Eisenberg reported that approximately 1 of every 3 Americans was using CAM therapies and that approximately 2 of every 3 people who did so were not telling their primary health provider about the use of these therapies. Following this landmark study, the National Institutes of Health established the Office for...

Mind Body Interventions

Meditation is the ability to self-regulate your thoughts in order to suspend the normal stream of consciousness. A common goal of meditation, which distinguishes it from relaxation, is to reach a state of thoughtless awareness during which you are passively aware of sensations at the present moment. There are a number of different methods that people use to meditate. The methods that involve the constant repetition of sounds or images without aiming for a state of thoughtless...

Mood Changes

As your family struggles with issues surrounding cancer, there will be times when family members feel glum or worried. In children, the time to worry is when these moods become persistent or are present more than they have been in the past. All of us, including children, have a baseline mood level that fluctuates as things happen in our lives. When good things happen, we feel happier when bad things happen, we are sad. In children, as in adults, the baseline mood level depends on their in...

Pacing

One of my favorite quotes on pacing comes from Hugh Gregory Gallagher, who survived polio and struggled with its debilitating aftereffects. Gallagher wrote, My muscle power and endurance are as coins in my purse I have only so many and they will buy only so much. I must live within my means, and to do this I have to economize what do I want to buy and how can I buy it for the least possible cost Regardless of where you are in the healing process, you only have so many coins. To reach the goals...

Pacing Basics

There are a few basic principles when it comes to pacing. These may seem obvious, but as you read them, ask yourself whether you are following them. They are good tools to use in the recovery process. Here are the basics of pacing 1. Organize and plan your day ahead of time. Doing this costs you Table 4.1. How to Keep a Three-Day Activity Log Step 1. Organize a notebook with space to write in for each hour of the day for three days. Step 2. Record your activities each waking hour for the next...

Past Transgressions and the Emergence of Psychoneuroimmunology

Even though embracing a spiritual life has been shown to improve health in a variety of ways, a skeptical view of this notion is understandable. Historically, religion has been used as a cover to perform truly heinous acts some of which were purported as necessary to ensure the health of a particular community (even ethnic cleansing has been promoted as a public health issue). Today, religion is often considered antithetical to modern medicine because medicine is based in science and religion...

Setbacks

Being diagnosed with cancer is a ticket to a dangerous, sometimes thrilling, and always precarious roller coaster ride. If you are a cancer survivor, you have almost certainly experienced some of the emotional highs and lows that are characteristic of the cancer experience. With the initial diagnosis there is, of course, shock and fear. As time passes, the fear lessens if there are viable treatment options, and the shock abates. That is not to say that things go back to the way they were before...

Some Definitions

The following definitions are offered as a framework for discussion. I'll define spirituality as those things that relate to one's spirit. Spirituality may be used in a religious or a nonreligious context. Often people who are not religious nevertheless see themselves as spiritual beings and consider nature as a force to connect with their feelings of spirituality. A dictionary definition of spirit is an animating or vital principle held to give life to physical organisms. It can also be...

Spirituality

One morning, about a year after I was diagnosed with breast cancer, I was driving somewhere with my then 12-year-old son, and I asked him, Do you ever get worried about my having had cancer As I looked in the rear view mirror at this half boy half man, he said somewhat nonchalantly, No. I don't really think about it. I was a bit surprised but just chalked it up to the fact that he was a child, still very self-absorbed. We were both quiet for a few minutes and then he spoke again, But I pray for...

Step

Although it is possible and even sometimes necessary to modify your goals as you move forward, the ideal is to begin with goals that are realistic. Michael Jordan can't go back in time and play basketball the same way he once did, but for many cancer survivors it is entirely possible to become once again as active as they were in the past, or even more active. For example, let's say that before you were diagnosed, you ran two miles a day. Perhaps now you aren't able to run...

Table 134 Enhancing Physical Intimacy

Great sex is a whole-body experience or more precisely, a body, mind, and soul experience. Remember that your most important sexual organ is between the ears. Sexiness is at first mental then it goes somewhere else. Both partners need to be aroused to have a good experience. Play to your partner's dominant sense (sight, sound, or touch) to heighten his or her arousal. Make it easier to get an erection by using positions in lovemaking that take advantage of gravity, thus helping blood flow into...

The Older Child

School-age children will be able to understand more about what is happening. Once again, start with basic information about the name of your condition and what you expect to happen now and in the future. Simple diagrams and explanations from books and Web sites can help. Also, review with your children that your cancer is not their fault and that they can't catch it from you. Once you have provided this information, give some details about what is happening in your family. Who is going to take...

Fine Tuning Your Pain Filter

As I mentioned, nearly all cancer survivors have what I call a very sensitive pain filter. What a person might have ignored in the past now becomes a concern is that cancer pain I am feeling Fine-tuning your pain filter and recognizing when to seek medical advice can contribute to your peace of mind. Since most new pain will go away within two weeks, I usually advise people to monitor their pain over this time period and, if it persists, to seek help then. Here's some advice on adjusting your...

Table 104 Common Types of Injections to Treat Nonmalignant Pain

Medication is administered in specific areas of the muscle that are pain generators (for fibromyalgia, muscle pain syndromes, etc.). Medication is injected around, but not into, the tendon (for tendinitis, lateral epicondylitis, etc.). Medication is injected near the nerve but not into the nerve (for reflex sympathetic dystrophy, carpal tunnel syndrome, spinal nerve compression syndromes, etc.). Medication is delivered to the epidural space in the spine (for spinal stenosis and lumbar or...

Cancer Related Fatigue

According to guidelines published by the National Comprehensive Cancer Network, Cancer-related fatigue is a persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning. The International Classification of Disease-10 defines cancer-related fatigue as significant fatigue, diminished energy, or increased need to rest, disproportionate to any recent change in activity level. This type of fatigue is often described as an overwhelming...

The Power of Friendship

Friends can enrich your life and help you to heal. Maybe they can even help you live longer. In a fascinating study of a group of elderly Australians, researchers found that friends, not family, were the most important factor in survival. This research is not conclusive and does not address friendship in cancer survivors, but it is interesting to consider how one's relationships with others might impact health and healing. One thing that is clear is that people with strong social networks have...

Energy Therapies

Reiki is a Japanese word that comes from rei, meaning universal spirit, and ki, meaning life energy. Reiki is an ancient healing method that was revitalized in the 1800s by the Buddhist monk Hichau Mikao Usui. Practitioners believe that the health benefits of Reiki come from a universal life energy that they are able to channel to patients. Reiki masters position their hands in twelve to fifteen different places on the individual's body and hold them in each place for two to five...

The Genesis of This Book

When I finished my cancer treatment, I knew how to heal myself. I didn't start planning to write this book, however, until four days after I returned to work. The idea for After Cancer Treatment formed in my mind when the president of my hospital, Judy Waterston, invited me to attend a lunch in honor of several women, some of whom were cancer survivors, who were receiving awards for their various exceptional accomplishments. Hosted by the Boston radio station Magic 106.7, this annual event is...

Choosing the Right Treatment for

Suzanne Somers, the actress perhaps best known for her role as the stereotypical dumb blond on the sitcom Three's Company, made tabloid news for weeks when she was diagnosed with breast cancer and opted out of some of the treatments that her doctors recommended. She writes of her decision to continue hormonal therapy against her doctors' advice I'm going to continue to take my hormones, I am not going to take chemotherapy, I am going to have six weeks of radiation, and I am not going to take...

The Nccam Classification of CAM Therapies

Examples of CAM therapies in each of the five categories are described in this section (this is not a complete list of CAM therapies by any means). Note that even for CAM treatments that are believed to generally be safe, it is usually not advisable for someone with an unstable psychiatric diagnosis to use them. In addition, as I mentioned earlier, none of these healing methods should take the place of conventional medicine, especially when the underlying diagnosis is cancer. Rather they should...

Table 121 Prayers for Healing

Send me, O God, your healing, so that I may quickly recover from the illness that has come upon me. Sustain my spirit, relieve my pain and restore me to perfect health, happiness and strength. Grant unto my body your healing power so I may continue to be able to bear testimony to your everlasting mercy and love, for you, O Lord, art a faithful and merciful healer. (This nondenominational example was selected by the pastoral care staff at the Mount Zion Medical Center, which is affiliated with...

Back on Track

Over the past hundred years or so, our understanding of how to cure many ailments has dramatically advanced. Now when people go to the doctor, the prescribed treatments usually help without causing further injury. Even surgeries, after a relatively brief recovery period, generally relieve people of pain and other serious problems. Not so with cancer. People with cancer often don't even know they have a potential killer lurking in their bodies. A lump or bump, sometimes not even noticed by the...

Your Mood

Hamilton Jordan, the youngest chief of staff in American history (he served in the Jimmy Carter administration), survived three kinds of cancer before the age of 50. He titled his fascinating memoir No Such Thing as a Bad Day. After living through non-Hodgkin's lymphoma, melanoma, and prostate cancer, Jordan considers himself a lucky man. If you read his memoir, however, you'll find that in fact he had many bad days as he was struggling to cure his cancers and regain his health. Everyone who is...

Table 114 Antidepressant Medications

Selective Serotonin Reuptake Inhibitors (SSRIs) Action Increase serotonin levels in the brain. Drugs Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), Zoloft (sertraline). Notable Side Effects Nausea and stomach upset, agitation, difficulty sleeping, headache, decreased libido, and other sexual dysfunction (problems with erections, etc.). Rarely there are associated suicidal thoughts. Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) Action Increase...

Table 135 Questions about Intimacy and Infertility to Ask Your Doctor

Will cancer treatment leave me with a temporary or permanent loss of sensation If so, what can I expect Will I experience painful intercourse (due to reduced vaginal lubrication or changes in the genital tissue) If so, what can I do about the changes Will I undergo premature menopause If so, how can I treat the symptoms Will I have less feeling in my genitals If so, how will it affect me Will I be left impotent or have difficulty maintaining an erection or ejaculating If so, what can I do about...

Infertility

The ability to conceive a child is an issue with many different types of cancer, may affect both men and women, and can result from both adult and childhood cancers and treatments. Infertility can also be seen as a tragic consequence (a double whammy) of surviving a life-threatening disease. For some people infertility is a source of terrific loss and may bring about intense feelings of sadness, shame, worry, and anger. Just the possibility of future infertility can interfere with...

And Other Medical Systems

Acupuncture is one of the best examples of a nontraditional treatment that has been extensively studied and is now considered a conventional therapy. It is prescribed by medical doctors for a number of conditions and symptoms, including musculoskel-etal pain. Acupuncture has been practiced for several thousand years in China. The general theory is that there are patterns of energy flow (Chi, pronounced chee) within the body that help to maintain good health, and that disruptions in these...

Treatment of Fatigue

In 1796 Thomas Ball submitted a dissertation to the Philadelphia Medical Society on the causes and effects of sleep. Ball (who was about to become a doctor) suggested a number of remedies to produce sedative effects. First on his list was bloodletting (a formerly popular procedure in which a small incision is made in a vein and some blood is removed from the sick person), which he stated should be preferred to all other depleting remedies because we have it more under command than any other. He...

Other Modalities

Modalities are treatments that can be applied to a painful area of the body. Hot and cold packs are modalities that can be used at home. Caution is needed, though, because both heat and cold can cause serious tissue damage if applied for too long or if the temperature is extreme. Hot and cold packs should usually not be directly applied to the skin. Cold packs should not be left on for more than twenty minutes at a time, and there should be a break of at least an hour between treatments. Cold...

New or Exaggerated Behaviors

You need to not only assess your child's mood, but also look for new or exaggerated behaviors. For example, you should be concerned if your child who is usually outgoing becomes withdrawn, or if your child begins to act out at home or at school. If your child is usually neat but begins to become obsessive about keeping his or her room clean, this change could be a warning sign. (The opposite change is just as significant.) If your child usually needs prompting to bathe but now completely...

Table 72 Safe and Unsafe Physical Therapy Techniques

Modalities That Might Not Be Safe for People with Cancer Superficial heat (for example, hot packs) and deep heat (for example, ultrasound) Usually not used directly over a tumor site because of the theoretical concern that increased blood flow may encourage tumor growth. However, this issue is controversial. Massage manipulation percussion soft tissue mobilization Generally avoided in the area of a malignancy. This is another controversial issue there is also the suggestion that massage may be...

Table 111 Symptoms of Grief and Symptoms of Depression

Sleep disturbances, changes in appetite, decreased ability to concentrate, less interest in social activities, alterations in usual behavior patterns (for example, more irritable or angry) Depression Symptoms similar to those of grief but also may feel hopeless, helpless, worthless, and guilty and in some instances may have thoughts of suicide Generally waxes and wanes and the person vacillates between feeling hopeful and sad still able to enjoy activities Constant feelings of intense sadness...

Prayer

Another of my colleagues who works in the field of oncology, Dr. Jerome Groopman (probably best known for his book The Anatomy of Hope), wrote in a journal article about one of his patients who had cancer. She told him, Doctor, I'm frightened. I pray every day. I want you to pray for me. Dr. Groopman didn't know what to say. He explained, None of the training I received in medical school, residency, fellowship, or practice had taught me how to respond to Anna. . . . should I cross the boundary...

Table 101 Potential Problems with Opioid Medications

Serious side effects of opioids can include respiratory depression (slowed breathing), so it's recommended that these medications not be used in conjunction with alcohol, antihistamines, barbiturates, or benzodiazepines. (There are exceptions if you are taking opioids, just be sure to tell your doctor about any other medications you're taking that can be sedating or cause respiratory depression.) Other side effects may include rash or itching, nausea with or without vomiting, constipation,...

Beware the Charlatans Mystics and Quacks

I do not advise people to rely solely on nontraditional practitioners, though I believe that some of them can be very helpful. I do not want to taint legitimate alternative healers, but I want you to be aware of the booming CAM industry and to recognize its long and often sordid history with respect to cancer. In Bathshebas Breast, a fascinating history of breast cancer, James Olson writes about how frightened and vulnerable cancer patients have been exploited Desperation drives cancer patients...

Your Baseline Mood

My mother and father had a deep and abiding love for each other, and when my father died, my mother was truly despondent. I remember one conversation I had with her a few months after his death, when she told me about a TV interview of Dr. Joyce Brothers that she had seen. Dr. Brothers talked about how most of us have an emotional baseline, whether it's generally happy or chronically depressed or somewhere in between. When we suffer a terrible blow, for whatever reason, our emotional status can...

Fighting Fatigue with Food

Fatigue is a common problem in people who are undergoing cancer treatment or have finished with therapy and are in the process of healing. Although a person's diet may be just one factor among the many reasons for fatigue, in some people diet plays a significant role. So, what can you do diet-wise to have more energy and endurance Consider the following suggestions Be sure you are getting enough protein in your diet. Talk to your doctor and your dietitian about your protein needs. It may help...