Expert response: Healthy control now and later

In a recent post, "Tales of a cancer control freak," Marci McNaghten shared how her cancer diagnosis as a teenager led to extreme efforts to control her environment, her weight and her life - all while undergoing chemotherapy. Thank you Marci for your honest and moving account of a very challenging, frightening time. What Marci described is not unusual.

A diagnosis of cancer, especially when there seems to be no clear cause for the disease, can make you feel that you have no control in life at all. Concerns about what is happening to you, how your family will cope, how you will handle side effects of treatment and whether you will survive can be overwhelming. And as I noted in an earlier blog entry, "Combating end-of-treatment stress," ending treatment is unfortunately not the end of the challenge of cancer. Indeed, as Marci notes, while there may be initial relief that treatment is over, previously unacknowledged fearful feelings and anxiety may erupt at unexpected times.

In addition to the surgery, chemotherapy, radiation and other treatments, it is helpful to take proactive steps to lessen and/or prepare for the potential emotional consequences of cancer:

• Find a health care provider who is knowledgeable about cancer and is someone you feel you can easily talk to about treatment and other concerns (e.g., anxiety, depression, sexuality, family issues, etc.)
• Learn as much as you can about your cancer and the available treatments for it. Talk to experts, go online, read books. But make sure you seek information from reputable sources! See "4 pitfalls to avoid when researching on the internet."
• Ask lots of questions – especially when you don’t understand what your doctor or nurse is trying to explain to you. Take a friend or loved one with you to appointments.
• Look for psychological support, as Marci did. Experts such as psychiatrists, psychologists and social workers can meet with you one-on-one. And, for some people, support groups facilitated by a trained leader can be valuable.
• Reduce stress whenever and however you can. There are many ways to do this -- whether it’s through eating better, exercising more, journaling, intimacy with a partner, learning to meditate or taking up yoga. Just breathing deeply and focusing on this moment is calming.
• Take advantage of the survivorship services Providence Regional Cancer System offers: New Patient Orientations, Living with and Beyond Cancer Evenings, Cancer Transitions Program, Integrative Care services, Cancer Survivor Celebration Day (June 4), support groups, social worker services, etc.
• Know that you are not alone on this journey.

Tales of a cancer control freak

After my cancer diagnosis as a teenager, I became a control freak. My once sloppy room was always neat, and I began to obsessively count calories. (I lost 20 pounds the first month of treatment and was determined to keep the weight off.) One year later, after working hard to get all A’s my first semester of high school, I decided I needed to get through the next 3 ½ years with a 4.0 grade point average.

By my sophomore year, I was constantly stressed – trying to keep my grades up, my weight down and my room spotless (not to mention undergoing chemotherapy at the same time). But I didn’t understand why I was heaping all this pressure on myself. A concerned guidance counselor pointed it out. She thought I was trying to control whatever I could in my life because I couldn’t control my cancer.

Her words made sense, but it wasn’t until I finished chemotherapy (spring of my Junior year) that I started to let myself relax a little. During my three years of treatment, I had felt like there was a tightly wound cord inside of me. Whenever I got upset, an imaginary person cranked the cord tighter and tighter until I could barely breathe. When treatment ended, the cord unwound just enough to let me take a deep breath and begin letting go of my need for control.

I graduated from high school and went to college, which I got through with my sanity mostly intact. After college I moved to New York City for my first job. It was there that stress crept back into my life – not surprising in a city where Type A personalities thrive. I loved the energy of the city, but it was a place that required constant alertness. Being on my own and supporting myself for the first time also added to my stress. To deal with the growing pressures I was feeling, I did what many anxiety-challenged New Yorkers do, I went to a psychiatrist.

Trekking across town via subway, then bus, to get to my weekly sessions was a little daunting, but seeing a psychiatrist was the best thing I could have done for myself. It helped me deal with my immediate stress, and – over the course of two years – uncovered feelings and fears about my disease that I’d never acknowledged, let alone talked about with anyone. I was finally confronting my cancer head-on and understanding the impact it had (and was still having) on me. Allowing myself to do this – especially with the help of a professionally trained specialist like my psychiatrist – was the first big step in regaining a healthier relationship with control as well as other aspects of my life.

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Have you considered acupuncture?

You’ve seen it in the news, you’ve seen it on television, you may even know someone who knows someone who’s done it. What is it? Acupuncture.

And while it’s still relatively new in the U.S. (only about 200 years) it’s been used for thousands of years as part of Traditional Chinese Medicine (TCM).

So why should you try it?
I have personally treated patients diagnosed with cancer for:

• Nausea and vomiting
• Aches and pains
• Anxiety
• I have also been able to use acupuncture to help the newly diagnosed with insomnia and other sleep disorders.

But what really happens? Doesn’t it hurt?
Acupuncture is based on the idea that energy (qi) flows in channels (formally called meridians) through our bodies. TCM believes that qi, made up of two forces, yin and yang, can affect your spiritual, emotional, mental and physical condition “Yin and yang are opposite forces that work together to form a whole. The forces of yin and yang depend on each other and are made from each other in an unending cycle, such as hot and cold, day and night, and health and disease. Nothing is ever all yin or all yang, both exist in all things, including people. Many of the major organs of the body are believed to be yin-yang pairs that must be in balance to be healthy. When a person's yin and yang are not in balance, qi can become blocked. Blocked qi causes pain, illness, or other health problems.” Source.

Acupuncture needles are inserted at specific regions to access the qi. The biggest misconception is that an acupuncture needle is a normal needle … it’s not. The needles are about the size of a strand of hair, so small that instead of actually piercing the skin they just push apart the skin cells. Many of my patients report a soothing sensation as the treatment unfolds.

Does acupuncture really work?
In 1976 the FDA approved the acupuncture needle as a medical device. It’s important to note that acupuncture is meant to supplement your cancer treatment, not replace it. The best medicine is the type that’s going to work for you and, hopefully, improve your quality of life. Many people shy away from acupuncture because of the association of pain with needles. If you are suffering from any of the symptoms mentioned in this article I encourage you to give acupuncture a chance. For more information visit the Providence Integrative Cancer Care Website.

You might also like:

• Integrative care basics and what others are saying
• National Cancer Institute, Acupuncture
• American Cancer Society, Acupuncture

Combating end-of-treatment stress

Editor's Note: We will continue with Part 3 of the clinical trial series tomorrow.

Greetings from Austin, Texas - - Home of the Longhorns! I hope someone is knitting some horn mittens for the Lone Star cows: It is “19 degrees but feels like 10.” Given the horrific weather and travel hazards in most parts of the country, I am grateful to have arrived safely. The chill was only fleeting, for I am surrounded by hundreds of colleagues from across the United States who share my passion for cancer survivorship advocacy. (I am also hoping some authentic Tex-Mex chow will be warming.)

Austin is home to the LIVESTRONG, Lance Armstrong Foundation headquarters and I am here for a conference on the “Cancer Transitions™: Moving Beyond Treatment” grant awarded to Providence Regional Cancer System (thanks to the thousands of votes we received in the online challenge – thank you!). Conference attendees are also invited to the first ever LIVESTRONG “State of the Foundation."

When patients end treatment, they often report feeling lost, abandoned, and unsure of what to feel and do next. End-of-treatment stress is often unexpected because patients anticipate feeling relief when active treatment ends and hoping they can “get back to their lives.” The transition from cancer patient to cancer survivor can be very challenging.

Here's what LIVESTRONG says about Cancer Transitions™

Cancer Transitions™ is a program designed to support, educate and empower people with cancer in the transitional period after treatment is over. This program features written materials as well as interactive components to address the long-term effects of cancer treatment, as well as survivors' psychosocial needs during their transition to life after treatment. The evidence-based program was created with recognized experts in key aspects of cancer survivorship, incorporating information from peer-reviewed literature. Research shows that both men and women who participate can experience:

• Less worry about the negative impacts of cancer
• Better physical and social functioning
• More commitment to physical activity
• Improvements in fat-related dietary habits.

The six-week series incorporates support groups, education, nutrition and physical exercise, as well as addressing other medical management, psychosocial and quality of life issues. The program also provides survivors with practical tools and resources to formulate a personal action plan for survivorship beyond their participation in Cancer Transitions.

Up to 20 participants meet for a 2 1/2 hour session each week to hear presentations from experts, engage in group discussion, and directly address the emotional and social hurdles they face during the transition period following treatment. The program also offers a “booster” session held one month after the program ends, to reinforce many of the proactive behavioral changes discussed during the core program. Men and women who wish to better manage the short and long-term impacts of cancer— especially within the first 24 months after treatment will gain valuable skills through this program. Providence Regional Cancer System plans on offering the Cancer Transitions™ series twice in 2011, spring and fall sessions. There is no cost to participate in this program! Dates and other details will be coming in the next few weeks.

The last (and only other time) I was in Texas was in 1985 at a Houston conference when I was a graduate student. I presented a paper on how hypnosis and other relaxation methods could help chemotherapy patients who were experiencing nausea. No one was talking about Cancer Survivorship. We were just starting to pay attention to how we could better help patients deal with treatment side effects. The National Coalition for Cancer Survivorship (NCCS), National Breast Cancer Coalition, LIVESTRONG, Lance Armstrong Foundation and other organizations did not exist yet. I know we have a long way to go, but tremendous gains have been made in the past 25 years.

I feel privileged to be witnessing the evolution of truly comprehensive care for cancer patients and their families from diagnosis through treatment and beyond. And I feel especially privileged to work with the Providence Regional Cancer System as we grow our survivorship services: Cancer Survivor Blog, New Patient Orientations, Living with and Beyond Cancer evenings, Harmony & Hope event, Integrative Care Services, support groups, an inaugural Survivorship Day in June (details coming in the spring!), and now the Cancer Transitions Program! I look forward to sharing more details about this new program in the next few days from Austin and am happy to answer any questions you post.

What happens in a yoga class for cancer survivors?

Chances are you have seen a yoga class, whether it be on television, in a photograph, or even walking past a studio. But at Wild Grace Arts a yoga class for anyone living with cancer, survivors and caregivers is just a little bit different.

First, we sit in a circle. I’ve found that this arrangement creates a unification throughout the class and encourages the feeling of belonging and community cohesion. While traditional yoga classes begin with silence and self-reflection we take the time to chat and check-in with each other. It’s this time when students can talk about how they are doing, what treatments they’re currently undergoing, what fears they may have, really anything on their mind. We also use this time to provide feedback. Maybe a fellow student has already been through the same treatment or feels exactly the same way. In this manner my yoga class is very much like a support group setting. Over the years I am continually reminded how therapeutic it is to be able to tell your story to a sensitive listener.

Of course, we practice yoga too! And again, don’t worry if you have never done yoga before. We are very skilled at adapting yoga poses to meet the needs of any health or fitness level. This class is gentle, designed to release stress and optimize immune system function.

We also work to improve our relationship with our bodies. It’s about expressing gratitude to the body that we have in the present moment. Self observation without judgment is an important part of our practice. In a yoga class for cancer survivors (remember, survivorship begins the day you are diagnosed) we don’t dwell on who you were before your diagnosis. Instead we move forward and think about who you are now.

If you are interested in joining the group I would invite you to come and check it out. The first class is free. We meet every Tuesday from 10:00 – 11:30 a.m. at Wild Grace Arts located at 507 Cherry St. SE in downtown Olympia. An 8 class card costs $80.00. Family, supporting friends and caregivers are also invited to participate. Give yourself the gift of a therapeutic yoga class. You deserve it! I look forward to meeting you on the mat.

Editor's Note: Yoga Loft located at 219 Legion Way SE, Suite 202, is also part of the Providence Integrative Cancer Care Program. Taught by Maureen Oar, RYT, classes are every Thursday from 5:30-7:30 p.m. You can register for either class by calling 360.412.8951.

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• What is yoga and how can it help me?
• Integrative care basics and what others are saying
• Therapeutic yoga: Support for the cancer journey