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Lifestyle

Adoption of positive health behaviors (e.g. diet, exercise, stress, alcohol, nicotine, recreational drugs)

Cancer Survivors Wonder “What or Who Do I Get Angry At”?

Dr. Josie’s Attempt to Look “Angry” – How Did I Do? 😊

Recently, a survivor asked me “who or what to get angry at” when we are diagnosed with cancer? And I think there is a lot encompassed in this fascinating question. It caught me off guard for a minute. I have had a few days to think about it and here is my first attempt. I welcome your views!

Is the question “who/what do we get angry with” the same question as “who/what to blame”? Blame to me refers to causality and responsbility. In general, I think no blame is to be had as there is still a lot unknown about our body, “the black box”. With the exception of some exposures that are known to increase cancer risk (e.g. asbestos, nicotine, HPV), I do not believe that blame can be assigned at current time and age.

But back to the question – “who/what do we get angry with”? To me this question refers to “where do we target our anger at”? The question implies that anger is like a “hot potato” that has to be gotten rid of as soon as possible before we “burn our fingers”. It may be acted out and projected onto targets with whom we feel safe (e.g. our loved ones) or anonymous (e.g. strangers or objects). We may spend a lot of time and energy on suppressing or numbing our anger (with exercise, alcohol etc). Many of these approaches are unhealthy, not safe, or even destructive: they may make us angry that we are angry, perpetuating our anger only more.

But what if we look at anger differently? What if we view anger as a sign that nudges us to pause and reflect on what we are dissatisfied with or what is bothering us? Anger is a normal emotion to have and represents a validated stage of the grieving process, which many cancer survivors may go through as they “try to find the new normal” in the aftermath of cancer diagnosis and therapies. 

It starts by recognizing that you are angry – this acknowledgment itself may already be cathartic, validating, and healing. Sometimes the “working through” your anger is quick and easy – but sometimes it may be more painful and challenging, requiring honest self-reflection and support from our loved ones and perhaps even a professional. All we can do is our best. 

If we think and feel our way through our anger, then our anger may become less intense or even disappear. The freed up energy can instead be redirected to unstuck ourselves and proceed to the 6th grief stage: finding meaning and purpose. Pursuing new adventures and making new memories. You are more than a (permanent) reaction to your cancer diagnosis – it does not need to define you – you can rise above it and transcend it – in your own unique way – at your time and pace. My wish is that you treat yourself the same way as you treat others…..with more compassion, kindness, respect, and forgiveness. 

Cancer and New Years Resolutions

Cancer and New Years Resolutions

New Year’s Resolutions. I am sure many of us are getting ready to make ours, even if just to be ready when we’re asked about them. But for whom are we making these resolutions – for others or ourselves? 

Almost everyone seems to make them. Keeping them is harder. Maybe we put the bar too high or maybe the problem is that we’re creatures of habit. Many resolutions aim to deprive us of something (e.g. food) or do more of something we don’t enjoy (e.g. exercise). If we don’t follow through on them we can feel like failures and lose trust in our ability to accomplish change, often resulting in disillusionment. 

I wonder why we make them. I guess the reasoning behind it may differ from person to person. In general, they give us meaningful goals to work towards and perhaps a deadline to hold us accountable. The anticipation of them gives us hope for a bigger, better, healthier life. This annual inventory-taking may allow us to feel that we’re keeping an eye on the big picture so that we don’t stray too far and become too loose and free. Perhaps the attraction is that they give us a sense of belonging to a group of people who are also working on the common goal of bettering themselves. 

It’s probably clear that I’m not a big proponent of these resolutions, but it’s hard to escape them. Perhaps we can approach them differently this year. After all, even if you decide to be nicer to yourself, then you have made a resolution. Or if you decide to not make resolutions, then you have made a resolution, too. 

There’s a fine line between accepting who you are and trying to improve on yourself. If and when you make your News Year’s resolutions this year, I encourage you to take some time to give yourself credit for how far you’ve come in terms of your emotional well-being, health and functional status, social interactions, spiritual/religious growth, and financial or vocational goals. Taking stock of your progress instead of simply focusing on ways you want to change may allow you to like yourself ‘just the way you are’, as Mr. Rogers would say!  

Samenesses and Differences

Samenesses and Differences

Well, it’s me again! And there is only one me! 

I often answer the phone this way. The patient usually asks, “Who is this”? (Amazingly, none of them have ever hung up on me. I guess they’re intrigued.) 

“It’s Dr. van Londen.” 

“Ah, I thought I recognized your voice.”

“There is only one me.” This is the point when the person on the other side of the line starts chuckling. 

But it’s true, there is only one me – and only one you. We are all unique. Inside and out. That’s fortunate because otherwise we would have a boring world! But we are also very similar in many ways, often to our surprise. Realizing this can be a relief and gives us a sense of belonging. 

I find it fascinating to think about our sameness and differences. When interacting with another person, I try to find the features that make us similar to build a sort of common ground and from there feel comfortable to explore the differences between us. 

We all at one point or another have struggled to balance the desire to fit in, as well as a desire to stand out (and be brave enough to show our differences and uniqueness). Being different requires courage, since it may result in misunderstanding, resistance, or perhaps even rejection and bullying, making you feel like you are swimming upstream. 

The ability to achieve a perfect balance, ideally in sync with those around you, is an illusion. It’s an always moving target. The risk of getting out of sync is higher when only one of you changes their rhythm based on personal (perhaps even life-altering) experiences. 

At some point in our lives, we all have experienced our own unique combination of milestones, such as birth, illness, marriage, death, loss of job, or financial stress. However, the details and subtleties of these events and how each of us experience them are what make us unique. You are special, but not alone. The more you communicate with others who are like you, the more you will realize your strength and uniqueness. All of us together can complement each other and complete the pieces of a puzzle. 

Trying to fit in or stand out may not be sustaining in the long run. Give yourself permission to be you, to float along as the water ebbs and flows, back and forth in a natural, unforced cycle, a particle floating in sync with the universe.

Cancer: Why Me? Why Now?

Cancer: Why Me? Why Now?

Many of my patients understandably wonder and ask, “Why did I get cancer?” I do not necessarily have a medical or scientific answer. I wonder if the question behind the question is, “Why me?” From that question comes others: “Why now? Can it happen again? What can I do to prevent that?” 

There are certain risk factors that predispose one to cancer. These factors (including genetics, environment, and lifestyle) are also associated with poorer outcomes for certain patients. However, there is not always a cause-effect relationship. 

My late mentor taught me a simple way to explain the different levels of cancer risk; it can also be applied to those who carry a cancer diagnosis. On the one end is the general population for whom gender/age appropriate cancer screening guidelines apply. On the other end are those whose families transmit the cancer gene. For this group, we have proactive and comprehensive approaches to try to decrease the risk. Lastly, is the in-between group whose cancer risk is unknown. These are people who have had one cancer diagnosis. This puts them at an undefined higher risk than the general population to get another cancer, but at lower risk than those who harbor the cancer gene. (Unfortunately, data is lacking for those “in-between” individuals, so we resort to general population guidelines). 

Even though we are in the 21st century, nature and our bodies remain a mystery with many unknown variables. Sometimes we just really don’t know why cancer happens to you or why it happens when it does. Questions that probe the why are good, though. Our why questions reflect how we cope with our diagnosis and try to make sense of it. They indicate our curiosity to try to understand the mystery of life. This is healthy as long as we acknowledge that life’s mystery is one that likely won’t be unraveled entirely for another few generations, if ever.

A cancer diagnosis never comes at the right time. (If not now, when?) It can happen to anyone. (If not you, who?) As the current pandemic teaches us, we are not invincible or immortal. Life is not fair. Embrace your curiosity and let it empower you without letting it overwhelm you. 

Be kind to you and others….

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Cancer and Loneliness

Cancer and Loneliness

Currently, our society is engaged in social distancing to minimize Coronavirus’ footprint. Many of us are spending more time at home which can help us to rekindle our connections with our loved ones, but some of us are lonely. Elderly people may not have or know how to use devices that would allow them access to social media, FaceTime and the like. And even if you are able to stay in touch electronically, it’s not the same as having a physical, personal interaction. 

This made me think about cancer survivors (and their caregivers), many of whom may be alone at some point in their journey. This solitude may serve a purpose for many, but there’s a thin line between solitude and loneliness, which reflects a state of suffering and sadness due to lack of company. 

As a cancer survivor or caregiver, you may withdraw into yourself for a number of reasons. For instance, it may help you to process your thoughts and feelings and get ready for the overwhelming new situation that you have on your hands. Another reason could be self preservation; you may not want others to see you at your most vulnerable. Keeping up a facade to protect others from your feelings and thoughts or the severity of your situation may be another reason. Also, it can be distracting to have to navigate the reactions of others around you if you barely have enough reserve to keep yourself going.

However, it takes two to tango! People around you may give you more emotional or physical space than you need. They may want to avoid ‘bothering’ you. They may not know how to be of any help or what to say. They may not want to cause hurt by saying the wrong thing or introducing infectious organisms. But it can also be due to the fact that those not affected don’t want to physically contract cancer or have their perfect life stained by the perceived misery.

The reason for my outlining the different reasons for loneliness is that it may help you to gain insight into the potential drivers behind your behavior, which can prevent misunderstandings and allow you and your loved ones to communicate more openly and respectfully with each other and health care providers, and therefore act with more intent and purpose.

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Focus on the Journey

Focus on the Journey

Recently, I heard a speaker discuss the concept of “horse racing” in context of an academic setting where one’s career progress depends on one’s ability to compete at the national and institutional levels for recognition of one’s worth and legacy (grants, papers). It struck me that the same concept happens to some degree in our society as a whole. We often find ourselves in an exhausting rat race where luck comes into play. We all strive for a delicate balance between fitting into society’s mold and standing out from the crowd. A certain degree of peer pressure is healthy, but no matter how hard we try, success is not a guarantee. Many factors are outside of our control.

A cancer diagnosis may impede one’s ability to perform and compete due to lack of time, energy, or motivation. Plus, cancer survivors may find themselves in an additional race with life that may lessen their sensitivity to judgment and societal pressures. This may have its own anxiety-inducing aspects, initially. At the end of the day though, the race is never completed. Sometimes we change our definition of success. At other times, we realize our goals are unrealistic or that there are bigger and better goals to achieve. Realizing it’s about the journey rather than the destination may provide comfort by allowing you to enjoy the here and now, rather than focusing on the past or future. In some strange way this may allow you to be less restless and conflicted and more able to listen to your inner voice which can guide you to find the peace and courage to serve a unique purpose in this world. Don’t be afraid to ask for support from loved ones or professionals while on this journey. 

Thank you for visiting me. Remember, I share ‘extra treats’ if you follow me on Facebook, Instagram, Twitter, or Pinterest! Plus, you can get notified of a new posting by subscribing to our newsletter!

Learn & Think, Live & Feel:

Breast Cancer Conversations‘ podcast: “Making Sense of What Just Happened“.

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Pulled in Different Directions

Pulled in Different Directions

We all know that time is precious, but my patients tell me — and I experienced myself — that the concept of time changes after a cancer diagnosis. You suddenly wonder how much time you may have left for everything you want to accomplish. Oh boy, there is so much to be and do! Make your legacy. Spend time with loved ones. Maintain your body as healthily as you can. Some of these goals and tasks, whether simple or complex, are in direct conflict with each other which can cause decision fatigue and frustration. How do you decide what’s more important? How do you compare the choices when they are different like apples and oranges?

Do you eat that cookie or a carrot?

Do you go to the gym or sleep a little more?

Do you spend time with loved ones or alone?

Do you stay in your current secure job or do you venture into a job that is more meaningful to you?

Do you work on your career or preserve your free time?

Do you build towards a legacy or make memories with loved ones? Can you find something that would target both?

Do you simplify your life by downsizing your house or keep everything as it is until the end and have others help at that point? 

Do you spend money on a trip to visit your loved ones or a trip to a new destination so you can broaden your horizons and become newly inspired?

Do you have a(nother) child, find a new partner, friend, or pet or spend more time with the loved ones currently in your life? 

There is no magic answer, no way to know that the choice, decision, or path you arrive at will work for you. In fact, the “right” answer may continue to change over time. 

Some choices might be more challenging than others. Desire and fear can coexist; human minds are fascinatingly complex. Your thoughts and feelings can be opposed, perhaps resulting in feeling ambivalent, conflicted or shut down. You might be able to repress one of the opposing thoughts or feelings temporarily, but sooner or later the conflict may come to haunt you again. Conflicts between quantity vs. quality of life and hope vs. reality might become more intense when the stakes are higher, such as for cancer survivors.

It’s possible to work your way through decision-making on your own by reflecting on it in your diary or during a nature walk, but sometimes you may need to talk with loved ones or even a professional. We all have blind spots and others can help us understand why we are conflicted and facilitate a resolution. 

Here are a few pointers to help you with your next fork in the road:

  • Make decisions or plans when you are well rested and well fed.
  • If you have the luxury, sleep a few nights over your decisions to ensure you’ve made a choice you’ll continue to feel good about.
  • Discuss the decision with your loved ones and the persons who will be affected by the decisions you’re about to make. This, along with possibly talking to a professional who can help you gain insight into the motivation behind your thinking, will hopefully provide clarity.
  • Sometimes it can be helpful to break a decision down into smaller steps and decisions.

Nature has a way of working things out on its own. A constellation of circumstances like humidity, temperature, and wind create a unique snowflake that can travel for miles carried by the wind, being pulled in seemingly random directions, until it reaches its destination and falls into place with many other snowflakes creating a beautiful white blanket that provides shelter from the harsh weather for animals and protects plants and roots until the warmer weather causes each snowflake to turn into water again, continuing the circle of life.

Thank you for visiting me. Below I’ve included a few things to educate and entertain you. Remember, I share ‘extra treats’ if you follow me on Facebook, Instagram, Twitter, or Pinterest! Plus, you can get notified of a new posting by subscribing to our newsletter!

Learn and Think:

Live and Feel:

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Magic Wand

Magic Wand

Once upon a time, I wished there were a magic wand that would:

Take all the pressures, stress, and worries away and allow me to be in peace. 

Fix it all.

Make me feel invincible again. 

Remove the dark cloud hanging over me, push away the fear of recurrence that was always in the back of my mind. 

Prevent me from needing to see so many health care providers and do so many tests.

Make the simple things easy again, such as using my body to get around in life. 

Allow me to be comfortable with my own body.

Enable me to keep up with work, family, friends. 

Prevent me from asking, ”How do you know?” when people tell me that all will be fine and “Do I have a choice?” when people tell me to hang in there. 

Make my medical bills disappear. 

Remind me to go through life walking like a tortoise, with occasional little sprints like a hare. 

Reduce my use of the words “I should” and make me less hard on myself. 

Teach me to accept not having made the healing progress I was told to expect, rather than fighting it. 

Help me grieve for my old me and find the new me.

Make me feel I belong and am accepted for who I am as a person, rather than for what I do professionally or what I cannot do emotionally and physically. 

Even though there is no magic wand, I believe humans have magic powers. Over time, sometimes with the help from loved ones or professionals, we can find our “happily ever after”. It may not be in ways we imagined, but it may be more happiness than we would have found without having gone through cancer. It often takes hardship to be humble and appreciate the good. 

Thank you for visiting me. Below I’ve included a few things to educate and entertain you. Remember, I share ‘extra treats’ if you follow me on Facebook, Instagram, Twitter, or Pinterest! Plus, you can get notified of a new posting by subscribing to our newsletter!

Learn and Think:

  • Colon cancer screening guidelines have been updated to reflect the new advised starting age of 45. Katie Couric has televised one of her prior colonoscopies and provides logistical and practical guidance on this site. 
  • Middle-class Americans getting crushed by rising health insurance costs is a sad reality. If you find yourself in financial difficulties, there is no easy solution, but please let your healthcare providers know so they can connect you with local resources for support. At the national level, the American Cancer Society provides some very practical and concrete solutions. 

Live and Feel:

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Cancer Fight – Supplements, Time

Cancer Fight – Supplements, Time

Dear Fellow Traveler,

It seems like I’m always seeing and hearing people describe cancer patients as being in a fight with cancer. The word “fight” makes sense in many ways, but at the same time it makes me cringe a little because the word can mean many different things depending on one’s cancer status and where a survivor is in their healing journey. 

Dealing with cancer might be the major fight of and for our lives using a heavy arsenal of artillery like chemotherapy, radiation, and surgery. However, using the word “fight” suggests that cancer and we are equal partners and that we have a fair chance to win. With our current medical knowledge, we do not always have that chance. Thinking of cancer as a fight may make cancer patients feel like they have failed their loved ones (who are often unrelenting cheerleaders!) and themselves when cancer starts to “win”. This may give a person in the final stages of their life a heavy burden to carry – shame, embarrassment, and guilt — as if they could and should have tried harder to fight it. It is important to remember that the fight with cancer is not fair. The knowledge and therapies available to us in the 21st century do not yet guarantee that we can outsmart cancer. And yes, lifestyle may play a role too – but we have to note that there are so many other, often unknown, factors in our body, the black box, that affect cancer outcomes. 

Cancer is our enemy, since it can literally attack and break our bodies down resulting in suffering and death. The emotional rollercoaster it sets us on may result in anger, sadness, and frustration. But over time, perhaps with help from others (including professionals) we may be able to see the silver lining of a cancer diagnosis. It confronts us with the fragility of life and teaches us empathy, humility, and the value of time and love (which can, at times, seem rather abstract). In the end, we all try to make sense of our lives, the good and the bad, by telling our life stories in a way that makes sense to us, comforts us and allows us to be at peace. 

Cancer therapies can result in battle scars. Emotional scars, in the most extreme form, can be similar to the PTSD (post traumatic stress disorder) that soldiers have when they return from war. Physical scars — from surgery, radiation, procedures, port placements, etc. — serve as a constant reminder of your illness when you look in the mirror or when other people ask about them. That may be more than you or your loved ones can handle. Healing may require a little bit of work to allow you to accept that cancer is a part of your life story and new identity, but nothing more than that. Even though cancer can be all-consuming, you are defined by more than your disease. Recognizing this may allow you to remain graceful, resilient and adaptive when others comment on your scars. You may openly explain to them that you are not ready to delve into that topic yet or are not ready to deal with their emotions. Alternatively, you may have a ready-to-go, light reply that strikes a balance between humor and respect (“Oh! Those are my battle scars!”) that allows you to kindly dismiss and change the topic. Most people will get the hint. 

When a person deals with cancer, depending on where they are in their healing journey, describing them as fighting cancer can be a seemingly innocent, yet charged label, that may give them the feeling of being a loser or a failure.  Remember, the fight isn’t always fair. I believe every person is brave and deserves a Medal of Honor! 

Thank you for visiting me. Below I’ve included a few things to educate and entertain you. Remember, I share ‘extra treats’ if you follow me on Facebook, Instagram, Twitter, or Pinterest! Plus, you can get notified of a new posting by subscribing to our newsletter!

Learn and Think:

Live and Feel:

Please help by nudging us if you encounter technical problems.

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