Cancer

It’s About Time!

It’s About Time!

The concept of time is interesting. It doesn’t always seem to be aligned well with what we need or want to do. Sometimes we have too much time and sometimes too little. Sometimes it goes too slow, and sometimes too fast. Oftentimes we wish our time away because we eagerly anticipate the weekend or a certain event. This can make time feel like it has slowed down. Then we find that when the anticipated event happens, time flies by seemingly at warp speed! Days and weeks may feel like they pass slowly, while years pass quickly. At times, we feel we waste half our lives standing in line.

I think we all have a conflicted relationship with time. There is never enough time in life. But whether we are in a period that we enjoy or one we wish would pass, all of these times are part of our finite life. I wonder if our conflict may be helped by an evenly-suspended attention span, to be able to observe ourselves and our surroundings at every moment in time in a neutral perspective without any expectation or judgment. If we could master not being constantly engaged or disengaged, but to be evenly submerged throughout all our activities every day. By not giving preconceived importance or priority to any part of our days or lives, we could allow ourselves the freedom to find meaningful opportunities even in the rougher times. Some may compare this to mindfulness meditation activities, but these activities are short-lived, while an even attention span is one to be applied throughout the whole day. Some infinities are longer than others. 

We tend to say that time flies when you’re having fun, but then a patient reminded me that time also flies fast when you’re not having fun! Not feeling well due to cancer and its treatments can make you retreat into a cocoon and lose track of time, while the world (hopefully only temporarily) continues to evolve around and without you, almost rendering the illusion that you are standing still. In short, cancer survivors have a complicated relationship with time. Being aware of that may perhaps help you remain kind to yourself, set (realistic and do-able) priorities, ask for and accept help, and make choices (and memories, hopes, and wishes) that fit best with where you are in your journey. 

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: Quarantine

Cancer: Quarantine

We all desire a magical touch, a mysterious click, or a chemistry connection. However you may choose to label these experiences, they make us feel like we matter, are understood, and have a place in this world. To be touched is important for everyone, but in particular for those of us who cannot actively keep up with the world due to health issues such as those connected to cancer and its treatments. We sometimes feel pushed to the outskirts and demarginalized, wondering how we can reclaim our spot in the race (perhaps with a bit of a  recalibration to allow us to keep up)! 

You may be excluded socially because of illness when you have:

  • Impaired ability to sit, stand and/or walk around: This may hamper your ability to go to events that lack (comfortable) chairs, accessible entries or parking, or require you to walk long distances. Having to plan ahead to assure accessibility hinders spontaneous plans and can exhaust you before the event has even started. 
  • Impaired immune system: This can cause you to avoid large crowds and may make you feel vulnerable when you roam around in your local community, dampening your ability to enjoy yourself because you are always on the lookout for those who have obvious signs or symptoms of infection. 
  • Unpredictable bowel and bladder pattern: This requires you to adapt your intake of food and drink to minimize your risk of needing to urgently find a restroom. It can also draw uncomfortable attention to you when you need to use a non-hygienic bathroom. 
  • Fatigue: When you experience fatigue regularly, you need to preserve your energy for your work and family which makes it less appealing to leave the comfort of your home for a recreational or social event. 

This is what I like about quarantine — everyone is limited in their freedom to go about their lives. It makes me feel like I am not an outcast anymore. Now, we are all being accommodated and I am not any different. Everything in my professional and personal life is accessible virtually. I hope it will stay like this when the pandemic subsides so that something good will come out of this stressful time in our history and so that those who are forced to stay at a physical distance can still stay in touch socially. 

I have been able to take part in concerts, book clubs, meetings (locally, nationally, and internationally), which I wouldn’t have been able to do if we weren’t quarantined. It made me feel included. I did not feel like I had a target on me, drawing attention to myself with my inability to keep up. There’s been no need for me to awkwardly explain (or justify) myself or avoid invitations or opportunities altogether. Being able to keep up with those around me is very good for my mental health and leads to reduced physical strain.

I hope that when we come out of quarantine people will continue to think about how to make life virtually accessible for those of us with impairments. Of course, there are many benefits to an in-person meeting that can never be replaced by the cyber world, but as long as we find a happy medium and do not overshoot the pendulum from one extreme to the other, then we all at least have a choice between attending in person versus virtually. I hope that the last few months have empowered you to find a comfortable way to gently remind your healthy loved ones to continue to include you once life swings back towards the direction of  “normal”. 

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Cancer: Touch

Cancer: Touch

Humans crave touch, which can mean different things to different people…

Someone may desire to be touched physically in a manner that reflects passion, desire, love, or care, releasing hormones that promote trust and bonding. The physical touch can be delivered by a loved one, a random person (when standing close to each other in the elevator, for example), or even an animal. A lack of physical touch may result in touch starvation or skin hunger. 

Emotional touch is when a living creature, whether an animal or another human being, is able to connect with your thoughts, feelings, intellect, mind, or soul in a way that makes you feel valued, appreciated, and respected. This can take the form of a meaningful look exchanged in line at the grocery store, a random conversation with a stranger in a coffee shop. Moments like this may make you feel like you have known this person for years while you have just met for the first time. These brief moments cannot always be acted upon and may just remain random memories that you hold onto as a trail of lights illuminating your path through life, but sometimes, when the time or place is right, they may lead you to expand your social circle by finding more like-minded people with whom you share priorities and values. 

Cancer survivors may have a conflicting relationship with touch. They may desire more touch to help soothe and comfort themselves, but may be concerned to be a burden to loved ones. Survivors may be apprehensive given contamination risk from infections (please ask your provider for advice). Physical touch may also release negative emotions or repressed memories that have kept one from progressing in their healing.  Touch can be physically painful depending on the nature and lingering effects of cancer treatments.

The point I’m trying to make is that cancer survivors are still human, although our preferences for touch may have changed. Please be kind to yourself and openly communicate with loved ones to ensure that your needs, wants, and boundaries are being respected. Let them know how you’d love to stay in touch!

And now…..drum roll…..! I am very excited to be able to announce today’s launch of our Facebook group for post-treatment cancer survivors, who have completed their active therapy phase (i.e.. surgery, radiation, chemotherapy). For now, we will only focus on this specific group, but please note that there are other Facebook groups for those living with cancer and/or undergoing active therapies. My hope is that this Facebook group will provide a sense of community, validation, empowerment, and a safe place for healing. We are stronger together! Please let others know about this resource. This group does not offer medical advice (see Facebook group rules and disclaimers on https://cancersurvivormd.org/disclaimers/).

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Cancer: Legacy

Cancer: Legacy


 When a disease confronts you with your mortality, you may start to wonder about your legacy — how you would like to be remembered when you have passed on. Everyone’s hopes and expectations about legacy differ. We all write our own unique life stories, like chapters in our book of life. Cancer may influence the direction of the story, but it cannot control our narrative. 

We all strive to leave behind a footprint when we are gone. The question is how. People have different ideals for their legacy. On one end of the spectrum, some people may prefer to focus all their time/energy/love on a select few people, while others may choose to invest in an activity that would leave a larger footprint in the world. 

Everyone is different and preferences, hopes, and ideals may change. There is nothing wrong with that, as long as you are aware of what drove that change. A healthy self awareness is good for life in general. I found the movie The Fault is in Our Stars, which shows two teenage cancer patients exploring their own perspectives on legacy, to be a great example of this concept. 

We leave a legacy in one way or another by just going about our lives. It’s hard not to. However, all we can do is shape our legacy, realizing that how we made people feel will be remembered more distinctly than our actions. We all touch other people, make an impression on them and impact their lives in a manner that we may not even be aware of. This is the so-called ripple effect which allows us to continue to live on indefinitely. 

It’s important to strive for connection, purpose, and meaning in life. Building towards your idea of a legacy will foster this pursuit and may allow distraction, healing, and channeling of your inner energy into an external target that helps both you and others. But more than that, it may allow you to get a sense of calm and peace, knowing you are working towards building a legacy that fits with who you are and where you stand in life.

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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 – Embracing Our Emotions

Cancer – Embracing Our Emotions

Many of you may feel like being in the midst of this pandemic has you stuck between a rock and a hard place. What’s worse — delaying cancer testing/treatment or risking Coronavirus exposure? Having to choose between two evils, you must try to anticipate and minimize your risk. 

Medically speaking, this is unknown territory, so I strongly recommend that all of you make decisions about your personalized cancer care with your medical oncologist. Here is a resource that may help to facilitate your communications. 

There is a reason we have a spectrum of emotions that can range from fear, sadness, anger, and sorrow to happiness and joy. There is no need to put up a facade and deny any of these feelings. Doing so may make things worse and make us feel fragmented. Allowing all these feelings to coexist and being in touch with them will facilitate integration, healing and inner peace. I had previously outlined a few examples of mature coping styles, but only you know what will soothe you most. If emotions are causing you or your loved ones debilitating pain or dysfunction, please reach out for help! 

I think the trick is not trying to keep the joys and the tragedies apart but you kinda gotta let them cozy up to one another, you know, let ’em coexist. And I think if you can do that, if you can manage to forge ahead with all that joy and heartache mixed up together inside of ya — never knowing which one is going to get the upper hand — well life does have a way of shaking out to be more beautiful than tragic.

Dr. Nathan Katowski (by Gerald McRaney) in This Is Us.

When you are aware of all your feelings, you can choose how to approach and act on them.  Embracing fear without letting it paralyze you, but allowing its energy to cautiously propel you forward can help you to express the best version of who you can be so you can love and honor yourself and the world. The hope is that a new (and better) normal will be born out of the Coronavirus tragedy — at global, national, local, and personal levels! 

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Cancer and Coronavirus Disease 2019 (COVID-19)

Cancer and Coronavirus Disease 2019 (COVID-19)

How are you? Really…?! It has been a brutal week for many. For me too, as a loved one, friend, and provider, but also as a patient, as my surveillance testing has been delayed by a few months.

Like you, I find myself homebound, trying to find a new normal for the time being.

I thought I would write a quick post for not only cancer survivors, but those who find themselves in the midst of the Coronavirus Pandemic.

  • General Coping Strategies:
    • Be kind to yourself and others. There is not one normal emotional reaction to a global (and terrifying) crisis like this. It affects all of us differently. If you have been traumatized before then these same thoughts/feelings can be easily triggered by other overwhelming experiences like this epidemic. And for some of you, your treatment regimens may be changed around. Please know that organizations and institutions do not make these decisions lightly. They look at each situation on a case-by-base basis and strive to minimize the impact on the patient’s health outcomes. Being stuck in this state of uncertainty between two life-threatening choices, a rock and a hard place, is an impossible place to be for anyone. Please remind yourself that we are all unique. Allow yourself time to transition, to become aware and experience your feelings on your own and/or by talking with others. If you feel the walls are closing in on you while you are quarantined — no pun intended — or if you are experiencing financial stress, please rise above your feelings of shame or guilt, and reach out for support! 
    • Educate yourself by following reputable resources that are updated frequently to respond to this rapidly-evolving series of events, such as the ones listed above. Information can be comforting and empowering. Following the recommended preventive measures may give us a sense of control and togetherness. However, don’t let information consume you. Too much information may result in anxiety and panic. 
    • Keeping a physical distance does not have to result in social isolation! However, nothing can replace the in-person experience of a major event (such as a wedding, funeral, or even a moment the passing of a loved one). This can be heartbreaking and soul-crunching. These once-in-a-lifetime moments have been taken away by a force de majeur. No one can control this. You will never forget the pain of not being able to be there, but hopefully the passing of time will allow the sting to become less intense. Modern communication tools, including a landline, are there to allow us to safely connect with others and to creatively still be able to commemorate a special event. 
    • Distract yourself from your negative thoughts with everything from necessities (such as chores) to fun activities, in solitude or with others. Perhaps now is the time to connect with a person you have been meaning to call for a long time or to pick up a hobby that your life ordinarily has no space for. Even try doing absolutely nothing. (It’s hard to do. I challenge you!) The silver lining of this terrible time for our world might be that you have the opportunity to pursue new experiences that you may want to continue even after the pandemic has dissipated. 

I wish you all the strength you need to endure the following few weeks to months. Be kind to yourself and others….together we stand strong! 

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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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Cancer and Intimacy

Cancer and Intimacy

Sexuality plays an important role in society, facilitates reproduction, and helps us to feel connected to our partner as well as to ourselves. When you are told that you have cancer, it can affect the desire of either or both partners. For some people, desire decreases (as they are distracted and not in the mood), while for others physical intimacy may sooth or provide welcome distraction.

Cancer therapies can affect sexuality in many ways. Qualitatively, your routine sexual act may need to be adapted due to anatomical changes (e.g. pelvic or breast surgeries) or functional changes (e.g. erectile dysfunction, vaginal dryness or scarring). Quantitatively, the frequency and duration of sexual acts may change, usually lessening. Reasons for the latter can be due to the experience of pain, discomfort, shame, or guilt, but also because one’s desire may be decreased when going through premature menopause/andropause, anxiety, or depression.

Oftentimes, I see couples, whether in brand-new or long-lasting relationships, in which I sense that both partners are longing for a connection but are not communicating about this out of concern for disrespecting or hurting the other. Finding a safe environment for this communication may help healing to begin. Also, it may encourage a cancer survivor to feel confident enough to talk with a health care provider to find if there is anything that can be done to improve matters.

There are medications and devices that can improve, if not resolve, anatomic/functional deficits. (As a gentle reminder, hormone replacement therapy is not an option for those who are survivors of tumors that are fueled by hormones.) Talk- and/or pill-therapy can emotionally support partners.

However, at the end of the day some things may not be fully restored to the pre-diagnostic state. Some emotional and physical scarring may be permanent. In these situations, partners may have to work harder and be more creative in finding ways to connect with each other in ways that are enjoyable, pleasurable, and satisfying for both. In addition to intimacy, identity and security can also be altered by cancer. Therefore, even couples who have been together for a long time may need to reset and rekindle their relationships. Keep in mind that sexuality is one form of physical intimacy. You may want to explore other forms of physical intimacy, such as sensuality and eroticism.

There are many other ways of being intimate that can enhance or compensate for the impaired ability to connect physically. Examples of these alternative forms of intimacy are emotional (connecting with someone else in spoken or unspoken ways that express your love), intellectual (participating in communication about a topic that both parties are passionate about), and experiential (sharing activities and making memories together).

Enjoy connecting!

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Learn & Think, Live & Feel:

My family decided to go all in. For years we have held ourselves back due to various issues including active or anticipated medical issues. Recently, we decided to get some more love in our house. A month ago, we expanded our family to include our beloved cat, Melky. In another month, we will be expanding again with a dog, Cookie. We are fully aware that having a pet may bring more responsibilities, worries, and expenses, so we have backup plans in place, but we do not want to miss out anymore on the therapeutic joy pets can bring. Stay tuned for our adventures!

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