Mental Toughness

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When my patients would enter the hospital to receive chemotherapy or a bone marrow transplant, I always saw them as having courage and mental toughness. However, I never questioned them as to how they got it.

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It’s not easy maintaining a positive mental attitude when going through cancer treatment. I didn’t always have one, that’s for sure. Fear, anxiety, and panic would sometimes spiral my mind into a dark place. Deep breathing, saying prayers, and feeling the support from others helped. And, I would tell myself, “This is what I need to do right now,” (get chemo or a scan or whatever it was) but this is not how my life is going to be forever. It helped when I could look at the big picture instead of my current circumstances. I had to hurdle the obstacles on my path which developed a stronger mental toughness.

“I learned that courage is not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.” Nelson Mandela

Support from Caregivers

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Caregivers play a huge role in helping someone through the cancer experience. Working as an oncology nurse, I would see family members (or spouses) at the hospital next to their loved ones for hours and days on end. I would see their tired eyes as they had to juggle work and things at home, while still focusing on their number one priority which was being a support for their loved one with cancer. I have a deep respect and gratitude for family caregivers!

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It was a huge adjustment for me to have to depend on people for help. I was used to being independent and managing my own life, until cancer. Then I needed help in so many ways. Allowing others to care for my needs when I couldn’t was a lesson in humility. At first, it felt uncomfortable. Then, I got to the point where I accepted their assistance and support with appreciation. My heart swells with gratitude for my caregivers.

Nausea

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Certain types of chemotherapy drugs are more emetogenic (causing nausea and vomiting) than others. Oncology healthcare professionals are the best resource in giving a patient their treatment plan and educating them about what to expect.

Independent risk factors associated with chemotherapy-induced nausea and vomiting are: female gender, patient younger than 50, history of light alcohol use, history of motion sickness, and anxiety. Gonella, S., and DiGiulio, P. (August, 2015). Delayed Chemotherapy-Induced Nausea and Vomiting in the Hematology Population: A Review of Literature. Clinical Journal of Oncology Nursing, 19 (4) 438-443.

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The nausea monster! Yuck. It’s one of the worst feelings in the world. The chemo regimen I received called CHOP-R is moderately emetogenic. I remember taking so many medications for nausea. Some helped, some did not. I needed to try and sort through what worked best for me and what didn’t. Alternative therapies can be used to help alleviate nausea. Guided imagery, meditation, acupuncture, herbal supplements, and more are sometimes used in conjunction with medications. Always ask the healthcare providers for their expert recommendations.

(This blog was updated on October 29th, 2015)

Patience for Patients

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I remember telling patients when I worked on the bone marrow transplant unit, It takes time and patience to heal. Since your immune system has been destroyed by chemotherapy and radiation, it takes time to get your new bone marrow to grow again. It’s like a garden, we’ve pulled out the bad weeds, planted seeds, and now we have to water it, care for it, and give it time to grow.”


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It feels like it’s so easy to destroy things but it takes so long to replant and get the flowers to bloom. It takes water, fertilizer, light, the right soil and, of course, time. For me going through cancer treatment felt like it took forever. In reality it was seven months, but if felt like six years! As I look back on that time it was hard and painful, but really there were good things going on-growth spurts-which have prepared me for where I’m at today. Patience produces strength, endurance, character and inner beauty.


Follow-up Care

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In the hospital, patients receive 24-hour care. At the time of discharge, they receive an appointment for follow-up. Sometimes, I would hear that patients would skip their follow-up visits and it made me sad. All cancer patients need follow-up care.

Many people finish their primary treatment for cancer unaware of their heightened health risks and are ill-prepared to manage their future health care needs. Furthermore, recommended follow-up care is often not delivered and the psychosocial needs of cancer patients are often not addressed.” Hewitt, M., Greenfield, S., and Stovall, E. (Eds.). (2006). From Cancer Patient to Cancer Survivor: Lost in Transition. (P. 4). Washington D.C.: The National Academies Press.


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It’s not always easy going back to the oncologist office for a re-check. Flashes of the chemo room experience can invade our minds. Waiting for the results of a CT or PET scan can be a challenge; anxiety can fester about what the result might be. As scary as it might be to get follow-up care by an oncologist, it’s vital for all cancer survivors. General practitioners might not be versed in the nuances and details of cancer care follow-up, screening and prevention. I still go to my oncologist yearly for regular check-ups and get blood work done-12 years post diagnosis. It’s very important!


Fatigue

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As a nurse, I have watched many cancer patients practically stumble to their beds fatigued after taking a shower in the hospital. Most slept countless hours. Their bodies were being taxed, and potentially cured, by the harsh medications they received, and thus fatigue resulted.

There are many theories about cancer-related fatigue. One theory is that chemotherapy causes toxicity at the mitochondrial (cell energy) level, thus causing a person fatigue. Other contributing factors could be from insomnia, depression or decreased level of physical exercise. Lindsey, H. (2013, February 25). Fatigue: The Forgotten Syndrome. Oncology Times, 35(4) 26-28.


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The fatigue during cancer treatment was unlike anything I had ever felt. I knew what it was like to be tired from a long 12-hour plus day at work, but this was sheer debilitating exhaustion. I went from being a physically active person, to sometimes having trouble walking down the aisles at Target. It was depressing, but that was part of the cancer journey. How I dealt with it was I slept when I needed to, and learned to put the guilt of not doing this-or-that aside.


Spirituality

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I’ve prayed for many of my patients. Since we humans consist of mind, body, and spirit, I believe this connection is a necessary component in caring. There have been studies done that show people who are prayed for have better health outcomes. It has also been shown that those who have spirituality in their lives have a greater sense of fulfillment. Olver, I., Dutney, A. (2012). A randomized, blinded study of the impact of intercessory prayer on spiritual well-being in patients with cancer. Alternative Therapies in Health and Medicine, 18(5):18-27.


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Cancer affected me on every level, including spiritually. I remember one particular time I tried to read the Bible but couldn’t. The words didn’t seem to penetrate and frankly, I think I was angry at God. Why did this happen to me? Thankfully, God sent an army of people to help. I was on many church prayer lists and had enormous spiritual support. A co-worker set her watch to beep during the time I was getting chemo so she could pray for me. A spiritual warrior from church prayed for me constantly. People I didn’t even know were praying. Honestly, there were times I could feel people’s prayers. It gave me such comfort.


Support Groups

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Having worked in the hospital with cancer patients for many years, I encouraged them, and their family members, to find camaraderie with others who were walking the cancer path. Some attended support groups and said it was helpful, and some did not.


When I went through cancer treatment for non-Hodgkin lymphoma, I sometimes felt lost and alone. Sure I had friends and family to help, but they hadn’t felt the struggles I was going through. In other words, they could sympathize but not empathize. Since I was in my thirties, I wanted to talk to others who were on the cancer journey that were my age. There was a breast cancer support group offered for my age-range, but not for my diagnosis. I decided to attend. Even though we weren’t dealing with the same diagnosis, I still felt relief in listening to women discuss struggles they had with chemotherapy and treatment. We bonded discussing our trials, and sometimes even laughed. It made me feel better. I wasn’t in this alone. “It’s one thing knowing you have people cheering you on, yet another to know they’ve walked in your footsteps.” Quote from Both Sides of the Bedside by Christine Magnus Moore


Fear of Recurrence

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One of the major issues cancer survivors mentally struggle with is fear of recurrence.

“For many cancer survivors, fears of recurrence can result in persistent anxiety and difficulties in planning for the future.” Hewitt, M., Greenfield S., and Stovall, E. (2006). From Cancer Patient to Cancer Survivor Lost in Transition. Washington, DC: The National Academic Press. p. 69.


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I have definitely experienced this. I remember one night feeling despondent, worrying about if “it” was going to come back. I cried, prayed and finally a mental image of a stop sign came to mind. I literally told myself to stop. Now if the haunting thoughts of “what if” pop into my head, I tell myself STOP! No! I visualize the stop sign, a reminder. I don’t let myself tumble down the road of paralyzing fear. Besides fear, one thing being a cancer patient brings is mental toughness. Worry doesn’t help. I give it to God.


Cancer-related Post-traumatic Stress

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Some patients develop post-traumatic stress while going through the trauma of treatment. This can include anxiety, nightmares, disturbing thoughts, irritability, and other assorted symptoms.

“Patients dealing with cancer may have symptoms of post-traumatic stress at any point from diagnosis through treatment, after treatment is complete, or during possible recurrence of the cancer.” National Cancer Institute. (2015). Cancer-related Post-traumatic Stress. Retrieved October 29th, 2015, from http://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq


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While undergoing treatment, I remember waking up from a nightmare feeling that even in my dreams I was being pursued by cancer. I also had anxiety and disturbing thoughts that would sometime spin me into a frenzy of panic. It helped for me to take deep breaths, talk to my nurse and doctor, seek comfort from family and other survivors, and to journal which allowed me to express my thoughts and feelings onto the page and out of my mind. It was definitely a time to accept help and not go through the cancer experience alone.

(This blog post was updated on October 29th, 2015)