F.I.E.R.C.E. Breathing: Transform Your Life in the Face of Adversity

DLC note: the following guest post is written by Carolyn Colleen, Ph.D., author of F.I.E.R.C.E.: Transform your life in the face of adversity, 5 minutes at a time! Out of sheer necessity, Carolyn developed the F.I.E.R.C.E. 5 method, which helped her grow from a downtrodden, scared and ragged victim, standing in a food line at the Salvation Army, to the confident and successful person she is today, living a happy life she never realized she deserved.

When I wrote F.I.E.R.C.E.: Transform Your Life in the Face of Adversity, 5 Minutes at a Time!, it was aimed at helping people escape the clutches of abuse and live the lives they deserved. While I knew that the Breathe, Focus, FIERCE Action component of the FIERCE process could help anyone dealing with anxiety, I never envisaged that it would help cancer patients navigate their treatments. That's why I was incredibly humbled to receive this note from a breast cancer patient:

"Sometimes all you need is a reminder to breathe - not only breathe, but also move forward. Moving forward starting with one small goal, helped me get through the rest of my treatments. Practicing these  FIERCE steps gave me permission to think about what was in front of me in smaller, more manageable pieces with the reminder to be courageous and take action for myself." - Laura*

Since the launch of my book, I have had the privilege to work with many cancer patients through my Ph.D. research, and many of them have testified to the fact that the process has helped them acquire coping skills. By using the Breathe, Focus, FIERCE Action element during times when they have been overwhelmed by their situations, they were able to summon the grit to push forward with incredible courage. I'm so honored to have been invited to share this process with you here on Don't Let Cancer Steal Your Joy, and hopefully, it will help you find the FIERCE warrior inside of you.

FIERCE: F for Focused Breath

The F in FIERCE stands for focused breath, and the process involves taking a deep breath, facing fear, finding the fire and focusing on the way forward.

In her article Stress and Cancer on PsychologyToday, Lucy O'Donnell explains the link between stress and cancer. It is not uncommon for a healthy person to come down with a viral infection after a period of intense stress, so it is only understandable that there is no benefit to exposing a cancer-afflicted body to prolonged stress.

A 2013 study showed that stress reduces the effectiveness of cancer drugs while another study found that a group of breast cancer patients who received ongoing psychological interventions, relaxation training, and advice on minimizing stress, were 45% less likely to experience a recurrence of their breast cancer than those who received no psychological interventions. The same study found that of those who did experience recurrent breast cancer, those in the intervention group were 59% less likely to die from breast cancer.

“Make BREATHING your best friend ALWAYS.”

Step #1: BREATHE

Breathe in for a count of 7

Breathe out for a count of 11

Deep breathing aids relaxation and blood pressure reduction. With stress reduction, your mind is cleared to reallocate your energy for positive action such as clearly focusing on the goal at hand.

Set small, simple, achievable goals, even if it's just to get through your next treatment procedure.

Step #2:  Focus

What is your immediate goal?

Focus on your immediate goals to avoid being overwhelmed by the road ahead.

Step #3:  FIERCE Action

What are the steps you need to take to achieve your goal? Indeed, your immediate goal might be a small stepping stone in the path to beating cancer. That's alright, too!

Choose an action you can take right now that will propel you in the right direction.

This is the tool Laura used to combat debilitating fatigue from chemotherapy and muster up the courage - although exhausted - to push forward through the next steps of surgery and radiation therapy. I encourage you to take a moment to stop and breathe. For just five minutes, stop thinking about the 'what ifs' and the 'maybes,' and just take some time for focused breathing. Do it daily for best results.

 

Carolyn's Joy Tip

Sometimes the greatest limitations are the ones placed upon us by our own minds. Carolyn's message inspires us to face our fears and push past the things challenging our well-being using small increments of 5 minutes at a time. Despite the circumstances, Carolyn shows how to ignite your inner ferocity and create the life you deserve!

Carolyn Colleen was born and raised in the Midwestern United States. She describes herself as a F.I.E.R.C.E. mother, daughter, sister, and friend. Encouraged to write a book about her experiences, Carolyn took up the challenge. Now, with it completed, she hopes that by sharing her story she will provide others with the hope, resources, and willpower needed so that they too can live the life they deserve.

 

Send us Your Joy Tip

What is your Joy Tip? We’d love to hear from you! Send along a brief story and joy tip, and we may highlight it in an upcoming blog. Email us today at hello@dontletcancer.com

Tending to Your Physical and Emotional Bank Account: What's in Your Wallet?

DLCSYJ note: the following guest blog post is written by Hester Hill Schnipper, LICSW, OSW-C, an oncology social worker and blogger with years of experience helping women with breast cancer.

Do you feel as though cancer has depleted your reserves? There is no question that cancer treatment and the prolonged period of recovery that follows are costly in many ways. In addition to the financial impact of treatment, some additional costs that can accompany a cancer diagnosis include missed work days, reduced income, the price of gas, parking at the hospital, childcare, take-out meals, house cleaning, and laundry assistance. If you’re feeling the crunch financially, there may be resources from national and local agencies or foundations that can help. Consider speaking with an oncology social worker at your hospital or clinic where you receive your care.

 

Your Physical and Emotional Bank Account

Just as important as your finances are, the bank account on my mind is the one that tallies your physical and emotional health. It is just as important to keep your eye on the bottom line here as it is on the one that comes from the bank. We all make frequent withdrawals of energy and emotion, and you may find it more difficult to make regular deposits into this account. When you are focused on just getting through the next treatment or even the next day, it may be hard to imagine ways to bolster the bottom line of your well-being.

Let’s consider the withdrawals that are regular, necessary bills, similar to your monthly mortgage or rent check. You have to show up for treatment and go through the experience of surgery, radiation or chemotherapy. Then there are possible side-effects including fatigue, nausea, or a general sense of malaise. Your many medical appointments may leave you feeling as though the hospital or treatment center is a second home. On top of all this, you have to try to keep up with your normal home and professional obligations, which can tap your reserves. 
    

Once active cancer treatment is done, the bills continue, and you’ll be getting back to your pre-cancer activities. But sometimes this is easier said than done. Although your family and friends may expect that you are immediately fully recovered, the rule of thumb is that it takes at least as long as the total duration of treatment to be 100% physically and emotionally healed. This usually means months, and many people continue to have periods of fatigue, sadness, and anxiety about the future.

“Being KIND and generous to YOURSELF will help fill your EMOTIONAL ‘FUEL TANK.’”

— Don't Let Cancer Steal Your Joy

 

Making deposits into your personal account  

The emotional side of your personal bank account can be harder to monitor. There are some moments that are reliably stressful: awaiting results from scans, hearing that a cancer buddy has died, or having difficult conversations with your doctors. Then there are the other times that are unexpected: wondering whether this holiday might be your last, the intense bittersweet feelings associated with life’s celebrations like graduations and weddings, or contending with insensitive remarks from people around you.

It is important to identify ways to make physical and emotional deposits so this account maintains a robust balance. Here are some possibilities to consider: 

1.    Naps and earlier bedtimes.
2.    Sleeping in when possible.
3.    Splurging on a new quilt or high-quality bed linens.
4.    Continuing with regular mild exercise, which has been demonstrated to improve a sense of well-being.
5.    Allowing yourself comfort foods and periodic treats with less than your usual standards of high nutritional value.
6.    Going out for some meals with friends. If dinner feels daunting, try breakfast or lunch.
7.    Chatting with a friend every single day, even if it is a brief conversation.
8.    Allowing yourself to binge watch a good television series on a gray day.
9.    Getting out to a movie; the experience of being in a theater is different than watching at home.
10.    Reading whatever delights you. Always have a good book going.
11.    Spending as much time outside in beautiful places as you can.
12.    Yoga or meditation. 
13.    Reiki, therapeutic massage, or acupuncture.
14.    Attending religious services if this is your tradition.
15.    Playing—and this includes cards or word games or dress-up with small children.
16.    Listening to your favorite music.
17.    Laughing as often and as much as possible.
18.    Being gentle with yourself. Treat yourself at least as generously and kindly as you do others.

 

Hester's Joy Tip

Being kind and generous to yourself will help you feel less depleted and more fulfilled.  Make a deposit in your personal bank account today and ease the stress that cancer brings.

 

Hester Hill Schnipper, LICSW, BCD, OSW-C is Program Manager of Oncology Social Work at Beth Israel Deaconess Medical Center. She is a breast cancer survivor, and has been working with women with breast cancer for over two decades. Hester is a published author and has written books about coping with breast cancer. She also writes a daily blog: "Living with Cancer": http://bidmc.org/livingwithbreastcancer

Your Turn! 

Hester has given us much to think about. Write down all the ways in which you currently fill your personal bank account, and then list 5 things you can do to boost your balance.  Schedule your deposits into your day and watch your bank account grow!

 

Send us Your Joy Tip

What is your Joy Tip? We’d love to hear from you! Send along a brief story and joy tip, and we may highlight it in an upcoming blog. Email us today at hello@dontletcancer.com

Does Cancer Have to Derail Your Life's Goals?

DLCSYJ Note: The following guest blog post is written by Lillie D Shockney, RN., BS., MAS, and is based on her extensive experience working with breast cancer patients. 

If you have just been diagnosed with cancer, your world may feel like it is spinning out of control. You can likely only think about cancer and nothing else. But chances are before you learned of your diagnosis, you had life goals you were planning to achieve in the future—some short-term and many long-term, even decades from now. These goals can still be part of your plan! You need to speak up and make sure your oncology treatment team is aware of these life goals. Why? So they can be incorporated into your treatment planning process. Don’t allow cancer to rob you of your life goals. You will want to still be on track for accomplishing them, rather than sacrificing them to this disease. 

 

Identifying Your Goals is Key to Survivorship

Initially, it is common for patients to say they only have one goal “now”—to survive cancer and its treatment. This goal might be driven by young children you are rearing, or perhaps you are caring for an elderly parent or a spouse with medical needs. You may feel you have only this one goal because you are so scared. Take a deep breath. Sit down. Take your goals—all of them—seriously, and think about where you see your future, as a cancer survivor. 

Most medical oncologists will discuss fertility preservation with you if you are young and of child-bearing age. But beyond that, it is common for oncologists to focus on the cancer and how to treat it, losing sight of what else may be important to you. So make a list. Here are some examples from experiences in breast cancer:

• You are up for a promotion at work—you will likely want to try to work as much as possible during your treatment, to demonstrate your commitment to the company. By informing your treatment team, steps can be taken to minimize your time off from work. This can be accomplished by planning your chemotherapy treatments so that the days following treatment that may limit you due to side effects would naturally occur when you are already scheduled to be off. 

• You want to breastfeed in the future—assuming fertility preservation is already being considered, you may give more serious thought to the type of breast cancer surgery you want. For example, doing a bilateral mastectomy (that is by choice and not medically required) would steal away your ability to breastfeed. Some women are so frightened that they opt for a bilateral mastectomy when only a small lumpectomy was actually needed. 

• You are an avid and competitive swimmer—the type of breast cancer surgery you receive may impact this physical activity. For example, you may not want a Latissimus dorsi flap reconstruction that would take the muscle from your shoulder blade. This also applies to women who are avid golfers. 

• You are looking forward to enjoying your new grandchildren, or perhaps ones you may have in the future. Therefore, if you require a mastectomy, you may want to avoid a TRAM flap reconstruction that sacrifices your abdominal muscles, restricting you from heavy lifting. 

Assert yourself and give voice to the life you want to be living after your experience with cancer and its treatment. This is your opportunity to preserve life’s goals, and now is a good time to be clear and upfront with your care team.

“Give voice to the life you want to be living”

 

Redefining Your Goals with Metastatic Disease

What would your situation be, however, if you learned you had metastatic disease and could not survive despite the best treatments available? Even if you are facing a terminal diagnosis, you can still achieve your life goals. They may need to be altered a bit, or they’ll need to be fulfilled in alternative ways. For example, being present to watch your 10-year-old daughter walk down the aisle as a blushing bride 10 to 15 years from now. You can still ‘be here’ by writing her a card or letter now, describing your wishes and hopes for her, sharing your motherly advice and your deep and continued love for her. You can even make a video or audio recording. By doing this, you will still ‘be here,’ just in a different way. To fulfill these goals and hopes, you’ll need to ask your oncologist for an honest timeline if possible, so you can arrange to create the appropriate items for these various milestones. Doing so requires thought and planning. 

No matter your stage of diagnosis, make sure your goals are well articulated and clear. Request that they are factored into the treatment planning process.

 

Lillie’s Joy Tip

Identify, clarify, and share your goals with your treatment team. Give voice to the life you want to be living, regardless of your cancer! Only give cancer what is required to treat it. Don’t allow it to have any more of your time—not your personal time, social time, work time or family time. Be well.

 

Lillie D Shockney, RN., BS., MAS is a University Distinguished Professor of Breast Cancer, and Administrative Director at the Johns Hopkins Breast Center. A two-time breast cancer survivor, Lillie has worked tirelessly to improve the care of breast cancer patients around the world. Lillie has published several books on breast cancer and is a nationally recognized public speaker on the subject. She is the co-founder of ‘Mothers Supporting Daughters with Breast Cancer’ and is the founder and Director of the Academy of Oncology Nurse Navigators (AONN). 

 

Your Turn!

Let’s all take a lesson from Lillie’s joy tip. What are your goals? Take a moment and write down what comes to mind. Include those that are small and easily attainable, and bigger ones too. They can be short-term and long-term. Writing them down will help give you clarity and even identify ones you hadn’t thought of.

 

Send us Your Joy Tip

What is your Joy Tip? We’d love to hear from you! Send along a brief story and joy tip, and we may highlight it in an upcoming blog post. Email us today at hello@dontletcancer.com.

Post Traumatic...Growth?

By Ted James, MD, MS

Most people are very familiar with the term, ‘post-traumatic stress disorder.’ But how many are aware of post-traumatic ‘growth’?

The American Psychological Association defines post-traumatic stress disorder, or PTSD, as “an anxiety problem that develops in some people after extremely traumatic events, such as combat, crime, an accident or natural disaster. People with PTSD may relive the event via intrusive memories, flashbacks and nightmares; avoid anything that reminds them of the trauma; and have anxious feelings they didn’t have before that are so intense their lives are disrupted.” Although PTSD is most often associated with traumatic events such as war, bodily attacks, natural disasters, and serious accidents, it can also affect people with a history of cancer. For example, a recent study found that nearly 1 in 4 women diagnosed with breast cancer experienced some form of PTSD(1). It is normal for a cancer survivor to have feelings of worry and anxiety. However, if these feelings fail to diminish over time, grow in intensity, or begin to affect daily life, this could be a sign of PTSD.

PTSD is a serious condition that can lead to depression, substance abuse, eating disorders, loss of relationships, and an inability to function. Fortunately, PTSD is treatable. Treatment can include various types of therapy, medication, and support groups. It is important to seek professional help if you feel you may have PTSD. Talk with your doctor or another member of your health care team for help and recommendations.

Some of the known risk factors for PTSD include having high levels of overall stress and using avoidance strategies to cope with stress, such as drugs or alcohol. Reducing stress and managing anxiety through mindfulness and other related techniques may help people avoid these risk factors. Research also indicates that cancer survivors are less likely to develop PTSD if they receive strong support from family and friends, are given correct information about the stage of their cancer, and have good relationships with members of their health care team(2). Regular visitors to our website will find numerous resources to help promote the practice of stress reduction, self-care, and strengthening personal relationships.

Now, consider this fascinating fact: distress and disorder are not the only responses to a significant life trauma. There is some indication that ‘post-traumatic growth’ may be an even more common reaction to these challenging life experiences. Post-traumatic growth may go by other names, including adversarial growth, stress-related growth, altruism born of suffering, and benefit finding. Researchers have studied the remarkable phenomenon of positive transformation following a major life adversity such as a terminal illness or the loss of a loved one. Through the process, people develop qualities of diligence, resilience, generosity, love, perspective, purpose, and humility. The results include improved relationships, spiritual change, and an enhanced outlook on life.

In his book, ‘Flourish: A Visionary New Understanding of Happiness and Well-being,’ internationally recognized psychologist Martin Seligman describes his many years of research and experience with emotional resilience and positive psychology. He states that people who suffer often develop resilience and growth following the event, rather than experiencing prolonged depression or despair. Dr. Seligman states, “people emerge from these challenging events stronger than they were before.” After going through a very difficult experience, they see new doors open to them. When these doors open, simply knowing that growth and strength is a common response can help us walk through them – rather than being paralyzed by fear, depression, and anxiety. According to his research, the majority of people are resilient – an important fact to keep in mind when dealing with the effects of cancer. “It’s important to know that the normal response is not going under, it is resilience and often growth.”

Of course, we must recognize that there are still people who legitimately experience PTSD after negative experiences, to no fault of their own, and they require appropriate medical treatment and support. It is also important to recognize that just because some individuals have experienced growth through adversity, this doesn’t mean that they have not also suffered. The pain is real, and the road to growth often involves a great deal of emotional sorrow. The awareness of post-traumatic growth as a possible outcome of experiencing trauma does not imply in any way that suffering or traumatic events are good. They are most certainly not good. Cancer is traumatic and by all means should be avoided; however, we do not always have a choice. Unfortunately, such crises are an inevitable part of life, but tragedy doesn’t have to be the end of the story…it can be the beginning. Accepting hardship and rising through resilience can be a pathway to peace. Although we are not given a choice to avoid painful experiences, perhaps we may be able to weather the storm with growth and transformation that can have a positive impact on our lives.

“…suffering produces endurance, and endurance produces character, and character produces hope”

— St Paul

Action Item

To the extent that you can, create a narrative of your challenging experience, in which new principles and an expanded way of viewing the world arise. Think about what story you are telling yourself and the world about your cancer. Is there anything you could do to change the story or give it a positive spin? Write down your new life narrative (it can be as little as one page). Refer to this often and find ways to live it out to the fullest. 

References

1.    How traumatic is breast cancer? Post-traumatic stress symptoms (PTSS) and risk factors for severe PTSS at 3 and 15 months after surgery in a nationwide cohort of Danish women treated for primary breast cancer. M O'Connor, S Christensen, A B Jensen, S Møller, R Zachariae. Br J Cancer. 2011 Feb 1; 104(3): 419–426.

2.    Post-Traumatic Stress Disorder and Cancer. At Cancer.Net: http://www.cancer.net/survivorship/life-after-cancer/post-traumatic-stress-disorder-and-cancer

3.    Flourish: A Visionary New Understanding of Happiness and Well-being. Martin E. P. Seligman. Atria Books/Simon & Schuster, 2012

What is ‘Don’t Let Cancer Steal Your Joy’ all about?

by Ted A James MD, MS, FACS

For many cancer survivors, living with the uncertainty of their diagnosis and the potential for recurrence can result in a great deal of stress and worry that persists long after the initial diagnosis and treatment. To a certain degree, these thoughts and feelings are quite normal and are often part of the process of dealing with cancer. However, when the fear of cancer starts to cast a shadow over everything else, it can lead to a constant state of distress that slowly erodes a person’s quality of life. Sadly, in some situations, the distress caused by worrying about cancer may actually do more harm physically, emotionally and spiritually than cancer could ever do itself.

The truth is that nobody knows what tomorrow holds. We take the necessary steps to reduce risks in life and plan appropriately for the future. Beyond that we have no further control. Worrying about what we cannot control does not give us any more mastery or authority over it. Instead it makes us give cancer more power to negatively affect our lives than it deserves. Simply stated, worrying about tomorrow does not help us live better today. Ideally we would practice letting go of worry over the things we do not control, and instead, fulfill our purpose for each day.

Admittedly, this is much easier said than done. However, many people have found ways to maintain, and even increase joy in their lives as cancer survivors. Their stories provided the inspiration for this website and the Don’t Let Cancer Steal Your Joy campaign. The DLCSYJ campaign is all about approaches to optimizing well-being in the setting of cancer. Ultimately the goal of this movement is to serve as a source of support and inspiration for cancer survivors who are seeking a life of resilience and joy. 

 

What exactly is joy?

The term joy, as used throughout this website, is more than a feeling of pleasure or happiness. Happiness is a state of mind and pleasure is a physical experience. Joy goes beyond this and stems from the core of one’s spirit or self. It is a sense of contentment, fulfillment, and well-being. Joy is an orientation of the heart. Most importantly, joy is a choice! It is independent of circumstances or external factors. Your joy is defined by you and belongs to you alone. It can enhance your quality of life, overcome your fear, and allow you to face the most challenging of situations with a sense of peace. Even in the midst of a difficult, painful or life-threatening condition that legitimately brings us suffering, our inner joy is never taken away. The very core of our being can still express joy.

This website will explore how cancer survivors have found, maintained, and enhanced their joy. We review the relevant strategies and techniques learned from behavioral psychology, neuroscience, philosophy, and religion. These include, mindfulness, gratitude, generosity, self-care, and finding one’s greater purpose. We hope that you, too discover that cancer doesn’t have to deprive you of your joy---Don’t let cancer steal your joy.