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How to manage stress at a macro and micro level as a cancer survivor? There are a lot of stressful things occurring in the world. On a global level we see and hear about wars, terrorism, and violence, poverty and hunger, pandemics, climate crisis and natural disasters. It can be very scary and anxiety inducing, which may lead to feelings of hopelessness and powerlessness. Additionally, you may be experiencing stress that is related to your health, family, work, school, friends, and at this time- the stress and anxiety that often accompanies the holiday season. It is very easy to be weighed down by everything going on both at the macro and micro level. Therefore, it is important to find ways to slow down and engage in coping skills that can alleviate the stress in your life. The power of gratitude Gratitude is an often overlooked and undervalued skill (and state of mind) that can have powerful and meaningful benefits to your health and well-being. The act of being grateful, searching for the good, and appreciating what you have can decrease stress and anxiety ( Petrocchi & Couyoumdjian, 2016 ). Furthermore, being grateful can boost your overall well-being and increase your sense of happiness in life (Behzadipour et al., 2018) . It even helps to create positive feelings and increase connection in your relationships ( Park et al., 2019 ). Additionally, implementing an attitude of gratitude in your life can be easy and enjoyable. Some ideas to try to implement gratitude in your life • At the end of the day, use a notebook or journal (or notes on your phone) to write down 3 things for which you are grateful. Do this every day for a month and see how you feel. Bonus challenge - try not to repeat any item you have previously written. • Engage in mindfulness and meditation . Both help with slowing down and focusing. Mindfulness engages your current/present state to be more aware. Meditation explores your inner and outer world - connecting with your emotions, senses, and ideas (learn more on Getting Started with Mindfulness ). Both focus on being non-judgmental and encourage curiosity and appreciation of self and one’s environment. • Catch the good. Gottman and Silver’s (2015) research suggests couples should express fondness, admiration, and appreciation for each other. Whether for a romantic partner , parent, child, friend, etc., search for the positive characteristics, traits and behaviors of that person. Bonus challenge - share with them what you see and feel. • Set boundaries for how often and how long you engage in stressful events (e.g. looking at the news), and schedule time to ponder the positive things. It is not about dismissing or denying the hard stuff. Rather, remembering that good things still exist, too. Plus, planning it on the calendar will help with engagement. • Focus on the people, activities, and things that you love, make you happy, feel good, and bring peace into your life. Being grateful can mean engaging with the person or thing that brings positive feelings. If you are struggling to find things you are grateful for, consider other words (e.g. love, happy) that are often connected to gratitude. When life gets busy and chaotic, take a step back and breath In conclusion, when life gets busy and chaotic, take a step back, breathe, and remind yourself of the good things around you. It does not have to be a huge gesture or grand activity in which you engage in order to be grateful. Rather, the small consistent efforts of gratitude will provide the longer lasting and meaningful impact on you and your health as well as those around you. About Dr. Tommy Biscshoff Dr. Tommy Bischoff , Ph.D., LMFT, is an experienced therapist specializing in grief and loss, couples counseling, trauma, depression , anxiety, infertility, and self-esteem. He is a cancer survivor and offers video consultations as a part of The After Cancer's Care Team.

Reimagining fitness after breast cancer diagnosis I considered myself to be in good fitness health the day I was diagnosed with breast cancer . Well, certainly all that changed as I went through multiple biopsies and surgeries. It was a roller coaster of emotions waiting on final test results in addition to not being able to move parts of my body post operatively, and friends and family wanting to lift my spirits by feeding me awesome homemade southern comfort foods. So, when I was given the green light to get fit again, I had to rethink of how to achieve fitness. The meaning of fitness can be tied to being healthy. And to be healthy means to be disease free. Well, that was my goal…I wanted to be cancer free. Another definition of fitness may be the ability to perform work or leisure activities without an issue. Again, I wanted to be able to work and play without limitations. I set out on my mission and researched how to get fit. Changes in your fitness journey No matter what level of fitness you have when you are diagnosed with cancer, your fitness level will change as you undergo further testing and treatment. First thing I learned is to listen to your doctors and ask what you can do and be specific about the activities. Your doctor may not want you lifting anything heavy or even raising your arms but this will change you recover. Start out with simple activities such as walking . Resistance training is a great way to regain strength and it does not increase your risk for lymphedema . If you have a favorite workout, definitely ask to be sure you don’t have any setbacks with your recovery. Your body goes through a lot of changes after surgeries and treatments so also listen to your body and be mindful of any aches and pains and don’t start out too hard. Your endurance will not be at the same level but will get there slowly. Be patient with yourself and your body’s current abilities. Your fitness level will improve with time and consistent effort. The thought of going to the gym, taking a class, lifting weights, or going for a run or bike ride may be daunting. Pick one activity and start there. Although I had been training for a marathon prior to my diagnosis, I started with walking around inside my house and then progressed to walking in my yard. I did not even think about going anywhere because I got tired after just a few minutes. But slowly my endurance improved and my confidence in my body to hold up also improved. The power of exercise for physical and mental well-being Exercising not only helped my physical fatigue but also mental fatigue. This mind-body connection came to life because as I was able to do more physically, my mental game got stronger in handling the stressors of more doctor’s appointments, awaiting test results, and making hard decisions. During cancer treatment and even after your mood is affected. Being active has been shown to decrease depression and anxiety associated with cancer diagnosis. In addition, it may help decrease the side effects of some of your treatments. Working out may also help with sleep which we all know plays a key role in our overall health . Being fit and cancer free means you have to eat healthy. But this can be difficult depending on your treatments and the side effects of medications you may be required to take. Again, talk with your doctors and ask what’s best to eat to strengthen your body or when you’re not feeling well. You need to fuel your body well in order to move it well. When you are exercising or moving your body regularly, you are more motivated to stay on plan with eating a healthy diet full of cancer fighting nutrients. Once your doctor releases you to do certain activities, devise a fitness plan so that your body can be as strong as possible in your recovery process and beyond. Exercising (after breast cancer diagnosis) has been shown to be associated with longer survival. Seek a trainer who listens to you and understands your potential limitations and how to work around them. Taking care of your body to be fit as possible in turn make you as healthy as possible. Here are the fitness guidelines according to the American Cancer Society : Avoid inactivity Take part in regular physical activity . Start slowly and build up the amount of physical activity over time. Build up to 150-300 minutes of moderate (or 75-150 minutes of vigorous intensity) activity each week. Exercise several times a week for at least 10 minutes at a time. Include resistance training exercises at least 2 days per week. Do stretching exercises at least 2 days each week. About Dr. Maria Cayelli Dr. Maria Cayelli  is a breast cancer survivor and a physician specializing in integrative medicine and survivorship care. Her goal is to partner with you on your journey to achieve optimal health and wellness.

The desire to become a doctor Ever since I can remember I wanted to be a doctor. As I learned and experienced the different specialties in medical school, I enjoyed all of them. I liked treating the whole person and body instead of focusing on just one part. This led me to a career in family medicine where I did it all, delivering babies to visiting patients in the nursing home. Discovering the allure of family medicine However, after a few years, I was drawn to pursue further studies in Integrative Medicine . I felt that I was missing a critical piece in helping my patients. It seemed the current medical system was too disease-focused, so I completed a fellowship in integrative medicine to learn other ways for my patients to achieve wellness. A shift towards integrative medicine This new information came in handy when I was unfortunately diagnosed with breast cancer . I not only sought treatment from my surgeon, oncologist and primary care doctors but also from a variety of practitioners that ranged from massage therapists , acupuncturists, Traditional Chinese Medicine doctors, naturopaths, counselors and chiropractors. My experience receiving medical care helped me to understand even deeper the issues and concerns of my patients. It was so important to me to feel comfortable and safe to speak with my doctors about my treatments and how I wanted to achieve wellness again. This is why now I take an integrative approach and consider lifestyle, fitness goals, and current state of health when I come up with a treatment plan for my patient. I blend together traditional and non-traditional medicine to care for them in a way that is individualized and that addresses their unique concerns and health goals. About Dr. Maria Cayelli Dr. Maria Cayelli  is a breast cancer survivor and a physician specializing in integrative medicine and survivorship care. Her goal is to partner with you on your journey to achieve optimal health and wellness.

What is neuropathic pain? Nerves help you to feel and move and these bundles of fibers can be affected by radiation or chemotherapy treatments. During and after cancer treatment, you may have neuropathy which means you feel strange sensations such as numbness, tingling, or pain in various parts of your body. Other symptoms may include balance issues, trouble using your fingers, and sensitivity to heat/cold/pain. This may cause you to have problems with falls, walking, and dressing yourself. For some folks, this resolves once therapy is done or shortly after but for others it may take longer or be a more lifelong side effect. How to deal with neuropathic pain? If you think you have neuropathy, it’s important to bring it to you doctor’s attention so you can try solutions to relieve it. Your doctor may decrease the chemotherapy agent causing the issue or change it to give your nerves time to recover. You may also have labs done to check for other causes such as B12 deficiency or diabetes. There are medications like duloxetine (Cymbalta) that may ease your symptoms. Exercise programs with physical or occupational therapists in addition to acupuncture, yoga, mindfulness meditation and massage can help your neuropathic symptoms. Living with neuropathic pain Living with neuropathic pain is difficult and is not curable but it’s important to do all you can to manage the potential problems. Doing the following may help lessen the impact on your life: Eat an anti-inflammatory, balanced diet Minimize alcohol intake Get fresh air Prevent falls Protect your hands and feet. About Dr. Maria Cayelli Dr. Maria Cayelli  is a breast cancer survivor and a physician specializing in integrative medicine and survivorship care. Her goal is to partner with you on your journey to achieve optimal health and wellness.

Cancer prevention is optimal Prevention of cancer is optimal but unfortunately, most of us know someone with cancer or are cancer survivors ourselves. Despite the prevalence of cancer, there are steps you can take to prevent it or decrease your risk for reoccurrence. Talk to your doctor Talk with your doctor about your concerns and take the time to do any cancer screening tests available. You are the expert of yourself so monitor for any unusual symptoms you may be having or lingering aches and pains that are out of the ordinary. There are many ways to achieve optimal health and it helps to have the medical expertise of your doctor in navigating the best path. Partnering with your doctor by discussing your health concerns and goals is the first key step. Communication is important so ask questions, listen carefully, and discuss with your doctor your options. It’s best to have all the information about your choices and then make a decision on how to go forth that aligns with your values, beliefs, and lifestyle. Lifestyle as cancer prevention What you can do to prevent cancer or lower your reoccurrence risk: No tobacco products Eat healthier Movement Maintain healthy weight Minimal or no alcohol intake Avoid toxins, unnecessary radiation (sun exposure), infections Get good quality sleep Get screening labs and x-rays as recommended. Check our weekly blogs about key aspects of a healthy lifestyle focused on cancer prevention. We'll be posting about nutrition, movement, environment, and stress management. About Dr. Maria Cayelli Dr. Maria Cayelli is a breast cancer survivor and a physician specializing in integrative medicine and survivorship care. Her goal is to partner with you on your journey to achieve optimal health and wellness.

Pelvic Pain One of the dearest subjects to my heart that has affected so many women who have come into my office to see me as a pelvic floor therapist has been pelvic pain. According to the NIH, chronic pelvic pain continues to affect 4-16% of the population of women. These are people who live the majority of their days having pelvic pain. Physical therapy can help patients with chronic pelvic pain and with intermittent pelvic pain. Some people are misdiagnosed for years with pelvic pain just because for them it is not present all the time. So they forget it exists until it returns again sporadically. Pelvic pain may also present in individuals who have different cancer diagnoses (ie. breast, uterus, bladder, cervical, abdominal cavity).  Pelvic pain also presents with diagnoses of endometriosis, dysmenorrhea (painful periods), painful bladder syndrome/interstitial cystitis. Some other diagnoses that cause pelvic pain may be irritable bowel syndrome, vulvar pain, vulvodynia, vestibulodynia, vaginismus, pelvic congestion, polycystic ovarian syndrome and pelvic pain due to undisclosed diagnoses after having a baby or a hysterectomy. Pelvic Pain and Intimacy Having pelvic pain can stress your marital relationships , place a strain on your mental health and even put you in a space of depressed mood. It can cause anxiety because you are not sure when it will return or you know exactly how it will return ie. in the bedroom. This is by far when enough is enough. It has been plaguing you for a long time but when you can no longer have intercourse with your partner and your intimacy has continued to plummet you have to do something about your pelvic pain NOW!!! Some women struggle with being afraid for your partner to touch your vaginal area because this may cause increased spasms in your pelvic floor. Others struggle with relaxing their pelvic floor muscles to empty their bowels or bladder.  There is a condition called vaginismus which is categorized as primary or secondary. Primary vaginismus happens when vaginal penetration is impossible because of pain you have experienced for your entire life. No object, speculum or penis is able to enter the vaginal canal. Secondary vaginismus happens when you were once able to have penetrative intercourse, but because of life’s circumstances now you can no longer participate in the act. Pelvic Pain and Cancer Treatments This occurs sometimes after having received treatment for cancer especially if you had a decrease in estrogen hormones, total hysterectomy, or radiation. These are things that your physicians may or may not tell you. Sometimes they educate patients that this could happen but most patients are so focused on decreasing their cancer that they look over this conversation and forget that pelvic pain could come as a result of treatment as a secondary issue. Tissues may be very dry, brittle and thin following treatments for cancer and after certain hormones have been reduced in the body. Our minds are also affected by lack of intimacy. Some women are in a place where they are so super stressed and there is a lack of concentrating on relaxation and breathing appropriately. Because of this penetrative intercourse cannot happen and pelvic pain is the result. Not breathing well affects how we move in the bedroom. There is a strong connection. How to manage pelvic pain and how can your PT help? This is the place where a pelvic floor PT can help reduce pain . There are 10 practical methods to help one reduce pelvic pain.    Remove unnecessary stressors from your life Learn to breathe properly through your diaphragm Learn how to relax your pelvic floor muscles with a pelvic floor physical therapist Stretch muscles of your hips, low back and abdominal wall Learn how to appropriately use a vaginal wand/dilators Use lubrication  Communicate how you feel with your partner/spouse Request a Pelvic Floor PT consult - (request a visit with me) Get a mental health therapist or coach to help you talk through your intimate concerns Exercise I hope that you have found this information helpful and that you can apply some of these strategies to your daily routine if you have pelvic pain or know someone who does. Be well!  About Dr. Katrina Heath Dr. Katrina Heath is a physical therapist specializing in pelvic floor rehabilitation. She works with patients who have pelvic floor issues due to cancer treatment like surgery, radiation or chemotherapy.

Ouch!!!! Why am I hurting during intercourse now? There is one more thing that I have to worry about, and I never expected it to affect my performance in the bedroom! Does any of this sound familiar? Perhaps you have been diagnosed with a pelvic floor dysfunction commonly known as dyspareunia or vaginismus. Dyspareunia refers to persistent or recurrent pain experienced during sexual intercourse. This pain can occur at different stages of sexual activity , including vaginal touch, penetration, during intercourse, or after sexual activity. There are various potential causes of dyspareunia, and they can be physical, psychological, or a combination of both. Physical causes may include conditions such as cancer diagnosis, pelvic inflammatory disease, endometriosis, vaginal dryness, infections, or structural issues. Psychological factors like anxiety, stress, or a history of sexual trauma can also contribute to dyspareunia.  Vaginismus is another type of common pelvic floor dysfunction divided into primary and secondary forms of vaginismus.  Primary vaginismus is the prevention of sex secondary to pain where a female has never had penetration at all.  Secondary vaginismus is where one has had penetration in the past but is no longer able to have intercourse secondary to trauma, surgery, cancer diagnosis, or mental health issues including anxiety . Both vaginismus and dyspareunia have similar treatments but first one needs to identify the underlying cause.  Pelvic Floor Physical Therapy Physical therapy can be a helpful and effective approach in managing dyspareunia and vaginismus, particularly when the pain is related to musculoskeletal or pelvic floor issues. Pelvic floor physical therapy is a specialized form of physical therapy that focuses on relaxation and strengthening of muscles, ligaments, and connective tissues in the pelvic floor and its attachments. Here are some ways in which physical therapy can help with dyspareunia and vaginismus: Pelvic Floor Assessment:  A physical therapist performs a thorough examination to identify any muscle tension in the pelvic floor muscles. This exam begins externally assessing spinal alignment, hip mobility, postural awareness. With the patient’s consent there is also an internal exam of vaginal or rectal muscles to see if these are contributing to pain and dysfunction. Biofeedback :  Biofeedback is a technique that provides visual or auditory feedback about muscle activity and relaxation. Manual Therapy:  Hands-on techniques may be used by the physical therapist to release tension in the pelvic floor Education and Counseling:  Physical therapists can provide education on anatomy, sexual function, and techniques for relaxation. They will refer out to a mental health provider as needed. Breathing Exercises:  Proper breathing techniques can contribute to overall relaxation and reduce tension in the pelvic floor muscles.  Posture and Body Mechanics:  Addressing posture and body mechanics during daily activities and sexual positioning can be important, as poor posture and positions may contribute to pelvic floor dysfunction. Collaboration between healthcare professionals, including gynecologists, urologists, mental health professionals and physical therapists, may be necessary to determine the most appropriate and comprehensive treatment plan for an individual's specific situation. About Dr. Katrina Heath Dr. Katrina Heath is a physical therapist specializing in pelvic floor rehabilitation. She works with patients who have pelvic floor issues due to cancer treatment like surgery, radiation or chemotherapy.

Getting cancer saved my life “Getting cancer saved my life,” ‘Dave’ whispered at the opening of our first session. He went on to explain that he had not even realized that he had “not really been living” prior to the unexpected diagnosis. Life had become a routine exercise of “going through the motions” without awareness of its brevity. Time passed blithely by day after day, year after year, decade after decade. Until learning of his advanced cancer, Dave admitted he was on autopilot hardly noticing that he had entered the third quarter of his life – meaning there was more life behind him than there was ahead. It wasn’t until his late 60’s that Dave awoke to the reality that his days on this earth were numbered. Cancer got his attention. What cancer patients teach a psychotherapist As a psychotherapist who has specialized in working with cancer patients since 2018, I have met more “Daves” since then than I can count. I was new to the oncology space when Dave told me that cancer saved his life, and it really took me back. At the time, I knew very little about the myriad cancer diagnoses and treatment regimens. I was on a very steep learning curve, and I had a mind full of cancer-story stereotypes and misinformation. In the last 5 years, however, I eschewed everything I thought I knew about cancer. My patients have taught me the whole truth about living with cancer that you don’t often hear about in the world. Obviously, patients share about the terrible lows, the shock, and the dark despair of receiving the initial diagnosis and treatment plan . I expected that. I was somewhat ready for that, although it never gets easier. It seems that all patients must first pass through an ominous and painful valley of the soul. But, what I didn’t know was that, amazingly, most do not stay there. My patients teach me that the journey through the valley of the shadow of death, as awful as it is, is often followed by unexpected “blessings” and is a prerequisite to the discovery of a completely new perception of self, time, and other people. The valley and the struggle to trudge it creates a secret portal that each patient enters to discover a new existence. On the other side, they see an unfamiliar vista replete with unexpected gratitude, forgiveness, and strength. The struggle to endure the trauma of cancer births a brand-new creature – a stronger, softer, kinder, gentler, and more loving, generous, and accepting self. What I wasn’t expecting were the scores of “Daves” that have sat opposite me talking about the “unexpected blessings” in their lives since getting diagnosed with cancer. I mean, who would have even thought this was possible?? This side of cancer so gripped me that I decided to devote my doctoral studies to exploring this phenomenon known as post-traumatic growth. Post-traumatic growth after cancer The theory of Post-traumatic Growth (PTG) was developed by Tedeschi and Calhoun in the 90’s to describe the inexplicable personal growth that most people who suffer and struggle through earth-shattering traumas and tragedies experience. Tedeschi and Calhoun’s PTG research data revealed that posttraumatic growth was evidenced in five discrete domains of human life: gaining a deeper appreciation of life, improved relationships with others, development of personal inner strength, the ability to see new possibilities in life, and deepening spiritual growth. The individual’s grappling with metabolizing their trauma is a necessary and paradoxical step to experiencing some or all of these five positive character changes. I have personally observed this growth in most of my cancer patients. The burgeoning research literature connects PTG to many other populations, such as police officers, first responders, survivors of violence and natural disasters, and even Holocaust survivors. I have always been drawn to the “silver lining” of man’s suffering, probably because of my own experience with suffering. Many good things emerged from the ashes of my pain that I had not anticipated. In fact, long before I ever heard of PTG, I made a point to recommend Viktor Frankl’s Man’s Search for Meaning to many of my patients to learn how one man metabolized his untold suffering to go on to live a long and productive life after the hell of Auschwitz. I discovered one of the greatest paradoxes in working with cancer patients over the last five years – confronting one’s death creates a deeper appreciation of life. Good can surface from suffering No one wants to hear they have cancer. No one asks for suffering. Yet, suffering and illness are universal, inevitable, and terrifying realities of the human experience. No one escapes suffering. But, the good news about suffering is that much good can flow from it if we don’t give up in the valley of the shadow of death. There are blessings on the other side that only come into view as we move forward through the pain, one day at a time, with the help of loving and trusted others. About Dr. Diane Benfield Dr. Diane Benfield , DSW, MSW, LCSW, is a dedicated therapist specializing in psychotherapy, grief, depression, and anxiety. Working with oncology patients is the most rewarding and fulfilling work she has ever engaged in.

From world traveler to clinical oncology social worker I have been very blessed with many opportunities to travel and study in my life. Psychotherapy is my third (and final) career. I was very fortunate to have studied in Europe for my bachelor’s degree in hospitality management in the 80s and early 90s, worked in hotels and restaurants in the Caribbean for many years after college, and then traveled the world with my backpack - returning to the USA in 1997 to put down roots. I set my sights on becoming a middle school teacher and did it proudly for almost 10 years and loved it. When I desired a more one-to-one helping relationship with people, I went back to school to get a Master of Social Work degree. I worked in substance abuse treatment for my first 8 years as a therapist. An amazing opportunity opened to become a clinical oncology social worker at the Cleveland Clinic . I needed a change, and I jumped at the chance! Exploring posttraumatic growth in psychotherapy Since early 2018, I fell in love with oncology and have not looked back. I went back to school to earn a Doctor of Social Work degree that same year and explored posttraumatic growth for my dissertation – it describes the unexpected and positive changes that occur in people during and after great life-changing suffering. Witnessing this undeniable growth in people after trauma is a beautiful process and happens routinely in the lives of my clients. Journey with AEDP Therapy: Healing and Certification After years of practicing and learning, I found the therapeutic style I most resonated with, and it is called Accelerated Experiential Dynamic Psychotherapy (AEDP) . This approach is deeply relational, attachment-based, emotions-focused, experiential, and somatic in nature. This model of therapy begins healing from the very first session by undoing aloneness and having an emotionally engaged therapist. I meet regularly with a master AEDP therapist for 1:1 supervision and engage in routine workshops and long weekend courses all year long. I am a level 2 AEDP practitioner and am well on my way to level 3 and then on to certification. I am licensed to practice in NC, FL and WA. I am working toward becoming a snowbird between the mountains of Asheville and South Florida to spend more time with my dad. I visit Scotland each year to see my mother who has Alzheimer’s and the old stomping grounds of my youth. About Dr. Diane Benfield Dr. Diane Benfield , DSW, MSW, LCSW, is a dedicated therapist specializing in psychotherapy, grief, depression, and anxiety. Working with oncology patients is the most rewarding and fulfilling work she has ever engaged in.

Life is learning to let go from the first to the final breath. We are alive for such a brief moment. I can remember so vividly my bedtime ritual as a little girl- clinging to my mother’s hand begging her to stay with me until I drifted to sleep, craving her nearness and warmth. And the next thing I knew I was awake, it was morning, and I was alone….feeling sadness in her absence.  Now only a few years later it seems, she is 82 with Alzheimer’s and doesn’t know who I am. Time is a funny thing.  I travel to Scotland every year to visit her. She returned in 2018 - a year before Alzheimer’s stole her memories. Scotland is in my bones because of her. Melancholy, longing and passion permeate Scottish history, music and poetry. In 1788, Robert Burns captured this ethos in Auld Lang Syne . I cry when the doleful melody plays at midnight. “Should old acquaintance be forgot and never brought to mind?” The lyrics urge listeners to cherish friendships, embrace the inevitability of change and let go of the old for the new. There’s something hopeful, frightening, and sad about letting go – of holding on loosely to life and marching toward the unknown. The yuletide song is a poignant reminder of the brevity of life, the fragility of health, the ebbing and flowing of friendships, the moments cherished and taken for granted, the wins and losses, the celebrations and disappointments. I am reminded to savor every moment, to embrace the vicissitudes of life and to reflect on the fleeting special moments that I didn’t realize at the time were going to be the last, and my total inability to slow the clock. This is not a new struggle. In the 90 th  Psalm, Moses’ cried out to God in the desert “Teach us to number our days that we may apply our hearts to wisdom.” Oh, to truly understand how little time we have! What different choices we might make if we really comprehended the brevity of life! Moses continues “The years of our life are seventy, or even by reason of strength eighty; yet their spin is but toil and trouble; they are soon gone, and we fly away.”  Oh, to make our days and hours count, for they are finite. One day I will breathe my last. No one knows this better than a cancer patient.  They did not want or ask for it, but cancer patients receive the paradoxical gift of understanding the brevity of life. Their diagnoses force them to number their days and to grow in wisdom - allowing valuable course corrections while there is still sand in the hourglass. Scrooge, in A Christmas Carol, is given the same painful gift of seeing the grim reality of the future if he remains the same man. A cancer diagnosis is a similar kind of eye opener - shocking, painful, and motivating; it changes you. A cancer diagnosis is a ghost of Christmas future in a way - A painful yet precious second chance to reevaluate, to mend, to forgive, to re-prioritize , to slow down, to cherish, to love and, yes, to let go.  New Year: new opportunities to let go and live! Every New Year’s Eve I am reminded to number my days. To count my blessings. To remember that my heart will one day beat its last. To remember friends and family, cherish them and then let go so I can make room for whatever the future holds. As the clock counts down the last minutes of the year, I remember the warmth of my mother’s love before it was taken from her, my halcyon days of youth in Scotland, my wins and losses, successes and failures, friends kept and friends lost… but, especially I remember my clients living with cancer who taught me about the courage to face their mortality, to enjoy each day as if it were the last, to let go of resentment, bitterness, and regret and to make impactful changes for a better today and tomorrow. No one knows more about the brevity of life than they do. They often find the courage and motivation to live a whole different life than they did before cancer. Knowing our days are numbered can do that for us all. Nothing like New Year’s Eve to give us that reminder - to let go and live! These thoughts fill my grateful heart as I sing along and toast my pals with bitter sweet tears in my eyes…”For auld lang syne, my jo, for auld lang syne, we’ll tak’ a cup o’ kindness yet, for auld lang syne.” About Dr. Diane Benfield Dr. Diane Benfield , DSW, MSW, LCSW, is a dedicated therapist specializing in psychotherapy, grief, depression, and anxiety. Working with oncology patients is the most rewarding and fulfilling work she has ever engaged in.

Have you ever been in a large room full of people and felt completely alone? Cancer patients sometimes feel this way in their own families. To those unfamiliar with cancer, this must seem so strange, but hundreds of patients and caregivers have reported this to me. The disease of cancer is very isolating , and certain dynamics and communication styles in families can ironically enhance  the loneliness a cancer patient feels. Sometimes families don’t realize that they are not being as helpful as they could be. Many patients and family members have reported to me that being the caregiver is more difficult emotionally than being the one with cancer. A sweet patient put it so well when she told me, “At least I (the patient) am doing something  about the disease by having chemo, getting radiation, going to appointments etc. My husband can only watch, and he feels powerless.” Below are a few challenging family dynamics that have repeatedly shown up in my practice. If you see your family in one of them, there is hope for you! There are action steps you can take to improve how you communicate with your loved one listed at the end.   1. We must be positive all the time Some families refuse to allow themselves or the patient to utter any so-called negative words or thoughts regarding the illness as they fear it will somehow bring it into being. They believe that the power of totally positive thinking (which many big thinkers call it the tyranny of positive thinking) somehow enhances survival odds. But this notion is fantasy, not reasonable or realistic, and can lead to massive disappointment. The truth is there will be difficult times on the cancer journey for every member of a family. Not being allowed to talk about these scary and sad truths is unhelpful and dishonest and can lead to burying negative emotions. 2. Let’s pretend This dishonest style of communication usually flows from the prohibition on sharing anything deemed as “negative.” Some family members and patients will simply not show any evidence that they feel fear, sadness or anger – preferring to stuff the powerful emotions deep down. Patients and family members sometimes believe that sharing their honest feelings and thoughts will “make it worse” for the other. The cancer becomes the elephant in the room that everyone pretends to not see. 3. You have to, no matter what  Some families insist that the patient get as much treatment as possible, as quickly as possible, and for as long as possible – sometimes in spite of the patient’s doubts or reluctance about the debilitating side effects. Some families pressure or cajole a patient to continue treatment against his or her wishes to satisfy their desires to “do something!” I have worked with patients who endured highly toxic treatments against their will to assuage their family member(s)’ fear that they did not do enough to “fight the cancer.” Patients are entitled to self-determination to choose their treatment or to choose not to take treatment.   4. Can’t we just get back to normal now that treatment is over? Caregivers unaffected personally by a cancer diagnosis just do not understand the concept that who the patient was before  the cancer - is gone forever. That version of the patient no longer exists. After cancer, the patient is changed forever. The changes are not all bad, but there is no going back. Ever. There is no “going back to normal.” There is growing into the “new normal - the life after cancer.” Even with complete remission, the fear of recurrence and some of the long-lasting effects of the disease and treatment do not ever go away. The patient may look like they used to on the outside, and they may be smiling and laughing, but I guarantee you, they are living with the fear of it coming back and the internal and external effects of what just happened to them for the rest of their lives. Many patients have told me that survivorship is much more difficult than active treatment. 5. Refuse to prepare for the end of life Some families just will not go there. They won’t allow end-of-life discussions or planning to occur. Perhaps they fear it may hasten death, seem uncouth, or be too painful – but, paradoxically, many amazing opportunities to deepen relationships and heal brokenness are lost when this topic is avoided. Even if imminent death is not on the horizon (and most of the time it isn’t), planning and talking about what the patient wants is never a bad thing. No one is guaranteed tomorrow. If anything, cancer at least makes us face the cold reality that we are all going to die one day. A cancer diagnosis gives an unexpected, uninvited, and yet beautiful opening to explore this mysterious area together- to plan – to prepare – to bless – to heal. To create confidence, security, and harbor no regrets.   Now, what can I do? Families can overcome these challenges if they are educated, willing to change, and motivated to grow. No one has to go through cancer alone – including family members. Get help. Imerman Angels will match the patient and his or her caregiver with a separate 1:1 mentor who either has the same diagnosis or who is related to someone with the same diagnosis to provide emotional support through a cancer diagnosis. Invest in inspirational books written by and for cancer survivors and their family members to read together, such as Cancer for Two  by Dave Balch and 50 Days of Hope  by Lynn Eib. Join a support group and open up. Through The After Cancer, you can join our virtual support groups called "Circles." These monthly sessions are safe spaces to connect with others, learn from our Care Team facilitators (all survivors themselves), and authentically discuss life after cancer with people who understand your experience firsthand. Invite your loved ones to join a caregiver support group and open up. A couple of caregiver-specific websites to get you started are: www.Caregiver.org www.cancare.org/events/cancer-caregiver-online-support-group Read The Four Things That Matter Most  by Dr. Ira Byock for four excellent ideas of what to start talking about when cancer’s shadow affects someone in your family. Lastly, consider working with a therapist who has expertise in oncology or grief and loss to help you and your loved one navigate this new landscape. It’s likely you’ve never been here before, so you have a lot to learn – and it’s never too early or too late as long as we are still alive! About Dr. Diane Benfield Dr. Diane Benfield , DSW, MSW, LCSW, is a dedicated therapist specializing in psychotherapy, grief, depression, and anxiety. Working with oncology patients is the most rewarding and fulfilling work she has ever engaged in.

Challenges of negative body image after breast cancer diagnosis When I was diagnosed with cancer, I struggled with a negative body image as I lived with one breast for over a year, then several years and several surgeries later until I reached the completion of my reconstruction process. Over the last 12 years, working with breast cancer survivors, I have come to understand that a negative body image can happen with any degree of diagnosis, whether dealing with a partial, full, or prophylactic mastectomy. Whether reconstructed or flat. But also, for those who do not have breasts removed. For some, it is the loss of feeling secure in your own body or losing trust in the body’s ability to function properly. The tendency to not feel like a whole person after a breast cancer diagnosis and intense feelings of loss can lead to a negative self-image. Tools to re-gain a positive body image Here are some of the things associated with a negative body image. (As shared by my clients over the years and some of which I’ve experienced as well) Having a hard time looking at a photo of yourself. Choosing loose clothing to hide your figure. Feeling anxious when going to a social gathering. Being uncomfortable in your body, especially with a shift in body shape and/or weight through treatment. Feeling that people are staring at you, particularly at your breasts. Developing a forward slump, to lean in to protect the area of the breasts. Understanding and being authentic with exactly how you feel about your body is a first step to gaining or re-gaining a positive body image. If you are grieving, allow yourself to feel the grief without trying to mask it for others. If you are angry, it’s important to acknowledge the anger to get to acceptance. Embracing self-love and acceptance Give yourself time, feelings of loss can come in waves. Even when you think you are ok! It is not as simple as flipping a light switch or saying, “I choose to have a positive body image”. It is a process with specific steps to take. Have a soft landing, a safe place, someone you can talk to who loves you unconditionally and will allow you to express exactly how you feel without judgement. A safe space to explore feeling of loss is integral to getting back to a positive self-image. Here are some of the tools that can help you regain a positive body image: Redirect negative thoughts with a chant such as “Cancel! Cancel! Cancel!” Develop a set of words that you can repeat when you realize you are saying or feeling negative thoughts about your body. Create and practice Affirming Statements about your body. Two goals here: 1. Focus on how functional your body is and what it does for your physical health and well-being. 2. Acknowledge and respect your body’s new unique qualities. “I am whole and beautiful and choose to honor my new body as it continues to heal and support me.” Make Self-Care a priority. (learn more HERE ) Take time in your day for a long hot bath. Take time for a daily gentle walk in nature. Build an integrative routine with massage , acupuncture, Tai Chi , etc. Make an appointment with a health coach at The After Cancer. Start a gratitude journal. Take a positive inventory of all the things you love about yourself and record them on the first page. Revisit often. Invite a loved one to do the same. Read them out loud. Record at least one thing each morning for which you are grateful. Give yourself permission to NOT step on the scales every day in efforts to lose or gain weight. Weight is not the end goal; a healthy attitude is the priority, how you feel and building a healthy immune system are the cues to follow. Give yourself grace. Understand that you may sometimes have a bad day. You’re not going to fall off the proverbial wagon of doom. Each positive step forward is getting you closer to where you want to be, even if today is a hard day. With practice and patience, soon you will be filled with self-love and seeing your beautiful essence in the reflection. Listen closely, she may be saying, “Hello Beautiful!!!!!” With love and understanding, Cheryl Lecroy. About Cheryl Lecroy Cheryl Lecroy  is a breast cancer survivor and has been supporting cancer patients for over 10 years. Her mission is to offer tools to reignite inner joy, purpose, and help reconnect survivors to their true essence; the after cancer paradigm.