Angelina Jolie, gorgeous woman she is, broke silence by courageously offering knowledge to all of us she chose a double preventive double mastectomy in an op-ed piece, New York Times.  She lost her mother to ovarian cancer and Angelina carries a gene that could result in breast and ovarian cancer.  For her, what made sense was to have her breasts removed before cancer could erupt.

Women will forever remember Angelina Jolie making this decision.  She has taken leadership, opening the door by her own example, to women who are or may be in challenging process deciding for themselves what to do.

Never an easy decision, coming often with tremendous emotion, women must find their own voice, clearly deciding what is best for them when making the choice of preventive mastectomy, separate from Angelina Jolie.

While being proactive is often empowering, feeling “right on”, “yes let’s do this”, consequences of emotional turmoil on down the line often surface.  Feelings of anger, depression, loss, overwhelm, and/or anxiety jump in as one deals with “after effects” of their decision to have a preventive mastectomy.  It needs to be said, these emotions are normal, regardless of what decision a woman makes, preventive mastectomy, “watchful waiting” or making another choice.

Women must have choices.  They must have gene testing available to them no matter cost or insurance.  And they must have tools to deal with emotional “spill-out” affecting their wellbeing, whatever course of action they take.

Angelina Jolie and all women making decisions about their physical health are also dealing with their emotional wellbeing. How will we ensure their emotions are cared for before, during, and after… whatever path is chosen? Hugely important and necessary to consider, unquestionably!

How are you or your loved one dealing with  the emotional wellbeing aspect?

Q

My wife had lung cancer, and passed away after terrible suffering. I feel lost now and so guilty… Please what can I do, I don’t have any medical insurance.

A

I’m so sorry to hear about your wife’s passing and appreciate your writing to me.  It’s not unusual to feel lost or guilty while grieving.  I recommend calling your wife’s treatment center and asking about a grief (bereavement) group and/or talking with a psychotherapist or social worker.  These services are usually free of charge. Both the group and the therapist can provide support as well as guidance through grieving.

Grief is not easy and cannot be avoided, better to allow yourself to feel what you feel.  Be easy with yourself, moving with grief.  Time does help, tears heal, and you do move forward at your own pace.

Triangle breathing is a great tool to use for effectively decreasing stress whether you are  cancer patient or caregiver.  You can use triangle breathing when you’re sitting in the waiting room, having a difficult conversation with a family member, or while you’re relaxing.  The only time NOT to use triangle breathing is when you’re driving.

Draw a triangle on a piece of paper in your spiral notebook.  On the outer left side of the triangle, in the center of the line, write the letter I.  On the outer right side of the triangle, in the center of the line, write the letter E.  On the outer edge of the bottom, in the center of the line, write the letter P.  I is for Inhale, E is for Exhale, and P is for Pause.

Take a deep breath saying “inhale” silently.  Breathe in slowly,    I N H A L E.  Then exhale slowly, saying E X H A L E silently, as you breathe out.  After you’ve exhaled, say the word P A U S E silently.  In the pause, nothing is going on.  You are not inhaling and you are not exhaling.  You are simply pausing.  When you are pausing work with thinking P A U S E 1, 2, 3, 4.  If the pause feels too long, adjust the numbers to feeling comfortable.

Once you’ve tried the exercise several times, you can substitute:  a favorite word, phrase, or color for the word “pause” and for the counted numbers.  For example, inhale slowly, exhale slowly, then say PEACE or CALM or BLUE.  Drag these words out to a count of 4 to get your full pause, or whatever is comfortable.  Using this tool, choose a meaningful word, color, or phrase for enhancing relaxation.

You will want work with this tool before you need it, as it is a skill requiring practice for its effectiveness. I think you’ll find it very handy to keep with you, using as needed.

What tools do you use for decreasing stress?

What if you heard what your own voice had to say…Listen…                                

We aren’t so much schooled in listening to our own voice.  Rather, early on, we become very accustomed to our parents, teachers, coaches, ministers, etc giving us relentless advice on what to think and on what to do.  As adults, we are handed further advice from partners, spouses, extended family, bosses, and friends.

But where is your own voice?  Where is the part that guides you in everyday life and in disease?  Where is resulting peace from listening to your own self?

Cancer tends to escalate listening to other people and rightfully so.  Now, instead of a primary care doctor giving you advice, you have a team of doctors giving you advice.  Now, instead of talking with one nurse, you have a team of nurses, and a team of “healers” caught up in getting scans, chemo, radiation, etc.

How do you, can you, listen to your own voice, when all around you many people—family members to medical team are “advising” and “suggesting”.  And how do you, can you listen to your own voice when you are surrounded by statistics of those that were successfully treated and those that weren’t or by cancer stories from well-meaning family and ones you meet perhaps in the waiting room or standing in line at the grocery store?

How do you come back to you?… to your own clear voice, your own thoughts and ideas, your own decisions and your very own self?

You take time outs, you surround yourself with nature, you write, you draw, you listen to music, you ask yourself what you think, what you’d like to do separate from the bounty of others advice and directives.  In effect, you are creating a room of your own, real or imagined…a place where you consult with you.

Giving yourself “room” to discover your own thoughts and feelings results in a certain inner strength and wisdom.  You still feel normal anger, despair, worry, fear, and overwhelm, but underneath, you now have a foundation of “you” becoming ever stronger with time spent here, in this room.

Backing yourself up allows for listening more clearly to your medical team, and taking appropriate action.  It allows for family, friends, and others to offer their stories and advice.  .  It allows for a certain unshakable clarity not often found when not tended to. You with you….the best of best!

What if you heard what your own voice had to say?  Does it matter?

Think of a camera.  You can zoom in for a close-up or you can take a regular picture.  Using the same idea, you can check in with yourself to see how things are going by zooming in.  Ask yourself: “how am I feeling”; “how are things going in my world”; “how am I in my immediate surroundings”.  Then, zoom out:  How am I in the “big picture” in relation to family members and friends; my community; life in general.  Using Zoom In/Zoom Out gives you a quick reading of how things are going from a balanced perspective.  Any adjustments need to be made up close?  How about in the big picture?

With anxiety, zooming out in particular provides relief.  Since anxiety tends to be focused on what’s in your immediate, “up close” attention, choosing to pull back (zoom out) brings perspective and balance.  For example, “I’m not the only one who has gone through this”.  “I wonder if I could find resources in places I haven’t even thought of”, leading you into problem solving and away from various degrees of anxiety.

With depression as with anxiety, zooming out is very effective.  Like anxiety, depression is caught up in the immediate, “my sadness, my disconnect from life”.  You can get so focused on “your own” picture (zoomed in), forgetting life outside of your “up close” world offers quite a lot.  Pulling back, you begin to re-connect with life seeing the “bigger picture”.  For example, “other people have concerns and they’re actively participating in various ways”.

How can you use this tool most effectively?

In what circumstances?

What you tell yourself matters.  If your thoughts are centered on “I can’t handle this” self-talk, or if you continually use the “I can’t handle this” phrase in talking with your family and friends, you are setting up a self-fulling prophecy.  You start really believing you, in fact, can’t handle the situation.  But you are telling yourself a lie.

You CAN move through whatever is going on for five minutes at a time.

If five minutes at a time is too much, go for two minutes at a time, or sometimes one minute at a time works even better.

Use self-talk like, “of course I can handle XYZ for five/two/one minute at a time”.  “I may not know how right now, BUT I Will Get Through This!”

Take action with your self talk and keep yourself moving forward.

How do you keep yourself moving forward with self talk?

To quote from L. Marie’s guest post,  “Why was I walking around cancer-free and she wasn’t? Why did one of my best friends and my own mother die of metastasized breast cancer and I’m walking around just fine from my Stage 2A diagnosis from a few years ago? I didn’t understand. I wanted to understand!”

Exactly.  The “why” can be emotionally excruciating.  Understanding the why seems like it would solve survivor’s guilt.  As L. Marie points out no one in fact know why.

COULD SURVIVOR’S GUILT BE SIMLIAR TO GRIEF?

I wonder if it is possible to think of survivor’s guilt as similar to grief.

By its very definition guilt comes from doing something wrong, but you of course, didn’t do anything wrong.  Instead perhaps you’re filled with grief, sadness for your loved one and what they are going through….grief that your loved one is going through a more challenging, difficult cancer.

Grief and grieving are such a normal part of cancer both in life and in death.  Allowing yourself to cry, to scream, to get angry, to feel despair is all part of healthy grieving.  You may find yourself crying one minute, angry the next, and deciding you are just fine in the next (though you don’t really feel just fine).  Expect this.

COPING

Give yourself permission to grieve.  Share your grief with others and have time by yourself to grieve.  Important!

Give yourself some TLC—some Tender Loving Care.  This is a good thing to keep in mind throughout grieving.  Grieving calls for being especially gentle and loving with yourself, continually finding ways to soothe and ease the emotions you are experiencing.

Grief and smiles do not often go hand-in-hand.  Yet, taking a bit of time to smile is helpful for lightening the weight of grief.  Some people feel guilty when they smile while going through sadness, but it’s okay to smile.  What one thing could you find right now to smile about?

If grieving is interfering with functioning in your activities of daily life, schedule a time with your doctor.  Sometimes grief can be so deep and intense medical intervention is needed.

What has been your experience with survivor’s guilt?

Do you think survivor’s guilt is similar to grieving?

Why was I walking around cancer-free and she wasn’t? Why did one of my best friends and my own mother die of metastasized breast cancer and I’m walking around just fine from my Stage 2A diagnosis from a few years ago? I didn’t understand. I wanted to understand!

I consulted with my friends who said that my change in diet probably had a great deal to do with my current good health. I reluctantly agreed but I still didn’t feel any better. For weeks, no months, I kept asking myself why I was saved from a reoccurance. I should have been so happy, but I was just so full of guilt that I was alive.

After seeking out advice from a mind-body wellness expert, I came to accept that life isn’t always fair and sometimes that unfairness isn’t always going to be with me. In addition, I consulted with an oncologist who indicated that my genetic makeup probably had something to do with it. Even though I was ER+/PR+/HER2+, I was BRAC1 negative and BRAC2 negative. I was and still am a good weight for my height and, as I stated earlier, I eat well and stay active.

The bottom line is that no one really knows why cancer behaves the way it does. The only thing any of us can do is our best to reduce our chances of a reoccurance and be a positive influence for those around us. And sometimes that positive influence comes in the forms of tears.

L. Marie Shadwick is an early-stage breast cancer survivor and author of the book, “Have Cancer and Eat Cake, Too.” To learn more about her story, go to http: //www.memory-builders.com .

I had a question on twitter from a woman asking about uterine cancer and lynch syndrome (a genetic digestive cancer, can include further impact for women).  Living in “the unknown” pops out dramatically within cancer and many other concerns linked to cancer.

Answer:

How does one deal with living in “the unknown”.  It’s not easy and it’s very normal to have all kinds of emotions flowing through you.

~feel what you feel: scared, confident, sad, disappointed, hopeful, numb, worried, whatever you feel.  (If you’re feelings are interfering with your daily functioning, definitely talk with your doctor.)

~stop the “what if ” thinking game in its tracks.  What if the cancer spreads, what if the medical treatment isn’t effective, what if I die?  ”What if” thinking is destructive and a game you cannot win.  Be on the lookout for these thoughts, catch them quickly and distract yourself by choosing other thoughts or actions.  Watch the little girl skipping down the block, turn on a good movie, make your list of errands, wonder what kind of bird is outside chirping, or cuddle with your pet. You know how to distract yourself in a healthy way, become an expert at it.

~ask yourself frequently is this thought helping me or hurting me? Answer and take needed action.  Specifically, if your thought is helping you, keep thinking it.  If it’s hurting you, think of a thought that would in fact be helpful.  Example:  I just don’t know what’s going to happen to me….instead… that’s true, but now I’m going to think about watching my team play.  That’s true, but now I’m going to wrap this package.  That’s true, but now I’m going to….

It’s not easy, but you can work with “the unknown” by focusing on right now and using distraction.

Please, let me know how these tools work for you.  Thank you for asking!