Say you are considering having a ‘breast’ reconstructed after a mastectomy (removal of the breast). Ask to be referred to a plastic surgeon who has done a lot of these operations. Only someone with plenty of experience is in a position to explain beforehand exactly what result you can expect, and then to actually produce the promised result.

All of these are just examples. If you are in doubt about the experience of your doctor, ask directly how often he or she has done the procedure in question. Ask whether there are doctors who specialise in the procedure and, if there are, ask to be referred to them.

A word of warning: specialists have advantages when it comes to knowledge, experience and technical skill. However, they also tend to have a major disadvantage — they are less likely to see you as a whole person. Specialists do not take a broad view, on the contrary, they tend to take a very narrow view. Specialists tend to see their patients as caricatures, with the particular aspect they are interested in blown up out of all proportion to everything else. They may even act as though other aspects of their patients don’t exist.

Try to think of your specialists as resource people who have a lot of very specialised knowledge, some of which they can share with you. They also have special expertise which you can take advantage of, if you choose. However, even if, for example, someone knows everything there is to know about chemotherapy and is very experienced at giving it, this still does not make them the best person to decide whether you should have chemotherapy. The best person to decide is someone who knows a bit about your cancer and what you can expect from chemotherapy, and a lot about you—your values, priorities, expectations, strengths and weaknesses. That person is you.

*24/40/1*

Antioxidant Salad

4 stems broccoli

4 stems cauliflower

1 celery stick

4 large lettuce and kale leaves

4 large rocket leaves

1 handful green beans

È chopped Spanish purple onion

1 stick carrot

1/2 cucumber

10 cherry tomatoes

1 handful walnuts

Chop and mix all of the ingredients together in a glass bowl. Serve with Antioxidant Dressing.

Apple, Celery and Tuna Salad

80 grams tuna in spring water, drained (not brine)

1 green apple

2 sticks celery, sliced

1 gem lettuce, sliced

1 large handful bean sprouts

75 grams natural live yogurt

2 teaspoons apple cider vinegar

Black pepper to taste

Rye bread 1 avocado

Drain tuna and combine with the other salad ingredients. Blend the yogurt and vinegar into the salad. Season with black pepper. Serve with rye toast, thinly spread with avocado.

Brown Rice Salad

1 cup brown rice

2 stalks celery, chopped

1 handful snow peas

Sweet pepper, chopped

2-3 cloves garlic, crushed

1 small chunk of ginger, crushed

1 tablespoon tamari

1 tablespoon apple juice concentrate

1/2 lemon, squeezed

Boil the rice and drain. Add the chopped celery and sweet pepper, and the snow peas. Make a dressing from the rest of the ingredients by simply stirring them together. Drizzle dressing over the vegetables and serve.

Brown Rice, Tuna and Bean Sprout Salad

100 grams brown basmati rice

100 grams tuna in spring water, drained (not brine)

1 tablespoon olive oil

1 teaspoon tamari or soy sauce

The juice of half a lemon

100 grams bean sprouts

1 carrot, chopped

1 spring onion, finely sliced

Cook rice and allow to cool. Combine with the other ingredients.

Exotic Bulgar Salad

225 grams bulgar

400 ml boiling water

1 teaspoon salt

2 tablespoons chopped mint and parsley

2 tablespoons sunflower seeds

1 garlic clove, crushed

50 ml olive oil or flaxseed oil

50 ml lemon juice

Freshly ground black pepper

450 grams tomatoes, chopped

1 small cucumber

Mix the bulgar, water and salt. Leave to stand for 15 minutes. Add all but the tomatoes and cucumber, and leave until cold. Stir in the tomatoes and cucumber, and serve.

*228/34/5*

Comparisons to your old self or to others are counterproductive.

Train yourself to avoid comparing your current situation or self to your pre-cancer one. Avoid comparing yourself to people who are not dealing with cancer and to others who are. It is nourishing to be inspired by someone else’s achievements but defeating to compare.

Look toward building a new you as opposed to re-creating the old you.

Trying to recapture you before cancer is a goal destined for failure or at least major frustration. Your body, emotions, and perspective are different. Physically, think of yourself as building up to a new you, not back to your old self. Recognize your limits and handicaps so that you can work on overcoming the ones that can be overcome and accepting the ones that are unalterable. Emotionally, make your survival such a strengthening force that, after time for adequate healing, you feel unstoppable.

Focus on the good things that have come from your cancer experience.

Make a long list of the good things that have come from your cancer experience. Have them ready in your mind or, better yet, on a piece of paper kept in your wallet. At moments when you feel discouraged, angry, frustrated, or depressed, review your list. Although your situation may not change, thinking positively will help you see and feel it differently.

What does not kill you makes you strong.

Nietzsche’s words can apply to you. Like survivors of wars or serious accidents, you have faced a challenge greater than any that many people ever face in their lifetime. And you survived. Take pride and gather inner strength from the fact of your survival. If you can survive cancer, you can survive other challenges.

During the immediate recovery phase, when you are still experiencing physical problems and changes and when you face a host of transitional stresses, you may feel that the experience has left you weaker and more vulnerable, not stronger. What does not kill you makes you strong in the long run. Immediately following a fight or challenge the victor is tired and weak. In the long run the victor is stronger.

Break up life’s challenges into manageable pieces.

Every task, no matter how big, is composed of smaller, more easily managed parts. Learn how much you can handle, physically and emotionally, and then approach your life by focusing on the manageable. If you worry about how you are going to make it to your next checkup three months hence, just think about getting through the month, or week, or day. Ask yourself to handle what you know you can handle.

*183/32/5*

Does My Exposure to Radiation and/or Chemotherapy Increase the Risk of Congenital Abnormalities in My Children Conceived in the Future?

Most studies addressing this issue have failed to show an increased incidence of congenital malformations when the mother or father was previously treated for cancer. The conclusions are somewhat limited by the relatively small number of babies born to cancer survivors (although this number is increasing annually) and by the fact that most analyses are based on data for survivors of Hodgkin’s disease (a type of lymphoma).

There is some evidence to suggest that women previously treated with chemotherapy and/or radiation who are now fertile have a higher incidence of miscarriage.

Cancer survivors of both sexes who are contemplating pregnancy should strongly consider getting genetic counseling. In this cutting-edge field of medicine, experts in genetic counseling are best equipped to help you make an informed decision with the information available.

(for men) When Can I Think about Safely Fathering a Child?

Discuss with your oncologist your desires, needs, and concerns regarding conception. In general, you will need to wait until the quality and counts of your sperm appear satisfactory. Wait until you feel ready for the stress of a new baby emotionally, physically, and financially. Recovery from cancer entails a stressful transition, and you should take on additional major stresses only after weighing the pros and cons, and the risks and benefits to everyone involved.

(for women) When Can I Think about Becoming Pregnant?

Discuss with your doctor

•when you are felt to be adequately recovered to carry a full-term pregnancy

•when your cancer situation is felt not to be jeopardized by the normal changes of pregnancy, such as the hormonal changes

•when your cancer situation will no longer require tests that would put a fetus at risk, such as X rays or scans

When possible, wait until you feel ready to handle the physical, emotional, and financial stress of a new baby.

What Are My Options for Becoming Pregnant If My Cancer Treatment Has Permanently Decreased My Fertility (Made Me Subfertile) or Made Me Permanently Sterile?

Various options are available for women rendered subfertile or sterile by their cancer treatment. For example, some women are candidates for ovum donation (implantation of an egg from a donor). If childbearing is an issue, seek consultation with specialists in assisted reproductive techniques. The names of fertility clinics or services that specialize in this area can be obtained from your primary care giver or the gynaecology department of your local hospital. You should review with your oncologist any decisions regarding treatment for fertility before you proceed. The potential for problems or risks in your specific case as a result of proposed treatments must be considered.

*89/32/5*

How quickly your energy level returns to normal will depend on

•your energy level before you were diagnosed

•the type of cancer treatment you received

•the intensity of cancer treatment

•the duration of cancer treatment

•the type, intensity, and duration of any pain

•the presence of any depression, anxiety, or other emotional distress

•the soundness of your nutrition

•the quality of your sleep

•your hormonal balance

•ongoing medical problems, such as infection or wound healing, kidney failure, or heart failure •your ability to pace yourself

•your level of fitness

•factors that we cannot measure (cellular changes, your will to live, and so on)

•your need for medications that have a side effect of causing fatigue

In general, people need two days to two weeks to recuperate from uneventful minor surgery. Allow two weeks to three months for recovery from uneventful major surgery. Radiation therapy can cause fatigue lasting for one to five months after the completion of therapy, depending on the area that was exposed and the total amount of radiation received. Chemotherapy lasting four or more months is usually associated with fatigue that persists for six months to a year or two after the last treatment, depending upon the agents used, the intensity of treatment, and the duration of treatment. As progress has been made in the safe administration of aggressive chemotherapeutic regimens for previously uncontrollable cancers, fatigue has become a more common, and often more debilitating, problem.

In general, the more intense your treatment, the worse your symptoms. Exposure to more than one type of treatment—such as surgery plus radiation, or radiation plus chemotherapy—has a cumulative effect on energy levels. The presence of other fatigue-inducing factors, such as anemia or malnutrition, will exacerbate that due to cancer treatments.

These guidelines are very general. Many patients, usually those requiring relatively little treatment, bounce back to their precancer state of well-being quickly. Most people who have received a significant amount of radiation or chemotherapy take weeks to months to feel well consistently. Fatigue is universal after rigorous treatments such as high-dose radiation or chemotherapy requiring a bone marrow transplant, and it usually persists for at least a year or more.

Recognize that many unmeasurable factors affect energy, making it impossible to provide an accurate prediction of when you will feel normal in terms of energy. Although for most survivors fatigue is a temporary, if protracted, problem, for some it becomes a chronic disability, especially if factors that contribute to it persist indefinitely.

Two thirty-six-year-old women had the same type of leukemia and were simultaneously given the same treatment regimen prior to their bone marrow transplants. One year later they were both in remission, but one felt well; her bone marrow had recovered completely, and her blood counts were normal. The other suffered from debilitating exhaustion because her bone marrow had never recovered fully, and she remained anemic. Unless her bone marrow recovered—an increasingly unlikely event the longer she went without improvement—low energy levels would continue to be an issue.

Your treatment changed your body’s physiology, at least temporarily. Something else changed during your treatment, something that had nothing to do with cancer or treatment: you got older. The same intense treatment regimens that are administered over many months, or even years, demand a longer time interval between “before” and “after.” The passage of six to eighteen months of treatment plus another six to twelve months of recovery means you will be comparing yourself to how you were at least one to two years earlier. If you felt poorly before your diagnosis, the time since you last felt well is even longer. A few years might not seem like a lot of aging, but healthy twenty-year-olds often notice a difference in stamina compared with when they were eighteen; forty-year-olds, compared with when they were thirty-eight; or sixty-five-year olds, compared with when they were sixty-three.

*62/32/5*

Is It Okay to Go to The Doctor for Every Little Lump or Cough?

If you develop a cough or a lump that concerns you, make an appointment to go to your doctor as soon as possible and have it evaluated. If you are not sure whether it needs evaluation, call your doctor’s office for advice. You deserve to find out whether the problem needs attention or not. You deserve a speedy evaluation if the problem does warrant medical attention. Having a plan of action for problems will relieve everyone’s anxiety before and when problems arise. The earlier you go for evaluation,

• the less time, energy, and emotion you will waste worrying about whether or not you should

have it evaluated

• the less time you will have for your imagination to work on all the possible outcomes

• the less time a real problem will have to get serious

What If I Feel like a Hypochondriac?

A hypochondriac is someone who suffers from imaginary illnesses or problems. We use the term loosely to apply to anyone who seems overly concerned about his or her health.

After cancer, just as after a heart attack or after being treated for asthma, you are entitled to be a bit of a hypochondriac, especially in the first few months after therapy. It is adaptive and beneficial to you to be tuned in to your body’s signals, especially when you are still adjusting to its changes.

Be safe, not sorry. It is better for you to call or see your doctors about a small problem and have them reassure you that it is nothing significant than to wait with a problem in order to avoid being considered a hypochondriac and end up with a more difficult problem to treat.

One survivor did not hesitate to put her family through the stress and expense of having her mild back pain evaluated. Another survivor tried to avoid the appearance of a hypochondriac, and to minimize her family’s stress, by enduring a similar pain. The first survivor found out she had a pulled muscle and had it treated before there was any significant impact on her health or the family. The second woman got progressively worse. Her pulled muscle went into spasm, causing her to favor it and strain other muscles. The stress of worry caused her to develop an ulcer and her family relationships to become tense.

Doctors expect patients who have had cancer to be tuned in to their bodies and to be more concerned about common symptoms than a person who has never had cancer. Do not worry about being a hypochondriac. Do the right thing: listen to your body, and get yourself checked.

*149/32/5*

What Do My Children Need?

Children require continuous satisfaction of their basic physical and emotional needs. You have to provide food and shelter, transportation to school and after-school activities, love, and comfort for their hurts.

Your children have to understand what they see going on around them, on their level. They will try to understand why you are tired or why you are still going for checkups, whether you talk about it or not.

Your children need reassurance that their needs will be met. Although their concerns may pale next to yours, fulfilling them offers great stability. Birthday parties may feel like a stressful inconvenience to you, but they are important to your children. Postponing or canceling these celebrations would disappoint them and could cause them anxiety by conveying the message that something is seriously wrong.

Remembering these three basic needs will help you prioritize your responsibilities to your children, and find the right words to comfort and reassure them:

• satisfaction of their physical and emotional needs

• a truthful explanation, appropriate to their age, of what is going on

• reassurance that their needs will be met

Do I Have to Tell Them the Truth?

It is crucial that you tell your children the truth, in order that they can trust you. The importance of this trust is amplified by the uncertainties and stress surrounding your health. Children are resilient and can handle challenge, loss, and uncertainty. They can accept your losing a body part or function, needing ongoing treatment, or living with a chance of recurrent cancer. When they see you as the same loving, caring parent despite physical changes, they are learning a powerful lesson about the value of the inner self and the triviality of appearances. Telling white lies to protect them (“My cancer cannot come back”) handicaps them by making their world unreliable and untrustworthy.

Good communication with you is your children’s best defense against frightening news stories or people’s gossip that may give wrong information about cancer and about your condition.

If you achieve remission, you would naturally like to reassure your children that your cancer will never come back. This would seem to protect the children from worrying about recurrence, as well as to help you believe that you are going to stay well. Unless you have a 100 percent guarantee that you will not have a recurrence, you are taking a risk that can destroy the foundation of trust between you and your child. If you ever develop recurrent cancer, or your child learns that most cancers have a chance of recurrence, you will either have to continue the lie or admit to having provided erroneous information. It will be less stressful for you to help your children adjust to the truth than to maintain an untruth and worry about being exposed.

You can minimize your children’s fear and anxiety about the truth by choosing how much you tell them and how you tell them. If you explain, “The cancer is gone. My doctors think that it won’t come back. If it does, I’ll get more treatment. There might be a new, easier way to treat it by that time, too. I’m going to plan on its not coming back, but if it does, I’ll be ready to be treated again. We dealt with my cancer this time, and we can deal with it again,” you offer truth, comfort, and hope in the same breath. This is the key to communication with children.

*122/32/5*