Wendy Harpham on Healthy Survivorship

A Cancer in the Family

If you ever wondered if you might be at increased risk of cancer because a family member has or had cancer, this book is for you: A Cancer in the Family by Theodora Ross, MD, PhD.

Colonoscopy Comparison

Colonoscopy naturally makes you think of all the inconvenience and yuck. Here’s the problem: If you compare the colonoscopy experience to your normal routine, you might be tempted to delay (or decline) the cancer screening test.

Accepting Uncertainty

"Doctor, will my illness return?" If the answer is "maybe," the uncertainty can cause suffering in patients who are doing well now. Since you can't live as fully as possible (the second criteria of Healthy Survivorship) if you are overly anxious, let's talk about how to accept the uncertainty, both intellectually and emotionally. 

An essential step is to get good medical care. Receiving accurate information and making wise decisions with your physicians helps calm anxiety, even if the facts are upsetting. Knowing that you are doing the best you can brings calm and confidence. After all, "best" is the best possible. 

Use self-talk:

• "Illness doesn't make life uncertain; it merely exposes the uncertainty of life."
• "Uncertainty is unsettling." 
• "More than I want the comfort of certainty, I want the reality of being as healthy as possible, even if it means living with greater uncertainty."
• "I can enjoy today, even when tomorrow feels uncertain."
• "I will enjoy today because tomorrow is uncertain."

Take action:

• Pursue activities that occupy your attention. 
• Find some small way to celebrate today.
• Get some exercise (doctor-approved).
• Do something to help someone else.
• Use meditation, yoga, prayer.
• Talk with someone who understands and can help (e.g.,a co-survivor, support group, counselor)

If anxiety persists, notify your physicians, because your medical condition and/or medications may be causing or exacerbating anxiety. And they may be able to adjust your therapies without compromising your recovery-- and maybe even enhancing it.

Disease and Uncertainty

In "When Do You Give Up on Treating a Child" Esther Levy concludes, "'There are only two states after such a diagnosis: disease and uncertainty." Both sound terrible.

Hope and the Desire for Certainty

My blog posts on The Riddle of Hope hint at the complexity of hope. To address hope and the desire for certainty, let's explore further the story of Esther and Dan Levy, parents who gave up hope of their son's recovery (When Do You Give Up on Treating a Child).

Riddle of Hope Part II

In my post on exceptional responders. I wrote that patients need to have hope to have a chance of being an exceptional responder. Yet in my last post I shared the story of a little boy who became the exceptional responder after his parents gave up hope. What does that tell us about hope?

The Riddle of Hope

Esther Levy, a mother who describes her family as “the luckiest of the unluckiest people in the world” offers an inside view of her struggle to balance hope and fear. Her story may lead to new insights about the challenge of figuring out what to hope for when the outcome you want most is not likely.

The Dilemma of Hoping to be an Exceptional Responder

To be an exceptional responder, you must maintain hope that treatment will work for you, even if it rarely works in patients like you.  My concern about success stories like mine and Ella Remmings' is that some people draw the wrong conclusion from stories of exceptional responders. 

Are You Going to Be An Exceptional Responder?

If your treatment options offer only a small chance of improvement, how do you know if you should proceed with hope of being an exceptional responder? It's a question Ella Remmings addressed in her email message mentioned in my last post.

Exceptional Responders and Healthy Survivorship

Perhaps the greatest challenge for Healthy Survivors is deciding when it is time to let go of hope that treatment will help. "If I believed the statistics," Ella Remmings emailed me, "I would have been gone a long time ago. My chance of surviving Stage IV gallbladder cancer for five years was a whopping 5%. My oncologist said it would be more like six months. I was only 45."

Theories and Facts

Scientific theories have been getting a bum rap, which hurts everyone. Part of the problem has to do with people confusing the scientific term with the colloquial use of the word "theory."

Personal Note

If you're wondering why I haven't posted much lately, it's because I've been happily adjusting to my new name: Grammy.

Good Posture and Healthy Survivorship

What does good posture have to do with Healthy Survivorship? 

What I Hate More Than Soliciting Donations

Do you know what I hate more than soliciting donations? I hate underfunded trials slowing progress in finding more effective and less toxic treatments.

Lesson on Action in Beckett's "I'll go on."

Healthy Survivors influence their outcome positively through proper action.

Lesson on Hope in Beckett's, "I Can't Go On."

"I can't go on. I'll go on." A look at Samuel Beckett's famous declaration offers insights about hope and Healthy Survivorship.

When Breath Becomes Air -- Lesson 2 (Informed Consent)

Here's a second lesson on Healthy Survivorship found in When Breath Becomes Air:  Informed consent is a process that involves sharing information and strengthening healing bonds.

If Patients Feel Guilty

A perceived or real delay in arriving at the diagnosis of advanced cancer can cause distress that becomes an obstacle to Healthy Survivorship.

When Breath Becomes Air -- Lesson 1 (Patient Delay)

When Breath Becomes Air offers lessons on Healthy Survivorship. One is about dealing with a delayed diagnosis.

When Breath Becomes Air -- Why It Succeeds

Why does When Breath Becomes Air succeed where so many other books fail or, at best, only come close? Using memoir format to offer useful lessons on life, author Dr. Paul Kalanithi had the exceedingly rare combination of all the following:

Dr. Kalanithi -- A Healthy Survivor

Dr. Paul Kalanithi's spectacular writing is the vehicle for sharing his clear and useful insights on facing death.

After the release of Kalanathi's best-selling book, When Breath Becomes Air, a NYTimes interview with his widow, internist Dr. Lucy Kalanithi, sheds light on the role writing the book played in their shared experience with his dying and her experience with moving on.  

Pushing to Your Limits--Part II

In my January 7th post I asked: How do you know if you are pushing yourself too much during or after cancer treatment? My first piece of advice was to discuss your symptoms with your physicians. What if your physicians cannot give you a clear answer?

Pushing to Your Limits

For Healthy Survivors dealing with aftereffects of past surgeries and/or medical treatments, a key question is: How do I know if I'm pushing myself too much?

Tears and Healthy Survivorship

Susan Gubar's latest entry in her Living with Cancer Series (NYTimes Well Blog), titled Shedding Tears, is filled with insights about tears and Healthy Survivorship.

Painful Platitudes

I regret the times a stupid platitude popped out of my mouth in my efforts to comfort or support. Sadly, I'll continue to screw up because platitudes are ingrained in our culture of comforting. My hope is that the more I talk about the problem, the fewer times I'll say something that mght harm another.

Death of Cancer

This new book offers insights into where we are in curing cancer: The Death of Cancer: After 50 Years on the Front Lines of Medicine, a Pioneering Oncologist Reveals Why the War on Cancer is Winnable -- and What We Need to Do to Get There. 

Audrey's Story of a New Beginning

My 10/27/15 post introduced New Beginnings: The Triumph of 120 Cancer Survivors. Here are insights gleaned from Audrey Orr's new beginning.

Thanksgiving 2015

 Thanksgiving 2015 is a letter to my daughter, a 3rd-year resident in internal medicine. The confluence of my oncologist's retirement and my 25th Anniversary Thanksgiving stirred thoughts about the doctor-patient relationship. 

What if Watching the News Upsets Me?

For people dealing with illness, the evening news can present a dilemma: "Watching the news upsets me. Not watching gives my illness control over my life." 

Lessons from a Healthy Survivor of Metastatic Cancer

You can be a Healthy Survivor, whatever your diagnosis or prognosis. Journalist Jody Schoger offers lessons on living with cancer that are useful lessons in Healthy Survivorship, such as (edited):

25th Anniversary Thanksgiving

November 13, 1990 was a Tuesday, the day a cancer diagnosis changed the direction of my life. 25 years later, as I explain in my forthcoming "Thanksgiving 2015" column in Oncology Times:

Dropping a Seriously Ill Friend

Nurse Carol A. Miele writes about her life with Stage IV breast cancer to help people understand and talk about the challenges many such patients face in their efforts to embrace life.

When Minutes Matter

Dr. Toby C. Campbell offered a useful insight on end of life in "When Minutes Matter." The oncologist's essay opens with: "The day I realized I had bucket lists all wrong..."

Turning Survivors' Guilt into Joy

Ruth Pennebaker's eloquent essay, Sisterhood of Memories, gives voice to the complex emotions that often accompany long-term survivorship.  

New Beginnings

New Beginnings: The Triumph of 120 Cancer Survivors captivated and surprisingly inspired me. It breathed new life into one of my core beliefs about Healthy Survivorship: People can set the stage for living as fully as possible by choosing to use their illness as a positive force in their life. 

Active Surveillance and Cure

In a few clinical situations, patients with a potentially curable  low-risk cancer have the treatment option of active surveillance. What is active surveillance and what are the challenges of pursuing that option?

Birthday Post

After another trip around the sun, I am beginning my 62nd year with a post about celebrating. I actively try to celebrate every single day by...

Widow's Wisdom for Healthy Survivors

My last post referred to Rachel Ward's FAQs on Sudden Widowhood, with her wisdom for Healthy Survivors. Here is one pearl.

FAQs on Sudden Widowhood

What's a post on widowhood doing on a blog dedicated to Healthy Survivorship? 

Why It Takes So Long to Get Test Results - Part IV

If my scans are completed and the results are available, don't I have a right to know?

Why It Takes So Long to Get Test Results - Part III

To shorten patients' wait, why don't nurses relay scan results to patients?  Given that I desperately want to minimize the time patients wait for results, here are reasons why I think that is not the answer. 

Why It Takes So Long to Get Test Results - Part II

Many reasons explain why it can take so long to get test results. I strove to get results to my patients as fast as possible, especially when their waiting was stressful. But even more than I wanted to deliver news quickly I wanted to deliver news well.

Why It Takes So Long to Get Test Results

I welcome disagreements, such as a response to my September 9th post on how clinicians can help minimize patients' scanxiety. A reader posted, "The pollyanna spin/advice on this may help some. For me, I'd just roll my eyes and say, 'You're kidding. Right?'"

How to Minimize Scanxiety

My prior post addressed steps clinicians can take to help minimize their patients' scanxiety. Here's an excerpt from my patient handout, Waiting for Test Results:

Helping Patients Minimize Scanxiety

A common problem among cancer survivors is scanxiety: the anxiety elicited by undergoing and waiting for the results. As a Healthy Survivor, I've explored how to minimize scanxiety. in Minimizing Scanxiety" I've shared with clinicians what I've learned.(Oncology Times July 25, 2015)

Over-reliance on Tests -- Part III

Here's a third lesson embedded in "Over-reliance on Tests: Why Physicians Must Learn to Trust Themselves and Their Patients": Give credit where credit is due after an undramatic recovery. 

Over-reliance on Tests -- Part II

As a follow-up to my August 20th post   on "Over-reliance on Tests: Why Physicians Must Learn to Trust Themselves and Their Patients," here's a lesson on false negatives found in that essay.

Over-Reliance On Tests

An essay for clinicians, Over-Reliance On Tests: Why Physicians Must Learn To Trust Themselves And Their Patients, offers a few vital messages to patients in pursuit of Healthy Survivorship. The first is to make sure your doctors are listening.

Worst Day Ever?

This poem by Chanie Gorkin has gone viral, and I can see why. In the pursuit of living as fully as possible (the second criterion of Healthy Survivorship), let me share her poem here:

Healthy Survivorship and Letting Things Go -- Part V

So how do you let things go, when letting go is difficult to do?