The grieving process

For many of us, the ‘festive season’ is anything but festive as it reminds us of loved ones lost, or of easier, healthier times. Clinical psychologist Marc Lipshitz has written three blog posts that will help you through the grieving process. This is the second.

Grieving is an active process that the griever needs to engage with. It does not passively happen to you but requires hard work and effort. Grief involves choices in coping because we can also choose not to grieve.

Think of a past or current loss that you have not fully grieved. What was or is the reason for this? See if the list below resonates:

• Fear of having to deal with prior losses (as current losses trigger previous losses)

 

• Fear of the unknown and change (especially if this is your first significant loss)

 

• Having other commitments or being too busy(as a result lacking the time)

 

• Being overly medicated (psychiatric medication can numb/dull feelings if the dosage is too high)

 

• Fear of going crazy, losing control or becoming depressed (as a result fear of being trapped in a depression)

 

• Experiencing too many losses at once (this is referred to as bereavement overload)

 

• Lacking the right support (support availability is not the same as support satisfaction- I can have lots of people around me but not one person that I can turn to)

 

• Already being disconnected from your feelings at the time of the loss (in other words I arrive disconnected)

 

• Having difficulty tolerating strong emotions (thus soothing feelings with substances or food and never feeling the feelings)

 

• Believing it was not culturally acceptable to mourn the loss (especially if there was stigma around the death, for example, HIV/Aids or suicide)

Grieving is a non-linear process that occurs cyclically with no specific end point. It involves alternating periods of intensification and subsiding of symptoms. Symptoms may return for years after the loss. The grieving process is highly personal and individualistic involving progress and setbacks- four steps forwards and three steps backwards.

One benchmark of grief that has been processed, and worked through is when the person is able to think of the deceased without pain. There is always a sense of sadness but it is a different kind of sadness- it lacks the wrenching quality it previously had. The griever is able to stay connected to the deceased by redefining the relationship whilst reinvesting his or her emotions into life and in living…

Grieving mindfully

For many of us, the ‘festive season’ is anything but festive as it reminds us of loved ones lost, or of easier, healthier times. Clinical psychologist Marc Lipshitz has written three blog posts that will help you through the grieving process. This is the first.

Grief is a personal journey never the same for any two people, and as unique as your life and your relationships.

Grief may be the experience of continuing to love someone after they die, of longing for a loved one’s presence, and yet knowing that is no longer available. However, grief is not limited to loss through death. Every time you lose a relationship or are faced with uncertainty, you grieve the loss of a predictable and safe world. You experience grief when you move to a new town, lose a job, or go through a divorce. You experience grief when you are diagnosed with a life-changing illness, or when you are separated from a loved one by circumstance. You experience grief when you experience any change in your relationship with yourself or to the world.

Paradoxically, it is often when you try to resist the intense emotions of grief that they linger, and even hurt more deeply when they inevitably surface. Grieving is the process of using your emotional vulnerability not to suffer greater distress, or to intensify your pain but to redirect this pain toward your growth as a human being.

Engaging in this process begins when you come in full contact with yourself and learn to ride the waves of grief. Your thoughts, your feelings, your identity during a life-threatening illness or after loss of a loved one all become vehicles for your own evolution.

Grieving can be understood as making the decision to allow yourself to mourn, and to fully experience the lessons of grief with the goal of living life better. The terrible emotional pain of grief tends to have a life and process of its own. Allowing the process to unfold does not remove all distress but it can soften the sharp edge of pain. To allow the process means to allow yourself to feel and experience each day on its own terms; we cannot assume that we know what tomorrow will bring.

As you are experiencing this process, you will feel that very natural pull to escape or numb yourself from the pain. However, by being aware of grief rather than ignoring or denying it, and by working to understand what drives this pain, you can release yourself into the person you are and the person you want to be. In other words, you can move closer to the people in your life who matter the most, and begin to change habits or beliefs that have been keeping you from living fully.

Just as love depends on the courage to share yourself with another person, grieving depends on the courage to accept your own feelings.

We have a tendency to associate grief and distress with something being wrong. Loss and grief is a part of life. It will happen no matter what we do. If we view grief as a problem, we will think of one of the most natural parts of life, and love, as a pathology or “disorder.” But grief has always been part of the order of things, and it always will be.

Basic banana body builder

If your appetite is suppressed, if you need to build up muscle, if you need to put weight on, or if you are worried about insufficient protein.

4ozs (100g) plain tofu (silken tofu makes a smoother drink)

1 pink (500ml, generous 2 cups) soya milk

2 bananas

2 tablespoons organic maple syrup

1 tablespoon slippery elm powder

2 teaspoons vanilla essence

Whizz together in a goblet blender or food processor until smooth and creamy

If you have difficult drinking from a glass, use a teaspoon and eat it from a small bowl like dessert, or add more soya milk to thin it and use a pretty straw.

 

Try any of these additions or flavour variations

2 tablespoons ground almonds

2 tablespoons cooked brown rice/millet/oats

Any fresh fruit – try mangoes for a real treat

Soaked or cooked dried fruits

1 teaspoon honey or concentrated apple juice

1 tablespoon organic, sugar-free preserves

THANKS TO DR ROSY DANIEL, WHO HAS GENEROUSLY SHARED THE CANCER LIFELINE RECIPES WITH US. THIS RECIPE IS FOR THE TOUGH TIMES, FOR USE WHEN YOU ARE VERY ILL, DURING TREATMENT, WHILE THE APPETITE IS POOR AND THE WEIGHT LOW.

 

What is normal?

Let’s normalise a few things right now:

• There is no “right way” to make sense of what a cancer diagnosis means in anyone’s life
• We can’t expect everyone to react in a similar way, or say the same things as anyone else – each person is unique and of course their response to their cancer treatment will be individual as well;
• It’s very common for people to feel confused, disbelieving or angry when newly diagnosed, but this is not true for everyone;
• Sometimes our bodies even respond to the stress and shock with physical responses – headaches, nausea, diarrhea, sighing, poor sleep patterns etc; and
• Often people look forward to the end of treatment, but sometimes folks feel fearful, uncertain, or more emotional than they did during the treatment.

Blog by Clare Manicom, Oncology Social Worker

The importance of psycho-social care

First up, let’s be clear that our precious family members and our special friends cannot be our therapists.  The honest ones among them will tell you that they really don’t want to be our counsellors either – they just want to be their normal selves – mom, friend, cousin etc.

Then, while we’re being honest – most of us try to protect the people we love from the ugly, ungrateful, hurtful, or dark thoughts that we have around the topic of cancer, its treatment or an uncertain future.  Which makes it hard to truly share with any one person exactly what we’re thinking or feeling.

• We edit what we share
• We filter what we hear
• We are selective about what we remember

So suddenly it’s very clear that actually, it’s pretty tough chatting through our deep emotions with people who are important to us.  We might not have the words to say what we’re feeling, we might not know what to think.  We usually don’t even know where to begin with our emotional “stuff” that we’re told we have to “deal with”.

And that, very simply, is why it is so helpful to meet with a neutral, objective, trained and skilled person when you’re feeling scrambled, low, overwhelmed or plain pissed off.  It is a huge relief to offload on someone whose job it is not to judge you, but to listen to you.  Their job is to calmly provide a safe space where you can say what’s on your heart, cry or rant without hurting anyone’s feelings.

There will be times when that professional needs to challenge your opinions or perceptions, or may need to provide you with clear information that will help set you on a better path.  There are times that your listener may probe a little deeper, or may ask you questions that make you think and reflect more carefully – all this is part of your healing journey.

Seeing someone for emotional support might mean having a few sessions to examine different issues or concerns, or practice new skills in between sessions.  You will not always come away from a session smiling and jumping for joy – sometimes we need to have a “heavy session” that may include tears or rage, as a catharsis.  What you should feel every time is that you have been heard and acknowledged as an individual.  Often you will feel a sense of relief or lightness that you’ve been able to speak your mind – you’ve been brave and honest enough to express yourself and that is an important beginning point…

A social worker with medical or oncology experience will be able to provide emotional support with an understanding of the psychological impact of cancer and its treatment, as well as having insight into some of the practical challenges that people face.  Most State oncology departments employ social workers, and some private practices offer this service as well – ask your oncologist and ask again if you’re not given names to contact!

Some people are keen to join a support group when facing their illness and treatment.  As these groups are run in different ways by different organisations, ask your local clinic about what may be available in your area.  Remember that groups run for the purpose of sharing information are not designed to provide in-depth emotional support, so make enquiries about the purpose of the group, and about who runs it to help you decide whether it’s a comfortable place for you to be or not.

Social media may also be a source of general support but it’s advisable not to risk your in-depth personal emotions in a public forum, or to take advice from people who may not have the professional skills or training to provide psychological support.

Blog by Clare Manicom, Oncology Social Worker

Introducing… The Breast Health Foundation

The Breast Health Foundation was launched in 2002 to raise awareness of breast health among women through a series of community based education projects and creating awareness via community health facilities.

The projects currently employ six women, themselves breast cancer survivors, who give talks at churches, places of employment and public clinics about breast health, breast self-examination and the importance of early detection.  Fourteen years on and there has been a noticeable increase in the number of women being diagnosed early.

Over the years the organisation has, through expansion, based itself in the Vaal/Sedibeng area, Cape Town and Durban. The women based in those areas facilitate educational talks, counselling and patient navigation. These educators are also at the regional breast care centres to assist the patients that have been referred and provide counseling if diagnosed.

To date our community educators have directly impacted 72 811 women through community education projects and have made 291 clinic visits. In total, 2913 women have been navigated and 376 diagnosed with various stages of breast cancer throughout all our active areas.

Bosom Buddies (BB) was established as a project of the BHF, a support group for survivors and their family and friends. The group aims to provide emotional and informative support to all individuals diagnosed with breast cancer and is run by survivor volunteers. The ‘buddies’ provide support to people affected by breast cancer at point of diagnosis and during treatment. BB hosts public meetings in Johannesburg every seven (7) weeks and speakers are invited to share knowledge and experiences with the buddies.

Buddies for Life, a bi-monthly lifestyle magazine, is published by Word for Word Media on behalf of the Breast Health Foundation. In sustaining the aims of the Breast Health Foundation. All of the persons involved with Buddies for Life are either medical or healthcare professionals, and they have been affected by breast cancer themselves or have been inspired by a breast cancer survivor. Each issue of Buddies contains a section dedicated to the early detection of breast cancer.

The Breast Health Foundations purpose is to:

• increase the awareness of breast health;
• promote education and treatment and
• provide support in respect of breast health.

Our mission is to

• create breast health awareness in the community,
• ensure individual access to information,
• potentiate access to appropriate healthcare resources,
• create an ongoing audit of operational effectiveness and
• offer emotional and informative support.

 And through our projects, we have succesfully managed to realise great results.

You can connect with us on a daily through our social media pages:

:

BHF: https://www.facebook.com/BreastHealthFoundation/

BB: https://www.facebook.com/groups/31260668033/?ref=br_tf

Buddies For Life: https://www.facebook.com/BFLMagazine/?fref=ts

EBC:  https://www.facebook.com/groups/903665216386353/

BHF: @BreastBhf

Buddies For Life: @BFLmagazine

This post was written by R.Vanessa Mthombeni for The Breast Health Foundation

 

 

 

Creamed root gratin

Another recipe for the tough times. This is pure comfort food for when you feel like nothing else.

500g potatoes, peeled and chopped
a generous cup of celeriac, peeled and chopped
1 small parsnip, peeled and diced quite small
1 small chopped onion
1 clarge carrot, peeled and very thinly sliced
1/2 teaspoon ground nutmeg, and the same of black pepper
1 teaspoon low salt stock powder
Soya milk to cover

Bring to the boil and simmer until the vegetables are very soft. Drain and mash or blend to a smooth puree.

Pile into an oiled, overnproof dish, splash with a little olive oil and soy sauce and bake in a hot oven (200 deg C) until golden.

Serve hot, sprinkled with parsley or chives.

Yummy!

THANKS TO DR ROSY DANIEL, WHO HAS GENEROUSLY SHARED THE CANCER LIFELINE RECIPES WITH US. THIS RECIPE IS FOR THE TOUGH TIMES, FOR USE WHEN YOU ARE VERY ILL, DURING TREATMENT, WHILE THE APPETITE IS POOR AND THE WEIGHT LOW.

Buddies for life!

Buddies For Life is a bi-monthly lifestyle magazine, published by Word for Word Media in association with the Breast Health Foundation, for breast cancer patients, their families and friends. It was launched in June 2011, and 22 issues have been published to date with many more to come.

The glossy print and online magazine aims to educate, encourage and provide support. An array of medical professionals and experts write supportive and educational articles for the magazine on topics such as treatment, health and wellness, diet, fitness, sexuality, new advances and psychological advice that will assist those affected by cancer to understand the disease and treatment.

The content is essential reading written in a style that simplifies terminology. Super Survivor is featured on the cover of every issue and the breast cancer survivor’s story is told. On the Chemo Couch is another platform for survivors to share their unique story.

In keeping with the aims of the Breast Health Foundation, each issue contains a section dedicated to the early detection and awareness of breast cancer.

Oncology Buddies, supported by CANSA, is a new section within the magazine catering for other cancer awareness, early detection and various support groups.

Buddies For Life is available in print at hospitals, private clinics, oncology practises, mammography units, radiology centres and support groups. Medipost courier the distribution of the print magazines to all the various distribution points.

A digital version is also available on www.buddiesforlife.co.za and yearly subscriptions are offered.

 

The Breast Health Foundation is one of the partner organisations in the Advocates for Breast Cancer (ABC)

Hormones and the endocrine system

The role of Hormonal / Endocrine therapies in breast cancer

Approximately two thirds of breast cancers are oestrogen positive which means they have oestrogen receptors on the surface of the cells and therefore depend on the hormone oestrogen for growth.

This has meant that a range of treatments could be developed with the aim of decreasing the cancer growth or stopping the cancer from coming back by preventing oestrogen action on the cells.

These treatments include: Tamoxifen, Aromatase inhibitors, and Zoladex injections.

But what are they, and how do they work?

Tamoxifen

How it works

This is a synthetic hormone that binds to the oestrogen receptors on the breast cells in place of the woman’s own oestrogen. Unlike natural oestrogen, it does not stimulate breast cell growth and therefore has the effect of “blocking” the receptors.

It can be used in both pre-menopausal and post-menopausal women.

Trials have confirmed that tamoxifen significantly reduces the incidence of local recurrence, metastases (spread of breast cancer to distant organs) and breast cancer in the opposite breast.

It is taken as a single tablet daily.

The benefits have shown to be optimal if taken for a period of 5-10 years.

Side effects

Tamoxifen is in the group of Selective oEstrogen Receptor Modulators (SERMS) which means that it has different effects on different tissues in the body. While it blocks the action of oestrogen in breast tissue, it also has partial estrogen activity in other tissues.

This is the basis for its possible side effects such as hot flushes, vaginal dryness/bleeding and endometrial thickening or polyps.

Other side effects have been associated with its use such as thromboembolism, nausea/diarrhoea, weight gain,headaches or dizziness, and low mood.

It is important to realise that not all patients experience these side effects and some may experience them to a very mild and completely tolerable extent.

Aromatase inhibitors (AIs)

How they work

Aromatase inhibitors are another way of reducing oestrogen effect in post menopausal women. In this group of women, oestrogen is no longer produced by the ovaries, but smaller amounts of oestrogen are still circulating. This oestrogen is derived from androgens which are converted into oestrogen by the aromatase enzyme in peripheral tissues such as fat. The AIs block this enzyme and, in so doing, reduce oestrogen production.

There are 3 main AIs: Letrozole (Femara), Anastrozole (Arimidex), and exemestane (Aromasin).

They are prescribed as a single tablet every day for or at least 5 years.

Sometimes they can be used in sequence with tamoxifen where the patient will switch to an AI after 2-3 years of tamoxifen, or as an extended adjuvant therapy where an AI may be started after 5 years of tamoxifen.

Side effects:

Due to the different mechanism of action, the side effect profile of AIs is slightly different to that of Tamoxifen.

The gynaecological side effects are less of a problem with the use of AIs compared with tamoxifen. However, the AIs may cause joint pain, stiffness and bone loss.

Women who are scheduled to start an AI should have a baseline and then periodic Bone Mineral Density assessments (an outpatient X-ray or DEXA scan). Calcium,Vit D supplementation and, in some cases, bisphosphonates may need to be considered.

Ovarian ablation/ suppression

Surgical removal of the ovaries or ablation of the ovaries with radiotherapy has been shown to arrest breast cancer growth due to the depletion of oestrogen.

Ovarian suppression can be achieved medically by using gonadotrophin-releasing hormone (GnRH) analogs. This has been shown to have equivalent effects as surgical or radiation induced menopause with the added benefit of being reversible after the completion of therapy.

Examples of these treatments are goserelin (Zoladex) and leuprorelin (Lucrin).

They are administered as an injection under the skin either monthly or 3 monthly.

These drugs can be used in combination with tamoxifen and aromatase inhibitors in both pre-  and peri-menopausal women.

Resistance

Although tamoxifen and the AI’s have been proven to be extremely effective treatments, resistance to treatment has been described. Further research is being done in order to understand mechanisms of resistance and to combat resistance pathways.

Endocrine treatments such as fulvestrant (Faslodex) are being used in cases of advanced or metastatic disease or recurrence of breast cancer during endocrine therapy. It is an oestrogen receptor down- regulator and is given as a monthly injection.

Selection

The selection of which endocrine therapy or combination of therapies is individualised and depends on whether the patient is pre- or post-menopausal, whether she has contraindications to any of the treatments, treatment interactions with medication she may be taking for other conditions and the extent of the side effects she may develop on the medication. Of course, patient preference is an important consideration. Financial implications may influence treatment decisions too.

Dr Ronelle de Villiers

MBChB, DCH, BSc(med)

 

 

 

 

 

 

 

 

 

 

 

Keeping cool in the tough times

It is hard to imagine feeling hot and bothered in our chilly winter weather, but cancer treatment can play havoc with our normal body temperature.

And even if you are not feeling the heat, you can always do with a fruity vitamin boost!

Two Coolers
When you feel hot and bothered or sore try these to soothe and refresh.

Strawberry and Citrus Sorbet

Fresh juice of 2 big oranges
Fresh juice of 1 pink grapefruit
Fresh juice of 2 tangerines
Zest of 2 organic oranges, finely grated
10ozs (250g,2 cups) fresh strawberries or raspberries, cleaned
5 tablespoons maple syrup

Whizz together in a goblet blender or food processor. Pour into a shallow dish and freeze for 2-3 hours. Break into chunks and process again (using a sharp blade) until smooth and creamy. Return to the freezer for 30 minutes before serving. If you want to leave it longer in the freezer put it into little ice-lolly moulds at the final freeze and get them out as you feel the need.

For a change with added food value, try adding:

4ozs (100g, ½ cup) plain silken tofu
2 tablespoons more of maple syrup
2 teaspoons vanilla essence

Include frozen bananas at the final whizz stage before the second freeze.

Frozen Bananas

The simplest soother ever! Just peel ripe, firm and perfect bananas, wrap them individually in kitchen wrap/film and freeze overnight. Nibble on them whenever you fancy something cool and creamy. Don’t keep them in the freezer for too long, just do a few at a time.

If you can find sugar-free carob drops (try health food shops) melt them like chocolate in a ‘bain-marie’ (double saucepan) and dip your bananas in for an iron fortified, luxurious treat.

THANKS TO DR ROSY DANIEL, WHO HAS GENEROUSLY SHARED THE CANCER LIFELINE RECIPES WITH US. THIS RECIPE IS FOR THE TOUGH TIMES, FOR USE WHEN YOU ARE VERY ILL, DURING TREATMENT, WHILE THE APPETITE IS POOR AND THE WEIGHT LOW.