Survivorship | Creative Transformations, LLC

Healing Body, Healing Self, Survivorship 0

Moving through the habits that keep us stuck

When you have been through something traumatic, like having cancer, it’s common to develop habits around managing the leftovers from the experience. When you are fearing that cancer could return, it is really difficult to see constant reminders of what you have been through. Like surgery scars, missing hair, brain fog, and so forth.

Yet, if you want to really feel like you’ve moved beyond the experience of having cancer, you are going to have to address those habits at some point. While these habits might initially help you avoid discomfort, in the long run that avoidance amplifies the unprocessed pain that we have been through and can cause you to feel more anxious or depressed, rather than less.

One example that comes to mind is the story of a client who came in to experience art as therapy. She was a young breast cancer survivor with three children, someone who had been able to reach the coveted NED status- no evidence of disease. She felt appreciative of being cancer free, yet experienced a lot of anxiety about cancer coming back.

In our work together, she was able to identify how she avoided fully washing her chest, because she was afraid that she would find a lump again. We explored this through art, her experience of avoidance and fear, and I guided her to use the art to see how she might be able to support herself. Through this guidance, she was able to connect with the color yellow, as a warm, safe and supportive color.

The change was visible as she drew the yellow color around her image of anxiety and fear. Her body began to relax, her shoulders help less tension. I suggested that she bring in the energy of yellow with her the next time she showered, and she found it to be highly effective in breaking the avoidance behavior while also feeling less anxiety about washing.

It was a significant step towards reclaiming her connection towards feeling safe again in her body. The anxiety and fear that had been driving her to avoid was less dominant, allowing her to decrease the tension without having to control the outcome. Since cancer is a reminder that you don’t have total control, taking steps towards accepting that through actively supporting yourself can decrease the distress that comes as you face what is causing you fear.

Next week I am going to be releasing my free self assessment tool that I have developed to help you identify the ways in which cancer has impacted your body, mind, spirit, and self. It will come with the link to the virtual workshop: Back to Life Back to Reality: Decoding Cancer Survivorship. That is a space limited workshop, which will allow a lot of time for participants to share with one another in addition to learning how to move forward. So stay tuned!

-Stephanie McLeod-Estevez, LCPC, is an art therapist and breast cancer survivor, and a former oncology counselor at the Dempsey Center. She began Creative Transformations to help others who are healing from a life threatening illness or injury. Through Creative Transformations, she works with people in person and online to offer cancer coaching, an Art as Therapy program, workshops, and this weekly blog. Check out the individual packages. Sign up today so you never miss a blog and find us on Facebook, Twitter and Instagram.

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When tangible measures fly out the window… you end up on shaky ground

When you are in active cancer treatment, there is often a next step- next appointment, next blood draw, next infusion, next scan to evaluate effectiveness of treatment, next poke, next prod, next how to you measure on the scale of symptoms. Appointments, appointments, appointments. Measurements, measurements, measurements. Somedays you feel like you have hardly come up for air before you are back at the doctors again.

When you are post treatment, there is often a next step- for example the next appointment with your oncologist- but in between that moment of- “adios treatment and follow up”… well, for the most part, it’s essentially up to you.

What is really tricky about this next step is the lack of concrete tools to measure exactly how you are doing. During treatment, my doctors could be so precise about how my body was doing, the blood work told the story of how I was faring with the toxic medicine. The blood work, plus the intensity of a specific list of symptoms, provided clear information to help us make crucial decisions. Scans gave us a sense of whether or not the treatment was being effective. Going through chemotherapy was scary, yet often I felt very comforted by the close attention that my team paid to my health and how expertly they navigated the waters towards our intended destination- NED.

Post treatment life is a different beast altogether, it is not as concrete of a path, nor are their concrete tools to measure where you are, nor are there tools that can predict how far you can go exactly in reclaiming who you are. Your blood work can’t measure the emotional impact that cancer has left, which means that you have to develop your own sense of trust in understanding exactly how you are doing- because no test, no scan, will be able to provide supportive evidence.

And that is tricky, right? Because one of the most common after effects of cancer is wondering who the heck you are, and what the heck you have been through. Not only do you feel lost, but it typically erodes your sense of self confidence. And why is that? Because you have been completely thrown to the wolves, facing the four universal fears (of dying, of being alone, of losing a sense of purpose, of losing freedom) while simultaneously being reminded that you have very little control in this life.

Let’s face it, that often leaves us feeling like we are on shaky ground.

The good thing is, you are not alone. Yes, we may need to give up our attachments to having concrete evidence. Yes, we may need to give up our attachments to knowing exactly how close to “normal” we may ever be again. Yes, in order to heal, you will need to walk through the fire. And yes, in order to do that you need to have solid connections to your fellow cancer survivors, who can look you in the eye and affirm- they know exactly what you mean.

In the meantime, I am in the process of working on a free assessment tool that will be available shortly. This tool is designed to help you reflect upon the changes, challenges and raise awareness of what you might want to address to improve your health and wellness. The tool may not ever be as concrete as reading the results of your lab work, but it is a step in that direction. Stay tuned for more!

Healing Self, Survivorship 0

Sometimes you don’t realize what you are holding on to, you just know something is wrong

As I prepare the webinar, Back to Life, Back to Reality: Decoding Cancer Survivorship, different stories are coming to mind of the cancer survivors who I have worked with in addition to my own healing process.

This first story is of a cancer survivor who was a few years post treatment. During treatment, she had experienced a variety of reactions to the fact that she had cancer. Some of the reactions contributed to her fear that she was going to die, even though she had a good prognosis, whereas other reactions were diminishing of her experience. For the most part, the reactions were from one extreme to another, with the exception of her immediate support system.

As treatment wound up, both sides of those extremes receded, yet no one imagined that perhaps moving on emotionally would be an issue. She returned to life as it was, sensing that things were not quite right but also needing and wanting to move on.

Fast forward and another medical issue rears its head, and while it was not life threatening, it involved significant changes to her lifestyle. It also stirred the under-processed, under-recognized impact of cancer, which began to surface in unexpected ways. She began seeing an acupuncturist, who helped her identify that she likely needed to work through her cancer experience, and eventually she started working with me.

She scheduled an appointment because she trusted her acupuncturist, and she was desperate to feel better. She struggled to understand why she was having such a hard time, after all she had a loving and supportive partner and adult child, and felt like the other things “shouldn’t matter” because she was cancer free and knew of others who would never hear those words.

As I walked her through the common challenges cancer survivors face with regards to emotional healing, she began to tap into the various reactions to her cancer diagnosis and how it had impacted her at that time. We connected these reactions to how she herself had reacted to her diagnosis, treatment, and recovery. She was sent home with the preparation guide that I developed for the healing the body session, a series of questions to help assess our experiences and relationship to our body.

At the following session, I lead her through the flow of the healing the body session- finding our jump off point, exploring it visually through art and then reflecting upon the work’s impact on her understanding of herself. As she talked me through her drawing, she had a breakthrough moment. She uncovered something unexpected, something that she had been holding on to, something that she had no idea she had been feeling.

In this moment, she recognized that the tissue which had been removed during the surgery, the tissue that held the cancer and the clear margins, the tissue that had been examined by pathologists, this tissue had never been returned to her, not had she been able to say goodbye.

Deep down, this had caused her to feel like she was not whole, a piece of her was missing, and that she was no longer able to protect it. This loss had not been acknowledged until this moment, and thus she had been carrying around grief that needed to be expressed.

This spontaneous release of sadness and deep appreciation of her need to grieve what she had been through, helped to transform the unease she had felt about “something being wrong”. The act of my witnessing and guiding her walk through the process, supported her validating her inner landscape- allowing her to lean in, feel through and then let go.

I have written before that our feelings are messengers, who hold key information about our experience. These messengers take their job seriously, and can come out sideways when we do not allow them to speak openly. When you develop ways to hear the message, you ultimately give yourself the gift of validation, which is a critical step in the emotional healing process.

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The elusive nature of post cancer treatment solutions

When I was at my chemo teach, I felt overwhelmed by the information about the toxic, life saving, medication I was signing up for, AND I recall feeling this sense of- ‘WOW- they have thought of everything’. You know…

Constipated? Take stool softners

Nausea? Take Ativan, Zofran, Compazine

Can’t sleep because you are too anxious about the fact you have cancer, too nauseous, in pain, hyped up on steroids? Take Ativan, melatonin, listen to guided meditations…

No white blood cells? Take Neulasta or Neupogen

Chemo shredded your red blood cell count? Have a blood transfusion.

The list was long, the solutions were concrete, and at each appointment your treatment team surveyed you about the most common side effects, concerns, red flags that your body was not managing the treatment well. Your blood work told the story of how well your body was coping with everything. Carefully monitored, hopefully you had a sense of safety even though you were facing a life threatening situation.

There is nothing fun about being in active treatment and the number of appointments you have feels like an unending process of being poked, prodded, and evaluated. Normalcy seems like a thing of the past, yet when treatment ends, you don’t just walk back into life as it was. This is likely something you are somewhat prepared for, as it is a common point of discussion in the cancer community.

What I was not prepared for, and I am certain that I am not alone in this, was that unlike the beginning of treatment, the notion of concrete problems and solutions seemed to evaporate. Nothing seemed to be clearly plotted out, beyond follow up medical appointments and tests.

My providers were caring and responsive if I brought up a concern, but they no longer seemed to have it all figured out. Their uncertainty when coupled with the fact that now I needed to not only process what had happened to me, manage the uncertainty I felt about the future, pick up the pieces of my life, was unnerving.

There was a list of areas to address on the survivorship plan, such as: nutrition, exercise, physical signs to monitor for signs that the cancer had recurred, and encouragement to do so. Yet the tone had changed dramatically- ie super generic rather than driven by identification. This left me with that feeling of being stranded all alone in a boat with oars that may not be strong enough to last the journey back to land- if I could even figure out in which direction that land might be.

I loved my treatment team, and I still do, but as I did make my way from being stranded to finding land once again, it became more and more clear to me what the issue was. My providers are medical experts, they are brilliant when it comes to diagnosing and treating cancer. I refer people to them all of the time.

But the members of my treatment team are not mental health experts, and therefore are not equipped to be our only guides through post treatment life. Post treatment life has short and long term physical consequences that cancer treatment brings, yet it is the psychological, spiritual and emotional challenges that often linger the longest.

Part of the challenge of post treatment guidance is the fact that we are all unique, and therefore are all uniquely impacted by the experience. The side effects of most medical interventions are well known and therefore much more predictable, lending them to more concrete solutions.

My years of practicing psychotherapy helped me to craft a map for healing, and I have used that experience to create tools that others can use to understand their post treatment needs and to build their own plan. I will soon offer this assessment tool to my community and a webinar- Back to Life, Back to Reality: Decoding Cancer Survivorship, in which I will guide the group through identifying and creating a personalized post treatment plan. Stay tuned- when I am ready, I will announce it on the website and social media links.

Until then, hang in there! Solutions may not always seem as concrete or easy to identify and we may need to come to terms with things that cannot be changed. Reaching out for support before we get to the ‘can not take it one more second’ zone is one thing that you can do.

Healing Self, Survivorship 0

Sending love to our previvors

When I was 30, my PCP suggested that I meet with a genetic counselor, given the family history of cancer. I found the process to be quite enlightening, as I had never met with a genetic counselor before. I did qualify for testing, a decision I wrestled with, because I was still grieving the death of my mom from metastatic breast cancer. The impact of that loss really had me questioning a lot of things about life and trying to figure out major questions, like whether or not to try to become a mom, knowing that I could also die young from cancer.

One of the factors that tipped the scale for me, was the strong possibility of having an ambiguous result. Since I was already grappling with trying not to say no to major life decisions, I determined that it was not in my best interest. I decided to move on and I was fortunate enough to become pregnant and have two children.

When Angelina Jolie underwent a preventative double mastectomy, a little voice inside me pondered revisiting the genetic testing. The reasons that prevented me before had passed, and I was coming closer to the age in which my mom and her sister were both diagnosed (42). I never followed up with that thought, in part due to having crappy insurance at the time.

Ultimately, I did find out that I am positive for a BRCA2 genetic mutation, which we discovered after I had begun chemotherapy for triple negative breast cancer. While I was determined to not second guess my choices, I did have regrets.

I think it is such a brave act to undergo genetic testing, because it means that you are staring straight into the web of possibility, having to process a probable reality of something that still has yet to occur. And then of course comes the decisions of what to do if you do have a mutation. On one hand, having choices is a privilege yet on the other hand decisions made on possibility or probability meaning that we are having to predetermine our own fate.

The reality is, even if you make calculated choices for prevention, they still don’t guarantee outcome nor do they prevent you from having many thoughts and feelings to cope with.

There is still loss for previvors, loss of innocence, loss of opportunity, loss of our body as we know it. There is pressure to determine if you should have offspring, because that means that you are putting them at risk of receiving the genetic mutation and/or having to face having a parent with cancer or getting cancer themselves. Last time I checked, this isn’t an openly discussed topic amongst people who are trying to get pregnant or who have become new parents.

The decision to have children, whether it is a previvor or a cancer survivor, is a touchy subject. There are those who judge parents who make the decision to have children, even though there are risks ahead. To be fair, none of us have any guarantees in this life, so in my opinion we need to stop living life as if we can control it.

Our previvors are brave AND they still face the “What ifs” that the rest of us do. Our previvors confront their own form of survivor guilt, knowing they had the chance to do something we wish we all had. There are support services for previvors, but they tend to be more of a hidden subgroup. If you have been reading my blogs for a while, you know how I loathe the impact of silencing. Silencing leads to isolating, which leads to more complex issues.

HBOC, a society dedicated to supporting previvors list the following on their website:

At any stage of a previvor’s journey the road is difficult, especially for young previvors who have not yet had their children or are in a committed relationship. A typical previvor journey includes several or all of the following:

■ a childhood fraught with the loss of loved ones to cancer
■ a realization that cancer could also happen to you
■ the decision to go for genetic testing and the lengthy wait for the results
■ confirmation of a genetic mutation or a family history worthy of you being deemed an HBOC syndrome carrier
■ constant fear that you or a loved one will be next
■ adulthood with more loss of loved ones to cancer
■ increased screening starting at the age of 25 for breast and ovarian cancer which includes a variety of tests, some invasive
■ chemoprevention drugs that reduce estrogen, thus causing chemical menopause
■ all of the fear, appointments, tests and surgeries associated with preventative-double-mastectomy and in some cases, to remedy complications
■ all of the fear, appointments, tests and surgeries associated with breast reconstruction
■ all of the fear, appointments, tests and surgeries associated with preventative salpingo-oopherectomy (fallopian tubes and ovaries) and in some cases, to remedy complications
■ surgical or chemical menopause and the resulting side-effects that usually include hot flashes, mood swings, cognitive issues, and long-term side-effects that may include bone loss and heart health
■ body image issues, loss of feeling and reduction of sexual function
■ loss of fertility
■ relationship issues
■ depression

So to the previvors, I honor you and want to send you love. You are deserving of the care and consideration you need. Together we are stronger.

– Stephanie McLeod-Estevez, LCPC, is an art therapist and breast cancer survivor, and a former oncology counselor at the Dempsey Center. She began Creative Transformations to help others who are healing from a life threatening illness or injury. Through Creative Transformations, she works with people in person and online to offer cancer coaching, an Art as Therapy program, workshops, and this weekly blog. Check out the individual packages. Sign up today so you never miss a blog and find us on Facebook, Twitter and Instagram.

Healing Body, Survivorship 0

The potentially bad news that turned out good so don’t worry about, ok? Next!

Raise your hand, or even better, comment below, if you have experienced the following scenario…

You are at a follow up visit to hear results following a procedure- scans, biopsy, or surgical interventions, like having your boobs taken off to remove cancer or reduce the likelihood of cancer growing.

You are likely a little anxious about what will be revealed- even if you are a chronic optimist.

The doc delivers the news with a caveat… everything’s fine BUT…

For me, it was hearing that the neoadjuvant chemo had destroyed the cancer we knew about, and that Stage 0 DCIS was found in the non-cancer boob that was removed due to my mutant BRCA2 gene. This info was quickly followed by reassurance that I should not worry about it because what was done (ie mastectomy) would have been the recommended intervention.

This blog is not meant to be a criticism of doctors, PAs, and NPs who deliver the news. I trust that they are all well intentioned when they try to minimize our distress by delivering the good news that the potentially bad news has been taken care of. I get it and still the impact is the same. The person left sitting with the news is shell shocked, trying to process what feels like yet another betrayal by our body in addition to a reminder of how closely we walk to the edge of illness and our mortality.

There are some very tiny tweaks that I feel providers could adopt that would make us transition along with them to the “so don’t worry about it” frame of mind. But since I am not sure that providers are going to read them, you might copy down this list somewhere to help you advocate for yourself if you are experiencing a whiplash moment at a medical appointment.

delivering the news without the medical jargon initially- because those labels scare the pants off of us
asking how we feel about the fact that something unexpected was detected (ie no minimizing even if it is to try to keep us feeling more optimistic)
reflective listening to make sure that we understand what was said- because again it is hard to fully listen when we are taken by surprise, again.
having a medical staff member, like a nurse, do a follow up call to check in and make sure that there were no further questions (and since this may be you, calling them, I just want you to know that asking for what you need is so important- because when left to our own devices the stories we tell ourselves can become very dark)

Sending out some good juju for anyone who can relate to this blog. You are not alone.