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One practitioner might always think that the best treatment is the one that results in the longest average length of life, regardless of side effects. Another might prefer to stick with familiar treatments rather than to try new ones. Others try every new treatment that comes along without first critically evaluating the available evidence. Some practitioners are themselves so frightened of cancer and dying that they recommend that patients keep having intensive anti-cancer treatment even when there is no real hope of controlling the disease. Some practitioners are doing research into cancer treatment and want all their patients to have the research treatment regardless of other considerations. Dare I say it—some practitioners even allow consideration of their own financial gain to influence their recommendations. All that I have said in the above section applies equally to doctors and to non-medically qualified practitioners.

I know it is frightening to read all this. I know you would rather believe that your practitioner is a selfless, devoted, up-to-date saint who thinks entirely in terms of your own individual interests. Even if your practitioner were perfect, he or she could not know what issues are important to you, what your priorities and values and beliefs are. So be fair and kind to yourself. Get the information, trust your own knowledge of yourself and be prepared to make your own decisions.

*18/40/1*

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Natural Antioxidant Muesli

1 green apple

1 teaspoon pecans

1 teaspoon almonds

4 tablespoons oatmeal

1 tablespoon LSA mix

4 chopped apricots

1 tablespoon honey or brown rice syrup

4 tablespoons raisins

125 ml natural acidophilus yogurt

Wash the apple, leave the skin on and cut into fine strips. Place in a bowl with the oatmeal, LSA mix, raisins, apricots, honey and nuts. Add the yogurt to the muesli mixture and leave for 5 minutes. Serve.

Porridge

300 ml water

55 grams porridge oats

1 teaspoon manuka honey

1 dessert spoon ground flaxseeds and pumpkin seeds

Put the water in a saucepan and sprinkle in the oats. Bring to the boil for 5 minutes and keep stirring. When the porridge thickens and is soft, serve with skim milk or soy milk, or fresh juice, seeds and a little honey.

Tofu Omelette

200 grams tofu

2 egg whites1/4 to 1/2 cup water

1 tomato, chopped

1 garlic clove, chopped

1 small onion, finely chopped

1 tablespoon olive oil

2 spring onions

80 grams mushrooms, chopped

Blend tofu, water and egg whites in a blender. Put olive oil in saucepan and place blended mixture into the saucepan. Then cook over a gentle heat. As the tofu begins to cook, add chopped tomato, garlic, onion, mushrooms and spring onions. Cook until slightly browned. Flavour with sea salt, if desired.

*222/34/5*

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What If I Have Trouble Thinking about My Future or Picturing Good Things in My Future?

Cancer made your future seem less certain. Soon after treatment is completed, you may feel that you are safe only for a day, a week, a month, or a few months.

Picturing the future may elicit enormous anxiety, anger, or sadness because you fear that you may not get to experience it. You can experience anticipatory grief when picturing the future because projecting the future is a setup for allowing a glimpse of all possible future outcomes, including the fearsome one of illness and death. This occurs even if your prognosis is good and you are picturing happy events, such as a graduation, marriage, or the birth of a child.

What If I Have Trouble Planning for the Future?

Planning for the future means having confidence that the plans will come to fruition. You lost a lot when you got cancer. You feel vulnerable. You want to protect yourself from avoidable loss and pain. If, on any level, you are insecure about your future you will feel anxious when you start to make plans, because you do not want to lose any more.

Sometimes a component of magical thinking makes it difficult tor you to make plans. You may feel that if you make plans you are setting yourself up for a problem that will sabotage the plans. “If I don’t make plans, there won’t be any plans to get ruined. If there are no plans to ruin, I won’t get cancer.”

*177/32/5*

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What If My Appetite Is Hill Poor?

All the factors that affect appetite during cancer treatment can continue to affect it after treatment is completed, such as

• medications

• changes in the digestive system due to the cancer

• changes in the digestive system due to the treatments

• weakness

• infections

• impaired or altered sense of taste or smell

• depression and emotional stress

If My Appetite Is Poor, When Will It Return to Normal?

It can take many months for your appetite to return. You must take steps to evaluate your lack of appetite if

• you are not able to eat enough for healing

• you are losing weight or getting weaker

•you have pain in your mouth, throat, esophagus, stomach, or rectum

• you have difficulty swallowing

•your stools are black, maroon, or bloody

What If It Hurts to Swallow?

Changes that make swallowing difficult or painful include

•irritation of the esophagus from radiation, chemotherapy, or acid reflux from the stomach

•infection of the esophagus, such as viral or fungal infections

• decreased saliva

• narrowing of the esophagus

• spasm of the muscles of the esophagus

What Is a Stricture of the Esophagus?

Months to years following radiation to the chest, some patients develop scarring of the esophagus that causes the opening to be narrowed. This narrowing, or stricture, makes it difficult to swallow solids. The narrowed esophagus can be dilated, or stretched, fairly easily.

*83/32/5*

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Is There Any Interaction between the Late Effects of Chemotherapy and Radiation Therapy?

Sometimes. There are potential interactions for various combinations of chemotherapy and radiation when given together or sequentially. Some chemotherapeutic agents will cause a flare-up reaction of the area radiated weeks, months, or years prior to the chemotherapy. For example, a region of the skin, lung, kidney, or brain that was radiated can become inflamed following the administration of certain chemotherapy.

What Causes the Physical Aftereffects of Surgery?

Most aftereffects of surgery are experienced immediately and resolve within weeks. Aftereffects are due to

• the anesthesia

• the energy demands of healing of the surgical incision (inside and outside)

•changes in eating habits (e.g., not eating before surgery, eating less after surgery)

• changes in activity level •pain

• a change in sleep patterns

• the need for new medications or changes in medications, especially pain medications

• the adjustment to an amputated or damaged body part, such a surgically altered lung, breast, kidney, or segment of intestine or stomach

• emotional stress

• hormonal changes caused by lost organ function, such as I infertility, metabolic changes, and psychological changes that follow castration, or the metabolic imbalance following removal of parathyroid glands

Does How I Fared with My Cancer Treatment Give Any Clues Whether or Not I Will Have Serious Late Effects?

No. Severe problems during your cancer therapy, such as mo problems, extreme low blood counts, or pneumonia, can be lowed by no late effects. An absence of problems during treatment can be followed by significant late effects.

*56/32/5*

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The best cure for checkup anxiety is a series of normal checkups. Until that time, you can minimize checkup anxiety with some practiced attitudes and habits:

•Treat checkups as just one more necessary part of your life, like getting gas for your car or locking all the doors and windows before you leave your house.

• See checkups as an opportunity to confirm that you are doing well. You will feel great after you find out that your tests look good.

•Plan a special treat for yourself for soon after your checkup. Whenever you start to feel anxious, visualize yourself enjoying your special treat in the same way that you anticipate other planned, special happy events.

•After each checkup, fulfill the planned special treat. Reinforce the experience of good checkups. Make checkups something to look forward to, something associated with great memories.

One young mother who had intensive chemotherapy used to go to a department store after each treatment to buy something special. “Doesn’t treatment mean you are meant (ment) for a treat?” she asks. She jokes with her friends that she is still paying off her medical and her department store bills from her treatments. She continues to do something special after each checkup and to joke about her department store bills. It can be an inexpensive treat, or just taking time to do or see something special. The key is a special reward to turn checkups into a celebration.

• See checkups as your opportunity to stay well. If you should develop a problem such as anemia, a recurrent cancer, a new cancer, or a heart problem, regular checkups will maximize the chance that your problem will be picked up early, when it is most easily curable and has the least impact on your life.

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Will Exercise Interfere with My Checkups?

Exercise can cause some changes in your blood test results that will be misleading. Do not do any vigorous exercise during the hours prior to blood work.

Do I Need to Participate in a Special Exercise Program?

All exercise during recovery should be supervised at least to the degree that

•your doctor is aware of exactly what exercise you are doing •your doctor is following your progress and is aware of any symptoms or problems experienced during or after exercise

Depending on your general medical condition and the specifics of your cancer and its treatment, your doctor may

• clear you to proceed with exercise on your own

• recommend a closely supervised rehabilitation program, preferably one geared to the cancer patient

Rehabilitation exercise programs geared to heart, lung, or arthritis patients may provide the optimal supervision for your particular situation. Find out about available programs by calling your local hospitals and rehabilitation centers.

Does Exercise Affect How Well My Immune System Functions?

Studies in humans suggest that regular exercise is associated with a decrease in the number and the severity of infections in elderly people. Laboratory studies support the idea that exercise “boosts” the immune system. We need further studies to determine how this applies to healthy young and middle-aged people and to people with cancer.

A healthy immune system helps prevent infections or decrease their severity. Avoiding infections during recovery from cancer treatment would be expected to speed your overall recovery.

The immune system plays a role in how the body deals with some cancer cells. The exact role differs for different kinds of cancer. There is reason to believe that a well-functioning immune system may help some people to

• prevent cancer

• prevent a recurrence of cancer

• slow the progression of cancer

• improve the response to cancer therapy

Beware of unsubstantiated claims for methods to boost your immune system.

*116/32/5*

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