A bit of a book

Hi everyone,
As most of you know, I’m busy working on a book about dealing with fear of recurrence. It’s a huge problem for most people that have survived cancer and the one I get asked about the most.

I’m still playing around with what to call it but at this stage the working title is ‘Worried Sick by Cancer’. I thought you might like a bit of a sample from the opening chapters, so here’s a taster:

The downward spiral of distraction

Just about everything I’ve read about dealing with fear of recurrence recommends distraction as a strategy. We’re told to go for a walk, watch a movie, play with the dog or bury our attention in a new hobby.

Some people distract themselves with healthy activities and others use food or drugs or risk taking to try and conquer their fears. Distraction is a ‘flight’ response to our fear.

All forms of distraction will work some of the time and there are some particular types of distraction that are really useful (more on that later) but for the most part, distraction isn’t a reliable response to fear.

Let’s go through this step-by-step.

You’re facing the fear that your cancer will come back and so you try to distract yourself. You go for a walk, watch some television, maybe phone a friend. If you’re like most people the fear comes with you.

You find yourself experiencing a cycle; a little bit of distraction followed by a little bit of fear. You notice the distraction isn’t working. This makes you even more anxious. You don’t want to be fearful and now you’re anxious about being fearful.

You stick with distraction and perhaps even change activities in the hope of stopping yourself from being frightened. It doesn’t work. Or it works just a little bit and then it doesn’t work. Pushing your fear away is like trying to hold it at arms length. It takes strength and effort and it makes your arm tired.

Sooner or later you need to stop trying to push that fear away and then it’s right back in your face again. So you have another go at trying to push the fear away. This is a bit like trying to hold it above your head or behind your back but you know you’re still going to get tired. You’re aware of the tension in your body as you try not to feel your fear.

Now you notice that the activity you’re using to distract yourself is not a source of pleasure. Using it as a distraction has sucked the joy from it. It’s as if you’re doing it with one hand while you use the other hand to push away the fear. You can’t give the activity in front of you your full attention because you need to make sure you keep that fear at arms length.

You notice that even though you’re trying really hard to distract yourself, the fear keeps creeping back into everything you do. Sometimes you get short bursts of time when you stop thinking about the fear, and then you notice you’re not thinking about the fear, which makes you think about the fear again.

You’re frustrated. You’re anxious about being frustrated and fearful about being anxious. The thought occurs to you that feeling this way isn’t good for your health and now you’re really upset! What if the fear of cancer is actually contributing to the risk of cancer!

At this point your fear might escalate, or it might shift into one of the many emotions that grow out of fear. These include the evil twins, worry and anxiety. Both recruit the phrase ‘what if’ to amplify your fear. You might also find yourself feeling angry, frustrated or annoyed. These emotions are a reaction to feeling out of control and fear is their foundation.

Does any of this sound familiar?

Most of us find distraction somewhat useful some of the time. You might be one of those lucky people that can just switch off, but for most of us, distraction is not an effective way to respond to fear.

Distraction is a bit like trying to pat your head and rub your belly at the same time. With practice, you can do it, but it’s not going to become easy or fun. You might develop some pride in your ability to do two things at once. That’s understandable. But you’re still caught in a slow, downward spiral.

Here’s why I think distraction doesn’t work for most people; Remember what I said about your mind trying to keep you safe? Distraction means you’re not listening. Your mind is sending you an important message about staying alive and you’re ignoring it. What does your mind do? It gets louder!

It’s possible that some of our ancestors never felt fear but they almost certainly got killed and eaten. The nervous and frightened ancestors had much better survival odds. We’ve evolved to feel fear and to pay attention to it. When we try to use distraction to avoid our fear it’s only reasonable that our very clever brain will keep ramping up the fear factor to get out attention. After all, it’s the reason our ancestors survived.

The most important thing to remember about your fear that the cancer will come back is this; your fears are not irrational.

You’ve had one of the biggest frights of your life. It was not imaginary. It was real. You’ve had several more frights along the way, probably involving test results, medical procedures and even the unexpected reactions of people. You have had a really, really big fright!

Your highly evolved brain wants to stop you from ever being that frightened again. It wants to make sure you never put your precious life in that much danger again. You’ve correctly identified a major risk to your survival and your mind wants you to pay attention.

Instead of helping you to deal with your fear of recurrence, distraction does exactly what it has always done. It momentarily takes your mind off something. But your mind doesn’t want to forget about cancer. Your mind wants to warn you. So eventually that fear is back up in your face.

Many people describe this as feeling like they are stuck. They get periods of time when things seem almost back to normal and then the fear sneaks up on them, or ambushes them when they’re not expecting it. The methods I’m going to teach you will help you to overcome this pattern.

For some, fear becomes a downward spiral. Each time they experience fear and an inability to cope with it, they repeat a pattern of behaviour. It might be that they reach for drugs or alcohol, experience a panic attack or find themselves feeling tearful or angry. Each experience of fear sends them back around in a circle.

Their mind establishes a kind of neural loop, and this pattern becomes a well-worn track. They now have a one-track mind when it comes to responding to fear and that track leads them to an increasingly frightening place. If this is you, I can show you how to fix this.

Please take some time to think about the extent to which you’ve used distraction to deal with your fears. How has that worked for you? Is it a reliable way to deal with worry or do you find yourself cycling back through fear again?

There’s nothing wrong with using distraction if you’ve found it effective. It’s just that most people don’t. I’ll teach you a better way of dealing with your fears so that you can return to the activities you enjoy for their own sake, and not as an escape for your mind’s legitimate concerns for your safety.

* * * *

M J McGowan



Hospital Food

My friend, Ricki, is back in hospital again for treatment. Today she posted a picture of her meal on Facebook. Rick is fortunate enough to be in the Seventh Day Adventist Hospital in Sydney, Australia (everyone calls it The SAN) and her meal includes freshly cooked fish and a delicious salad. Most of the items on her tray are reusable rather than disposable and everything is prepared on the premises.

What’s surprising about Ricki’s photo is how unfamiliar it will be to most people staying in a hospital other than the SAN. Even during my stay at the Mater, just down the road, I was shocked by the poor nutritional quality of the food. The food was reasonably tasty, but there were very few healthy options.

I wound up ordering double portions of their tiny side salad to get some leafy greens on my plate. The default option for most items was highly processed and single use packaging with lots of sugar. I could have flavoured yoghurt (full of sugar) but not plain yoghurt. I could have a white bread roll but nothing with seeds or wholemeal and certainly nothing gluten free.

Sweets were offered as standard with each meal and the catering staff seemed surprised when I chose not to have them. ‘Are you sure you don’t want the sticky date pudding?’ Yes, I am sure because I’m flat on my back for the next few days and not getting any decent exercise for a month or more so why are you feeding me sugar?

It just makes sense to me that if you want people to recover faster from treatment or surgery then giving them delicious, nutritious food will speed things along. There’s also the issue of the constipation that usually follows any surgery. How do they expect to get things moving with such an over processed menu?

Now that we understand how integral our gut health is to our physical and mental health, shouldn’t we be designing hospital food to repopulate our system with healthy bacteria? This just makes sense.

There’s also the psychological impact of opening the lid on yet another boring meal. If we’re in hospital and still able to eat then food is probably one of the few pleasures still left to us. Imagine the difference to patients if meals are something we can look forward to  and chefs get the opportunity to delight us.

Spare a thought too for the poor catering staff that serve this stuff up to patients. They’ll bear the brunt of all the complaints.

If food like this was a bit more expensive you could still justify it on the basis that people left hospital sooner. The thing is, anyone that works in catering will tell you it costs no more to serve up healthy food than it does to serve up processed meat and overcooked vegetables.

The desire for healthier food in the general population has seen a boom in companies providing fresh raw ingredients as well as packaged products. There’s also a much better understanding of the importance of nutrition and its impact on our physical and mental health.

The other worry with hospital food is all that disposable packaging. Often this is seen as ‘convenient’ but the truth is that the cost of all that packaging is built into the cost of the product. There’s also growing concern about the impact of leached chemicals from plastic packaging, particularly with foods that have a high fat content (like yoghurt and ice cream).

A meal constructed of half a dozen disposable packets, a plate of not very delicious food and disposable cutlery tells me, as a patient, that feeding me is an annoying consequence of my stay in your hospital. A tray full of freshly prepared, delicious food served on a real plate with a proper knife and fork makes me feel like a special guest. Simple.

And does anyone ever like eating their food with plastic cutlery?

When I asked about the menu at the Mater I was told that they were responding to what most patients wanted. Surely if what most patients want is an unhealthy diet then there’s a real opportunity to give them an experience of a healthy alternative. Giving people nutritious food might just help them to understand the difference between what they’ve been eating and what they should be eating, along with a personal experience of how much better they might feel with a few dietary changes. There’s a real opportunity for re-educating people with poor diets here.

This isn’t the first time Ricki has posted photos of her meals at the SAN. How wonderful to be in a hospital where the food is so good you want to show your friends. It begs the question; if the SAN can do this, why can’t everyone else?