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Overcoming depression

Depression is one of the most difficult issues a patient that had been diagnosed with cancer has to face. I am a physician who had been diagnosed with throat cancer four years ago and am writing this manuscript to share my personal experiences as a cancer survivor and a clinician. You can read my story and read my book on my experiences as a patient with cancer at my Blog: http://dribrook.blogspot.com

I am doing so hoping that my perspectives will assist other individuals who had undergone similar experiences cope better with their situation and hopefully gain insight into their lives. It is also presented to health care professionals who care for patients with this illness in the hope that by gain insight into the patients� world would be able to better assist them in their plight.

Coping with and overcoming depression is very important not only for the well being of the patient but may actually facilitate their recovery and may even increase their chance for longer survival and perhaps even ultimate cure. There is growing evidence in many scientific studies that there is connection between mind and body. Even though much of these connections are not yet understood it is well known by experienced practioners that individuals who are motivated to get better and exhibit a positive attitude recover faster from serious illnesses, live longer and sometimes survive immense odds.

There are so many reasons to become depressed after learning about cancer and living with it. It is a devastating illness to the patients and their families and medicine has not yet found a cure for most types of cancer. By the time cancer had been discovered it is too late for prevention and if the cancer had been discovered at an advanced stage the risk of dissemination and ultimate cure is significantly decreased.

Many emotions go through the patient�s mind after learning about the bad news. �Why me?� and �Can it be true?� After first becoming stunned by the news, feelings of denials, which are followed by anger, with ultimate acceptance of the new reality. It is believed that depression is a form of anger. Perhaps anger at the new devastating reality.

The patient has to face their ultimate mortality, sometimes for the first time of their life and have to deal with all the immediate and long term consequence consequences on them and their loved ones. Paradoxically feeling depressed after learning about the diagnosis allows the patient to accept the new reality. By not caring any more it is easier to live with the uncertain future. �I do not care any more what happens �feeling makes it easier for a while. However, this coping mechanism carries a heavy prize because it can actually interfere with getting appropriate medical and surgical care and can actually lead to rapid decline in the quality of life.

Hopefully a patient can find strength within themselves to fight the depression. In my case after I returned home from the extensive surgery I had to remove my cancer which included also the excision away of my vocal cords, I was overwhelmed by the daily tasks I had to perform and the new realities I had to accept. I was mourning the many losses I had experienced, which included my voice, my wellbeing, and the need to accept many permanent deficits such as not having a normal voice any more and having to speak using a weak and rusty voice generated by a prosthesis that connects my trachea and esophagus. I felt that I had to make an early choice between succumbing to the creeping depression and let it consume me or become proactive and fight back and return to life. I chose the latter because deep inside I had a very strong desire to get better and overcome my handicaps. I also realized that my struggle is not over and will be with me for a long time and that I will need to conquer the down hill slope again and again.

The driving force on many occasions to become proactive and resist depression is my wish to set an example for my children that one should not give in the face of adversity. I new that they may and unfortunately would also have to face difficult in the future and did not want to leave them the legacy that their father gave up and did not do his best to get back to his feet. This was and still is a driving force that I resort to whenever I feel down.

Support by family members and friends is very important. Feeling that ones� continuous presence in the world and actual involvement in their lives is very helpful in reigniting the will to go on. The involvement and contribution to others lives can be invigorating. As a parent� or grandparents� one can draw strength and will to go on by seeing and enjoying the interaction and the impact one has on them.

What I found out to be helpful was to become re involved in activities I liked before and find a continuous purpose for my life. I started to return to the hospital to participate and teach in medical rounds and listen to medical lectures. What was most encouraging and rewarding was that my contributions impacted and improved individual patient care. I felt that I was making a difference again. This made me want to return to the hospital and teach even more. In the process of helping others, I was also helping myself.


I was also able to gradually return to many of my other routines. I started with simple challenges such as reading medical literature again, accepting invitation to review articles submitted to medical journals, learn how to take a shower without aspirating water, and even simply walking more. I gradually became able to ride a bicycle and even climb to the top of a mountain with my family. Even though I realized that the quality of my voice is not the same as before, one of my greatest comebacks was to be able to teach and lecture again with the help of a microphone. Each of these small steps made me feel better and stronger. I was discovering the world again, quite like an infant learning to walk.

Seeking the help of a mental health professional can be very helpful. I was fortunate to be assisted throughout my illness and recovery process by an excellent, compassionate and skillful social worker. We discussed various issues relating to my recovery process, as well as my anxieties and frustrations. Having a caring and competent physician and speech and language pathologist that can provide continous folowup. Their involvement can help deal with any emerging medical and speech problems are very important for the sense of well being.

I Brook MD



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Dr I can feel your pain and understand. I have gone thru many surgeries and came out smiling or pretending to. As I type this, I am ready to go to Allegheny General in Pittsburgh for the 3rd go around with an Abdominal Anneuersm in 2 days. I have never asked or even thought Why Me. Esophagus has been repaired using the Nissen Fundiplication which is one that never lets up with the pain. 2 elbow surgeries and 4 shoulder repairs, both rotator cuffs and 2 times on the right bicept tendon. Kidney stones 11 or 12 times. Many scopes and biopsies of my Esophagus since 1996. I won't include the OC surgeries and biopsies. I like the post you put in here and it sure might help others with this dreaded disease we have. Not much of a tongue and no teeth. Losing lower jaw in the next few weeks too. But , this sure beats the alternative. Good luck and I have you in my prayers.


Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
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My baby brother has finished rad & chemo tx and is having a difficult time. Everything seems to be going wrong in his life - his cat had to be put to sleep, he can't eat (still has feeding tube), his wife's place of employment will be shut down for a month or so due to fire - it's just unbelievable what stuff has happened in the past month. He's coming to visit - what can I do or say to help him?


Sister to Randy (47, nonsmoker)
Base of tongue, scc, stage IV, lymph node involvement
Dx Nov 2009, started rad/ chemotherapy 12/09,PEG tube
Finished 02/10
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Not being able to eat is the WORST. I don't know how people who can't eat for long periods (or forever) do it. I know you have to eat, but if possible do not openly show how much you enjoy eating in front of him. My family would come to visit to supposedly cheer me up, but they can't have a get together without snacks, and they would just chomp away on chips and dips in front of me until I was ready to scream when I was on my feeding tube. Playing cards and other games were always enjoyable to me when I couldn't eat. Just being company and his big sister I'm sure will cheer him up.


BOT-SCC Partial glossectomy 7/16/09.
Stage IV, Rt ND 10/2/09.
Teeth out 11/5/09.
Port/peg in, 11/20/09.
7 wks rad & chemo, end 1/22/10
lung, colon biopsies 1/9/11 - both cancer
colon resect surg 1/10/11
Folfox + Avastin - discontinued 6/11
lung surgery 3/13/12, 5/1/12
mets to liver and bones
passed away 9/4/13
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Jim - you are one very special guy - and you've brought many smiles to the rest of us. I like what you said about coming out smiling "or pretending to be" because if you can pretend for long enough, you begin to feel it and believe it. One of my favorite books to read to my children when they were little, was "The Little Engine that Could" with the words: "I think I can, I think I can. . . " and pretty soon that little engine DID get over the mountain!
RandysSister - My son, did not like for people to say, "Well, it could be worst!" But he did enjoy company. As his big sister, maybe you could ask him to make a list of anything he might need or enjoy and let people who come to see him know. My son enjoyed playing video games with someone, and really appreciated it when one of his friends brought him a new video game. It helped to bring him up a notch from being depressed or thinking dark thoughts. One of the first times my son smiled was when I took him to see a funny movie. I think it reminded him of his own sense of humor.
Bloop - you really brought up something I hadn't thought of and so important about not eating in front of someone who couldn't! It's true, there are so many other things to do that are important when getting together with family or friends.


Anne-Marie
CG to son, Paul (age 33, non-smoker) SCC Stage 2, Surgery 9/21/06, 1/6 tongue Rt.side removed, +48 lymph nodes neck. IMRTx28 completed 12/19/06. CT scan 7/8/10 Cancer-free! ("spot" on lung from scar tissue related to Pneumonia.)



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Here I thought there would never be a time when I was glad that I will never be able to eat or drink again but just use a feeding tube. But thanks to OCF and Bloop, it has happened.
Because otherwise I'd be reluctant to assert that "not eating" is not the worst thing to happen with oral cancer. I don't have to worry about someone posting on how I don't understand the total deprivation.
Bloop is right that every social occasion ends up with a food component - and not being able to take communion at Mass is something I'm still not over. Yet when you read the OCF posts, there is enough suffering to go around for everyone.
Charm


65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
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Bloop, thanks for your reply. My brother is staying at my mom's house and she will NOT be cooking. We all feel so guilty eating around him. I like the idea of games, maybe that would be entertaining. My brother tries to act like people eating around him doesn't bother him but it does. Plus, the smell of food cooking makes him nauseous. I didn't realize he could have his feeding tube in indefinitely. After radiation tx does the sense of taste change a lot? Is eating a disappointment because of taste loss? So much to learn so little time before he arrives.




Sister to Randy (47, nonsmoker)
Base of tongue, scc, stage IV, lymph node involvement
Dx Nov 2009, started rad/ chemotherapy 12/09,PEG tube
Finished 02/10
Joined: Mar 2008
Posts: 3,082
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I certainly hope Randy is not on a feeding tube very long if it upsets him to see other people eat. Trust me, it's a self-defeating attitude. It's true everyone is different, and I would have felt guilty if my loved ones and family didn't eat around me. As I posted above, social situations and family reunions always involve food - the sooner Randy gets used to it, the better IMO.
The point about cooking smells is an excellent one as they did make me nauseous at first. Now however I savor the smell of food as I won't be eating it.
Finally, games are indeed good. Randy is lucky to have such a caring sister who worries about him. Love is something Cancer can't take from us unless we let it.
Charm


65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
Joined: Jul 2010
Posts: 531
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I'm sorry but you really can't make people who can eat feel bad. That's just not healthy for them or you. We do feel bad that you can't eat like we do, but how can you expect people NOT to eat to stay healthy themselves? Especially your caregiver. Could you imagine if they didn't eat and how that would affect taking care of you when they themselves don't have the stregnth to take care of themseleves because they feel bad so they don't eat? That's just not right or healty for anybody. I disagree on not eating in front of Ron. He doesn't mind, I cook all the time and he loves it and the smell. My cooking helped him in surviving and getting his weight back when he had Non Hodgkins Lymphoma and as soon as he gets better with his swallowing I hope to get his weight up a bit if not all the way up to where it was. Even his Doc commented on how his weight was back to normal and he said it was his girlfriends cooking. His swelling in his throat is getting better and he is slowly getting better with eating and I apoligize to those who will never be able to eat food again. The nausea thing though is a different story. How long ago was he diagnosed and had treatments? Hopefully the nausea will subside and also there is medication to help with the nausea. what is you mom gonna do to sustain herself while he is there? You can't hide eating. I'm sorry but I don't think it's selfish for us to be able to eat, it's survival and staying healthy ourselves to take care of them. We have to eat.


CG to Ron
Out of Pain 4/3/13
4/12-lung and under chin growth no treatment
1/13/12 lung biopsy
6/11 recur 6/30 resection #2 Clear margins
Clear 12/10
Surg 5/13/10 neck dis/nodes part gloss/flap R thigh all teeth out
RAD 30 8/10
DX 4/2/10 "Oral Cavity" T3NOMO
12/28/07 Non Hodg Lymph remission 7/08
passed away 4.3.15, RIP Ron, you are greatly missed
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Posts: 3,082
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Hey Dr Brooks - the OP of this thread

Although I am guilty of participating in the hijacking of your thread, (although in our defense, not being able to eat is very depressing and worrying about a patient's feelings is not very cheery either so there's a tenuous connection), I did click thru to your link and read your story/book.
I almost didn't since your original post seemed more appropriate to your medical colleagues who don't have a clue about what we go through as opposed to OCF members who have lived through it.
I'm glad I did though, since your operation horror story is the worst I heard of for oral cancer: they used a laser to take out the scar tissue and miss the actual cancer tumor itself and don't even realize it until you have been in the ICU and Pathology reports their error. Surely depressing.
What may be more depressing is your report that you had to leave out not only that error but all the other mistakes your doctor made in order to get published in a journal that doctors read.
Charm

Last edited by Charm2017; 11-01-2010 10:05 AM. Reason: typos

65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
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