TUMOR --TRYING NOT TO THINK ABOUT IT



"Now THAT'S a growth!"

 How can you not think about a tumor that is growing inside you when you've been diagnosed with cancer?

My mother faced this problem. Her tumor interfered with her ability to swallow food and even to breathe comfortably. For her, that tumor was a huge problem. Would it grow larger? Would it take over?

It's hard to tell yourself not to think about it, isn't it? After all, you know it's there. The scans confirm it. You've probably been tested for it. How do you cope with the reality that there is a growth inside you?

Sometimes the best way to cope with a situation is to meet it head-on. Information can be a lifesaver. When my mother found out she had this tumor, she also found out what treatment could do to it. Radiation made a difference. Chemotherapy made a difference. We made a point of asking a lot of questions. We wanted to know what her best options were. Slowly, but surely, she began to feel better as her cancer treatment kicked in. When she started, she needed oxygen round the clock, to help her breathe. But as the tumor began to shrink, she could leave that tank behind. She was able to resume a more normal life and do many of the things she loved to do.

It's hard to cope with your fear about a tumor. Some people may tell you to put it aside, not think about it, or even let it go. But sometimes confronting that fear can be helpful. When you understand what the goals of your cancer treatment are, when you communicate effectively with your oncology team, you have a better understanding of how that tumor will affect your life. Much of the time, there will still be unknown factors. Will you have weeks, months, or years? Can the tumor be kept in check? And if it does grow, how will the oncology team continue to help you?

Every day, there are new ways of attacking cancer. Over the years, I've met people who have survived for decades with different forms of the disease. I've even met several Stage 4 patients, alive and kicking, despite receiving a terminal diagnosis years earlier. The truth is everyone is different. The more you understand about your own situation, the better. Sometimes the hardest thing about having a tumor isn't the tumor, but the fear of the tumor and what it means for your life.

As for that tree, I've watched it for several years now. It continues to survive, despite that enormous growth. I am always amazed that it is still there when I come upon it during a hike. I expect it to die, but it doesn't. In the spring, the leaves still come out. In the summer, I am still shaded by its canopy. In the fall, it still sheds its leaves like all of the other trees in the forest. Somehow, it goes on. Maybe you will, too. Be hopeful. Fight hard. Embrace life. With cancer, it's important to see the forest AND the trees.

CANCER TAUGHT ME TO "ENJOY THE PARTY"

We don't always think of cancer as being a teacher, but it taught me some important lessons. One of the biggest was that it's important to "enjoy the party".

For many years, I spent a lot of time in the kitchen at the holidays. Coming from a family of non-cooks, I was the one in the kitchen with my mother, fixing the feast for the holidays. Even my mother wasn't a big fan of cooking, although she was good at it. Usually, she would bake her pies the day before, and then get up early in the morning, to start the turkey. I often filled in with the rest of the dishes, with relatives contributing their specialities.

Over the years,  I cared for her when her health began to fail. She still wanted to participate in the cooking process, but her energy was limited. That's when I became her sous chef, chopping and slicing, so that she could do the actual cooking. It was important for her to feel that she was making a meaningful contribution to the gatherings.

But when she was diagnosed with lung cancer, everything changed. She was too fatigued from chemotherapy to stand in the kitchen, cooking for hours. Neuropathy robbed her of the use of her hands and feet. It's hard to cook when your fingers can't even do simple things, like button your own shirt or tie your own shoes.

And yet, my mother was still determined that we would entertain the family. There was nothing she loved more than a big gathering with lots of laughter. I learned to get the meal together in stages, so that most of it could be re-heated when the guests arrived.

As time went on, I continued to sharpen my organizational skills, trying to find ways to make my life easier. After all, my mother was still going for treatments and medical appointments, and that meant we spent a lot of time at the hospital and in doctors' offices. I didn't have a lot of time to fuss with food.

But more than that, I learned over time that it wasn't so much the food that made the party. It was the people. Without family and friends gathering to share, a meal is just a meal. With the people you love all around you, there is laughter and love.

This year, Thanksgiving is going to be less complicated. I've got my pie crusts thawing in the refrigerator, ready to become apple pie when I chop my apples tomorrow. I made them in the Cuisinart earlier this week, with Julia Child's food processor recipe. My corn muffins are in the freezer, baked fresh last week. I made a double batch of cheese sauce, used half for tomorrow's cheddar broccoli and the other half for tonight's macaroni and cheese. I cooked the turkey today, so it can be sliced up, piled on the big casserole dish of stuffing I will make tonight, and moistened with the canned gravy I bought to save myself some time. Tomorrow, I will try my first pumpkin souffle, as a side dish. One of the guests is bringing a wonderful cranberry-walnut tossed salad with gorgonzola. I'll slice some cheddar cheese and make a platter with whole wheat crackers and red seedless grapes. If I have the time, I might even make a dip to serve with carrot and celery sticks. But one thing I'm not going to do is stay in the kitchen tomorrow.

Cancer is a big disease and the lessons it teaches us are big, as well. Tomorrow, I will join the party. I will listen to the stories, share the laughs, and be a part of the moment. I will appreciate the opportunity because time is promised to no one, and I know now that I should not wait until the next party to get out of the kitchen. We have to seize the day and embrace it. In the end, it's not the little things that really matter. It's the life you have. Make the most of it. Enjoy the party.

CANCER IS LIKE AN AUTUMN HIKE

You're probably wondering how in the world I can compare cancer to an autumn hike.
I'm not talking about the early autumn days, when the leaves are still on the trees and everything is painted in glorious color. I'm talking about the later days, when the leaves have fallen upon the trail, and when you look around you, the trees are bare.
This is the time of the year when footing is precarious. You never know what lies beneath the leaves, but every step of the way brings the crunching sound of your boots on the ground. Sometimes you slip, lose your balance, and start to slide.

It's the time of year when the trail disappears under the vast sameness of the ground cover, and you have to rely on your keen eye to find the subtle dips and rises of the ground to guide you.

I go hiking with my little Yorkie friend. Any other time of the year, she is scampering through the woods, bold and curious. She climbs boulders and hops right over big logs across the trail. She feels confident in the woods, exploring every nook and cranny and hole. But in the fall, she has trouble moving through all those dead leaves. Even she doesn't know what lies under them, and sometimes she falls over tree limbs and rocks. She becomes timid. The crackle of the leaves must be deafening to her.

With cancer, you never really know what lies beneath the surface. You hope for the best, but sometimes you can stumble over the unseen obstacles. It's hard to know what to do and where to go, because when you look out on the horizon, all you can think about is that cancer. You sometimes wait for it to crop up unexpectedly. And it's so hard to think straight, until you know that it is in remission.

And that's why cancer is like an autumn hike. You go slowly. You study the terrain. You look for the clues to point you in the right direction. You try to find your way using all of your senses.

But there are also trade-offs to being on the trail in the fall. This is the time of year there is more sky above you. You can see further, because the trees are bare, so you get a broader view. In the vast sameness of the woods, where all you see are dead leaves on the ground and bare trees, you can also begin to see other things when you look. The treasures of the forest begin to reveal themselves to you. There might be a small grove of new pines emerging, or an unusual mushroom with a crooked cap on its head. You might discover, as I did today, the remnants of an old stone wall, from a couple hundred years ago, half-buried on the wooded hillside. It could even be something as simple as an aerial dance performed by winged insects, caught in a sunbeam. These things only appear when you look for them. Sometimes you have to force yourself to find the beauty in the never-ending brown landscape of fallen leaves.

To a hiker, the forest is never the same experience twice. Every hike looks and feels different. Things change, sometimes evolving over time. But you come to rely on your senses to help you navigate the unseen and unexpected. You train yourself to look for the pleasant surprises along the way. Let cancer be more than just a disease that affects your life. Let it be an opportunity of which you take charge. You may not be able to change the season of your life, but you can choose what you discover within it. Find the treasures that life offers along the way. Appreciate the goodness you stumble upon. Celebrate the love that shows itself. These are the things that really matter most.

BATTLE FATIGUE FOR CANCER PATIENTS

I was having a conversation recently with a couple of baby-boomers who had been walloped by the economic crisis that is squeezing the middle class. After a sustained unemployment situation challenged their savings, they were starting to get back on their financial feet, but it will be a long struggle for them to regain economic stability. With new income going out to pay financial obligations as soon as it arrives, it's hard to feel like there is much reason to carry on. Add to this some other stressful changes in their lives, with the death of a loved one and an empty nest as their child entered college, and they are right smack dab in the middle of a psychological obstacle course.

How does this apply to cancer treatment? The subject arose as to what they would do if either developed a serious illness. The feeling was that they wouldn't bother to take extreme measures to treat the illness, because who wants to live a long life if it means suffering?

In reality, this couple is suffering from what amounts to battle fatigue. People who face prolonged struggles often come to have this kind of mindset. When it occurs during treatment for a manageable disease, it can imperil the outcome.

Sometimes patients who have been treated for cancer more than once come to feel that it's not worth the effort. Or that they are burdening their families by seeking treatment for a recurring disease. When this kind of situation arises, it's important that caregivers appreciate what is really happening and why.

If your loved one seems reluctant to seek treatment, perhaps the biggest problem isn't the cancer itself, but the battle fatigue that accompanies it. What are the chances that your loved one can get past the obstacles and go on to live comfortably with the disease under control for several more years? Is there a reasonable expectation that the cancer can be brought into remission with treatment?

Sometimes the hardest job for a caregiver is to understand the real prognosis for the disease. When people talk about quality-of-life care, some will avoid it until the last minute, because they hope desperately for a cure. They're willing to fight the fight and take on all the discomfort that goes with that. Some of these people would benefit from understanding the reality of their prognosis, that end-of-life care can be a better option. Sometimes people need to live their lives more than they need to pursue the potential brass ring. But other people sometimes opt for surrender long before that may actually be the best option. If a disease is manageable and the quality of life can be good with treatment, people need to understand that a negative mental attitude can prevent them from pursuing viable opportunities. If there is battle fatigue, patients often won't see the potential for a future. If they are scared from their emotional and physical battles, they will think it isn't worth fighting anymore.

Cancer treatment is always more than just surgery, radiation, and chemotherapy. It's about helping the patient and the family understand that there are so many details in treating the disease.

Every combat veteran on the battle field dreams of the day he or she can go home again, to live in peace and leave the war behind. Your loved one is really no different. Cancer is an enemy that wages war with a ferocity that can intimidate. Help your loved one to recognize the realistic opportunity to survive. Keep the home fires burning. Work on the morale of your loved one. That what real support is all about.

PERSPECTIVE IS EVERYTHING -- HOW AN ARTIST'S EYE SEES CANCER

As an artist, I value perspective. As a caregiver, I've found it can make all the difference in how a cancer patient looks at life.

Some artists like to work outside, capturing the feel of the scene they are painting.  They spend the hours immersed in the fluidity of the scene, as the light changes and the breeze blows. Me? I'm more interested in capturing a moment in time, and I like to take my time in examining it in all its intricacies. I take digital photographs and study them. I learned long ago that my mind, if allowed to wander, will imagine what is there if it doesn't have enough information on what I am looking at, and as a result, my paintings aren't accurate. To me, there is great beauty in reality, but only when you look for it, and only if you have the capacity to appreciate it.

When I start to paint a canvas, I block out the shapes. As I move forward, I begin to fill them in, stroke by stroke. At first, my mind only takes in the big picture.

Unfinished Canvas of Parker Memorial Park, Branford, CT

In the case of this painting, still a work in progress, I see the shapes of the stone wall, the rocks, and the treeline. Once those are in place, I start to focus on the details. There are changes in color in the trees, the water, and the rocks. Once I get those done, I notice there are people in the park, and picnic tables, benches, even a car. As I keep working, I start to see that the shadows come into focus, and there is a hidden roof there and a couple of boulders I missed earlier, when I was too busy trying to fit everything in. I even discover that there is a heart shape in one of the rock formations in the foreground. It's little things like that which I so enjoy discovering as I paint. In every painted scene, there are secrets that only reveal themselves to me when I have enough understanding of the scene I am painting to recognize them.

How does all this fit in with cancer? When you are first diagnosed with it, you're faced with the task of blocking it all out, just like I block out each of my paintings. You have to fill in the sections and put things in their proper place, before you can see the details. But as you go along, you will find that there are subtle differences that can be good or bad.

The first thing you see in the big picture for cancer is that it can be overwhelming in its power. But after the big picture, you start to look at the big blocks of information -- not all cancers are the same. There are different kinds and they don't all have the same results. Some people live with cancer for decades. Some people don't. Once you understand that, you start to focus on the details. Survival rates are up for certain kinds of cancers. New treatments are discovered constantly, improving life sometimes for weeks, months, or even years. Why does it matter if you can live another few weeks, months, or years? Because things can happen in that time that can change your life. By the time you get down to the little details, you begin to see that time is your friend. It gives you options for treatment, for quality of life, for making choices. You start to understand that, as a cancer patient, you may not have the choice to have cancer, but you can start to make decisions about how you will live with cancer. And you also start to understand that while your life may be limited in some ways by your disease, you often have a greater understanding and appreciation of what really matters in life than a lot of people who are never forced to really examine their lives. Life matters to you because it's under attack by cancer, and you have to navigate your way through the maze of treatment options and choices. Some people never discover just how precious life is, or why we should celebrate the good moments we have, because in the end, life is always too short. Live every day like it matters, and it will.

LOSING INDEPENDENCE DURING CANCER TREATMENT

My mother lost her confidence in herself when she was on chemo, and with good reason. She was weak and had great difficulty just walking any distance. But she wanted to drive her car again. She was extremely frustrated that the doctor suggested she practice off-road first, to make sure she would have the strength to stop the car suddenly and to make sure she had enough concentration to keep her attention on the road. One day, I took her out driving. It was a disaster. She had no idea where she was. Her rhythm was off. It was like watching a movie in slow motion. She was close to tears when she accidentally scraped the car mirror on the side of a building. For me, it was rather like taking a teenager out for driving lessons. I had held my breath several times as we came perilously close to objects. The truth was she was in no condition to drive, and it had little to do with her age. It was all about the chemo and its effects on her nervous system.

If your loved one is going through chemotherapy, it's important to be sure that he or she is capable of doing tasks like driving. The last thing you want to do is send someone on the road who poses a risk to the public. Having to tell your loved one that he or she shouldn't drive is tough. There's no real upside to losing your independence, even if it's for a couple of months. Suddenly, you go from being an adult with a life and the capacity of making decisions for yourself, to someone who requires transportation wherever you go and you are forced to rely on the kindness of the people who love you, without really being able to give back. That little imbalance creates a real sadness in a lot of people, and rightly so. Imagine being too weak to do your normal activities, and now suddenly, you actually are dependent on people for everyday needs. For some people, chemotherapy isn't this devastating. They manage to function quite well while chemotherapy drugs are coursing through their systems. They continue to work, exercise, and drive without problems. Others are totally knocked off their feet.  For most people, though, the effects are somewhere in between. Different chemotherapy drugs have different side effects. But they all have one thing in common. They are designed to affect the cancer. It's difficult for your loved one to keep that in perspective when it means giving up his or her independence. Your job, as caregiver, is to help balance that sense of loss.

How do you do that in a reasonable way? If your loved one has the energy and the inclination to get out and about, but can't drive, the solution is simple. You can drive your loved one or arrange for family and friends to do the driving. But if you want your loved one to feel less guilty and more relaxed about his or her dependence, make it a social event. Don't make it seem like it's a chore for you.

I learned this the hard way. Sometimes, when my mother was most frustrated, she would pick a time when I had already made plans to do something, and then she would announce she wanted to go out. Part of this was the self-pity she felt. She was mourning what she couldn't have -- the independence to pop out to the store when she wanted to go. But it was inevitably when I was on my way out the door to do something I needed to do for myself. Sometimes, I would offer to take her where she wanted to go hours before I had to be somewhere. And inevitably, she would be late. I would feel myself getting frustrated because it was going to ruin my plans. It took me a while to realize that it was her way of feeling some power, albeit at my expense. That's when I realized that I had to do what I had to do, but I could adjust my plans to times when I knew she wouldn't be able to stop me.

My mother was not a morning person, especially during chemotherapy, and I learned that if I made my plans during the hours she was too fatigued to want to get out and about, I could have my own life and still meet her needs. She seemed to come alive from 11 AM to about 3 PM, but after that, she needed a nap, especially if she had been very active during the day. That window of opportunity kept me sane. I made it to my own medical and dental appointments, got to the gym for my daily workouts, and took the dog for her walks, all while keeping my mother as active and social as possible. I also did my best to help her channel her energy in more positive ways, to help her feel more in control of her life, so that she didn't try to regain her sense of power by thwarting me.

When people are under great stress, they will say and do things that are counterproductive. As a caregiver, you have the responsibility to be the voice of reason, and that requires that you exercise your mental facilities to figure out what that is. Sometimes it's hard to know where the frustration is coming from and what the solution to the problem is. Imagine what that's like for someone on chemotherapy, with your nervous system under attack as the drugs flow through your body in search of cancer cells. Your body is going through changes that don't necessarily feel good to you, and you're expected to endure these side effects without falling apart physically. What about your emotional well being? What about how you feel?

That's the problem with chemotherapy. It affects your body in ways that can be confusing and upsetting, and when your body feels like its been turned upside down, your emotions can run rampant, all while you don't necessarily have the capacity to understand what ails you. Many people vent their frustrations on the people taking care of them. At times like these, it's a good idea to develop a thick skin, bite your tongue, and recognize what you're seeing in your loved one.  You have to stand up for yourself in an appropriate manner, so the relationship can regain a more natural balance, but you have to choose your words carefully and appeal to the goodness in your loved one. No decent person enjoys losing emotional control of himself or herself, and when it's compounded by a loss of physical control, it's even scarier. That fear can add to the confusion of the situation. But if you recognize it for what it is, you can help your loved one avoid bad behavior that is driven by fear and frustration.

SAVING MONEY DURING CANCER TREATMENT

A number of families find their expenses go up significantly when a loved one is undergoing cancer treatment. Obviously, there are prescription drug costs, in addition to bills for medical treatments, and a lot of these aren't always covered by insurance. But there are also often a lot of out-of-pocket expenses. These can wreak havoc with family budgets. How can caregivers manage these changes?

I noticed a big change in the family grocery bills when my mother was having cancer treatments. Why? Because a number of her medications had severe side effects that required buying over-the-counter remedies to treat them. Prescription drugs like Prednisone, which help with related breathing issues, require an over-the-counter drug like Prilosec to address the negative side effects, such as acid reflux disease.  Some drugs cause side effects like constipation, so the use of laxatives and fiber may be directed by the physicians. Every cancer patient's needs will be different, according to his or her situation, but one thing is certain. There will be an increase in spending, to accommodate these changes.

If you're used to shopping at a traditional supermarket, you're going to have to find ways to cover the added expenses that cancer treatment can bring. Plan the weekly grocery shopping carefully. Shop the weekly specials and buy in bulk if these are items the family usually uses. Clip coupons for more savings. A number of over-the-counter remedies can be bought at reduced prices, through manufacturer's coupons and discounts or by purchasing them in larger quantities.

Consider joining a warehouse club, like Sam's, B. J.'s, or Costco. Normal household items, like paper goods and laundry products, are expensive, and if you buy these at a warehouse club, you can cut your costs. It's also true for fresh produce, dairy items, and prepared or frozen meals. This will save money for the overall family budget, but if you also purchase over-the-counter remedies in bulk, you can really cut down on costs.

If your loved one has lost a lot of weight and needs to have products like Boost or Ensure, you can save money at warehouse stores, or even at Walmart. My mother hated the cloying sweetness of nutritional supplements, so a nurse shared her recipe for protein shakes with me. The shakes gave my mother the extra calories and protein she needed, but tasted better to her, especially when I added ice cream to them. I bought the protein powder in big cans. At the supermarket, it was $22, but at Walmart, the same product was under $14. That's a big savings when you're mixing up shakes two or three times a day. I saved the nutritional supplement drinks for emergencies, and that worked out well. Sometimes you have to be creative in how you approach the situation, and you have to make it work for you.

It's also helpful to realize early on that your loved one's cancer treatment will have a cumulative effect on the family finances. If you can understand this, you can avoid some of the pitfalls that a number of families fall into at one point or another. Cancer treatment is expensive, and by conserving the financial resources of the family in little ways, you will be better able to meet the unexpected costs that crop up along the road. 

If your loved one did the "heavy lifting" for the household, mowing the lawn, raking the leaves, doing the garden, you may have to take over some of these responsibilities or temporarily hire someone to do it. If you live in an area of the country hit by rough wintry weather, you may find yourself shoveling snow, chopping ice, and sanding the driveway and sidewalks, or paying someone to do it for you. These bills can add up quickly, which is why it's really helpful to conserve money where you can throughout the cancer treatment. 

What if you don't actually need the money you've saved during cancer treatment? Why not use it to take a family trip? Reward yourself and your loved one by having some fun once your loved one gets through with chemotherapy, radiation, and surgery. Not only will you have a chance to make some happy memories, you won't spend your time worrying about how you're going to pay for it all.

And sometimes if your loved one knows there is a rainbow at the end of the storm, it makes it easier to get through it. Why not start planning for a celebration trip during your loved one's treatment? You don't have to dream big. Sometimes that can be overwhelming. But think about something that you'd both enjoy doing together. Maybe it's a weekend at the shore, just enjoying quiet walks on the beach and family cookouts. Maybe it's a few days with the kids at Disney World or Universal Studios. Maybe it's a trip to the city, to see a musical, visit a special art exhibit, or enjoy a concert. Maybe it's a cruise to the Caribbean or a trip to Bermuda. It's a lot easier to pinch pennies when you have a positive goal, and your loved one will be able to appreciate your efforts if he or she thinks a trip is your main purpose in cutting expenses. Cancer patients often feel guilty that they are using up the family's financial resources. By giving your loved one hope for the future and by protecting the family budget, you're extending your care-giving above and beyond the physical needs of your loved one. You're also taking care of the heart, the head, and the spirit. We all need to feel free to be more and experience more, but in order to do that, we have to appreciate how things can build up into problems if we don't take preventative measures to prepare for the rainy days ahead. 

HOW CAN CANCER PATIENTS STAY PRODUCTIVE IN THE WORK PLACE?

How many cancer patients waste their work expertise and experience during cancer treatment? How many are forced to quit their jobs as a result of being physically incapacitated? How can they be supported in the work place, so that cancer doesn't take from them their livelihoods and their future opportunities?

Many people manage to get through cancer treatment while still working. They make arrangements and handle the rigors with grace. But there are others for whom the personal cost of cancer treatment is much more severe.

If your loved one is struggling with this issue, consider a few things before throwing in the towel. Analyze the strengths and talents he or she brings to the job. It may help provide opportunities to keep working during cancer treatment. Can his or her employer provide administrative duties that allow your loved one to be productive while still conserving energy? Can your loved one reasonably scale back some of the normal responsibilities of the job, just long enough to allow the cancer treatments to have a positive effect?

Consider the plight of a teacher who may be going through chemotherapy. How can a school system accommodate the issues he or she might have? We know that kids often are a breeding ground for germs, and a teacher under chemotherapy treatment, with a weak immune system, really shouldn't be exposed to such risks. Is it possible for the school system to offer this teacher a temporary position, possibly as an educational coordinator, a developer of curriculum, or as a long-distance tutor? Maybe a teacher can teach home-bound students, via Skype or another Internet service. It not only cuts down on the risk of infection for the teacher, it provides a home-bound student with appropriate educational resources that might otherwise be missed. Having a teacher who is also a patient can be inspiring.

Sometimes it's hard for patients in the service industry to continue working. Chefs and cooks need to be physically capable of moving about in order to perform their duties. Restaurant work can be demanding. In the interim, what about your loved one working as a personal chef? If you pitch in and help with the grocery shopping and driving duties, would this work?

Nurses and other professionals who are going through cancer treatment have a difficult time remaining on the job in their normal capacities, but certainly there are other opportunities within the medical field, even on a temporary basis. Maybe your loved one can scale back his or her work load to a half day until physically capable of resuming a regular shift.

What about cancer patients who serve in law enforcement? Can't they also be accommodated in practical, useful ways by their employers? Certainly, it's not wise to send a cop out on the street if he or she can't run or keep up with the rest of the team, but there are always cases that could use another review by a seasoned investigator, who can pursue information that was never followed up, and even make phone calls to clarify cases. It's certainly not ideal, but having the opportunity to remain on the job in some form is usually preferable to being cut loose. Maybe there is a law enforcement study that needs doing, or community services that can be improved. It's important for cancer patients who are willing to work to be reasonably accommodated.

If your loved one has a job that allows for Internet communications, it may be possible for him or her to telecommute to work, handling a lot of the normal duties of the work place from home. Even if he or she needs to occasionally go to the office for important meetings, it makes it a lot less stressful if the bulk of the work can be done in between periods of rest. Salespeople, financial advisers, stockbrokers, and others can still function on the job, even if it's in a more limited capacity. Sometimes it's a matter of scaling back the number of clients who can be served, or joining with other colleagues to get the job done in the interim.

Real estate agents may feel they have few options while undergoing cancer treatment, but what about pairing with a partner during cancer treatments? If there is another agent who works part-time and is willing, why not share the load together? Maybe it's a mom who wants to be home for her kids or a retired realtor who doesn't want a full-time position. Your loved one could continue to work part-time, with a lot of the work done on the Internet. Having a partner could help make the sales.

It's important for your loved one to feel like he or she is able to stay abreast of developments in the field. That means keeping one's hand in the game somehow. By working part-time, even if it means job-sharing, it may allow your loved one to have a smoother transition back into the work force, when the cancer treatment is ended.

Another option is to take university classes for credit. There are a number of opportunities to pursue online education for people in many professions. Some employers would welcome the opportunity to allow cancer patients to use their down time to improve their professional skills. Some employers may even want to pay for these courses.

There are also times when employers appreciate creativity on the part of employees who show initiative. If your loved one has a special project he or she thinks will help the company or agency, why not encourage pursuit of this goal? Maybe your loved one had a great idea to try a new management training module, or wanted to develop a new client list. Now's the time to offer it up. Or maybe your loved one has an idea for a new product or service. Why not use the time during cancer treatment to do the research and put together a package?

Just because your loved one is going through cancer treatment and finds it too overwhelming to work full-time, that doesn't mean he or she has to retire or quit. Working is important to the psyche, and feeling like a contributing member of society is very important. Cancer patients just sometimes need support and accommodation to help them remain in the work place. Employers who recognize this and encourage it will often find that this is a win-win situation. Cancer patients are still living, breathing people with a lot to offer, and when they feel they have a future, they often will pour themselves into the opportunities they find.

HOW DO YOU HELP A CANCER PATIENT KEEP GOING?

Some patients' cancer is caught early on, when it's possible to intervene and predict a rosy future. Other patients find their cancer has advanced to late Stage 3 or Stage 4 by the time it's discovered. For them, doctors often scramble to find acceptable options that can have a positive effect for cancer that's already out of control. But for many patients, their cancer is caught in that middle ground, when it's not really horrible enough to be critical, but also not easily treated and forgotten.

 It's so hard to keep the fears at bay when there is uncertainty. When a patient hears that the prognosis is good, the glass is more than half full, so it's easy to keep one's optimism going. But when a prognosis is "wait and see", and the patient is looking at the potential of having repeated treatment courses over the next few years, the glass is less than half full. How does a heart not feel disappointment over the prospect of handling all that uncertainty?

More importantly, how long will it take for doctors to feel confident that the cancer has been controlled enough for a patient to begin planning his or her future? Two years? Five years? During that time, there will be no promises, no guarantees, no certainty that the treatment is working.

How does a caregiver help a cancer patient get through that long, seemingly endless wait? How can you help your loved one stay focused and motivated, even after cancer treatment ends and the next months are spent waiting to see the results of the next body scan?

First, consider this. What are the goals of your loved one over the next year, and are they reasonable? Sometimes cancer patients stop living while they wait to find out if they are going to survive the cancer. Imagine putting your life on hold until you know. Think of what that means. You can't make any long-term plans until you're sure you will be available the following year. What does that say about this year? That it's not worth living?

Second, what is the condition of your loved one at this moment in time? What is he or she capable of achieving and what kind of support will help him or her get it done?

Third, how will you feel if you let your loved one languish during the wait for news, especially if it turns out the news isn't good? Will you have regrets that you didn't take the time to help your loved one to complete achievable goals now?

If your loved one is treading through that great "unknown", when it's impossible to know how all of this will work out in the end, seize the day. Take what is before you and make it matter. Understand the role of worry and stress on patients and the damage that can result. If your loved one spends the next year in an emotional limbo, that will result in greater stress, and that stress often has real physical manifestations. Your goal, as a caregiver, is to help your loved one be as healthy as possible under the circumstances. That means understand that stress over time can do great damage to the physical body, but it can do even greater damage over to the heart and mind.

If your loved one puts his or her life on hold while waiting for the results of cancer treatment, he or she will begin to direct all energy towards waiting and wondering. It becomes a habit to stick to the sidelines of life. When the wait is over, what will your loved one have to show for all that sacrifice? If the news is good, your loved one will need to get back to normal activities, but he or she will still have to work through that anxiety and fear that the cancer is still dangerous. If the news is bad, he or she will have lost all the time spent waiting, without a positive outcome waiting in the wings.

That is why it is so important to embrace the here and now and make it work for your loved one. He or she probably won't be able to climb mountains or leap tall buildings, but if there is a dream that's achievable, now's the time to go for it.

Sometimes it's not easy to live in the here and now. Your loved one may hesitate for fear of not being able to finish reaching for a dream. That's why it's important for you, as caregiver, to help your loved one focus on the achievable goals and to make the effort to get to each finish line. Build on each success as it's achieved. When your loved one reaches the first, start planning the second. Not only will this help improve the confidence level, it will create a more positive momentum. You'll both find the long wait feels shorter and that time goes by more quickly because your loved one is focused on living, not dying. However things turn out, you will always have these moments that you shared, and the goals that are reached will be part of your loved one's history, regardless of what course cancer takes.

KEEPING UP SOCIAL OPPORTUNITIES DURING CANCER TREATMENT

Cancer is a tough foe. Patients often find themselves thrust into intensive cancer treatments. There might be radiation, chemotherapy, surgery, or a combination of these. Sometimes patients are treated daily. Between the time spent at the hospital or cancer center and the time spent dealing with the side effects of treatment, there's little time left to keep up with normal activities. One of the first things to be sacrificed is socialization. Without it, patients often don't have the human connections they need to feel human.

In a lot of ways, going through cancer treatment is a lot like going off to war. The patient's attention is focused on getting rid of the cancer, and so much energy is devoted to that goal, because without it, there's little hope of survival. Most cancer patients have an immediate circle of support. It might be a spouse, children, or parents. It might be a close friend or two, a cousin, or sibling. But as cancer treatments move along, there is sometimes a tendency to keep to that narrow circle, and other relationships can fall away.

Some of this is the result of the demands of cancer therapies. Vulnerable patients with a risk of infection learn to stay away from crowds. Or they find they just don't have the energy to get out and about as easily. It's an effort to go through treatment and still have an active social life. Some patients even begin to withdraw from social opportunities for fear of seeing that pity in the eyes of people who care.

It's important for caregivers to help cancer patients engage in pleasant social interaction. Sometimes, it's a matter of adjusting the opportunities to fit the capabilities of the patient.

I learned over time that my mother was wiped out after chemotherapy two days after a treatment. It would hit her like a brick and she would barely be able to keep her eyes open. She felt it was weakness on her part that she couldn't fight the fatigue, until she learned from several younger  patients at the cancer center that they felt the same effects. One of the benefits of talking to other patients is that you begin to learn what is normal during treatment. Some chemotherapy drugs can really knock a patient for a loop, and when you begin to understand the pattern, you can begin to plan social outings that are much more enjoyable. Every patient is a little different in experiencing the side effects, but once treatments start, you can begin to see the onset of side effects as they commence.

For my mother, it was important to know that what she was feeling was the drug, not the cancer. That helped her to let go of some of the fear of the fatigue. We knew that she felt good the day of treatment and the day after treatment, so we would plan outings for that time. We also knew that by the weekend, she'd feel more like her old self again, so that allowed us to plan more opportunities. But in the middle, when the side effects took over, there was really no sense in making plans. Accept what you can't change and change what you can.

Another symptom we noticed for my mother was that she had little energy in the evening. Her peak hours were from 11 AM to 3 PM. That gave us the chance to go out to lunch, visit a museum, take a picnic to the lake, or even take in a movie matinee. If she was really exhausted, we sometimes brought a companion wheelchair along, just in case. If she was feeling good, she wanted to walk. And walk she did. She enjoyed herself immensely on these outings. She felt connected to the world again. Very often she would start conversations with strangers, share laughs with old friends, and see new sights. She still wanted to explore and experience life. She needed to do this. It made her feel human again.

Sometimes, when I was feeling ambitious, there might be a dinner party for family or for friends. I would start the food preparations ahead of time. I often took shortcuts and kept the menu simple. I let other people bring food, instead of trying to do everything myself. But most of all, I let my mother do what she most loved to do, and what she most missed when cancer sapped her strength. She got to be hostess to her guests. She sat at the dining room table, opposite my father, and socialized with the people who mattered most to her. She knew she couldn't do the party clean-up any more, but once in a while, she could find the strength to sit at the table and have fun. Once she stopped worrying about all the "extra work" she was making for us and understood we wanted her to have fun, she let go of her guilt. She would rest up in the hours before the party, while my father and I got all the preparations done.

If you are caring for someone who is going through cancer treatment, remember that there are little ways in which you can use your creativity and caring to help someone still feel connected. Even if it's picking up pizza or a prepared meal for a group, do it. Or invite friends for pot luck. Let someone bring an appetizer, someone else a salad, someone else a dessert, and so on.  Laugh together. Share the fun. Celebrate the little moments in life. It's important that we always remember that we have these moments and that we use them to full advantage. Sometimes the greatest healing takes place in the heart. Cancer patients can be weary from all the rigors of treatment. Sometimes the greatest toll is emotional. Having a chance to put cancer aside for a few hours and feel like a normal person again can be priceless.