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ОглавлениеMoving on from diagnosis and prognosis, what about the treatment options? How do you develop a comprehensive treatment plan that is most likely to work and take account of your individuality, your personally unique situation? How to move beyond generalizations and standard treatments, to taking account of individual needs? How do you personalize the appropriate response for your particular situation?
Again, we rely on logic for the framework and then aim to draw on experience, wisdom and insight for the details.
Nearly everyone in the Western world will be diagnosed and consider initial treatment within the conventional Western medical framework. This makes good sense and is as it should be.
Given that the diagnosis and prognosis will be provided by the best medical people available, it is they who will recommend an initial treatment plan. This too makes good sense. Certainly if there were a simple, medical solution to cancer, one piece of surgery, one pill we could take that ensured a cure, we would all do it. You would be a fool not to. But it is not so simple.
Definitions • Curative Treatment, Palliative Care or Living with Cancer?
While the medical treatment of cancer tends to focus on one of two outcomes, to be curative or to be palliative, there is a third option. Let us be clear with the definitions.
Curative Treatment
Curative treatment involves more than what many people imagine it to be, which is to be free of cancer after five years. Actually, curative treatment aims to render the person clinically free of detectable cancer and restore the person to their normal life expectancy.
Palliative Care
On the other hand, palliative care is an umbrella term for assisting those approaching death—a fundamental need and right. It is generally used in the context that death is imminent and inevitable and aims to make dying as easy and comfortable as possible.
Palliative Treatment—Living with Cancer
Palliative treatment is a specific but integral part of palliative care. Palliative treatment can be more interventionist. It is noncurative by definition but aims to extend life, ameliorate symptoms, and increase quality of life in situations where a cure is not medically feasible.
The lines between palliative care and palliative treatment can often be blurred, but these days, palliative treatment is often called living with cancer.
While overall survival rates in the conventional management of cancer may not have improved all that much, in recent years many people are living longer with cancer. This can involve significantly slowing the progression of the disease, minimizing any side effects and maximizing all the quality of life issues. Palliative chemotherapy often plays a significant part in conventional medicine’s management of palliative treatment.
What to do When a Medical Cure is Likely
Now the logic. If a person is offered medical treatment for cancer where there is a high probability of a cure, then, in my view, what to do is fairly straightforward. Embrace that treatment as your main focus while you go through whatever it entails. The common treatment options are surgery—which often comes first—then maybe chemotherapy and/or radiotherapy.
However, right at the start or even better still, before you start your treatment there is more to do. As soon as possible, review your lifestyle and do whatever you can to complement and support the treatment with your own efforts. The details of what this entails follow in the subsequent chapters. Lifestyle medicine will have your body and your mind in the optimal state to get the best out of any treatments and to minimize the potential for any side effects.
When it comes to the complementary, traditional and alternative options, there may well be useful things to consider that will support your body’s healing capacity, minimize or manage side effects and have other useful benefits. These options will be discussed in later chapters as well.
The Choices When a Medical Cure is not so Likely
However, what if a cure is not so likely from the medical point of view? What if at first diagnosis, or further down the track, it becomes clear that a medically based cure is improbable? What if palliative care or living with cancer is all that remains medically? There are three options.
1. Acknowledge Death as the Likely Outcome
This is probably not the option you are opting for if reading this book. However, we do need to recognize and accept that some people do accept their prognosis and do acknowledge death as the likely outcome. They then may choose to focus on what can be done to garner the best from whatever time remains, to live with cancer as long as possible and to prepare for a good death.
Yes, prepare for a good death. Death is like everything else in life. We can stumble into it, hoping for the best, or we can prepare for it and, in all likelihood, have a good death. To be open about this, when I started working in the early eighties with others affected by cancer, I knew little of death and I was preoccupied with the desire to help people to recover. I admit to being apprehensive about what would happen if and when people died of their cancer. While many did recover, others did go on to die of their disease. Over the years I have worked closely with many of these people and it has been incredibly heartening to observe how consistently the people I have known who prepared for death were able to die well. What they learned and what they did stood them in good stead, and the quality of their deaths was exceptionally high. We will speak more of this in a later chapter.
For now, it needs to be said that some people faced with the situation where there is no medical cure on offer do accept death. Some are content to focus on living with cancer and are keen to utilize palliative care when the time comes. Again, that is a perfectly reasonable and logical choice. However, if for whatever reason you are not ready, if you do not accept death, and if you are still intent on getting well, you need to be logical. If medicine cannot cure you, what will? Can anything?
2. Seek a Cure from the Nonconventional Medical Options
Remember the different styles of medicine: conventional, traditional (TM), complementary and alternative (CAM). If conventional medicine says a cure is beyond them, do any of the others have a solution? I have the personal knowledge of many individuals telling me that individual TM or CAM therapies were very significant in their recoveries. But I do not have the experience of consistency in this. It seems that from time to time, for some individuals, individual TM and CAM modalities fit really well with that particular person and are highly effective. But I am not aware of a TM or CAM therapy that reliably will be of major benefit to a wide range of people. I do not know of a magic bullet in the realms of traditional, complementary or alternative medicine.
3. Seek a Cure Within—Recovering Against the Odds
Even when conventional medicine says there is nothing more we can do toward a cure, I do believe there still is real hope on offer. Where the “magic bullet” actually does reside is within you. In the face of difficult odds, a cure may be much more likely through mobilizing your own inner healing than through chasing after some elusive external TM or CAM treatment.
Remember, it only has to be done once to show that it is possible. You only need one person to use their own inner resources to recover without the aid of external, curative medical treatments and you know that it is possible. Just one case demonstrates that there is the potential for the body to react, to reject the cancer within it, and to heal. And if it can be done once, it can be done again. And the truth is it has been done many more times than once. What I have been studying and teaching for over thirty years is what makes this most likely to happen.
Clearly, if you aim to recover against the odds, it is not likely to be easy. There is no point misleading anyone here. If it was easy, everyone would be doing it and no one would be dying. My experience is, as we have discussed already, those who do become remarkable survivors make a good deal of effort. They dare to hope, they seek out good information, they rally support, and they put good intentions into action. Then they persevere. They deal with the ups and downs. They learn from what others might judge to be mistakes, are prepared to experiment, try new things, and in doing so, develop an inner confidence. They learn through their process, often see it as a journey and commonly come to enjoy the challenge and reflect warmly on their achievements. And in all probability, they have a little good luck as well!
Recovering against the odds is not a casual business. It takes focus, energy and commitment. What then is the main thing to focus upon? Clearly if conventional medicine has said it cannot cure you, it is not that. In my view TM or CAM therapies cannot do it reliably either. The focus in this situation needs to be on inner healing, and to support this inner healing with the best of what conventional medicine, TM and CAM have to offer. Maybe more surgery or chemotherapy is useful to minimize the amount of cancer your body needs to attend to. Maybe you use medical, TM or CAM treatments to boost your immunity and your healing capacity, or to minimize symptoms. But in the situation where no medical cure is on offer, you may be wise to focus on your potential, the lifestyle medicine as we call it, and support that with all else.
How to Combine the Best of What is Available • A Summary
When Curative Treatment Is a Real Prospect
Focus on the medical treatment, and support that with all the other options available to you. Lifestyle medicine will always be useful; use TM and CAM judiciously.
When No Curative Conventional Medical Cure Is on Offer
The choices are
i) Palliative care—accept the diagnosis and the prognosis, and plan for a good death. Lifestyle medicine is likely to be of great benefit for extending life as well as preparing for a good death. Use conventional medical treatments and CAM judiciously.
ii) Living with cancer—accept the diagnosis and the prognosis, then accept that your real goal is to live as long as possible, as well as possible. Quality of life becomes the focus—along with whatever is likely to extend your life. So again, the lifestyle factors set out in this book warrant being the focus of your plans, supported by good medicine and whatever TM and CAM therapies may be helpful.
iii) Accept the diagnosis and reject the prognosis. Dare to recover. Focus on developing healing within by employing lifestyle medicine—and support that with all else. Use conventional medicine, TM and CAM judiciously.
What Specific Treatments Will You Accept? How to Decide What to do
Before we examine in detail how to activate the healer within, let us pause to investigate what external forms of treatment, if any, to which you will be wise to commit. Let us begin with the medical options.
The logical way to assess any proposed form of medical treatment would be to ask your doctor the following questions:
(a) What does the future hold for you if no treatment is given, and in such circumstances what range of life expectancy would you have? The best way to ask this question is statistically. Ask if there were one hundred patients just like you and they had no treatment, what would be a reasonable estimate for the following:
i) How many people would be alive after one year and what would their health be like?
ii) How many people would be alive after five years and what would their health be like?
(b) What range of life expectancy would you have if given the proposed form of treatment? Again, ask for the answer to this question in statistical terms. If there were one hundred people like you who had the same condition and they received the proposed treatment, what would be a reasonable estimate for the following:
i) After one year, how many people would be alive and what would their health be like?
ii) After five years, how many people would be alive and what would their health be like?
Note: These statistical ranges should be available in virtually all medical situations, barring those that involve very rare cancers or experimental treatments including chemotherapy trials. If they are not provided upon request, I would seek another opinion. If you are considering an experimental treatment or a trial, you can only assess it on its possible merits.
In other words, through these first questions you are aiming to find out the anticipated benefits of the treatment, expressed in statistical terms.
(c) What are the side effects of the treatment? It will be most useful to obtain the answer to this question in statistical terms as well so that you obtain a real sense of any potential risks. So again, ask:
i) If there were one hundred people like you who had this treatment, what side effects are possible and how many people are likely to be affected by those side effects? Do 5 percent or 95 percent have nausea? Do 5 percent or 95 percent lose their hair?
ii) And how long are those side effects likely to persist? For a few minutes, weeks, years? Will they be permanent?
iii) How might they be managed if they do occur? For example, there are many good treatments available these days for the side effects of chemotherapy, and hair that falls out because of chemotherapy commonly grows back fairly quickly.
(d) What impact will my own response to the treatment have on the outcome? In truth, the answer to this question may be harder to define than the previous three. The medical system is very good at evaluating its results. This is made easier by the fact that a single intervention, such as a drug therapy, is relatively easy to study and accurately evaluate. By contrast, the human being is incredibly complex—the role of emotions, mind and spirit are extremely interwoven. They are not so amenable to the standard double-blind, crossover trials used to research and evaluate so many drugs.
What does seem clear, however, is that how you respond has the potential to affect the outcome of anything you do. If in cancer treatment you are treated with chemotherapy, full of fear and loathing, preoccupied with potential side effects and the possibilities of damaging your immune system, you are highly likely to undermine the potential benefits of that treatment. If, on the other hand, you think it through and decide to accept the treatment, regard it as in your best interest and do all you can to work with it, you are likely to get the very best from that treatment.
The Key to Great Outcomes • Embrace Everything You Do
This is why you are strongly advised to make conscious decisions about all you do. Nearly always, there are pluses and minuses to consider when making medical decisions. Take your time and think things through. If you need help with this, a very useful decision-making technique that draws on both the intellect and intuition is presented soon in the first chapter on mind training (chapter 7).
Once you do come to a decision, the strong recommendation is to embrace all that you do. Embrace! Not just put up with, not just tolerate, nor even just accept it. Embrace it! Understand that this is what you have chosen to do. It is in your best interest—like when you would take antibiotics for pneumonia. Know that whether it be having chemotherapy, changing your diet or practicing meditation, the more you welcome it into your life, the better you feel about doing it, the more you support your choice, the more you embrace it—the better it will work.
When you embrace what you do, you release all the positive potentials of your mind, emotions and spirit. My belief is that when you embrace a treatment and really work with it in positive expectation, then you can reasonably hope to get the best possible results with the least side effects.
However, given all this, you may still have a very difficult decision to make.
The reality is that most current treatments for cancer are hard on the patients—sometimes very hard. It is a fact that most of the conventional therapies are toxic to the body. Radiation and chemotherapy frequently impair the body’s own immune system along with other components of its defense mechanism. This reduces the body’s ability to heal itself. Often this impairment is severe and side effects can be marked. Radiation burns, vomiting and loss of hair are obvious problems that can follow. Tiredness, lethargy, “foggy” thinking, depression and loss of memory are all observed as regular consequences of cancer treatments.
The impact of many medical treatments upon the rest of the body can be less obvious, but nevertheless more drastic in nature. Minor infections that previously would have been of no consequence can assume major proportions. Most important, the body’s own ability to fight the cancer is frequently lessened.
However, while the side effects of conventional treatment require careful consideration, chemotherapy or radiotherapy may still be the best medical treatments that are available at present. It may well be that it is in your best interest to use them. If this is the case and if you are having a toxic form of therapy, it is all the more important to concentrate on those self-help techniques that aim to boost the immune system and help the body to help itself. These techniques are discussed in later chapters.
Be Brave—Communicate!
Here again, good communication with your doctor is essential. The ideal is to be able to discuss all your concerns freely and easily with your main doctor. If this is not the case, talk with that doctor about the communication problem. We all know how some personalities clash and there are some people we just do not seem able to get along with. If you cannot find a way to correct the situation and communicate well, then request a referral to someone more suited to your temperament. No one should be offended by this. It will make life easier and more constructive for everyone. (For more detailed recommendations, see Appendix A.)
The final choice regarding what conventional treatment to accept may still be difficult. Again recognize the value of making this decision with clarity and confidence and the imperative of committing to what you do decide to do. A reminder then of the value of taking your time. Better to avoid a rushed, hasty decision that may later cause you doubt or regret. Best to take your time, seek expert opinion, discuss the options with those you value, contemplate, give due regard to your intuition and then commit.
Maybe in the final analysis it is the level of confidence and trust you place in the doctor(s) involved that decide it for you.
If surgery is what seems necessary, it seems wise to leave the details of the surgery to your surgeon. If chemotherapy is something else that you decide to commit to, again it would seem wise to leave the choice of agents to your chemotherapist.
You may desire, however, to know more or less of the details of your treatment and you can reasonably expect to have your questions answered in an open, cooperative manner.
Whatever the final choices you make, the next step is to do all that you possibly can to make sure the treatment works to full effect. We will discuss the means to achieve this throughout the book.
How to Enhance Surgery, Chemotherapy or Radiotherapy
The majority of people diagnosed with cancer will have one or more of the conventional treatments recommended to them, and decide to commit to the treatment. With the intention of minimizing any side effects and maximizing the benefits, it is important to be well prepared and to do the best possible to work with any treatments. While the details of what to do unfold in the coming chapters, a quick summary of the recommendations regarding how to prepare for medical treatments forms Appendix B.
Activating Your Inner Healer
Based upon many years of clinical experience and supported by the most recent research, the way to activate healing through your own efforts is easy to define. Your body’s capacity to heal is directly affected by what you eat, what you drink, and whether or not you smoke. Sunlight, vitamin D and exercise all play important roles, as does your emotional life and state of mind. How you manage stress, your capacity to relax, to be mindful and to meditate—along with the way your spiritual view impacts on your life and those around you; all these factors impact on the inner healer.
While I have to say it strikes me as a somewhat bland term, all these elements are best described as being under the banner of lifestyle medicine—they are to do with the things you can control and do in the course of your daily life. And the key? It is your mind. Again, it is your mind that decides what you eat and drink. It is the mind that helps you to adopt a healthy, healing lifestyle or remain stuck in old unhelpful habits. Truly, it is the mind that changes everything and so we will begin the road to recovery with the mind.
To embark on the healing journey, to embrace outer help with conventional medicine, TM and CAM, to begin to activate the inner healer—all this is best achieved by being in a stable state of mind, clear and confident. What meditation promises and reliably delivers is a stable, clear mind. As stability becomes more constant, clarity more natural, and confidence more assured, it becomes easier to go from the broad recommendations regarding what to eat, how much to exercise and so on, and to be able to personalize those recommendations. Therefore, in seeking a stable, calm and clear mind, we begin with meditation.
To Those Interested in Prevention
If you are well, just how well are you? Are you just symptom free or are you as fit as your true potential allows?
When this book was first written in 1984, the statistic quoted was that “one in three people alive in the United States today will get cancer during their lifetime. One in five in Australia will die from it.” Now the figure is closer to one in two people alive today will develop cancer and currently one in four Australians dies of cancer. This is not scare-mongering. This is fact. Cancer is a lifestyle disease. Are you prepared to learn the lesson of this disease and take up on a lifestyle aimed for optimal health? A lifestyle that is highly likely to prevent the majority of cancers?
These techniques we talk of can save the lives of people affected by cancer. We have seen them work for many other disease conditions as well. Also they can make a basically well person a picture of health. Back in 1981, in his landmark work, The Causes of Cancer,5 Professor R. Doll gave the medical evidence that 85 percent of all cancers could be prevented by changes in lifestyle! The challenge is there. It takes effort; it requires commitment and an ability to be open to change. Again, it can be done. Our natural state is health. Please take up that challenge. It would be wonderful to see people learning from the difficulties of others and not having the need for change forced upon them by physical disease. While it is wonderful to help people to recover from cancer, how much better—and wiser—not to get sick in the first place.
Four Features of Long-Term Survivors with Advanced Malignancy
Throughout this book you will pick up many features of long-term survivors and gain insights into what they did to recover. However, reflecting on a long and illustrious career as a cancer surgeon, Professor Gabriel Kune highlighted special characteristics of a particular group—people with advanced malignancy who became unexpectedly long-term survivors, and I quote:
1. They seek a wide exposure to conventional medical opinion and treatment.
They take “control” of their health. They will decide for themselves what advised treatment to have and what treatment not to have. They are often critical of their medical management.
2. They seek a wide exposure to nonconventional opinion and treatment.
Again, they will decide for themselves what they will choose to have and they are often critical of nonconventional management.
3. They operate at an intuitive level.
They are usually not “thinkers” or intellectuals. They tend not to operate at a rational level as their main guide for making decisions and appear to make decisions “intuitively.”
4. They are at peace with themselves.
One often gets a sense of tranquility, peace and spirituality while in their presence. They are not at all fearful.6
Now, in my own experience I would agree with all this generally, and while I certainly recognize the importance of the intuition in decision making, many of the long-term survivors I have known have also been very smart and drawn on their intellects well. Where people can get into trouble is when they think too much, get lost in the range of options, lost in doubt and worry, and as such do not access their intuition, do not make clear and confident decisions, do not commit to what they are doing.
Maybe we can summarize Professor Kune’s four points by saying that long-term survivors have a calm and clear mind. This enables them to think clearly, to make good decisions and to be at peace with the world and themselves. Given all the challenges cancer can present, how do we avoid fear and even panic? How do we develop a calm and clear mind? Meditation provides a well-proven solution, plus it has real healing benefits in its own right. In the next chapter we will begin to unlock meditation’s secrets.
