I was trying to think of where to start for a reaction paper
on any current health issue in a media source for my Health Behavior and Health
Education class for grad school. Public Health seemed the best fit for a new
start in life. After Mom’s diagnosis with pancreatic cancer my brain shifted
gears entirely. I started rethinking my
career, rethinking my health…rethinking my marriage. I wish they’d shifted more
towards just moving to Savannah and taking care of her for her last 9 months of
life…but we didn’t want to really believe in the stats then. You never do. “Everyone
is a Statistic of One,” my former Surg-Onc boss used to say. Except that
statistics exist for a reason. The
information shows a pattern. This is a pattern of who will die and who will
live within a given time frame and within a reasonable measure of error. This
is how we plan and provide for ourselves when it comes to disease, especially
chronic disease, because there is time. Time to act.
Yet, the human spirit is at odds with statistics when it
comes to hope. We try to ignore the facts bearing down on us, telling us there
is an inevitable and unbearable outcome. We focus, instead, on the
inspirational stories of miraculous battles fought to beat the odds and to reach
5-years-out when the prognosis was only 12 to 15 months. We search for the outliers, the anomalies to
the statistical analysis that show that those Ones exist. They are their own
statistic well beyond the area under the curve. And they have survived beyond
all reasonable doubt. How reasonably
dubious that is, though, to ignore a massive amount of data showing that your
mother, with a multitude of comorbidities, fits ever so precisely into the molded
Kaplan-Meier curve. The Survival curve, they say. The average survival after
surgery was 9 months. And wouldn’t you know…she surely did survive for 9
months. Shortly thereafter, I enrolled
in the School of Allied Health’s Masters in Public Health.
I thought that being in oncology would have prepared me for
helping Mom and my family deal with her cancer. It did in some senses,
certainly, at least with the factual point of view. But if I’d been in the
Public Health program instead at that time, I would have been much more
effective in helping her manage her radical life change. There are so many ways
a person can thrive in our society based on the programs and information
available, even through life’s nastiest challenges. It is just a matter of
having someone guide you. So, I’ll be able to be that guide for someone else
now. Just not Mom. I have had enough time to come to peace with that. God
prepared a path for me, fueled by the fear and angst of losing my mother,
towards pondering and discovering how we can live more like a Statistic of One
when the time arrives. We will never be able to squash our hope for survival as
this is our nature, so evolutionarily sound in our minds…so how do I show
someone how to take back a small amount of control?
The article I chose for my reaction paper is from the latest
issue of Cancer Today: “The Weight of
Obesity on Cancer Patients” by Melissa Weber.
I knew without looking at the statistics that obesity was probably one
of the risk factors for developing pancreatic cancer. Mom had been obese for
the latter third of her life, much of it stemming from her hypothyroid and
relatively sedentary lifestyle. My parents also tended to eat out a lot. At
home, Mom created full, nutritious meals since she had been a dietician by
profession. Yet somehow, there was a lack of knowledge, or just some apathy
towards action, maybe, that kept them from maintaining a truly healthy
lifestyle. So I have no doubt that obesity was one of the causes of cancer
within Mom’s body – the environment was ripe for disease and cellular
malfunction. I was only just starting to understand how a person can change
that environment within her body after a cancer diagnosis. But, as Weber quotes
a nutrition scientist in her article, “There’s a world of difference between
knowing what you’re supposed to do and having the skills to do it.” I had no
idea how to impart the knowledge and help my mother make a change
post-diagnosis, post-chemo, post-radiation, post-feeling-like-hell towards
creating a best-case-scenario-cancer-recurrent-proof body. Or, at least, how to
help her be cancer resistant. That’s where public health professionals come in.
The American Institute for Cancer Research estimates that
over 120,000 people, just in the U.S., develop cancer every year that is
associated with being overweight or obese. More than one third of people in the
entire country are obese. The growing numbers, especially among children, is
startling. We have set ourselves up to fail in the realm of control over our
bodies and health. Not only have we created a society ripe with cardiovascular
disease, chronic pain, depression, and immobility, but one where excess weight
contributes to increased deaths for men and women because it increases cancer
occurrence or recurrence. The consequences for an obese cancer patient extend
beyond just having cancer, as they have other concerns that arise during
treatment, such as an increased risk for lymphedema in breast cancer, incontinence
in prostate cancer, as well as an increase of clots, cancer-related fatigue,
and hormonal imbalance causing inflammation (Weber). In fact, the CDC reports that obese people
have a healthcare cost of almost 1,500 dollars more than healthy weight people.
The burden of an obese person extends beyond their own health risk. The weight
is figurative on the national healthcare system.
Oncologists, or even primary care physicians, are
inadequately trained on whole body health. Luckily, ASCO, the American Society
of Clinical Oncology, just released 2014 guidelines for exercise in cancer
patients. Though the guidelines are more of a suggestion than an actual
how-do-you-motivate-a-survivor-to-exercise guide, it represents a shift in how
we are addressing the care of our cancer patients. According to Weber, the ACS
and American College of Sports Medicine are picking up the slack by offering
more precise advice on duration and quality of exercise for which these
patients should strive to achieve. How, then, do we ensure that this shift in
the mindset of the medical world actually has an impact?
Enter Public Health. Education and promotion of healthy behavior
starts with understanding your population. In this case, the thought of long
term survival or decreasing one’s risk for recurrence is actually on the back
burner for many patients. They have immediate issues facing them as they
complete cycles of chemotherapy and receive grays of radiation. They are
fatigued, nauseous, cannot taste food, have a foggy mind, as well as lymphedema;
not to mention the onslaught of mental depression and hopeless thoughts. Promoting
a health and wellness program at this point in a person’s life takes twice the
effort that it would if it were done for preventative means. Understanding the
audience is the public health professional’s first goal – in this lies the
means to show someone the skills needed to make that change. The research is
clear. Exercise and healthy nutrition help mitigate the immediate challenges
facing cancer survivors. These practices improve patients’ quality of life by
lessening the side-effects, or at least their severity. As a bonus, the risk of
recurrence for various cancers is shown to decrease. Other chronic health
diseases will be mitigated, as well; Weber states that a 5% loss of overall
body weight leads to a lower risk of heart disease and diabetes. This does have
to be sustained over time for it to be effective, yet it indicates how even the
slightest efforts in overall health can have a positive impact.
It certainly takes a community to create the kind of
programs necessary to support and promote these healthy habits. In public
health, after searching out the needs or perceived needs of a group of people,
the next step is to start looking into assets to help develop a program that
would address these needs. Until I worked in oncology, I had never looked
around my community to see what was available to help people achieve health.
Multitudes of resources exist, actually, and surprisingly. They are under-utilized,
in my opinion, simply because of lack of marketing capital or knowledge. Every
cancer center has support groups, the YMCA has low cost exercise programs and
access to a plethora of trainers and nutrition experts, many churches offer
space for yoga and light aerobics, and the internet offers us all the
opportunity to be responsible for our own healthcare.
I have learned most of this and have delved deeply into
wanting to share my knowledge on health and nutrition in an effort to help
folks help their moms, and perhaps themselves in the realm of prevention. The
audacity fostered in being a motherless daughter becomes quite helpful in this
regard. I have always pushed myself, but to motivate another person is a
totally different angle. How do you show someone what she or he is capable of? That
came with confidence in knowing what I am capable of and then witnessing it in
people around me once I surrounded myself with others striving for similar
well-being. The Public Health program then gave me the tools to share what I
have learned and search out the resources in our community to make us all more
effective in creating healthy lives.
I am not subtle when I coach or teach. I expect when someone
comes to me, asking for help, or when I have gone to a venue where someone
has made the effort to show up and learn…I expect that they have come for a
reason to change. I expect that they are looking to me to help them achieve
self-efficacy to create their own healthy body environment. I enjoy watching
people see what they are capable of. This is, by far, the most amazing process
you can witness, whether within yourself or someone else. When a woman looks at
me and says, “I didn’t know I could do that!” after a tough workout or a week
of eating a huge amount of vegetables minus the daily junk food, it fills me up
with joy for her. My approach is, in fact, audacious. I am not a fan of too
tiny of steps toward your goals. If you have made the commitment, then there is
no reason but to succeed towards that goal as quickly as possible. I thrive on
being a task master, for sure, but I believe it is helpful – because we have
become used to being handled with gentle hands in our society when it comes to
being responsible for our own healthcare.
Weber’s article makes me ponder our society’s change just in
the last 50 years. Why isn’t health our highest priority? Where did we lose the
desire and ability to maintain our own bodies? I am a diehard proponent of
self-efficacy when it comes to fitness and nutrition. This is what the “Ahha!”
moments lead to when someone reaches beyond his perceived capacities. This may
be different for each person, but the moment it happens, they can never go
back. They have asked more of themselves, fought for it even, and seen success.
This is where my specialty is – I’ll take your inkling of motivation and push
you past your comfort zone just enough to show you that you really don’t need
me – it was there all along. You just needed someone to holler at you a bit,
whether to get moving or to stop making excuses.
It’s also about self-reflection and truth. I can eat
chocolate all day, too, but I darn sure will not deny that every time I do it,
I’m creating inflammation in my body’s tissues and a potential for cellular mutations
to occur that lead to disease. I will never tell you that moderation is the key
– I have never seen results that I want with moderation. If I moderately eat
chocolate, I’ll stay fatigued and bloated. If I moderately exercise, I’ll hit a
plateau and start to gain weight or lose muscle tone or decrease my
cardiovascular capacity. I have many, many days when eating right is a mental
challenge that I can’t always win. So, I practice and preach at the same time –
I screw up and climb back on the horse every single day. I’ll expect you to do
the same. You’ll find me in the Public Health Extreme section and not
particularly accommodating once I know you have had enough of your current
state of being. I have seen people respond to me over and over with this type
of accountability; when it comes down to it, folks are ready to step up to the
plate and be challenged with some intensity. That is precisely the seriousness
with which you should take your health once you face the facts.
Motherless daughters can be so bold and confident at the
price of knowing how precious life really is. I could not offer advice and
motivation to my own mother to help her prevent cancer or, then, to survive her
cancer better. Yet, as I reacted to Weber’s article and understood where my
path has led me since Mom’s death, I can embrace this whole-heartedly. As time
passes, my mother does stay relevant and ever present in my life. She becomes
the inspiration behind my coaching and teaching.
Obesity is an epidemic - an epidemic with consequences as
devastating as death and severe disability and depression for our loved ones. If
you are ready to make that change, then heck, yeah, I’ll help you do that. We’re
in luck that we don’t have to do it alone, either. The community supports
health, it really does. It’s just a matter of targeting where the resources are
and using them and then witnessing what you are capable of once you have the
skills to take that next step.
What did I find when I Googled my mother? Well…billiongraves.com
had a very nice photo of her gravestone. I don’t get to see it since it is in
Savannah, GA, and I’m in Louisiana. I could look at it without the image
catapulting me into a deep melancholy, so that’s quite a healing process that
has occurred over this long 3 years post-mom, post-divorce, post-career change,
post-life assessment. I attribute that to people like Weber who write about the
things that catch my attention and give me more direction and motivation towards
creating a successful way of living in order to share it with others. Not to
mention my professors, my classmates and all the people with which I exchange
ideas and experiences to obtain this ultimate health and fitness - the multitude
of training partners, health nuts, coaches, students, and clients.
I’ve learned over and over these past years, that my mother
continues to bless me even after her life with me is complete. So, really…I’m not
so much a motherless daughter with her ever present spirit guiding me to
continually learn from her life and use that to positively impact those around
me.
Melissa Weber's article can be found at: http://www.cancertodaymag.org/Fall2014/Pages/Overweight-Obese-Cancer-Patients-Face-Worse-Side-Effects-Survival-Odds.aspx?Page=0
