This is the third and final installment of a series of essays on post-traumatic stress after cancer, which I began experiencing in December of 2012, just short of two years after my cancer diagnosis.
After these fires had raged inside of me for six solid weeks there was nothing left of me but smoldering piles of rubble. My mind was scattered into a million pieces on the ground and I hadn’t a clue on what was supposed to go where, nor what the final picture was even supposed to look like. I was just gutted. As much as my life changed after being diagnosed with cancer, it changed just as much, if not more, after I started experiencing post-traumatic stress disorder in the years after cancer.
In Part 1 of these essays, I described what post-traumatic stress felt like to experience, and in Part II I described the various things I did to cope with and recover from it. In this final essay, I’m sharing the things I’ve done to manage my life after experiencing post-traumatic stress after cancer.
1. Post-traumatic stress is not what’s wrong with you, it’s what’s right.
If your home burned to the ground and you lost everything and only narrowly escaped with your life, you can’t tell me the smell of smoke or the sound of a fire engine coming down the road wouldn’t make you cringe and possibly want to run out the door. This is a normal, healthy reaction to traumatic events in our lives.
Human beings haven’t evolved over billions of years to our position of dominance on our planet because we have poor instincts. We actually have extremely powerful instincts, and post-traumatic stress represents our protective instincts kicking in, trying to remove us from harm and situations that are perceived as threatening.
You should never feel ashamed if something or someone that reminds you of a traumatic event makes you feel afraid months or even years after the traumatic experience. It matters not whether it was a house fire, a plane crash, a war, or fighting cancer; when we experience things that remind us of our past traumatic experiences, it’s the same protective instincts that kick in, trying to remove us from perceived harm.
If something or someone reminds you of a traumatic experience, you’re supposed to be afraid, you’re supposed to want to run away, or hide or fight back. Post-traumatic stress isn’t what’s wrong with you, it’s what’s right. It’s a sign that all is well and that your mind is working exactly as it should be.
2. Post-traumatic stress is not “PTSD.”
There’s a huge problem out in the world with how post-traumatic stress is perceived. Post-traumatic stress after a traumatic event, such as fighting cancer, is very normal. Such episodes might last anywhere from an hour to a few days, or maybe a week. Full blown post-traumatic stress disorder is when you have all of the symptoms of post-traumatic stress for extended periods of time, several weeks or more, and that never seem to let up even after being removed from the stimulus that had triggered the post-traumatic stress episode.
This is a very serious situation that requires professional help or treatment, but because any sort of post-traumatic stress is generically only referred to as PTSD, some people might be more reluctant to seek the help and support that they need.
Rest assured that feelings of post-traumatic stress after cancer are very normal to experience and there’s absolutely nothing wrong with you. These are self-protective instincts coming to the surface, trying to remove ourselves from situations that have been perceived as threatening.
3. Accept what you’re feeling.
The extreme feelings of fear and anxiety that post-traumatic stress can cause us to experience come from our subconscious and thus, we have no conscious control over such feelings. We can’t just tell ourselves to not be afraid. All we can control is how we consciously react to these subconscious feelings and instincts that come to the surface. We can beat ourselves up and berate ourselves for being afraid when we feel like we shouldn’t be, but this is denying ourselves. We’re hurting inside, and beating ourselves up just makes things even worse.
A far better approach is to simply accept what we’re feeling without criticism or judgment. Instead of criticizing yourself for being afraid, simply accept that you’re afraid and try to find healthy and productive outlets to channel those feelings into. Write about how you feel or dump this energy into an exercise routine, for example.
4. Stay close to your coping routines.
As suddenly as the post-traumatic stress mechanism in our minds can be switched off, it can also switch back on again. Thus, it’s very important to stay close to whatever routines you’ve developed to help manage your post-traumatic stress. I took to runningas a form of therapy to help manage mine, and I always made sure my running shoes and clothes were prepped and ready to go so that there wouldn’t be any delays (should I suddenly need to go for a run).
If I’d come home from lunch dealing with PTSD issues in my mind and didn’t have my running gear ready to go, that’s 30 minutes wasted trying to track everything down with terrible, panicking, freewheeling energy burning me up inside. It’s best to have ready-to-go “turn key” coping methods at your disposal that you don’t even have to think about, whenever the need arises.
Stay close to your coping routines.
5. Stay close to people that bring you comfort.
As important as it is to stay close to whatever routines you’ve developed to help you cope with your post-traumatic stress, it’s just as important to stay close to the friends and people who help you to cope as well.
Most people in my life genuinely cared about me but just didn’t know quite what to do for me or how to support me. Post-traumatic stress was just as foreign for them as it was for me, and some tended to shy away simply because they didn’t want to cause any harm. There was a highly select group of people who just “got me” in some way, as though there were a very deep soulful connection in play that just engaged naturally when I needed it to.
With or without having ever experienced anything I had or not, these friends of mine have always known what to say and do, and not once have they ever run afoul of me or done anything that’s come even close to upsetting me in the years I’ve now known them. These are the people I needed to spend my time with because they helped me feel normal and at ease and gave me a break from this terrible hurricane in my mind.
To have friends and people in my life that could help me forget all I was in the midst of during such a terrible storm was an unbelievably great gift and blessing to have. These select friends of mine know who they are today, and it’s a very deep and soulful love I have for them.
6. Never stop living and enjoying life.
Don’t ever let post-traumatic stress keep you down and stop you from enjoying life. As I wrote in PTSD Part II, I pushed hard against the boundaries that post-traumatic stress was trying to keep me within and made sure to get out with friends I felt fully comfortable around. This is why it’s so important to have or find friends who really get you — even if you don’t understand how or why.
Go with what feels right, even if you don’t understand. These friends of mine helped rescue me from the inner turmoil in my mind and allowed me to keep busy, active, and enjoying life, even during these times of great distress. The best way to survive cancer, is to live!
7. Find little things to enjoy every day.
When I was experiencing post-traumatic stress I felt like an endangered species and like my life was being threatened every day. As those of us who have experienced this have felt, post-traumatic stress can feel like you’re walking around with a loaded gun pointed at your head constantly. You feel like a marked man, and the level of stress I felt from this were unlike anything I had ever experienced in life — even while fighting cancer!
Weekend activities with family and friends and vacation planning wasn’t enough. I needed to find little things I could enjoy every day and that gave me some sense of comfort and happiness. You have to eat every day, so why not eat well? Treat yourself daily.
I’ve become a well-known foodie to friends and post all sorts of food pictures over social media and especially Instagram (when I had almost never done so before). I tried to pinpoint the time I really got into food and became a foodie, only to realize this was born out of my post-traumatic stress and my desire to find things I could enjoy in life every day — no matter how small.
A nice “last meal” every day because at the time, I felt like it could be.
8. The importance of self-love.
For years I lectured myself and beat myself up for being afraid when logically I knew there was no reason to be. I had a highly curable stage II cancer. I went through a chemotherapy protocol that was a virtual guarantee of being cured and then did the retroperitoneal lymph node dissection surgery on top of that for good measure. If there was even one stupid little sub-detectable cancer cell floating around my body after four rounds of chemotherapy, I just wanted it gone.
I know what the stats are; I’ve read the medical literature. Almost no one who had a stage II testicular cancer that does both primary chemotherapy and the RPLND surgery ever experiences a recurrence, yet I was still so afraid and terrified.
Allow yourself to be. Don’t fight yourself! Love yourself by accepting what you feel without judgment or criticism. Beating yourself up for what you feel just compounds the pain and makes things worse, and your subconscious will never let go of what it feels. Stop denying it.
Love yourself, forgive yourself, accept your feelings and work with them rather than against them. Be your own best friend.
9. Find something to believe in.
My lack of firm spiritual beliefs ended up being another source of pain and difficulty for me in the aftermath of my cancer, and especially while dealing with post-traumatic stress. What makes the aftermath of cancer so terrifying? It’s because we fear our cancers will return and that we’ll die. Firming up my spiritual beliefs helped to take the wind out of the sails of my fears of death, which in turn helped me to stop being afraid.
We live in a society today that seemingly shuns religion and spiritual beliefs and looks upon them with contempt. Yet it’s my own independent spiritual beliefs that I fully developed and embraced that helped me to overcome my post-traumatic stress issues and fears of dying of cancer. In the world we live in today where mental health is at the forefront, why are we shunning and vilifying things such as religions and spiritual beliefs that can help us feel more at peace?
I feel this is a huge mistake. If you’re experiencing anxiety, depression, or post-traumatic stress but don’t have firm spiritual beliefs, reconsider why you don’t. The lack of such beliefs might actually be contributing to the very anxiety you’re experiencing. This was the case with me.
10. Time does heal.
I’ve been asked this and I don’t think you can ever completely heal or cure yourself from post-traumatic stress, but it can get easier with time. Once you’ve been through a traumatic event or two in your life and associations are made that trigger these fiercely protective self-preserving instincts, it can be difficult — if not impossible — to break them.
That said, I have broken some associations with extreme difficulty, but to this day I don’t think I could casually walk back to the infusion lab of my oncologist’s office to say hi to some of the wonderful nurses I know back there without breaking out into a nervous sweat or my heart rate jumping through the roof. The mere thought of it sends shivers down my body, and that’s still post-traumatic stress in the background. I’d have to do something to break that association. I can’t un-experience all of the hell I’ve been through fighting cancer, such that the associations were never made in the first place.
As time has gone on the post-traumatic stress reactions have become much less intense, my subconscious has seemingly become a bit more trusting of my conscious ability to keep myself out of danger, and plenty of positive memories made in the passing years has helped to write over the painful memories of the past.
Another thing I had feared: never really getting to live and enjoy my life. I’ve done that and then some in the past few years, and this has brought me a great sense of peace and comfort as well.
The best you can do is love yourself, care for yourself, forgive yourself, be your own best friend and cope as best you possibly can. Finding the help you need, the friends that know how to support you and make you feel right, hobbies and activities that serve as effective outlets and keep you present and engaged as much as possible, are all a part of the “cure” for post-traumatic stress.
There’s a reason why the photo above appears on my homepage, as it represents all of the above in one photo. An enjoyable activity with my family and with friends that just get me, and who have always made me feel right.
This post was originally published on StevePake.com.
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Testosterone controls the development of the reproductive organs and other male physical characteristics.
Although testicular cancer is uncommon compared with other cancers (0.7 percent of all cancers), it is the most common cancer in males aged between 15 and 35 years in North America and Europe. Every year, 8,000 males in the United States are diagnosed with testicular cancer, and 390 men die each year in the from the disease.
- Testicular cancer is one of the most common forms of cancer in young men.
- Common diagnoses include examination, blood tests, and ultrasounds.
- Treatment is successful in 95 percent of men with testicular cancer.
Symptoms of testicular cancer do not normally appear until a later stage.
In most cases, the individual finds the cancer himself. Sometimes, it is discovered by doctors during a routine physical exam.
Anyone who notices anything unusual about their testicles should see a doctor, especially if they detect any of the following:
- a painless lump or swelling in a testicle
- pain in a testicle or scrotum
- discomfort in a testicle or scrotum
- a sensation of heaviness in the scrotum
- a dull ache in the lower back, groin, or abdomen
- a sudden accumulation of fluid in the scrotum
- unexplained tiredness or malaise.
It is worth noting that these symptoms may not necessarily be caused by cancer. In fact, less than 4 percent of lumps in the testicles are found to be cancerous. Individuals should not ignore a lump or swelling in the testicle, though. It is important to see a doctor. They can then determine the cause.
Even though testicular cancer can spread to the lymph nodes, it hardly ever travels to other organs. If the cancer does spread, a person may experience:
- breathing difficulties
- swallowing difficulties
- swelling in the chest
It is important to catch testicular cancer early to improve the chances for successful treatment.
The earliest signs that occur are a painless lump and swelling. The testicle may also seem to be larger than usual.
However, this type of cancer may not cause noticeable symptoms until a later stage. That is why self-examination is so important - it is often the only way to catch testicular cancer at an early stage.
Although scientists are not sure what the specific causes of testicular cancer are, there are some factors which may raise a man's risk of developing the disease. These risk factors include:
- Cryptorchidism (undescended testicle): If a testicle has not moved down when a male is born, there is a greater risk that he will develop testicular cancer later on.
- Congenital abnormalities: Males born with abnormalities of the penis, kidneys, or testicles.
- Inguinal hernia: Males born with a hernia in the groin.
- Having had testicular cancer: If a male has had testicular cancer, he is more likely to develop it in the other testicle, compared with a man who has never had testicular cancer.
- Family history: A male who has a close relative with testicular cancer is more likely to develop it himself compared with other men.
- Abnormal testicular development: Conditions, such as Klinefelter's syndrome, where the testicles do not develop normally, may increase a person's risk of testicular cancer.
- Mumps orchitis: This is an uncommon complication of mumps in which one or both testicles become inflamed.
- Ancestry: Testicular cancer is more common among Caucasian males, compared with men of African or Asian descent. The highest rates are found in Scandinavia, Germany, and New Zealand.
Having a vasectomy does not increase a man's risk of developing testicular cancer.
Around 95 percent of all men with testicular cancer make a full recovery after receiving treatment. The sooner a patient is diagnosed and treated, the better his prognosis is.
Treatment for testicular cancer may involve surgery, radiotherapy, chemotherapy, or a combination.
Orchiectomy is usually the first line of treatment. The testicle is surgically removed to prevent the tumor from spreading. If the patient is diagnosed and treated in stage 1, surgery may be the only treatment needed.
An orchiectomy is a straightforward operation. The patient receives a general anesthetic. A small incision is made in the groin, and the testicle is removed through the incision. The patient remains in hospital for a few days.
If the man still has one testicle after the operation, his sex life and chances of reproducing should not be affected.Fertility
If after the operation, the patient has no testicles, he will be infertile. He will not be able to produce sperm.
Males who wish to have children one day should consider banking their sperm before the operation - some sperm is kept in a sperm-bank before the testicle or testicles are removed.
Other testicular cancer therapies, including radiotherapy and chemotherapy, can also affect a cancer patient's long-term fertility.
Lymph node surgery
If the cancer has reached the lymph nodes, they will need to be surgically removed. This usually involves the lymph nodes in the abdomen and chest. Sometimes lymph node surgery can result in infertility.
Radiotherapy involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce.
Patients with seminoma testicular cancer will typically require radiotherapy as well as surgery. The radiotherapy is used to prevent cancer recurrence.
Patients whose cancer has spread to their lymph nodes will need radiation therapy. Radiation therapy may cause the following temporary side effects:
- muscle stiffness
- joint stiffness
- loss of appetite
Chemotherapy is the use of chemicals (medication) to destroy cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing.
Chemotherapy is usually given to patients with advanced testicular cancer - cancer that has spread to other parts of the body. Treatment is administered either orally (tablets by mouth) or injection. As chemotherapy attacks healthy cells as well as cancerous ones, the patient may experience the following temporary side effects:
- hair loss
- mouth sores
Most people immediately link chemotherapy with uncomfortable side effects. However, side-effect management has improved considerably over the last 20 years.
There are several ways to diagnose testicular cancer.
These measure levels of tumor markers, such as alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG), and lactate dehydrogenase (LDH). However, it is possible that blood tests come back normal, even though cancer is present.
An ultrasound of the scrotum can reveal the presence and also the size of a tumor.
A small sample of tissue is taken from the targeted area in the testicle and examined under a microscope to determine whether the lump is malignant (cancerous) or benign (non-cancerous).
Testicular cancer types
Seminoma testicular cancer cells pictured.
When the doctor has determined the type of testicular cancer the patient has, they can then devise a treatment plan and make a prognosis. There are two main types of testicular cancer:
- Seminoma testicular cancer: These contain only seminoma cells. All age groups can get this type of cancer.
- Non-seminoma testicular cancer: These may contain many different cancer cells. Non-seminoma tumors tend to affect younger patients and will spread more rapidly than seminoma ones.
Most testicular cancers start in the germ cells - the cells in the testicles that produce immature sperm. We don't know what causes those cells to become abnormal and cancerous. Sometimes, both types of cancers may be present. If this is the case, the doctor will use non-seminoma treatment.
Staging the cancer
After carrying out all the relevant tests, the doctor will then be able to stage the cancer. This helps determine what treatment to use.
- Stage I: The cancer is only in the testis and has not spread.
- Stage II: The cancer has reached the lymph nodes in the abdomen.
- Stage III: The cancer has spread further, to other parts of the body. This could include the lungs, liver, brain, and bones.
The best time to check yourself is when the scrotal skin is relaxed; usually after a warm shower or bath.
- Gently hold the scrotum in the palms of both hands. Stand in front of the mirror and look for any swelling on the skin of the scrotum.
- Feel the size and weight of the testicles first.
- With fingers and thumbs press around and be receptive to any lumps or unusual swellings. Some men have one testicle that hangs lower than the other. Some people have one testicle which is bigger than the other. This is normal.
- Each check, try to detect any significant increase in the size or weight of the testicles.
- Feel each testicle individually. Place the index and middle fingers under the testicle while your thumbs are on the top. Gently roll the testicle between the thumbs and the fingers - it should be smooth, oval-shaped, and somewhat firm. There should be no lumps or swellings. The top and back of each testicle should have a tube-like section where sperm is stored, known as the epididymis, which may be slightly tender. It is normal for it to feel tender.
Preventing most cases testicular cancer is not possible, as the causes are largely unknown. Many men who develop testicular cancer do not have any known risk factors.
However, it is possible to make sure the cancer does not advance before treatment.