Dealing with your Diagnosis and not Despairing!

Good day and welcome to Medicine Health with Dr. Paul Anderson. That's me, I'm Dr. Paul. And today we are gonna be talking about dealing with your diagnosis and not despairing, something that's not easy to do when you have a difficult diagnosis, whether it's really any sort of health problem. But what we wanna talk about today, and we're gonna probably have this over a few a few installments, because we certainly won't get through everything today, are the more chronic and critical diagnoses that many people unfortunately have and, and are given and have to deal with. So if we want to make those under an umbrella, we'd want to talk about the idea of the life-changing diagnoses of cancer and many other chronic illnesses. Now, it would be simple, certainly, to go through this and, and take each one of them individually. But there are so many things that cross over with respect to how it hits you as the person, how it hits your family, and how you all have to deal with it, and what you can do to be more empowered and on top of the situation, as opposed to just kind of feeling run over by it. You know, like like you're a victim of the situation. There's a lot of things that can be done. Doesn't make it any better or any easier, but it can make your outcomes better in the long run. So I decided when I was putting together the content for the next few of these that we would take a trip through the the book that I wrote called Cancer: The Journey from Diagnosis to Empowerment. You can Get that anywhere you get books. We'll talk about where later. But really, in writing that book, that book was deconstructing patient interactions that I've had over many, many years. So if you look at the, the decades that I've been working with people with chronic illness, you know, you can go to the '90s and then the 2000s and then the 2010s and teens, and now we're here in 2021, if you're listening live. So it's been a long time, it's been a lot of people. And in that time, the majority of the patients that I worked with had either cancer or some sort of fairly extensive chronic illness. And the extensive chronic illnesses could be things such as autoimmune diseases, things that generally don't go away, complex chronic infectious diseases that then alter a lot of the rest of the person's physiology. And so they're chronically ill. Chronic diseases like chronic fatigue syndrome and fibromyalgia and all of the depths of what that means. Many, many things. And what they have in common with each other and with diagnoses of cancer is that they are a life-changing disease. They make your life never the same again, generally. Now, I will say, as we've talked about in other situations on the program, that everything in life tends to settle out in sort of a bell curve. You've seen those where there's a little bit on the sides and then a big bump in the middle. So more of things tend to fit in the middle and follow the rules better. And as you get outward, Yeah. you get less and less predictability and you get things that happen. So for example, on one end of the spectrum of cancer and chronic illness, you might have in the littler ends of that curve people who get very sick quickly and unfortunately have very aggressive disease and don't, don't live very long. And then you have the average experience, which is generally where you get sick more or less quickly, you find out what you have eventually. Sometimes that takes a while. And then you have more of a long-term chronic process that you're going through. And then if you go to the other end where there's, you know, tapering into the bell curve there, there are definitely people, and I don't want to, you know, write this off or not talk about it. There are definitely people who do heal and either go into complete remissions with these diseases. or wind up with no evidence of any disease left. So you do have an opportunity for all of these experiences, but what I can say from those many decades of dealing with patients who are chronically ill is the majority of people are somewhere in the middle. So, um, yes, certainly we have, you know, the very tragic cases where something comes on very rapidly and there's not really time to work on a lot. And they're either completely disabled or passed away rather quickly. And then we have people that do find either remissions, healings, that sort of thing. But most of the people, there is one or the other way of getting diagnosed. And it's not our topic today to talk about that, but anybody who has been around anyone who's had a chronic illness, whether it's cancer or something else, or who has had that themselves, sometimes they've had the experience experience where it was diagnosed rather quickly. A lot of times there's the experience of a fair amount of frustration in that the person just doesn't have, you know, they get misdiagnosed or they have, you know, temporary diagnoses or they get shuffled around to different types of specialists. And that can be very, very frustrating. That's, you know, it's a piece of the puzzle. Where we want to start though, really, is what happens when you do figure out what is wrong? You and your healthcare team, whatever that may be, come up with a firm or pretty firm diagnosis, and you've been given a diagnosis and you have leukemia, you have lymphoma, you have breast cancer, prostate cancer, colon cancer, whatever, or you have been told you have lupus or you have Crohn's disease or Colitis or ankylosing spondylitis, or you have been told you have the aspects of chronic fatigue syndrome or some other chronic complex illness involving a lot of infections, etc. Well, when you get any of those diagnoses, either as a patient or a loved one, caregiver, family member, It immediately stops everything in your life, and your life is never the same again. And as I said, there's always exceptions to things, but I can't think of that many people who ever received that sort of diagnosis and then really just went about their life as if nothing had happened. Generally, we'll talk about that, but there's a, there's a name for doing that, and that's not the most healthy thing. So the things that we want to think about in this respect, some of them include concepts such as these diagnoses are definitely life-changing. There's nothing you can do about that. And they will change your life. They'll change the lives of those around you, those who love you, those who are close to you, et cetera. And sometimes they're life-changing, even for people who you might not think are that close to you, but they're, they're a bigger part of your life than you assumed. And so you can't change that. You can have different ways of thinking about your diagnosis, but if the diagnosis is correct and you have disease X, Y, or Z, and it is chronic and potentially life-threatening, Nothing will change the facts of that. And so the important part I want to bring out just to start off and kick off our, our talk about our first section today— as I said, this will probably stretch out over a few programs— is that how we deal with the information that we have does make a difference. Makes a difference in our ability to respond. It makes a difference in the way that we see, think, and feel about the disease process. Makes a difference in the way that we deal with the disease inside ourselves, or if we are a caregiver or a loved one, how we deal with the other person and how that makes us feel. And Although it won't be a big topic of things we talk about today, one of the things that came out just in life and dealing with all these patients, but I decided I really wanted to put in the book, is there actually is a medical benefit to getting past the shock of all of this and the trauma and becoming what some people would say is, you know, on top of their diagnosis. Diagnosis or empowered in their diagnosis, or there's other words to describe that. And you may think this is sort of obvious and doesn't even need to be said, or you might be surprised by this. But there's actually medical research that shows that a lot of critical factors in that are predictive to your quality of life and overall. Treatment response and all, all these other good things. A lot of those critical factors are improved when you have somebody who is empowered within themselves as a patient. And if you can do that as the caregiver, it's even better. So a lot of the discussion starts with the idea that this is a life-changing moment when you're diagnosed and things are never the same again. And obviously you're going to have to go through a lot of things to process all of this, but how you think about it and how you internalize it and how— what we want to talk about is how you process it from A to Z makes a huge difference in outcomes such as quality of life, sometimes length of life. And in some real linear sorts of things medically, such as more empowered patients have better pain management, pain control. More empowered patients generally have statistically better responses to therapies. And that seems, you know, interesting to, you know, some people who haven't thought about this or don't think about it in this way. They'll say, well, you know, if 2 people are getting the same chemistry in their Therapy, you know, let's say it's a drug cocktail or some sort of other therapy, and it's kind of the same, you know, the same stuff going into these people, and they're humans and they have the same disease. Why would, you know, why would one work better than the other? We see this all the time. Well, there's many factors to that because no 2 people are actually the same, obviously. But the other thing is the level of connection between that person and themselves and how they view how the treatment is going to go actually does make a difference. So there's a few things that I want to kind of talk about up at the top. And the first thing is whether you're looking at a diagnosis of cancer or a severe chronic illness, you, as I said, have this moment where it all comes to you, what's going on, and your life is never the same again. So one of the first things that is very important, I think, to get across is that the point of all this is not that you ignore your diagnosis or that you downplay your diagnosis. It doesn't do you any good to pretend that your diagnosis is different than it really is. It does make a difference how you think about it, but what we're talking about is if you're going to become, as you know, you might say, on top of things diagnostically or an empowered patient, et cetera, that is done through the lens of, of, of a very realistic view of the disease. And that's taking all the good and all the bad into account so that you're very aware, very well-informed, and you're not shielding yourself from any eventuality. One of the first things that happens that becomes a huge area where you can kind of run off the rails and It's 100% understandable, is this area of facing your own mortality or disability or both. So regardless of what you're diagnosed with, if it's chronic, you may be looking at a disease process that could shorten your life. And maybe you look at a disease process that might shorten your life Some, but has disability with it, or both. Those are very, very difficult things for us as humans to come to grips with, because as it goes in discussions with people when they're first, you know, dealing with their diagnosis, um, everybody knows that they don't live forever on this earth. You are finite, and we all have some time which we are no longer going to be here. We're all going to die, so we all have mortality. Those who are healthy can fall into the trap of thinking, well, maybe, you know, I got so long I don't even need to worry about it. Right, so we sort of push our mortality way, way out there. Now, many people, you know, who don't have cancer or chronic illness diagnosis will come up to their mortality very quickly if they have a health scare or a bad accident or something like that. We hear about that all the time, obviously. But normal human nature is if you're not sick, you tend to Diminish your thoughts of mortality and maybe disability in your mind. And an important part about that is it's natural to not want to face your mortality, even though we all have it. And it is unpleasant to face it for many people when it is forced upon you because your doctor has told you now, I'm very sorry to tell you, but you have You know, this type of cancer, or you have this type of autoimmune disease that's chronic and has these other problems, or you have this immune issue going on. And so facing your mortality and the disability that goes with it, for better or worse, is very necessary. It's very unpleasant. And one of the things that kind of spins people up as far as You know, having a negative impact of the information is that they've spent most of their life choosing not to think a whole lot about their mortality and certainly about disability. And now today it's being pushed right into their face. And that can create a lot of feelings and a lot of ways that you can become very non-empowered. So one of the things of bringing these things up, uh, and laying them out there and talking about them is the idea that if you— if we understand the process and we understand the major areas where things kind of go wrong mentally, emotionally, spiritually, physically with this information, however you like to look at that, it demystifies it and it makes it normal. So you should, you know, a lot of people I've talked to over the years didn't realize it was normal, you know, to not think about their mortality and suddenly be a bit angry that they're having to think about it now. And in reality, that, that's the norm. Now, the important thing about these things that come up that, that I look at as sort of roadblocks to moving forward And becoming an empowered patient with your diagnosis is a roadblock can always be solved. There's always a way around it, but ignoring the roadblock is not the best way to get around the roadblock. If you ignore a roadblock and you're in a car, you're probably going to crash into it one way or the other. And so that's not the most efficient way to keep on your trip. If you know the height or depth or breadth of the roadblock and you know the limits of the roadblock, sometimes you can go around it or somehow get past it. Well, it's the same way with these things. Once you realize that we all are mortal, we all have, you know, a desire not to have the end of our life come too quickly or have disability, and you can lay that out and deal with it. It takes the power away from the roadblock, and it's the first one I want to talk about, but it's a very, very important one, which is literally facing up to your own mortality. Now, something that I put in the book as a subchapter heading, and it's a lot of discussion about it, is the idea that, you know, I was diagnosed with— and you fill in the blank— any of those things that we talked about. And I feel, you know, lost, angry, and confused. So what do I do with that? Well, it's as a second roadblock to talk about. The first is sort of getting the idea out there that, you know, we're all mortal and we all should think about our mortality at least a little bit. But when we're diagnosed with A chronic or lethal illness, it brings it right to our face and we cannot get away from it. So we have to deal with the emotions around that being forced to deal with it, but we still have to deal with it. Well, the second thing is, it is very normal unless you had a long time to think about your disease coming prior to it coming for you and also everything I say, of course. Applies to everyone who loves you and who's around you and who takes care of you and helps you. You now suddenly— your life's changed. You have to deal with this, and you can feel a whole soup of emotions: lost, angry, confused, all sorts of other things. And the biggest thing that comes from that is not so much that, well, that happens. You know, okay, but what do we do about that? What you do about it becomes extremely important because just like not dealing with your mortality, which is not a good idea, you should at least face it and objectify it so it kind of takes the power away from that idea, or not facing the idea about disability that you may have, etc. Facing these initial, you know, hits you right, you know, in the head emotions that you feel about your diagnosis, whether it's yours or your loved one's diagnosis, needs to be done. Now, it would be very dumb, and it would be very unrealistic to try and, you know, imagine that you're going to face all of this stuff and handle it in The first day, right? Um, that's just not reality. That's not how the human processes things. But the important part about it is, is to say, okay, I feel that way. There's nothing abnormal about that. That is a normal human emotional response to getting bad news. And if it's you or somebody you really care about, That emotional response isn't going to go away today or tomorrow or next week. So just like facing your mortality and facing disability and facing all of these unknowns, which humans don't like unknowns, but our lives are full of them. Just wait 5 minutes. And facing the unknowns, as I say, takes a lot of the power away from them. to negatively impact your life. Well, after mortality and disability, these soup of emotions of anger, confusion, all this stuff, you need to make them normal, realize they're a part of life, but not stay there with them. Because one of the points in the book, and people have actually looked at, you know, this, this book, The Journey from Diagnosis to Empowerment, and they say, well, it's a lot thinner than your other book, Outside the Box Cancer Therapies. Well, Outside the Box Cancer Therapies was all about therapies and research and what's working and not, and all of this is— it's more of like an encyclopedia about what you're doing for cancer. This book I specifically wrote for families and cancer patients To make it not intimidating. So it's a quick, easy read. It can be gone back through. You can use it as a roadmap to process through these things. And if there's a chapter you're really great with, you can skip it, you know. And if there's a chapter you really got a lot of trouble with, you can spend some time there. But it's meant to help you navigate these things and move forward. And so The point that's made when we talk about that in the book, you know, facing your mortality and dealing with this emotional soup, is we need to not try and minimize that because that's part of being human and part of getting a diagnosis here you don't really appreciate. But if we stop there, that's where literally it poisons us emotionally. And when we poison ourselves emotionally with thoughts and feelings, emotions, etc., and don't find a way to deal with them and work on them, our ability to become empowered and get the benefits of that, which include, you know, usually better quality of life, better, you know, management of pain, better outcome of treatments, better all kinds of things. Um, If we get stuck in these toxic emotions that, that don't get dealt with, even though they're very normal for us, we don't want to sit there and just keep going back to step 1 over and over. There's a lot of, you know, tips and ideas and examples in the books— in the book. Um, one thing that I did that the editors encouraged me to do to make it a little bit more You know, a little less manual. So it's sort of like a how-to manual, but it's also got some depth to it, I think, emotionally, is I told the story of 2 different patients that handled all of this very differently to sort of illustrate, you know, what would be— what would it look like in a patient who gets stuck and kind of has this poisonous relationship with their diagnosis that doesn't help them, and what would It looked like for somebody who, you know, has a very terrible initial reaction to their diagnosis, as we all would, but does find a way to work through it and, and work beyond it. So one of the things I wanted to make sure we got to today, and thankfully we have the time for it, is there has to be some way. So I'm telling you, okay, so the first couple of things you're going to be forced to face when you get a hardcore diagnosis, whether it's cancer or chronic illness, etc., is your mortality, potential for disability, and then this mixture of emotions. It's very, you know, very human and very realistic, but, you know, can be unique to you. So how is it— is there a way to think about this where you can start to move past what's going on And get, get a foothold around a way to process as you go and then move forward, as opposed to processing a bit, getting discouraged, and recycling back to the beginning. Because one of the things that can be very, you know, deleterious, very unfortunate for your progress, is if you just simply get stuck. and don't have the tools or maybe the understanding or maybe some just sort of external help to take you past where you're at. And so the point of the book is to try and leave a roadmap and some, you know, trail of breadcrumbs for you to follow. One concept that I found just from watching people and, you know, giving people unfortunate diagnoses and walking through them, through that with them, or having people come in who had already received the diagnosis and we were working with them to do certain things, etc. Um, in looking at that, what struck me over all those years I had mentioned was there was a pattern that people went through, and it very much mirrored a pattern that has been written a lot about with respect to grief and loss. Because in a sense, if, you know, you are told that you now have this diagnosis of a disease that could shorten your life, give you disability, change everything, or a little of all of the above, you're grieving the life that you thought you had before. So in a sense, you have, you have grief to deal with. But the reason that I included the, the Elisabeth Kübler-Ross stages of grief, which almost everybody is, you know, aware of, talk about it a lot in the book, and they're very— you can look them up online, you get a lot of information about it. The reason I use them is not because they're flawless. There's no, you know, way of dealing with things or situation that's flawless. Right. But they really do match what I saw go, uh, people go through when they would get these diagnoses. So the first step, which is very common as most people know, is denial. It's the first, first stage. Um, denial is essentially often just the overwhelming shock to you in your brain that says, well, I couldn't have cancer, I couldn't have ALS, that's something other people have. That's not me. I don't, I don't have that. And denial can be rather quick, you know, or it can last a little while. As an example, A lot of the people— remember, there's the bell curve. Um, most of the people, the bulk of people, you know, the shock is the initial thing that triggers denial, and it might last, you know, short amount of time. And their, you know, better angels or their other ways of thinking kind of have this perspective that says You can think that that's not happening to you, but you really kind of know that it has. Anyone who's lost someone very close to them, who, you know, someone close to you has passed away, you have those experiences where you think that they're still here. You know, you think they're still alive, and you'll go to call them, or you'll go to do whatever, and that's not You know, real conscious denial. You, you know, once that happens, that it's, uh, you know, obviously that's not going to happen because they're not here, but your brain will, you know, play tricks with you about that. You know, a lot of people talk about waking up, you know, the next morning or 10 mornings later and waking up and having forgot they got that diagnosis of cancer, and it's just this wonderful moment, and then they think, oh no. That, that, that really did happen. That's going on. So that's really normal. And the important part about it is, if it's normal and you understand what's going on, then you can call it what it is and deal with it. If you don't, or you are choosing to, you know, kind of live in a fairyland and ignore things, you will choose not to deal with it. And you may go very deeply into denial. And I've had people say, especially medical students, how in the world could somebody ignore that they had something really bad, cancer, you know, or any other, you know, thing that had a lot of symptoms and signs and, you know, things that might tell you there's a problem? Well, I've seen again over the years, this is certainly thankfully not the majority in the middle of the bell curve, but on other ends of the bell curve where there's fewer people. I've literally seen people come in, um, and, you know, we would have somebody and they would say, well, um, you know, you always tell your person, doctor, what you're there for. Uh, so there, you know, you go in the room and you say, okay, well, I see on the chart here that, uh, you're complaining of, um, of a wound. Uh, and, uh, so, you know, tell me about the wound and let's take a look at it. They'll say, yeah, you know, I've had this, this wound, and I've been treating it. And, you know, it's not getting better. And I've been treating it for, you know, fill in the blank, 2, 3, 4, 5 years in some cases. And you go to take a look on the examination. And I have literally seen cancer that had grown not only on the outside of the body, but all the way through the chest wall and pushing in on the lungs and You know, all kinds of things that go on that any other person, even who didn't know what cancer looked like, would look at that and say, there's something very, very wrong there and something should be done about that. So denial can extend to that level. Now, normally, these people, when you run into them, are either very insulated You know, that some people that have some mental health conditions can, you know, isolate and they're very insulated and they'll stay in denial that far. Most people who are around others will— someone will eventually say, you really should go get that checked out. But that's how bad it can be. So while most people, denial is just this sort of natural You know, gee, that's news I didn't want to hear, and my brain is going to tell me for a while that I don't need that news. Um, they will get past it, but you do need to know it's very normal, and it's usually the first thing when the shock hits you. The next thing, which sadly I've seen a lot of people kind of get stuck in— so yeah, we talk about getting stuck. These are main roadblocks, right? Um, The second phase that usually happens is the rebound from denial, which then is anger. And anger can be, uh, just so poisonous to you. Now, anger is a very realistic and rational response to being told that you have a disease that will shorten your life, give you disability, or a bit of both. It is not irrational for you to feel angry about that. As a matter of fact, if somebody has a diagnosis like that, that's chronic and life-changing and generally negative, being angry is something you would expect at some point. Because again, you lived your whole life up to this point believing you did not have this problem, and suddenly you do. And now it's settling in, not just that you're dealing with mortality and Disability, but all the little details about how this is going to affect you. How's this going to affect my family? How's this going to affect my income? How's this going to affect my ability to do things? All of that's going to change. And just like denial, it's usually a spread of, you know, like I like to refer to the bell curve, but it works. The majority of people, it's a normal response. They may have to work with somebody to deal with the anger, et cetera, but It becomes something they can get past. But again, I have seen people— again, if you go to the, you know, other ends of the bell curve, I talk about this in the book actually as an example— I've seen people get stuck in anger, the anger phase, and not get less angry and deal with it, but actually get more and more angry. and lose the ability to deal with the anger or choose not to deal with the anger and just stay there. And what I can tell you from a lot of experience walking through this with people is if you stay angry, if you stay any of these things, but if you stay in the angry phase, you are not going— you're certainly not going to be able to be on top of and in charge of yourself through your illness. But you're also not going to be able to be empowered. Because anger and empowerment are inimical. They do not, you know, they do not support one another. So again, you have to start with the idea that this is a natural thing. This is very normal. But it is a roadblock, and you have to normalize it. You have to deal with it, not shove it behind, you know, behind the shelf or something. You have to face it. deal with it and realize that you have to move on. Now, some people with any of these stages, they'll move on, you know, kind of seemingly naturally, and they'll, you know, they'll process it. And one of the things to talk about in the book is, hey, a lot of people process things because maybe they've had experience in that area and they've done some work to realize that their anger response, you know, is natural and it's a righteous anger response, but also they have some tools Tools to deal with it when it happens. Now, maybe it's not because they got diagnosed with cancer before, but it's from some other thing. They've got some tools. Those people kind of move on. But the people I've seen where they get stuck there, um, it literally becomes a poison. Denial can become a poison too. It can delay you from doing the right things and all this stuff. But anger becomes a poison because It can damage not only you and your mental and emotional and physical connection, but anger can poison your relationships. It can poison the very things that, that bring empowerment through connection and through community and through family and friends, etc. It can be a way that you insulate yourself, and that definitely happens. So Again, there are tools and resources for looking at these different areas, but, you know, normally you go from the denial phase to the anger phase, and then if you've been through this, bargaining can happen to a greater or lesser degree depending on how your brain is processing things. But bargaining is just the idea that, well, I'm You know, and bargaining can actually lead to some things that aren't all bad, but I'll just give some positive examples of— I've had, you know, people get a bad diagnosis, something chronic, cancer, etc., and they will suddenly completely revamp a lot of lifestyle things. They will change the way they eat to be very clean and healthy, and they'll Start to, you know, exercise, to do all the things, you know, that grandma told you you were supposed to do all along. And that can be very good. When it's not as good is when it's connected to an, you know, if-then sort of statement in the back of the mind, which is, well, if I radically change the way I'm eating, Then maybe, you know, the cancer can just go away, or maybe my multiple sclerosis will just go away. And it's important to know that those diet and lifestyle things can be remarkably world-changing. And I have seen actually people go into remissions of diseases doing those things, but your motivation has to be that you're doing it for the sake of you and your health. Yeah. Not because you're making some sort of bargain. And so a lot of times people think of bargaining as, you know, bargaining with, with, with God, with a deity, or, you know, something on that level. And that certainly is one way that it's done. But sometimes it's just this internal bargaining where it's a literal if-then statement, you know, if I make these changes, then I expect, you know, it's gonna happen now. Now, Every single thing that we're talking about, and we'll wrap up in a few minutes, but every single thing we're talking about, as I said, is not abnormal. These are just the way humans are wired to think and react and feel. So there's nothing wrong with doing these things. It's, you know, like I said, there can be some very good things to making changes, you know, during the bargaining phase. That's a great time to do it because you're heavily motivated. You just want to be realistic about it. And, you know, and realize it is what it is and then move on. Now, if there's something good that comes out of it, for example, I have seen in families where when the anger phase hits, it could be the patient or it could be their loved one or both, and that could actually trigger Um, the realization that, you know, gee, we— okay, we, we know we're going through this. They get some outside help maybe, and I've actually seen that trigger some healing of other things that were related to deeper anger issues that were going on. Same with bargaining or denial, etc. It can, it can turn out to be very positive if it's named and looked at and objectified, and then you work your way through it. Now, I keep saying, you know, family, friends, loved ones, and all that. It is important to know that you as the patient go through this, and obviously you are the primary person in the equation, but the people around you who are close to you, they all go through the same process too. So when I was writing the book, I was very mindful that I wanted to write so that These steps can be used whether you are, you know, the spouse or the loved one, brother or sister, coworker, or the patient. It doesn't matter. We all go through the same stuff. And the healthier we do it, then the healthier we can be there for the person who is the patient. Because imagine, and we see this a lot, if you get stuck in any phase, but let's say, you know, You're you're stuck in the anger phase because you don't want your loved one, you know, to have this disease. Well, nobody does, but you get angrier and angrier. That does not bring any healing or empowering mental, emotional, or spiritual, you know, energy and effect into the equation for the person. And I've seen that. With people and their significant others, close family members, etc., it's usually someone very close. If you get that where either the patient or the, or the loved one has a very deep exposure and falls into the anger pit, for example, or any of these others, it can literally poison their relationship. And then the other person is— is not going to enjoy as much health as they could. Now, after bargaining— so denial, anger, bargaining— then comes a crash. You are depressed. And if you think about it, you know, you sort of like to have this roller coaster arc. Your denial, you're going up on the roller coaster, but you don't really realize you are. And then anger, you're sort of hitting this top with this, you know, negative energy that sort of just hits you all at once. And then bargaining, you're sort of tipping over the top and heading down with gravity as a roller coaster would do. So your mind is spinning and sort of on, you know, almost on the manic end of making deals and trying to figure out what you can do to, you know, to game the system here. And then you hit the bottom. And you can hit the bottom very hard. And that's— it's universal, but it can be very, very bad for people. So when you reach the stage where you're feeling depressed, in one sense it's good because you're moving on, but another sense, depression is very dangerous and you can need help. You need help at all these stages. And one of the things I say in the book is, you know, this— you shouldn't just do this on your own. You need others to help you, someone in the helping world to help walk through you with this, or at least people you're in contact with, or people you can be accountable to. And depression is, is not only expected, but it's very, very normal because you've gone through this roller coaster of being diagnosed and having that wash over you and your mortality and disability and all these things. And now it's just like Man, I don't know if I have the energy to deal with this and to move this forward. Very, very real. Now, all of the stages can have their negative. Depression is a time where many people don't wind up needing, you know, medication for that. Now, if you're depressed to start with, that might be different. But most of the time, they do need to process it. And they need to just let it out. And that is, in my experience, better with somebody who is trained to help you work through letting it out, as opposed to just letting it out. Because one of the things I've seen, it's very important to have friends, family, have people to bounce things off of. But a lot of times, as I said, they're going through this stuff too. And if you get to something that's scary to them or disturbing, Like your depression or your anger, they may be able to help you and give you feedback, but they're not an objective observer who's, you know, not connected to you, who can maybe help you not just give feedback but move through that. And again, the first thing to know is it's normal to hit that depression crash, and it's also normal to be able to work through it and move to the other side. So that's a very important thing. And if you haven't by that time, it's a time to get somebody on the outside. Now, in the book, we're very— I talk about this in a very open way. There are, you know, we worked with in our cancer and chronic disease clinic, we had relationships with psychiatrists and psychologists and social workers and counselors and pastoral counselors. Just, you just want to make sure the person A, knows about specifically about chronic illness cancer world, and B, you know, has the qualifications and the tools to deal with it. And then they'll be able to help you walk through that. There are people in all of those helping professions who are very specifically— their practice is very specifically focused on cancer and chronic illness, so that can be very useful. If you already have something, someone you're working with, it might just be a time to, you know, connect and do a little bit more work with them. So once you get through this sort of initial roller coaster of facing your mortality, facing your disability and all that, and then you kind of have the various amounts of denial and anger and bargaining and depression, you reach what Kübler-Ross called acceptance. Now, What I've done in the book, and this is where we'll pick it up as we move on in the next groups of things, I pair the idea of acceptance not as— there's no period after acceptance because acceptance kind of sounds like, all right, I have MS, I have cancer, I have A bunch of chronic infectious immune problems. I have— you fill in the blank. It's a bummer. And so here I am in all of its reality, you know, just stewing in the idea that I have this diagnosis. If that's where you end with acceptance, you may have gone through those stages and you might be on the other end. But that is not what brings you the actual mental, emotional setup to have benefit. The benefit comes when you are in acceptance and working on being empowered. Now, empowerment is a common term, I think, especially in modern times, and there's a lot of talk about empowerment. And, you know, these people are empowered and whatever. And there's nothing wrong with that. It's a good concept, it's a good idea. But really what is behind empowerment is not just that you've gone through this process of grieving the loss of your previous life and you're accepting your diagnosis and all of that, but being empowered is not simply passively accepting. Being empowered is actively participating in working through your really deepest thoughts, feelings, emotions, and all the roadblocks attached to them of whatever it is that's going on with you. And normally it's those big things we talked about, which are Facing the fact that you're mortal and your life may be shorter than you thought it was going to be, that you're going to have some level of disability and change in your life, and that your loved ones and your family and friends are also going to have to deal with this. So you're realistically having acceptance over those things. But The empowerment portion of it is saying that is all true. Okay, I as the patient get to decide how I think about that, where I put all of that, what I do about all of that. And one of the most important things, one of the most important factors in all of that is that you then are no longer a victim of all of those things. And so normally, I try not to just leave it as it's this, you know, either/or of you're either, you know, empowered or a victim. But it's a good way to think about it, at least as a stepping-off point. So when you are empowered You are actually able to realize benefits that are physical. You certainly have mental and emotional benefits, but as I said, you know, in research, certain, you know, medical interventions do seem to work better in people that feel more empowered in their situation and are not feeling a victim of it. And so, as we kind of transition here to the end of this program, and it'll be a nice, you know, segue into the next program where we're going to talk about other things. The concept I'd like to leave with us is this is a normal process. It's not something anybody wants to have to go through, but as with many things in life, it's going to happen. If you or a loved one get diagnosed with something like cancer or a significant disease, autoimmunity, etc., etc., there is going to be the facing of not only mortality, disability, but all of these things that go on. You're going to go through these processes, whether you're the caregiver, loved one, or the patient, and you're going to have to process it inside. You want to normalize the processing of it. You want to realize that those stages are there. They're the way humans generally process, and you want to objectify the process to the degree that you know that this is something that does not last forever. It's a part of getting you from the shock of being diagnosed to being able to be empowered and involved in your care and in your health. And so once you realize that it's not mysterious, it's not unique to you, it's not malevolent, it just is what it is, then you can literally become on top of it. And then you can work towards becoming empowered so that then you can gain all the benefits possible Of the empowered patient, so that's why I like to not end with the idea of acceptance, which certainly is it's the last stage generally that they write about because that is the place after you know depression and bargaining and stuff where you wind up and you're sort of realistically accepting that this is going on in the case of a major health event. It has changes in your mortality and your ability, disability, etc. You really need to think about the idea that acceptance is the gateway now to working on empowerment. So at this point in the book, this basically takes us, by the way, through the first 2 chapters of the book. We go to, okay, I've got all this idea, you know, you've talked about this top-down. I realize what's going on. What am I supposed to do with this? How am I supposed to process this? How do I think and feel? And we do realize that there's a difference in the way all of us do this. No 2 people do it the same. But that's the basic roadblock. Now we can take the movement to realistic acceptance and turn it into empowerment, which is where I want to go. In our next session, now really quickly because we're going to get kicked off the podcast here any moment. Want to just talk about where you where you can get the book. So there's the book Cancer: The Journey from Diagnosis to Empowerment, Dr. Paul Anderson. That's me. I wrote it. Very easy read. Very easy for friends and family to wrap their heads around and use. And you can go back. recycle stuff if you need to. But the new website, DRA, like Dr. A, dranow.com, is a gateway to all of these things. We've got the newsletters and all kinds of things up there. There is a website called drabooks.com, B-O-O-K-S, and on there, there's a portal to all the ways the book is. So the book is in electronic formats like Kindle and e-readers. It's in audio formats like Audible and the other audio formats you can get. If you like books on paper, you can get it through any online outlet or on the drabooks.com site. You can order a hardcover that's signed from me if you really want that sort of thing. A lot of people nowadays would prefer to have an electronic or audio version, and we have all of those available. But if you want a physical book, any online bookseller will have the paperback, and if you want a hardcover that's signed, Dr. A Books has a way to get that. You can still follow me anywhere, DRA Online, either Facebook or Instagram. Of course, put links up there, but the Dr. A Now, DRA Now, is the portal by which Most of these things, we're kind of trying to put everything under one roof. All right. Well, that is me for today. Dr. Paul Anderson, Medicine Health with Dr. Paul, and it's been my pleasure speaking with you. And next up in the next segment, we're going to deal with the following chapters, probably the middle of. of the book talking about going from acceptance and empowerment and how do we turn empowerment to our advantage? How do we become empowered? How do we process through these things? And how can that actually help us physically? Not only mental-emotionally, which is very important, but how do these things help us physically? Thank you, and I'll see you all next week.