Building Up Emotional Resilience: The Key to Recovery

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

As I noted in an earlier series of blog posts, I’ve been dealing with an intense course of cancer treatment. During my treatment, I’ve come face-to-face with some important but difficult facts—and since I think many of those facts hold true for others dealing with serious chronic illnesses like cancer, I wanted to share them here.

First, I’ve learned that cancer treatment can be a real rollercoaster. Your emotional resilience—or your ability to bounce back from a challenge—can dip. Along my journey through a long, slow recovery, for example, I’ve experienced dark moments when my resiliency has all but faded. I know that many people who cope with chronic illnesses experience these difficult, dark moments—which is why it’s so important to recognize them when they appear.

I’ve also learned that losing your resiliency is often as hard on your caregiver(s) as it is on you. It’s tough when you’re the person undergoing treatment, but it can be equally painful for a caregiver to watch someone struggle with a difficult recovery. These are the moments when you need to say to yourself—or reach out to your loved one and say—“Please fight just a little bit longer.” Let’s look at some ways to make that possible.

Strengthening Your Resiliency Muscles

Where resiliency is concerned, what can you do to help yourself or the person you are caring for draw on inner strength for the road ahead?

Begin by recognizing the difference between physical and emotional resiliency.

We’ve already seen that emotional resiliency is your ability to bounce back from a challenge. Physical resiliency, on the other hand, refers to your ability to recover physical strength after you’ve undergone intensive treatments for cancer, surgery, or other serious medical conditions. Each type of resiliency can be impacted by an illness, and each person may respond to resiliency differently. Physical activity is something that I truly enjoy, for example, so remaining physically resilient was less challenging for me than maintaining my emotional resilience. You need both types of resiliency when you’re dealing with tough medical challenges. Let’s focus here on strategies for conserving your emotional resiliency (my next blog post will be on regaining physical resiliency). Continue reading

How to Be the Best Caregiver/Care Coach You Can Be (Part Two)

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

Remember my recent blog post about being a terrific caregiver and care coach?  Here are some more tips based on my professional and personal experience.

Remember, Actions Speak Louder Than Words

You may not be an individual’s primary caregiver or care coach. You may just want to show you care. We all have people in our lives we really care about who have received some type of life-threatening or life-impacting diagnosis.  It could be anything from experiencing a hip fracture or a stroke, or a cancer diagnosis requiring treatment or palliative care management (comfort care).

It is hard in these situations to know how to respond and what to do.  Personally, I am a big believer in “actions speak louder than words.”  It never hurts to reach out to someone you care about who is undergoing treatment or who needs help and support coping with a long-term illness or disability.

Never be afraid to just DO or SAY something. Don’t be afraid to let the person know you heard about their illness and wish them well.  Show you care in any and every way.  Don’t hesitate because you are afraid you are intruding on the person’s privacy. If you heard about their illness, it is no secret!

Avoid Useless Gestures

Personally, I recommend against saying things like “let me know if I can do anything” or “call me if there is anything I can do.”  Essentially, when someone is ill they are not likely to pick up the phone and call for help.

Instead of empty gestures, provide words of encouragement that may have helped you in the past. For example, when I first started my course of radiation and chemotherapy, a colleague sent me a quote that Christopher Robin said to Winnie the Pooh:  “Promise me you’ll always remember that you are braver than you believe, stronger than you seem, and smarter than you think.”  I put this on my desktop and read it daily to help me through my own challenging treatment.  Continue reading

Decisions, Decisions (Part 2)

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

Let’s recap where we are in my story: When I last wrote, I talked about learning my diagnosis with esophageal cancer and working through the process of making care and treatment decisions.  I opted for additional scans to test for metastatic disease (cancer that’s spread beyond the original tumor), and I was able to do so for several important reasons: I decided, took charge, and planned for the possibility that a spot on my liver could be confirmation of metastatic disease.

Much to my amazement, I was informed that, in fact, the liver spot was simply a hemangioma (noncancerous growth due to an abnormal collection of blood vessels), and the oncology team was recommending a full blast treatment approach with a way more optimistic outcome than I believed possible. Thus, I weighed the possibility of better quality of life against the risk of treatment just making things worse.

I decided to go forward with treatment—a combination of 5 weeks of daily radiation, chemotherapy, and then surgery if the response to treatment was good. Surgery being the reward, as it is only done when cure of current disease is noted.

This entire process at my age (a few months from 60) made me realize that, no matter what age one is when diagnosed with a potentially life threatening disease, decisions around treatment are tough. Did I have things to look forward to? Of course: a recently awarded research project grant from the National Institutes of Health, a fourth grandchild on the way, and many other professional and personal goals I still wanted to achieve.

Many older adults have an equally expansive list of things they’re looking forward to. They will tell me they still enjoy playing bridge, want to finish a professional paper or book they are working on, and want to continue going to dinner with friends and seeing family. I will never again assume that an older adult does not want to pursue a treatment option when faced with a new and what might be life-ending diagnosis.

I have always believed my responsibility to patients was to inform them of the pros and cons of treatment options to help them decide on an approach most consistent with their goals. For older adults, cancer treatment or surgical interventions for cardiovascular disease may make their quality of life worse and even hasten death, but the decision to forego the treatment may still be difficult.

Whether you are a healthcare provider or a friend or relative of someone having to make these decisions: be open and supportive. and try to empathize. I still don’t know the outcome of my decision…but I am living with the consequences, doing the best I can to cope with the daily challenges, pulling on my own resilience and the resilience I have learned over the years in doing geriatrics, and hoping that I will come out on the other side and say it was a good decision!

Decisions, Decisions (Part 1)

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

A cancer diagnosis, particularly a second cancer diagnosis, is difficult at any age. Bordering on being a geriatric patient (in Maryland older adults are defined as those 55-years-old and older), I was diagnosed with my second cancer. The first one was 18 years ago when, at the age of 41, I learned I had breast cancer.

At that time, with teenage children and much of life (hopefully) ahead, the decision was not so much whether or not to go for treatment but rather what treatment to endure….the options for me being removal of all breast tissue (also known as a) mastectomy with the possibility for reconstructive surgery, as well as chemotherapy (the medical term used for treating cancer with special types of medications). The chemotherapy was actually based on clinical research into effective options for my type of cancer. A researcher at heart, I of course consented to that study—and 3 others!

Almost twenty years later I was faced with a new decision around a second cancer and whether or not to undergo a diagnostic workup, pursue treatment, or to crawl into bed and call Hospice (a type of supportive healthcare given to people with serious or terminal illnesses). I started developing difficulty swallowing, and after being diagnosed by multiple providers with a digestive disorder known as gastroesophageal disease, I finally was sent for an Esophagogastroduodenoscopy (EGD, or a procedure to diagnose and treat problems in your upper gastrointestinal tract).

I was told, quite bluntly, I had esophageal cancer. I was neither a smoker nor a drinker and had no risk factors short of a very strong familial history with both parents having multiple malignancies. Decisions needed to be made this time, as I was not particularly anxious to endure treatment and worried about what we see all too often in geriatrics: treatment just making things worse.

On the flip side, my quality of life was not particularly pleasant given that I couldn’t eat or engage in the social activities that go with eating (going to dinner meetings or lunches, going out socially, etc.). I had significant pain and gastroesophageal symptoms associated with the tumor and I feared what death would be like if I let nature take its course. I wrestled with that thought along with my age, almost 60, and the value of using health resources on me at this point in time.

I further wondered how I could progress toward the end-of-life (aside from starving to death), since I was otherwise healthy—a lifelong vegetarian, runner, far from even a moderate drinker, and a non-smoker. Weighing the pros and the cons, I did follow medical advice and the push of family, friends, and colleagues, and I connected with an oncology group that has expertise in esophageal cancer.

Additional decisions needed to be made as I went through a work up for metastatic disease (which refers to a cancer that has spread beyond the original tumor), as initial scans showed a spot on my liver. Pending the results of this additional testing, I would need to decide if I would pursue palliative treatment, or healthcare focused on helping me manage pain. For anyone who has gone through this period of limbo or has friends and relatives that have to endure it, you know what I know: it’s extremely difficult.

I knew (having been through chemotherapy before) that I was not going to consent to palliative treatment, so I made a decision, engaged my resources (I have a daughter who is a nurse!), and planned for a death with dignity. I might add I cleaned closets, organized who would teach my summer course, and took over several ongoing and some new research studies, as well. I decided, took charge, and planned in the event that the spot on the liver was confirmed as metastatic disease.

(Stay tuned for Part 2 next week.)

Aging and Hearing Loss

Alice Pomidor & John Reynolds

Palmer MH high(8) res

Alice Pomidor, MD, MPH, AGSF
Florida State University School of Medicine

Mary Palmer, PhD, RN, FAAN, AGSF
Helen W. and Thomas L. Umphlet Distinguished Professor in Aging
UNC School of Nursing

You may find yourself turning up the volume on your favorite TV shows. Conversations in restaurants or other public places may become harder to understand—and you may find yourself wondering when these places got so loud. During a chat, you may ask a friend to repeat herself because you couldn’t hear words, or you may even find yourself “cupping” your ear in order to hear her better. If you, or someone you care for, has these experiences, they can be signs of possible hearing loss.

Older adults can experience hearing loss that ranges in severity from minor to major. It is the third most common chronic health condition affecting older adults—about 1 in every 3 people aged 65 or older has some degree of hearing loss. By the age of 85, as many as 70 to 90% of people will have some hearing loss. The condition tends to be more common in men than in women.

Hearing loss can lead to symptoms of depression and lead to feelings of isolation.What’s more, research suggests that older adults with hearing loss can also have cognitive problems. In fact, in one study of people aged 70 to 79, hearing loss was linked to faster cognitive decline and impairment, whether or not they were having other symptoms.

Finally, in a recent study published in the Journal of the American Geriatrics Society, researchers found that when older people with hearing loss wear hearing aids, their mood and social interactions improve, which might slow cognitive decline. Continue reading