Your Brain On Cancer

Once you enter cancerland, your brain takes detours all the time. Where do these detours go? BAD PLACES!

"Is that a zit? No, of course not. Its a tumor. Must be skin cancer."
"A headache? No, a brain tumor. Dead in 3 months."
"Is that a swollen lymph node? Quick, leukemia or lymphoma, which one?"

As you can easily see you brain with cancer goes down the wrong roads. Usually in the middle of the night. Or when your are stuck in traffic by yourself.

You start making little deals with yourself. "I'll wait a month and see if its still a problem. No, a month? No three weeks. Wait, two weeks. Maybe ten days. Do I have any blood work coming up? Maybe that will tell me something."

"Wait, am I a lunatic? Actually thinking like this will turn me into a lunatic!"

The big thing is to learn to control your brain so it doesn't take all the detours. That is the really hard part of living with cancer. Your brain develops a this ability to drive you crazy and lead you into bad places. You need to get it under control so you can keep your sanity and avoid things like depression and anxiety.

Its a lifelong problem. It will never go away.  Such is cancerland.

Living For Now

I am a big supporter for living for now. Sometimes we are so focused in living for the future - saving for retirement, a rainy day, or whatever. We plan our future for ourselves and our family members - education, get a good job, etc. Our culture tells us this. It seems like the biggest reason we have jobs is to save for retirement.

However once you have cancer a time or two, you start questioning this saving for the future business. Why are we doing this if we may not be here to use it? We save up to 10% of our salaries or more.... And cancer? It could take us any time.

When I was diagnosed with breast cancer, it was my second cancer and I really started questioning all this.... Today I read an article about a British news presenter, Victoria Derbyshire, decided to start living for now after her breast cancer diagnosis and treatment. She stopped saving for retirement and got rid of her mortgage protection insurance.

This is another example of how a cancer diagnosis knocks you off your feet. People may wonder why we get so stressed at a cancer diagnosis. Yes it can kill us so we may not want to plan for the future any more because we might not be there for whatever we have saved. So we like to live for now.

Live Life the Fullest

Don't let anything hold you back in your pursuit to live life to the fullest. You want to experience everything and anything (well except maybe eating insects, flydiving, going over Niagara Falls in a barrel, or other really weird things). Get out there and do as many as many things as you can.

I think I want to say that I don't think you need to constantly push yourself to do something every minute. Sometimes you need to sit there and appreciate what you just accomplished. You should also share your experiences with others who might benefit from what you have done.

Do not let your health hold you back. Okay, if you break your leg or blow out your knee, you can put off climbing Kilimanjaro until it is healed.

I had always wanted to spend a semester or school year in Europe studying during college. Even though I was treated for thyroid cancer in the summer between my freshman and sophomore years, I still went to France for my spring semester of my junior year. I brought several bottles of my thyroid replacement medication and information on how and who to contact at the American College in Paris in case I needed medical care and set off. You have to remember this was before fax machines, cell phones, and the internet so the only way to contact the US from Europe was by slow air mail or very expensive international calls. My health wasn't going to stop me.

Since then I have traveled far and wide. I have been to Europe and Japan. I have been to events all over. I have climbed mountains. I have skied. I have done lots of things. I had a lot of fun (getting my body into the shape it is now).

Every so often I run into someone who is out there living life as full as they can. Claire Wineland is one of those people. I would love to meet her someday but for now I will continue to read about her and follow her. This article starts off with:

"As a small child, she played hide-and-seek with nurses, ripped out IVs to race around the hospital floor naked and left an explosion of glitter in her wake.

As a teen, she got boys to carry her uphill when she was tired, taught her best friend how to flirt and watched her doctor squirm as he gave her the safe-sex talk.

And as an adult, Claire Wineland has continued living out loud, even as her body fails her.
Claire, 20, has cystic fibrosis, a genetic and terminal progressive disease that's landed her in the hospital for a quarter of her life. Ask what's on her bucket list, and she'll say she doesn't have one.
Fixating on a checklist of goals before she goes "sounds exhausting," she says, especially "when you've been dying your whole life." Instead, she'd rather focus on doing all she can in each moment."

She also has written a book (but not one about a happy sick person), heads a foundation, and makes videos among other things. One of the videos I do like is 'Dying 101':

Get moving and fulfill your dreams!

Is Moving On After Cancer A Myth?

I am approaching my ten year anniversary of the ten year mark after my breast cancer diagnosis. Am I supposed to celebrate? I think so but I am not sure how much of a celebration it is. It doesn't mean I can say it is gone for good. It just means that in the ten years since I was diagnosed with breast cancer and I am still here.

Now I do know that is a good thing. But am I supposed to celebrate? But I don't feel like celebrating. I am not sure that I should celebrate. I certainly won't be having a party.

The last ten years have been a growing time for me emotionally (and for my waistline). I have had many new experiences that I would never have had without breast cancer. Some I can appreciate - like learning to fly fish or making lots of new friends - but some not so much - my first CT scan, chemotherapy....

I have met many wonderful people during these past ten years. However, I have lost many of these new friends as well to cancer. I have also held hands, physically and emotionally, with many people who I never would have met, to help them and to help me coping with cancer. Some of that is good, but some of that - I still miss many friends.

My breast cancer diagnosis was not my first dealings with cancer. I had been diagnosed with thyroid cancer twenty five years and some months earlier.

It took me a long time to get my life back together after that diagnosis but I was never the same. Actually I don't really know. I was diagnosed at the age of 19 while in college so was never really an adult on my own without cancer. I don't know if I would be different if I had never had cancer because I never had the opportunity. It took me so long to deal with that cancer diagnosis, I don't think I 'grew' that much.

Since I can't tell if I had grown emotionally after that cancer diagnosis because I have no comparison. And am I any less of a person than I would have been? How much did cancer change me? I have no idea. Again, I have no comparison on that how can I tell how much my cancer diagnosis changed me and my life again?

I go back to my question - is moving on after cancer a myth? I don't know. I don't know how much I have moved on  because I can't tell how much I changed in the beginning.

All I do know is that once someone says 'you have cancer' you are changed. Your focus on life is very different. You question what is normal to every one else - life insurance in case anything happens to your children (if you can still have children), or changing jobs and getting new health insurance (with a pre-existing condition). Or planning for the future? Why should I save for retirement if it looks like I probably won't be here for it?

Personally I believe that anyone who says you can move on after cancer, has never had cancer. They are the same people who came up with the soldier/battle/warrior/s-word stuff. But I don't have the comparison so I can never be sure.

How Long Do I Have?

When we are first diagnosed with cancer, one of the first questions we ask is 'how long do I have?' We assume/hope/pretend we will beat our cancer and live a long life. But for me, the little voice inside has always asked 'will I live a long time after the beating my body has taken, mostly due to cancer treatment?'

With two cancer diagnoses behind me, I have wondered how long I will live. My family mostly lives into their 80s, my parents are currently 86 and 88, my maternal grandmother lived to 96. I have always thought I will make it a while longer, being very indeterminate. I don't think I am dying anytime soon.

My body is not what we call 'in good shape'. I have aches and pains all the time, as well as arching pains across my back, twinging hips, throbbing knees. All of this wears on my body. It has gotten me concerned.

I am currently 35 years from a thyroid cancer diagnosis and 9 years from a breast cancer diagnosis. But today I read about a woman who is 50 years from her breast cancer diagnosis. She was diagnosed at age 29 in 1966. Now she is 79 and still here.

That is very encouraging. I really hope to make it 50 years after both cancer diagnoses. I have 15 and 41 years go to. I am not sure if that 41 years is doable for me but I wouldn't mind.

So I hope you are also encouraged by this as I am. With a breast cancer diagnosis, we deal with surgery, radiation, chemotherapy, and more. Our bodies are stressed and strained. But now we have a hero to look up to. If she can do it, so can we.

Has A Cancer Diagnosis Changed How You Think?

I was reading over at KatyDid Cancer that she turned 41. After being diagnosed with breast cancer before 35 she was never sure she would get to 40, or 41. (But now she is thinking 50.)

This made me think. How do I think about how long I will live? And how would I think differently about how long I would live if I had never had cancer?

At 19 (and invincible) I had no thought of how long I would live. Because I was barely an adult and between my freshman and sophomore years of college. And longevity was the last thing on my mind. I just assumed it would be shorter than without cancer.

At 45 I was more responsible and married with a second diagnosis. The thought of how long I would live definitely popped up again. But what was most concerning was how would I have thought differently if I had never had cancer? I have struggled with this one: how had my life been impacted by cancer which was something I never wanted. 

During the intervening years my thought processes had changed of course. But how would I have thought different if I never had cancer? I never really had a chance to be an adult without cancer so I have no idea on what I would have thought.

But since I can not undo the past, I have to settle with my current thoughts. Which doesn't give me any good answers.

Being Open About Cancer

Here's a question: how open are you about your cancer diagnosis? I realize this is a matter of choice. I think of myself as being fairly open about talking about my cancers, but it took me until my second diagnosis to learn to talk openly about it. But I never mention it with  new people unless I am in a cancer 'situation' such as at a cancer patient event.

I think learning to talk to your cancer diagnosis is part of learning to accept it. (Remember those five stages of acceptance???) But as a result of seeing friends run for the hills at the word 'cancer', many of us learn to keep quiet about it.

Last week, my husband and I came to the realization that our lawn is not going to mow itself and we need a new lawn mower. I started doing some research and shopping online to get some ideas of what we want/need.

I decided if I am going to be able to do anything about mowing the lawn, it has to be easy to use. Self propelled is a must for both of us - our lawn is on a hill. An electric start means I could actually start it myself. There are many things I cannot do around the house because of my health so if there is a possibility I could help with anything, I try to make it possible.

So I started doing my research and looking for what is available with the features we want vs. the ones we can afford and found this in a real Troy Built mower review at Lowes:

"I used to use a Troy Built push mower, but when I was diagnosed with prostate cancer and started chemo, I began to lose the strength I needed to do my entire lawn with my push mower.
I decided to buy the Troy Built electric start self propelled mower.
Just let me say, I can now mow my entire lawn with strength to spare"

I was quite taken aback by this. I mean how many people would include their cancer diagnosis in a lawn mower review? If I had written it, I would probably have said "but when I was diagnosed with significant health issues and its treatment caused me to lose strength...." or something along those lines.

Anyway, I brought this up with a group of friends with cancer and asked them how open they are about their cancer diagnosis and what they think of this guy putting it in a lawn mower review. There were some snickers and then we decided:

1. None of us would have ever put their cancer diagnosis in a product review, much less a lawn mower one.
2. It must partly be due to the fact that it was a man who was probably less sensitive on his medical issues. (Not to be sexist but men tend to be more open and less concerned with the responses to what they say than women.)

We did agree that it really depends on the situation and who we are with on how open we might be. But how open are you about your cancer diagnosis?

About That Positive Attitude

Having a positive attitude with a bad diagnosis can be like putting lipstick on a pig.

The pinkification of breast cancer includes that perky little attitude with perfect make up and a big smile. Sorry but some days I just don't feel that way. I read this article about how the positive attitude requirement of breast cancer or other icky diagnosis can lead to a feeling of guilt. Um, yup.

Cancer (and other icky diseases) bring a whole range of emotions and some days, especially during chemo, a positive attitude can be fleeting. Or just not there if you are working on keeping your lunch down again. And after treatment its the same thing. And, as I said, its not just with cancer, but any crappy diagnosis, a positive attitude doesn't always happen.

I can tell you that my positive attitude can be virtually non-existent many days. Sometimes people ask me how do I do it. I think what are they talking about? I am just going through my life and putting one (aching) foot in front of the other (aching foot). Please don't tell me you are amazed by that. I'm not amazed. I'm just getting through my day.

The ever knowing 'them' tell us to keep our positive attitude. It will help us get through treatment better, prevent depression, and make us better people. Well, lah-di-dah, I try but I'm not going all out.

And if I am so happy and perky, what happens when I lose a friend or my next scan isn't as hoped? I'm not going to be so perky am I? And maybe I'm not going to be so happy. I might even feel a little guilt about my lost friend. And more guilt about a bad scan. What did I do wrong? Why did this happen to my friend?

That so-called required positive attitude can be a pain in the butt. I know it takes drugs and therapy to get through life sometimes.

What would you do?

This morning I was reading Kaylin's blog over at Cancer is Hilarious. She has had all sorts of cancers before the age 30 (4 diagnoses I believe) and now is faced with a recurrence that looks like will do her in sooner as opposed to later. She has a dilemma. She wrote:

"Now that my very aggressive and deadly bone cancer has come back for a third time, I don't have many options. It is almost a certainty that it will kill me. There is one regimen of chemo left that might prolong my life, but of course chemo is absolute hell, and I am on my own here in NY with no family or husband to take care of me. I'm not entirely sure I can handle it on my own, for the third time. So now I am trying to decide what the rest of my short life will look like: do I stay in NY? take a break to feel healthy and enjoy myself before chemo? Or start right away to maximize my chances of remission? Should I move back to CA where I have family to take care of me? Should I be planning my death? How should I spend the rest of the life I have left?"

My comment back to her is to skip the proverbial bucket list and go find her happy place to live out her life - on the beach, in the mountains, visiting friends, what ever works for her. But my question for all of you is if you were given this kind of diagnosis, what would you do? Not a bucket list, but how would you make yourself happiest if you were given a short time to experience it?

Personally I find  the idea of a bucket list a bit of an avoidance mode - you focus on doing the little things that you want to do but are skipping the big picture that you are dying. I keep changing my mind. Would I want to live on the beach or in a cabin in the mountains? Would I watch sunrises or sunsets? Would I continue to seek medical care or go the palliative route to be more comfortable? (Probably palliative.) My funeral by the way will be a kick ass event where everyone has fun and not a lot of tears. And the guest list will be huge.

Are you normal?

So are you? After cancer, we are supposed to reach a 'new normal'. That means I am on my third normal at this point. I am not sure how normal that is. And I have completely lost track of what normal is supposed to be anyway.

This is the yesterday's Prickly City. For some reason it resonated with me. And I don't believe that 'new normal' crap anyway.

Annual state of denial

This week, I believe, I have my annual mammogram. I can't remember when it is and that is just fine with me. I just cannot afford to let my life be stressed out by a single annual appointment. I have too many annual/six month/three month and other appointments to get stressed by any of them.

In the meantime, I have other things going on. First of all the new kitties have settled in quite nicely. We have kept two of them. Layla was just too shy and intimidated by the other ones. That little saying that 'curiousity kills the cat' is very true with two less than a year old intrepid explorers.

I took my pills out of the closet to fill our weekly pill boxes. Immediately Boots (dark gray with white feet boots) climbed up on the closet shelf and tried to explore this newly accessible area. Operation fail. Peanut (the all black one), a/k/a Penguin, who will now be known as Zitipat is sporting a scrape from some effort to squeeze his tiny body into or out of an even tinier space.And they managed to rip a curtain rod out of the wall - pulling the bracket and nails right out of the wall.

But I woke up in the middle of the night with a purring cat sleeping on me.

So life moves along. I will survive handle my mammogram and any other medical adventures coming my way

That cancer part that never goes away

Ask anyone with cancer and they will tell you the cancer part never really ever goes away. You can think, and dream, and ponder, and hope, and do anything you want. You get slashed, burned, and poisoned (surgery, radiation, and chemo) and deal with baldness, nausea, fatigue, weight gain, and more. You get countless scans, blood tests, and millions of doctors.

But it still hangs there in the background to wake you up in the middle of the night with the little 'what ifs'. Those cause the stress that does all sorts of bad things to your body (that might even cause the cancer to come back). And might cause overeating which causes weight gain (which might also cause the cancer to come back.)

You can also go to therapists and support groups and they give you advice on how to deal with your emotions, your feelings, and your fears. They have such great suggestions (my personal favorite is when they told me to avoid fatigue by putting on a terry cloth robe instead of toweling off to save the extra exertion.)

My cynical side often comes out when I am dealing with the cancer things. I am also waiting for that supposed cure that is getting closer and closer every day.

A lovely few days

Its been a lovely few days. Wednesday I was in so much pain from my back, arm, and a headache I left work early. Thursday I had an 'oh so fun' back procedure and my headache hung around. Friday I didn't do much and my back hurt in recovery from the procedure and I still had a headache. Friday night I spent some quality time in the bathroom. Saturday I didn't do much of anything.

In the meantime all sorts of thoughts crossed my mind as only someone with multiple ailments can have:

• Could my headache be the first signs of a brain tumor?
• Why did I throw up? Was it something I ate? Was it a reaction to my medications? Did I develop an allergy to another medication (not for the first time)?
• Could my headache be the first signs of a brain tumor?
• When will I feel better? I have to go to work on Monday.

Then I woke up this morning and felt fine! What the difference a day can make. So today I get to go to a brunch with a bunch of friends I never get to see. But then I promise to come home and go to bed early.

Issue #937.2a that they never tell you about having breast cancer.

There are so many things they don't tell you about having breast cancer. Here's is another one. You may not be able to wear your wedding ring. Really. My cancer was on my left, I had a bad node that lead to a axillary node dissection, which lead to lymphedema issues.

I woke up in the middle of the night last night and noticed my left arm was puffy. This morning I spent some time and got my wedding and engagement rings off. Now the puffiness is subsiding. I have done some of the stupid lymphedema exercises. I will wear my sleeve today.

But my rings are on the pinky finger of my right hand. They feel like they might fall off. Damn. I want to wear them on the ring finger of my left hand and can't.

Cancer sneaks into your life in little ways. I wish they told us about all the issues before hand.

Cancer fears

Normal non cancer people have normal fears - being bitten by a dog, speaking in public, getting the flu, spiders, snakes black cats, etc. If you add cancer people to the mix, their fears include cancer spread, cancer return, and another cancer diagnosis, on top of all the other normal fears.

With cancer, we need to learn to balance our cancer fears and not obsess over them. That is the hardest thing about a cancer diagnosis. Since my first cancer diagnosis, I have always had the thoughts of 'what if' cancer came back, spread, etc. What would I do? What would I want from my treatment?

And then it happened, I did get a second cancer diagnosis. That was the triple loop corkscrew roller coaster ride. And it took a long time to get the fears under control. I learned a lot in that time period.

First, I had to stop obsessing about cancer all the time. I couldn't live in cancerland 24/7. I had to get out of cancerland and be a normal person who went to work, grocery shopping, getting together with friends, spending time with my husband.

Second, I had to learn to let cancer have its place in my life. I couldn't cut it out completely because it had to be there so I can get the follow care I will need for the rest of my life.

Third, I had to learn to stop feeding my fears with the 'what if' moments and letting the fears take over my life again. I don't need the work/life balance, I need a cancer/life balance. Yes, cancer may come back again but it might not either. I could find a snake while weeding in the garden too.

Cancerversary?

I want to count in decades, not years. After thyroid cancer in 1980, I was pleased when I could count cancerversaries (if the word did exist back then) in decades, not years. I was 26.5 years out and whoopsie a new cancer diagnosis. Breast cancer that time. I was less than thrilled to start counting over.

But now I can say I am 32.5 years out from thyroid cancer and 6.5 years out from breast cancer. Those are nice numbers.

People quote five year survival rates as if they were Gospel. But they aren't. I learned recently that five year survival rates were started in the 1930s for blood cancers. This timeline/goal quickly spread to other cancers and people started believing them.

But they really aren't true. A couple of examples are both breast cancer and thyroid cancer which can return at any time. So five years is good but not great. Thyroid cancer has been known to recur 30 and 40 years out.

Every person with cancer counts their years differently. Some celebrate their cancerversary with a big celebration and their five year date with as an epic event. For more on the five year dates and cancerversaries (which is just a weird word) you can read this very interesting article on how people celebrate and how we got to where we are. It was shared on FB by a friend who was marking his cancerversary and reaching out to those he knew who were in the same boat. I read it and enjoyed it.

But for now, I'll go back to counting decades and waiting.

PS if you do the math, I am really 37 years old as I stopped counting some time ago.

#IStandWithLisa

In case you missed the ferfuffle in the land of cancer blogging and tweeting, allow me to fill you in. Ann also wrote about this and you can see her opinion over here as well.

Lisa Bonchek Adams has stage IV breast cancer and tweets a lot about her life with cancer. You can follow her @adamslisa on Twitter or her blog. She is living her life as best she can and talks about it on line through tweets and blog posts.

Then along came Emma, who we will call the Idiot for lack of a better term, who wrote for the Guardian and compared tweeting to funeral selfies - really? Hence the name. What she wrote was taken down by the Guardian after a day or two but you can read it here. (See things on the Internet never really go away).

The Idiot complains that Lisa tweets too much. Is that really possible? Some people have conversations and dialogues on Twitter so they might have a high volume of tweets. So what?

And the complaint that of over exposure on twitter becomes a funeral selfie? She is not dead so its not a funeral.

So anyway, the Idiot's column was posted and then many complaints were received and it was taken down because the Guardian said it did not meet their standards.

That was bad enough and then Mr Idiot (her husband) wrote for the New York Times comparing Lisa's fight to I'm not sure what. He did talk about his father's death from cancer in England a few years ago and medical costs but it was fairly pointless in my opinion.

When I first read these articles and the blog posts about them from others in cancer land, I wondered have these two journalism professionals (Mr. and Mrs. Idiot) ever bother to talk to Lisa directly? I do not think so. I could be wrong but their writings were not about Lisa but about her tweets. In professional journalism, isn't it appropriate to contact the subject of their writings? I mean again I could be wrong but in terms of verifying information and all that, isn't that correct?

So I stand with Lisa on this. And Mr and Mrs can go take a hike.

How long?

When I was diagnosed with breast cancer, someone told me it is a year out of your life and then you get back to some sort of normal.

Another blogger this morning announced that after two years of blogging about her Hodgkins Disease she is moving on to blog about social media and other things. Her cancer adventure has slid into the background of her life - right on schedule as she had been told when she was diagnosed.

The wise people who tell us the deadlines on our diseases are not doctors or medical specialists but usually other patients reflecting on their experience and what they have been told by other patients.

So how do you put a schedule on a cancer diagnosis? My life, six years out from diagnosis two, is a never ending stream of doctor appointments. Well yes I did develop additional, non cancer ailments - bad back, rheumatoid, fibromyalgia, but at every doctor appointment there is still a little cancer hanging in the room. Maybe if I could go back to annual physicals I would be more relaxed about it.

I just don't think I can ever put a date on the end of cancer stress. The little cancer roller coaster rides through my life like the little train that could. I don't see an end of the line for it.

Maybe I am a bit pessimistic these days but I am tired. I just woke up and still need a nap. The nap is the fibro/RA speaking to me. I do need to go to the grocery store and want to go for a walk in this nice weather.

But I would like to kick that little cancer train out of my life....

Blah, blah, blah, exercise...

Cancer people are special. You can't just categorize us and tell us to get out and exercise. We need more than that. We need a bit of hand holding and direction. We have concerns about what we are capable of and may have new limitations that we are unsure about.

Several new studies (of course they were needed to keep researchers busy) were announced at ASCO earlier this summer. The conclusions were:

• Clear benefits were shown in several studies of exercise during and after treatment help decrease side effects and reduce the risk of recurrence. 
• Cancer patients need a bit more direction than 'just go exercise' they need help with what time of exercise to do -  whether newly starting or adding to an existing exercise regimen.

I took part in the Pink Program which was a collaboration between the local YMCA and funded by a grant. The Pink Program was a sixteen week exercise program which incorporated lots of stretching and gentle exercise. I felt the benefits quickly of more flexibility and it led me to join a real gym and go there regularly.

My feeling is that exercise is good and it relieves a lot of stress and prevents many diseases (this is from the person who spent most of yesterday on the living room couch). But after surgeries where I had lymphedema issues and my back started to go bad, getting started in a regular exercise program was harder than I thought. I have many limitations that prevent me from doing basic things - no treadmill, no twisting my back, no jumping up and down, and more.

But with guidance from trainers, I have learned what I can and can't do. It has been  a learning experience but for the first time in my life I have stomach and arm muscles.

So before more researchers get rich deciding what cancer people need for exercise, talk to your doctor about limitations and then find a trainer who can work with you to figure out what you can do.

Finally someone sensible when faced with cancer

I have always been overwhelmed by the stupidity of normal people when they hear the word cancer when referring to other people. They either turn into loud mouth idiots spouting uneducated and therefore unwanted advice, or they run for the hills and pretend the person with cancer no longer exists. I'm not saying everyone does this but an amazingly large number do. I'm not sure which is worse - the ones who run for the hills or the ones who give the bad advice.

But now we have an example of a person who is sensible and sensitive enough to ask 'what should I do to help my friend who is faced with cancer' and even wrote in to Annie's Mailbox. Basically the answer comes back as:

- treat them as you normally would
- expect a little more reticence than normal
- don't offer advice and try not to be patronizing 'I know how you must feel...'

And I like this reply. People with cancer are exactly that - PEOPLE with an ailment. Do you treat a friend with the flu any differently than one with cancer? You shouldn't.