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Colorectal Cancer: Post Treatment 0 - 6 Months: Day To Day Living: Stages II,III,IV

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Following is a thumb nail sketch of subjects to think about now that treatment is finished and you are re-etering the worls in what is commonly known as a new normal. The links take you to more information about each subject.

Consider taking some time to think about how your diagnosis and treatment have changed your perspective on life – if at all. If you learned life lessons during treatment, start putting them into practice. Otherwise they may be lost until the day you wake up and wonder what happened.

  • It is not unusual for an experience with colorectal cancer to change one's perspective. Possible changes run the gamut from what is important and not important in life, personal relationships. what to do for work,  the balance between work and personal time, long term goals - to something as simple as deciding to repaint a few walls at home. Alternatively, the experience may not change your perspective at all. There is no right or wrong here.
  • Consider taking some quiet time to think about this subject to help pull together changes you may not have focused on.
  • Think about how, if at all, you want to act as a response to those thoughts. If the action you are considering is a major one, consider holding off acting on it for at least a few months until emotions settle.
  • If your new perspective affects your relationship with friends or family members, talk about your needs. If the change means a relationship no longer fills your needs, give serious thought to changing the relationship.
  • For information, see Couples and Sex, Sexualit y and Intimacy

If You Have A Spouse Or Significant Other

  • Your spouse or partner is likely to be anxious to regain balance. He or she has likely experienced the same fears you have. However, a spouse or partner may be reluctant to talk about them.
  • It may help to know that the incidence of separation and divorce is no higher for people with cancer than the general population.
  • Don't be surprised if issues and tensions that existed before the diagnosis resurface.
  • Things to do:
    • Talk about each of your feelings and your needs. The two of you have been through a stressful ordeal. Don't think that one conversation will be enough. It will take time to adjust to the new physical you and the emotions that are likely to stay around for a while.
    • Look for time alone together. A post treatment trip is recommended in our Emotion article. Consider taking a post-treatment survival trip together.
    • Work toward a new balance that takes into account both of your needs.
    • Perhaps start intimacy with other methods such as cuddling, or massaging each others' backs. (For tips about sex and intimacy, click here.).
    • If the situation with your spouse or partner is difficult to handle, consider speaking with a counselor or therapist, especially one who has experience in working with couples during a transition period after the end of colorectal cancer treatment. (Ask other people with colorectal cancer for their suggestions about counselor they have found effective).
    • If it appears that things won't work out between you, don't make a definitive move yet. If it makes you feel better, start exploring the pros and cons of splitting up (including speaking with a divorce lawyer). Wait until at least the nine month mark and preferably the twelve month mark before making and acting on a decision.

If you have underage children: As a general matter, children need to be told what is going on. They will likely sense something has changed and think it is their fault. If you tell them, their behavior needs to be watched for changes. Giving children chores helps make them feel involved.

  • Telling Children
    • It is your choice whether to tell children about your health situation. If you do tell, do so in an age appropriate manner. 
    • If you have ongoing needs, it is wise to tell children. They will instinctively know there is a change and think it is something they did.
    • If you do tell:
      • Remind them you are fine now. You see the doctors to keep it that way.
      • Tell them that you will always be honest with them.
      • Under age children do not need to know about your worries about the future, or what could happen.
      • If you err on either side, do it on the side of caring too much.
      • Tell in an age appropriate manner
  • Watch for reactions.
  • Tips for helping children cope 
    • Spend one-on-one time with each child.
    • Encourage each child to talk about how they felt during treatment and how they feel now.
    • Ask teachers to watch for behavioral problems.
    • Prepare to answer the question: “Are you cured?” Be honest. For example, you can say something like: “I am okay now. I’m hopeful that I will stay that way.”
    • For more information, see Children 101.

Relationships with  family, friends and co-workers likely changed. It will take educating people about your continuing needs. It will take time to adjust to the new normal. 

  • Expect relationships to change
    • Just as you have to adjust to life after treatment, the people around you also need time to adjust.
    • Family roles likely shifted during treatment, with other family members taking on more of the chores and responsibility. The same thing may have happened at work. You may still need to depend on others during this time because you are not able to take care of the chores you did before. It can take time to adjust to returning to the norm of the previous family dynamic, or to work through a new norm that works for all members. You may still need to depend on others during this time because you are not able to take care of the chores you did before.Let people know your needs and current capabilities. Do not be afraid to ask for help.
    • Your relationship with friends may also have shifted during your treatment. It can take time for a relationship to readjust, or for you to adjust to the new relationship norm.
    • Relationships are mutual.  It is time for things to no longer just be about you. Start listening to their stories and needs if you haven't been
    • Do not be surprised if problems that existed with family and friends before the diagnosis resurface.
    • If your diagnosed eyes now see things differently than certain friends, be honest with yourself and think about whether the relationship is worth continuing.
  • Educate the people around you about your continuing needs.
    • With most illnesses, when treatment is over, life for everyone returns to normal. An immediate return to life the way it was before your diagnosis is likely what your friends expect.
    • However, this is not generally the case with colorectal cancer. After treatment for colorectal cancer you are likely to be exhausted for a while, both physically and emotionally. Physical symptoms and emotional needs are likely to continue. (For more information, see: Medical Care.)
    • You may feel that you aren't getting the support you need which might make you angry or frustrated. Keep in mind that most people do not know the reality of colorectal cancer. They need to be educated in a manner they understand about your ongoing needs from the cancer or your treatment. 
    • Explain which physical symptoms continue as well as unusual emotions. 
    • Explain that while you are optimistic, colorectal cancer may recur and that this sometimes weighs on you.
    • Talk about the changes you are going through and your needs. 
    • Consider letting friends know you are likely to be anxious before going to medical appointments so they can be supportive during those periods of time.
    • Ask for any help you still need. 
  • Relationship Tips  Here are some ideas that have helped other people recovering from colorectal cancer treatment deal with relationship concerns:
    • Let others know what you are able to do as you heal - and what not to expect you to do. For example:
      • Do not feel that you must keep the house or yard in perfect order because you always did in the past.
      • Help the children in your family understand that it may take a while for you to have the energy you used to have.
    • Talk about your needs. Ask each family member to talk about their needs and concerns. Don't let breast cancer be the 800 pound gorilla in the room that everyone knows is there, but no one talks about.
    • Give yourself time. 
      • You and your family may be able to adjust over time to the changes. 
      • Just being open with each other can help ensure that each person's needs are met.
    • Ask for help when you need it. 
      • Include your underage children when asking for help. It will help children feel as if they are assisting your recovery if they have age appropriate chores to do.
      • Help the children in your family understand that it may take a while for you to have the energy you used to have.
    • Accept help. When friends or family offer to help, say yes. Let them know things that they could do to make your life easier. In this way, you will get the support you need and your loved ones will feel helpful.
    • Keep in contact with friends. 
      • It will help relieve their anxiety about you. 
      • If you do not have time to contact everyone, consider sending out periodic group e mails or posting what is happening on one of the social sites such as Facebook.

How To Eat Healthy After Cancer

  • Many eating problems go away when treatment ends. Once you finish cancer treatment, many of your eating problems will get better. Some eating problems, such as feeling full and changes in taste or smell, may last longer than your course of treatment. 
  • To help prevent a recurrence of colorectal cancer or the appearance of another cancer, eat healthy with an emphasis on plant sources.
  • There are a variety of sources to learn about a cancer prevention diet.  The following tips are from the National Cancer Institute:
    • Prepare simple meals that you like and are easy to make.
    • Cook 2 or 3 times a day. Freeze the extras to eat later on.
    • Stock up on frozen dinners.
    • Make cooking easy. For instance, buy cut-up vegetables from a salad bar.
    • Eat many different kinds of foods. No single food has all the vitamins and nutrients you need.
    • Eat lots of fruits and vegetables. This includes eating raw and cooked vegetables, fruits, and fruit juices. These all have vitamins, minerals, and fiber.
    • Add beans, peas and lentils to your diet and eat them often.
    • Go easy on fat, salt, sugar, alcohol, and smoked or pickled foods.
    • Choose low-fat milk products.
    • Eat small portions (about 6 to 7 ounces each day) of lean meat and poultry without skin
    • Use low-fat cooking methods, such as broiling, steaming, grilling and roasting.
    • For more information about a cancer diet, click here.
  • In addition, speak with your cancer doctor or a dietitian/nutritionist about a diet that works specifically for your situation, including additional vitamins and supplements. For instance, it is generally recommended to take an aspirin a day to help prevent colorectal cancer. 
  • According to Dr. Mark Pochapin, a gastroenterologist who specializes in colorectal cancer and author of WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT COLORECTAL CANCER:
    • “Keeping tabs on your daily caloric intake is important (for survivors of colorectal cancer), since eating too much food stresses the digestive system. There is some evidence showing that a high level of calories in your diet, regardless of whether the source is fat, carbohydrate, or protein, may favor the development of cancer. In other words, the more food that passes through your colon, the higher your risk. Most people should eat no more than two thousand calories a day – an amount that helps keep pounds from piling on, especially if you stay active and exercise regularly.”
    • “Drinking enough water each day (at least eight glasses of pure water) is vital to the health of your colon – and indeed to your entire digestive system. Water helps separate stool from the mucous lining of your colon, assists in stimulating the muscular movement of your intestines, and keeps material flowing through your system at a health rate.”
  • Be cautious about claims that a particular diet, food or supplement can prevent recurrence. Look for scientific proof rather than anecdotal evidence. Check what you find with your oncologist.
  • If eating healthy is a big jump for you:

NOTE:  Studies show that we are influenced by the behavior of the people close to us. It is likely to be easier to eat healthy if the people around you eat healthy. Helping your family unit eat healthy is something positive that can come from your cancer experience.

Be active. Exercise.

  • The Importance Of Overall Exercise
    • Exercise helps in the healing process. It is often said that exercise is one of the least risky and most beneficial treatment options doctors have to offer cancer survivors.
    • Exercise may also help prevent recurrence and possibly recurrence. Recent studies show that lack of physical activity increases the risk of developing colon cancer. This is in line with other studies which show that people who exercise regularly have about a 30-40 percent reduction in their risk of contracting colon cancer.  Physical activity improves quality of life and diminishes emotional swings.
    • If your weight changed since your diagnosis, exercise will help you normalize it as well.
    • Exercise also has a large number of other benefits such as helping to prevent other chronic diseases, and reduce risk of cardiovascular and metabolic disease.
    • There does not seem to be any downside to exercise unless you have a serious heart or lung problem.
    • You can even exercise with an ostomy. (For more information, click here.)
  • You do not have to join a gym to get benefit from exercise.
  • Exercise And Incontinence
    • Incontinence is common after all types of colorectal cancer treatment.
    • There are exercises known as Kegel exercises which can help the bladder to hold urine. To learn more, click here
  • MET Hours
    • In general, studies show that the more vigorous the exercise, the greater the benefits.
    • Consider the following which relates to colorectal cancer. There does not appear to be any harm in applying the concept of metabolic equivalent task (MET) hours to your exercise. One MET hour is the equivalent of the energy expended by the body during one hour of rest. You can use several MET hours of exercise during one real time hour. For example, one hour of doubles tennis is equal to 5 MET hours.
    • A study published in the Journal of the American Medical Association followed 2,987 women with colorectal cancer. Women who exercised more than three MET hours a week after diagnosis were less likely to die of their cancer.
    • To see a list of activities and the MET hours each generates, see: http://prevention.sph.sc.edu/tools/docs/documents_compendium.pdf offsite link
  • Exercise Programs For People With Cancer 
    • If you have special needs, there are exercise programs designed for people with cancer throughout the country.
    • The American College of Sports Medicine has a certification program for health and fitness instructors who work with cancer patients. To find a trainer in your area, go to www.acsm.org, offsite link Click on "Certification."   Then click on "Find An ACSM Certified Trainer."  On the next page, scroll down to "ACSM/ACS Certified Cancer Exercise Trainer". (The program was developed with the American Cancer Society).
    • Other professionals who can help develop exercise programs for your specific needs and situation are physical therapists, occupational therapists and exercise physiologists.
    • For other programs, check with your local gyms, disease specific non-profit organizations, and your oncologist.
  • How To Sustain Exercise
    • Exercise can be difficult to sustain over time. Think about techniques to help keep you motivated. For instance:
      • Set up a system that reminds you periodically of why you exercise. For example, a posting on your refrigerator, or an alert that pops up on your computer every few weeks.
      • Find a buddy to exercise with. (One of the advantages of classes or gyms for people with cancer is the company and support of people in a similar situation). Note that an exercise buddy is not necessarily the same as a cancer buddy.
  • For more information about exercise, see Exercise For Survivors.

NOTE: Check with your doctor before starting new exercise or increasing current exercise levels

Get rest.  If you are having difficulty sleeping, click here.

Avoid unnecessary infections.

  • Infections lower your disease fighting immune system’s ability to fight disease.
  • A few techniques have been shown to greatly reduce the risk of infection. For instance:

Manage BodilyChanges

  • Our medical article relating to recovery from treatment describes the various bodily changes that may continue after the end of treatment, including those that may ultimately become permanent.
  • Our article about ostomies describes how to manage living with an ostomy. (As you will see, there is nothing you cannot do with an ostomy).
  • For day-to-day living purposes, keep in mind that whatever the change, it can be managed. It may take a while to figure out how, but in time things will become easier as they become routine.
  • The change should not keep you from doing the work you want to do (unless you have an ostomy and your work involves heavy lifting), from engaging in all life activities you enjoy, including sex, or even from travel. Activities may take more thought and preparation than previously, but that is a small price to pay for this amazing thing we call life.

If You Had Chemotherapy Or Radiation And Want To Have Children

  • It is advisable to wait until the effects wear off before conceiving a child.
  • Women:
    • If chemotherapy caused you to stop menstruating do not assume that you are not fertile just because you stopped menstruating. Itis still advisable to use birth control such as latex condoms,possibly with lubricant.. If you get pregnant, and cancer returns, you will face questions about the impact of cancer treatments on the fetus and about possibly terminating the pregnancy or risking your life.
    • Pregnancy after cancer:  Pregnancy does not cause cancer. However, hormones that accompany pregnancy may hasten a recurrence. Current thought is it is okay to get pregnant if you are cancer free for at least three years – preferably for five. Speak with your cancer doctor for information about your particular situation. You can find additional information from Young Survival Coalition (www.youngsurvival.org offsite link) and Fertile Hope (www.fertilehope.org) offsite link
    • Consider Post Treatment Fertility For Women
  • Men:
  • Adoption.
    • The Americans With Disabilities Act and similar laws (ADA) prohibits discrimination against people with a disability. The law covers adoption agencies. Your colorectal cancer may or may not be considered to be a disability for purposes of the act depending on the impact on your life.
    • Whether it is covered or not, expect that an adoption agency will want clarification about your health status and the possibility of a recurrence. At least a letter from your cancer doctor will likely be required. Do not be surprised if the agency requests that you wait for a few years after end of treatment before adopting.
    • For more about adoption, click here.

Consider getting a pet.  Yes, a pet.

 

  • While pets are mentioned in other parts of this guide, they are mentioned here because there are numerous physical and emotional reasons to live with a pet. For instance, pets motivate people to exercise, help fight depression, loneliness and stress, reduce blood pressure, and even help prevent heart disease. Pets can reduce pain. Some studies indicate pets increase longevity.
  • While dogs and cats may be the first pets to come to mind, there are all kinds of pets with different characteristics to suit your physical, emotional and financial needs and lifestyle.  If you don't have a pet, consider getting one. Many doctors now even prescribe having a pet as part of medical care.
  • To learn about pets, including which to choose, how to avoid getting infected from a pet, and how to travel with a pet, click here

 

Reclaim Your Life

  • Treatment can play havoc with your self image including how you see yourself in your relationship, as a sexual partner, physically, and in the work place. Now is a good time to reclaim yourself . If you agree, consider the following steps:
    • Prioritize what you have to do on a daily basis by order of importance. Carry over what doesn't get done from one day to the next.
    • Focus on activities that can have a short term result, particularly with an accompanying sense of accomplishment.
    • Return to those parts of your old routine that still make sense to you. Start slowly and build up as you go.
    • Reassert control over as much of your life as you can.
    • Celebrate being here today and the things you can do. Let go of yesterday and what you were able to do.
    • At work, start taking back activities you may have handed off to other people. 
    • Work on the parts of your to-do list that you let slide. 
    • Keep your limitations in mind. There is a reason people still use the old adage "Rome wasn't built in a day."
  • Get back into your social world at a pace that works for how you feel physically and emotionally. 
    • If you have to go to events before you're ready, showing up for 20 minutes to a half hour lets your host know you care without pushing your limits. 
    • Avoid stressful events and situations until you feel strong enough.
  • Do what you can to make yourself look better, to feel better physically, and to feel okay about your body.
    • To look good, if you haven't participated before, make contact with the American Cancer Society's "Look Good, Feel Better" program. Call 800.ACS.2345.
    • To feel better physically: follow a cancer prevention lifestyle. Take care of your oral health. Do what you can to keep a positive mental attitude.
    • Even if there is no change in your body, your body image may have changed. Take the time to learn to live with the new image. Having a strong body image may help you worry less about how other people react to physical changes. For information, click here.
  • Regain physical intimacy. Physical intimacy is important for human well being. Now that treatment is over, it's time for adults to consider the three letter word: s...e...x. If you don't want to have sex for reasons other than your cancer, that's your choice. However, if you are refraining because of your cancer, or what the treatment did to your face or body, it's time to reexamine the issue. . About sex and intimacy, click here.
  • If you are single: 
    • Start dating again. Don't let cancer define you.
    • When it comes to telling a date or someone you are seeing about your cancer history, there is no right or wrong time. Make an informed decision that works for you.
    • For information, see dating
  • Travel if you want to once you get clearance from your doctor. TSurvivorship A to Z provides guidelines for traveling safely with a health history in Travel and Travel Outside The United States.
    •  If you are traveling with an ostomy, click here.If you have an ostomy: you have a new appliance that may take some adjusting to. Keep in mind that no one can see your appliance through your clothes and you haven’t changed. You can continue all aspects of your life with an ostomy. There are time tested tips for dealing with a changed body image. Click here
  • Keep in mind that physical changes can be managed. If it relates to you, see: If You Had Chemotherapy Or Radiation And Want To Have Children

It helps to keep in mind that you are not your disease.

Consider thanking the people who have helped since treatment began.

  • Thank the professionals, family members and friends who helped you through treatment as well as those who continue to help. In addition to it being a nice thing to do, there is no way to know whether they will be needed in the future.
  • Thank you notes work well, particularly when hand written. A sincere moment of person-to-person thanks is also appreciated.
  • Something home baked dropped off at your doctor’s office is generally especially appreciated. 

NOTE: For additional information about the effect of recovery during the first six months after treatment ends, it is recommended that you read at least the Summary section of our other categories. For a complete list, click here


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