Regaining Control After a Cancer Diagnosis: Identity, Intimacy & Agency

(upbeat music) - Hello and welcome to the love me of each podcast sponsored by Tham Pharma. I'm Jerry DPNO, founder and CEO. Thank you for joining us as we discuss all aspects of women's healthcare. Please note, this podcast is for educational purposes only, always refer to your healthcare practitioner for personal advice. (upbeat music) - Hello, Dr. Halzer. I'm Jerry DPNO, and I'm here with my frequent guest in co-host Dr. Juliana Halzer, a psychologist and sex therapist and expert. Dr. Juliana to share a little bit more about her background. So Juliana, share with our guests more about your background, your backstory. - Sure, I am a twice-licensed mental health therapist, couples and marriage family therapist, and individual therapist. And I have a focus and expertise in sexuality and psychedelics and menopause. I work with people all over the world with my public practice, and then I love speaking to you and speaking on different kinds of stages. - Well, thank you for that. And yes, we have good fun. But most importantly, you impart great knowledge, and that is what our guests are here for. They are here to be empowered with knowledge and speaking of empowerment. Today we're gonna chat about a tough topic, but it is definitely one that deserves attention. And that's how to regain agency after cancer diagnosis. And irrespective of what that malignancy is, it does come with challenges, and I don't wanna minimize that they are challenges that you can face in the near-term, obviously during treatment, but also post-treatment, even as you are a survivor, even as you define yourself in that way. But before we launch into that, since we're gonna talk about agency, let's have you define agency. - Sure, it's a concept that I've been working with for many, many years, several decades. And it's a big concept that I'll kinda siphon down to a few steps with it, which is that you have to know who you are in order to have authority and authorship of your life. So agency is having self-knowledge. It is like being able to see decisions and see choices. It is the ability to take action with your choices and live with the consequences of those choices, and then to a purposeful and intentional meaning making of how all of those things go together. And all of that leads to more self-knowledge. So the more self-knowledge you have, the better agency you can enact, the more that you practice acting in agency, the more you learn about yourself. And so there's a beautiful synergy to it. The shortest way of saying it is, learn what your terms are, and then learn how to live your terms. - I love that. - And for most of us learning what your terms are can be a challenge, but it can be up and even when you think you know what your terms are, when someone hands you a diagnosis, in this case, since we're talking about cancer, cancer diagnosis, it can feel as though one is losing control of your autonomy, because it's facing, you're now part of a system of care, where you should be part of a system of care. So we hear this from survivors, and although I'm not a survivor, I was on the board of living beyond breast cancer for two terms, so eight years. And in that process, I really studied what it meant to be a survivor, what it meant to be diagnosed, because I listened to the women who were part of that community. And so we would hear things like, I have no control, like the medical system has taken over my life. So between appointments, chemotherapy, the illness that one may experience as a consequence of the treatment. It feels like someone else has invaded your body and something has invaded your body, and so you're the loss of control in that regard. So let's discuss the impact first of hearing those words. - Yeah, I mean, there's a multitude of things that happen when someone receives a diagnosis of cancer. And I also am not a survivor, but I have had a lot of people in my life who have experienced this moment of finding out they have cancer and a lot of clients too. So I have sat in this moment with a lot of people, and the observations that I've had is that there are common themes that people often feel, and there's variance from person to person. But really, what happens is most people describe it to me, and they don't use a word agency, but in a flip, there is some choices that are taken from you, control that is taken from you, and a change of identity that happens in an instant. And as well as just learning the severity of it, or what impact this is gonna have on you, if there's also this almost invisible aspect of it, which is how do you gain control in a situation where it began by something that you had no control over? And that loss could be hard to name, and also hard to go on top of, and it's why we're including agency in this time period because it is one of the places when you can enact your agency that you can minimize a difference of that. But the impact can be anything from health wise, like you're really changing how your body is feeling, and whatever the treatment is, that that can have a very big toll in your life. There's a mental health aspect. It can change how you feel about your mortality. You can have a lot of mental health issues relating to the fear and the loss of control, the change of your life, the change of how you're physically feeling, and then mentally compare to that, how you're family, or your loved ones are doing, the change of your work, if you work, and then as I said earlier, there's an invisible aspect, which is like a loss of identity. One moment you were a mother or a wife or a worker, and then the next day you were a person who has cancer, or a person who's going through cancer treatment, and that can change too. I hear very often, bless the people who don't talk to me constantly about what I'm going through, like just let me live a normal life. So there's so many ways that this diagnosis impacts you. - It's interesting when you think about someone that is going through this, and like you, I also have close friends, family members who have been diagnosed with cancer. They are thankfully, they are survivors now. One of the things that they don't talk about is the trauma experience that they may have undergone, but there is a bit of trauma to this diagnosis. And it's not just the trauma of feeling sick and knowing that you need to have treatment, but it's a psychological, and I think that that's something that we're going to explore during this conversation. You see a lot of, there's a lot of rhetoric out there about the fighter, we're strong, we're going to take control, you're going to adapt, you're not going to let this control you, you're not going to let it define you. And becoming informed in your care is certainly important, et cetera. But empowerment and agency are different because it really comes down to an individual level. So what feels right for me or for you, Juliana, may not feel right for your sister or for your friend. - Yep, yes, and that can make it really difficult, especially like one of the things that people are often suggested to do is to join a support group or to talk to other people who have gone through this. And I think there is something great about that in getting knowledge and not feeling alone, but also it can feel confusing and overwhelming if your treatment options are different or if you're handling things in a different way, then the person or people that you're speaking to because it really is individual and it's not predictable either, which again brings me back to agency because agency can then center you again to, okay, so it's good to have information but what do I do about this now? And I like asking the question like, what is true for me right now? What do I know about this, about me, about my options right now and staying in the present as much as possible? Because it's very difficult to stay in the present when you have a diagnosis. And even though we've come a long way with cancer treatment, there is still a guttural reaction of being terrified of what this means to your mortality, to your long-term, to even the short-term, and so staying present and knowing like, what do I know right now? And what do I do with that information? It's a really, really great way to start. I also like asking the question when you might be talking about the trauma, which is like, so what am I afraid of? And really not being afraid of asking that question [BLANK_AUDIO] And sitting with the answer because fear is a very big part of it. And fear makes it difficult to actually act and live an agency. Fear is a really terrible decider and decision maker. So naming your fear and being able to address it and getting help for the fear aspect of it can make a very big difference in the impact and a trauma associated with it too. And your fears may be very different than your loved ones' fears. And so taking out like what is yours versus what is theirs, I think is an important part of it. And you know you were talking earlier about that there is this wonderful and a lot of ways wonderful movement of like we're going to fight this and warrior like everyone makes the bracelets and we're going to do this and and and I love the positive aspect of that and the like we're going to take care of this but I also know people who feel intimidated by that energy or it doesn't resonate with them and some people will go ahead and start a campaign without getting consent from the person going through this and so again going back to like what do I know right now what it feels right for me and allowing yourself to show up for those moments for the things that that you know. And then that leaves me to like the next thing because like self-knowledge is the first and the second is choice which is really looking at even though a lot of choices have been taken or changed that not everything has what do I have choice in and in what's happening to me right now. Do I have a choice in physicians or I have a choice of getting a second opinion. Do I have a choice of who comes to appointments with me or how or who I'm going to get information from some of those things may sound really obvious but when you're in the fighter flight of this you can lose some of that and you can minimize the importance of seeing that you do still have agency. It's different. It may have gone from here to here but you still have it and looking for those places will help you in overcoming fear and feeling like you have more of a say what's happening to you. And then the third would be action which is so with what I know right now and the choices that I have what am I going to do how am I going to make the decision and what is the decision to be made that I'm going to enact and when I work with anybody an agency no matter what the topic is when they go through the first two steps and they're at step three which is the action of it. I will say to them I want you to pay attention to exactly when you make this decision. Look at the clock if you need to write it down in a journal and to say at this point I decided I'm going with this physician or I say yes to this treatment or no to this treatment and in stamping it can really help reinforce self trust which helps with self knowledge which helps with agency. It also is something that you can really anchor yourself in. I did make this decision with what I knew at this at this moment. And if I find something else out or something else changes then that's okay too. I will go and change that but as simple as that may sound I have found it to be quite profound and a lot of people will go back and be like okay this part didn't just happen to me. I did show up for myself in this way and the last step of this is ownership the authorship of it all which is I look back and I knew myself and I looked at my options and I showed up the best that I could with the choices and information that I had and now how do I inhabit those choices how do I live with the consequences intended and unattended. How do I flex if there's consequences that I don't like or the way the things that played out aren't how I want it to be or something else is popped up so now I have like another tributary to go down. How do I inhabit that and for some people that's meditating for some people that's really making their social circle really small or taking time in the morning but really sinking into your own thoughts and and your own grounding makes a very big difference in again dealing with the uncertainty of cancer treatment and the trauma of that and then feeling like your agency has been taken from you. And obviously this varies depending that that's why we keep coming back to the individual because it's let's face it if you were diagnosed when you were in your 20s with a malignancy and I've been privileged to know many women of varying ages and stages that have survived the cancer diagnosis most of them with breast cancer and I in one in particular and obviously I'm not going to share any confidential information but she was young in her 20s was unmarried but engaged and all these thoughts crossed her mind she had a stage 3 breast cancer diagnosis the recommendation was a dual mastectomy and she first thought how is that going to feel to my fiance so she thought about her sexual self confidence first and then because she was newly engaged and thinking about the future and wanting to become a mom the next question was and will I ever have a family and is it fair to me and to my soon to be husband if we can no longer have a family naturally and so navigating those kinds of issues is very different than someone who may be in their 50s or 60s completed their family maybe they decided not to have a family established relationship so it is very different ages and stages or someone who doesn't have a partner at all how it does and when I've talked to people who've gone through this the if you have a spouse or you have children and putting their needs and their reactions into place into the decisions that you're making can feel hard sometimes it's quite a line sometimes it isn't sometimes people will take in everyone else's feelings over their own and feel burdened by that or or not be able to show up for themselves because they're so overwhelmed by the amount of people that they're worried about and then people who don't have a spouse or loved ones that are really a part of it can feel quite alone in the process too at the end what I would say is I think there's just hard parts to whatever your constellation is it's a very scary hard thing whatever age it is because the word cancer is just such a witty response to our nervous system and it has its own place and ritual in our lives that really show that it changes the course of things for you does and you can't pretend that it doesn't even if you're in that you know I'm okay war your stance and gosh that's a hard story to hear I mean to be so young and to be worrying about those things and to again feel like in an instant is so much is taken from you and things you weren't prepared for as a therapist I'll often say to my clients it's hard being a human there's no manual for us and so often we are hit with things that we're not expecting to have is just really difficult it's interesting that you're talking about the sexuality too because some people go go pretty quickly with that depending on where the cancer is and how it's affecting you and others it's it's it's comes later if they're in a relationship or are wanting to date and infertility is such a huge factor for a lot of this too it's also body image and you know how you're feeling about your body even if it's not something to do with your reproductive organs or your breasts it's learning to have a new relationship with your body and is a very big endeavor while you're either fighting for your life or fighting for your health you know we we have spent a lot of time out working with the cancer community as I said primarily the breast cancer community but also with women who have ovarian cancer so we've learned a lot as a company and I've learned a lot individually and professionally working with that that group most of what I have heard is that finding out about yourself when you are diagnosed actually gives women a sense of more empowerment because perhaps they hadn't thought about agency and empowerment until they feel that's being taken away which is kind of a perverse way to think about it but maybe not what are your thoughts on that yeah agency comes for you in a lot of ways but there's always a time in someone's life where it presents itself to you and for some it's kicking and screaming or it comes for you in a very perhaps unwelcome way but what I have heard for those that agency has come in a crisis it feels like it's the lifesaver as well as the life jacket of this is how I'm going to get through this that and there's often an existential part of this of like wow it's really up to me even if you have a wonderful family and friends and everyone that is you know working to help your health it ultimately is up to you you and your body you and your psyche you making these choices you deciding how as much as you have a say and how your journey is going to go and I think that the reclaiming of a different kind of certainty and live it compared to the ambiguity of this which really can throw a lot of people and finding where your choices are when there's so many choices are taken from you those two things make a very big difference Those are two skills that are really highly related to your emotional regulation and to your emotional well-being and mental health. So in the case of this one individual that we're talking about, she ended up getting married. So that was the choice she did go through with it and she was able to freeze her eggs. And today she is two beautiful children and she's very healthy. So those were decisions she had to make. It wasn't a matter of, am I going to have children? I want children. If I'm going to have children, I want to make sure that I'm protecting my ability to have this family. So she was given great advice and she acted on that. But again, this gave her a sense of control. She could control her reproductive life. This is the way she was going to control it. She opted not to have breast implants. She said, I just don't want to take a risk. She knew she would never breastfeed, but she did not want to take the risk of having breast implants because she had studied the literature, but she's very self-confident in herself. But again, it was the series of decisions that she made to satisfy herself, not even to not even thinking about her partner, but really thinking about what she needed for herself in the moment. That's wonderful. And the process is always what I feel focused on, not necessarily what the choices are. It's the how did you get to the choices that you make that I know makes a very big difference in how someone's handling all of this. And when people ask me, how can I show up for my person differently? It is learn the concept of agency and be a protector of your person's agency throughout this process. Be somebody that doesn't take over. Be somebody that doesn't do not, not enough, but to sit there, be on the person's advisory board, not the decider of it, but someone who can give input, but never taking away someone's options. And pausing because there are some things, there are times that somebody's going through treatment or having dynosis like this, that they are flooded with so many choices. And they look at each other like, I don't know. I mean, I don't know how to decide this. I don't know what is the right treatment. I didn't go to medical school or whatever those things are. It can feel like you're not supposed to be the person, the president of your advisory board, but you need to be having people that remind you that you can make good decisions that this is the way to gather the information to make decisions can be so helpful to someone's experience through it. Back when I was talking about like the certainty versus ambiguity, what we know with research that having a high tolerance for ambiguity is a very important skill in life and for your mental health. Most of us don't like that, and most of us don't want to have a high tolerance for ambiguity, but it makes a very big difference. And so when you're asking about agency coming for you, being able to have the skill of ambiguity, like just not knowing how things are going to go and knowing how to be okay, as you don't know, it most of us have that happen in our life at some point. And how you experience those times of uncertainty will really show you how much tolerance you have for it. And having people help build that to you. For some it's prayer. Prayer is an answer to having a tolerance for ambiguity, meditation is another groundedness. There's all sorts of tools and ways to build your tolerance into address your tolerance. For some it's information gathering, having binders and binders of things. Again, I don't have an opinion of the choice that they make. I just want to be personal intentional to the truth of who they are as they're making it. Some people having five huge binders going to a doctor's appointment would be the worst thing ever. And in their way of doing it is having someone with them taking notes. And in the meeting, they're not asking any questions at all. Their person is to me, that's not giving up agency. If that was done with purpose and intention, and then they come back with the information and sit with them or figure out how to go through it as opposed to the binders. But for others, the binders is like, this is how I'm going to do it. And I'm going to ask all my doctors all these questions. I'm going to approach them with all the research that I've done. I'm here as my chat GBT, things that I've done. Whatever it is, it doesn't. You have to approach it in a way that is truthful to who you are, to alleviate your fears, to give you as much choice and also acknowledge that even with all of that, there is still an element of you just don't know how any of this is going to turn out. And you have to make the decisions without having certainty. And then you have to learn how to be okay with that as things come into play and learn how to be agile with it. And that's hard to do when you're fearful and when you're not feeling well. And you have a lot of people, you have opinions and voices in your head. But it's, but it's achievable. And knowing how to pivot is a skill that we could all do more of learn. We could well, I'll spend a lot more time investing in whether it's at work or with your family. Life is imperfect as we know in this case. This really does throw you for a loop when you get any kind of a diagnosis, much less one that could have a significant impact on many aspects of your life. And speaking of that, we think about relationships, intimacy and connection. And I've also had the experience of working with women who decide to socially isolate because they don't want people to know. And that's a decision in and of itself. They don't want they don't want the label. They don't want to be identified that way. Maybe they don't want to be identified that way because they're fearful that they will lose credibility at work or lose stature at their job. Others may not want their friends to feel to pity them. And that's a choice. That's also a choice. Yeah. So they're knowing yourself, knowing how you want to interact with other individuals. But certainly if you're in a relationship. And when there's intimacy involved, that's a different dynamic. And that's your specialty. So what about intimacy and relationships? Yeah. And as we we have settled, it's different for each person as to how that looks. I mean, there's physical aspects depending on what your treatment and your treatment sides. That could happen. That would preclude you from being able to physically be intimate and sexual. There are things that could be done about that proactively and and through treatment. When I'm working with somebody that it is affecting them and being sexually active is an important part of their life and a healthy part of their treatment. Then I teach them how to have medical agency and how to have those conversations with their physicians. Again, like for some, it's early in and they know it's going to be a part of it. For others, that perhaps are cancers in a different place and they weren't expecting it to change physically, having like, you know, dryer, a vaginal tissue or more pain during intercourse, then asking your physician to help with protect your sexual health or asking for treatments or asking for anything that can make a difference is really important, but it can be really scary. If you're not already comfortable talking about it or if the physician or your medical team hasn't brought it up, then it can be hard to own and claim this matters to me. But if it does, I want to always support women in asking for that and learning how to do it. But when I talk to physicians, I always say, please be proactive. Just ask the question, even if it's just once, ask the question, like, you know, it can be worded differently depending on your person and again, like what the treatment is. But let's talk about your sexual health. What are your needs here? Just something as general as that can make such a big difference. My preference is for it to be asked multiple times, like before or during and then after, but that isn't always the case that people will do this, but I think it's important. And then there's outside of like the physical aspect up there is the desire. For some, there is actually an increase of desire. That if depending on the meaning of sexual connection in their life and what that does for them, if that brings comfort, if it feels like let's go into this bubble and feel better or orgasm would just really help me right now or whatever. The need is for some, they are really drawn to it a lot more and others, their desire is immediately gone or starts fading as fear is taken over or treatment has changed or exhausted or if you're not feeling well or you're very sick, that could be the last thing that you want to do and care about. We do know there's a statistic that shows that for women going through cancer treatments that there are a lot of men and heterosexual relationships that leave women during cancer treatments. It just makes me sigh a very heavy sigh and frankly really pisses me off and I know of several people that that has happened to and I remember feeling so shocked and frankly disgusted by that. And then when I heard this study and then when I started asking nurses, infusion nurses, they all said, oh yeah, we all know this, we know it, we know the difference of like he's not coming, we can we can kind of just feel of marriage that's going to make it through this and not and then all of a sudden she has women helping her, she's coming alone to these kinds of things and how hard and tragic that is. It definitely have it on a lot of relationships. And there's lots of reasons for that. But one of which is if it's a relationship that's already strain or a relationship that was working because the woman was bearing so much of the weight of things emotionally or physically logistically, then it's not going to operate the same when she has to concentrate more on herself or doesn't have the energy to do what she normally would be doing. And that's really terrible scenario, but looking down further in the continuum, not all couples grieve the same way. There's a lot of grief that comes with the cancer diagnosis and cancer treatment. It's a different kind of grief than grieving death, but it's certainly a grieving of loss, and it's something else that I wish that was more a part of the cancer treatment and the cancer team is having someone taking care of mental health or if you're in a couple, taking care of the health of the relationship. Beyond that, I would say I work with people who have gone through cancer treatments that are single and it's very isolating. They're like, I was just starting to date or I want to date or like I want to be sexual. Some that are feeling well enough to be sexual and wanting to date, but afraid to tell somebody they're in treatment. Would that make someone not want to date them or want to leave them before they're more committed? And there's not a lot of places for people to talk about this because the focus really is survival and health, but the way I look at this is looking at it holistically, your support system and the connections that you have and the quality of those connections make such a big difference in your mental health and your mental health has such a big impact on your physical health and the ability to go throughout this that I'm always relieved when someone who's going through treatment picks to have a therapist on their treatment team because you need someone looking out for all of that and at that involve sex and sexuality than fabulous. And again, there's a whole variety of how people feel about it. I've had people come to me and say, help me protect my sex life, help me figure out how to have sex while I'm going through this and others that think like how do we protect our marriage when that is off the table for us and we want to survive this and still feel sexually connected, but penetration's off the table. What do we do? We also hear again through the community about women who have partners who just are fearful of hurting their partner. Maybe, you know, if they've lost their breasts and the breasts were an erogenous zone, they don't want to touch the breasts, they don't want to come near it, they're afraid. Their partners are afraid and irrespective of whether they're in a same sex relationship or a heterosexual relationship, the fear does strain the relationship. So when you talk about mental health and couples mental health, you are going through this as a could be a family. But if you have a partner, you and your partner are going through this, even though you are the one that's experiencing the change, right? The physical changes and the emotional changes. The person who loves you and cares about you is experiencing this in a different way and it and may actually be more frightened because they do not have the control. You are the one making the decisions for the most part, unless you're doing it as a team, but you're often the one on the front lines and if you are taking control and you don't have your partner involved and they are out of the equation, that can feel very scary to the person that loves you. Yes. Yes, absolutely. And the caregivers are often overly fatigued and are worried and caring the weight of a lot of other things too and not necessarily at their best to be making decisions to or to be looking out for themselves and it's just absolutely critical to have them have somebody to talk to and to share these fears with. I've certainly had clients that they didn't realize her vaginal tissue was going to change and all of a sudden had blood happening and we're terrified by that and we're not able to get aroused again because they were so afraid of you said of hurting somebody. I've had mothers who've had double mastectomy not wanting their teenage daughters or their preteen daughters to see their chest because they were afraid that they'd be afraid of them or afraid of what could happen to them. The bodily changes can't be underscored how important it then affects your mental health journey in the process too. Thinking about what women can do because there are things that you can do. We always like to lead with hope. Yes, because as you said this is an individual decision. You make the decision and you live with the consequences good, bad or indifferent. There are things that you can do to hold on to that control and hold on to that space while you are either getting the diagnosis, living through the treatment or you are a survivor. Let's talk about that. To bring the point in again, I think one of the number one things you need to do is bring an agency into your whole process and start using those words and asking yourself that and talking through the formula and that is like self-knowledge. It is choice. It is action. It is ownership. Those things will make a really big difference. I'm just sitting down and asking your question. Even just writing it down. People write it down. If they have like a partner or someone doing this with them saying, "Hey, let's walk through the steps of all of these decisions." Let's go through each one of these and make sure that we are enacting them. I think it's very important to look at your mental health and having a therapist on board. I think that it is important if you are sexual and have a desire to keep your sexual connection going to look at self-pleasure, lubrication, all the tools, products that you can use to increase your pleasure and decrease any kind of pain or discomfort. Then I also want it there to be room for there to be no sexual activity and no sex acts to really step into this experience to see how the skill of having a high tolerance for ambiguity can benefit you on all sides of this. I don't want to say I believe in and looking for silver linings when something is just shit. But I think that there is something beautiful when you can get to the place at some point in the journey and it's like, "Okay, I didn't want this to happen." But this is something that I can look at and think, "This part is good. This is what I've learned. I wouldn't have learned this about myself or other people. I had not gone through this." You don't have to stay there long, but I think it's important to have some conversations and thoughts about that. I also think it's important to give yourself permission to have a dual sense of feelings. You can feel grateful that you have access to this kind of treatment and really resent that you feel terrible because of it. You can feel grateful that you're alive and miserable that you feel terrible. You can feel grateful that you've got family and friends that are looking out for you and being incredibly annoyed that you don't get time alone. Giving people permission to do that is important, but also giving yourself permission to have those differences, I think, can make a really big difference. I'm glad that a cancer diagnosis these days is different than 30 years ago in a lot of cases. And I'm grateful that we have a progression of treatment and a whole more of a holistic way of looking at somebody who's going through treatment. But I also say it's important to acknowledge this is there's a time stamp to this. There's before a cancer diagnosis and there's after for those who get to live a full life in the after part of it. It's a beautiful thing to live that after life with a lot of agency and doing what feels right for you and making most of that time. Those are the ones that was at the privilege to make that choice, other ones who get to color the time stamp afterwards. There is a wonderful book that I'm going to recommend. It's Life After Cancer because most of the time when one thinks about a cancer diagnosis, they think about what's going on with the treatment, so it's the treatment. It's eradicating the cancer to the degree that that is possible. But it's a really living after cancer and it's the author is Gerald Lamole and Pelleve Metta and Pelleve is an oncologist who happens to be with MD Anderson Cooper locally. So using the Mid-Atlantic region you can look him up. He's wonderful oncologist but they talk about what happens after. How do you navigate afterwards and some of what you have shared in the way of advice? I agree with you on the toxic positivity. It sucks. If you get this or any diagnosis that puts your life in the crossroads, it sucks. Let's face it. But it's what do you do with the lemons? As somebody said, you try to make lemonade. Sometimes it doesn't really taste like lemonade because there's not a lot of sugar you can add. So thinking about it that way, if that's what sustains you, you talked about prayer, meditation, turning oneself over to a higher power, they all work. The life after cancer because there is. It's what makes sense for you though. Yes. Right. And when you've gotten a taste of not being to escape your mortality, like looking at it, having to make those answers, having to look at them. It's important to embrace that. Part of it. embracing it does not mean it's all happy and wonderful and like you're now going to just live this bucket list. Some of it is rest and grieving and being mad and frustrated with the process. That's just as much of embracing it. It's just it's part of a full life is having a range of feelings and a range of experiences. I would say a full life means having a genuine life, an authentic life with all of it and having a cancer diagnosis really does change a lot and some of it you can't control what it changes and some of it you can. Embracing that the parts that you can change can make a very big difference in it. You grow a skill that you don't ever want to let after fee again. And as strange as it is, relinquishing that control is also part of agency because you've made a choice to relinquish that control. Yes. Yes. It is life altering when you live the concept of that and see is not nearly as scary and terrible as it has felt in the concept of it. Well for those that are interested in support groups there are lots of organizations living beyond breast cancer. There's breastcancer.org and so many others and if that's your thing you will be surrounded by a wonderful group of women, a wonderful group of practitioners, resources, so check it out if that's your thing and if it's not then find your thing. Yes. Find your thing. Absolutely. Find your thing and then live everything. Yes. Dr. Juliana Houser, thank you once again for all of your wisdom on the love me of you to podcast. And remember, even when life may suck, love me of it. Support for the love me of you to podcast comes from femfarma. We talk a lot on this show about maintaining a vibrant life at every stage and that includes your intimate health. Me of you to personal lubricant and moisturizer is formulated to address dryness and thinning skin made without hormones or harsh chemicals. It's about reclaiming your confidence and comfort on your own terms. Use the science-backed solution trusted by women everywhere. Find your relief at femfarma.com Thank you for joining us on the love me of you to podcast. Love me of you to means love my life and that is a mantra we should all live by. Please like and subscribe wherever you get your podcasts and remember to follow us on social media and on femfarma.com. Thank you and be well.