Psycho Oncology

 

Dr. Colin Goodwin

This is the Sick & Good podcast and joining us today is Dr Rhonda Sherman she is a licensed psychologist in the state of California as well as Texas where she is currently in a private practice in the Houston area. Dr. Sherman has been in private practice for the last nineteen years with over twenty five years in the field of psycho-oncology. So welcome to the podcast. Can you define psycho oncology for our listeners? Just wanted to start with that.

 

Dr. Rhonda Sherman 

Ah I'm happy to be here.

 

Dr. Rhonda Sherman

Sure, um, the field of psycho-oncology actually began developing in the mid 1970s and basically it's a subspecialty of oncology and it addresses the psychological, behavioral, emotional, social. spiritual issues that may arise for cancer patients and also studying and looking at um. How a individual's psychological states and issues can affect their treatment and their care.

 

Dustin Mesick, RDN

So what made you interested in this field.

 

Dr. Rhonda Sherman

Well, that's actually an interesting story indulge me. Um I started developing an interest I didn't know it was back then an interest in psychology at a young age. Wondering basically about individual differences sitting across the dinner table. Why does my brother like cauliflower and I don't and why does some people are shy and quiet and some people are not um so I always very interested in human beings and individual differences. Um, as I moved along in high school I became interested in science and I was a volunteer at our local hospital during high school I liked being in a hospital I liked being at the bedside of patients I love science class. And so when I went to college I was in a liberal arts honors program and gave me a lot of flexibility I found myself gravitating towards psychology and wound up with a couple of majors 1 being psychology um and doing some research. So. Figure What do you do with an undergraduate psychology. Do you go to graduate school and as I went to graduate school unfortunately the year before I started both a friend of mine and my father were diagnosed with cancer and they both passed away in the fall of 9092 during my.

 

Dr. Rhonda Sherman

Ah, second year of graduate school so then cancer became personal. Um as I started um, moving through graduate school coming upon a dissertation time. Um. I found myself perusing the books in oncology in the library and found one on cancer and sexuality and it just hit me. This is what I want to look at and so I wound up completing a dissertation about sexual functioning of bone marrow transplant survivors. At Roswell Park Cancer Institute in Buffalo and then as I continued along I just gravitated again towards hospitals and did an internship at the va in long beach working in oncology with h iv this is in the 90 s chronic pain cardiac rehab spinal cord injuries. Um, and found myself. Ah answering ah a ah for a job that was posted at a pain conference at the city of hope cancer center outside of Los Angeles which I started in 9099 and I haven't stopped.

 

Dr. Rhonda Sherman

Since working in oncology and love it. It is where I just need to be and it's what I do the best as a psychologist and what I know the most about.

 

Dr. Colin Goodwin

Thank you so much for sharing that I was ah curious about perhaps the referral process. How clients are referred to you or perhaps how listeners can find psychologists in their area.

 

Dr. Rhonda Sherman

Right? So um, ah as a psychologist in private practice. It's really up to us those of us in private practice to go and find our referral sources and attempts at marketing. And so I am kind of embed myself. My office is located within a hospital system in a medical office building connected to a hospital and previously when I practiced in San Diego the same thing I found an office. Ah. On a hospital campus because I wanted to be surrounded by oncologists I felt like that's where I needed to be and so I tried to meet the oncologists on my campus and in Houston we have the Texas Medical Center and we have plenty of hospitals in the Houston area and so I will um, connect with oncologists and directors of oncology programs and so my refers come straight from the oncology offices. A lot of the oncology nurse navigators in the nursef. Nurses in the practice and that's mostly where my referrals come from in terms of the listeners trying to find a psychologist or mental health provider in the with oncology experience can be a little challenging.

 

Dr. Rhonda Sherman

I think the first place to start is our professional organization. The American Psychosocial Oncology Society and I will yeah give you the website and maybe you could post it. It's w ww ww dot. a p o s hyphen society dot org and that is the national organization for psycho oncologists and there is also if there are any international listeners. There is the International Psychosocial Oncology Society and I would start there to find a therapist or mental health provider another place or for listeners to call their local American Cancer Society office in their city.

 

Dustin Mesick, RDN

So just to switch gears a little bit here I just wanted to ask what are some of the most common issues that clients present with in their initial appointment?

 

Dr. Rhonda Sherman

Oh so yes, the initial appointment was the keyword I find it very interesting that um, over the years patients will be referred to me because they have a cancer diagnosis and they are exhibiting some type of distress. Crying anxiety. Maybe they have voice some thoughts about harming themselves or refusing treatment and so they come with you know, basic anxiety sadness. Difficulty coping with um cancer treatment. The side effects. Um, there's a lot of lot. What I say to my clients a lot of loss and change cancer is all about loss and change.

 

Dr. Rhonda Sherman

And um, maybe the clients have never dealt with loss before so this is new but it is a very acute fast change and loss in their life and loss of their. Future that they expected to look a certain way and it may be different because the cancer experience the cancer diagnosis follows you um, but interesting enough. So That's the initial presentation and we provide interventions and support and and what's needed. Ah, but I find that with a large percentage of my clients. It turns into other things that issues that were really going on with them prior to their cancer diagnosis.

 

Dr. Rhonda Sherman

Seem to come up and that turns and kind of to ah I'll say regular psychotherapy that some people might come into therapy for a lot of marital issues. A lot of marital dissatisfaction. A lot of work dissatisfaction so people wind up. Sometimes changing relationships sometimes improving their marriage. Ah sometimes changing jobs and professions. So. It's really interesting. It starts with the cancer and sometimes I wind up seeing clients longer term to address other issues. Um that they never address before so it's really. I consider cancer in any crisis but specifically cancer an opportunity an absolute opportunity for I Always say.dotdot for anything but for growth and well-being and a lot of my. Clients that I work with said that they are happier Now. Ah since their diagnosis than they were before their diagnosis because they have addressed. They've addressed these issues that were never addressed before and now they are.

 

Dr. Rhonda Sherman

Yeah.

 

Dustin Mesick, RDN

So that's really interesting. Um, you mentioned some of the interventions that you rely on what would what are some of the types of interventions that you utilize with these clients.

 

Dr. Rhonda Sherman

Um, again it it depends on what they're presenting with um and also depends on what type of cancer they have and what stage I forgot to mention that but if someone comes there's a lot of anxiety. So We first have to figure out what the anxiety is about I learned very early on in my work in oncology to not assume that every cancer patient is anxious about dying I Made that. Big mistake and I will not do it Again. It wasn't a huge mistake but I was so I don't make that assumption So I would do an assessment like any other mental health provider psychologist to try to understand the anxiety I work a lot from ah the cognitive therapy Approach. Where I help the clients identify what their thoughts are their thoughts about their diagnosis. Their thoughts about treatment their thoughts about death and dying sometimes spirituality. And I try to help them identify if those thoughts are helpful or distorted or irrational and learn how to modify them and in addition to that for anxiety we'll do some relaxation exercises a lot of sleep Hygiene Sleep is a problem for a lot of us now.

 

Dr. Rhonda Sherman

But especially during cancer treatment sleep can become a problem so we work with some sleep interventions. Sometimes there's a need for um, communication skill building which. Teaching them how to not only communicate to their providers about what they need or what's important to them but even more so to their family their spouse their children their sisters their friends. Um, and then. We work on some approaches if there is some existential anxiety and death anxiety. We discuss those or from an existential approach if they are religious or spiritual I'll help facilitate their thinking about it I always tell them I am not a religious expert. Um, but I could help facilitate their process or thinking about it. So when it comes to depression some of the same cognitive therapy labeling feelings sometimes clients don't know what the feeling is. And so I'll give them a list I'll pull out my happy face chart or Smiley Face chart or ah, just to label what the feelings are and really process with them about what it's about um and learn help them learn to hopefully my goal is with depression.

 

Dr. Rhonda Sherman

To maybe help them shift their perspective about cancer about what's happening to them. Um about their future and with the majority of these cancer patients I See. We are able to identify actual gifts quote unquote gifts that come from this cancer experience and I love it when that happens you just you just see it on their face and there's relief and to identify there are some good things that can. Come out of very a very traumatic and experience filled with some physical suffering and emotional suffering that there are some good things that could come out of it So That's most of what I see you know so. Times will bring in a spouse if they if a client begins to bring up some relationship issues I will have the spouse join us and we'll do some work there. Also.

 

Dr. Colin Goodwin

And you'd mentioned a couple different issues that are are commonly brought up in that initial appointment and having marital issues or occupational problems. Um I was curious if ah, you can tell me a little bit about how the psychosocial issues impact.

 

Dr. Rhonda Sherman

The ha.

 

Dr. Colin Goodwin

Cancer care and the cancer experience for patients.

 

Dr. Rhonda Sherman

Yes, So I don't even think I could list them all Now. It's it's it's fascinating to me for example, yeah, we talk about work and jobs. Um, what I see. A lot in the younger ah clients with breast cancer I see a lot of those clients. Um, they're usually very bright, very hardworking very driven. Responsible women and many of them are mothers some with small children some with high school to young adult children. Um, and these hardworking driven bright. Capable women. Ah sometimes the experience is harder for them because they feel like they have to continue in that same driven successful path and they don't take the time for themselves. To do the self-care to take the time off of work if they're able to financially they want to go I'm working with some now they want to go right back into work after some time off couple months off and they go back full time and I always suggest if possible.

 

Dr. Rhonda Sherman

Have a slow entry back to work. Maybe go in 4 hours a day twice a week then four times a week half a day and maybe the third week going full time three days a week and slowly back in and you won't be surprised. They don't listen because of their mindset. And so that can have a great impact on their recovery and their emotional wellbeing if they feel like they have to perform at the level. They've always performed at so that I find very interesting um compliance to treatment to oncology treatment. You know if someone is very depressed or very anxious and fearful of chemotherapy of needles it very well may impact their compliance they may cancel appointments cancel surgeries um to be so. Fearful of needles are so fearful of chemotherapy that they're vomiting before they get there and they're highly distressed and then they don't get their chemotherapy that day. So also I find that some clients. That are highly distressed and we haven't been able to lower that distress level can sometimes exacerbate the physical side effects that they may be going through and so then you get a lot of calls into the oncologist and complaints of pain and nausea and it's all very real.

 

Dr. Rhonda Sherman

Side effects. But I find sometimes it's correlated with high levels of Distress. So The physicians and I have to work Um, from both ends they need to work with treating the side effects with their medical interventions and I work on trying to treat the distress. And sometimes we call in psychiatry or I refer to psychiatry for some so medication that may help with their distress. Um, if an individual a cancer patient does not have good communication skills. That may lead to not receiving the best care for themselves. Um I Really want cancer patients to have a good relationship with their providers and feel safe and feel they could trust and if. Someone is not used to being assertive or speaking up about their needs. Not only do they they might not get the best care for themselves. But emotionally um I think they have higher levels of Distress. They're kind of white knuckling treatment and white knuckling. Having their doctor as their doctor. The research also shows that individuals who have healthy and a lot of social support seem to do well.

 

Dr. Rhonda Sherman

With poor social support again compliance they might not go to their appointment Poor Social support. They might be too depressed. They might not eat Well they might not be sleeping. They're depressed. No One's helping them. No One's calling on them and it doesn't go as well. Um, and then another psychosocial issue is I think if someone doesn't have the skills of decision making and this is a hard one because if you don't have. Much experience or knowledge in the medical healthcare system and then all of a sudden you have this significant diagnosis and life threatening. Potentially it's Scary. It's a lot of information. It's hard to um.

 

Dr. Rhonda Sherman

Make a good decision and and actually that's what I do a lot with clients is help them think through decision making in terms of treatments or treatment providers.

 

Dr. Colin Goodwin

That's great I think you did such a great job of ah explaining some of these you know psychosocial issues that cancer patients have in particular you know you had mentioned that you see a lot of breast cancer patients and survivors. Ah I was curious. What are some of the presenting issues specific to breast cancer?

 

Dr. Rhonda Sherman

Again, it's varied with age with relationship status and with type of cancer type of breast cancer. Um, your your listeners may be familiar with the different types of breast cancer and the stages. Um, and some may be more aggressive. Some may be very very early stage and that then leads to the type of treatment. So some may have more aggressive treatment. Some may just have a lumpectomy. Or mastectomy and no other treatment. Some people may have chemotherapy radiation and surgery or any variation of that some may have hormone treatment which comes with its side effects. Some may not so the issues are very depending on all those factors but common. Presenting issues specifically to breast cancer I think obviously would be body image concerns um hair loss and reconstruction if they will be having a mastectomy. Or bilateral mastectomy or even Lumpectomy um, but over the years the Twenty So two 23 years I've been working in the field. The reconstructive surgery.

 

Dr. Rhonda Sherman

They just keep coming up with more and more types of surgery for better outcomes for women. So. It's really exciting. Um, so body image they feel some of them feel like their breasts if they have implants are not their own. They don't feel like it's part of their body so that affects how they feel about themselves sexually it feels differently and usually the partners are supportive. Um. Maybe occasionally we might have a partner that's unhappy with the changes I Guess so then we try to work together but mostly the partners that I've worked with are pretty supportive regarding the body image. Them the other issue big issues kind of what I was talking about before with some of these younger successful driven intelligent women is balancing everything they're balancing work. Balancing and parenting. They're balancing family. They're balancing marriage. They're balancing caring for themselves having their own friends. Ah, if they have you know hobbies and interests. It's very very difficult.

 

Dr. Rhonda Sherman

Very difficult I would say at this point in the past ten years that's the number 1 issue is doing it all. Um the sexual issues can become problematic, especially if um. Their breast cancer is hormone receptor positive and so they are taking medication to prevent future recurrences by suppressing hormone production and so you have very low. Sex drive painful intercourse. There's atrophy of the tissues a lot of cancer patients who have chemotherapy or radiation or post-surgery have fatigue which plays a role and sexual issues. So that's ah, that's a big one for breast cancer because the hormones or the lack of um and then I think those are the specific to breast cancer then you get the usual kind of anxiety ah to your future. So. Clients come in and share with me that they're private and they don't want anybody to know so they don't tell anybody except their spouse or partner and employer and I will tell you I don't recommend that.

 

Dr. Rhonda Sherman

And because every client that I've worked with that doesn't want to tell anybody I find that they're more at risk for depression and it's very stressful to keep a secret. It's hard to keep this a secret and so it takes a while eventually they find that they can. Share with people and they could get supportive Receiver supportive responses and it's all okay.

 

Dr. Colin Goodwin

And it sounds as though that there's a lot of expectations that you're voicing here that or rather your patients are voicing of wanting to then continue to achieve and barriers even produce at a high level.

 

Dr. Rhonda Sherman

Yes, yes.

 

Dr. Colin Goodwin

And oftentimes that that can be problematic. Um, you also mentioned that there's ah sexuality and intimacy issues specifically that are common for this population and I was wondering if you could just tell us more about that. Um, you'd brought up a couple. Um, perhaps.

 

Dr. Rhonda Sherman

Yep, yes.

 

Dr. Colin Goodwin

Difficulties and I was curious if that's ah something you could just speak more to. Thanks.

 

Dr. Rhonda Sherman

Um, when um, a breast cancer patient or survivor presents with that. Um I Usually first start to explore with her. About what the issues are and again the history counts here prior to prior to cancer counts if they have a history of sexual trauma. Um, that's going to play a role even usually exacerbate the sexuality issues post Cancer. So We have to look at the history. Um their sexual history and after we explore that we could identify I asked them what what their goals are in terms of the sexuality issues and then if they have a partner or spouse we bring that. Person in and ah start with communication both ways which is mostly listening is the the skill to teach is listening not speaking um and helping the the couple listen. To each other and you know it's interesting because usually they both have the same goal and we just have to figure out a way to ah help them work. The 3 of us work together to help them reach their goal and it's usually just communication I Wish you would touch me like this.

 

Dr. Rhonda Sherman

Or ask me or not ask me or not touch me this way or that way and so both need to express what they need how they feel and it's really a negotiation I think marriage and relationships aren't a bunch of negotiating anyway. And so. And then usually um, if it if it's a heterosexual couple. The husbands I tell them I joke with him I said if you just listen to me and your and your wife trust me, you will you will get your needs met um. And it. It usually is fine and so we work it out the 3 of us that way now with the single the patients the clients who are single dating comes up and the first question is. Do I tell someone I'm dating I have or had cancer and so it takes a while to kind of look at that. Um, depending on the date the type of date have they met in person you know everybody's on apps. So it's a whole new dating world and. Um, I find that the women do fine with dating and again it just comes back to communication and listening and if you're dating someone who doesn't want to listen or doesn't care about what your needs are then it's an easy answer for you too.

 

Dr. Colin Goodwin

Yeah, run for the Hills at that point, right?

 

Dr. Rhonda Sherman

No not to date that person right? That's right? and so it's it's kind of nice I think sometimes with cancer if you bring it up at an an appropriate time when you're comfortable bringing it up the response of whoever you're dating tells you is going to tell you a lot. It's going to tell you a lot and so having. Had cancer and dating might actually make it easier to find the right person.

 

Dr. Colin Goodwin

And you know I could share a personal story on that I mean that and ah one of my first dates I laid all this my 5 year plan um and I think that that was specifically because I'm like yeah I'm not going to mess around like ah.

 

Dr. Rhonda Sherman 

Right? That's right.

 

Dr. Colin Goodwin

It's a different perspective in that sense. Ah, now in in speaking to the ah perhaps support here. You had mentioned that communication is really key here.

 

Dr. Rhonda Sherman

Refer.

 

Dr. Colin Goodwin

Ah, with having loved ones support someone who's going through a cancer process I was curious if there's a way that that can be expanded if you can tell us a little bit about how others in the family or um, friends colleagues. Whatever that might be. Just sort of expanding it. Um, how someone can best support someone through the cancer process.

 

Dr. Rhonda Sherman

Um, yeah, right? you know it's difficult I think for friends and loved ones and colleagues to know what to say and what to do and I've had friends and colleagues. Um, and neighbors have cancer and even though I do this every day and I'm very comfortable I Always you know it's a little hesitant because you don't know exactly what they need. So um. I Think one of the best things is to ask? Oh you know I I have calling you up to see how you're doing I know you're going through Chemotherapy ah is there anything I can do. They usually say no. Because I have to teach Why can't my clients how to ask for what they need. They don't want to ask people because they don't want a burden So I'll work from that side. But um, if they say oh no, no I'm Fine. You know sometimes the small things like ah finding them.

 

Dr. Colin Goodwin

Right.

 

Dr. Rhonda Sherman

Ah, someone to help clean their house finding rides if they have children to school or to extracurriculars or to birthday parties. Um, so you could offer that to of course you know food the problem with the food is everybody jumps in with the food and my. Clients tell me then they have too much food and it goes to weights and it's just too much and then all the refrigerator Space. So if you want to provide meals there needs to be a um, some calendar someone needs to be in charge to make sure the family doesn't have too much food. But I.

 

Dr. Colin Goodwin

Yeah, like ah, there's there's like a meal train as a yeah.

 

Dr. Rhonda Sherman

Yeah, real train right? Um, So I think just to ask it and it depends if it's someone who's just an acquaintance so there was a parent of a friend of my daughters that I didn't know well but I. My daughter told me that she was going through breast cancer Treatment. So I didn't know her that well but I knew her enough and we'd see each other and so I just went up to her and I said oh my daughter said you were going for treatment for Cancer. How's it going. How are you doing? How are you feeling and I know enough and I'm in the community that could say oh where are you being treated and things like that and hopefully one could pick on pick up if they want to talk or not and if someone doesn't want to talk then just say I'm thinking about you I'll be thinking about you and then every so often. Send a text leave a voicemail send a card in the regular mail thinking of you. You know, brighten your day something like that instead of asking any questions or offering anything and I do that now when I have friends that are unfortunately my cohort there. Parents are starting to pass away were of that age. A lot of us and so I'll just send text randomly say just thinking of you Hope you're having a good morning. So I Think that's the best way.

 

Dr. Colin Goodwin

I like that I think that's an artful way of showing your support what that being pushy or asking. You know if they need something um because they can be repetitive or maybe even unwanted.

 

Dr. Rhonda Sherman

Right? Yeah, it may be unwanted I think um, what not to say if I'm if I may I mean and I'm well.

 

Dr. Colin Goodwin

Oh please? Yeah, okay.

 

Dr. Rhonda Sherman

I am going off of what my clients who are cancer patients and survivors tell me they don't like um which is oh, you're so strong. You're going to be fine or when treatment is over and everybody wants to celebrate. Um. At least the breast cancer clients that I or the the clients with breast cancer many times will tell me yes I rang the bell when they finished with my treatment but I don't feel excited I don't feel like celebrating. Um. There's many reasons for that. 1 of the reasons is for these breast cancer folks. It's not over There's usually more treatment ahead with the hormone suppression or immunotherapy or reconstruction I mean it just goes on and on. Um, so don't tell anybody they're going to be okay.

 

Dr. Rhonda Sherman

And it will all be okay or when they're done with treatment. Oh you're done. You don't have to worry about it anymore. Well I could tell you as a psychologist even if someone reaches remission and no evidence of disease and even if they've been cancer-free for 3 years or 5 years many people still worry about it. So those are things I wouldn't say or don't tell them about a friend or loved one that died of cancer. That's not good either.

 

Dr. Colin Goodwin

Yeah I recall during my experiences that I had ah like my brother asked like has your brother die yet like and yeah, that's not the best thing to say ah and I I had that.

 

Dr. Rhonda Sherman

Aha.

 

Dr. Rhonda Sherman

Oh my? No no.

 

Dr. Colin Goodwin

Same personal experience. Um, where I had come home after my initial chemotherapy and hospitalization. Um, prior to my bone marrow transplant and it the support just kind of fell off after like okay, you're home. So everything is different now and you're you're good, but that wasn't.

 

Dr. Rhonda Sherman

Yes, ah yes.

 

Dr. Colin Goodwin

Case at all so that is ah a very helpful point to bring up because it it is ah so much of an adjustment and like you said ah to maybe circle it back at it dealing with this is ah a lot of the theme of loss and change.

 

Dr. Rhonda Sherman

Yes, yes.

 

Dr. Colin Goodwin

Ah, or perhaps even dealing with the new normal having to and have that opportunity to look at how your life is now that you've had this cancer experience.

 

Dr. Rhonda Sherman

Yes, yes, and I would think with bone marrow stem cell transplant. Um, most people don't understand it at all and so I would Imagine. That may be even more difficult. They just they just don't I find that a lot of people didn't really understand it that was hard to understand as opposed to a solid tumor breast cancer or colon cancer.

 

Dr. Colin Goodwin

Right? I think the common misconception there is a bone marrow transplant is a surgery and it's not exactly a bad I mean for me I mean it was you know high dose radiation to bring the bone marrow. Um, you know.

 

Dr. Rhonda Sherman

You're right? No no, not at all.

 

Dr. Colin Goodwin

To kill off all the remaining bone marrow and then the process of just having an IV with the the new bone marrow for my sister that was ah you know a match and and that was the the process but it' ah then making sure that it's actually taking and that there isn't any, um.

 

Dr. Rhonda Sherman

Look it.

 

Dr. Rhonda Sherman

Right.

 

Dr. Colin Goodwin

Issues with a complication such as graph versus host disease. But.

 

Dr. Rhonda Sherman

Right? And that could be chronic so it's not over as as some of my clients at my clients. A lot of them talk about and these are these women with breast cancer. Sometimes they're quite funny but many of them have said and.

 

Dr. Colin Goodwin

Exactly yeah.

 

Dr. Rhonda Sherman

Don't even know each other. They just say the same thing the gift that keeps on giving and they kind of laugh you know is sometimes just constant and you know with bone Mar or stem cell transplants if you have graph versus host or it becomes chronic I mean it's not over so.

 

Dr. Colin Goodwin

Um, right? yeah.

 

Dr. Colin Goodwin

Right? Yeah, there's plenty of those late effects that I know that Dustin and I have ah come across since our treatment and and it it is that you know it is that gif that keeps on giving that there's just ah, it's kind of always things to be.

 

Dr. Rhonda Sherman

Right.

 

Dr. Colin Goodwin

Aware of or perhaps diligent and making sure that you're on top of your medical care your your personal but personal health that is.

 

Dr. Rhonda Sherman

Yes, yes, yes, yes, yeah, and um, sometimes um, you know the psychological. Issues that came up because of a cancer diagnosis. Don't get addressed. Um, for many reasons but you know I've had ah some individuals say. In the oncology office. Oh well, this patient was crying or they're anxious. But of course they're anxious or course they're upset they have a cancer diagnosis meaning it's normal or common to cry when you're given a diagnosis. So because it's so common we don't need to do anything about it because it makes sense and they don't refer patients for maybe a screening by a social worker referral to therapist or psychologist because of course you're upset or anxious or sad. And for some of the patients I'll get calls. Oh my oncologist told gave you gave me your name a year ago I get this a lot a year ago and finally they're here they are six months ago and there's there's still stigma around mental health I think it's getting less and less.

 

Dr. Colin Goodwin

Oh wow.

 

Dr. Rhonda Sherman

But you know back in the 70 s when the field started they were running. You know there were 2 stigmas. There was a cancer stigma for many many decades cancer was a bad word and you whisper it prior to the 70 s and.

 

Dr. Colin Goodwin

Right.

 

Dr. Rhonda Sherman

They slowly cancer became less stigmatized. But then now we have mental health. Ah the stigma of that and so it was a hard start but I have to say even since I've been in the field. Since the late 90 s we've come a long way to have distress screening and cancer programs and cancer centers I think in the past I don't know what would you say? 5 to 7 years Mental Health is more in the mainstream. Would you say? The talking about mental health so that's good.

 

Dr. Colin Goodwin

I would yeah I definitely agree with that I think that there's just been kind of a a shift ah to having that recognized as ah, a piece of that overall health.

 

Dr. Rhonda Sherman

Yes, yep, so move we're moving in the right direction.

 

Dr. Colin Goodwin

I wanted to thank you so much for being with us today and sharing your expertise.

 

Dustin Mesick, RDN

Sorry for being so quiet. This is just a very fascinating conversation. Um, just talking to Colin prior to this and probably heard about some of what I'm saying is I've got a really bad cold. So just.

 

Dr. Rhonda Sherman

Oh oh I'm so sorry.

 

Dustin Mesick, RDN

Yeah I'm like holding in the coughs of holding in the coughs whenever I talk. Um, but yeah I know it's definitely a very interesting dialogue and um I could you know relate on a lot of levels with all the side effects that you have and stem cell stuff. It's pretty pretty big I.

 

Dr. Colin Goodwin

He's a trooper.

 

Dustin Mesick, RDN

My my stem cells were my home so slightly different but I did some pretty intensive chemo. So yeah, but yeah, no no comment ah Colin I feel like everything was really good. Thank you for being on our show.

 

Dr. Rhonda Sherman

Yeah, yeah.

 

Dr. Colin Goodwin

All right.

 

Dr. Rhonda Sherman

Oh my pleasure I hope um you know a lot of people listen and are able to get some help and comfort or find that mental health provider in their community to talk to? yeah.

 

Dustin Mesick, RDN

A.

 

Dustin Mesick, RDN

Um, yeah, that would be really nice. There wasn't a whole lot of that when I was being treated.

 

Dr. Rhonda Sherman

Right? right.

 

Dr. Colin Goodwin

All right? Thank you so much.