Psycho Oncology with Rhonda Sherman, PhD Part Two

Dr. Colin Goodwin
I'm pleased to welcome back to the conversation. Dr Rhonda Sherman to remind the listeners. Dr um Dr Rhonda Sherman is a licensed psychologist in California and Texas who specializes an area of psycho oncology. And joining us today is actually 1 of her clients Jennifer and Jennifer is a breast cancer survivor. She was diagnosed with stage 2 b invasive ductal carcinoma following a mammogram so I wanted to welcome both of you to the podcast.


Dr. Rhonda Sherman
Good to be here again.

Jennifer Rachal
Thank you.


Dustin Mesick, RDN
So Jennifer can you tell us about your diagnosis and treatment and your current cancer status.


Jennifer Rachal
Sure, um, so I was diagnosed at 41 with stage 2B actually so was there for a routine mammogram and it was already metastasized to my lymph node. So um I, after following chemo radiation reconstructive surgery I'm glad to say that I have been in remission or cancer free for the last five years um so currently doing well.


Dr.Rhonda Sherman
Um, would.


Dustin Mesick, RDN
Congratulations on that. I'm curious when it when it spread to the lymph nodes. What does that mean for somebody who's already got cancer who's already got breast cancer.

Jennifer Rachal
Well, Ah, it's a little bit more I guess invasive or aggressive as oncologists would say so it's already left the site the the breast and therefore could have spread in the lymphatic system. Um. You know through the lymph nodes and to just distant organs and stuff like that. So being that it had spread even though the cancer was slow growing. They still had to run all the scans. So Ct Scan bone Scan all of that just to make sure. It had not spread any further than the lymph nodes.


Dr. Colin Goodwin
Did you have any Lymphose removes did you had a ah lymphectomy I think that's cold I might have mispronounced there.


Jennifer Rachal
Yes, yes I did um lymph dissection. They called it I guess um I had actually 25 lymph nodes removed out of the right side of my arm under the armpit and then one. Removed on the left side where there was nothing nothing found. Um and the results from that pathology was just 1 lymph node involvement. So I was lucky yet they treated it very aggressively just to make sure.


Dr. Colin Goodwin
Like well I'm very interested that hear how you were able to get in contact with Dr Sherman and and how you were able to identify your need for therapy. Perhaps maybe you can discuss just what you brought what brought but you into therapy and. That referral process. Okay.


Jennifer Rachal
Sure um, in one of my visits to my medical oncologists. Um I spoke with a nurse navigator and that person kind of coordinated efforts you know, just with all the team of doctors. And she also just provided some resources. Um and one of which was a psychologist. Um, just for my mental health and I think my husband and I both looked at each other like that was top of the list like we had to get that um done. You know and and look into that a little bit further I will say I was a complete wreck complete mess. You know two young kids 9 in 11 ah career just my whole life. Basically ahead of me so it just really stopped me dead in my tracks I guess. And had never had anything big like this traumatic experience in my life before so I needed some help. Um I needed to speak to someone that wasn't a friend wasn't family. Um, just a professional to help me and. Dr. Sherman was actually one of the people that were with you know that they had given to me to look into and I think when I started the research on her I had I forget how I found out but she most of her practice was breast cancer.


Jennifer Rachal
And so I was like done and she's a woman and you know felt like she could understand you know from the the female side of things and you know body image. All the the woman type stuff. Um, so I was really lucky to to land with her and. Get just really like her from day. 1 She's was no nonsense and just started digging right in and just felt very comfortable with her so I didn't have to shop around if you will um and we're still together after all this time. So.


Dr.Rhonda Sherman
Yeah, can you I wonder Jennifer if you could when you say you were a mess I mean you kind of describe you you had kids you had jobs but are you able to talk about what you were feeling and. Thinking that was causing you psychic discomfort that you felt you and your husband felt you know seeing a psychologist would help you with.


Jennifer Rachal
Sure, Um, just to be pretty blunt about it I was scared of dying like I thought with a breast cancer diagnosis or the C word as they call it any cancer that was a death sentence that was the way. I looked at it from day one um I know it doesn't sound rational. Um, but when someone tells you that it's like your life flashes before your eyes and I think everybody handles that differently but in my perspective it brought me over the edge where. Major major anxiety like I couldn't even think straight I couldn't go to appointments. Luckily my husband went to every appointment still does but he just started taking notes and just getting it all together and had a pink binder and backpack and I couldn't even see straight. So I couldn't fill out the forms I was just when I say just in another world I really was I just could not focus on anything and every every time I turned around I thought okay this is it like how many more days do I have left. That's just where my mind went. Um.


Dr.Rhonda Sherman
Close.


Jennifer Rachal
So I needed some help I just I couldn't function through my daily life being a wife a mom an employee I couldn't I couldn't do that in the state I was in and both my husband and I knew that pretty much initially. Um. Because initially when I was diagnosed I went into made my husband drive me to the HE B parking Lot. You know close to my house because I couldn't even go home I couldn't even face my kids I couldn't face my mother I was just I didn't know what to do so.


Dr.Rhonda Sherman
Yeah, that's.


Jennifer Rachal
That's I guess yeah I was just a mess. Um I couldn't quit crying all of that stuff so it was bad.


Dr.Rhonda Sherman
Right? And so you know I just want to kind of comment on that that the react that's a reaction a severe reaction. Not uncommon. But severe reaction to receiving a cancer diagnosis for many people because you're going along in your life and you are fit and healthy. You weren't a smoker a drinker I mean none of that and um.


Jennifer Rachal
Oh.


Dr.Rhonda Sherman
And then you're told you have an illness that you could die from and it's It's so how the psyche can't it takes a while to grasp and understand what it means because it doesn't make sense because you're this healthy person. And you don't feel Sick. You don't feel bad. You don't feel tired. You don't you know and it's It's very traumatic to hear for the psyche and so what I heard is your brain just couldn't just couldn't make sense of it at all.


Jennifer Rachal
Um.


Dr.Rhonda Sherman
And then the anxiety is response to a threat and the threat was you're going to die or the threat is uncertainty. The threat is the unknown of what the future is going to bring you know treatment unknown. If you do treatment side effects will you survive what about work. What about income I have two kids I need to parent What about my marital life. My sex life I Have you know my physical body changes all of that and I think for you, it just was it was just way Overwhelming. You weren't functioning.


Jennifer Rachal
Um, correct.


Dr.Rhonda Sherman
Because you're emotionally overwhelmed with everything. Yeah, glad you came fall.


Jennifer Rachal
Me to.


Dr. Colin Goodwin
Almost had this ah like visual of like the spinning plates. You know Rhonda had mentioned just all these things that come up and all these thoughts that come up with the diagnosis you know and and having all these things be overwhelming. Um.


Dr.Rhonda Sherman
Um, yeah, yes.


Dr. Colin Goodwin
And I think I just wanted to comment on that as well. Just like that's pretty common experience having that reaction. Um, but it did sound like there was more of a severe reaction where you weren't able to then function in the ways that you would like to have or in the roles.


Dr.Rhonda Sherman
Um, this.


Dr.Rhonda Sherman
Yes.


Jennifer Rachal
And.


Dr. Colin Goodwin
Being a mother and and so on I'm really interested to hear how you've benefited from psychotherapy.


Jennifer Rachal
Wow, that's a ah that's a big question because I think my whole life changed. Um, and when I say that I mean you know initially I was there for. Breast cancer shock you know having cancer and how to deal with those feelings. Um, and one of the biggest words that came from Dr Sherman was just to accept this. Um, except where I am you know and this is my story and. You know if you don't accept it. You're going to keep fighting it and that was big. Um, so once I got past that I was a little better. Um I started taking more of things in stride rather than just fearing the unknown so much. Um.


Jennifer Rachal
Because I knew it wasn't going away that was the big thing I knew that even through treatment even through being told it's gone. All that stuff thought that whole shock of cancer and what it did to my life. Um. Carries on so benefited from accepting this is my life. Um and just ongoing um, you know there are times that we've stopped or I've stopped therapy for a brief time. And then have had to come back for other things and when I think about it. It's really a lot related to the cancer. Um, you know, different areas of my life that you know I struggle with but. Um, handling all of that so much better. You know, different things that are coming into my life or different things that are happening whether it's my aging parents or my 2 teenage boys. Um, my marriage all of that stuff. Um, handling those things better and learning how to cope with Dr Sherman's help as well. Just I would say our sessions now are um, not as intense they're just um, more tweaking here and there which is.


Jennifer Rachal
Good You know good to that I'm to that point I think initially it was just really a struggle you know couldn't quit crying. You know my phone would ring I'd freak out you know thinking it was the doctor things like that. So um, it has benefited me.


Dr.Rhonda Sherman
Um.


Jennifer Rachal
And so many areas of my life I Now recommend to everybody that they should be in therapy whetherthey have cancer or not um, it's I think it's 
should be required for everybody to stay normal.


Dr.Rhonda Sherman
I do want to add. Um that prior to the cancer diagnosis. Um, you know I think Jennifer probably had some type of anxiety disorder. Um, and. So maybe that was part of the severity of her reaction and what I find is that whatever an individual is struggling with in their life or has a tendency towards psychologically emotionally or if there's relationship issues or family issues. With a cancer diagnosis those all have a tendency to get worse. So I'll see patients who have a history of depression and their presentation to my office may look very different than. Jennifer's presentation because of their history of depression if a person has a history of let's say sexual trauma and the diagnosis is breast cancer. Ah they may be re-traumatized or have different a set of issues. Because of their history of their trauma. So um, you know we're not just treating how does a person respond to cancer but a person a human being has a history in a past and some brokenness or issues.


Jennifer Rachal
Um, and.


Dr.Rhonda Sherman
And that plays a role into the presentation.


Dustin Mesick, RDN
That's really interesting Dr. Rona um I you know hearing this acceptance piece that was such a big part of your journey so far Jennifer um I'd like to hear more about that like how you got there.


Dr.Rhonda Sherman
Person.


Jennifer Rachal
Are.


Dustin Mesick, RDN
And second part of like my question is also maybe some of the different modalities that you you did working with Dr Ronda Sherman like was it just talk therapy or was there any like specific things that you found to be the most beneficial um working with. With them.


Jennifer Rachal
Sure? um, as far as acceptance I think that I don't know I always thought when I saw Dr Sherman or we had a an appointment or we were talking. She just she was very to me. Um, and it was good for me. It was very direct meaning. Okay, you have cancer. You know that's not going away. Ah there was no sugar coating that this is a great deal or you know.


Dr.Rhonda Sherman
What.


Jennifer Rachal
Trying to make this better. It was It is what it is. It's horrible I'm sorry that you have this but we got to figure out a way for you to live to live and to cope through life you know and be prepared because there are going to be other things in your life that. May come Up. You know you may lose a spouse. She may lose a kid you know things like that and I started to think yeah I I have to be prepared. Not only with this but anything else in my life that were to come up I think prior To. Cancer I was floating around through life thinking I'm going to make it till ninety I you know work out all the time I eat Well do all this stuff Work. You know put my went to college got a good Job. Things are great and Then. Bam! It's like big reality Check. So I had to start looking at all the the things that it taught me you know, meaning Perspective. So I just started looking at at things a different way. And I did truly at some point it was like a trigger a light switch like I realized I have to accept this diagnosis and make the most of it pay it forward. You know, help somebody else that I can I can do and that's what I did I started Volunteering. Um.


Dr.Rhonda Sherman
What.


Jennifer Rachal
And that too gave me more gratification and more healing just to tell my story to other people who were going through similar things. So I think it just has to click like it has to click with that person as are you going to. Live in a hole and never come out and fear everything constantly or are you just going to take it and run with it and run with your new Body. You know, always tease you know, kind of joke around saying I have this.


Dr.Rhonda Sherman
Visit.


Jennifer Rachal
My body is put back together. You know had a major reconstruction surgery and a lot of complication or several complications. So. It's all put back together and this is the new me. So I think that I just really had to take. Things you know, take things a different way but I did have good support. My husband has helped me through a lot. So I can't go without crediting him for some of this He's extremely positive so that did help me. Um, so through therapy I mean. He's met Dr Sherman I guess a couple times but he's always excited when to have it on the calendar because he thinks it's so good that you're always better after you see her I know so I don't know if that answered your questions. But um.


Dr.Rhonda Sherman
Um.


Dustin Mesick, RDN
Yeah, yeah, that definitely that definitely answered acceptance and like ah as far as like working with Dr Rod Rodner Sherman is there anything in particular in your sessions like do you feel like it's all talk therapy and just talking is enough to kind of heal or is there.


Jennifer Rachal
And acceptance.


Dustin Mesick, RDN
Maybe different techniques that they use with you that you feel like it has really worked with you.


Jennifer Rachal
I remember 1 session 2 was big and I tell this to people when I was so scared of dying. Um, one of the things she told me was ok. Let's pretend you're dying.


Jennifer Rachal
And I was like what and she says what what's going to Happen. You're basically going to you know everything goes Black. You know you pass Away. You don't know what other people are grieving. Yes, they're going to Grieve Life's going to go on and I Guess. Just you know, putting that into perspective meaning. Um you know the reality of things the reality of death which was a big fear and that was one of the initial um things I had to Overcome. It was huge.


Jennifer Rachal
Secondly is life is not perfect and you will have more trouble. You will have things that come up and you're not going to know when it's coming so you can't live this. Couldn't live a life where I had just a bulletproof vest that nothing would ever happen Again. So a lot of that conversation just giving me certain things to think about more like realistic um things because I think like I said I was I was in this little.


Dr.Rhonda Sherman
Um, so.


Jennifer Rachal
Bubble thinking. You know my life's great. Nothing's going to happen. Everything's going along fine. So again like Dr Ron ah Dr Sherman said everybody comes with a different. Situation. Mine was anxiety clearly I've I've had a lot of anxiety all my life never diagnosed but when I look back on it I was constantly worried about something something happening going for my mammogram being told I had cancer. Well guess what that happened. And I think that was a an appointment I had with her to you know and even now like when any doctor I'm like go to my dermatologists and I'm thinking. Okay, well if she's got a biopsy something I have to go I have to actually think through that.


Dr.Rhonda Sherman
Um, River river.


Jennifer Rachal
And that was something Dr Sherman told me okay if she finds something they're worried about it. We just got to deal with it. It has to go off for a biopsy then you'll know hopefully it's caught early just like the breast cancer and you go on. Um.


Jennifer Rachal
So I guess just talking 3 things more to myself and the reality of the unknown like if it does happen I mean I can't prevent it from happening anyway. So but I have come a long way I can say those words now. But back then I'm like you're crazy I could never think that way but it didn't I don't think unless you disagree Dr Sherman I I don't think it took that long for me to get over that hump. Um.


Dr.Rhonda Sherman
Um, yeah.


Dr.Rhonda Sherman
Um, love you? yeah.


Jennifer Rachal
But maybe it did I had other things come up in the whole process. But that initial thing didn't take too many sessions I don't think.


Dr.Rhonda Sherman
Ah, yeah, so we did individual therapy for about a year um and about eight months seven eight months into it and we didn't necessarily meet every week um you started making a lot of progress about acceptance and um Dustin you you keep on. You're asking great questions. So let me see if I could kind of answer them more specifically about techniques and interventions. There are many of them. And I try to give clients a toolbox different types and modalities of helpful things. Um, because you just never know what's going to speak to 1 person is different than the other. The issue regarding fear of death and dying could be complex and I'm very open and encourage if the client wants to talk about it to really dive in in reality about. Death and what is death and what does it mean to them and what exactly are their fears about and the reality of when someone's body dies. You don't know that you have died and so the suffering isn't there.


Dr.Rhonda Sherman
It's the anticipation of thinking about it because this life is all that we know and it's very scary to think about not being in this life existing like this. So. There's conversations like that there's conversations from the existential kind of approach of. Ah, why are we even here and sometimes you know meaning making therapy what what do we want out of this life. What brings us meaning and let's focus on that. Let's not focus on you may or may not be here in 5 years but let's focus on the. Present in the past of what brings meaning and how could we continue to create it the concept of mindfulness comes up a lot because all we have is the present and we need to be in the present and we need to accept the present. As it is and not judge that what we're experiencing right now should or shouldn't be or is good or is bad. That's my interpretation of mindfulness that you stay in the present moment without judgment and that's acceptance that you accept it. Ah, accept it without thinking it should or shouldn't be here. Um, there is the traditional cognitive therapy approach and I think with Jennifer um, this was helpful Jennifer has attendancy had maybe has.


Dr.Rhonda Sherman
A tendency to think about the future outcomes in her life. But in a negative way and I think had you know that something may happen and it's going to be negative. She wasn't thinking about the future in a positive way and um, not that i. Ever told her to think positively about the future. In fact, I never tell anybody to think positively about the future because I don't know what the future is you know a client ofite might die in a month I don't know but um so to help them identify catastrophic thinking which are a lot of what ifs. What if the treatment doesn't work what if I go in for this biopsy and it's cancer like Jennifer was saying um so those are some of the specific techniques and interventions is that kind of what you wanted to you were asking.


Dustin Mesick, RDN
Yes, that was a really good answer Dr Sherman so I have 1 more follow-up question for Jennifer but you you definitely had kind of closed the gap there on just like what I was curious about sounds like maybe was there any like reframing that you ever had to do with Jennifer just like you know i've.


Dr.Rhonda Sherman
Through her.


Dr.Rhonda Sherman
For the.


Dustin Mesick, RDN
I've heard in like cognitive behavioral therapy they like teach like reframing to ah patients.


Dr.Rhonda Sherman
Um, reframe you know I reframe a lot in my work in general in terms of Jennifer so Jennifer like a lot of my clients that are breast cancer. Patients and survivors are very educated. Bright driven capable independent women and so for those types of ah individuals I think and Jennifer you'll I'd like to hear your opinion. But.


Dustin Mesick, RDN
Um.


Dr.Rhonda Sherman
This like Jennifer said the straightforward rational thinking discussion is helpful. Um, and I'd like to hear Jennifer's opinion but that also speaks to ah Jennifer encouraged me as a client.


Dustin Mesick, RDN
Um.


Dr.Rhonda Sherman
To form a group of women but that I just described to come together as a group and facilitate group group therapy and group discussions and I think that was also beneficial and Jennifer could talk about that too in terms of a different modality. So individual we did and we did group. Also.


Dustin Mesick, RDN
Okay, Jeffrey were you going to talk about that now.


Jennifer Rachal
Sure, um, yeah, like she said I think in our sessions we were talking. We'd have conversations like oh you know or should mention a client has this struggle sometimes or we same struggles and I was like huh. Maybe we should. Kind of do a group therapy session you know and just kind of see because sometimes you can benefit from hearing other people's um, perspectives because I searched out for you know group counseling or you know support groups. Um, initially and I went to a couple none of which I'd walk in the room and everybody's twenty years older than me or more and I wanted to meet women because I didn't know that we're going through some of the same things small kids career they were working. Um, marriages things like that um that I couldn't associate with in the bigger. Um support group settings. So yes, we did that I think it was very good I actually um, you know, learned some things. Um.


Jennifer Rachal
Felt like I could share some of my things that I was going through that helped them. So I really enjoyed that. Um I think that should be for breast cancer I really I would think that would be something that you know. Therapists could really use with their clients that would be helpful because I mean it's 1 thing to talk to your therapist or like I said a family or a friend. But when someone's actually going through cancer or treatments and things like that. It's a different talk. And a different understanding um that you can kind of share experiences with and know you're not alone like know that the person next to you is going through something very similar and also found that at.

  
Jennifer Rachal
And my volunteer work that I do um it we would get in conversations about sharing some of the same experiences so it helped people and it helped them to know you're not in this alone. There's a whole world out there. Um.


Jennifer Rachal
That's going through similar things and they're doing fine and coping with it and things like that. So I think that was helpful.


Dr.Rhonda Sherman
And we did that group. Um for fifteen months pretty regularly so and it was I chose they were all individual clients of mine that were I felt were very similar that could help each other.


Dr.Rhonda Sherman
Um, they all worked. They all had careers. Um, there was you know a physician there was a flight attendant. There was a Vp of finance at a big oil and gas company. Um, and I think they all. Because I knew their personalities were very similar. It was very very helpful to talk to other women going through the same thing and at that point Jennifer had worked through a lot of her anxiety and coping with a lot of aspects of cancer and I viewed you. Jennifer as probably um, putting helping the group more which benefited you but it was you weren't coming in with high levels of distress like maybe some of the other women were and you were able to help them.


Jennifer Rachal
Um, absolutely yeah, there's definitely phases I think and everybody goes through phases of I would say grief and in a cancer diagnosis. Um.


Dr.Rhonda Sherman
Which first helped you.


Jennifer Rachal
Some stay in certain areas longer and there's nothing wrong with that. Um, but if I can help somebody and whenever I have someone say oh my gosh just listening to you has helped me I mean that's big I'm like maybe that's what I'm. Supposed to be doing and helping others know that it's not the end of the world. Um, but I've come a long way though I couldn't say that on day one for sure.


Dr.Rhonda Sherman
Um, yeah, yeah I Wonder um, can you talk a little bit about the ah so you had hormone. Receptor Positive breast cancer and I know it's a lot of talk out there for breast cancer patients about taking Medications post-treatment for cancer prevention that suppress hormones. And that was ah I think that's a big topic for a lot of breast cancer survivors. Do you want to tell a little bit about what you went through what you're going through how you managed it.


Jennifer Rachal
Oh sure. So yes, um, like Dr Sherman said I was um estrogen and progesterone positive erpr positive almost 100% estrogen which is good and bad. Um. Good meaning. There's a lot of therapy and treatment out there for it. Um, but too. It's like you have to really limit that hormone in your body almost to zero. So. Of course my treatment was to get on at the time because I was premenopausal to get on Tamoxifen for 10 years Um, so I took that and I was actually lucky in comparison to what a lot of people will. Ah, hear out there. Talk about I didn't have many side effects I did have the hot flashes. You know, made swings here and there but it wasn't bad. Um, in my case, um then research came out um probably around 20 late Twenty seventeen early 2018 about really suppressing the ovaries. Um, even in my case being at ah at a young age or younger 40 s and so they suggested i.


Jennifer Rachal
On loopron injections which limits you know, ovary function and any estrogen coming into the body that way. Um, that was a horrible thing for me. Um. I would take it once a month and have mate I felt like I was someone that wasn't like someone evil living inside my body I was just really short tempered just oh was not I was not good. Um like snap at my kids snap at my husband. So when I realized I would have to stay on this till close to 50 I was like no way we're gonna take everything out I went and saw a gynecological oncologist and. We talked about the benefits of removing the ovaries and potentially everything full hysterectomy so I did that because I wasn't going to have kids I didn't anymore kids and. Because I would have had to stay on Tamoxifen or do the loopron injections for the next seven years I said just take it out. You know I don't I don't need it so I did that 2018 and then went on a remedex.


Jennifer Rachal
Um, So it's the post-menopausal type because my body was forced into menopause by doing the hysterectomy and now I'm on a Reedex I will say the hot flashes were more intense. Um, the libido is bull Bla. Just nothing there. Um, it's definite weight gain. Ah there is some you know weight gain I struggle every day working out and eating right? but nothing changes. Um, so I'm currently dealing with that.

37:31.70
Jennifer Rachal
Part of things. Um, but the way I look at it is I'm here. Um, and if that's what I have to do to keep this away and not have a recurrence I'm going to do it So I don't try not to focus on the negative. There is some negative to that. Um. Again. Libido is a big one I mean in the in the marriage and um hot flashes which is fine. They come and go so other than that I don't really have a lot of um other side effects. But do you hear a lot out there of people. Who do have that or even just the ones that I have and it's causing issues for them in their life and again it's It's an acceptance thing I have to ah accept this is the way it is and cancer whether it's.


Dr.Rhonda Sherman
Is it.


Jennifer Rachal
And your body or not doesn't go away. Does it change things. Um, so that's where I am now in the whole survivorship portion I'll probably have to stay on this probably for another four years she said so Mark.


Dr.Rhonda Sherman
Is the.


Dr.Rhonda Sherman
So did you at 1 point or currently take an anti-depressant or in that category to manage some of the effects of the hormone blockers.


Jennifer Rachal
Oh yes, yes I did um some still taking effects are and I don't see a huge difference with the way it's managing side effects. But what it is helping me do is handle the anxiety portion as Well. Um, and I will say I started at the lowest dose and I forget what the milligrams are but took that for a while.


Dr.Rhonda Sherman
um 37.5 then.


Jennifer Rachal
Correct I was doing that for a while and then one of my appointments with my oncologist. Um, you know like I said my husband comes to every appointment and she had asked how was doing and Lloyd just my husband just looked at me I said I'm fine. And he was like do you really want to tell her and so she just laughed and she said ok, let's up it a little bit because and I just start Crying. You know I said well maybe I'm not fine and so now I'm on the next highest ah dose and. Been Fine. It really has been Fine. Um, so I'm taking that more not for managing symptoms of those things um hot flashes and whatnot but more for anxiety I don't find that it helps with the hot flashes that much.


Dr.Rhonda Sherman
And I want to point out. It's really important for everybody understand with breast cancer. Specifically you know Jennifer was diagnosed in August of 2016 and here we are six and a half years later


Jennifer Rachal
Be honest.


Dr.Rhonda Sherman
And the treatment and preventive preventative treatment and the psychological or social or marital issues or medical issues still go on and what I hear from other breast cancer clients clients who have breast cancer. Is they finish their surgery their chemotherapy their radiation and then they ring the bell and everybody's happy in their life family and friends. Oh yay, you're done my clients tell me they don't feel happy because they don't feel like they accomplished anything and they don't know it at that time. But as a lot of my clients have said breast cancer could be the gifts that keeps on giving and so you have six and a half years later for Jennifer and yes, disease free and functional wonderful in some ways. Her life is better emotionally. Um, but it goes on and on. For some of these breast cancer patients and it would be good for family and friends to know that it's not just over when the main treatment's over.


Dr. Colin Goodwin
Yeah I was curious if there was some of those same themes that were explored and in the group that was then wrong as far as than sexual side effects and perhaps body image or even just late effects of the treatment. Um, those are some I think that were kind of just brought up in ah and the conversation. But I was curious if there were other themes or other things that you found um, particularly salient to the conversations.


Dr.Rhonda Sherman
For my side. Um, yeah I 1 psychological theme that came up in the group is after treatment some of the women's. Said that they were having challenges relating to other people one because the others in their lives colleagues or friends couldn't really understand this ongoing nature of breast cancer treatment and prevention. But also that. They had been through this huge trauma physically and emotionally maybe some other ways and they felt they couldn't relate to other people or that other people couldn't relate to them. I think that was a theme there. There's and still today in my practice I have women going back to work. Let's say they took eight months off or so to get through the chemotherapy surgery radiation reconstruction or parts of that and then they are let go from their job that. Has happened multiple multiple times to clients and body image. Absolutely and sexual functioning not for everybody but for many women. So yeah.


Dr. Colin Goodwin
And Jennifer I was curious if there's anything that you have ah found especially helpful to then talk about in the group or other themes that maybe we haven't touched on just curious there.


Jennifer Rachal
Um, no, not necessarily but I will say like Dr Sherman mentioned I forgot about that and it comes up a lot in my volunteering but the people understanding. What you're going through and relating to people I know personally I struggled that was probably another session I was interested in talking to Dr Sherman about was I felt like my circle was becoming very small and and that was all after treatment because. When I was diagnosed and treatment. It was like everybody just rallied you know and was wanting to help and support and all that stuff and was great but then after it was like you know people just figured I was fine and you know yeah yeah, and you know.


Dr. Colin Goodwin
There's a drop off there right.


Jennifer Rachal
I Think that's just a natural response when I look back on it. But what I struggled with personally was I didn't necessarily need the cheerleaders and the stuff like that. It was just my a good friend or a good conversation and. I Felt like every conversation that I would have was so um I don't know just not fulfilling to me. You know it was complaining about packing lunches for your kids or um. You know, doing something around the house and I'm like look I'm happy to make lunches for my kids you know like I'm just glad I'm here to do it I'm still packing their lunch because that's. Tell my kids I joke around my husband gets macks I make the lunches but I'm like that's my labor of love like I still look back on those days where I struggle to get out of bed from the surgery or chemo or whatever and I'd make their lunch just because that made me feel better and made me feel like.


Dr. Colin Goodwin
You know some accomplishment.


Jennifer Rachal
Yeah, yeah, even something so little so I just find that people. Um it was harder to have conversation with people. Um and it was all about the cancer. You know, just. I was identified as the cancer patient and how am I feeling the only place I didn't feel like that was work and I'm so blessed that that that happened because I still had so much work to do like they let me do as little or as as much as I wanted to do. But that's where I could go and escape and never really have to talk about it. You know my clients didn't know no one really knew what was going on well people that I worked with but they wouldn't even really talk about it too much. Um, so. I was lucky to have that but like Dr Sherman said a lot of people lose their job or they quit while they're going through treatment and I don't recommend trying to leave your job if you can try to do the minimal or do something to keep your mind going um work from home. There's a lot of those options now. After covid it just really really helps. Um and then also like she was talking about after active treatment after radiation after chemo surgeries all that it's like what now there's that question.


Jennifer Rachal
Am I doing everything I should be doing um, where are my appointments like I was going to appointments every week or in radiation my case every day and that all drops off and it's like man. It's kind of weird so I had to. Readjust after that as well and I find a lot of people do the same thing.


Dr. Colin Goodwin
Just adjusting to that structure or that regimen of your time. Ah and then shifting to finding meaning you know I was hearing that with your recommendation just to stay at your work and to stay in in doing.


Jennifer Rachal
Yeah.


Dr. Colin Goodwin
Ah, you know something to maybe speak to that role or just that that purpose um certainly would be ideal. Ah, and I'm not sure if it's ah not ah, always possible.


Dr. Colin Goodwin
You know this is going to be ah other treatments that are going to be more important that came to my own hardcore. Ah but to make.


Dr. Colin Goodwin
So just coughing off Mike here. Don't mind me. Ah.


Dr. Colin Goodwin
I did want to ask you know I was curious if you had a similar experience and and this is just as I was listening to kind of talk about how it was harder to feel like others were able to understand what you were going through and that your circle was getting smaller. I mean I remember having similar kind of thought processes in that I knew what I was doing for my treatment I knew what I was going through was pretty awful and unpleasant and I would get to the point where I would have conversations with others and I did not want to talk about myself. I Would only want to have it be. You know like a onesided conversation like I don't really yeah I know about that. Um, let's talk about you. That's so what's going on with you. So I think that was my way of being able to. Ah.


Dr. Colin Goodwin
Just focus in the conversation and have that shift in the conversation. So it it wasn't I think maybe there was the thought that I would be bumming others out or that it would just be negative in ah in a way and just curious if that was anything that.


Jennifer Rachal
Oh yeah, absolutely everybody wanted to ask about me and the first question was how are you feeling which is fine. That's a normal thing to ask. But I'm like do we really have to talk about this again, you know or do I really have to.


Dr. Colin Goodwin
You've had experienced.


Jennifer Rachal
You know rehash all of this again and that was one of the reasons I um ah created and it was the advice of a friend of mine I created like a private page on Facebook during all of this because just to give updates to people. And you know I still from time to time I'll post on that just depending on you know if there's any relevance but I'm like didn't you read all this you know I I just felt like yeah yeah, it's just i.


Dr. Colin Goodwin
Yeah, aren't you updated.


Jennifer Rachal
Didn't really want to talk about that anymore because I didn't want to be. It felt like I would yeah or just sharing negativity. Um, because a lot of it wasn't pleasant. Um that I've had to go through so again, that's where I thought this is.


Dr. Colin Goodwin
Um, a broken record or.


Jennifer Rachal
This is why I volunteer and this is why I do this is because I can talk to other people like me and that are going through similar things I Just that's where I find some purpose and and meaning now that I've had the diagnosis. Um. Because honestly when I was diagnosed in 2016 I didn't know one person um around my age that it had it since then I guess because it's just out there but it feels like it's closing in on me where there's lots and lots of. People this age diagnosed so but I didn't have anybody So I think it's It's just important to kind of come together for a lot of people. But that's that's not everybody's cup of tea I can tell you that there are a lot of people that just want to. Crawl in a hole and not talk to anybody and say anything so everybody handles it differently and that's when I I really tell people they need to get in therapy because you do need to let some of this out and talk through it What you're feeling.


Dr. Colin Goodwin
Yeah I think in my perspective. It's ah, a little bit of avoidance there of not wanting to face the fact that there's these unwanted experiences or um, you know things that we've had to go through that We really. Didn't want to have their words unpleasant like we were saying in a.


Dr.Rhonda Sherman
Yeah I think a lot of people. It's so Painful. The the natural tendency is to run away from pain and run towards pleasure. So If you're having painful thoughts and feelings about whether they're fearful or sad or. Whatever you want to run away from them and thinking Well I could just forget about It. Let me busy myself and I'm just gonna not talk about it. I'm not gonna I'm gonna do my best to not feel and think um and in my 25 years of doing this work I have never. Found that to be effective because at some point um these issues these feelings trauma is going to come out because it's in you. It's inside of you somewhere and it just never works the avoidance and suppression of thoughts and feelings.


Jennifer Rachal
Are.


Dr.Rhonda Sherman
I understand it Why people have that tendency but it doesn't work.


Jennifer Rachal
Oh.


Dr. Colin Goodwin
And I think I like the analogy of ah avoidance being like the Chinese finger trap you know, like more that you you struggle with that that a board's going to then tighten and be that mort.


Dr.Rhonda Sherman
Um, yeah, yeah, yeah, absolutely, that's a good That's a good metaphor like that.


Dr. Colin Goodwin
Difficult to then get out of.


Dustin Mesick, RDN
So there's also that one what you resist persists.


Jennifer Rachal
Is.


Dr.Rhonda Sherman
Yep, Yep! absolutely.


Dr. Colin Goodwin
Nice's a little of work there.


Dustin Mesick, RDN
Yeah, not not as cool as your your Chinese finger drop.


Dr.Rhonda Sherman
Yeah, it just becomes bigger and bigger I mean feelings just don't disappear I mean we all could remember certain feelings good or bad feelings from childhood decades ago, but we remember them and we can feel them. They don't disappear.


Dr. Colin Goodwin
Well Jennifer I was curious if he could tell us a little bit about your volunteer work. It sounds like you've been involved with some local cancer programs.


Jennifer Rachal
Yeah, so I guess it was a year or so after the diagnosis I got involved with ah can care and it's local here in Houston however, they they match volunteers I mean um. Clients up with everybody you know around the states but I got introduced to can care my first day of diagnosis. Um, there was someone in my oncologist's office.


Jennifer Rachal
That was there. She was a two time breast cancer survivor again 30 years older than me. Um, or 20 years older than me maybe and but she had been through it twice once in her 40 s um and then once ten years later but it really helped just to have that person like you know while I was in tears and a basket case at least tell me you can get through this you know there, there's options in treatment and all of that so that was big I mean I think. You know my husband will even tell you like once she left the room I was better. Um, just talking to someone like that. So it was a big thing for me on day one because day one was really hard and.


Jennifer Rachal
So after that you know I I kept in contact with her also another one another volunteer with the program and I was like I want to do that so I went and got trained and in my head I think even I talked to Dr Sherman about this I wasn't quite sure I was. Necessarily ready at the time but I did it? Um I felt like it was time and I went through the training and you know since then I've had probably 20 clients. Um that we provide emotional 1 on one support for them.


Dr.Rhonda Sherman
Who.


Jennifer Rachal
Um, so they get matched up based on what they're what they're wanting. So if they want someone similar age similar diagnosis. Um, you know kids treatment surgeries all that stuff. Um, they'll match them up as close as they can. So I've had. Pleasure of having many clients and talking through them from all over not just Houston and it has been very very rewarding. Um, again, most of the time even after the initial phone call that we have is thank you so much and these conversations. Usually are hour hour and a hal hour hour and a hal hour um and it's just a lot of listening a lot of listening a lot of tears. You know, just meeting them where they are in their journey and helping just again, just emotionally, it's not like I can provide any you know. Counseling I can't provide any medical advice or anything like that. But it's just to listen and they all say like I said before the same thing. It's so nice to talk to someone who's been through this and then I tell them my story and complications and they're like whoa. You know that's. That's big. Um I don't want to scare them. But I'm like look things can happen you know and you'll still be fine. You know you still hopefully conquer that and move on. But.


Jennifer Rachal
So I've been doing a lot of that my. My husband also was trained as a caregiver um volunteer and he now sits on their board. So we're very involved with the organization. Um, just giving back because I felt like you know I came through this pretty good. Um, and. Want to help others and like Dr Sherman said I ah do feel like I'm a better person. Ah since everything has happened and I know it's hard hard to say and hard to believe but it really is true I I look at things differently and. Think about things differently and some of the things I think about I wouldn't have thought about before so just changes your whole perspective of life. Um, so I want to just share that with others.


Dr.Rhonda Sherman
Well said well said.


Dr. Colin Goodwin
Yeah I Really like how ah you're able to share just how you've been able to change your thought process and and get to a place of acceptance of you know things kind of happening that you don't want happen and that things will come up and.


Dr. Colin Goodwin
And that you've been able to work on some coping skills and and and find ways to give back by then participating in the peer-to-peer support and um, you know and then also being a member of that group therapy. Um that you recommended and and kind of ah. Had a maybe part of that brainild with Dr Sherman right yeah just strong armed into existence I like it.


Dr.Rhonda Sherman
Oh no, she she pushed I think she must passed asked and yeah about I know 3 4 even 5 times over months and months oh do it do it. You know she really encouraged me to do.


Dr.Rhonda Sherman
Her and for others. So yeah I probably wouldn't have done it if she didn't ask about 4 or 5 times.


Jennifer Rachal
Yeah I just thought it was it would be really good like I said I think most people um, look for support groups and I've even heard that you know they go to these support groups and it's just a larger audience not as intimate. You don't feel like you can share maybe because it's just a larger group. You don't want to out speak somebody or over them or it's just a different setting and with Dr Sherman there as a facilitator. It was really nice too because she kept us. On track and maybe brought up things or questions that we wouldn't have asked if it was just us alone. So I think that was huge, um, definitely like that idea Dr Sherman out know if you've done it since then but it's. Would be interested honestly to do it years later like in the survivorship portion in the in those struggles too because I think those are big I mean I don't talk to anyone right now about that except Dr Sherman and my husband it's not.


Jennifer Rachal
Not something that you know it's a topic of everyday conversation. So I think that would be great too.


Dr.Rhonda Sherman
Yeah, so the you know we don't want to leave a negative bent on support groups because I think support groups can be very helpful I think the difference between what we did as a group group therapy in my office. They're anywhere from 3 to 5 women I guess um is very different than at least the support groups here in Houston the breast cancer support groups that I've attended or were guest speakers is just that they would. Ah, have people come together of course have food and and be together. Um, but they were mostly educational and they would bring in speakers on various topics related to cancer breast cancer bone health or. Ah, exercise or they'd bring an oncologist talk about the latest treatments and they were more educational but supportive. Um, they weren't necessarily focused on or geared towards or eliciting feelings. Ah my experience has been and.


Jennifer Rachal
Or her.


Dr.Rhonda Sherman
There are let's say breast cancer patients and survivors who want to gather together with other breast cancer patients and spouses sometimes and you know eat and talk and start forming relationships and then. Listen to an educational speaker and they may not be ready and vulnerable enough or comfortable enough sharing kind of like what you said the group we had was a group So Therapy group Psychotherapy where the goal was. To address the psychological and emotional and other you know psychosocial spiritual issues. Um ah and work on and like addressing them to improve on on those issues. So. You know you and I think a lot of the other women in that group not all of them though. But most of them because they've already been in therapy with me were ready and comfortable to work in that manner and then the support groups are there for women who want to gather together. With other breast cancer patients as survivors and socialize a little bit and then have a speaker at where it works for them to.


Dr. Colin Goodwin
So I just wanted to thank both of you for being open and willing to having this conversation with you.It's ah, always humbling to be able to then hear both of your the perspective and just the amount of ah.


Dr. Colin Goodwin
Passion you have for then talking about this topic.


Dr.Rhonda Sherman
Well's my pleasure I Hope this is you know, helpful to other people and the listeners I Really do so it was pleasure to be here.


Jennifer Rachal
Same year. Thank you.