BEYOND CANCER

Cancer is a condition which touches us all. 

There are few people who have not had a loved one diagnosed with cancer. 

Many have had an encounter with the disease itself.

This page is for those whose lives have been touched by any type of cancer. 

May it be a place where you find understanding, hope, meaning, inspiration,

courage, and love during the journey of cancer. 

You are not alone. Together, may we find ways to see cancer as a new beginning. 

From my heart to yours, 

Namaste. 

Dr Oshi

Understanding the cause of a problem helps us resolve it. We make observations, then analyse them through the paradigms of existing theory and potential for discovery. It is a constant evolution where nature knows the objective truth, and we continually explore her dynamic grand design.  When united in harmony, healing occurs.

As knowledge accumulates, humans gather expertise. Clustering of knowledge has been necessary to allow humans to master the detail of a complex universe. We created science, technology, medicine, art, music, law, politics; the list is endless. Our ability to advance each frontier is dependent on our tools of measurement, attention to detail when collecting data, skills of analysis, reasoning, interpretation, communication, and willingness to adapt our world view. Our ability to comprehend what is not measurable at a given time is equally important.

In healthcare, when exploring the cause of disease, we often hear the phrase nature vs. nurture, seed-soil theory. Let us examine these familiar words with cancer in mind. 

Cancer is not one disease. It is many diseases that share a common thread; the life cycle of a normal cell has been hi-jacked. The human body has a sophisticated cohesive protocol and surveillance mechanisms to ensure synchronisation between its many parts. This process takes place while we are busy living our lives. However, there can be interruptions to this process.  Cancer is a classic example.

Let us begin with nature. One might inherit a genetic constellation that is more vulnerable to failures in the accuracy of the cell cycle (e.g., high-risk gene carrier). One may be exposed to something in the environment e.g., harmful levels of radiation during Chernobyl, excessive sunlight, cigarette smoke that results in cell damage, and genetic mutation. One may be infected with a virus or bacteria that is associated with some types of cancer e.g., Epstein Barr Virus, Helicobacter Pylori, and Schistosomiasis. Depending on the type of cancer, there might be things we can change to improve outcomes. A patient and their families could explore these with their cancer specialist. It is important to remember sometimes there can be no obvious cause. 

Concerning cancer, nurture can exert more subtle influences that can be unrecognised. I want to explore two aspects with you; beliefs and resilience. Beliefs are personal and defined by experience. Life on earth provides a myriad of different moments. Being aware of how life shaped your beliefs and articulating them to your cancer team allows them to respond in the most supportive way. I have patients ask me if they may say a quick prayer before I perform their scan. I have patients say, “I only want the hard facts doc – I don’t believe in mumbo jumbo.” I adapt to their needs easing the stress of the situation. Nurture also influences resilience. Cancer is a stress test in every sense of the word. Creating a nurturing environment to deal with diagnosis, treatment, and survival supports the cancer journey. Being self-aware of one’s beliefs allows the patient to integrate treatment decisions in a way that will cause the least amount of stress. e.g., one may live in a culture where the physical changes associated with the removal of the breast or bladder are less acceptable. Surgeons have responded to such challenges by developing techniques that allow them to recreate the removed organ using a combination of prosthetics, and other parts of the human body. A nurturing environment will enable you to explore your priorities with the treatments available to you. Reducing stress in these ways allows your immune system to be at its best. 

The seed-soil theory is fascinating; the seed is the cancer cell; the soil represents the environment around it.  For cancer researchers the evolution of technology has been a gift. We can now visualise and characterise details never seen before. We can see how cells behave, how they grow, how they respond, and how they move. As these stunning images are shown in scientific meetings and shared with the public across multiple platforms, it redefines our understanding of cancer. We are learning that even within one cancer type in one patient; there are many different clones of cancer cells. This phenomenon is described using the term heterogeneity of cancer. We are starting to learn that by taking a sample and characterising disease, we only get a glimpse into part of its nature. We are noticing that the genome of a cell is intricately linked to its environment. Research in pre-clinical facilities are providing us with clues suggesting environments that are more acidic, nutrient-deprived, and lack oxygen drive a more aggressive cancer phenotype. And that modulating these environmental factors may change the biology of the cancer cell. 

Dear reader, this is exciting as the latest discoveries support the scientific basis of holistic medicine. As modern science unravels phenomenal details, and older world rested in understanding that both humans and their environment were one. There was no separation. Today we have the opportunity to integrate the wisdom of the ancient with the detail of the modern age. 

Exploring the concepts of nature, nurture, and the seed-soil theory teaches us something important. Different forms of medicine are not mutually exclusive options. All types of medicine aim to assist the body in healing. e.g., removing some of the disease (surgery), trying to control the rapidly dividing cells (chemotherapy/radiotherapy), boost the immune system (immunotherapy), provide the micronutrients to restore cellular function (nutritional therapy), and align energy and reduce stress (energy medicine.) One has the privilege today to take the best options and create a personal treatment plan. The plan is a shared responsibility between you and those who provide care for you. 

We are in it together.

Today as citizens of our planet, we face a global pandemic. Its size and scale have challenged our existence, and the way we once lived our lives. As we find ourselves on unfamiliar territory, survival is a common goal that unites us all. It is often at times of extreme that human resilience has a chance to reveal the magnificence of its design. The wisdom, knowledge, flexibility, and understanding we embrace will empower the transition across unknown territory. 

Let us begin with understanding this disease through the lens of a doctor in allopathic medicine. A virus is a package of genetic material enveloped in a protein and lipid coating. It is not a living organism. However, it can enter a human cell and use the machinery of the cell to replicate, cause disease, and spread via droplets that can be exhaled, sneezed, or coughed. Allopathic medicine studies a virus by analysing its genetic material, giving it a name, and a name to the disease it causes. It observes the way the virus spreads e.g., droplet infection. It analyses the incubation time i.e., the time from exposure to the time of symptoms. It tracks the presence of infection and the severity of the disease. In the case of infection with the coronavirus, this can be variable. Some humans infected will show no symptoms. There is then a range from mild coughs, sore throats, body aches, fatigue to fever, difficulty breathing, and death. Doctors on the frontline are trying to figure out how best to control the replication of the virus and provide supportive therapies to assist the human body overcome the viral infection. It will then look to see if there is an element of immunity that remains among those exposed to the virus.

Strategies to minimise spread, accurate tests to facilitate diagnosis, modulating the immune response, and therapeutic regimes to improve outcome are pursued. Public health measures limiting the spread of the virus have become critical in managing the strain on health care resources, as every nation has its limits. The virus and the disease are of national importance in every country as it requires the co-operation of everyone to achieve a balance between the resources available and caring for the people who need it. We all have a role to play. 

The scope of a pandemic as significant as COVID 19 has extended its power well beyond the health care sector. Nations had to close borders, universities and businesses shut down, social distancing and self-isolation became necessary, bars and clubs which once added colour to the cultural landscape remain eerily closed. Vital services are kept open to allow provision of essential human needs; while people adapt to a new norm of staying home. There is a sense of wondering what next? As the reset button is pressed on the pace of modern life, a stage for a cornucopia of human emotion has been created. There is no place to hide.

We all search for strategies to cope. In this search, there is a question that lingers. It is an uncomfortable question, one we may want to ignore. However, ignoring it doesn't make it go away. In its purest form - it has no blame or fear attached. That question is, Why? 

To explore a meaningful answer to this question, I'd like to look through the eyes of a healer; one who has an inheritance of generations of holistic wisdom. Ancestors who understood reality in a multidimensional way. The complete human is more than their body; we have a physical, emotional, psychological, and spiritual formation that is interconnected. 

All disease has its roots in dis-ease. All dis-ease is due to an underlying loss of alignment. The resulting symptoms are proportional to the degree of imbalance in the system. Now, what does a world pandemic of an epic scale represent? 

As our populations grew, social, economic, political systems evolved in the quest to create an organised society. To a great extent, we had both free will and free choice. What did humanity create? Is it a world that reflects the best of human nature? Or is there a call for change?

On a deep level, if we sit long enough in the presence of the vastness, stillness, and wisdom of the Earth, the significance of these times may be understood. Even in isolation, there can be a distraction. There is no shortage of the endless number of digital programmes that can be streamed to the couch. For those who have the discipline; to create a structure to their day, nurture relationships with love, show kindness to those in need, clean their homes, and reflect, the answers will be many. The world we once knew no longer exists. There is an opportunity presented to create a better one. There is also an opportunity to perish. This time of reset is a rare gift. We have the freedom to blend in the creativity and inspiration that is born of necessity. This journey is a venture into the unknown. It requires courage to sit with uncertainty and embrace the present. 

Dear reader, this is where you have a strength you may not even recognise. You are here because your lives have been touched by cancer. Mortality has knocked on your door before. You have grappled with the unknown and have survived it. You understand that disease does not define you. It is something that you learn to live with. Cancer was the condition that built a bridge to a new place. You already have this courage in your system, and at times like this, you can draw on it to assist in creating a better world for everyone. The resilience needed to live with COVID 19 is no different. 

Approach these times with the same principles you once used. First and foremost – no one should be alone. We must care for one another. We must be discerning, study, and educate ourselves about the new disease and conditions which unites us all. Discoveries will be made almost on a daily basis. Learn and adapt to survive. Be involved and engaged. Source your information with wisdom. Look for the early signs of illness. Seek medical help early. Build your immune systems with an exemplary diet, exercise, good sleep, and rest. Minimise stress. Practice simple holistic measures such as frequent warm drinks, steam inhalation, and saltwater gargling. Take supplements such as vitamin C, and Vitamin D. Invest in natural immune boosters. Wash your hands often and moisturise one's skin well with good quality essential oils. Find energy practices (e.g., meditation, yoga, taichi, qi gong) which resonate with your soul and commit to a daily routine.  Allow this time to be one of profound transformation. 

We all have a journey to make. Let us make it together, creating a bridge to a world we can all be proud of.  

Life requires us to make choices. How we make a choice is multifactorial and multidimensional. Our level of knowledge, reasoning, experience, emotions, beliefs, and intuition guide us. Understanding the implications of choice, is a powerful foundation to make a good one. Being aware, accepting, and adapting to the consequences of choice facilitates peaceful living. Investigating the benefit vs. risk is critical to this process. 

The goal of cancer care in allopathic medicine is personalised precision medicine. A doctor will analyse your symptoms (e.g., pain, weight loss, fatigue), signs (e.g., lump, skin changes), test results (e.g., tumour markers, blood count, pathology, imaging, genetics), and make a diagnosis. They will define the type of cancer, stage, and grade the disease. The grade is a measure of aggressiveness. The stage is a measure of the spread of the disease. Establishing the stage and grade requires biopsies and imaging tests. A biopsy will provide a tissue sample of cancer, which can be analysed under the microscope and imaging tests will help understand the size, spread, and relationship of disease to other vital parts of your anatomy. Depending on the cancer type, there maybe be different prognostic classifications, which are considered. (e.g., in Breast Cancer; molecular profile.)

Your cancer specialist will strive to create a management plan based on scientific evidence and your personal needs. There are national and international guidelines that summarise the best evidence available. These inform the doctor which treatment pathway might be best for you. There will then be a multidisciplinary team that will care for you till the end of treatment and surveillance. 

Sometimes there is a treatment pathway that has more benefit to the patient than another. At other times there may be less clarity in overall survival. In both situations, it is imperative to discuss options with your cancer specialist and explore in detail the risks and benefits of each choice. Take a trusted friend or family member with you so that the information provided is heard by someone who can support you. 

When the diagnosis of cancer is made, it has an impact on one’s life and their loved ones. Patients respond and cope differently. As both patient and multidisciplinary teams embark on the journey of cancer, there should be a shared responsibility that is based on openness, respect, and trust. Every test, every treatment has benefits and risks. Clear communication gives time for a patient and their loved ones to adjust to the outcomes they might have to cope with. This journey is made most comfortable by creating a team that can understand the needs of your physical, mental, emotional, and spiritual body. Yes, every patient must have their crew.

In traditions of ancient medicine such as Ayurveda, diagnosis is made by focusing on the imbalance of the system and analysing the altered physiology (e.g., heart rate, sleep pattern,) and energy flow of the body. The treatments focus on restoring that balance. Many different disciplines that have evolved over the years. This wisdom, which has assimilated over centuries, has something to contribute too. The evolving specialty of integrative medicine highlights the potential of a personalised care plan which adds the best of every system.

Navigating the landscape of information available today can be daunting. A useful place to begin is to give yourself quiet time to adapt to the new reality and challenge. Create a routine that carves out time in silence and stillness where you create space to contain the new problem which has entered your life. Organise the information that is provided to you by everyone. Investigate the reasons and evidence behind those recommendations. Understand that there are many levels of evidence. Look closer at the translation of applicability to you as an individual. Seek the counsel of those you trust. 

Where possible, take action from a place and calm consideration. Be patient and kind to yourself, as this is not always possible. Sometimes decisions will need to be made in a whirlpool of emotions, and you may wish an outcome was different. In moments like this come back to the present moment. Breathe deeply and cultivate a simple series of techniques which will help you realign and make sense of everything that happened. Realign after the storm and realise it too is part of the process. 

Most importantly, remember that you are still you, a human who has already survived many years in a complex world. While the journey of cancer will provide a plethora of choice points, you have a method of navigating the world, making choices that worked. Perhaps you mapped things on paper, made a spreadsheet, wrote in a journal, created to-do lists, meditated, listened to your intuition…. don’t forget these. They are your tools. While you may acquire new tools and update some old ones, using them effectively with a good heart and head will help you make the best choice for you.

The world health organisation describes screening as the use of simple tests across a healthy population to identify individuals who have a disease but do not yet have symptoms. Examples of screening include mammography for breast cancer, faecal occult blood tests for colon cancer screening, and pap smears for cervical cancer screening. Several factors need assessing to set up a screening program. These include the biology of the disease and the availability of a suitable test that can detect changes associated with the disease. The accuracy of the test and limitations of the test. How common is the disease? How serious is the condition? Can the condition be treated? Most importantly, does early detection reduce the mortality and morbidity associated with the disease? Last but not least, the cost vs. benefit is considered. Screening programs should be carefully monitored to ensure that they meet quality standards, and the public receives excellent and safe screening services.

In more recent times, the benefits of screening have been a matter of public debate raising concerns of both over-treatment and under-diagnosis. It is essential to understand the science, the myth, and appreciate the unknowns when making an informed choice. It is also important to look beyond the surface to recognise some aspects of the spectrum between wellness and illness. Screening strategies are developed to saved lives. To reap the benefit having a sound understanding of disease at a physical, emotional, and spiritual level is important. It also raises the questions of choice, risk, and being able to navigate the pre-cancerous changes seen in cells. Screening in allopathic medicine detects a physical change; a range of tests can be performed at institutions with a license to complete them. In holistic medical traditions, screening is performed by the individual or a practitioner. Imbalances or blockages of the energy flow within the body can be detected via many disciplines of holistic medicine. Treatments will include energy practices, nutrition, lifestyle changes, and natural remedies to return the body to health. 

Screening opens up many questions. At its core is intention. Do we screen for disease because we value life or fear disease? Understanding our intent is important because it contextualises the next steps that follow a screening test in two different paradigms. The second factor which influences the paradigm is the understanding of what cancer is and isn’t. 

Let us explore a screening program that flows forth from valuing life, and understanding cancer first. In this paradigm, the human body is your greatest gift. You care for it with good nutrition, sleep, energy practices to support emotional and physical well-being. You have routine check-ups with your family physician and engage in the screening  programs available in your country. You understand the connection between mind, body, and soul and how these interact to create a state of health or illness in your body. When you engage with screening, you understand that you are going to have a simple test that will give you a result, one which requires further tests to establish whether or not you have cancer or you require no further action till the next screening round. You understand that each cell in the human body has a life cycle and a mechanism that keeps that cell in coherence with other cells in the body. You know that there are surveillance mechanisms in the body that keeps this process in check. You know that for the harmony and flow of your body to be optimal, the number of stressors experienced must be balanced with rejuvenation. You appreciate that life is not always an organised spreadsheet and that you must respond and adapt to environmental change, balancing the needs of your physical, emotional, psychological, and spiritual body. You know that when a cell is under stress, it will have a breakdown of its natural life cycle, and there is a spectrum of change between a perfectly healthy cell and the most aggressive form of cancer.

When you engage with screening: if you have a routine recall screening outcome, you rejoice in the result. You are also aware that no test is perfect. You know that screening does not prevent cancer. It provides an opportunity to detect cancer early and hence potentially have treatments that have fewer side effects and improve survival. Therefore, between screening rounds, you keep a good check on your-self (e.g., self-examination). You don’t fear cancer. You know it is a disease like many others. You are well informed about the condition you are being screened for, and you are self-aware in your ability to live with risk. Hence, if you did have subtle changes that may one day be cancerous – you know the level of risk you are happy to live with. You understand that the health care providers will provide you with the best science available. However, in this spectrum of health to illness, there are many unknowns, and you have considered the thresholds at which you could lead a happy life. You discuss all options with your health care providers and make your-self a personalised plan that makes you feel empowered. You understand that screening could be a positive choice; you engage in screening to improve your life. 

Now let us look at the combination of a screening program that flows from a spring of fear and not understanding cancer. With this root, the invitation to screen creates anxiety. What if you have cancer?  Cancer is a dreaded condition when people die. You must detect it early to try to save your life. You lose sleep before the test, and until the result arrives, your life is on hold. A routine recall result is a relief. An outcome of recall is the bombshell that dropped in on your regular day. You anxiously await the date of the assessment and then will undergo a series of further tests. The process is nerve-wracking because, at times, it takes several tests to know if disease exists and establish the precise extent and type of cancer you have. Now if you are in this group of people the dreaded C has entered your life and changed it forever. Supposing you had some changes that were not cancer yet but may progress to cancer, what should you do? Should you take a watch and wait for approach? Should you have, the abnormality removed. The strategies for risk reduction are confusing to you. This adds another layer of stress. What is best? You are trying to make decisions in the heat of the moment. Stress and common sense are not mixing well. Cancer is finding its way into every chapter of your life. Cancer is changing everything.  

When you read these two paradigms, which are two opposite ends of the spectrum, how does it make you feel? Where would you like to be?

Supposing the fear paradigm is closer to where you are right now would you like to change that? Would you like to move towards the reality described with the valuing life/understanding cancer paradigm? It is possible to change. You could use this moment to start learning about health and illness and gradually drift towards a reality where engaging with screening comes from a place of ease, flow, and empowerment. A small amount of anxiety is natural and may always exist but it need not consume you. 

To create the reality where screening flows from valuing life, we as a community of health care providers and the public have choices to make; responsibilities to educate, communicate and create a paradigm that promotes wellness of our society. Screening can be an excellent tool to increase well-being. Like all choices in life, it has pros and cons. We must understand these and continually improve our efforts to improve the tools we use to screen. There is always an opportunity to do it better. Education, understanding, good quality research, honesty, openness, and good communication allow the creation of programs that will enrich human life. We live during times of extra ordinary change, perhaps this is a time to learn more, understand, find ways to improve, and integrate screening into our lives in a complete/holistic way. 

Preparation is a vital ingredient of success. Knowing how to prepare provides a patient with a framework to approach their cancer journey from a position of empowerment. There are three main routes to see a cancer specialist. The first two occur when you notice something wrong; visit your GP/family doctor who refers you to a cancer specialist, or you access a cancer specialist directly based on the health care system. The third is when you engage in screening, and the screening program detects an abnormality that is potentially cancerous. 

Knowledge about what to expect, cultivating a positive outlook, and creating a method to organise all the information that needs communicating between you and your health care providers is a good start. Let us explore the first two routes. You noticed something different. What changed? Is it a lump? Weight loss? Fatigue? A change in your bowel habit? Bleeding? The list is long. When you notice the difference, carve out 30 minutes in your day with a journal and reflect on when this change may have first occurred and what other more subtle changes may have occurred, which you may have dismissed. Seek medical help early. Do not fear engaging with health care providers; we are here to make your life easier. Educate yourself about health and well-being so that you are aware of the changes that take place in your body early. Early detection can save lives. Keeping a daily journal will increase self-awareness and help you seek help. 

Before your appointment, organise your-self with a paper or electronic organiser. I found having both useful. I used to have two key sheets. One a list of all the things my family member had noticed. The second a list of questions that we had collected. As I attended appointments with family, my doctor’s appointment bag contained these two sheets, a note pad to write things down, bottles of water, healthy snacks, relaxing music, ear-phones, and inspiring reading material. I realised that the time in waiting rooms in hospital was stressful. And everything we wanted to ask could be forgotten in a blink in the face of information provided to us. 

The time of diagnosis and investigation is often the most nerve-wracking as it takes a series of tests to curate the best possible treatment plan. Often it is helpful to have a series of questions to understand your disease. Please see my checklist of questions for your cancer specialist. The human mind can play many tricks with us. The first question is often “Am I going to die?” The answer to this question from Eastern philosophy can be liberating. It is a resounding, yes. All who are born will die one day. The focus is on living well; live with any condition that comes our way, including cancer. 

All forms of medicine have evolved. The days when cancer was a fast track to the graveyard is most often not real. There is much that we can do, and a focused mind gives you the best chance of making the journey to a new place, which may be better than where you were before. While specialists will schedule a range of appointments and biopsies to stage and grade your cancer, use the time to adjust to the new reality. Educate yourself about the cancer type you might have. As you have each test, a mindset of the glass being half full is infinitely easier than half empty. As each test result comes through, ask for copies, and keep them in your cancer journey folder. The speed at which this process occurs will depend on the complexity of your disease and the healthcare system. A tip I give my patients to keep the condition in perspective is to stand in front of the mirror and note how big they are. Then take a ruler and look at the maximum size of their cancer. It helps you realise that a more significant proportion of your body is functioning well. There is a part of it with disease that needs attention. Patients have found this simple technique helpful in creating a perspective where cancer becomes a chapter in their life rather than consume it. Once you have a diagnosis, I encourage you to read about your disease from web sites that provide useful information (I include a list I would use in the comments section.)

During this time, look for ways to support your healing journey. Look for proper nutrition, self-care practices, and energy practices that will assist you during this time. I include a list of resources I found helpful during my journey in the comments section of this post. Consciously create a new routine that will help you during this time of diagnosis and treatment; adapt it accordingly. There are some key components that I found beneficial. I include these, too, in the comments section. Check out the comment – my supportive routines. Note how I have set times for tasks. I encourage you to do the same. It helps avoid pitfalls of missing appointments, bingeing on cancer info online, and stress.

When deciding on a treatment plan, thoroughly investigate the risks and benefits of each choice and how it will affect your life. Choose what is right for you as you embark on treatment and adapt to your new realities. Create a cancer team that includes your medical team, holistic practitioners, cancer support charities, friends, and family. I understand that at times it may feel more comfortable to shelter those you love from the truth of what you are experiencing. However, in my experience, bridging the gap between that feeling and engaging loved ones has been supportive in ways sometimes patients least expect. I also learned that cancer could open up the pandoras boxes of people’s emotional lives. It is not always pretty. However, staying true to your-self will connect you with new people even if those you expected to be there may disappoint you or walk away. Use every resource available to you. It is not selfish to look after yourself now. One day after you thrive, you will stand and support others again. It is also important to remember that you are still you. There is a new event in your life. It is not your life. In the comments section, I list the charities I am aware of; some have helped me personally. 

One of the most poignant moments I had was the time I shifted away from wanting certainty and cure. I realised that cancer specialists, including myself, could only provide a range of probabilities based on the best science available to us. As we continually make discoveries and refine our models of predicting outcomes, the accuracy improves. However, it cannot definitively state which group an individual patient will belong to. I started helping my family, loved ones, and patients approach cancer as a condition which is treated. I shifted our focus to build resilience and knowledge to make the best choices. The priority became living. How well can we live together? 

One of the things I found most challenging was that I could not step away from cancer in modern society. In urban neighbourhoods every 10-20 minutes, there will be a poster or advertisement that reminds us of a war or fight against cancer. This constant reminder lead to my second shift in attitude. If cancer was a cell that lost its way, waging war on it and fighting with it didn’t make sense. If I injured my arm or leg, I would not go to war with my broken bone or fight with it – I would aim to fix and restore it. I would engage the best of all disciplines to help me recover. I started to approach cancer in the same way. To be at peace with it vs. resist it. Given my profession, cancer touches my life every day, the lives of family, and patients. Could we together find a way to live well, allowing cancer to be cared for and nurtured back to health with the integrative wisdom and expertise across disciplines? 

Let us try.