22 Jun 2012

Ethical Will

Ethical Wills are not new  - apparently, they have existed verbally for millenia and are even mentioned in the Bible.  I was unaware of the concept however, and find the idea novel and thought-provoking.

An Ethical Will is not a binding, legal document but rather one that is written by you, to your family and friends, as a legacy of what you want them to know and remember about you.  Its contents can be summarized by the following questions (familiar to some as the prologue to meditation):
  1. Who were you?
  2. What did you truly want?
  3. What was your purpose?
An Ethical Will is based on your values, not possessions.  According to the legal society, it is a more treasured inheritance than any material gift.  It may take the form of a letter, a book, a voice recording, a video, favourite music, pictures, crafts - a combination of all of these - in essence, your memoires as you have experienced them.  Many of us have attended "Celebrations of Life" - post funeral gatherings - where family members have amassed some of the foregoing and leave its interpretation to the viewer.  An Ethical Will is you, writing about your life, your view of how you want to be remembered - your "bequeathed comments" made to specific individuals.

Why do it?  An Ethical Will is an extension of who you are - a form of continuity, perpetuity.  It explains.  It gives you the ability to say things you may have left unsaid.  It's introspective and passes on your hopes and wishes for others.  In a sense, it's a way of controlling your outcome.

http://www.survivorship.org/ lists some topics you may want to consider:
  • What would I not want left unsaid if I died tomorrow
  • My definition of true success
  • The lessons I've learned in life
  • Why I love you and why I will miss you
  • What I appreciate the most
  • What I've learned from mistakes
  • What I've learned from other members of my family/friends
  • What spirituality means to me
  • My happiest/saddest/funniest moments
  • My wishes for you/my husband/my children etc.
I'm not sure that this is the appropriate forum for bringing up old grudges or complaints - but who knows?  Maybe it is - you certainly will have the last word!  That is, until Aunt So-and-So dies, her Ethical Will is read and she denies everything! 

Preparation of an Ethical Will is a soul-searching process - it's a special inventory of your aspirations, hopes, principles - your life's work.  Open a file - add to it when you think of something that says "you".  Keep this information in the same safe place as your other legal documents.  Here's a free template: http://www.ethicalwill.com/

18 Jun 2012

Weighing In

We've all felt the shock (and fear) of seeing an extremely emaciated person at the cancer treatment centre.  With ovarian cancer, there are many reasons for severe weight loss including complications from surgery, intestinal blockage, ascites, disease encroachment, chemotherapy side effects, pain and depression.  Our tabs on Advanced Disease and Advanced Disease Dietary Help give an in depth description of the more notable causes.

Putting on weight during illness is as daunting as dieting and is equally frustrating for the patient and their families.  A "healthy" appetite is viewed as just that - healthy. Oncologists have reported that some of the most stressful times in a patient's journey is when their spouse or loved ones interpret their lack of appetite as giving up - an unwillingness to live. 

Whether you're being weaned off TPN or recovering from a bowel obstruction, knowing that you must put weight back on is challenging, a bit scary and requires diligent work.  Not regaining  weight weakens your immune system, puts you at added risk for osteoporosis, causes nutrient deficiencies and will ultimately lead to disease progression. 

Theoretically, one needs to add 500 calories a day in order to gain one pound per week. 32 years ago, when my mother was originally diagnosed with breast cancer, she was told by her doctor to eat everything and anything she wanted.  He told her to choose cream over milk, butter over margarine.  Today, we think we're a little wiser (maybe not!)... remember being taught the difference between good and bad calories?  Also be reminded that cancer thrives in an acidic environment so try to choose the majority of your foods accordingly.  Here's a chart outlining foods which are alkaline and those which are acidic:

Normally, a patient's healthcare provider should guide them as to what form of food is appropriate - i.e. if you're post-bowel blockage or surgery, you would be encouraged to start with juicing and purees rather than raw foods.

Here are some basic suggestions for regaining weight:
  1. Plan and count your calories.  Make every mouthful count.  Livestrong has a neat calorie counter app for either wanting to gain or lose weight.  It will calculate your ideal weight, let you search their library to see the caloric benefit of millions of individual foods and help you track your progress.  http://www.livestrong.com/thedailyplate/  Check out the site before preparing your shopping list.
  2. Start slowly and eat/snack six times a day.  Overwhelming yourself with large meals can be harmful and discouraging.  Additionally, carefully planning scent and taste can make a significant difference in stimulating your appetite.  I remember my own emancipation from the "feed bag" - having been nourished with a completely balanced liquid (TPN) for ten days following surgery - then with the flick of a switch returning to solid foods - was very confusing and more than a bit frightening. 
  3. Add healthy fats such as nut butters, avocado, omega 3 oils.
  4. Make liquid calories count - choose 100% fruit drinks.  Wine is a fruit drink and an appetite stimulant!  Don't be afraid to revert to a food supplement drink in lieu of a snack.  Freeze it in a popsicle container for variety.
  5. Be consistent - keep a journal - write down what you've consumed and add it up each day.
  6. Include exercise...it builds muscle, increases your appetite, helps with chemo fatigue and improves your mood.
  7. Go easy on yourself...leave a little room for a treat!
Educating caregivers is essential in supporting patients with weight loss "whiplashes".  The speed of the decline can be alarming and the recovery can take time.  In cases of very advanced disease, recovery is not always possible - this too, requires special understanding.