The best kind of fibre for lowering cholesterol is soluble fibre. This kind of fibre becomes a gel-like consistency in the intestines, and it is able to bind with cholesterol and other toxins in our intestines and carry them out of our body. Good sources of soluble fibre include oats, legumes such as kidney beans or chickpeas, rice, barley, apples, strawberries and citrus fruits.

Another benefit of fibre is that it slows the absorption of sugar into our bloodstream when we eat some in our meal. This means that fibre lowers the glycaemic index of a meal. This is good for reducing your risk of Syndrome X or diabetes, both major risk factors for heart disease.

*9/53/5*

Simple breathing exercises in which you learn to breathe deeply and at a controlled rate can help to slow down your mind when your thoughts are racing. You can also incorporate simple physical exercises which help to relax your muscles, especially those in the neck and shoulders where many people carry much of their tension. You can ask your GP or at your hospital for help in learning these techniques. Some hospitals run classes and workshops, for exactly this purpose.

Using essential oils (aromatherapy) can have a pleasurable and calming effect. Oils can be used in the bath or diluted in a ‘carrier’ oil to use in massage (or simply rubbing into your hands or feet, for example) or to burn in an oil burner. Different oils have different properties and can help to promote relaxation – or simply be pleasant to use. Again, some of the nurses on your ward may have had training in the use of essential oils, or be able to recommend sources of information.

Some people use ‘visualization techniques’ – images of quiet or happy places, for example – to help them relax. Shutting your eyes and visualizing yourself in a favourite tranquil spot, imagining how you feel when you are there and allowing the image to take over your thoughts, if only for a minute or two, can have a calming effect.

If you want to practise relaxation techniques, you need to ensure you are in a quiet room without interruptions or excessive background noise. If you feel a little foolish at first, practise when you are alone. Remember that loved ones will be experiencing their own stresses too, and might like to share in practising your relaxation techniques.

For some people, relaxing may have a different meaning, such as the opportunity to watch a favourite TV programme or to listen to music undisturbed. What you do is less important than being aware of what makes you feel more relaxed and perhaps more refreshed afterwards. Achieving a more relaxed state may not directly affect your cancer treatment, but if it helps you to cope better in a calmer frame of mind, if only for a limited time, then it is surely worthwhile.

I had always been pretty sceptical about what I regarded as ‘hippy stuff, although Helen swore by the physical and mental benefits of her yoga classes and the occasional massage. On the whole, I preferred to relax by listening to music, preferably very loudly and often joining in the lyrics myself, to the occasional alarm of our neighbours. I suffered some nerve damage in my hands and feet as a result of my chemotherapy, and Helen persuaded me that massaging them with essential oils might help to release some tension – and that I might just enjoy the sense of being pampered! This became a regular fixture – if my feet or hands were sore (or even if they weren’t), she would rub them as gently or vigorously as felt comfortable while we were watching TV or chatting.

Although it could not directly help the nerve damage, it did help me to relax and she was right about the pampering!

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If you are also feeling physically low, this can make you feel even more helpless. If you have previously worked but are now too ill to do so, or you led an active life with regular commitments which you can no longer fulfil, the sense that your life is out of your control can be cruelly emphasized. It may be that you need help with personal tasks you could manage perfectly easily before, and you fear becoming increasingly dependent on your family or nursing staff for basic necessities. Living with cancer can take considerable adjustment.

How can you maintain some control over your life when you feel that events and other people are taking over? It is hard to accept that you need more help and support than before, especially if you are usually very independent. You can start by trying to become well-informed about your treatment and progress, and you can still take decisions for yourself. Let your family and friends know that your cancer does not mean that you can no longer think for yourself, even if sometimes you can’t muster the enthusiasm even to decide between chips or mashed potatoes! Although there may be times when you feel too ill to be interested in what is happening around you, it is important for you to feel that you are still treated as an individual, and not just a cancer patient.

*46\118\2*

The nature of our society is such that men are encouraged to be physically strong and to shrug off pain, so the acknowledgement of a fear of pain or actual pain is not necessarily an easy matter. Most of us can tolerate some degree of pain for a short time: the pain from toothache or sporting injuries is unpleasant but we generally know that it will be short-lived. Pain resulting from a serious illness is a different matter, partly because of its physical effects and also because of the fear which arises from the inability to control what is happening within your own body. Around a third of people who have cancer suffer no pain at all. For those who do experience some pain, it can generally be controlled extremely effectively.

There are some people for whom a fear of needles (needle phobia) is a source of discouragement from admitting to pain, as they are very much afraid of being subjected to painkilling injections. This is a perfectly valid fear, and one which should be treated sympathetically by medical staff. Furthermore, there are many forms of pain relief which do not require any injections so you should not be afraid to voice your fear to your medical team. In fact, many people manage to overcome their fear.

The degree of pain or discomfort you experience is not necessarily an indicator of how advanced your cancer is. Pain is often not caused by a tumour per se but because, for example, the tumour is pressing on its surrounding tissues or on a nerve. The pain caused by pressure on a nerve may manifest itself in a part of the body quite remote from the tumour site. Pain may also be caused by other factors, such as

infection;

because a tumour is obstructing the normal action of your bowel;

because of a secondary tumour in a bone.

We all have different levels of pain tolerance, and in any case, people with the same type of cancer may not have the same symptoms or experience of pain or discomfort. For this reason, it is very important for you to be able to describe your particular pain to your medical team so that they can treat it in the most effective way possible. As with your other symptoms, it is easy to overstate or understate pain depending on your frame of mind that day, so keeping a written note of the points you want to tell your doctors may help.

Describing pain is not easy especially if it is quite severe and you just want a doctor to make it disappear. There are a number of points that will be helpful to doctors in working out what is causing your pain and therefore in prescribing the most effective form of pain relief:

•    Where do you feel the pain? Does it spread?

What type of pain is it – a continuous dull ache, a brief stabbing pain or a burning sensation, for example?

Do you have the pain all the time or does it come and go? How long does it last? Does it keep you awake or can you sleep through it?

Does anything make the pain worse – eating or drinking, moving around, coughing, lifting or stretching?

Does anything make the pain better – painkillers (what sort?), lying down, keeping still, heat or cold?

Analysing your own pain in terms which help your doctors can be difficult and frustrating at first, especially when you are getting used to communicating with them – there may be times when you just want to shout at them to make it go away. Be assured that they genuinely want to ease your pain, and will do all they can to do so.

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While you are having your treatment, the hospital will take precautions to avoid the possibility of exposing either your visitors or the Staff who are caring for you to radiation. You will probably be nursed in a side room, and lead screens may be placed around your bed to absorb any radiation given out. Nurses and doctors will only spend short periods at a time in your room, and your visitors may be restricted to short visits or asked to talk to you from outside.

These precautions may seem rather severe at a time when you need the support of family and friends more than usual. However, they should only be necessary for a short period, and only while your radioactive implant is in place. You may find it helps to distract yourself as much as possible by watching TV, reading or listening to the radio, for example. This may not be easy when you are worried and feeling under stress, but it is worth persevering as it will help to make your time in hospital pass more quickly.

Some people worry about the continuing risk of radiation after the treatment is over. Once the radioactive implant is removed, all radiation disappears. If your treatment is in the form of a radioactive liquid, then you may have to wait for some days for the radioactivity to lessen before you can leave. You and your belongings will be checked thoroughly to check you are free of radioactivity, and you will be advised of any precautions you should follow when you get home.

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shortness of breath

chronic cough, sometimes with blood in the sputum

chest pain and/or infection

Most lung cancers originate in the air tubes in the lungs, and can be split into two main categories – non-small cell tumours and small cell tumours.

In diagnosing both small cell and non-small cell lung cancer, tests will be performed to establish the extent of any spread. These may involve a combination of blood tests, X-rays and scans, and an examination of the lungs and lymph nodes in the chest by using a thin telescope. This is either inserted via the mouth to look at the lungs (bronchoscope) or via a small incision in the neck (mediastinoscope) under anaesthetic to examine the lymph nodes.

Non-small cell tumours usually grow more slowly although their prognosis is still not good, and often follow a pattern of spreading first to the lymph nodes in the chest and neck, and later to the liver, bone and brain. If the tumour is small and accessible and has not yet spread to the lymph nodes, then surgical removal may be possible. The other most common form of treatment is radiotherapy. Although it is not usually curative, it can help by relieving blockage by the tumour of major airways, and by reducing pain.

Small cell tumours generally spread faster and thus frequently involve multiple parts of the body, even before they are diagnosed. The areas affected tend to be the liver, bone marrow and brain. For this type of tumour, chemotherapy is the most effective form of treatment, to which radiotherapy may be added because if the cancer has already spread then surgically removing the primary tumour in the lung will not have any effect on the secondary tumours.

*10\118\2*

Like many couples these days, Marvin and Caroline had found it difficult just to have enough time for sex, let alone intimacy. They both worked at demanding jobs and often felt exhausted when they came home. Because they were so fatigued, it was difficult to recharge and concentrate just on each other. The sex therapy program, with its homework assignments, required Marvin and Caroline to devote time and energy to their relationship, to each other and to physical intimacy.

After the initial interviews and a discussion of expectations and goals, Marvin and Caroline were ready to begin the sensate focus exercises. The first week they were instructed to caress, touch and enjoy each other, but avoid any genital and breast touching. The exercises progressed week by week until intercourse was allowed. Some couples, like Marvin and Caroline, find that erections occur early in the program. Sex therapy clients are typically instructed not to take advantage of such events, but to continue with the program as instructed. That’ s because the exercises are supposed to teach partners to enjoy each other and to learn what feels good without having intercourse, or the pressure to perform. If such enjoyment can be learned, future occasional bouts of “erectile failure” will not stand in the way of sexual pleasure.

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Begin by remembering the person who attracted you. This is the person you fantasized about. Recall those times when you were closest. Consider that she is still there with you, but doesn’t have a pill that will help to boost and restore her sexual longing. To help her unleash those sleeping passions, you need to reestablish an emotional connection. Your desire for her must be conveyed in the ways that you remember she likes. These, of course, will vary greatly from couple to couple. But you know yourself—and your partner. It’s up to you to go the necessary distance.

Without acknowledging the other person’s wants and needs, sex cannot be the totally encompassing event that you hope it will be. Getting to know someone well does take time—and is worth the effort. A person whose longings and pleasures are recognized is going to be a lot more receptive than one whose libido is dismissed or ignored. Not paying attention is an added stress, which can only serve to harm your relationship.

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The thing to remember is this: habits don’t change overnight. The last thing you need is to feel pressured to follow each and every suggestion at once. That’s why I’ve divided the program into three easy-to-follow sections. Each one has advice on supplements, dietary adjustments, and exercise.

The most important thing to do is start. And once you have started and see how well you feel, my best guess is that you will make the recommendations a lasting part of your life.

*109\183\8*

“But those events are less and less frequent. From my own personal poll, I can tell you that a lot of men out there are having erectile problems. I hear a lot of excuses, from too much drink to fatigue. Those men who decide to go the distance often can’t—and I’m talking a wide age range here, from thirty to sixty-five years old. I sympathize with them, I really do. But all talk and no action is frustrating. I can only imagine that it’s the same for them—and probably a lot worse.”

I agreed with Elizabeth that ED appears in a variety of guises. In all likelihood, the men with whom she had those disappointing interludes were occasionally suffering from some degree of erectile problem but refused to admit it. Although such failures can be normal there could be an underlying ED problem. An additional factor in her case may have been Elizabeth herself, whose aggressive sexual style might have been intimidating to men experiencing even once-in-a-while failures. Performance anxiety could have been an unseen presence in those cases.

But, I informed her, the pills were only prescribed for the patient who used them. Not even a concerned wife would be able to have a prescription written in her name. More importantly, I explained that I prescribe the medication in the context of sexual medicine therapy; the pill is an integral part of a larger therapeutic process. And finally, giving a man a drug without taking a thorough medical history first is not the practice of good medicine.

*80\183\8*