Courtney Collen (Host): Hello, welcome to our podcast series ‘Beyond the Diagnosis’, focusing on embracing life after cancer, through Sanford Health survivorship programs. I’m your host, Courtney Collen with Sanford Health News. We’re so glad you’re here. Once a patient hears those words, “you have cancer”, that patient becomes a survivor. Through my conversations with health providers on topics related to survivorship, we’re learning more about how Sanford continues its commitment to help people live their best life beyond the diagnosis.
Today, we’re talking about stress management and supporting that path to healing.
I have two guests – both are integrative care educators who spend a lot of their time with individuals who have been diagnosed with cancer. Andrea Paradis in Fargo, North Dakota and Terry Bentler in Bemidji, Minnesota. Thank you both so much for being here, welcome!
Terri Bentler: Hello.
Andrea Paradis: Thank you.
Host: Before we dive into our topic, Andrea, I’ll start with you. What does an integrative care educator do?
Andrea Paradis: Well you kind of said it. What I do, how I summarize it for people is, I help them with stress management and we do that in non-medicinal ways. You know, we’re not giving out medications or things like that, but offering mind body techniques to help with the stress reduction that stress that can come along with a diagnosis of cancer. And we do that in a lot of different ways.
Host: Terry, I’ll ask you this. What is integrative care when we talk about a non-medicinal approach?
Terri Bentler: Integrative care is focusing on the whole person. So, we’re really good at medicine and treating physical ailments and focusing on what problem you may have physically and treating that. But sometimes it’s more difficult to look at that person more broadly. That’s what integrative care does. It reminds us that we are all mind, body and spirit, and all of those parts of us are integral to our health and wellbeing.
Host: Now getting into our topic of stress management. As humans, we all feel stress at one point or another, but when we talk about cancer survivors, how does stress impact a patient, an individual who has been diagnosed with cancer? Tell me about some of the challenges that they might face once they’re diagnosed.
Andrea Paradis: Well, I hear the most often from people, what they are stressed about is the unknown, right? They’re given this diagnosis. And when you hear that, you don’t have all of the information right away. Oftentimes anyway, you hear that it’s there. We got to do some treatment. We got to figure out what that treatment is going to be. So in that in-between time waiting for the surgery or waiting for chemo or radiation to start, that unknown this it’s a reminder that there’s not a lot of control. There’s really no control in this situation. You’re being told this thing that you never wanted to hear. You never chose to hear it, but you heard it. And then the, well, ‘what do we do next’ is where at least the starting off point of where stress starts off for a lot of people.
Host: And Terry, why is it so important to pay attention to how we’re feeling after a cancer diagnosis?
Terri Bentler: Oh, because our bodies are so amazing. There are actually physiological components that happen when we feel stressed. There’s hormones that go through our body. And they’re great when we have something that’s maybe causing danger in the very near future. But when we have prolonged stress over time and those hormones are activated, they can have a more detrimental effect on our wellness. And so learning some tools to help keep those hormone levels down and to have a better sense of health and control is going to be good for us in the long run.
Andrea Paradis: Stress management really does assist the immune system which is so important as you’re going through treatment for cancer. It’s important for all of us to have healthy immune systems, but when you’re going through treatment and after treatment, as you are healing, having that healthy boosted immune system is so important and spending time and relaxation, having low amounts of stress, can really help that immune functioning.
Host: That leads us into the integrative essentials class. Talk about the approach that your team takes to manage stress in this area.
Andrea Paradis: Yes, Integrative Essentials pre-treatment is a program for spending some time and relaxation, some stress management tools that people can take home with them. You know, it’s great to be able to come see myself and see Terry, but, you know, we can’t be at home with you. So these tools – one big part being a relaxation audio practice – it just gives the body the mind that time and relaxation. It works with some healing imagery, which is helpful going through this process as well. And it can help with a lot of different things, having this intentional time and relaxation, having intentional imagery that you work with. For example, for surgery, doing practices, using tools like this before the surgery can help with pain management can get you out of the hospital faster, can again, boost your immune functioning. So it’s just really helpful all around.
Host: Now, at what point does this class become part of the conversation?
Andrea Paradis: Ideally, we are working with people with this program before their treatment begins. So they have all those tools at their disposal as they go through those beginning stages. Before the surgery, before the chemo or radiation. Now that doesn’t always happen. Sometimes, I sometimes get called in to talk to somebody who is halfway through their chemotherapy and I suggest that program. It’s no problem if we take them through that program, when they’re halfway through their treatment, chemo or radiation, and they can just use those tools from there on out. And I’ve heard from a lot of people like, ‘Oh, I’m really glad I got these at-home tools. They were really helpful for the stress, the anxiety, those worries that I was experiencing’.
Terri Bentler: I would add that it’s not just for the patient, there’s a caregiver piece as well. And that caregiver piece, I’ve used myself, because we’re all a caregiver in some fashion or form. It’s short, 15-20 minutes and so beneficial to coming back to a calm mind and relaxing the body and giving yourself support.
Host: Yeah. So what can someone expect if they are new to this program? If they are first time coming into this class, walk me through the process.
Andrea Paradis: It’s a one-time class about four 45 minutes to an hour where we sit down and we go through the program. We talk about the three steps of the program, listening to a relaxation practice, having people thinking of you the day of your treatment, whatever that may be, and preparing some intentional messages either for your surgical team to read to you as you go under anesthesia or intentional messages that you can say to yourself when, or if, you need it. So we go through the steps. We talk about the importance of reducing stress. We talk about why you might want to do that as you go through treatment. Then, we help people personalize these three steps because these healing images are working with imagining yourself in a healing place, imagining that your treatment goes well so on and so forth. So what we do is help people create that personal image for themselves that they can then use when they listened to the relaxation track.
Terri Bentler: That is very much a supportive part of the program and effective.
Host: Aside from lowered stress at the end of the class, what other benefits or outcomes do these cancer patients, these cancer survivors see from this experience?
Terri Bentler: There’s many benefits, actually. When your body is more relaxed and you don’t have that feeling of stress and worry and bit of frantic-ness. Andrea mentioned that it can boost your immune function and that’s so important for all of us. It also helps the experience of pain and may decrease pain, recovery faster. It lowers your blood pressure. I actually use a deep breathing technique when I’m in to see my physician to hopefully make my blood pressure a little less. It improves sleep. And they are just simple tools that can be very beneficial that you can use any time throughout the day.
Host: What are you hearing from these individuals after they go through a class like this… after they go through this program?
Andrea Paradis: Well, I’ve been working with this program for a while now and have heard a lot of great feedback about it. People will come in skeptical sometimes and part of the time that we spend together, when we’re helping everybody personalize the audio practice and the intentional messages, we actually take them through the relaxation practice. And 100% of the time, I can say that pretty confidently, they come out and they say, ‘wow, that was really relaxing’. You know, sometimes they’re kind of surprised that it works. So, we get a lot of, ‘well, I didn’t think that would actually help me, but it, really did help me’. A while ago. I heard a comment from someone who said that she had gone through a lot of different surgeries in the past and never had a program like this. She went through the program, had the surgery and she said it was an experience like she’s never had before that she was so calm. She said, ‘I’m so used to surgeries. Usually I am calm going into surgeries, but there was this new sense of peace. And I felt really supported by the surgical team when they read the intentional messages’. And so it really does change the experience
Terri Bentler: And what a gift to be able to give patients some sense of control at a time when they feel like there’s nothing they can do. They’re kind of a victim in this whole process. When in fact we need their help to give them the best treatment possible and get the best outcome possible. It’s in their power to participate.
Host: I was just going to ask, Andrea, what is it like to know that you get such a great response and that the work you’re doing and Terry as well, the work you’re doing is really changing someone’s I would, you know, trajectory or, you know, what’s that like for both of you?
Terri Bentler: It’s wonderful.
Andrea Paradis: Oh, that’s a big question. Yeah. When you are working with these tools, you know, a lot of times I get some people who have worked with things like relaxation practices, but not not many. When you see people just saying, well, what have I got to lose? I might as well try this and then really get benefit from it. It is, you know, it is that ability to be an active participant in this entire process where you don’t have control, but you can make choices and learning that you can make those choices as you go through this. And then watching people choose to spend time and relaxation in order to be as compassionate and nurturing toward themselves as they go through this process is really rewarding.
Terri Bentler: In medical care right now, this is a little different avenue and it’s so needed and so appreciated. It’s just so rewarding to be able to offer it.
Host: How would you encourage somebody to really embrace this opportunity? What would you tell them?
Terri Bentler: In Bemidji talking with their medical oncologists, radiation, oncologists, any of our support, people from the registered dietician, counselor, social worker, nurse navigators, and nurses, any of those people can get the ball rolling so that someone can participate.
Andrea Paradis: Here in Fargo, it’s very similar. Having mentioning that you’re interested in integrative care or this integrative essentials program, mentioning that to your nurse navigator, your physician, any of the nurses in radiation or an infusion, you know. Saying, ‘hey, I’m interested in that integrative care thing’. Your name will get across our desks and we’ll give you a call or they’ll hook us up in, some way. So asking someone at the clinic is a good first step.
Terri Bentler: When people are diagnosed with cancer, their whole future life story sort of disintegrates right in front of them. They just don’t know what to think, what to do, how to be anymore. This sort of a program and the whole integrative care philosophy, I guess, is to help them become a partner in their own care, to get that control back and also become more knowledgeable about what to expect in the future. It shows that we care about them and we respect them and we want them along as partners in their own care.
Andrea Paradis: What I would add to that is I talked to people and some people will say, ‘yeah, I’m going through this thing, but I’m not really stressed’. And, you know, sometimes when you’re in the middle of that, getting a cancer diagnosis and going through treatment, your body goes in and out of that fight or flight. I would argue that you’re a little more tapped into that fight or flight… what we would call like the part of the nervous system where you’re “revved up”. And being in that for a long period of time. Number one, sometimes when you’re just trying to put one foot in front of the other, you don’t realize that you are in that fight or flight. And number two, if you’re not feeling stressed, what a wonderful opportunity to learn tools that you can use, if stress does come up. I just love what Terry said earlier, and it’s, so I think it’s worth it to say it again, is that you are an entire person. You’re not just your body, you’re your mind, your emotions, your spirit as well. And all parts of you are going through this experience. And so what Terry and I do – and the other integrative educators – we are there to support those other parts of you as you go through this process.
Host: Wonderful. Everyone kind of handles their stress differently. Do you see that in the individuals that you work with?
Terri Bentler: Absolutely. But, but that’s, what’s so nice about these tools is they’ll still work. You know, there’s, there’s always something out there that’s going to work and going to support you.
Host: Now, I know integrative care is a new approach to a lot of people. So if they have questions, what should they do?
Andrea Paradis: Some of these techniques, we’ve been talking about these relaxation, audio tracks, and the, the other things offered in integrative care, like energy work and yoga, meditation, Roma therapy, hypnotherapy, different things like that. It is really new to people. Some people haven’t tried any of that at all. Oh, I can’t forget massage as well. Some people haven’t tried those. And so, like I said before, they’re a little skeptical or they don’t even know how it could help them. I would really encourage people to give myself or Terry or any of the integrative care educators a call just to have a conversation of how these modalities may assist you as you go through treatment. And then to just give it a try, because what can it hurt? It really can’t hurt much. So, just give it a try and see if it’s something for you and you may decide, ‘oh, well that one modality isn’t for me, I’m going to try this one’. And we’ll help you find your best stress management technique for you.
Terri Bentler: Yeah. And even the simple, simple task of taking a few deep breaths, you don’t even realize how shallowly you are breathing and that when you take a full, deep breath and slowly let it exhale, it feels so good. So you have that with you all day long every day, and it’s a simple, effective technique.
Host: Anything else that you want our listeners to know?
Andrea Paradis: Our services are free. These services are free services as you are going through treatment. So there’s no need to worry about paying for them or even, you know, putting them through insurance. It’s all free. Our positions are philanthropy and grant funded. So there’s no need to worry about paying for them. And free is great. So why not come in and try it.
Terri Bentler: When you’ve worked with someone through the relaxation process and they’ve found it beneficial. And they’re reaching over into their purses or their wallet and you say, ‘no, this is because we want this available to you. This is, this is part of your care’. There’s a little amazed and that’s fun to see.
Host: Well, this has been wonderful. Andrea Paradis in Fargo and Terry Bentler in Bemidji, both integrative care educators. Thanks to both of you for being here. This was another episode of our cancer survivorship series Beyond the Diagnosis. I’m your host, Courtney Collen. Stay well. We’ll see you soon.