Hi Sarah. Hi Kim. You must be Tim? Hi. It's nice to meet you. You too. Sarah, tell me how things been going. Well, they've not been great. The pain nausea just won't go away. It's been rough, we've been trying to manage it as best we can, but it's rough. Emotionally I'm all over the place, socially I can hate everybody right now. Sounds like the last few weeks have been really difficult. Yeah. You want to tell me is there anything specific that's, and making it more difficult? I don't even know, do you have a take on that? I guess it's hard to say. I think initially we were in a fight mode trying to take it all in, make a good plan. Then as we've settled in, I think reality set us and this isn't going away, and we have to wake up each day and deal with it. Honestly, I don't know if I can. It's making you feel that way? I've just fallen down. I'm tired all of the time and I'm still nauseous and even with the meds I'm still in pain. I just don't feel good, and that makes everything else harder to deal with, like I had to stop volunteering at Jessey's school. I know that sounds like a little thing, but it's a really big deal to me, because I just really enjoyed being there. It's one of the things that made me feel normal, because all the normal everyday things like cleaning or going to the store, even picking Jessey out from school it just all feel so epic right now. Even the littlest things just leave her exhausted. Yeah. She's just always so, so tired. It must be so frustrating for you? It is. It's been really hard and not just on me, it's been really hard on you and Jessey too. Going through this treatment can be really rough. People feel like they're losing a part of themselves when they can't do the things that they normally do. That's exactly it. I just feel so sad and so angry that I can't just do things that used to be normal and easy. Am sorry. What if we start today by talking about some of the things that are physically burdensome for you? I think if we get you feeling physically better we can maybe start working on some of the emotional and social things, going through this is a bit like going to a marathon. Controlling some of the physical symptoms, we can work on that, and then maybe we can brainstorm about some ideas to work on the other stuff that are affecting you. Okay. How does that sound? I don't know, it makes sense. True, sure You mentioned you're feeling really tired? Yeah, I'm tired all the time. The pain and the nausea I can almost wrap my head in there, I get where that comes from and it comes and goes, but the fatigue, it's just pervasive. All the time? Yeah. Do you think you'd be open to some strategies about ways to deal with the fatigue? Yes, please. Okay. Yeah One thing that works for a lot of people is scheduling rest breaks throughout the day. I know you've mentioned that you want to work, or you enjoy working at your son's school and you've been able to. Maybe if you're able to schedule some rest time before going to a school, and then scheduling some rest time after going to the school. That might be something where you might be able to fit in some time to do a meaningful activity like that. Yeah. That can be tricky but it makes sense, so you know what? I could work on that. We could try that? Yeah. Another thought is finding ways to conserve energy. Sitting maybe instead of standing to do things, or you can consider delegating tasks. Maybe Tim, or Jessey could help out with some of the tasks that you normally do. Sure we can definitely help. Okay. Well, people at church keep asking what they can do to help. Yeah. You're not alone in this, so utilize those people, your family, and friends. I know. Spend your time and focus your energy on doing things that you enjoy. If you can make at least one meaningful activity a day, it makes things and the days go by a little bit less frustrating. That make sense to me, we can talk some more about that. You also mentioned the nausea, do you want to talk a little bit about your stomach? Yeah. It comes and goes, but it's definitely still a big issue. I'm taking a Zofran, but the Compazine really messed me up, I think only two that like once. Okay. Yeah. Well, I can talk to Dr. Ramachandran about the Compazine and thinking about some other alternative medications that might be effective and the Compazine if you're interested. I don't know, I'd really rather not take any more new medications right now since I'm on so many. How about some simple strategies that might work for nausea. Is okay? What about thinking about eating what you want to eat when you want to eat it? It sounds good. Well, are you eating? She's not eating much. It's really important that we somehow get you the nutrients you need to have the energy to do the things you want to do. I'm thinking maybe it might be helpful to meet with one of our dietitians. Okay. They're really good at coming up with strategies to give you the most nutrients that you can. Even sometimes in the smallest amount of food if taking in volume of food can be difficult and that's really normal. The other thought that comes to mind is, maybe they can come up with some ideas to help curb some of the nausea, some foods that might be milder, a little bit easier to ingest. That would be helpful. How about constipation, are you taking the center? Yes, and that's been helping. Great. Because constipation is something that can decrease your appetite and can increase nausea. Right. I'm glad we have that under control. Yeah. Anything else? How is everything else? What are you thinking about? Sorry, I just get these waves. I just get scared. Tell me more. I just feel like I go from feeling so optimistic to just so hopeless. Now, my mind and my body just feel so out of sync and so out of control. Filling out of control can strip a lot of anxiety for people? Yeah. What have you been doing? Have you had any strategies that you've used in the past to help with these feelings? Well, prayer, focusing on what I need to do next, focusing on Tim and Jessey and how I can be there for them. Are they working for you now? I don't know. I just feeling like more and more lately I'm just in this other world and it's getting harder and harder to bring myself back. Feeling out of control is something we hear a lot from people. There are some things that we can do to help with that if you're interested. Sure. Medication is one. I know you've said in the past that you didn't really want to have more medication, but that's an option. The other option is things like meditation or relaxation techniques, sometimes that works for some people. Sandy Chan who's our social worker is really experienced at helping to guide people through meditation, or teaching relaxation techniques you can use at home. If that's something you're interested I can always talk to her. Other people seek out support from the counselors or peers, or from their church, or things like that. Do any of those things sound like something you might be interested in? I think I still feel weird about the medication things, especially since I'm already taking so many. I do think we need to tap into our friends at church more. I think I prefer probably just to keep talking with you for now. We can do that. The next time we meet we can talk further about this. If it comes up that you're open to ideas of meditation or relaxation, we can go there when you're ready, but right now we can just continue to have the conversations about ways to help. Okay. Okay? Yeah. Okay. Now, one of the things I wanted to talk with you about was, I know that you had spoken with Dr. Frank about pain, and I wanted to see how that's going and if you've been keeping your pain diary. Oh, no. Sarah, I know that sometimes it can seem like a lot to write it down, but in fact actually it takes one less thing that you have to think about, okay? Yeah. It makes it easier for Tim and for our team to follow your pain, and for you to see where things are for you. To track, am I get more of my pain in the morning, or at night, or things like that. Now, it makes sense. Just a simple notebook. Okay. Is there anything else that we haven't touched on today that the important. I can't think about anything. Let's think about what we've talked about today. What do you think that you'll be able to take home from today that will be helpful for you? Pop quiz. I'm going to try to focus on meaningful activities and get a rest both before and after. I'm going to talk to the dietitian about some ideas for the nausea. Okay. What else? I'll schedule the appointment for you with the dietitian. Like you said the rest before and after, ways of conserving your energy, delegating some tasks, and then we can talk further about this feeling out of control, which I said before is really normal, and ways to cope with that. Okay. Then I'll I'll plan to see you in a couple of weeks. Okay. If anything comes up for either you, or Tim between now and then you have my number, you can always give us a call. Okay. Otherwise, we'll plan to see you in two weeks. Okay, thank you. Okay. It's good to see you. Thank you very much. You are welcome.
