Summer 2011 Issue

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Summer afternoon – summer afternoon; to me those have always been the two most beautiful words in the English language. – Henry James

There’s nothing quite as exhilarating as a Pacific Northwest summer. Clear, blue skies and temperatures that never seem terribly unpleasant make it easy to find an excuse to be outside. This issue of Life to the Fullest includes simple tips for protecting your skin while you are out in the sun – especially if you are drawn to the water, like so many Northwest residents.

We have also included an article by Dr. John Wynn about the importance of continuing to find meaning and purpose in your life. If you are looking for a respite from your home or work activities, check out the list of classes scheduled for this summer and fall – there’s something for everyone.

We hope you find this newsletter helpful and that you will consider sharing it with your family and friends.

Table of Contents

Download the .pdf version of Life to the Fullest Summer 2011

Sun, Fun and UV Safety

sunAfter a very wet and rather dreary spring, the sun has finally come out to play in the Northwest – just in time to help us celebrate UV Safety Month. During the month of July, health-care professionals nationwide are encouraging us to protect our skin – and our kids’ skin – from the damaging effects of the sun.

Although this is important information for everyone, it is particularly important to cancer survivors who may have areas of skin that are overly sensitive to the sun as a result of chemotherapy or radiation therapy. These sensitivities may be temporary or long term, so it is important to consult with your medical and/or radiation oncologists for specific recommendations about sun exposure.

The Yin and Yang of Sun Exposure

Just because you aren’t a fair skinned, blue- or green-eyed blonde or red head, doesn’t mean you can’t get skin cancer. Anyone can get skin cancer.

Sunburn, especially in children, is associated with a greater risk of skin cancer. Isn’t it ironic, therefore, that we produce 80 percent of our required vitamin D (an important anticancer agent and builder of strong bones) from exposure to the sun?

Tips for Sun Seekers

You don’t need to be a hermit – shades drawn and never going outside – to protect yourself from the sun. You just need to be smart.

  1. Stay out of the sun between 10 a.m. and 4 p.m.
  2. Use sunscreen with SPF 15 or higher.
  3. Cover up with long sleeves and pants, and a wide-brimmed hat.
  4. Wear sunglasses to protect your eyes and the skin around your eyes from UV rays.
  5. Check your skin.
  6. Remember – you are exposed to UV rays even on a cloudy day.

Learn more about skin cancer from the National Cancer Institute.

Meaning and Purpose

by John D. Wynn, M.D.

Joanne has been in chemotherapy for the last four months and will begin radiation soon. She still has some pain from her surgery, but she is feeling optimistic that her treatments are going to work. In the course of her treatments she finds that she sees her life in a new way — the people she has known for years, the work she has done, the choices she has made.

Cancer patients and their families often find themselves asking new questions, such as: “What makes a day worthwhile?” and “What do you find most satisfying?” In other words, what gives meaning and purpose to your life?

Our lives need a balance of work and love. We need meaningful activity that is in some way fulfilling. We also need to feel connected to others, or at least one other person, in a way that feels affirming and warm.

You might say that we seek balance in what we do and with whom we do it. An inability to work or love is a terrible fate. It is precisely what is often most frightening for people with life-threatening illnesses. We fear being cut off from the people we care about and who care about us. We also fear being incapacitated, with monotonous days of nothing to do, talk or care about.

This fear is most acute early on, when we first start to think about how our lives can be changed by illness. Cancer diagnosis and treatment threaten our livelihood, our family relations and our ability to be in charge of our own lives. All of the doctor visits, tests, treatments and side effects can take the wind out of our sails. Sometimes we wonder: Why bother? What’s the point? Why not just cash in my chips?

This kind of thinking comes from the fear that life holds no meaning or purpose. Each disruption is a threat to how we make meaning and how we find purpose in our lives.

Meaning is something we construct. One person sees a pile of wood, while another sees the bridge or house to be built. One person sees a rock pile, another a future cathedral. If I show you a rope, do you see a noose or a lifeline? Does a mischievous child look like a future delinquent or a clever inventor? Meaning is where we find it, and how we create it. The meanings you create say a lot about who you are and how you bring value to your life and the lives of others.

Purpose refers to what we do and how we feel about it. Once I’ve decided that pile of wood is meant to be a bridge, I feel a sense of purpose as I dive into the work. “Diving in” may mean grabbing a hammer, or lobbying City Hall to do the work. Either way, if I have decided that this really matters, my sense of purpose drives me to care and to do something about it.

At the Swedish Cancer Institute we find that the feeling that one’s life is on the line often makes us think about things more explicitly. The meanings and purposes of our everyday lives suddenly demand to be made clear.

Carlos and his brother Miguel had not spoken for years. Miguel had been disrespectful. Carlos had shut him out, saying, “I have no use for such a brother.” Carlos then learned that Miguel was diagnosed with prostate cancer – and that changed things. The disrespect was not forgotten; rather, it was put in perspective because la sangre es mas gruesa que el agua. (Blood is thicker than water.)

This makes immediate sense. The push to find new meanings, new purpose comes from how we think about our mortality. For most of our lives we act as if we are going to live forever. This habit starts in childhood when it is easiest to believe, and can extend well into late adult life. But when cancer appears, this fantasy disappears in an instant. Once we accept that life is finite, things are put in perspective. Buried in Carlos’s angry words we can see an “until” or “unless” or “for a while” that quickly surfaced once mortality was on the scene. For Joanne this was just as real, just as dramatic. Mortality rearranges our priorities, our meanings and our purpose.

During the Great Depression, the song Life is Just a Bowl of Cherries1 reminded that,

The sweet things in life
To you were just loaned;
So how can you lose
What you've never owned?

This is a plea for new meanings. The sweet things you have prized so highly and thought were yours to keep forever were just loaned to you for the brief span of your life. So, how can you lose — and why would you get so attached to — what you’ve never owned? The answer to that question is also in the song:

You work,
You save,
You worry so…

Of course! We invest our time and energies and lose sight of the ultimate truth, that

… you can't take your dough
When you go, go, go.

Joanne and Carlos felt changes in their close relationships when cancer put things in perspective. What is most important in your life – your work? your loves? What is most meaningful to you and why? What meanings are changing as you become more aware of your mortality? Will the answers to these questions change how you spend your time and energy?

When is the best time to think about this? Today.

1 Lyrics by Lew Brown, music by Ray Henderson (1931)

Editor’s Note: The patient names in this article are fictitious and do not represent any current or past patient of the Swedish Cancer Institute.

About the Author

johnWynnnewsletterDr. John Wynn received a bachelor’s degree in philosophy from Yale University and his medical degree from the University of Illinois College of Medicine. He is board certified in psychiatry and internal medicine, and is medical director for psycho-oncology (cancer psychiatry) at the Swedish Cancer Institute, where he cares for patients and families and develops support and educational programs for our physicians, nurses and social workers. Additionally, he is clinical professor of psychiatry at the University of Washington School of Medicine.

Dr. Wynn is widely recognized as a leader in the care and education of physicians, and is a resource to organizations promoting the well-being of physicians, including the American College of Physicians, the Institute of Medicine, and the Washington Physicians Health Program. In 2005 the American Psychiatric Association honored him as a Master Clinical Educator.

A Personal Survivorship Goal Becomes a Treatment Roadmap

Breast cancer — for many women those are two of the most feared words in the English language. For Amy, knowing her grandmother had died of untreated breast cancer meant the disease was part of her history, but it never weighed heavily on her mind. She routinely scheduled annual mammograms and periodically performed breast self-exams. Every year she was rewarded with reassuring results from her doctor and went on with her busy life as a music producer.

This year was different. Her routine mammogram triggered a four-month, high-speed medical journey. Just two weeks after her screening mammogram, Amy was sitting in a medical office at Swedish Cherry Hill listening to a doctor tell her she needed a biopsy. The lump, which was detected on the mammogram and confirmed by an ultrasound, was very small — so small that even the well-trained, sensitive fingers of several physicians could not detect it.

All Amy remembers of the call she received the day after her biopsy was hearing the word “unfortunately.” The remainder of the conversation was a blur as she was already wondering, “What do I do next?”

Choosing the Best Option for Her Survivorship

Throughout the next several months, Amy had one guiding principle. She was determined her surgery and post-surgical treatment would be the most effective and the least invasive. Along the way, she asked each of her physicians to embrace that principle.

“The goal with any breast cancer surgery is to balance what is medically appropriate with the patient’s desire to conserve her breast,” said Amy’s surgeon at Swedish Medical Center. “In Amy’s case, the size of the cancer relative to the size of her breast, as well as its location and Amy’s overall medical history, worked to her benefit. I was able to remove the cancer and obtain clear margins without leaving a significant cavity that would contribute to a visually deformed breast.”

Discovering a Genetic Predisposition

Sortly after her surgery, genetic testing provided Amy much more information about her familial risk factors. Growing up, she had known very little about her father’s mother who had died of breast cancer. The genetic test results provided proof that Amy was positive for the BRCA1 gene, a gene mutation that significantly increases a woman’s risk of breast cancer. The BRCA1 and BRCA2 genes are commonly found in women of Ashkanazic Jewish heritage, such as Amy and her grandmother. Because her grandmother only had male offspring, awareness of abnormal BRCA1 and BRCA2 genes skipped a generation.

The next step in Amy’s medical journey was to meet with Sandra Vermeulen, M.D., a radiation oncologist at Swedish and executive director of the Swedish Radiosurgery Center. Vermeulen discussed conventional radiation therapy options, as well as newer options that would be in keeping with Amy’s most-effective, least-intrusive guiding principle.

cyberknifeBecause CyberKnife is a relatively new treatment option for breast cancer, Vermeulen offered to write a letter to Amy’s insurance company advocating for the use of this radiation therapy technology. Within two days she had received approval. About a month after a second surgery to clean up the margins and place gold fiducials (a requirement for some types of radiation therapy), Amy was ready to begin her five days of CyberKnife treatment.

“I am so grateful CyberKnife was available and that Dr. Vermeulen was willing to make me one of the first beneficiaries of this new technology,” says Amy. “I had none of the side effects of regular radiation. No super-sensitive skin. No burning. My heart rate and blood pressure were super low. I never felt tired. And, I still have all of my really thick hair.”

Although Amy’s medical journey has not ended, she retains a positive outlook. Her ongoing treatment includes intravenous Vitamin C and Herceptin, a relatively new drug that targets cells in early-stage HER2 tumors. As she takes each step, she is reminded of the value of researching treatments and finding doctors who will work closely with you and listen to your goals for living beyond cancer.

Editor’s Note: The patient’s name has been changed to protect her privacy.

Knitters Unite for Life!

You are invited to join a group of volunteers who have turned knitting into a healing experience and a way to enhance the lives of cancer patients, and their families and caregivers, during treatment and recovery. On Monday evenings, from 6 to 8 p.m., the knitters gather at the hospital lobby Starbucks at Swedish Cherry Hill (500 17th Ave., Seattle). On Tuesday afternoons, from 1 to 3 p.m., they meet in the first-floor lobby of the Swedish Cancer Institute at Swedish First Hill (1221 Madison St., Seattle). The group offers a supportive environment for beginning and experienced knitters. There is no cost and no registration, and all supplies (needles, yarn and patterns) are provided.

Expressing Your Hopes and Fears Through Art

Art therapy is different from art classes in that the focus is on the creative process, rather than the art product. One-on-one, confidential sessions are held with an art therapist who offers a variety of art materials and encourages you to find your own meaning in your art. Art experience or confidence is not required.

Art therapy is available to Swedish cancer patients, and their family members or caregivers at no cost. Family members and caregivers may come with the patient or separately.

For more information or to schedule an art therapy session, please call 206-215-6178.

Learning and Sharing Throughout the Summer and Fall

The Swedish Cancer Institute’s Education Center doesn’t take a break during the summer months. It continues to offer a wealth of educational and support opportunities. Do you need a break from your day-to-day demands? An emotional boost by visiting with others who have experienced cancer and are making a similar transition to survivorship? Or, do you know someone who may benefit from attending one of these classes? The Swedish Cancer Institute makes its classes available to all cancer patients, and their families and caregivers regardless of where they receive their care. There is no cost, but registration is required.

For more information, or to register for a class, go to or call 206-386-2502.

After Breast Cancer: What’s Next?

Wednesdays, Sept. 28-Nov. 16, 4:30-6 p.m.
(eight-week class)
Swedish First Hill, Arnold Building
1221 Madison St., Seattle, WA 98104
Clearwater Conference Room C
Join Jacci Thompson-Dodd, M.A., MSSS, and a group for women who are preparing to live their life after breast cancer treatment. The class uses discussions, self-assessment, journaling, and the development of vision maps and survivorship plans.

After Cancer Treatment: What’s Next?

Thursdays, Sept. 29-Nov. 17, 4:30-6 p.m.
(eight-week class)
Swedish First Hill, Arnold Building
1221 Madison St., Seattle, WA 98204
Clearwater Conference Room C
You’ve completed your cancer treatment. Now what? Jacci Thompson-Dodd, M.A., MSSS, facilitates this class, which includes patients who have completed treatment for all types of cancer.

Card Making Workshop

Monday, Nov. 14, 10 a.m.-noon
Swedish First Hill, Arnold Building
1221 Madison St., Seattle, WA 98204
Donald A. Tesh, M.D., Conference Rooms A and B
Get ready for winter with art instructor Tiffany Thiele who shows how to make festive cards. Experiment with stamps, inks and embossing techniques. All materials provided.

Fall Foliage Printmaking

Monday, Sept. 19, 10 a.m.-noon
Swedish First Hill, Arnold Building
1221 Madison St., Seattle, WA 98204
Donald A. Tesh, M.D., Conference Rooms A and B
Use fall’s gift of beautiful leaves to learn how to use plant material to make spectacular prints. All materials provided.

Gentle Yoga

Thursday, July 21-Aug. 25, 3:30-4:30 p.m.
(seven sessions)
Swedish First Hill, Arnold Building
1221 Madison St., Seattle, WA 98104
Donald A. Tesh, M.D., Conference Rooms A and B
Registered yoga teacher Ann Ford invites you to bring a mat and blanket, and create balance in your body, breath, and mind.

Jewelry Workshop

Monday, Nov. 7, 10 a.m.-noon
Swedish First Hill, Arnold Building
1221 Madison St., Seattle, WA 98104
Donald A. Tesh, M.D., Conference Rooms A and B
It's easy and fun to make your own jewelry. Art instructor, Tiffany Thiele, helps each person design and create their own necklace or bracelet. All materials are provided.

Life After Treatment

Wednesdays, Aug. 3, 10 and 1, 6-7:30 p.m.
(three sessions)
Swedish First Hill, Arnold Building
1221 Madison St., Seattle, WA 98104
Donald A. Tesh, M.D., Conference Rooms A and B
Join health educator Carol Robl to explore opportunities for personal growth and new challenges following cancer treatment.

Seven Level’s of Healing

Tuesday, Oct. 11, 6-7:30 p.m.
Swedish First Hill, Arnold Building
1221 Madison St., Seattle, WA 98104
Donald A. Tesh, M.D., Conference Rooms A and B

The Anticancer Lifestyle

The same class is offered three times at three different locations.

Wednesday, July 27, 7-8:30 p.m.
Sammamish Library
825 228th Ave. S.E., Sammamish, WA

Wednesday, Sept. 21, 7-8:30 p.m.
Swedish Issaquah
751 N.E. Blakely Dr., Issaquah
Medical-Office Building, Rooms 2022 and 2023

Tuesday, Nov. 29, 6-7:30 p.m.
Swedish First Hill
1221 Madison St., Arnold Building
Donald A. Tesh, M.D., Conference Rooms A and B

Health educator Carol Robl helps you explore recent findings on ways to increase your resistance to cancer and to create an anti-cancer lifestyle by eating beneficial foods, protecting yourself from environmental threats, and enhancing your physical and emotional well-being.

Watercolor Painting

Monday, Sept. 12, 10 a.m.-noon
Swedish First Hill, Arnold Building
1221 Madison St., Seattle, WA 98104
Donald A. Tesh, M.D., Conference Rooms A and B
Join art instructor Tiffany Thiele to learn fun and surprising watercolor techniques. All levels – beginning to advanced – are welcome. Materials provided.

Oral and Head & Neck Cancer Support

SPOHNCSupport for People with Oral and Head and Neck Cancer, Inc. (SPOHNC), hosts monthly meetings to offer information, support and encouragement to oral and head and neck cancer patients in all phases of treatment and beyond. Family members and friends are also invited to participate.

The SPOHNC group meets the third Thursday of each month from 6-7:30 p.m. in the 1 East Conference Room at Swedish First Hill, 747 Broadway in Seattle.

SPOHNC is a patient-directed, self-help organization that was founded by an oral cancer survivor. It is a non-profit organization dedicated to meeting the emotional, physical and humanistic needs of patients and their caregivers.

For information, please contact Joanne Fenn at 206-215-1770 or, or contact Susan Vetto at

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