February 2007: Partners, Loved Ones, Caregivers: Taking Care of You

Helping a friend cope with fear, stress?

Question from DonnaA: My friend has a lump on her breast and under her armpit. She went for a needle biopsy one week ago, but she found another lump on her breast. She also has burning and soreness on her breast and armpit. Yesterday she told me she felt weakness in her legs. I don't want her getting stressed out over it. Can you help me with a suggestion to help her cope with it? Plus she is scared of the diagnosis.

Answers —Rosalind Kleban, L.C.S.W.: In this situation where you're suspicious over a diagnosis of cancer, people need to rally around to help the person pursue the diagnosis. The feeling ought to be first: we need information and we can tackle whatever is in front of us. Without the diagnosis or information, things can get out of hand and we're flying in unknown territory without information. If you should get the diagnosis of breast cancer, we'll have a plan, we'll get treatment, and together with a lot of support you can help her get through this.

Marc Silver, author: It's really important that your friend has someone with her at doctor visits. And whether it's a family member or a friend it can make a huge impact having someone along listening with her. And perhaps taking notes of what the doctor says, or tape recording the visit.

Okay to show fear around friend?

Question from BDT: Is it better for the person to know how frightened I am? Or should I hide my fear?

Answer —Rosalind Kleban, L.C.S.W.: At the very beginning, your friend is much too vulnerable to be able to tolerate anyone else's fear. The patient's own fear is too intense and she needs to feel that she has strong people to lean on. You can confirm for her that it's understandable that she is frightened, that most people would be. But together, you'll get through this.

How to put worried mother at ease?

Question from bbaby: My grandmother and two aunts have died of breast cancer. How do I convince my mother I won't die of the same disease? She has had cysts, but no malignant tumors and my only sister has not shown any signs of breast cancer. I was diagnosed at 41.

Answer —Rosalind Kleban, L.C.S.W.: Every breast cancer case is unique and different. Breast cancer is a term that describes many, many different diseases. The knowledge that we have today is vastly improved, very different than in Grandma's day. Success with breast cancer today can be expected and very different than in the old days.

I think what your mother needs is a positive example, somebody who has had breast cancer and has survived for many years. Her own family experience has been a bad experience, but she needs to know that the vast majority of women with breast cancer survive and live long, healthy, normal lives. A good person to think about is Betty Ford. Or Shirley Temple Black. They have lived for 30 or 40 years after a diagnosis of breast cancer. You can also meet people living beyond breast cancer on the discussion boards and in chat rooms here at Breastcancer.org.

Common for husband's feelings to change?

Question from LDurand: My wife and I are having a pretty rough go at things these days. I've gone to doctor's appointments with her and all her chemo treatments, but I haven't been there emotionally for her. She's changed a lot these past months and I feel like a jerk, but I'm not sure I still love her like I used to. Is this common? Is this it for our marriage?

Answers —Marc Silver, author: When someone says they're not there emotionally for their partner that can be really devastating when she's facing a disease like breast cancer. I think it's common for a guy, including me, to feel like a jerk because we don't know how to help our wife. I know some marriages do flounder because of breast cancer, but others grow stronger. I think it's important to ask your wife what she needs from you. It may be a sympathetic ear. It may be a massage. It may be someone she can cry to when she's feeling really bad. And what I found in our marriage is that being by my wife's side throughout her breast cancer ordeal really did bring us closer together.

Rosalind Kleban, L.C.S.W.: It's possible that this is a situation that has arisen because of the lack of communication. It's easy to understand that the patient is feeling different, is not entirely sure her husband will continue to care for her, and is behaving differently than anything he has ever seen. Because of this, he may be unable to be there emotionally, he may feel shut out, and feel that the marriage has changed.

These two people need to begin to talk to each other. To say how they feel, and, as Marc suggested, to ask what they expect of each other. Breast cancer rarely destroys a marriage that was working well before the diagnosis. So whatever coping techniques a couple used before the diagnosis, they have to work hard to maintain now.

Educate family on how to be supportive?

Question from windos: How I can explain to my family the way I am feeling as to the pain, fatigue, and just plain sick? I am cancer-free at this time, but over time have had a melanoma, atypical lobular hyperplasia, a basal cell carcinoma, and a papillary carcinoma. I fear these cancers can be related and my need for support may suffocate my family. I feel they think I just don't want to go out or am being lazy. Perhaps I can show them a site or papers on this topic?

Answer —Rosalind Kleban, L.C.S.W.: The explanation to people around you is that the accumulation of all of these problems have a cumulative debilitating effect on a person's emotions. As much as a family can possibly understand, they're also not equipped to be able to handle the situation and the ongoing problems. In situations like this with ongoing diagnosis, it would probably be helpful for the person to seek a counselor well-grounded in working with cancer patients to help cope with their feelings and very natural fears of the future. With this kind of help, it helps take the burden off your family and perhaps will make it a little easier for them to be supportive.

Healthy recipes for breast cancer recovery?

Question from Breeze: Where can I find great recipes for a friend who just had breast cancer surgery and is now going through chemo? Our church is taking her meals and they have to be low protein foods. I've been online but cannot find organic, low-protein healthy meals.

Answers —Rosalind Kleban, L.C.S.W.: I'm not exactly sure why it's necessary to have low-protein meals. The diet recommended for people undergoing treatments and for life in general is low-fat, high-fiber. Recipes and directions for that are readily available on the Internet. There are many cookbooks available featuring healthy eating for people with cancer. The only one I can remember offhand is written by a cancer survivor named Ruth Spear, but I'm sure the Internet is loaded with appropriate food plans. The important ingredient in how to eat after a cancer diagnosis is low-fat.

Marc Silver, author: I can recommend a couple of web sites: www.cookinglight.com and www.eatingwell.com both have wonderful, low-fat recipes. And also keep in mind that someone on chemotherapy may have very specific cravings, or foods that they don't care for, so ask your friend what her taste buds are like these days.

Editor's Note: For more, see Breastcancer.org's section on Nutrition and Breast Cancer Treatment.

Old friends abandon after diagnosis?

Question from irene4: I am 42 years old and all of my friends of 15-20 years have abandoned me since my diagnosis. I do not have anyone to drive me to/from the hospital to care for me for my upcoming reconstruction surgery. I have no family either. What can I do???

Answers —Rosalind Kleban, L.C.S.W.: I would suggest that one look to a wider audience and perhaps there are other people who have come forward during this time to be helpful. And if old friends have been a disappointment, are there new people in your life that you can count on? It may also be helpful to join a local support group to meet other people struggling with similar issues to see how they solve these problems.

Marc Silver, author: Don't be afraid to ask for help. Sometimes I felt that I could handle things with my wife on my own, but even the two of us needed to ask for help at times. Sometimes people may stay away from you out of fear. If you approach them with a specific request for assistance they may be grateful for the chance to help.

Anger for friend's diagnosis?

Question from colleen: How do I deal with the anger that I am not the one with the diagnosis?

Answers —Marc Silver, author: It's not helpful to feel anger, it doesn't help the person. You just have to put those feelings aside and reach out to them.

Rosalind Kleban, L.C.S.W.: I think the issue here is that patients at the time of diagnosis and during treatment are bombarded with very intense and difficult feelings. This may be very difficult on the caregiver. I think it's a difficult task facing the caregiver to try to be patient and understanding during this difficult time, to demonstrate to the patient that you're there to be supportive and hope that in time as treatment ends that the patient will get greater clarity. Anger is not a helpful feeling, but it's the kind of thing that needs to be worked out with perhaps a professional healthcare provider.

Role of pets in treatment and recovery?

Question from suited: Although my friends and family were wonderful help during my treatment and recovery, much of my emotional support came from our dog and cats (never impatient or judgmental, always ready to make me laugh, or just be there when I needed to cry). Will you talk a bit about the role of pets? Thanks.

Answer —Rosalind Kleban, L.C.S.W.: Much research has been done on the benefits of pet therapy because they provide exactly what you are talking about: unconditional love, acceptance, and care. For that reason, nursing homes, hospitals, and cancer centers have pet therapy programs. There's a pet therapy program at M.D. Anderson Cancer Center, Dana Farber Cancer Center in Boston, and one will begin at some point in the future at Memorial Sloan-Kettering Cancer Center in New York.

Good idea to gather all promising news for sister?

Question from Argus: I've become the official gatherer of facts and information about treatments for my sister, but I hate to get her hopes up every time something promising hits the headlines. How do I filter information so it's helpful, without being too scary or overly optimistic? Or should I filter at all?

Answers —Rosalind Kleban, L.C.S.W.: The first thing to do is to try to get a clear indication of what your sister wants. Does she want all of the information? Does she want you to filter it? Does she only want to hear the optimistic? The only way to know how to handle this is to ask her what she needs.

It is also best, where possible, to rely upon information provided by your healthcare team. It is your physician who will know what is possible for you, what is realistic, and what is in your best interest. You may also want to ask your doctor if he or she believes that it is in your best interest to seek a second opinion at another center. In the best cases, it'll be your physician who will help organize the information that's important for you. Information that is out there on the Internet is too vast and confusing for the average patient and their family.

Marc Silver, author: This is a situation that many husbands face as well. Men sometimes feel it's their job to go online and find the "cure for cancer." I think it's very important to keep Rosalind's guidelines in mind and also to remember that the amount of information one person needs is not the same as the next person. Even if you're married to her.

Help for sister in denial of terminal illness?

Question from sis: My sister is terminally ill with original diagnosis in 2004. She has protected herself with denial, which we understand. However, it is hard on my brothers and sisters, as we must pretend this is not happening, protect her, and be with her 24/7. What to do?

Answer —Rosalind Kleban, L.C.S.W.: You can only be where she is. If you feel that she's dealing with the situation with denial, that's the very best she can do. And it needs to be respected. The job of a loving, caring family is to be there with her, to stand by her, and to do what she feels is necessary.

Frustrated and worried by wife's negativity?

Question from Marco: It's getting harder and harder to be strong for my wife—she's more than halfway done with chemo, but her mood is worse, when I thought it would be getting better. She's not sleeping, she's started "chemopause," etc. I'm worried about her, but I get frustrated by her negativity. What do you recommend?

Answers —Marc Silver, author: My wife was also very negative during the chemo months and unfortunately she did feel worse as the months wore on. But I'm more of an optimist, so I would be thinking "three treatments down, three to go."

What I learned is that she copes by letting all of her negative feelings out, and I had to step back and respect that and let her say what she wanted to say, and not try to force my optimism on her. But deep down inside, I was still counting the days until chemo was over, and that made me feel better.

Rosalind Kleban, L.C.S.W.: For many patients, they begin treatment with energy and optimism. This optimism takes a lot of energy because a diagnosis of cancer induces negative feelings in most people, so a display of optimism takes a tremendous amount of energy. With each treatment the patient's energy is sapped. The effects of chemotherapy are cumulative, so after the fourth or fifth treatment, the patient no longer has the energy for optimism and how they truly feel becomes apparent.

I would take Marc's advice. Take a step back, respect your wife's feelings and never invalidate those feelings regardless of how optimistic you may feel. With treatment over, and your wife regaining her strength, if she was an optimistic person to begin with, she will slowly regain that.

Possible to be too accomodating?

Question from Susana: Is it fine to always say OK to whatever my mother (patient) asks? I feel like she is being too spoiled and nothing makes her happy.

Answers —Rosalind Kleban, L.C.S.W.: My response to a question like this is that most often the time of treatment is time-limited. During this time, the family is no longer a democracy, but a dictatorship. And the patient is in charge. This will end, treatment will end, and things will return to normal. During treatment, the patient has many intense feelings exhibited in many different ways. If the family can be patient and supportive, that is generally the best approach. So, the answer is you need to say yes to your mother unless she's asking for destructive things.

Marc Silver, author: The same goes for husbands. A lot of men have told me that the motto of the breast cancer husband should be "Shut up and listen!"

Help for partner's negative view of self?

Question from jao: My partner uses the word "mutilated" to describe her condition—mastectomy and DIEP reconstruction. Is this something she has to work through at her own pace or is there something I can do?

Answers —Rosalind Kleban, L.C.S.W.: Absolutely she has to work it out at her own pace. The job of the partner is to be patient and supportive. There's no way to tell her that she's wrong or misguided. It's more an emotion than a response to reality. The DIEP (deep inferior epigastric perforator) reconstruction is one of the best available and generally produces excellent results. This person's response to it is intensely individual and internal, and in time will improve.

Marc Silver, author: My wife had bilateral breast cancer and had lumpectomies. She has a dent in one breast as a result. Sometimes she'll ask me, "Do you mind the dent?" And I tell her, "No, not at all." I think when you're going through times like this, the words "I love you" become very important in a marriage.

Scared to lose sister, hard to be upbeat?

Question from Abigail: My identical twin sister is going through treatment for breast cancer. We have been so close for the last almost 44 years that I feel so lost without her when she's really sick after chemo. I am the main caregiver for her two young children. I find it difficult to always be upbeat.

Answer —Rosalind Kleban, L.C.S.W.: It is not necessary to always be upbeat. Your twin sister, whom you love, is going through a very difficult time. It's certainly understandable that you're not upbeat. Being emotionally honest does not mean that you're worried she won't survive, but that you honestly feel badly that she's going through this very difficult period. It's kind of a very narrow road where you can say that you're concerned and upset, and at the same time feel that things will work out well. But nobody needs to pretend that going through it, caring for small children, is easy.

Tips for caregivers to stay positive?

Question from sue: Marc, what tips do you have for caregivers on how to stay healthy, positive, and connected to their own lives while also supporting a family member with breast cancer?

Answer —Marc Silver, author: Boy, that's a question that I struggled with. I'm an avid jogger and bicycler. I wondered if I'd have time to take care of myself when I felt like I had to take care of my wife and family as well. So, you know what I did? I would ask my wife, "Do you mind if I go for a run?" "Do you mind if I take a yoga class?" Usually, she was fine with it, so then I didn't feel guilty and I had some very important time to do the things I like.

And what I learned is that every caregiver needs a break. And it doesn't mean you're falling down on the job. It just gives you time to regroup, and in the end it will make you a more patient and effective caregiver. When I went jogging, I used to feel as if I could run away from breast cancer for a half hour or so. But I always did run back home.

Dealing with husband's breast cancer?

Question from Cath: My husband has breast cancer. He had breast cancer 12 years ago and it recurred 2 1/2 years ago. He has a stint in his kidney, which usually is bleeding. When he feels up to having sex, I am petrified with the blood and his body fluids contaminated with the chemo, as well as other drugs. His body fluids are waste products of his treatments, and I am afraid of being infected.

Answer —Rosalind Kleban, L.C.S.W.: The best way to handle this fear and anxiety is to ask a physician and to be very straightforward. I'm sure this is not an unusual situation, and the doctor will have a clear-cut answer to help allay your anxiety.

Coping with insecurities after treatment?

Question from Cecille: I am a breast cancer victim and a survivor. I have undergone removal of my breasts and chemotherapy. What bothers me most is the feeling of insecurity towards my husband, but I know that he loves me. How can I cope with this?

Answers —Rosalind Kleban, L.C.S.W.: It's not an uncommon feeling to have. It's such a powerful and devastating experience. Many women themselves feel unacceptable and find it hard to believe that people can stand by them, be faithful to them, and love them. The only thing that will help with this fear is time and the caring actions and behavior of your partner. And hopefully with the passage of time you will gain back the security you had prior to the diagnosis. More often than not, the experience of breast cancer brings couples closer together.

Marc Silver, author: I think it's really beneficial to have a change of scene; get away for a weekend or a week's vacation. At home there are reminders of breast cancer everywhere. My wife and I found that even if we went away for one night it helped us reconnect and escape the shadow of this disease. I remember we went away on a vacation after she finished chemo and radiation and at the end of the first day, we realized we hadn't talked about breast cancer the entire day, which hadn't happened to us in six months. So, I'm a big fan of getting away and just having some time together.

Worry about pain during sex, loss of libido?

Question from SeemaP: I am 40 years old and in December 2005 I was diagnosed with breast cancer and I've completed my chemotherapy and radiotherapy. I've lost interest in sex and also the intercourse is very painful for me. Is there anything to worry about?

Answer —Rosalind Kleban, L.C.S.W.: It sounds like the treatment may have created menopausal symptoms. Time helps cure some of these issues. Medication helps. And talking to a health care provider can also help. With time and work hopefully a person's sexual desire and gratification will return to normal.

Editor's Note: For more, see Breastcancer.org's section on Sex and Intimacy.

Remain in new relationship after diagnosis?

Question from SamLA: My girlfriend was just diagnosed. We've only been together about 6 months and I'm not sure if I want to deal with this, or if I even fit into the picture anymore. What do I do?

Answer —Rosalind Kleban, L.C.S.W.: It's a very difficult question. You have to examine how you felt about this relationship before her diagnosis. What it means to you now. Did you think that this has a future? That will help you make a decision. You may want to give some thought to whether your girlfriend is depending upon you for assistance during treatment. An open and honest discussion is probably the only way to come to some conclusion. If this can no longer be a romantic relationship, you may want to think about whether it's possible for you to remain a friend and be helpful during this very difficult time.

Let wife know desire is still there?

Question from pello: My wife and I have always been in sync sexually, but since treatment (for stage IIIa, now on tamoxifen) she barely lets me touch her. I just want to let her know how much I love her and still desire her without being accused of being selfish.

Answers —Rosalind Kleban, L.C.S.W.: Right after treatment, patients are still extremely vulnerable and frightened. Diagnosis of a stage III breast cancer is particularly scary. Treatment may have produced side effects that continue. The role of a partner here is to continually be there, be consistent in your care and attention, and hopefully with time—and it could even be a long time, it could take up to a year or 18 months—you can return to a mutually satisfying sexual life.

Marc Silver, author: I interviewed couples who spoke of similar issues after treatment. And it is very difficult for the man, because his sexual needs are not affected by treatment, obviously. I interviewed a truck driver whose wife found intercourse very painful for some months after treatment. The husband told me "Sometimes you have to be an owner/operator."

Help coping with a loved one's diagnosis?

Question from Darif: How do you not let a diagnosis of cancer rule your life? My mom was diagnosed with metastatic breast cancer in August and since then I feel like my world is falling apart. How do you cope when someone you love so much is sick?

Answer —Rosalind Kleban, L.C.S.W.: A diagnosis of metastatic breast cancer is a crisis in anyone's life. This diagnosis is brand new. Hopefully, with time one will understand that it is not necessarily a death sentence, but a chronic illness. It is best for the patient and for the family to resume as normal a life as possible that is reassuring to both the patient and family. And with time, coping becomes somewhat easier, but never really easy. Cancer will become a big part of everyone's life.

Tips to get kids to go to counseling?

Question from laurie: I have 3 children that will not go to counseling. Any suggestions?

Answers —Rosalind Kleban, L.C.S.W.: This is hard to answer because I'm not sure why you believe that they need counseling. Most children go through the experience without requiring counseling. If children's lives remain relatively stable, they are truly able to weather this crisis. I would only be concerned if there was a large disruption in their ability to cope in school or to get along with friends. If those things are going well, just because there's somebody dealing with cancer does not necessarily mean they need counseling.

Marc Silver, author: From my experience, it's very important to be honest with your kids. You don't have to tell them everything, every little detail, but you shouldn't try to hide that Mom has cancer or isn't feeling well. And the Dad can play an important role. He should be the go-to parent if Mom's not feeling well because of chemo, surgery, or radiation. He should be the one the kids can ask their questions of.

Support becoming an overwhelming burden?

Question from SHEELA: I am a 2-year survivor of breast cancer. I am cared for too much by my partner and loved ones. Being reminded every day to take Arimidex at a fixed time makes me depressed. I can not think I am healthy and happy due to this. What should I do?

Answer —Rosalind Kleban, L.C.S.W.: If the care and support you're getting from your family has become burdensome and depressing, you need to be honest with your family. If they want to help you, and you believe they do, they have to stop treating you differently than they did before. They are not continually to remind you of the experience that is 2 years old. The pill that you take daily should be viewed as a vitamin that's going to help you continue to be the healthy person that you are.

How to help feelings of helplessness?

Question from JR: My wife has just started chemo. What can I expect? She gets sick easily, with different kinds of illness. What can I do to help? I feel so helpless.

Answers —Marc Silver, author: I remember those feelings all too well. I used to feel as if we were waiting for a big storm to hit, but didn't know when it would strike and how severe it would be. I learned to expect the unexpected. Some women bounce back from chemo quickly. Others struggle. As Rosalind noted, the effects are cumulative and the side effects often worsen as the treatments continue.

I remember weekends when my wife was in bed from Friday night after her treatments through Sunday night, and I was running around doing all of the household errands. One thing that helped me was remembering there was an end in sight for chemotherapy treatments. It also helped that friends sent us gifts to make us laugh. Even if my wife wasn't feeling well, it cheered me up. And that helped me cope during those difficult months.

Rosalind Kleban, L.C.S.W.: When you're wondering what you can do to help, the best and simplest thing to do is to ask your wife what she thinks would be helpful.

Marc Silver, author: A friend who recently had gone through breast cancer treatment told me that her husband always had fresh flowers in the house after each chemo infusion. I followed his example and my wife loved seeing those flowers. Although she always wanted to know how much I paid for them. I never told her!

Fear and anguish over mother's cancer?

Question from KarenL: My mom was diagnosed in 2003 and I took care of her while she went for treatment. After nearly 4 years, I still cannot shake the fear and anguish. I still find myself crying over it and feel bad when my son sees me. How can I convince myself that my mom will be okay and go on with my life?

Answer —Rosalind Kleban, L.C.S.W.: This sounds like a situation where it might be helpful to speak to a health care provider. It may also help to know that the bulk of recurrences happen in the first two years. And the longer a person goes from the time of diagnosis, there's a greater expectation that that patient will be well.

Top three tips for caregivers?

Question from Melinda: Marc, what would be your Top Three ways a spouse or other caregiver can help someone get through all that breast cancer involves? And how do you help yourself deal with it?

Answer —Marc Silver, author: Well, I repeat the motto of the breast cancer husband, "Shut up and listen." I think men have a tendency of wanting to rush in and fix things, but this is really a time to take your cue from your wife. And if she's not giving directions, ask for them. And it's important not to be a martyr, to make time for yourself with your wife's permission. I interviewed Cokie Roberts, the journalist who herself had breast cancer. Friends would call her and ask what they could do to help, and she would say, "Play tennis with my husband."

Recommended books/resources for caregivers?

Question from anthracite: Can you recommend any books or other resources for caregivers?

Answers —Rosalind Kleban, L.C.S.W.: There's an excellent book called Breast Cancer Husband, by Marc Silver.

Marc Silver, author: I wish I had had it when my wife had cancer.

Rosalind Kleban, L.C.S.W.: So you can attest to how valuable it is.

Recovery, care-giving time after surgery?

Question from mcgrath: I'm going to have a lumpectomy for DCIS in a couple of weeks. How long (on the average) will it take to heal? How long will my husband have to take care of me?

Answers —Rosalind Kleban, L.C.S.W.: The recovery from this surgery will be very quick and complete. In this situation there is often no concrete job for the caregiver, other than to be loving and supportive.

Marc Silver, author: Don't tell your husband I said this, but if there are any chores that you always wanted him to do, now's the time!

Child overwhelmed with caregiver role?

Question from madison: My mom just had surgery and is going through chemo for her breast cancer. I'm taking care of her and the house and stuff, but between that and school (I'm a senior in high school) I am completely overwhelmed and cry all the time, but my mom has told me that she needs me to be strong for her. How do I get her to understand how hard this is for me?

Answer —Rosalind Kleban, L.C.S.W.: It's perfectly okay for you to let your mom know that you're very concerned and you love her. Perhaps you could find additional help. Are there other relatives, friends or neighbors who could help with some of the chores? Patients often have more support and when they do they feel good about it. During the chemotherapy, there may be many days when Mom feels okay and maybe it would be good for her to see that she's well enough and strong enough to do some light chores on her own.

Tell mom she doesn't need to be "super"?

Question from bratgelina: My mom is still trying to be Super Mom while she's getting treatment and it wears her out. How can I tell her we don't care if the place is Martha Stewart clean, as long as she's okay?

Answer —Rosalind Kleban, L.C.S.W.: During treatment, many patients need to behave like Super Mom. It reassures them that they're well. Most often, they're not doing it for the family, but doing it for themselves. As treatment wears on and accumulates, and they feel more and more fatigued, all of this will stop and they will give the family an opportunity to help. But this is a person who has a strong need to feel well and capable. And it's best that the family does not interfere with this.

Advice for exes that want to help?

Question from LeeCho: My ex was just diagnosed and I'm not sure how to deal with the situation. We've maintained an okay relationship and I want to help any way I can, but I'm not sure if she wants my help. I want to be there for both her and our daughter, who lives with her. Do you have any advice for exes?

Answer —Rosalind Kleban, L.C.S.W.: The answer to this is really quite simple. You need to ask your ex what you can do, what she'll permit you to do, and what will be helpful. That will give you the guidance that you're asking for. You might also want to ask your daughter if she needs anything during this time.

Traveling/working husband feeling guilty?

Question from LeraNY: It is very difficult for me to stay home all the time as my job is very demanding and I need to travel like 50% of the time. How can I deal with my feelings of guilt, knowing my wife is not well and sometimes very depressed? We hired home help but that does not seem to solve all the problems around the house that only I can fix. How do I schedule the priorities?

Answers —Marc Silver, author: Can you ask your boss to adjust your schedule during this time?

Rosalind Kleban, L.C.S.W.: This is a very difficult conflict. An open discussion with your wife that talks about your conflicts, the demands on your time, and your feelings of guilt may help clear the air.

There is something dangerous in believing that there are things around the house that only you can fix. That's much too great a burden for any one person to carry. Are there other friends, neighbors, or relatives who could pitch in during difficult times? You might want to discuss with your wife what you described in your question. Would she be willing to discuss this with her physician? There are also wonderful medications that help people with depression. Dealing with major illness is very difficult and the use of medications is extremely helpful for many people.

It may also be helpful for your wife to meet with other women in her situation and learn how they've coped with the illness. It may also be helpful for you to see if you can find other people to talk to. There's truly no easy answer to this. You need to maintain your work, to pay the bills while you feel you're responsible for your wife. If there's a possibility of maintaining your work with less travel, that may be something you should look in to. But speaking to your wife's physician about more support for you and your wife is something that you ought to consider.

How can a survivor show appreciation?

Question from jnurse7777: What can a breast cancer survivor do for her partner to show appreciation for all the support during multiple surgeries and chemos?

Answers —Marc Silver, author: That's very sweet! Let me buy something that I've always wanted! You know, I didn't want anything from my wife, I was so happy she was back to herself after the months of treatment ended. And sometimes she cuts me a little slack for my bad habits, and I really appreciate that. But I kind of secretly wish she'd get me a bunch of flowers once in a while.

Rosalind Kleban, L.C.S.W.: So, I guess the answer is, that you probably know special things that your husband would appreciate. And that now's the time to do it.