During the year or two after surgery or treatment for a serious medical problem, many people find they need help to feel better emotionally and physically but don’t know where to turn. In You Can Heal Yourself (St. Martin’s Paperbacks, 2012), Dr. Julie Silver, assistant professor of physical medicine and rehabilitation at Harvard Medical School and chief editor of books at Harvard Health Publications (which publishes Harvard Women’s Health Watch), details practical steps you can take for optimal healing. Her recommendations are based on research and, says Dr. Silver, “years of listening to my patients tell me what helps them and what doesn’t.” We talked to her about some of the ideas behind You Can Heal Yourself.
Why did you write this book?
When I was in my 30s, I was diagnosed with breast cancer and went through treatment and was really sick. When I was done with treatment, I was told to go back to work, but I was too sick to go back to work. At the time, cancer rehabilitation wasn’t an option where I’d been treated, and I had to figure out how to heal myself. One of the biggest obstacles is that it can take a long time. Insurance doesn’t always pay for treatments, and there aren’t always enough resources. So people really are left to heal on their own.
You say “cancer rehabilitation.” What is that?
For every serious illness or injury except cancer, people are offered rehabilitation medicine interventions — physical therapy, for example — provided by board-certified and licensed professionals and covered by insurance companies. But if you ask most cancer survivors if they were ever offered rehabilitation, if there was ever a team that got together to help them recover, the answer for the most part is, no, they figured it out on their own. So there’s this huge gap in cancer care.
So what does cancer rehab look like?
It looks like a lot of other rehabilitation. Let’s say someone has had a stroke. You wouldn’t say, “Well, go to a yoga class or to an exercise class!” So we’re talking about physiatrists [physicians who use nonsurgical approaches to reduce pain and improve function], physical therapists, occupational therapists, speech and language pathologists, and other rehab professionals. For example, research has shown that people with head and neck cancer often stop driving during treatment and never start driving again. That’s usually because they have range-of-motion issues in the neck. They can’t turn their heads, they can’t work, they can’t be out in the community. But from a rehabilitation medicine point of view, that’s a very simple fix. There are a lot of interventions to help with that.
You talk about “the Healing Zone.” What is that?
That’s a place where you’re recovering [from illness, surgery, or treatment] and you can work toward healing goals. But it’s also a place where people can get stuck and not heal as well as possible, instead accepting a higher level of pain, fatigue, disability, or emotional distress than they need to. In cancer, there’s this saying, “Accept the new normal.” And what I always say is, “Don’t accept a new normal too soon.”
You say the first step is to listen to your healing voice. How do you recognize it?
Most of us learn not to pay too much attention to every ache and pain and change, lest we become hypochondriacs. And it’s a good strategy. You can’t be constantly focusing on every little aspect of how your body feels. But when you’re trying to heal, you have to start paying attention. You need to start saying, “Okay, what is my body really telling me, and how do I need to work with it?” Fatigue is a good example. When am I tired? Am I tired first thing in the morning? If so, there’s a good chance I didn’t sleep well last night, because sleep should restore me. If I feel great in the morning but hit a low point midday, what was my diet like? Did I really nourish my body to feel good midday? The same goes for pain. Where is it? What does it feel like? What makes it better, what makes it worse, how long does it last, and so on. In the book, I tell people to keep a three-day log of activities and when they have pain and fatigue — the two main symptoms that keep people from functioning as well as possible. It gives them so much insight and really helps them figure things out.
What are the biggest obstacles people face as they heal?
One of the biggest obstacles is understanding that you need to set aside time and energy for healing. I ask people, “What are your most important healing goals?” And they’ll say, “I’d like to be able to walk a mile,” or “I want to lose 10 pounds,” or “I want to sleep through the night.” Then I’ll ask, “What three things did you do last week to accomplish your most important healing goals?” And they start laughing. They realize there’s a mismatch between their to-do list and the things that are most important to them. It’s true for everyone. We say something is really important to us, but along come chores, errands, work, and other things — and all of a sudden, we haven’t done anything about our most important goals.
How do you make time for healing?
You can take a rehab approach, which is short-term and long-term goals. What can I accomplish today or in a week? What can I accomplish in a month or two? Just try to achieve those goals. You may fall short. And that’s also important, to understand that just because you don’t reach a goal doesn’t mean it’s a failure. It just means you need to reset that goal or re-evaluate or change it.
What do you say to encourage people to keep trying?
I share with them how healing works. It doesn’t work in a linear way, where you’re sick, and then better, better, better, done. There are lots of zigs and zags, where you get better — two steps forward, one step back — or you plateau. Healing plateaus and setbacks are totally normal and expected. Health care providers understand that, but patients get upset because they may not see how well they’re doing. All they see is this setback or that plateau. Sometimes you can’t see your progress, it can be so subtle. But then you need to look back and ask, “Where was I a month ago?” Short-term successes lead to long-term success. When you can change the conversation from failure to success, it’s huge in terms of an understanding and commitment to doing more.