Episode 125 | The Critical Step Between Cancer Diagnosis and Treatment Most Patients Skip with Psycho-Oncologist Dr. Manuela Kogon

[00:00:00] Dr. Katie Deming: Hello, I'm Dr. Katie Deming, and this is the Born to Heal Podcast where we share practical tools and knowledge to help you create conditions for true healing in your life. Let's welcome to the show Dr. Manuela Kogon, integrative internist with an appointment in psycho-oncology at a large academic institution.

[00:00:18] Dr. Katie Deming: Welcome, Dr.

[00:00:19] Manuela Kogon: Thank you very much for having me. Pleasure to be here.

[00:00:24] Dr. Katie Deming: So you are in the field of psycho-oncology, which I think is intriguing and a lot of [00:00:30] people probably don't know what that means. I'm wondering if you can talk about what is psycho-oncology and why would we need that in the space of cancer around someone having a diagnosis of cancer.

[00:00:41] Manuela Kogon: Yeah, I mean, everybody, who is diagnosed with cancer experiences a shock and, you know, it's a surprise, you don't know how to deal with it, and it's a form of ad adversity the nervous system responds to. And so, As part of oncology, you know, people now [00:01:00] realize that when your system is in shock, you don't make really good decisions.

[00:01:06] Manuela Kogon: You know, you have to make big decisions about chemotherapy, radiation, you know, surgery. That affect the quality and quantity of your life. And so the idea that we bring someone in, who has experienced what that shock means and how to deal with it, so the emotional aspects of cancer, the activated nervous [00:01:30] system that then really affects your decision making.

[00:01:33] Manuela Kogon: so, you know, I'm both trained originally as a psychiatrist and did a residency in internal medicine and then naturally realized that we can't really separate body and mind, so when the body has illness, the mind kind of hobbles along with it sometimes in a very distorted way. And so my job is to kind of help those two entities be a little more [00:02:00] coordinated.

[00:02:00] Dr. Katie Deming: Okay, beautiful. So I absolutely understand this need and I, I think it's actually incredible that some institutions are incorporating psycho-oncology into their approach and, and actually one of the things that has been most surprising for me. As a practitioner who's left the western medic medical space and you know, into more of a natural space, is really looking at the connection between emotions and [00:02:30] shocking events and the development of cancer.

[00:02:32] Dr. Katie Deming: And then just like you described, the diagnosis itself brings on this shocking event in people's lives that disregulates the nervous system and you know. There's so many things actually that I wanna talk to you about because decision making becomes very challenging in the space of an activated nervous system when someone's in shock.

[00:02:54] Dr. Katie Deming: And we want people to make the best decisions for them because it's really important to [00:03:00] make good decisions about their health. And yet you've got a nervous system that's almost working against you if you don't know how to calm it down. So I'm wondering what are. Some of the things that people can do to help, you know, calm their nervous system in the face of a new diagnosis and that shock that's going on,

[00:03:21] Manuela Kogon: Yeah, I mean, something we all notice, even with any other shock is that how our mind sometimes tells [00:03:30] strange stories. You know, it goes into kind of panic mode of a cancer diagnosis, for example, meaning death, but cancer these days doesn't automatically mean death. But their mind starts operating like, oh my goodness, I gotta write my will.

[00:03:44] Manuela Kogon: Or who is going to, you know, what flowers am I picking for the funeral, when in fact you might have a curable cancer? So people need to know that that can happen to their mind. And most people have the sense [00:04:00] that they can control their mind through their mind. So if I say, oh, I shouldn't eat any chocolate, or I can't eat any alcohol, I can, I can't drink any alcohol, or I can do whatever people's minds tell them to say, okay, you are now probably having a response from the mind that's based.

[00:04:24] Manuela Kogon: On the shock of your system. So if you go into the system from the bottom [00:04:30] up and you actually had someone on your podcast, had very interesting contributions,Jacob Gricar to say, Hey, when you look at your body, your heart, and your lung. Calm those things down. Your mind will calm down. Calm down, and then you can make be better decisions.

[00:04:50] Manuela Kogon: So don't challenge and change the mind through mind, but change the mind through body. And I can [00:05:00] illustrate, you know, with, with some examples, like if you extend. Exhale or you're slow, you, you slow your heart. You activate what's called the parasympathetic a, a nerve that connects you, you know, connects you to the brain.

[00:05:17] Manuela Kogon: And that slowdown, of that whole system helps you think more clearly. and then you can make complicated decisions. But if you make those complicated decisions [00:05:30] based on fear. You introduce bias and with bias, you might make choices that aren't as helpful as you want them to be for you and your caretakers.

[00:05:42] Dr. Katie Deming: Yeah. Well, and you said something interesting there that you said if you, you know, are like all of a sudden, okay, now I can't eat chocolate, I can't drink alcohol. That, that, that's a sign. That the nervous system is activated in that you're in like a [00:06:00] sympathetic activation. Is that what you were saying there?

[00:06:02] Manuela Kogon: Mm-hmm. Exactly. So, you know when, whenever people, whenever I hear the word should I tell people, you know, they say I shouldn't have negative thoughts, or I shouldn't be sad, or I shouldn't be angry, and I, you know, say good luck. You know, you will be angry, you will be sad, and you will have scary thoughts.

[00:06:24] Manuela Kogon: But once you catch yourself in that, see if you can shift your attention, you know, [00:06:30] towards what can I do, you know, what do I want to do? So use the word should as an indicator that your mind might bully you into something that's not helpful to your health or your cancer. use it as a signaling system and you know, we all know.

[00:06:51] Dr. Katie Deming: Presumably wanna exercise or eat healthy or sleep as healthy healthfully as possible, but not under the umbrella of [00:07:00] should, you know, should, will not help you sleep better, or eat better or move more. Yeah, one of my clients, one of my fasting clients, said a couple months ago, she said, I, the word should, she says, I've reviewed, reviewed it from my vocabulary because I was shoulding all over myself and.

[00:07:19] Manuela Kogon: it's, it's, it's very true. I mean, you can use the word as an indicator of what goes on in your mind, you know, what does that [00:07:30] word represent? I should eat healthier. You know, it's the implication. If I change that behavior, it somehow positively affects the quantity and quality of my life. And that might or might not be true, so I would redirect when I hear myself say I should not drink.

[00:07:48] Manuela Kogon: Whatever, or I sh whatever schism people are walking around with, we all, we all do that, you know, take a moment and say, what does that thought? What need does, does that thought represent? [00:08:00] And usually it's a form of taking, wanting to take control over the course of your illness. You know, get some, introduce some certainty, introduce some agency.

[00:08:11] Manuela Kogon: and if you want to do that, focus on the action of the agency. Not on the pressure of the should because often the should represents, something that's not feasible. You know, people always say I should exercise. If you're going through chemo or radiation, you know, you, most people [00:08:30] are very fatigue and if you then battery your poor body that's already fatigued with the idea that you should exercise, you're adding a lot of pressure to the system.

[00:08:42] Dr. Katie Deming: This is interesting, I think, because I can just hear, you know, my, my people. The, the next question that, that they ask then is, okay, well if, if I catch myself and this should. And then I'm looking at, I wanna make lifestyle changes or I wanna make changes in my life to [00:09:00] become healthier. So when you say it's just focusing on the action of, of what they want to create, is that what you're saying?

[00:09:07] Dr. Katie Deming: When they, if they catch themselves in the should, then what is, what is the, gimme an example of someone who's saying I

[00:09:13] Manuela Kogon: so let's use, you know, I, I should exercise that. That's a very, you know, one that's easy to illustrate. So let's assume you're going through chemo or have radiation and you're tired and you're, you want to [00:09:30] sit on the sofa and rest. Your body wants to sit on the sofa and rest, and your mind says you should exercise.

[00:09:36] Manuela Kogon: So then the body responds like, oh, well I can't, I'm tired. I'm not getting up. And then to say, what can I do and what do I want to do, and, determine if there is a discrepancy between the two. So if you say, I want to, I don't know, hike 10 miles, [00:10:00] and contrast that with the question, what can I do?maybe it is walking around the block.

[00:10:07] Manuela Kogon: And so then, you know, you have a dilemma between, I wanna climb Kilimanjaro, but I can only walk around the block. Can you shift your attention towards walking around the block, because that is what you can do. So create manageable units, that gear towards [00:10:30] moving or sleeping or nutrition. Manageable units minus the bully and realize that the bully is just an expression of fear.

[00:10:41] Manuela Kogon: That I wanna live as long as possible, as well as possible. And, it's overwhelming that I now, you know, have added a full-time job of cancer. to a system that's usually, you know, already overwhelmed. in, in our parts of the world, the day only [00:11:00] has 24 hours and if you add a full-time job, cancer, you know, the day doesn't expe expand to 32 hours because you added a job.

[00:11:09] Manuela Kogon: And how can you reduce that to really manageable and feasible units in the entities you want to change?

[00:11:18] Dr. Katie Deming: I love that it's helpful to see that concrete example of, okay, you know, what is it that I. That I want to do, and then what is it that I can do? And then leaning into those [00:11:30] things that are actionable that you can do that's not coming from this, almost like a punishment. Truly. I see people use cancer as a punishment where they're like, you have to do this.

[00:11:41] Dr. Katie Deming: You know, because this is the, you know it, you didn't do this, and this is why you have cancer. Making up all these stories. That's the other thing is there's just stories that start to run. Completely, off, off track with, stories that are not even necessarily true, but your mind wants to latch onto something [00:12:00] as this is why, and if I fix this, then I'm gonna fix the problem.

[00:12:03] Manuela Kogon: And, and thanks for bringing that up, because the mind tells story in an attempt at making sense of what's happening. There is a technical term, it's called cognitive closure. So the mind, you know, is wonderful at writing poetry and designing bridges, but it has no idea how to deal with uncertainty.

[00:12:25] Manuela Kogon: So instead of the mind saying, oh, this is scary. I don't really know what the future [00:12:30] brings, but I am doing the best I can now, it tells stories. About the past and the future. And as you point out, often they're not accurate. So when you catch yourself in storytelling, you know, is it your inability to say, oh my goodness, this is really scary, but I'm going to do the best I can within my, you know, feasible means.

[00:12:56] Manuela Kogon: And you know what my mind is telling me is [00:13:00] really an attempt at finding closure in my story or creating certainty, either creating a good outcome or in some people a bad outcome. They get comfort with what's called, you know, defensive pessimism. They tell themselves a very bad story, so they're positively surprised when that story doesn't happen.

[00:13:20] Manuela Kogon: But none of it is based on the reality of your illness. You know, it's rare that people don't say, oh, I ate the wrong thing and now I have [00:13:30] cancer, or I was exposed to something, or I worked too much. They're attributing, you know, a cause and effect that's usually not accurate. And then they try to prevent that presumed cause and effect to prevent a recurrence or profession or progression.

[00:13:48] Manuela Kogon: And again. That is, you know, not based in the reality of older cells. And the reason or part of the reason why I wrote, when cancer visits is that I was [00:14:00] hoping to help people integrate the storytelling mind with the reality of older cells. You know, it's a man, a minority of the cell composite that has cancer.

[00:14:13] Manuela Kogon: There are a lot, a lot of cells. It's the vast majority of cells that don't have cancer. They get a little attention also because they can really be helpful in, you know, your podcast is Born to heal is [00:14:30] the opportunity to allow healthy cells to get rid of cancer cells.

[00:14:36] Dr. Katie Deming: Yeah, I love that actually. You know that shift of. Looking at your body is like how many trillions of cells? And we're talking about a very small proportion that have, you know, something that needs to be healed. But the rest of you is really functioning so beautifully and how our body is always working to bring us back [00:15:00] into harmony, into nature and, and when someone gets sick, especially with cancer, it becomes all about this focus.

[00:15:06] Dr. Katie Deming: The, the term defensive pessimism is so interesting. I've actually never heard that word, but I see it all the time. I see people do this all the time. They're like, okay, well if I just set my expectation really low, then I won't be disappointed if the outcome is not what I wanted. You know? And then you're basically speaking to your cells, all of those cells that are healthy, saying that you [00:15:30] expect, you know, something bad to happen.

[00:15:32] Dr. Katie Deming: And it's like, you know it, it is. It can be very, I think confusing for people because they don't know where to rest their mind. Right. And, and I think you, you bring the point of, I think control is, is at the heart of it, it's fear. Fear and then wanting to control something out of that fear puts people in this position where if they can just control one piece of it or if they can control how, what their expectations are, then, then somehow.[00:16:00]

[00:16:00] Dr. Katie Deming: It's gonna make the process easier. But the truth is, like you said, it's un, you know, it's uncertain and it's unknown and there's, you know, the only way through that is to. Find comfort and peace in the unknown as you work towards healing the wholeness of your body and bringing everything back into harmony together.

[00:16:22] Dr. Katie Deming: So, I really, really, I think that that's important. Thinking about the defensive pessimism [00:16:30] specifically is this is really something that a lot of people do and. What would you say is, you know, to someone who is doing that right, that they're saying, okay, I'm just gonna set the expectations super low so that I'm not disappointed.

[00:16:44] Dr. Katie Deming: What would you, what would your coaching or guidance be for that?

[00:16:48] Manuela Kogon: Yeah, I mean, I discuss with people the principle of competing needs. So when you catch your mind in saying, oh, I know I'm going to die, [00:17:00] I say, okay, so just notice what you said. You know, your, your mind tries to find comfort in something concrete.and it makes total sense that you want certainty. It's your expression of wanting certainty, and if you want certainty, can you get that certainty?

[00:17:21] Manuela Kogon: In a different way where it's actually realistic. So you shift the desire onto something that's practical. [00:17:30] You know, a lot of people, you mentioned control. Yes. You know, it's a form control is a trying, is an attempt at getting certainty if you want control. A lot of people who are diagnosed with cancer catch themselves in taking control of their closets and their kitchens and they say, Hey, why am I cleaning so much all of a sudden?

[00:17:50] Manuela Kogon: 'cause you might not be able to get control over your cancer, but you can get control over your dishes. So when you point that out, say, Hey, you are having [00:18:00] these kinda cognitive closure, you know, ideas from your mind because your mind doesn't know how to not control. So shift your attention towards something you can control. So that's one way, of shifting the need that this mindset represents. And then also say, you know, is there a competing need? You know, sometimes people struggle with quantity versus quality of life. That's [00:18:30] a competing mechanism if you take a medication that you know will reduce, the risk of recurrence, but it comes at a price.

[00:18:39] Manuela Kogon: How do you make that decision? And you need to be aware that you want both, but they might be, you know, mutually exclusive and then to say, okay, which one matters to you more? Do you want quantity of life at the price of some quality? [00:19:00] Some people make very clear choices of saying, no, I prefer quality, even if that means my life potentially is shorter.

[00:19:08] Manuela Kogon: And that's an individual, you know, decision that you have to navigate because people get pushed back. You know, if someone makes a choice over quality of life, a loved one might say, Nope, you, you need to push through because I need you. I need you to be around. And then you have an [00:19:30] inner conflict that then also reflects itself in an outer conflict of a lot of.

[00:19:35] Manuela Kogon: You know, disagreements and to point it out, say, Hey, this is what's happening. You have an inner conflict between this need or that need. And which one do you feel is more important if you can't have it both. And is it reflected on the outside that someone puts pressure on you because they want something that's not compatible with what you need?

[00:19:58] Manuela Kogon: Hmm.

[00:19:59] Dr. Katie Deming: [00:20:00] Yeah, and this is, I think you hit something that's really, challenging for many people in this space, is following what they're feeling guided to do personally. And, and dealing with the family or close loved ones who are wanting something different, and that is actually one of the biggest challenges that I see for people who are healing cancer is really being able [00:20:30] to, number one. Know what they want. Right? Know what they want. When, when, like you said there, there can be challenging decisions and then making that decision and then being able to stand in it with having the pressure of, it could be, you know, loved ones, but also could be the doctor saying that you really should do this.

[00:20:51] Dr. Katie Deming: You know, and I think there's another nuance to this that a lot of times people don't even understand. The amount of time, the [00:21:00] quantity that actually some of these medications will give them is on the order of a few months. And if you're looking at, you know, something that it's gonna extend life for a few months, but it's gonna make you sick in that time that you have, and that is the time that you have, you know.

[00:21:17] Dr. Katie Deming: People will make decisions because they're, you know, like, well, of course I wanna do whatever I can. But it's like we've, we've mixed this up of like, you know, that doing whatever you can is really focused [00:21:30] on the quality a lot of the times from what is, you know, given in standard of care of like, this is what you should do because this is what we have to extend your life the most, most possible.

[00:21:38] Dr. Katie Deming: But like you said, it really is that balance of understanding. Okay. What is that true benefit? What is the duration that you're talking about? What are the implications and side effects that I'm gonna experience so that I can truly weigh this in real world? Like I think sometimes when it comes to medical.

[00:21:57] Dr. Katie Deming: And, you know, things that are prescribed by doctors, [00:22:00] we treat it differently than if, like my car for example, that's actually the interruption that I got a minute ago, was my car is in the shop. When I take my car into the shop, I'm pretty clear about making decisions. I'm like, it's gonna cost this much.

[00:22:11] Dr. Katie Deming: This is the benefit. This is how long my car is gonna last. And, and I'm able to make those decisions from a very neutral place emotionally. And I feel like sometimes when it becomes our health. We, we don't ask those very specific questions that can be helpful in understanding what the options [00:22:30] are and, and what they're gonna bring, both from quality and quantity.

[00:22:33] Manuela Kogon: Yeah, and that's a good illustration again, of how the mind, you know, isn't that good at making decisions when you have fear attached. So the fir worst case scenario with your car is, you know, you spend money and the car is still broken and you have to get a new car, but your life isn't threatened. And so since your life is threatened.

[00:22:57] Manuela Kogon: People want to make the right decision or the [00:23:00] perfect decision. And in the space of statistics and probability, there is no perfect decision. So, you know, I have this conversation a lot I describe in when cancer visits. There's a whole chapter about decision making that every time you make a decision, like what you just pointed out, you take a medication that might lower your risk of recurrence by 50%.

[00:23:26] Manuela Kogon: But if you have a risk of recurrence of [00:23:30] 60%, you know, half that, that's 30. So that's a considerable risk reduction. But if your risk of recurrence is. 4% and you reduce that to two. So do you have the bandwidth to really actually look at the numbers? Because God forbid, you are now deciding you're not taking the medication because the risk you know, was only reduced from 10 to five, and you can live with that, and then you are the person who gets the recurrence.

[00:23:58] Manuela Kogon: You will [00:24:00] automatically assume that it's because you didn't take the medication, even though that's not. Really true. You again, don't know. So in decision making, you always have to look basically at a four quadrant grid. I'm choosing to do something that has an upside and a downside, and if I choose not to do that thing, like take a medication, it has an upside and a downside, and you basically have to be comfortable with whatever choice you make.

[00:24:29] Manuela Kogon: Let's [00:24:30] assume. Not taking a medication that has, you know, reduces my risk of recurrence. but then I get a recurrence, well, I kick myself, you know, for not having taken the medication. So when you make that choice, you have to be ready to say, I can live with the consequences if they happen, even though I have no clue whether or not they happen.

[00:24:54] Manuela Kogon: And how can anybody do that? That's a huge stress on the system. You [00:25:00] wanna get it right in a sphere where you don't know whether or not you will get it right. And you know, e even as I'm talking about it, I can kind of feel my own system get activated in. You know, the fear and stress it evokes, in people and you know, others, if you now are the one who says, okay, I'm comfortable not taking that medication because I can't live with hot flashes and the arthralgias and the, you know, all the [00:25:30] side effects that some of these medications come.

[00:25:33] Manuela Kogon: Then your partner says, are you kidding me? That means you don't love me because you're not willing to do that. And then you know you have the next stressor into the system and can one stay reasonably peaceful with oneself and with the other in the complexity of that stressor. And that's really why I wanted to write, you [00:26:00] know, when cancer visits, I picked the title, with the implication that, you know, it visits, that means it can leave.

[00:26:08] Manuela Kogon: And you know, like I make the analogy to, to a house, unwelcome house guests that, you know, usually they do leave, but with cancer sometimes, you know, it stays and then we have to navigate that space also, you know, many people these days live with cancer. For years, sometimes decades.they belong in this world also.

[00:26:29] Manuela Kogon: So [00:26:30] it's, it's, you know, as I'm speaking, I realize that I can feel the stress of the, the decision, you know, people have to make. And if I can't stay calm in that space, even if I don't have cancer, how is it for a person who has to make that choice? Who has cancer? So I.

[00:26:48] Dr. Katie Deming: no, I can, I can feel it as we're having this conversation thinking, you know. And I and you, you highlight that It's so multifaceted because there's other people also with around making the [00:27:00] decision, and I love the the, when cancer visits. One of my clients who's been a guest on this podcast several times, she calls her breast cancer, the breast guest, and then. was the brain. Yes, because it had spread to her brain. Thankfully that all went away. when she water fasted, she had the brain metastases completely go away, but she refused to call it cancer. She said, this is a brain guest and it's not welcome. It's leaving. It's, it's having a short visit and then it's gonna go.

[00:27:26] Dr. Katie Deming: So I, I love that title, but you know. Something [00:27:30] in what you just said. I wanna call out because I think for many listeners it's really important to understand this. So let's just take the example that you said of that you have a 10% risk of recurrence and say you're gonna take, let's just say anti-estrogen or hormone, you know, medication to block the effects of estrogen in the body and it's gonna reduce the risk by 50%, which is really a risk reduction from 10% down to 5%, right? Even in the people who take the medication, they can still have a recurrence, right? [00:28:00] So that risk is going from 10% down to 5%. That means that 5% of the total a hundred, you know, are going to have it come back regardless of whether they took it or not. And I think that this is the piece that like you just described.

[00:28:17] Dr. Katie Deming: I love that you said that is can I live with. Can I think about this decision and can I look down the road and if I had a recurrence, still feel like this was the best decision for [00:28:30] myself? I think that that is a very sound way to think about making decisions, but. The interesting part, and this is why I feel like healing cancer can be so tricky, is that the doctors will come back to them and the doctors never say to the person who decided to take the medication who had a recurrence anyway, like, oh, well, that's your fault.

[00:28:51] Dr. Katie Deming: But oftentimes, if someone declines that anti-estrogen, let's just take an example. Then when they go back to the doctor, the doctor's like, well. This is [00:29:00] what happens when you don't do this. And you know what? When it comes back, it's gonna kill you. I've literally had like three clients in the past month have a doctor say something like that.

[00:29:08] Dr. Katie Deming: If you don't do this, then you're gonna have this. And so not only do they have their loved ones in their ear and like, you know, you would do, if you loved me, you would do this. But then there's also the piece of the doctors. And the doctors understand the statistics, right? So it's so multilayered that even when you make the best decision for yourself.

[00:29:29] Dr. Katie Deming: You [00:29:30] have to just be prepared for other people's impressions and specifically the medical profession professionals. It can feel very, Scary. I think that there's this, this piece of, like you said, wanting to get it right and wanting to have certainty, but also to make sure that you have people that will take care of you.

[00:29:50] Dr. Katie Deming: And there's this fear that if I don't do this and then it comes back, then the doctors label me and then that, you know, that this whole piece of it too, which think is, is [00:30:00] real and something that plays into people's decisions as well.

[00:30:03] Manuela Kogon: Yeah, I, I feel like, you know, I, I agree with you and I also feel a little more optimistic as we have a younger set of, you know, caretakers and physicians and PAs, and mps move into the world that, you know, I use the expression collaborative oncologist. So are you working with someone you can have this conversation with?

[00:30:29] Manuela Kogon: [00:30:30] And I describe in, in when cancer visits, when the, in the beginning when you get diagnosed, how are you approaching to find the team that works best for you? And that's trial and error. So, you know, you, if you have the luxury to interview more than one set of physicians do that. and you know, a, a physician who feels confident and is secure enough will tolerate, [00:31:00] you know, saying Sure.

[00:31:01] Manuela Kogon: You know, talk with whoever you want to talk. And you know, doesn't, you know, represent the fearmongering that you just described. For me, that will be an indicator as a patient whether or not I want to. Work with someone. So be thoughtful about the team you assemble if you have the luxury, you know, remember we live in a day and age where access to care is getting harder and harder.

[00:31:25] Dr. Katie Deming: And so, you know, many people don't have that choice. They have [00:31:30] to do what they're told to do. but if you have the luxury trial and error, ask friends. And the word is collaborative team. Yeah. No, I, I mean, I think that that is huge, and that's something that I talk about all the time on this show is that it's okay to interview multiple doctors. It, it, it's encouraged to interview multiple doctors and then it's okay to. Move on if it's not a good fit and trust. [00:32:00] You know, I think that's one thing that in my practice when I was practicing as a radiation oncologist, people would switch within our practice, we had like nine radiation oncologists, and if someone wasn't a good fit with one person, one.

[00:32:12] Dr. Katie Deming: On the doctor side, it's fine. We don't worry about people switching, so, but I think oftentimes patients feel really nervous, like, oh no, if I try and switch, it's probably better to switch and, and be with someone who feels aligned and is collaborative with you than to [00:32:30] stay in a relationship out of fear because then, you know what I'm saying, then you're nervous about really expressing what your needs are and what you want.

[00:32:37] Dr. Katie Deming: so absolutely, I agree on that.

[00:32:39] Manuela Kogon: Yeah, I, I am glad you're mentioning that, that, you know, in some practices kinda reject doctor switching because they don't want you to doctor shop. But I'm very, very glad to hear that, you know, your practice was flexible and open to do that because that is in [00:33:00] usually in the best interest of the patient to find a good match. Yeah, it's, it's, it's a, it's a stressful space, and so I have a lot of empathy for people who have to make those challenging decisions. So back to the basic message, since it is such a challenging space. You know, be aware that when your nervous system is activated, it will mess with your mind, and [00:33:30] if your mind is messy, it doesn't know how to make decisions.

[00:33:35] Manuela Kogon: So get to know your mind. You know, figure out what the mind tries to tell you in terms of needs. Usually these scary thoughts about the past and the future are just expression of something you need. You know, like control or certainty or predictability or comfort or support, or, you know. Inquire, what does this thought that's popping outta my mind?

[00:33:59] Manuela Kogon: [00:34:00] Represent in terms of need and want? You know, those were words you just used eloquently, and once you know what the needs and wants are. Are you realistic about? Can you get them, can you satisfy them in the cancer space? And if you can't satisfy them in the cancer space, how can you satisfy them so the system can calm, calm down a little bit so that you can make these very kind of life altering decisions and live with them.

[00:34:29] Dr. Katie Deming: I'm [00:34:30] wondering for someone who's newly diagnosed, someone who's, you know, just newly diagnosed, what are some of the things that you would recommend to help them navigate in a way that keeps their nervous system as calm as possible? Recognizing that it's, it's, you know, inevitable, just that there's gonna be activation with this diagnosis.

[00:34:50] Dr. Katie Deming: What are some things that are practical tools people can use? Navigating the diagnosis.

[00:34:56] Manuela Kogon: So navigating the diagnosis [00:35:00] or calming down their system is

[00:35:03] Dr. Katie Deming: Well, I think it's, I, I think, I think it's both, right? So I'm just, I'm curious as to what, whether it's, you know, calming your nervous system, what are the tools that you recommend for that? But also just what are some of the practical tips for someone who's newly diagnosed that can use to help them calm their nervous system, make the best decisions, and navigate a diagnosis that feels very scary.

[00:35:27] Manuela Kogon: Yeah, so my first order of business [00:35:30] is to recognize that the mind might not be your friend. And that is hard for people to wrap their head around. You know, they assume mind is this all knowing thing that will help them. And the entry point into calming your mind is through the body. And you know, in when cancer visits and I base those recommendations on physiology, the mind doesn't stop.

[00:35:55] Manuela Kogon: The mind just chatters. And so if you don't want the mind to [00:36:00] chatter, you need to give the system. Enough to do while you're breathing, or, you know, slowing down your heart or relaxing whatever technique people are using, to also engage the mind with something that prevents it from fearful chatter. So sometimes I, and people laugh at me, but it, it does work, to stand on one foot because that challenges the cerebellum, the part of the brain [00:36:30] that, regulates balance and it kinda maxes out the brain unless you do yoga.

[00:36:35] Manuela Kogon: So if you stand on one foot. Exhale and simply kind of check into what are my top five needs in life that re, you know, keep recurring. Like, am I someone, oh yeah, I need control, or Oh, I love support or, so, you know, you might stand in front of your microwave. Exhale, [00:37:00] stand on one foot, let the milk heat up.

[00:37:03] Manuela Kogon: Then sink into what are the five most important things in my life in general, but needs, you know, something like control or certainty. And once you recognize that the whole system calms down. Then you go about, you know, picking your team, deciding if your spouse or family is supportive or not supportive, something [00:37:30] that's also, you know, needs to be looked at.

[00:37:32] Manuela Kogon: People want to help, but they have a desire to help, but they often don't know how to help and take actions that aren't helpful to the patient, so they satisfy their desire to. Help, but not with an action. That's helpful. Be thoughtful about that. Yes, eye patient won't help, but is the action I'm being given helpful?

[00:37:55] Manuela Kogon: That's true for partners, family, doctors, [00:38:00] neighbors. so be need specific. And then assemble the people who really can help whoever they are, physicians, family members, and also be realistic that some people cannot do that. Some people do not know how to help you in that space.

[00:38:18] Dr. Katie Deming: Yeah. Well, and one of the things analogies that I use in this part where you're talking about with the family and your kind of support system is I think of healing as [00:38:30] like your, a little seed that's been planted into the soil. And when you plant a new garden, you don't let people just walk all over your garden, right?

[00:38:38] Dr. Katie Deming: You put up a little fence and you water it and you tend it. So. You, you need to, there are gonna be some people that you maybe need to keep out so that they're not trampling us in your garden while you're planting this seed of healing. And it's not, you know, sometimes the people who are, you know, maybe play the biggest [00:39:00] role in our life, may not be the best people to support us through a diagnosis for exactly the reasons that you said they wanna help.

[00:39:08] Dr. Katie Deming: But sometimes it just, you know. Any illness, but especially cancer, doesn't just affect the person who's, experiencing it. It affects the loved ones around them, and their nervous system is activated. They are in fear, their minds are shattering all this stuff, and it's, it can be really hard sometimes to calm that down and, [00:39:30] and recognizing that.

[00:39:31] Dr. Katie Deming: You do need some people, some key people around you who have calm nervous systems, who are those people who can show up and really support you in what's most important to you without having to feel like their desires are, you know what you need to do. And I think this is hard for people sometimes, but. I love the things that you said of recognizing that your brain is gonna maybe not help you maybe become a hindrance and, and learning [00:40:00] how to calm the nervous system, regulate your, you know, you talk about using your body.

[00:40:05] Dr. Katie Deming: I love that and I, I love that it ties in with the conversation that I had with Jacob Gricar. But, then the other piece about the people, you know, I think this is the tricky one that a lot of people struggle with, is that they want to, you know. I think people think that in a crisis and or if you know there's something really serious happening, that the people [00:40:30] around them are gonna step up and they're going to behave in ways that are supportive.

[00:40:34] Dr. Katie Deming: And I can just say from caring for thousands of people with cancer and also experiencing it in my own family, where my mom passed away from ovarian cancer. Oftentimes, people's worst behaviors come out when someone is sick. And so just understanding that that's not because they don't want to help, but you really need to think about, okay, this is my [00:41:00] experience, my health, my body.

[00:41:02] Dr. Katie Deming: I wanna make the best decisions and I need to have those people around me who are going to help me make good decisions and feel supported.

[00:41:09] Manuela Kogon: I mean, I love everything you say. I love the image of the little seedling and, you know, make sure that nobody steps on it. That's, that's a beautiful image. You know, like, like, you know, I don't want people. To hear like, oh yeah, just take a breath and everything will be fine. Not at all. You know the reason why you have to, you know, [00:41:30] calm down your system is so you know how to protect that little seed.

[00:41:36] Manuela Kogon: And I also love what you say about, you know, adversity. Really is the only time when you know who the people are in your life who know how to help. You know, adversity is the time when you know who the people are who can show up on your terms. You know, you are now the weakest link and is there [00:42:00] support to, to help you?

[00:42:01] Manuela Kogon: I, I often experience it with people who are caregivers. That then all of a sudden can't adjust to re, re needing to receive care because as caregivers, they haven't surrounded themselves with people who know how to take care because they're the ones and then they're shocked that what they have done all their lives caretaking now isn't.

[00:42:23] Manuela Kogon: Given to them, but in part related to them having a role of caregiver, where they didn't surround [00:42:30] themselves with people who know how to care. And so I always differentiate, you know, intention, action, impact. We can have a lovely intention to help and the action might, you know, even look beautiful, but the impact on the person who receives that action, matters.

[00:42:50] Manuela Kogon: Matters as much as your intention. So be thoughtful if, if caregivers are, are listening, family members. just realize your system, as you [00:43:00] pointed out, is stressed also, and in this activated, you know. System. We all try to execute what we want and then we have these competing needs that lead to a lot of, lot of, distress in the system.

[00:43:15] Manuela Kogon: And so if you are a c caretaker, check your intentions. Usually they are good, but then be thoughtful. Is the action you're taking going to be helpful to the person you're giving the action to?

[00:43:29] Dr. Katie Deming: [00:43:30] Yeah, it's interesting. I had an experience, I forget, probably like 2017 or 18, where I experienced this personally. IW we went to Mexico as a family. It was our first day of vacation. It was like the first day. Big expensive vacation that we'd taken with the children in quite a while and super excited. The whole family was really excited about this trip and the first morning of the trip, 11:00 AM I'm in the pool with my kids playing Marco Polo [00:44:00] and my son is.

[00:44:01] Dr. Katie Deming: And he's coming at me and I am, you know, trying to get away from him. And I decided to go fish outta water, which you can, you know, you, you just get up outta the water. And I was sitting up on the edge of the pool, but we had just gotten to this resort and I did not realize that the edge of the pool that I was backing up to and was going to sit on was actually an infinity edge.

[00:44:25] Dr. Katie Deming: And it was a two story building. Actually, and there was no [00:44:30] trough, like in the us this would never happen. It was like a straight down wall of just water going over this like, you know, tiled edge of this pool. And so my hand slipped and I flipped over and I fell two stories and, and I luckily only fractured my tailbone.

[00:44:47] Dr. Katie Deming: Couldn't sit for a year after that. But I didn't break anything else but. It was terrifying. Obviously I got taken away in an ambulance and the kids, we had a, you know, it was just a crazy thing. But I remember that evening when [00:45:00] we got back from the hotel and back to where we were staying. My husband let me have it.

[00:45:07] Dr. Katie Deming: Like I wasn't drinking, I wasn't doing anything. It was like literally the morning and I was playing Marco Pole with my kids and he lost his marbles and was like, what were you thinking? How could you have done this, blah, blah, blah. Like just going off. And I remember sitting there and thinking. Okay. I've seen this, actually, I've seen this with patients where their husband or their wife or their spouse is just freaking out [00:45:30] because they don't know what to do.

[00:45:31] Dr. Katie Deming: So I fortunately knew what was going on for him and just was like, you know what? You need to just go in the other room. I just need to like sit on my ice bag here and like take my pain medication. But. I, I realized in that moment I'm like, oh, most people don't know. Like, you know, I think any other person would've just gotten mad at him and been like, what?

[00:45:51] Dr. Katie Deming: Are you kidding? Like, how can you be getting mad at me for this? But he was so stressed that he didn't know how to, he had the best [00:46:00] intentions, but he was just scared that he was gonna lose me. And anyway, I just remember in that moment thinking. Oh, this is like what a, you know, a shocking event can do to someone.

[00:46:12] Dr. Katie Deming: He's acting erratic, even though I know that he's doing it out of love. But this is the kind of thing that shows up. And if you're sick, and like you said, a lot of times, and this is just a pattern that I see, you know, I've seen in my practice, especially caring for so many women with cancer, is they're often the [00:46:30] caretaker.

[00:46:30] Dr. Katie Deming: And then when they get sick and then their partners or their loved ones not only don't show up for them in the way that they have shown up for their loved ones for so many years, caretaking for them, but then act kind of mad or angry or, you know, get really agitated in these weird ways that it's so confusing and you take it personally like, oh my goodness, they don't love me.

[00:46:51] Dr. Katie Deming: They don't know, but it's, it's really that they have a dysregulated nervous system and don't know. How to handle their own emotions in the, in the [00:47:00] chaos of what's happening.

[00:47:01] Manuela Kogon: Yeah, that's a very good example for what fear does to the mind, and then you project it on the other. I mean, I witness a lot of arguments exactly the way you. Describe, I, I have a whole chapter in when cancer visits about how to navigate the partner and caregiving space, with, you know exactly what you just illustrated.

[00:47:25] Manuela Kogon: So the, the patient is stressed and needs something [00:47:30] and the partner or caregiver is stressed and needs something, and then people are at each other's throats with the respective need. And there I. Simply have them actually sometimes draw a normal distribution curve and say whatever. I'm in the 90th percentile of needing support now, but maybe the partner is only in the 30th percentile of being able to give support.

[00:47:55] Manuela Kogon: And so the longer the distance of on the curve with the [00:48:00] difference of the respective. The higher the probability of conflict. So I literally have them draw it out without seeing each other, and then there is this reality check where they say, oh my goodness. You know, there is a difference in how we're approaching this problem.

[00:48:18] Manuela Kogon: With respect to caregiving or support or nurturing, or all of a sudden, you know, someone needs more closeness and other people need more, you know, they become, [00:48:30] more introverted and need more distance and, and it comes as a surprise to the other. But if you point it out and let them realize what, how the needs shift, and you have them look at the curve and say, oh my goodness, the distance is very long.

[00:48:46] Manuela Kogon: Then you can also start to navi, navigate and, and be, be less angry, be less reactive, and have an understanding of where the other person is and see if you can accommodate it. You know, sometimes you can [00:49:00] reconcile competing needs. Sometimes you have to accept that they're mutually exclusive, but naming it, expressing it, and then deciding is it feasible to reconcile it?

[00:49:13] Dr. Katie Deming: That's beautiful. I, the, the drawing of the curve, I can see how that just kind of brings it home and people can see like in front of them. Oh, I see. And also I think. It gives you a perspective of what are your, because sometimes we don't even [00:49:30] know like, where am I on that bell curve of needing support versus not, and someone who's not used to needing a lot of support and is used to being maybe lower and supporting the other person, you've now have a shift.

[00:49:43] Dr. Katie Deming: And just seeing that visually, I could see how that would be very powerful for people.

[00:49:47] Manuela Kogon: Yeah, to you said it beautifully like that. You then see your shift. If you were a ca a caretaker and are in a 90th percentile, you're a caregiving genius. But then if you're now in the 50th percentile [00:50:00] because you're flat with fatigue and pain, then it's also hard on you. But as you pointed out earlier, your surroundings still view you in the 90th percentile.

[00:50:11] Manuela Kogon: And so there's a, is a. Mismatch that unless you see it in front of your, in front of your eyes or on a curve that you can say, oh my goodness. That's it. And you know, I sometimes laughingly say you can just tear page 167 out of the [00:50:30] book, which is literally what do we need? And throw out the book and just carry the page in your pocket to identify, you know, what are the needs and how, how can I be clear about them, honest about them.

[00:50:45] Manuela Kogon: And assert myself, you know, without being too angry or disappointed in them and do that with other people. But, you know, it's a, it's a work in progress. You don't even need to have cancer to struggle, you know, with, [00:51:00] with competing needs. In in relationships.

[00:51:04] Dr. Katie Deming: Absolutely. And I think that what cancer does is just amplifies, it just brings up the stakes. So then everyone is, you know, activated and operating with like half a brain and it's just it all the normal thing, like these are normal struggles that we have in relationship and caring for one another. And then, but it all just gets heightened, in a serious diagnosis like this.

[00:51:27] Dr. Katie Deming: And I love that you wrote this book, when cancer [00:51:30] visits Dr. Congen, can you tell us where can people find you? where is your book sold and, and where can they find you if they're

[00:51:36] Manuela Kogon: Yeah, I mean we, we have a website for the book. It's called When, when Cancer visits.com. so that's probably the easiest way to, if people are interested. Interested, you know, what's in it. you know, it describes it a little bit. It gives some, you know, feedback, it gives some, has little excerpts, so people can, can get a sense of what it's all about.

[00:51:58] Dr. Katie Deming: Well, thank you so [00:52:00] much for being on the show. It's been really a privilege to speak with you.

[00:52:03] Manuela Kogon: Thank you very much.