Elizabeth Thompson discusses how integrated care can make all the difference to cancer patients
Receiving a diagnosis of cancer can be a very frightening experience and many people remember the exact moment of hearing this difficult news. The experience can cause shock and anxiety and the feeling that one’s life is spiralling out of control. The person can often feel like their body has let them down by developing such a serious illness and they can lose confidence in themselves and their future. There is often a desire to look more deeply into their health in general and to find meaning in their lives as a whole.
Many supportive approaches such as psychological procedures exist to help people during this difficult time of adjusting to a life-threatening illness. Complementary and alternative medicines (CAM) can also offer an important avenue of support with an underlying philosophy that the individual experience is important and connections that a person may make in their life and health are important. CAM also honours the idea that the body has its own innate healing potential which can be strengthened in various ways. A preparation of Mistletoe would be an example of a complementary medicine which has been shown to stimulate the immune system and when given alongside chemotherapy and radiotherapy can reduce fatigue and improve quality of life.
We are very fortunate here in Bristol to run a complementary cancer care service that is integrated into the rest of the acute Healthcare Trust where the hospital is sited, University Hospitals Bristol Foundation Trust. We see about 250 patients a year with many referrals coming directly from healthcare professionals within related cancer services and research suggests patients want their treatment choices valued and approved by their oncologists. We have a close relationship with the breast care nurses working with the surgical team in the north of Bristol and the team at the Bristol Haematology and Oncology Centre.
Sometimes it is the simple things that seem to help and one of the things that we offer at the hospital is continuity of care. If a patient comes to us they stay with us throughout their five-visit package of care which involves one hour-long consultation and four 20-minute follow-ups. A common reason for referral is for women with breast cancer who are suffering side-effects of their treatments such as hot flushes with Tamoxifen or joint pains with Arimidex. Other problem symptoms might include anxiety, mood and sleep disturbance. This constellation of symptoms associated with oestrogen withdrawal has few in the way of conventional treatments and HRT is now contra-indicated in women with breast cancer as it could increase their risk of recurrence. Sometimes women do not want to go on conventional medication such as antidepressants, which is another orthodox treatment for these symptoms, because they feel they have had enough drugs and they want to approach it with gentler, non-pharmaceutical approaches. We also see men with prostate cancer, who have similar symptoms of hot flushes, sleep disturbance, anxiety and loss of confidence associated with their hormonal cancer treatment.
We see people coming at different points in their diagnosis. Some patients are often coming after all their cancer treatments have been carried out, but they are suffering from the ongoing side-effects of their treatments. Sometimes we see people who from the moment of diagnosis want to use homeopathy to support them through their surgery, radiotherapy and chemotherapy. Often they can be people who have used homeopathy regularly for themselves and their families and it is a natural choice to continue to do so alongside conventional treatments.
Sometimes it is the point of being told one has recurrent or advancing disease that might encourage someone to come and have homeopathy and engaging hopefully with someone can be very important at this time of crisis.
In September 2005, Alison was diagnosed with aggressive breast cancer, one year after the birth of her baby boy, Owen, and the news was totally shocking. Suddenly she was a disease and not a person and she became very, very frightened and incapable of managing her life. Only one year before, she had had extensive tests on a breast lump that didn’t feel normal to her, but as she was breastfeeding and had experienced a degree of mastitis, specialists at Weston Super Mare PCT first diagnosed a permanently blocked milk-duct. The lump was re-checked by biopsy when Owen was one and out of the blue, Grade III cancer was diagnosed which had by then spread to nearby lymph nodes. She was immediately told to stop breastfeeding and urged to take a course of counselling. In the space of a couple of days she was told she would have a mastectomy followed by radiotherapy and months of chemotherapy. She was also told that the treatment would mean that is was very unlikely she would ever have any more children.
Alison comments: “I think I went to pieces. I just couldn’t cope with the news. I became very irrational about everything. My husband and family basically took over and managed all my appointments and took care of my son. Of course, I had to give up teaching.”
Alison was concerned about aspects of the planned treatment. As a violinist, she wanted to reduce any chance of lymphodema as permanently swollen arms would have made it difficult to play again. She transferred to Frenchay Hospital where Simon Cawthorn had an excellent track record for avoiding lymphodema, as well as an excellent reputation as a breast care surgeon. She had surgery within weeks.
The counselling she received had proved necessary and effective. “I was so angry and scared and I needed to find balance for my emotions in order to function properly.” She attended a three-day course at Penny Brohn Cancer Care, a wonderful holistic centre previously known as the Bristol Cancer Help Centre. “Going there saved me from a kind of madness as I had felt like an anomaly before. There were mothers of young children, like me, and even a woman who was pregnant when diagnosed. I decided to book on to a five-day retreat at the centre during my chemotherapy.”
The chemotherapy treatment took nine months, during which she felt very sick, was crushingly tired and lost her hair. Her days on retreat had helped her calm down and look at herself more objectively. Always an open-minded person, she was now determined to use everything and anything to get better. So when her oncologist Dr Braybrook suggested homeopathy, she agreed to go to the Bristol Homeopathic Hospital.
Alison was referred to the Complementary Cancer Care Service via her oncologist and began a course of treatment to help with the side-effects of chemotherapy, to help her come to terms with her condition and to try and ensure no relapse of the cancer.
“If I had to single out one complementary treatment that I really felt helped me the most,” comments Alison, “it would be homeopathy. Dr Thompson was fantastic; she spoke to me as a person, she really wanted to know how I ticked. She didn’t focus on my symptoms but she focused on me as a person, how I was emotionally coping and how she could help ease the emotional pain I felt.
“I remember her asking in one session how I was and telling her that I did not think it was possible to feel more emotional pain than I felt – I said ‘I feel like my heart is breaking’. Much of this pain was associated with the devastating news about my fertility and coming to terms with the fact that I would never have any more children. The remedy she prescribed changed me utterly and I turned a corner.”
Alison also has regular acupuncture, takes Chinese herbs, osteopathy and massage to keep her arms mobile and has changed her diet in line with advice from the Penny Brohn Centre, so that now she eats an almost vegan diet, avoiding meat and dairy products.
There are still difficult moments: Alison was put on a drug which brought about an early menopause, including all its symptoms. She said it “made me feel very tired and old! – older than my years, dragged down and heavy” but a repeat of her homeopathic remedy in a different potency took those symptoms away. She has had scares too – she was recalled after a mammogram, which turned out to be clear in the end. She says she is lucky to have a loving and close family, a great GP, a group of excellent complementary therapists and a wonderful homeopath.
Alison recognises how far she has travelled. “When I was diagnosed I was one person. I know that I left that person behind when I started on my journey to recovery. Homeopathy played a huge part in that. I was able to find out what really mattered in life.”
Alison adds, “I am really angry about the way some of the press ridicules homeopathy. Choosing your treatment is a personal thing and the right kind of treatment is different for different sorts of people, so different treatments need to be on offer so that you can make that choice. All I know is without my wonderful son, the love and support of my family and friends and the homeopathic treatment, I don’t think I could have done it.
“My homeopathic remedy is like my crutch – I seriously feel as if I can’t live without it. I don’t know what I would do without Dr Elizabeth Thompson and the Bristol NHS Homeopathic Hospital.”
Prescribing for Alison
There is always an uncertainty when prescribing homeopathic medicines particularly when we are trying to individualise remedies. Along with Mistletoe injections, I also prescribed X-ray 30c on the morning of radiotherapy, along with Belladonna in the afternoon, both of which have been shown in one placebo-controlled trial to reduce the inflammation of the skin and deeper tissues that is caused with radiotherapy.
The remedy that really seemed to create the turning point for Alison, was Stannum muriaticum. This is a remedy from the mineral kingdom and is a salt of tin. We think of tin as rather a dull metal but it is part of the silver series which we associate with people who are musicians, talented in performance and creative by nature. In order to gain accuracy with our prescribing we are learning to understand the mineral kingdom in terms of the structure of the Periodic Table: which row does someone need a medicine from and which column is most suitable? Stannum is found in the silver series or row 5 of the Periodic Table in column 14 and Stannum patients can feel a lot of anxiety around performance as if they are somehow failing.
Someone who needs Stannum has an inner experience that their performance is no longer admired and they can feel discarded and on the sidelines. Alison had said: “I am a performer and I like to perform. I am a violinist but I did lose a lot of confidence. I was so anxious, I would vomit prior to a performance.”
My initial remedy Kali arsenicosum did help with the nausea but her anxiety over the coming months if anything got worse and when Alison realised that she could not have any more children this was a huge grief to her. I asked her about this and she said, “I feel crushed, I have always managed to achieve, but I feel like God is a puppeteer. I feel I have lost out.” This feeling, like a puppet, is also known in the inner experience of Plumbum which again is in the same column as tin but Plumbum is found in the gold series.
There was also another element to Alison’s story which would match the experience of the chloride – muriaticum – element, in row 3, column 17 of the Periodic Table and one of the halogen group. The chloride element has a relationship with mothering and being mothered and there can be the experience to feel that one does not get the attention and reassurance one has needed and this leads to disappointment and feelings of being let down. When the halogen state is felt strongly it can make one feel hot, restless and caged, with an anxious desire to escape or get away. Both of these substances, Stannum and muriaticum relate to physical problems as well. Stannum has a relationship with cancer and with voice problems, with a loss of voice or stammering or a sense of weakness with the voice and hollowness in the chest with a hard, deep, painful cough, better for holding the chest. The stomach can feel weak and empty and there can be problems with the ovaries. Alison had a knife-like pain in the ovary at ovulation and the silver series can relate to the testes and the ovaries. The chloride, muriatic, element can often have a physical relationship with the sinuses and with nasal discharge and post-nasal drip andthere can be pain in the sinuses or tenderness in the breasts which can sometimes be related to the menstrual cycle.
Great thinkers in homeopathic practice have helped us understand these medicines and be able to predict how an unknown remedy might appear. Stannum muriaticum is not a well-known remedy and yet seemed to be a good match for Alison as an individual. Nothing replaces a proving, as often the emergent properties of a substance in nature and the symptom picture that emerges through a proving, cannot be predicated, but there are many remedies we would not be able to prescribe whilst waiting for provings to be carried out.
I have been offering homeopathy now for 12 years in the cancer setting and it has always brought me great joy to help people at any stage of their journey through this difficult illness. The joy has been watching people get back in control, manage difficult situations for themselves and sometimes transforming entirely as an individual. Many have described cancer as a wonderful opportunity to do things differently, to grow and learn about oneself. There is always sadness as well as I have lost patients along the way who had become an inspiration to me in my busy working day.
I have learned to be flexible within this challenging area of integration and allow people to make choices that feel right for them and always to see homeopathy as just part of a wheel of healing approaches that people explore and connect with to support them. At the moment we are developing a business plan to try and increase the number of complementary therapies delivered into the Oncology Centre, so they might be seen as an integral part of someone’s care rather than the icing on top of the cake. I would like to see more integration in the future, a greater awareness of the wisdom of the body, the part each individual plays in their own recovery plus the role CAM has to help empower people and adjust to living with a cancer diagnosis.
Elizabeth Thompson BAOxon MBBS MRCP FFHom is Lead Clinician for a thriving outpatient service from the Bristol Homeopathic Hospital with a team of twelve doctors. There is an active research and audit programme and Elizabeth is Academic Director for a seven-year academic teaching programme.