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Upfront About Breast Cancer Podcast

What You Don’t Know Until You Do, with Dr Charlotte Tottman: Episode 7

Episode 7: Upfront About Breast Cancer – What You Don’t Know Until You Do, with Dr Charlotte Tottman: The Next Version of You: Managing Expectations

Let’s be Upfront about managing expectations.  

In this episode of What You Don’t Know Until You Do, with Dr Charlotte Tottman, we hear about post treatment adjustment and the role that the expectations we have of ourselves, and the expectations others have of us play in a cancer experience.  

Charlotte reflects on how she changed various aspects of her life through her cancer journey to adjust to the next version of herself and find a way forward, rather than trying to find a way back to her pre cancer self. 

We recommend that listeners exercise self-care when listening to this podcast, as some may find the content upsetting. BCNA’s Helpline provides a free confidential telephone and email service for people diagnosed with breast cancer, their family and friends. Our experienced team can help with your questions and concerns and direct you to relevant resources and services. Call 1800 500 258 or email contact@bcna.org.au

Resources:

Upfront About Breast Cancer is a production of Breast Cancer Network Australia. Our theme music is by the late Tara Simmons, and this episode is proudly brought to you by JT Reid. 

Want to get in touch? Visit our website at bcna.org.au, email us at contact@bcna.org.au, or call our Helpline on 1800 500 258 

TRANSCRIPT:

Ad [00:00:00] BCNA’s helpline provides a free confidential telephone and email service for people diagnosed with breast cancer, their family and friends. Our experienced team can help with your questions and concerns and direct you to relevant resources and services. Call 1800 500 258 or email contact@bcna.org.au.

Kellie [00:00:40] Welcome back to the podcast Upfront About Breast Cancer, What You Don't Know Until You Do with Clinical Psychologist Dr Charlotte Tottman, In the last episode, Charlotte, who also has a lived experience of breast cancer, talked about post-treatment adjustment, a topic not often talked about, let alone addressed today. It's about finding the way forward rather than trying to find the way back to your old self, a reminder that this episode of Upfront About Breast Cancer is unscripted. Some of the topics discussed are not intended to replace medical advice nor represent the full spectrum of experience or clinical options. So please exercise self-care when listening as the content may be triggering or upsetting for some. Welcome back, Charlotte.

Charlotte [00:01:26] Hi Kellie.

Kellie [00:01:27] And the next version of you. So many people crave getting back to their old life, to their old self, and it would seem that a little futile.

Charlotte [00:01:39] Yeah, and not only do they crave it, but they sort of often impatient for it so that it's not just that they want it, but they kind of want it straight away. Almost as the last chemo session or the last radiation treatment finishes, it's kind of like, Okay, right next. Next week, I'm going to be back. And that is something that they often come to realise is not possible. And that can set up lots of frustration, feelings of disappointment and feeling like a failure. This is often when I get referrals, when people are really struggling in that post-treatment phase. The other medical appointments have kind of largely resolved. Instead of opening a diary and finding every single day covered with multiple medical appointments, they've got gaps in time to think, and they're starting to realise that actually things are perhaps going to be the way that they were, and they're not often happy about that.

Kellie [00:02:35] Okay, so even yourself possibly thought that you'd swing back into your old life, too?

Charlotte [00:02:42] Yeah. Well, I mean, as we were discussing in the last episode, I think, you know, on reflection, I sort of hid it in my work. I went back too soon. I did too much and it took a big psychological crisis, a big crash several months later for me to kind of really come to grips with the fact that I couldn't go back. And in fact, what I was doing was, you know, everything that I see so many of my clients struggle with. And I was really resisting the fact that I was not the same. And not only was I not the same, but I wasn't ever going to be the same. And I tell you when I when I have those discussions with clients, when I have that discussion with myself back then, there is a really often a really strong resistant that idea that something else has wrought such a massive change on our life, unexpected and uninvited is so unacceptable, and we want to reclaim because we are so pissed off at the fact that that's happened.

Kellie [00:03:45] Okay. So as I said in my intro, quite often it's trying to get back to the way life was, to the way you were, to the way everything was. And even when we have those revelations of I'm going to be a better writer, but this is a bit of that, you know, a bit of a perspective change. Hmm. Is it just a case of time or is it that you have to move on to the next version of you?

Charlotte [00:04:11] I really believe, and certainly the evidence supports the fact that you don't ever go back to being the same person. And the reason for that is both on the physical front and the psychological front. If you think about the physical changes and I know we touched on this last episode, but it bears repeating the physical changes that are imposed upon you because of cancer treatment. You know, many they can be the loss of tissue, they can be scars, they can be white changes. They can be things like nail and hair and skin changes. So they are substantial and they are long lasting. And the psychological changes are also large and they don't just resolve. And for example, I know I will always be fearful of the cancer returning, so I didn't have that before diagnosis. So that means that psychologically I am now a different person. I worry about my body image. I worried about it a little bit before diagnosis. I worry about a lot more now. That sort of stuff is a change. And even if you work on those things and you reconcile and you come to grips with them, you're still different than you were before. And as with most things in psychology, once you kind of become more aware and you do confront the things that are making you feel uncomfortable, you actually do better. And in this case, confronting them sounds a bit uncomfortable. But it's kind of embracing the fact that, okay, there is a next version of me. I quite often use the analogy of a book and language in this space is quite important, and I know you and I have discussed, you know, the new normal, which is often used around post-treatment adjustment and is so overused at the moment in the covered space. And we're all sick to death of it, which is one of the reasons that we haven't used that sort of language here. And language is important because it reflects our thoughts. You can call it what you like the next version of you, the new normal Charlotte 2.0, but it is about embracing, acknowledging. And like I talked about last time, it's that adjustment process of coming to grips with the fact that this thing that was bigger than new has happened. And you can't turn back time. And once you can get to that place and you can actually kind of go or do you know what this next chapter of my of my story, my life? It doesn't have to be better or worse. It doesn't have to be measured against what my life was before. It can just be the next part of my life. And a lot of people fall into the trap of thinking that that this will somehow be a lesser version of them, that this will be somehow substandard and compromised. And I get why that would be. Because of course, coming through cancer like that would be quite a reasonable conclusion to draw. But because of the other things that go on that we've already discussed in some of the other episodes, like the perspectives shift, like realigning your values and priorities, maybe doing things a little bit differently, prioritising your own well-being. You can actually make this next version of you, match your values and give you the quality of life that you really want.

Kellie [00:07:17] OK, so also in the last episode when we were talking about post-treatment adjustment, the next version and all the new normal, whatever you call it, happens at different stages for everybody. And sometimes usually in that two-year period post. Yeah, the conclusion of treatment for you. You had the big meltdown and took some time off to realign. And then as you started to re-enter your life sort of in a bigger capacity by yet turning to work, I assume this is when the new version of you began to come out emerge. Yes, absolutely yes. So what's the new version? Or the next version of Charlotte vs. the old version of Charlotte?

Charlotte [00:08:06] Yeah, so I was quite conscious of this once I go through the early weeks of the meltdown because I thought it certainly gave me better insight into this experience and I started to write down if I am to embrace this, you know, even if I've come to it reluctantly with a lot of resistance. But if I am now at that acknowledgement stage of adjustment and I am going to embrace this new version of me, let's figure out, is it one thing, two things? So I started to write it down and to be truthful, it's kind of a list that still it's still growing. It's the pace of the list is slowing down. I don't add that much to it every every week or every month, but I'm conscious that I'm still learning how to live this next version. So some of the things that are different are, and I touched on this in the last episode is that I work a bit less, so I work 20 per cent less, which is a whole day a week, which is not a small amount. I go to bed earlier, so I'm in bed and asleep by 9pm. I sleep in a bigger bed. That was a big thing now. It sounds weird, but for those women who are on hormone blockers or have gone into chemical menopause, you will appreciate the joy of hot flushes. Not I call them sauna bombs because I feel like hot flushes just does not do justice to the actual feeling that that you have with a hot flush. I mean, I feel like I could power a small village with the energy that my body produces in a in a hot flush. And I get these. It's so disgusting, but women will relate to this. You know that bit of your neck where it's like your bones. I think it's your clavicle. My sweat forms rock pools. It's just so disgusting. And so one of the things that that we were mindful of Rob and I were mindful of, particularly because as I was describing last episode, I had this chronic insomnia was we were looking for anything that was going to improve the sleep. And so and not chim and not drain. Absolutely. I mean, I was it was like sleeping with, I, you know, with an active volcano in so many ways, physically and emotionally. Our three, probably one of the second best, not just a bigger bed. So I had long thought that a good mattress and a bigger bed. Was it just a bit, I don't know. I just I don't know why. I just thought that might make a difference anyway. We bought a bigger bed. Oh my goodness. It definitely has helped my sleep. I mean, so did the sleeping medication. But just that, that not being close to another human when you are literally burning up and also not being worried about disturbing him, that was a big thing. I felt so guilty that I was, you know, disturbing his precious sleep as well. So, yeah, a bigger bed was a big thing. I think has, as I said last time, I say no more. I'm much better about boundary setting, as we call it, particularly to social stuff. I don't apologise anymore. I don't I don't feel obligated to explain. I'm polite, but I just say no more things like I do stuff that's aligned with my values, more so I do more of this sort of stuff. I do more work with BCNA. I do more work with other cancer organisations. I feel that that's very important to me. And whereas I mean, this works always been important to me, but now it has a whole other, I guess, level of meaning. And I am happy. I want to put energy into that. I make more time for myself. I exercise if I can. I mean, I sound like a saint. I'm so not much, but I try and exercise every day what I do and this and this is something I do really strongly encourage other people to do, is with things like exercise. We can get sucked into sort of black and white thinking, which is kind of like, I'll have this perfect idea that I'm going to do 15 minutes on the treadmill every day, and that's going to be amazing. And then when I don't do it, once I got like, what's the what's the ball that I'll just won't do it ever again? And that's not obviously helpful. So when I start to feel, you know, I seduced by the idea of sitting down and watching the TV rather than getting on the treadmill, I just say to myself, OK, let go of let go of how long you're going to be on it or how fast you're going to go or anything like that. Just put your sneakers on and get on it and just get on it, even if you're only going to be out for a minute. And guess what happens? I get on it, and generally I stay on it for a reasonable amount of time, but it's it's just having that kind of willingness to go, look, something's better than nothing. So even if I don't, do you know that perfect idea of like, what's going to be good for me, just doing something that's aligned with what I now view as so important to me, would you?

Kellie [00:12:49] On the topic of perfect, would you have prior to your diagnosis? Consider yourself a perfectionist. And has that changed?

Charlotte [00:13:01] Yeah. I mean, my children will they've said that they will put on my headstone that my catchphrases was, I should say. Presentation is everything. So I definitely have a tendency towards perfectionism. And I am still vulnerable to that, but I am much better at letting go of stuff. It'd be interesting if we did a survey of people in my life how many people would agree with that statement, but I feel that's true.

Kellie [00:13:31] But it's like you're saying it's not. It doesn't have to be a complete overhaul. Not, of you. It's not.

Charlotte [00:13:38] It's just it's not like the next chapter. That's right. Exactly. You don't go from black to white. You just you just move a little bit on the continuum. And that's a good point to raise is that is that with most things in life, it's really binary. It's really one or the other. It's just that you sit somewhere along a spectrum. And so if I was quite far along the end of perfectionism, I've probably come back a little bit, you know, just off the boil to a simmer. And that's good. That's good for me. It's good for the people around me. It's less pressure and it gives me more pace and it gives me more time and energy to dedicate to other things. Yeah, definitely. I am less perfectionistic. Not all of the time, but some of the time

Kellie [00:14:21] You went from being full time and very full time at work to pulling back. So that's the change that you've made in your professional life. And I think you admitted that prior to the diagnosis, you always believed that. Everything would fall apart if you stopped working as much as you did, and thankfully it hasn't, the world's continued to turn. Hmm. What about what about at home? Has everything swung back into the roles that everyone had beforehand?

Charlotte [00:14:51] No. One thing that was really interesting was that when I got when I was diagnosed and this happened almost instantly without any discussion, which is sort of odd, but I don't know is that I stopped cooking and now I really cook. It's not because I don't know, if I don't want to cook, but I'm not cooking. What happened in the short term was, you know, as most people don't understand, we dive headlong into that treatment decision making scan's surgery. Hoo ha. And we had at that stage one adult child living at home and then our other daughter came home from overseas to be with us. So we had a couple of adult children, and my husband is an amazing cook and I had done the lion's share. Not all of it, but I had done the lion's share of the cooking across our child rearing years. And I just stopped. I kind of haven't started

Kellie [00:15:43] Again and no one starved

Charlotte [00:15:46] And no one starved and the world didn't stop turning. And goodness me, the meals are still amazing, possibly more amazing. Yeah, that's been a really fascinating thing. And we talk about and it's it is a bit of an odd one because I would say I like cooking and I would say I'm not bad at cooking again. It's something that that was probably partly at least partly about control, and I have just kind of gone to, you know, wash, I don't need to do that. And now sometimes if I do cook, I mean, I might cook once a fortnight, maybe not even it's much more for pleasure. Rather than that sort of like a there has to be food on the table for six people. So that's been an interesting thing and

Kellie [00:16:23] Unlikely to happen in most households

Charlotte [00:16:25] And unlikely to happen in most households, for sure. And this brings me to probably the point of expectations, which is that we all have expectations of ourselves and our loved ones and our social networks similarly have expectations of us. And those expectations are built on years and years, usually decades of experience for a lot of people, not for everyone, but for a lot of people. Cancer comes along in your point. When you've been you, you've kind of got a reasonably well established life. You know, you might have children and like a partner in a household, in a job. And even if you haven't got all of those things, you've probably got some pretty well established behaviours and those behaviours set up expectations. They operate as standards and motivators, and they can be really helpful in your pre-cancer life because they keep you going. They get you out of bed every morning. They keep you juggling all those balls and getting stuff done. And we educate other people about what to expect from us by our own behaviour. So if you've always been the person bringing the oranges to the netball on Saturday, guess what? Everyone's going to expect that you as soon as you get finished with that pesky cancer treatment, you're going to. Similarly, we'll be right back with those oranges at the netball on Saturday because women are socialised around this. This thing about being agreeable and kind of smoothing the rough edges of life and keeping all the family balls in the air. We often don't sit back in those early days post hospital treatment. We don't sit back and kind of got enough. I really do want to do the oranges at netball or I don't know if I've got the time or the energy to do the orange, the navel. So we try and do it, and we might find that. Actually, I don't know if I can. I don't know if I've got time. I don't know if I've got the resources are enough. I've got the inclination. But the risk is that we do because of the expectations of others, because we've dragged those expectations and behaviours and motivators from our pre-cancer life into our post cancer life. And sometimes, well, not even sometimes almost always, we find that they just don't fit. And that's when we come up short and feel quite frustrated and disappointed and like a failure because some of the stuff that we just used to do, like breathing, is now much harder and doesn't seem to fit and doesn't seem to feel the same.

Kellie [00:18:47] When we're talking about other people's expectations. Hmm. What does that include?

Charlotte [00:18:53] It can be well summed up in this thing I call the tyranny of competence, and that is that women are often incredibly competent, multi-tasking human beings. And it doesn't matter whether you've got a big career or a big family or just a big life or just a life, really. We're very used to being the competent ones. And the problem with that is that the more competent we are, the more competent we expect ourselves to be, and also the more competent other people expect us to be. And so that can lead to really quite high expectations of us to be back being that person. We were pre diagnosis as soon as possible and in a. Addition to that, we've often got quite a lot of pressure because by this time we're often looking and sounding pretty much the same as we did. He has grown back. Clothes are back on. I'm not wearing a tracksuit all the time. I'm not lying around on the couch. I'm actually up and about and doing stuff, driving people around that sort of thing. And so people start to because humans taking information through their eyes. So if you look mostly the same as you did before cancer, then the assumption is that you are mostly the same. And this is a really important thing, and I do often talk to my clients about this, about sometimes we have to be really explicit with language, about saying, I know I might look, you know, like things are kind of okay, I might look good and who doesn't like to look good? But how I look on the outside is really not representative of how I'm feeling on the inside. And sometimes we actually have to say that stuff to start to re-educate the people around us about the fact that things have changed and that aren't going to go back to the way they were.

Ad [00:20:39] BCNA’s Online Network is an active peer to peer support community where people affected by breast cancer can find information and connect with others who understand what you're going through. Read posts, write your own, ask a question, start a discussion and support others. The online network is available for you at every stage of your breast cancer journey, as well as your family, partner and friends. For more information visit BCNA dot org dot today you forward slash online network.

Kellie [00:21:11] Maybe I need to go a step back before you start educating others. There must be even like with your experience, that resistance. Absolutely. And before you acknowledge that you are possibly resisting what are maybe some of the forms that resistance might present?

Charlotte [00:21:33] Often it's about trying to resume activities at the same speed frequency standard and whether it's in a work context or a parenting context or a caregiving context or study. It's about kind of just trying to go back and pick up as if none of this stuff happened. I mean, I've had people plan parties, large parties to happen literally the week after radiation treatment finished and then be frustrated and disappointed when they simply obviously found that they were just not up to it at all.

Kellie [00:22:13] It's worth pointing out that radiation tends to have a cumulative effect.

Charlotte [00:22:17] It has its effect and has a lag. Yeah, exactly. And even once you're past the treatment side effect of that, that the adjustment process and actually, you know, feeling like you can go back to what you were doing if you like from a standing start, because I think that's the other thing is that through the course of treatment, physically, we are so depleted, you know, each chemo, each radiation session, surgery recovery, it's kind of like going down a staircase. Each one of those sessions takes you one step lower. So then when you finish, it's not like you're back at ground zero, you're back at the bottom of a really deep staircase. And it's going to take you, frankly, many months to climb back up to something that looks and feels a bit like ground zero. Except that the effort and the changes that have happened during that time means that whoever emerges at the top of that staircase isn't going to be the same person that went down there in the first place.

Kellie [00:23:18] And the look might be halfway up the staircase and the feel might be still at the bottom of the staircase, correct? And

Charlotte [00:23:22] And the end that is so important that whole look feel clash. Because of course, the other thing is, and we were talking about this with body image is that, you know, you're looking at yourself and it's not just other people looking at you, but you're looking at yourself and you're starting to go, Oh, you know, I'm actually not looking like I did with no hair and no eyebrows, and I'm not looking like I did with, you know, my scars are healing and I've got the hang of what I'm wearing. And, you know, I've got some of my colour back and I and I can move. And so your brain's going, OK, I am kind of starting to look more like I did. The risk is that we then make an assumption that I'm going to end up very quickly exactly like I was. And this is the thing that you may well end up look, I mean, I look pretty like if we looked at photos of me pre diagnosis now, apart from natural ageing, thank you very much. I don't look that different with my clothes on. I look incredibly different with my clothes off, but with my clothes on, I don't all that different now. If we use that as the basis of judging kind of like how much the same everything is, a lot of people would naturally assume that everything's kind of back. Normal, and it certainly isn't. So that whole thing about people taking in information through their eyes is so important.

Kellie [00:24:44] It makes me think of not a lot of people, but there are people who have had breast cancer who once saw the treatment, and everything's finished. They actually don't want to speak about it again. They almost want to airbrush it. Don't bring it up. I don't want to be reminded, is that apart from exhausting, I'd imagine counterproductive.

Charlotte [00:25:07] Yes, it is. It's a form of avoidance. And you know, on the one hand, not surprising because if we're resistant to the idea that things have changed now, we liked our life before, we'd really like to get back to our life before. So we're holding on to that resistance. We want to avoid anything that makes us confront the reality and say, if we don't talk about it, we don't say the word. We don't, sometimes we don't share. And that certainly is a thing where people have managed quite it's quite impressive the level to which people will go to keep that information secret. I certainly have seen people over the years who have kept their diagnosis or big parts of their treatment secret from family members or colleagues. And one of the things that people don't necessarily appreciate is that secret keeping. As you just said, is exhausting. You have to double and triple think everything what you've said to home and do that not just sort of once, every so often, but often on a daily basis, particularly if it's people closest to you that you're keeping the secret from. So avoidance is a year is often a very big part of this difficulty in adjusting what you see in people who are adjusted. I don't know that I'd say it's a comfort that that feels like it's overstating it, but it's a willingness to kind of go there and just be real about it and be like, Yeah, I mean, that happened and things are different and I'm getting the hang of it. And it's not necessarily a smooth ride, but I am reconciled to the fact that that chapter of my life is closed.

Kellie [00:26:47] So that's acknowledgement.

Charlotte [00:26:49] That is acknowledgement.

Kellie [00:26:51] Which isn't easy, as you've pointed out. And what do you have to be happy about it? Do you have to embrace it?

Charlotte [00:26:57] No, you know, you don't. And I think that's the other thing is that that positive pressure thing of which I imagine a lot of people have experienced where the messages from people around us, often with the best of intentions, can be, you know, like, you know, you're so lucky we caught it early and you're so lucky that you know, you got through the treatment, you know, relatively unscathed. And I feel like saying, and I don't usually, but I feel like saying, ‘Yeah, I'm so lucky’. I don't have any breasts, you know, because it doesn't feel lucky, it doesn't feel fortunate, and it doesn't feel very authentic to sort of go, Yeah, I'm so down with this, like, this is exactly the life I wanted. So it's not about being happy with it, but it is about acknowledging it as a reality and going, you know, this has happened and even acknowledging the fact that you're not happy about it because I think that's one of the things that we see in resistance is that when you don't talk about what happened, you know, also not talking about how you feel about it, you're not talking about the fact that it is actually eating you up inside and that that is causing you this distress. Whereas once you can start to talk about it and you can say, Do you know what? I am not happy that I don't have any breasts. On the other hand, I'm quite happy that I'm alive. So, you know, it's a comparison wrestling with that tension some days. But being able to talk about it is so much better than sitting with the distress and sitting alone in the distress because you are keeping secrets from other people.

Kellie [00:28:26] And that leads back to emotional isolation, which is a very unfortunate place to be. Correct. Okay. So you don't have to be happy about it. You need to acknowledge it. What are some of the other things that help to get you along that path of acknowledging.

Charlotte [00:28:43] The thing that when I was talking before about expectations and how important expectations are in this adjustment space is that, you know, we often as women, we go into this part of our life, this post treatment adjustment phase with these really high expectations based on our previous experience of being bold jugglers, multitaskers, problem solvers, the better that smooths the wheels of life. And then we find that we aren't able to do things the same way that we used to do. And so I say to my clients, the antidote for this is what I call it recalibrating expectations. Fancy language for just changing your expectations of yourself. So easy to say, much harder to do. And so when people say, ‘Okay, well, how do I do that?’ I say, ‘Alright, well, let's use maths’. Maths is cool. This is just very quick and dirty, but it works if something used to take. Three hours to do it doesn't matter what it is, doesn't matter if it's like a spreadsheet or cleaning the house or mowing the lawns or whatever. If it used to take you three hours to do. I encourage people to add on a half to a third. So you go, Okay, it's going to take me four or four and a half hours to do the same job as it used to before. So what you've done there is you've shifted your expectations in terms of how long if you had a standard to which you would do something. So, you know, as a perfectionist, if I was going to do something, it would have to be to 100 per cent. Yeah, it's about adjusting that standard down and going, okay, if I'm going to, this sounds lean, but this is it. This is a real-life example of me. If I'm going to wash my windows, I'm not going to 100 per cent anymore. I'm going for about 80 per cent. I don't care if there's a few dog hairs there anymore. Before I would have kept going and going and going until that, those suckers were clean. Now I'm like, Yeah, you know, they're a lot cleaner than they were before I started. That'll do. And the other thing I go is, is, again, using maths is if you would do something for a certain amount of time that required kind of energy, let's just say standing on the side of a of an netball game like I was saying before and maybe before, you are able to do that for two hours. I encourage people to again use maths and divide by a third or a half, so then say, ‘Okay, well, I'll probably then allow myself the chance to stand on the sidelines for maybe an hour or maybe like an hour and a bit less than an hour. So about 40 minutes’. So it's about just using something as clean and dry as maths to be able to recalibrate your expectations, also then gives you something much more tangible and concrete to communicate to others. So instead of just sort of going like, Oh, I don't know if I can come for the whole thing or I don't know if that's something that I can manage today. It's about going well, OK, maybe I can do it, but I'm going to do a little bit differently, so I'm going to be there for this long or it's going to take me that much longer to do it or if I do it. But I'm just just giving you a heads up might not be quite the way I used to be done, but it'll be done the new way. It's that sort of thing.

Kellie [00:31:42] The lesson, I guess, is that the next version of you is coming regardless of your diagnosis. And there's two ways to learn about it the hard way or the proactive way.

Charlotte [00:31:56] Yeah, I mean, I would love to think that it could be more proactive more often and I think that's where, you know, organisations like BCNA, the work that I'm doing with them, where we're probably going to try and work in that space a bit more to start getting this message out a bit sooner so that it doesn't come as this unpleasant shock at the end of hospital-based treatment. I think it would be great if people just had it on the horizon that there could be a bit of a dip coming. And these are some things to start thinking about. Rather than getting to the dip and the dip being more like a bloody great cliff or also just feeling like, well, I wish someone had told me a bit sooner so that I could have really got my head in. The game has some very real implications for things like returning to work or returning to study. I mean, if you know in advance, you can you can make plans, you can. And that has, you know, financial implications, childcare implications, all sorts of stuff. So it would help smooth that pathway as well. I think if we were talking about this stuff a bit sooner.

Kellie [00:33:03] Absolutely. And it would seem the next version of you might also lead to the realisation that some new ways to view intimacy might be in order. I think we'll talk about that in our next episode. And if this episode has helped you go ahead and share it with someone else who might benefit. Subscribe to the podcast to ensure you never miss an episode. Write and review it. And if you have a few minutes, there's a survey in the show notes. It helps BCNA create content that's relevant. Don't forget, My Journey provides tailored information to give you all the information you need and nothing you don’t, sign up at My Journey. Are you connecting with others? Full support is also a great way to know you're not alone in this. Join BCNA’s online network on the website. Coming up next time on the podcast, Yep, we're going there. Intimacy after breast cancer,

Episode preview [00:34:02] You get to a point with your intimacy partner where you've kind of got like a repertoire of intimacy and sexuality kind of moves a bit like dance steps. We don't use the same moves every single time, but we draw on maybe a set of moves. If you like those moves that repertoire has built up over time. They rely on a whole lot of things. Most importantly, they kind of rely on body parts. They rely on bits of you actually being there, being present, but they also rely on things like responses, sexual responses. Physical responses, psychological responses. They rely on it, not hurting. They rely on confidence and they rely on familiarity. But once you've had cancer treatment, a lot of that stuff changes. If you try and apply those same dance steps and you haven't got those necessary components. It can not work.

Kellie [00:34:58] Thanks for joining us. I'm Kellie Curtain. It's good to be upfront.

Ends [00:35:03] Thanks for listening to Upfront About Breast Cancer, What You Don't Know Until You Do, with Dr Charlotte Tottman brought to you by the Breast Cancer Network Australia and proudly supported by JT Reid.