The Benefits of Exercise During Cancer Recovery

Many people resolve in the new year to get more exercise. Today we are delighted to provide information from Karen Wonders, Ph.D., FACSM, a member of the Triage Cancer Speakers Bureau and Executive Director of Maple Tree Cancer Alliance.  

Cancer and its associated treatments often result in long-term physical and Exercise-after-cancerpsychological side effects that impact the survivor’s quality of life. More than two decades of research support the efficacy of exercise and positive physiological and psychological changes in cancer survivors. These include improvements in VO2 max, which in turn improve heart and lung function and promote a healthy blood pressure, blood volume, and gas exchange. In addition, improvements in quality of life, muscular strength and endurance, fatigue reduction, anxiety, depression, body image, immune function and emotional well-being have been reported. In response to this overwhelming research, organizations like the National Comprehensive Cancer Network, Commission on Cancer, and American Cancer Society have recommend that exercise serve as an integral part of an individual’s cancer care plan.

Patients should talk with their health care team prior to starting an exercise regimen. Once clearance is obtained, the ideal exercise program would be individualized to uniquely meet each patient’s strengths and weaknesses. Each person responds differently to treatment, and it is important for the cancer exercise trainer to understand and identify limitations that could hinder patient progress. The overall goal of the exercise program should be to minimize the general de-conditioning that often results from cancer treatment so that the cancer treatments are better tolerated.  In general, the exercise prescription should include a slow progression and demonstrate adaptability to changes in the patient’s health status, which frequently will change from day-to-day during treatment.

Each exercise training session should include a whole-body workout that targets all the major muscle groups, and consist of the following components:

  • Warm up: Begin each session with a 5- to 10-minute warm-up that stimulates blood flow to the working muscles. Warm-up activities may include walking or jogging to increase the body temperature and other physiologic responses, as well as decrease the chance of injury. Warm-up activities are also important to help ensure that the muscles and cardiovascular system are prepared for the activities to come in the training session.
  • Aerobic Component: ACSM recommends aerobic training 3-5 days each week, for 20-60 minutes each session. Appropriate modes of aerobic exercise include walking, cycling, or swimming (if infection is not a concern). During the aerobic component of exercise, it is important to frequently monitor blood pressure and heart rate. If the patient is on a medication that effects heart rate, the Borg Scale of Exertion may be used to monitor intensity. Based on this scale, a light-to-moderate intensity (RPE of 11 to 14) should be encouraged. If dizziness, nausea, or chest pain occurs, all exercise should be stopped. Frequent short breaks are sometimes encouraged to accommodate therapy-related fatigue.
  • Resistance Training: The type of resistance exercise performed will depend on the patient’s range of motion, tissue removal, and wound healing. Ideally, the patient should strive for 2-3 days/week of 1-3 sets, 8-12 reps per exercise. Appropriate modes include free weights, machines, resistance bands, as well as traditional body weight exercises. ACSM recommends at least 48 hours of rest between each resistance training session. Therefore, it may be advisable to plan a whole-body approach to resistance training, where all major muscle groups are targeted in one day. If the patient is unwilling or unable to participate in traditional modes of strength training, Yoga or Pilates may serve as an alternative form of strength exercise.
  • Flexibility Training: Aerobic exercise should be followed up by static stretching and range of motion exercises for all major muscle groups. Muscles should be stretched to the point of mild discomfort and held for 10-30 seconds per stretch.
  • Cool Down: Cool-down activities provide a reduction in injury risk occurring after an intense bout of exercise. The cool down should consist of less intense exercises and stretches to relax and lengthen the muscle and promote range of motion. The cool-down allows for a gradual reduction in the level of metabolic activity achieved during exercise training.

Initially, the intensity of exercise will depend on the patient’s functional status and exercise history prior to cancer diagnosis. Typically, previously active cancer patients may continue their exercise regimen, although intensity may need to be decreased during treatment.  Progression should consist of increases in frequency and duration rather than intensity.

Maple Tree Cancer Alliance is a national organization with a growing platform that can help patients get started with an exercise program. For more information about our programs, check out our website: www.mapletreecanceralliance.org.

With the right support in place, the patient will be encouraged to adopt an active lifestyle for life!

Need Insurance for 2018? Don’t Miss Out!

Open enrollment to buy private health insurance coverage for 2018 through Miss-Out-Smallwww.HealthCare.gov ends on Friday. Note: Medicaid applications are accepted year round.

But don’t wait until the last minute, to avoid any potential issues, like the website crashing with last minute sign-ups.

Crucial news you can use:

Were you impacted by the Equifax data breach? Did you freeze your credit report, to protect your credit? This may actually slow down your ability to sign up for health insurance coverage, because www.HealthCare.gov actually uses credit reports to verify your identity.  There is a workaround, but it make take your application longer, so don’t wait to enroll.

Do you live in one of these states?

  • California, D.C., Massachusetts, New York, Rhode Island – November 1 to January 31
  • Colorado – November 1 to January 12
  • Connecticut – November 1 to December 22
  • Maryland – November 1 to December 22
  • Minnesota – November 1 to January 14
  • Washington – November 1 to January 1

You have more time to sign up for coverage, but if you want your coverage to start on January 1, 2018, then you need to sign up by December 15.

Live in an area affected by the recent hurricanes?

Then you might have more time, too.  Read more here.

You may qualify for financial assistance.

For 2018, 8 in 10 people have Marketplace health insurance options for $75 or less, a month. This is mostly due to the premium tax credits available to people based on their income level.

Even though the Administration has said that they will no longer pay the insurance companies back for providing cost-sharing subsidies (aka cost-sharing reductions), the insurance companies still have to provide those discounts to consumers.

Is your 2017 plan not available for 2018?

If the health insurance plan that you have now is no longer being offered in 2018, you need to go to the Marketplace to see what your new options are and pick the best plan for you.  If you don’t, you will likely be automatically enrolled in a new plan that might be more expensive or not cover your providers.  It is crucial you take the time to shop around to make sure you get the coverage you need.

Find health insurance confusing?

Then watch our short video which breaks down the key things you need to know.

You can also watch our webinar on choosing a health insurance policy.

10 Ways Medicaid Affects Us All

Medicaid was created in 1965 as a program for the poor. Today, it helps 74 million people — more than 1 of every 5 people in the U.S. You or someone you know likely benefits.

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Sources: George Washington University study/Women’s Health Issues journal, The Kaiser Family Foundation

Big School Booster

Medicaid paid for nearly $4 billion in school-based health care services in 2015.

Dependent Children

Medicaid aimed, at its start, to insure healthy children and pregnant women. Children are still the largest demographic group served. How Medicaid coverage breaks down:

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Where The Money Goes

But a look at who benefits from Medicaid spending shows a different story.

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Sustaining Livelihoods

About 60 percent of non-disabled Medicaid adult enrollees have a job.

 

 

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Coverage Forecast

Most Medicaid enrollees churn in and out of the program every few years, depending on their circumstances. Odds are 1 in 4 you might need this safety net one day.

The article in its entirety can be found here. This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation

 

Taking Time Off: How laws work together

Often the ways that federal laws, state laws, and employer policies work together are like puzzle pieces fitting together.  Except that everyone’s puzzle is going to look a little different, depending on which laws apply to you, which state you live in, and what benefits are offered by your employer.

When you are thinking about taking time off work, you may have multiple options or puzzle pieces available to you.  In fact, many patients ask us, “Can I use my sick time, then my vacation time, and then my FMLA, and then I also have a short-term disability policy at work. Can I string them all out to cover all the time that I need to be away from work because of my cancer treatment?” And the answer is, it depends.

First, the FMLA can work with paid leave options and disability insurance.

Family and Medical Leave Act (FMLA): the FMLA is a federal law that provides eligible employees with up to 12 weeks of unpaid, but job protected leave, per year. For more information about the FMLA, read Triage Cancer’s Quick Guide to the FMLA.

Paid Time Off (PTO): Your employer may give you vacation days, sick days, or maybe just a general bank of PTO hours for you to use for vacation or sick leave. If you are not familiar with what your employer offers, contact your human resources representative or review your employee manual.

Disability Insurance: If you have to take some time off because of a medical condition, or have determined you are unable to work at all, the next thing you have to understand, is how you might be able to replace your lost wages. That is where disability insurance comes into play. Disability insurance benefits can be purchased directly from a private insurance company, or can be offered by an employer, some state governments, or the federal government. Get more, customized information about disability insurance at http://cancerfinances.org, or check out Triage Cancer’s Quick Guide to Disability Insurance

Finding out if you have any or all these options available to you, is the first step in the process.  Figuring out how they can work together is the next step.

Case Study #1: Jane has 3 weeks of vacation, 3 weeks of sick time, her employer is covered by the FMLA, and her employer offers a short-term disability insurance policy that last up to 12 months.  Jane thinks that she will need to be out of work for 12 weeks. What are Jane’s options?
How laws work togther CS1

As shown in the picture above, Jane can use all of her benefits together, concurrently.  In fact, her employer can require her to substitute the unpaid leave under the FMLA, with any paid leave that she has (e.g., her sick time hours). But, if her employer doesn’t require her to do that, and she still wants to, her employer must allow her to:

  1. Take her 12 weeks off work under the FMLA, which provides her with job protection and maintains her health insurance
  2. For the first 3 weeks that she is off, she is paid by her vacation days
  3. For the next 3 weeks that she is off, she is paid by her sick time
  4. And, for the final 6 weeks, she is paid a portion of her salary by her short-term disability policy.

Using these benefits together allows Jane to maintain her income, while also protecting her job and access to health insurance coverage.

If Jane prefers to string out her sick time, vacation time, then use her FMLA and short-term disability benefits, she may be able to do that, but only if her employer allows her to. However, Jane should know that just taking sick time or vacation time, or receiving short-term disability benefits does not protect her job.  In this situation, it is the FMLA that is providing the job protection.

Second, the FMLA and the ADA can work together to give you access to time off from work because of your medical condition.

Americans with Disabilities (ADA): The ADA is a federal law that provides eligible employees with disabilities protection from discrimination in the workplace, as well as access to reasonable accommodations. Reasonable accommodations can be anything from modifications in schedule, workplace environment, use of technology, telecommuting, and more. Employers are required to accommodate eligible individuals. For more information about the ADA, read Triage Cancer’s Quick Guide to the ADA. For more information about reasonable accommodations, read Triage Cancer’s Quick Guide to Reasonable Accommodations. Note, the ADA only applies to private employers with 15 or more employees, as well as state or local governments. If you work for a smaller employer, you may be covered by your state’s fair employment law.

If you have used up your 12 weeks of FMLA leave during a 12 month period, you may be eligible for additional time off as a reasonable accommodation under the ADA. However, court cases have suggested that additional time off as a reasonable accommodation will only be considered reasonable if the request for additional leave is for a definite period of time. How long is considered reasonable will depend on your job responsibilities and your workplace.

Case Study #2: Mark has 3 weeks of vacation, 3 weeks of sick time, his employer is covered by the FMLA, and his employer offers a short-term disability insurance policy that last up to 12 months.  Mark thinks that he will need to be out of work for 15 weeks. What are Mark’s options?

How laws work togther CS2

As shown in the picture above, Mark can use all of his benefits together, concurrently.  If he wants to, his employer must allow him to:

  1. Take his 12 weeks off work under the FMLA, which provides him with job protection and maintains his health insurance
  2. Take the remaining 3 weeks off work as a reasonable accommodation under the ADA. which provides him with job protection
  3. For the first 3 weeks that he is off, he is paid by his vacation days
  4. For the next 3 weeks that he is off, he is paid by his sick time
  5. And, for the final 9 weeks, he is paid a portion of his salary by his short-term disability policy.

Using these benefits together allows Mark to maintain him income, while also protecting his job and access to health insurance coverage.

As you can see, there are lots of details to using these laws and benefits. It is crucial to learn about all of your options before making decisions about taking time off from work, to ensure that you are making educated decisions, and putting together the best puzzle for you.

Visit http://TriageCancer.org for additional cancer survivorship information and educational events.  

Living Paycheck to Paycheck and then . . . Cancer!

Paycheck to PaycheckAt the beginning of 2016, headlines all over the country read something like “63% Of Americans Don’t Have Enough Savings to Cover A $500 Emergency.”  This alarming statistic was according to a 2015 study by Bankrate.com.  What it really meant is that nearly two-thirds of us are living paycheck to paycheck.  What does a $500 emergency look like– your car needs new breaks, your dog has to go to the vet, or your refrigerator breaks down. These are not uncommon expenses, and they shouldn’t be unexpected expenses.  Nevertheless, 63% of us are not ready to face these everyday emergencies.

What happens when someone in that 63% of Americans is diagnosed with cancer? It can lead to a financial catastrophe. Thanks to the Affordable Care Act (ACA), more Americans have health insurance than ever. But for many people, including those with health insurance coverage through their employers, that insurance doesn’t kick in until they meet their high deductible. If they don’t have $500 in savings, they certainly don’t have the money for their deductible, which often ranges from $1,000 – $10,000. For those without health insurance, they have to pay the entire cost of their cancer treatment. For those with insurance, patients often report being left with out-of-pocket costs ranging from $25,000 to $40,000, beyond what their insurance covered.

Cancer is expensive.  Patients face a myriad of expensive diagnostic tests and therapies including CT scans, MRIs, surgery, chemotherapy and/or radiation, hospital stays, anesthesiologist fees, on-going multiple doctor visits, lab testing, and more. According to the Kaiser Family Foundation, the cost of chemotherapy is going up 10% per year!  And all of this doesn’t take into account lost wages, travel expenses, child care expenses, and other unexpected expenses that may come along with a cancer diagnosis.

If you find yourself or a loved one in this situation, there is help.  Triage Cancer has many financial tools and resources available to you:

Talk with your health care team, as they may know of local resources, as well. The key is not to assume that you don’t qualify. If you don’t ask, you will never know. Remember, you aren’t the only one possibly living paycheck to paycheck.

ADA and FMLA: How Laws Work Together

Regardless of the type of job you have, if you need to take time off work because of ADA and FMLAyour cancer diagnosis and treatment, you should learn about your employment rights. More people are familiar with the Family and Medical Leave Act (FMLA), which is the federal law that allows eligible employees to take time off work because of their own serious medical condition or to care for a spouse, child, or parent. The FMLA provides 12 weeks of unpaid leave, per year.

Most people don’t think about the Americans with Disabilities Act (ADA) as a way to take time off work. But they should. The ADA requires employers to provide eligible employees with reasonable accommodations in the workplace. A reasonable accommodation can include changes to work schedules, telecommuting, or even extended leave from work.

Now the FMLA and the ADA can actually work together.

For example, meet Jane. Jane has been undergoing cancer treatment. She has taken time off from work under the FMLA.  She has almost used all 12 weeks of her FMLA leave and her doctor has not yet released her to return to work. She is concerned that she will lose her job if she tells her employer she will not be able to return to work when her 12 weeks of FMLA leave are up.  It is possible that if Jane is also eligible for protection under the ADA, that she could ask for additional time off as a reasonable accommodation under the ADA, if it does not pose an undue hardship on the employer.

However, ADA case law has suggested that additional time off from work will only be considered a reasonable accommodation if the length of additional leave is for a definite period of time. Some recent cases have also shown that employers shouldn’t have rigid leave rules, but be more flexible with leave decisions on a case-by-case basis.

So, if Jane gets to the end of her FMLA leave and she calls her employer and says, “I would like more time off from work as a reasonable accommodation, but I don’t know when I will be able to return”- that is unlikely to be seen as a reasonable accommodation.  But, if Jane calls her employer and says, “I would like three more weeks off work as a reasonable accommodation, because my doctor has released me to come back to work in 3 weeks” – that is more likely to be seen as a reasonable accommodation.

Before making decisions about working through treatment or taking time off work, it is important to get the facts and learn about your options, so that you can make educated decisions about what will work for you.

For more information about your employment rights, visit: http://TriageCancer.org/employment or read our employment-related blogs.

What do you have to disclose to an employer?

disclose to an employerMany individuals decide to work through cancer treatment or return to work, while still managing side effects of cancer treatment with medications.  Trying to figure out what has to be disclosed to employers or potential employers is a common concern for individuals.  For more general information about disclosure and privacy, check out our Quick Guide to Disclosure, Privacy, and Medical Certification Forms.

In this blog we wanted to focus on the issue of disclosing medications to an employer.  As with most situations there has to be a balance between the interests of the employer and those of the employee.  An employee may have a legitimate desire to keep the medications they are taking confidential.  An employer may have a legitimate need to know what medications its employees are taking. For example, a school probably wouldn’t want their school bus drivers taking prescription pain medications that would hinder their ability to drive. So, what does the law allow?

The Americans with Disabilities Act (ADA) protects the privacy of medical information of eligible individuals in the workplace. The ADA includes specific rules about how much information about your medical condition you have to share with an employer or potential employer, and when.

Under the ADA, employers cannot require blanket disclosure of prescription medications being taken by all employees. However, there are some exceptions based on where you are in the hiring process and the particular type of job you do.

Prior to receiving an employment offer, potential employers are not legally allowed to ask any questions about your medical condition or general health. After a job offer has been made, employers are allowed to ask you questions about your health history or to complete a medical exam, but only if they would be required of anyone entering a similar job. Furthermore, employers are not allowed to take back the job offer based on the results of a medical exam, unless the results show that you cannot perform the essential functions of that job, with or without a reasonable accommodation.

Once you are working for an employer, you can only be asked to complete a medical exam or questions about your health history, when it is “job-related and consistent with business necessity” or if there is a “direct threat.”

The Equal Employment and Opportunities Commission (EEOC), the federal agency that enforces the ADA, has issued guidelines providing some additional information on these exceptions. In these guidelines, the EEOC uses the example of a police officer. Because there is a significant safety risk involved with a police officer using certain prescription medications, an employer may be able to demonstrate that asking a police officer about his/her prescription drug use is consistent with business necessity. On the other hand, it probably isn’t reasonable to ask a firefighter, who acts in a purely administrative role, about her medications.

Unfortunately, the EEOC doesn’t provide a list of other occupations that would fall within this exception of being “job-related and consistent with business necessity.” So it is unclear, for example, if a nurse or construction worker who operates heavy machinery would have to disclose his/her use of morphine.

The EEOC does point out that there are other laws that might apply to certain employees, such as interstate bus and truck drivers, airline pilots and flight attendants, and mine workers.

If you have access to an Employee Assistance Program (EAP) at work, and you contact an EAP counselor, the counselor may ask you questions about your medical conditions, but only if the counselor: 1) does not work for or on behalf of the employer; 2) is obligated to shield any information the employee reveals from decision makers; and 3) has no power to affect employment decisions.

Resources:

Choosing to share information about your medical condition and the laws that protect your privacy or require disclosure can seem complicated.

For more information about the ADA, visit www.eeoc.gov or read our Quick Guide to the ADA.

For information about disclosure and privacy, read our Quick Guide to Disclosure, Privacy, and Medical Certification Forms.

Climbing the Winding Staircase: Navigating Complementary Approaches to Cancer Care

by Oncology Social Worker Rita Abdallah, LISW-S, LCSW-C, ACSW

Complementary Approaches to CancerWhen patients enter the cancer center doors for the first time, they see a tall, spiraling staircase. The mystery unfolds as they unwillingly take their first step onto the staircase. With the help of a medical team and loved ones, patients slowly take on this long and challenging climb. Some days, the way up looks clear and easy; other days the staircase seems dusty and difficult.

Swimming has been a lifelong passion for Cathy, a middle-aged woman with breast cancer. Cathy’s treatment plan included surgery, chemotherapy and radiation. At her initial oncology visit, Cathy and her doctor openly discussed when she could return to the pool. At first, Cathy adjusted her swimming routine to shorter distances. She updated the oncologist on her progress and/or setbacks. Cathy listened carefully to her oncologist for guidance. In time, she went back to swimming at her own pace. Cathy was so happy to reconnect with her body and find her old self again.

Patients soon realize that cancer is a series of steps involving physical, emotional, mental and spiritual effort. Regardless of how fast or how hard the stairs are climbed, patients desire options that minimize suffering and maximize quality of life. Outside of conventional medicine, they may discover less invasive ways of caring for themselves. Complementary Alternative Medicine, or CAM, offers cancer patients chances to feel better and reclaim some of their health choices. When it comes to using CAM and complementary approaches to cancer care, patients need to talk to their healthcare providers, ask questions and carefully evaluate the risks and benefits of each therapy.

What is CAM?

According to the National Center for Complementary and Integrative Health, CAM is defined as:

  • If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.”
  • If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.”

Other useful terms are “Integrative Medicine” which coordinates conventional and complementary approaches within care settings. The National Center for Complementary and Integrative Health officially uses “Complementary Health Approaches” to cover categories ranging from natural products to mind and body practices.

Talking to your healthcare team about CAM

When it comes to talking to healthcare providers about complementary health approaches, patients are hesitant to take that first step. AARP and The National Center for Complementary and Alternative Medicine asked 1,559 people age 50 and older about their use of CAM and why they don’t talk about it at the clinic. Respondents reported that doctors don’t ask about their CAM approaches and patients don’t know they should disclose this information. Some patients believe doctors don’t have time to talk, lack knowledge about CAM and/or discourage patients from using it.

In the cancer setting, it is crucial for patients and the healthcare team to talk about complementary approaches. When chemotherapy, immunotherapy, surgery, transplants and radiation may be a part of the treatment plan, the healthcare team appreciates a full picture of all healthcare choices made by patients. Open and ongoing communication is essential for reducing and avoiding contraindications, undue harm or unknown reactions.  An excellent resource, full of tips, worksheets and resources is a downloadable workbook published by the National Cancer Institute called “Talking about Complementary and Alternative Medicine.” It also includes a great list of questions for patients to take with them to their medical appointment. If patients don’t have the energy or want help with this conversation, they should bring a trusted family member or friend for support.

Risks and benefits of CAM

Doctors and patients share similar challenges with it comes to determine which complementary approaches are proven, safe and effective. Some therapies are not regulated while others are not standardized. The body of knowledge is fast growing but limited depending on use of complementary therapies for specific cancer stages and disease types. Studies may involve animal subjects but not human testing because of unfamiliar side effects. The American Cancer Society has more detailed information on this subject.

Climbing CAM stairs

Once patients get closer to selecting a doctor-approved complementary therapy, they begin the search of a professional to get help. Use these tips to ensure the experience is a positive and favorable one.

  • Check out the latest research on a specific CAM approach
  • Ask your health insurance provider if coverage available
  • Get referrals from friends/family/healthcare provider
  • Find out the practitioner’s education, training, licensing and certifications
  • Call local cancer organization
  • Carefully search online and check sources
  • Try your chosen CAM approach a few times. If it isn’t working out, try something else or take a break. Don’t buy pricy packages or invest lots of time until this option meets your wellness objectives.

To learn more about CAM and Cancer, register for our free live webinar on February 22, 2017. Oncology Social Worker Rita Abdallah will present Complementary Alternative Medicine (CAM) and Cancer: Show Me the Proof! Register today! 

Getting Back to Work: Ticket to Work Program

triage-cancer-blog-return-to-workIf you are receiving disability benefits because of a cancer diagnosis, you may be considering going back to work. You may even be eager to get back to the normalcy of working.  As Americans, we get a great sense of worth and identity from our jobs.  Work is also a great social outlet for a lot of people.  After a cancer diagnosis, working can mean more than financial independence.  It can also mean moving beyond your diagnosis.

Well, when you’re ready to return to work, the Social Security Administration is ready to help.  They have a robust program designed to assist you to find work after a disability: the Ticket to Work Program.

Ticket to Work
If you are receiving SSI or SSDI, and are between the ages of 18 and 64, you qualify for a program called Ticket to Work.  This is a free and voluntary service that can help you go to work, get a good job that may lead to a career, and become financially independent.  Essentially, this program matches you with career planners and vocational rehabilitation services that will help you make a plan for getting back to work, and then help you execute that plan.  They will review your resume, set up interviews, conduct job training, and much more.  They will also provide information about your disability benefits and what they will look like when you go back to work.  Here are some things you should understand about the Ticket to Work program:

  • Opening a Ticket to Work does not mean you will automatically lose your SSDI or SSI benefit. If you open a Ticket to Work and make timely progress with either an employment network or a state vocational rehabilitation counselor, your medical condition will not be reviewed and you will continue to receive you normal benefit until you start actually working.
  • Opening a Ticket to Work will not cancel your Medicare benefit. Even if you go back to work and make enough to stop your SSDI benefit, you are still eligible to keep Medicare Part A (hospital insurance) for up to 93 months.
  • Opening a Ticket to Work will not necessarily cancel your Medicaid benefit. If you make enough to stop your SSI benefit, but are still under the earnings threshold set by your state, you could still be eligible for Medicaid.  Even if you make more than your state earnings threshold, you could be eligible for a Medicaid buy-in program.  You need to speak with your state Medicaid office to find out what that threshold is in your state. Click here to find your state Medicaid agency.

Another concern you may have about returning to work too early is sacrificing the SSDI or SSI benefit that took you so long to get in the first place.  Social Security has a work incentive program called Expedited Reinstatement.  Basically this means that if your benefits ended within the last 5 years due to an increase in your earnings, and you still have your original medical condition, you do not have to reapply for benefits.  Instead, you will receive 6 months of temporary benefits while your case goes under medical review.  If you are found not to be eligible for benefits after that review, you don’t have to pay back the temporary benefits you received.

Don’t be afraid to get back out into the workforce if you are able.  Cancer can be very isolating and working can be just the thing you need to feel better and move on from your diagnosis.

Survivorship, Activism, and Cross-Cultural Relationships

By Ruth Ebenstein

I was nursing my baby when I got the bomb-drop.Survivorship, Activism, and Cross-Cultural Relationships

“That lump is cancer. If the pathology report comes back negative, I’m going to think it’s a mistake.”

Breast cancer? Mixed in with mother’s milk? In addition to my baby, I had two others sons under five and two young adult stepdaughters. In an instant, my life plans crashed. Forget a fourth child. Would I even get to rear the ones that I had? I was still mourning a friend I’d lost to breast cancer a few weeks earlier; she was in her 40s, around my age. I despaired, unable to access any hope. Was a good outcome even possible?

Three weeks later, I had a lumpectomy and an axillary dissection, to remove lymph nodes from my armpit. While the doctors tried to decide if I needed chemotherapy, I looked for a support group. I’d heard that women survived better/longer/stronger if they’d had support, and I was keen on that. But most of all, I was looking for a friend.

I’d always been a connector. As a girl, I had embraced babysitters as friends. I connected with everyone: long chats with the bus driver to school, discussions with the librarian over sandwiches at my house (yes, she agreed to come over!), and even my mother’s friends. Friendships were one of my great joys. And now was no different. I wanted women in my life who understood what I was going through. Of course, I did not want my old friends to get breast cancer! But I did hunger to find true companions in breastcancerland. Women with whom I could laugh, complain about hot flashes, share my fears, gather strategies for coping.

And then this email turned up in my inbox. “Would you like to join an Israeli-Palestinian breast cancer support group?” I wondered if perhaps something good could come out of something bad.

At the first support group meeting, a mother-earth woman with warm brown eyes came over to introduce herself. Although Ibtisam Erekat was a devout Palestinian Muslim woman hailing from the West Bank and I was an American-Israeli Orthodox Jewish woman hailing from Jerusalem, we discovered that we had very similar life narratives. We were both religiously observant and we had both married in our thirties, late in our respective traditional communities. Each of our husbands was a divorcé who was several years our senior and had brought children into the marriage. We both had birthed three children in three years. And we were both diagnosed with breast cancer while nursing our babies, which was rather uncommon.  I had never met anyone who shared so many critical elements of my life story. “Same here,” said Ibtisam at our first meeting, in impressive English she had gleaned off the television. I soon discovered that we were both fearless, outgoing, daring. The conversation flowed and we cracked each other up.

In 2012, we traveled together to Bosnia as part of an Israeli-Palestinian delegation of breast cancer survivors. The mission: to meet and learn from other breast cancer survivors who also cross religious, ethnic and cultural lines to support each other. On that trip, many incredible things happened. I felt a tremendous connection with the Bosnian women, women who remain my friends today, despite the challenges of a language barrier. I also developed beautiful friendships with the Palestinian breast cancer survivors, facilitated by the intimacy of togetherness and being miles away from the bloody headlines and turmoil of our region. In particular, my friendship with Ibtisam blossomed. Over the next months and years, we grew to be kin; our children, spouses, and extended families grew close, too.

I realized that this inspiring friendship story ought to be shared. So I did. I crafted a piece about our trip to Bosnia for Tablet, which won an award. I wrote another essay about our friendship for the Atlantic. Penning a memoir was a natural next step.  I’m working on that manuscript right now, with literary agents waiting to read my book proposal.

In 2014 I started to do public speaking across the US to share the positive things that emerged from my breast cancer experience. The cross-cultural friendships, the growth, the peace and health activism—and the hope. Most remarkably, the incredible sisterhood with Ibtisam Erekat.

Through my public speaking, writing and activism, I’ve made friends with breast cancer survivors who hail from Mexico City to Mostar, Herzegovina, from Abu Dis in the West Bank to an ultra-Orthodox community in Israel. Breast cancer has taught me how to connect in ways that I did not even know were possible. My hope is to spread this message to others: our real enemy is illness, not man-made conflict. And the greatest lesson of all? “Other” is actually just like me.